Traditional Rehabilitation Group Research Articles

Pulmonary Rehabilitation Exercises Effectively Improve Chronic Cough After Surgery for Non-small Cell Lung Cancer.

Cough is a major complication after lung cancer surgery, potentially impacting lung function and quality of life. However, effective treatments for managing long-term persistent postoperative cough remain elusive. In this study, we investigated the potential of a pulmonary rehabilitation training program to effectively address this issue. Between January 2019 and December 2022, a retrospective review was conducted on patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and lymph node dissection via video-assisted thoracoscopic surgery (VATS) at Daping hospital. Based on their postoperative rehabilitation methods, the patients were categorized into 2 groups: the traditional rehabilitation group and the pulmonary rehabilitation group. All patients underwent assessment using the Leicester cough questionnaire (LCQ) on the third postoperative day. Additionally, at the 6-month follow-up, patients' LCQ scores and lung function were re-evaluated to assess the long-term effects of the pulmonary rehabilitation training programs. Among the 276 patients meeting the inclusion criteria, 195 (70.7%) were in the traditional rehabilitation group, while 81 (29.3%) participated in the pulmonary rehabilitation group. The pulmonary rehabilitation group showed a significantly lower incidence of cough on the third postoperative day (16.0% vs 29.7%, P = .018) and higher LCQ scores in the somatic dimension (5.09 ± .81 vs 4.15 ± 1.22, P = .007) as well as in the total score (16.44 ± 2.86 vs 15.11 ± 2.51, P = .018, whereas there were no significant differences in psychiatric and sociological dimensions. At the 6-month follow-up, the pulmonary rehabilitation group continued to have a lower cough incidence (3.7% vs 12.8%, P = .022) and higher LCQ scores across all dimensions: somatic (6.19 ± .11 vs 5.75 ± 1.20, P = .035), mental (6.37 ± 1.19 vs 5.85 ± 1.22, P = .002), sociological (6.76 ± 1.22 vs 5.62 ± 1.08, P < .001), and total (18.22 ± 2.37 vs 16.21 ± 2.53, P < .001). Additionally, lung function parameters including FVC, FVC%, FEV1, FEV1%, MVV, MVV%, DLCO SB, and DLCO% were all significantly higher in the pulmonary rehabilitation group compared to the traditional group. Pulmonary rehabilitation exercises significantly reduced the incidence of postoperative cough and improved cough-related quality of life in patients undergoing lobectomy, with sustained benefits observed at the 6-month follow-up. Additionally, these exercises demonstrated superior lung function outcomes compared to traditional rehabilitation methods.

Effect of Fast-Track Surgery Nursing Intervention Combined with Probiotic Nutrition Therapy on Children During the Peri-Operative Period of Thoracoscopic Lobectomy

This study aims to investigate the feasibility and efficacy of fast-track surgery (FTS) nursing intervention and probiotic nutrition therapy in children during the peri-operative period of precise thoracoscopic lobectomy. A retrospective analysis was conducted on a total of 479 children who underwent the surgery at the pediatric department of the West China Hospital, Sichuan University between January 2011 and January 2018. The patients were divided into two groups: the traditional rehabilitation group (A, n = 78) and the rapid rehabilitation group with FTS and probiotic nutrition therapy (B, n = 401). No significant differences were observed in general information and the incidence of postoperative complications (P &gt;0.05). However, the B group had significantly reduced early out-of-bed activity time, early resumption of oral feeding time, intubation duration, and length of hospital stay (P &lt;0.05). Furthermore, patients in the B group had higher nutritional indexes compared to those in the A group. The levels of Bifidobacterium and Lactobacillus in the B group were higher, while the levels of Enterobacterium and Enterococcus were lower than those in the A group. Additionally, the patients and their families in the B group exhibited higher levels of nursing satisfaction (P &lt;0.05). The combination of FTS nursing intervention and probiotic nutrition therapy improved peri-operative outcomes without increasing the incidence of complications. Therefore, our findings support the feasibility, safety, and efficacy of thoracoscopic lobectomy with FTS care in pediatric patients, highlighting its potential as a promising surgical intervention.

Intravascular laser irradiation of blood as novel migraine treatment: an observational study

BackgroundMigraine is one of four major chronic diseases that cause disability. Decreases in regional cerebral blood flow (rCBF) occur during migraine attacks. Laser therapy is extensively employed in treating other vascular diseases; nevertheless, its effectiveness in migraine management remains largely unknown. Therefore, we evaluated the effect of low-level intravascular laser irradiation of blood (ILIB) therapy in patients with migraine.MethodsWe performed an observational case–control study in 24 patients suffering from migraine. Patients were divided into an ILIB treatment group and a traditional rehabilitation group. This study performed clinical assessments and single-photon emission computed tomography (SPECT) prior to and after the treatment and 1 month later. Changes in rCBF-SPECT between groups and between timepoints were compared to clinical outcomes.ResultsNine patients undergoing rehabilitation and fifteen patients undergoing ILIB were studied from baseline to 1 month follow-up. The ILIB group, visual analog scale for pain (P = 0.001), Montreal Cognitive Assessment (P = 0.003), and Athens Insomnia Scale (P < 0.001) symptom scores significantly improved after treatment. SPECT imaging showed a 1.27 ± 0.27 fold increase in rCBF after ILIB treatment, and no significant differences in the rehabilitation group.ConclusionsLow-level ILIB therapy is associated with better clinical and vascular outcomes, and may be a feasible treatment option for migraine. Although our sample size was small, our data provide a starting point for migraine laser therapy research.

Poster 322: Blood Flow Restriction after ACL Reconstruction Does Not Accelerate Quadriceps Strengthening

Objectives: The use of blood flow restriction (BFR) therapy has gained popularity as an adjunct rehabilitation technique following anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to longitudinally evaluate the impact that BFR has on quadriceps strength following ACLR with quadriceps tendon (QT) autograft in comparison to traditional rehabilitation protocols. Methods: Patients undergoing primary ACLR with QT autograft at a single institution were retrospectively reviewed. Included patients had a minimum of two isometric strength testing sessions via electromechanical dynamometer (Biodex). Obtained strength measures included peak knee extension torque of the operative extremity and knee extension ratio (KER), in which the ratio of peak knee extension torque of the operative extremity and nonoperative extremity were compared. Strength measures were compared between patients that received BFR during postoperative rehabilitation and patients that underwent traditional rehabilitation without BFR for up to three strength measurement sessions. Demographic and surgical factors including patient age at surgery, sex, BMI, level of competition, time from injury to surgery, time from surgery to strength measurement session, use of regional anesthesia, tourniquet time, and concomitant surgery were collected. Two group comparisons of continuous and categorical variables were analyzed by using Mann-Whitney U and chi-squared test, respectively. Statistical significance was set at 0.05. Results: A total of 45 patients (26 female) in the BFR group and 36 patients (13 female) in the traditional rehabilitation group met inclusion criteria. Mean age of the entire cohort was 19.5 years. There were no statistically significant differences among demographic or surgical factors between BFR and traditional cohorts. Of patients receiving BFR therapy, the mean