Term Rehabilitation Research Articles

Psychomotric Perspectives of Rehabilitation in Chronic Brachial Plexus Palsies

Background. The perspective of ongoing electric signals within the motor cortex, conditioned by continuous rehabilitation strategies (doubled by adherence to the treatment protocol), is of interest related to understanding how cerebral plasticity is being modulated in adult traumatic brachial plexus (BP) lesions. Very often, patients with chronic BP lesions tend to be less compliant to rehabilitation therapy over time, since multiple reconstructive microsurgery interventions may not always offer a proper upper limb functionality, especially in severe, complex BP cases. Material and methods. In order to asses the ongoing psychomotric projection of the limb’s representation among the motor cortex, in relation with long term rehabilitation protocol we followed up a group of 11 chronic patients, by transcranial magnetic stimulation (TMS) during a time-lapse of two years. Results. Although modest in relation with amelioration of the deficit on the MRC scale, the patients had mild improvements of the parameter latency, but more important, by assessing the amplitude of the motor evoked potential (MEP), we observed a dynamism of the motor area. This we consider suggestive for ongoing psychomotor components stimulated by rehabilitation: ideomotricity, perceptual-motor coordination, laterality and body representation, as a foundation in maintaining a proven measurable potential of continuous neuroplasticity. Conclusion. From clinical perspective, since psychomotricity actually means interdisciplinarity, this is the common denominator found in the collaboration between medical specialties: plastic surgery and reconstructive microsurgery, clinical neurology, electrodiagnostic and neuromotor rehabilitation.

Rehabilitation for adults with an intellectual disability and mental health and behavioural complexities: A scoping review

AbstractBackgroundThere has been significant focus in the past decade on reducing admissions to assessment and treatment units for people with intellectual disabilities experiencing mental health or behavioural concerns. This has included the development of intensive support functions of National Health Service Learning Disability services to bolster community support and treatment for people at risk of admission. However, in recent years, there has been increased consideration of service development to include rehabilitation functions which would aim to proactively provide medium‐term additional input to individuals with a complexity of need. This input would aim to improve future trajectories and support the individuals to remain living a good life in their own community. This review focuses on community and in‐patient approaches to meeting a complexity of need.MethodA scoping review was carried out according to established best practice guidelines. Papers returned from the search were screened by the following inclusion criteria (a) Models or Outcomes of Rehabilitation; (b) Intellectual Disability Population; (c) Sample being 18 or above and (d) longer than short‐term stay/treatment, defined as 6 months or longer; and (e) Mental health and/or behaviour complexities. The search was conducted in electronic databases CINAHL, PsycInfo, Medline, Embase and Social Policy & Practice. Here, 3790 articles were initially identified and 27 were ultimately included in the review.FindingsThere are few studies evaluating rehabilitation for people with intellectual disabilities and mental health or behavioural concerns. There was some evidence that accessing assessment and treatment inpatient provision resulted in clinical improvements. Some studies demonstrated initial evidence that longer term rehabilitation was beneficial as a step‐down from inpatient care. Some key principles were identified in terms of rehabilitation approaches: the need for person‐centred creative approaches, suitable staff training, focus on building skills, and a focus on increasing quality of life.ConclusionThere are some indicators of what good rehabilitation services might comprise for people with an intellectual disability, who have rehabilitation needs. However, far more research and guidance are required in this area. In particular, it is unclear whether rehabilitation is best provided within an inpatient or community model, and further detail is required about optimal components of such rehabilitation.

"We can all relate": patient experience of an emotion-oriented group intervention after Acquired Brain Injury.

Group interventions are carried out routinely across neuropsychological rehabilitation services, to improve understanding of brain injury and aspects of impairment. Treatment provided in a group modality can bring additional perceived benefits, such as co-operative learning. However, there are very few studies which explore patient perceptions and experiences of such interventions. In the present study we investigated the experience of attending a group-based educational intervention for the consequences of acquired brain injury (ABI), which had a strong focus on emotion and emotion regulation. Using qualitative semi-structured interviews (approximately 20 minutes), the study explores the lived experience of participating in the seven-session programme, the better to identify the perceived efficacy, salience and value of individual elements. Twenty participants with ABI took part in individual interviews, after completion of the group programme (the Brain Injury Solutions and Emotions Programme, BISEP). The study adopted a descriptive phenomenological philosophy, which focuses on lived experience to explore a phenomenon (i.e. the experience of BISEP). As regards methods, the study employed thematic analysis to cluster experiences into themes of meaning. Five themes were identified: (1) 'Long term consequences and psychological needs', which related to the persistent nature of direct consequences of injury and adjustment, and how these result in a need for interventions such as BISEP. (2) 'Positive experiences of participating in the programme', referred to participants' overall experience of the programme and valued elements within it. The remaining themes referred to the programme as (3) a social milieu; (4) a place to learn; and (5) a place to promote positive emotional experiences. Similar to previous studies, many people reported high acceptability and perceived value of the group programme, and its role in facilitating adjustment and understanding of injury. Of particular importance was the opportunity to socialise with people who "can all relate", in line with a growing emphasis on social rehabilitation. The findings especially highlight the relevance of emotion-focused group programmes for ABI, promoting emotion regulation, and practical tools that are delivered optimistically. Further implications for practice and future research include to focus on long term rehabilitation, a social milieu, and strategies to support adjustment.

Domestic fall – related multiple osteoporotic vertebral fractures: considerations amid late COVID-19 pandemic (a case on point)

Our purpose was to introduce a case on point of a menopausal woman who suffered a domestic fall with consecutive persistent back pain and reduced mobility, and delayed the presentation amid late COVID-19 pandemic. On admission, she was confirmed with osteoporosis according to DXA (lowest T-score of -5.5) and started zoledronate. She refused further orthopedic intervention and remained on non-invasive long term rehabilitation plan while surveillance of anti-osteoporotic medication was offered to her. Fragility vertebral fractures represent increasingly common issues that require prompt intervention to overall a better prognosis. Late presentation and a first diagnosis of 10 vertebral fractures is a part of real life medicine with consequences amid potential lack of compliance to medication and adherence to a rehabilitation plan with short term and long term effects. Transition to post-pandemic reality still represents a concurrent pitfall to delayed hospitalization.

HOW THE ITALIAN PRESS MAKE SENSE OF PHYSIOTHERAPY AND THE PHYSIOTHERAPIST A RETROSPECTIVE STUDY FROM 1989 TO 2019.

IntroductionThe legitimation of a profession provides for legal, formative, ethical, self-regulating and socially recognized development, which must pass through the appropriate mass media communication channels. The purpose of this study is to investigate the way in which the profession of physiotherapist and physiotherapy as a science are communicated in the newspapers.MethodsA cross-sectional, descriptive, structured, anonymous, non-funded survey was conducted through the analysis of articles in the daily newspaper "La Repubblica" in 2 distinct periods. A 21-item questionnaire was used, in which a distinction was made between semantic characteristics and content. The differences in the way the physiotherapist as a professional and the discipline of physiotherapy as a science are evaluated before and after the recognition of the professional profile in Italy (1994).ResultsThere is an improvement in the way the physiotherapist as a professional is communicated (from 14.6% to 25%), while physiotherapy as a science does not show any significant changes (from 19.5% to 22.2%). There is a meaningful improvement in the communication of various fields from few to multiple. A significant article in communicating educational aspects is often associated with the transmission of the value of Physiotherapy in research (VC 0.598), and the same association occurs between prevention and education (VC 0.552), autonomy of the physiotherapist and communication of the physiotherapist as professional (VC 0.503).DiscussionThe evolution of the profession and of the discipline over time was not matched by an adequate improvement in communication by the newspapers. The term rehabilitation cannot be distinctive from nor synonymous with the discipline of physiotherapy, of which it is an integral part but which cannot be defined by it.

A low-cost and portable wrist exoskeleton using EEG-sEMG combined strategy for prolonged active rehabilitation.

Hemiparesis is a common consequence of stroke that severely impacts the life quality of the patients. Active training is a key factor in achieving optimal neural recovery, but current systems for wrist rehabilitation present challenges in terms of portability, cost, and the potential for muscle fatigue during prolonged use. To address these challenges, this paper proposes a low-cost, portable wrist rehabilitation system with a control strategy that combines surface electromyogram (sEMG) and electroencephalogram (EEG) signals to encourage patients to engage in consecutive, spontaneous rehabilitation sessions. In addition, a detection method for muscle fatigue based on the Boruta algorithm and a post-processing layer are proposed, allowing for the switch between sEMG and EEG modes when muscle fatigue occurs. This method significantly improves accuracy of fatigue detection from 4.90 to 10.49% for four distinct wrist motions, while the Boruta algorithm selects the most essential features and stabilizes the effects of post-processing. The paper also presents an alternative control mode that employs EEG signals to maintain active control, achieving an accuracy of approximately 80% in detecting motion intention. For the occurrence of muscle fatigue during long term rehabilitation training, the proposed system presents a promising approach to addressing the limitations of existing wrist rehabilitation systems.

Map of Health Needs – basis for the national strategic frameworks

Abstract As the economies transform into data-centred, so do the health systems. Responding effectively to emerging challenges through right decisions and setting up adjusted policies require a well-functioning evidence-based tool. The one developed in Poland is called ‘Maps of Health Needs'. It provides key stakeholders with unbiased data to support decision making processes. The Map depicts the current situation in the system, and forecasts the changes in upcoming years. The system is shown widely: starting with the background of demography and epidemiology, later moving to the out- and in-patient care, including long term care and rehabilitation, concluding with resources (staff and infrastructure). This broad and unbiased view on the system now and in the years to come, allows the public sector institutions to plan the short, medium and long term actions. It regards both strategic and operational levels, for the whole country and for the regions respectively. The documents juxtapose the current and the desired state of the system in the future, outlining necessary actions and goals in order to achieve it. In the recent years a few strategic frameworks have been developed in Poland, as the preparation for the next EU programming period advanced and in reaction to the pandemic crisis. The main documents include: 1) Healthy Future, the umbrella-like framework for the period 2021-2027, 2) Recovery and resilience plan, 3) Transformation plans. The first and the second one became a part of the negotiation conditions at the European level, as they form a reliable source for modelling the flux of investments’ financing. In that way the maps shape the national policies, becoming the basis for strategic frameworks. Key messages • Reliable data is nowadays a key factor in strategic planning, also in the healthcare system. • The tool developed in Poland, called Maps of Health Needs, serves as a base for strategic national frameworks.

Impending atypical femoral fractures associated with bisphosphonates: postoperative diagnosis after hip prosthesis. Clinical cases presentation.

Number of hip prosthesis implants in arthritis, number of patients treated with bisphosphonates to prevent fragility fractures and, together, number of atypical femoral fracture's cases are increasing. This article describes two cases of hip arthritis, treated with hip replacement, in patients using bisphosphonates for a long time; in both cases an incomplete atypical femoral fracture was misdiagnosed before the surgery. Authors describe the importance to carry out a complete osteometabolic and radiographic pre-operative examination of patients in treatment with bisphosphonates going to hip replacement, to check the possible presence of incomplete atypical femoral fracture and to optimize surgical and pharmacological treatment. In hip prosthesis surgery, prior diagnosis of incomplete atypical femoral fractures can indicate the choice of a different kind of prosthesis stem to optimize surgical results. This can also positively impact to rehabilitation in term of duration and daily activities recovery.

Effectiveness of the Internet-Based, Job-Related Aftercare GSA-Online Following Inpatient Psychosomatic Rehabilitation: Results of a Randomized Controlled Trial

In order to sustain the treatment results of medical rehabilitation in the long term and to support the transfer of learned strategies into everyday life, outpatient aftercare is often indicated. This is especially true for psychosomatic rehabilitation patients with occupational stress, for whom reintegration into working life is a particular challenge. Since access to care services close to home is limited, internet-based aftercare interventions offer the possibility of timely and flexible aftercare tailored to the patient's needs. In a randomized controlled trial, the internet-based job-related aftercare GSA-Online proved to be effective across indications with regard to job-related and health-related outcome criteria. The aim of the present study is to examine these outcome criteria in a subsample of patients undergoing inpatient psychosomatic rehabilitation. Occupationally stressed rehabilitation inpatients were assigned to the intervention (IG) or control group (CG) by means of cluster randomization after meeting the inclusion criteria and participating an inpatient vocational stress management training. After discharge from rehabilitation, patients in the IG were given access to GSA-Online for twelve weeks. In the intervention, maladaptive social interactions in the workplace were identified with the help of self-written blog posts and addressed with the help of therapeutic comments. The active CG received access to selected online information on health-promoting behaviors. Target measures included subjective prognosis of gainful employment (SPE), depressiveness (PHQ-9), and anxiety (GAD-7). Self-report measures were assessed at the end of aftercare and at follow-up (twelve months after the end of rehabilitation). Missing values were replaced using multiple imputation. Ninety-one percent of the IG (N=89) and 70% of the CG (N=106) logged on to the website at least once. There were no group differences in the subjective prognosis of gainful employment at the end of aftercare but a trend toward more optimistic scores in the IG at follow-up. Significantly lower psychological distress was observed in the IG, especially with regard to anxiety (at both measuring points) but also with regard to depressive symptoms (follow-up) and experience of stress (end of intervention). In the subsample of psychosomatic rehabilitation, the internet-based, job-related aftercare GSA-Online led to a significant reduction in psychological symptoms. Regarding the subjective prognosis of gainful employment, there was at least a trend in favor of IG. A larger sample is needed to more closely examine the results of this exploratory evaluation. Additionally measures to increase adherence in the IG should be explored.

Comparison of Modified Broström Procedure with or without Suture Tape Augmentation Technique for the Chronic Lateral Ankle Instability.

Purpose To compare the clinical outcomes of the modified Broström repair (MBR) with or without suture tape augmentation (STA) for managing the chronic lateral ankle instability. Methods 72 patients with chronic lateral ankle instability treated at our hospital from January 2018 to July 2019 were included, with 37 patients receiving the MBR and 35 treated by the MBR with STA. The clinical efficacy of the two techniques was assessed in terms of VAS, AOFAS, and Karlsson scores and by physical examination in follow-ups. Results In all 72 patients, operations were successful, and the patients were followed up for 29.3 months on average (range, 24-43 months). There were no significant differences in preoperative pain, AOFAS, and Karlsson scores between the two groups. Compared with preoperative findings, all the functional scores were significantly improved in both groups 3 months after the operation and at the last follow-up. Three months after the operation, the STA group had significantly lower VAS and higher AOFAS scores than the isolated MBR group, suggesting that patients in the STA group suffered less pain and achieved better functional improvement. However, the VAS and functional scores at the last follow-up and the Karlsson score at 3 months postoperatively showed no intragroup difference in both groups. Conclusion MBR with or without STA could achieve good results for the treatment of chronic lateral ankle instability. Compared with the widely used MBR, combining with STA may be more effective in promoting rehabilitation in early term.

OPTIMIZED TREATMENT OF MEN’S HYPOHONADISM

Aim: to study the effectiveness of different treatment options for male hypogonadism. Material and methods: the paper investigates outcomes in treating male hypogonadism (86 patients with secondary male hypogonadism). Scientific literature was reviewed to single out the following methods: androgen replacement therapy subcutaneous testosterone pellet implants use of long-acting subcutaneous testosterone tablets (the use of subcutaneous long-acting testosterone tablets as replacement therapy), a combination of traction therapy and medication Testosterone undecanoate. Results: androgen replacement therapy promotes the development of a number of beneficial effects in terms of physique, metabolic control, psychological and sexual indicators. The use of long-acting subcutaneous testosterone pellets can enhance the androgenic effect at the receptor level. The combined method of treatment traction therapy and medication Testosterone undecanoate is relevant for men with concomitant micropenia. The surgical method of subcutaneous testosterone pellet implants is recommended for patients with contraindications to testosterone replacement therapy. The determination of sexual constitution’s indicators testified to persistent sexual rehabilitation in the long term after transplantation of testicle. Conclusions: Each clinical case should be approached individually and optimized in case of concomitant pathologies. According to the scientific literature, androgen replacement therapy is optimized as an application of long-acting subcutaneous testosterone tablets, which shows good results in case of concomitant pathologies. For men with concomitant micropenia, it is suggested to apply the combined treatment of traction therapy and medication Testosterone undecanoate. In case of contraindication to hormone therapy, subcutaneous testosterone pellet implants are the optimal option.

Investigating the association between inpatient stroke therapy and disability, destination on discharge, length of stay and mortality: a prospective cohort study using the Sentinel Stroke National Audit Programme

Objective‘More is better’ is a recognised mantra within stroke therapy, however, this has been developed in patients receiving long term rehabilitation. We investigated the relationship between amount of therapy received...

IMPROVING THE METHODS OF TREATMENT AND ELIMINATION OF THE RESIDUAL CAVITY AFTER ECHINOCOCCECTOMY IN RECURRENT LIVER ECHINOCOCCOSIS

Various methods of surgical treatment of recurrent liver EC are described in domestic and foreign literature. The choice of surgical approach, the nature and volume of the operation, the method of treating the cyst, the need for drainage or elimination of the residual cavity are still subjects of discussion. In this regard, this chapter is devoted to our developments on key issues that affect the results of surgical treatment, complications and its nature in the immediate postoperative period, quality of life, rehabilitation and work capacity in the long term.

Remote Cardiac Rehabilitation in Older Cardiac Disease: A Randomized Case Series Feasibility Study.

BackgroundCardiac rehabilitation (CR) in the long term is fundamental to achieve better outcomes. However, most patients may find it difficult to maintain healthy lifestyle behavior after ambulatory CR program. We aimed to investigate the feasibility on remote CR support program (Remote-CR) in older patients with cardiac disease.MethodsBetween October 2020 and February 2021, we enrolled older patients with cardiac disease after at least over 5 months of ambulatory CR program. The study was conducted as a randomized controlled case series to compare Remote-CR vs. center-based CR (CB-CR) after ambulatory CR in older patients with cardiac disease. The core component of Remote-CR is a web application, which evaluates vital sign and receives feedback through real-time video consultation once a week. We evaluated the satisfaction of Remote-CR, and impact of Remote-CR on adherence to exercise and physical activity management. Moreover, we assessed the change in functional status using handgrip strength, usual gait speed, short physical performance battery (SPPB), and Kihon checklist (KCL) before the intervention, at the end of the 4-week intervention, and cardiovascular-related hospital discharge within 6 months after completion of ambulatory CR.ResultsEleven patients were enrolled (six for Remote-CR and five for CB-CR). All participants completed the intervention without serious adverse event in each group. After the on-site initial remote system set up, all the patients completed the Remote-CR session without on-site assistance. Patients’ satisfaction with Remote-CR was generally high. Remote-CR helps to maintain healthy lifestyle behavior. In addition, Remote-CR and CB-CR seem to be equally successful in maintaining functional status and preventing cardiovascular-related hospital readmission.ConclusionsThis trial suggested the Remote-CR comprising a hybrid of information and communication technology and strategy for health behavior change may be a feasible and safe intervention option in selected older patients with cardiac disease after completion of ambulatory CR.

Profile Study of Motorcyclists Victims in Road Traffic Accidents at Jaipur Region- An Observational Antemortem Study

World Health Organization defined accidents as ‘’ an unexpected, unplanned occurrence which may involve injury’’1.Only 28 countries, covering 7% of the world’s population, have comprehensive road safety laws on all five key risk factors: drinking and driving, speeding, and failing to use helmets, seat-belts, and child restraints as per the global status report on Road Safety 2013 by World Health Organization1. India is undergoing major economic and demographic transition coupled with increasing urbanization and motorization. Injuries on roads, at homes, and in the workplace have increased due to lack of safety-related policies and programs. The health sector bears the maximum brunt in terms of provision of acute care, and short-term and long term rehabilitation service. This study describes profile of motorcyclists’ victims in road traffic accidents observation done and they were compared with the previous studies.This study was conducted toanalyzethe sociodemographic profile of motorcycle crashes among total cases of RTA.During study period, a total number of 22618 patients were admitted to trauma centre, from which 10564 were road traffic accident cases, from which 25 % were two wheeler clashes.

Adjunctive Physiotherapy – A Case Report on the Management and Effective Treatment of Diabetic Neuropathic Foot Ulcer Using Adjunctive Physiotherapy

Physiotherapy must be considered and reprioritized as an adjunctive medical service for long term health and rehabilitation. Comprehensive physiotherapy has the potential to be administered in out-patient rehabilitation facilities, hospitals, and Thermal Health Centers. A review of select adjunctive physiotherapy methods will be presented along with a case report of the successful treatment, with rationally selected physiotherapeutic agents, of a Diabetic Neuropathic Foot Ulcer scheduled for surgical amputation. By highlighting this case, the author is attempting to bring attention to familiar and time-tested therapies that have fallen out of use in a primary intervention context. This case report aims to exemplify that the role for rational physiotherapeutic methods stretches beyond current mainstream applications. Historical Context. Will supply the historical and foundational work in the field of physiotherapy that contextualizes the rational basis for the applications described in the case. Therapies. Lists the physiotherapy methods highlighted in this case, reviews the mechanism of action, discusses the therapeutic application, and provides modern citation for the rationalization of the therapy. Case Report. Reviews a detailed narrative of the case in review. Covers intake, case history, progression of case, as well as clinical applications for physiotherapy as they arise in the course of case management. Conclusion. Reviews the emphasis for reconsidering the role of Physiotherapy in the primary management of acute and chronic illness.

Resilience among nurses in long term care and rehabilitation settings

BackgroundNurses practicing in long-term care or rehabilitation settings face unique challenges from prolonged or repeated exposure to stressors, given their extended time with patients. This puts them at risk for compassion fatigue, burnout, and secondary traumatic stress, which can lead to decreased resilience and sleep problems. AimThe aim of this study was to examine relationships among resilience, professional quality of life, sleep, and demographics in nurses working in long-term care or rehabilitation settings, and to investigate whether demographics, professional quality of life, and sleep quality are significant predictors of nurses' resilience. MethodsIn this cross-sectional study, we used the following measures: demographics, the Connor-Davidson Resilience Questionnaire, the Pittsburgh Sleep Quality Index, and the Professional Quality of Life Scale (ProQOL). Data were analyzed with SPSS v25. Data analysis consisted of descriptive statistics, bivariate correlations, and multiple regression. ResultsParticipants (N = 120) were mostly female (85%) and registered nurses (90%). Mean scores were 52.13 for resilience and 7.53 for sleep quality. Mean ProQOL subscale scores were 41.78 for compassion satisfaction, 22.28 for compassion fatigue, and 23.92 for secondary traumatic stress. Multiple regression models showed that compassion satisfaction, burnout, and secondary traumatic stress significantly predicted resilience (β = 0.69, β = −0.61, and β = −0.34, respectively, all p < .05). ConclusionsResilience is important in nurses' personal and professional lives because it helps to protect nurses from the negative consequences of stressors. Strategies, resources, and workplace support can promote self-care and resilience.

Complete Traumatic Laceration of the Sciatic Nerve Secondary to Acetabular Fracture: A Case Report

BACKGROUND Sciatic nerve injury in acetabular fractures is a rare event, with the majority of cases being transient neuropraxias. To date there are no published cases of complete traumatic sciatic nerve lacerations due to acetabular fracture with associated hip dislocation. We describe a case of such an event confirmed at the time of acetabular fracture fixation. CASE PRESENTATION The patient was a 37-year-old polytraumatized victim involved in a motor vehicle accident who presented with multiple injuries including left acetabular fracture with associated femoral head dislocation. The patient had absent function of both divisions of the sciatic nerve on initial evaluation. She was hemodynamically unstable on arrival requiring multidisciplinary intervention and transfer to the intensive care unit after temporization of her multiple system injuries. Following adequate resuscitation and improved hemodynamic status she was taken to the operating room for definitive orthopaedic fixation of her pelvis, acetabulum, and multiple long bones. Intraoperatively the sciatic nerve was identified, found to be completely lacerated. Direct repair was performed. Following discharge to a long term rehabilitation facility on post-trauma day 53 she was lost to follow up for 6 months when she presented to the emergency department for abdominal pain. Her pelvic and acetabular hardware was radiographically stable showing fracture union, and her lower extremity neurological examination was unchanged from her preoperative exam. CONCLUSION Injury to the sciatic nerve associated with pelvic and acetabular trauma is relatively rare and is most often neuropraxic. To our knowledge there is no reports in the literature on complete lacerations in this context, and there is a paucity in the literature on managing such injuries. Orthopaedic traumatologist must be aware of the possibility of this presentation in order to manage it appropriately and counsel patients accordingly.

Hand Allotransplantation: Care and Challenges

Hand allotransplantation, a composite tissue allograft, is a time-consuming surgical procedure. This procedure has been shown to significantly improve quality of life in patients with upper extremity loss. The suitability of this procedure must be rigorously evaluated before surgery, and long term antirejection drugs and rehabilitation exercises must be carried out after hand transplantation. Moreover, its success requires close collaboration within the multidisciplinary team. Several related issues are addressed in this article, including the history of hand transplantation surgery, the pros and cons of this procedure, rejection response and immunotherapy, rehabilitation and hand function recovery after hand transplantation, and pre- and post-procedure psychological reactions and evaluations. Response suggestions at the patient and environmental level that reflect the multiple challenges involved in hand transplantation are provided as a reference for clinical decision-makers.

Global functional impairment in head and neck cancer survivors after completing radiotherapy treatment

Purpose Improvements in diagnosis and treatment of head and neck cancer (HNC) patients have resulted in improved long-term survival rates. However, a variety of symptoms and comorbidities, often secondary to the cancer and its treatments, are experienced by a relevant number of survivors. So, the aim of this study was to determine the global functional impairment in HNC survivors 1 year after radiotherapy treatment. Materials and methods A descriptive case-control study was performed. HNC survivors were recruited from San Cecilio Clinical University Hospital in Granada. The main variables included were functionality and quality of life. Results 30 HNC survivors were included in our study. Significant differences were found in the WHO-DAS 2.0 test, with a worse score in the HNC group in most subscales (p < 0.05), and poorer scores in the COMP test, performance (p < 0.001) and satisfaction (p < 0.001). Significant differences were also found in most QLQ-30 subscales (p < 0.05) and the QLQ-H&N35. In regard to the EQ-5D, significant differences were found between groups, with worse results in the HNC group (p < 0.05). Conclusion HNC survivors presented a poorer global function and a worse quality of life and health status 1 year after the radiotherapy treatment. Moreover, a good correlation was found between functionality and quality of life outcomes. IMPLICATIONS FOR REHABILITATION A worse quality of life and health status are shown in head and neck survivors 1 year after radiotherapy. Global functionality is related to quality of life outcomes in head and neck cancer survivors. There is a need to recognise the need for and to provide longer term rehabilitation.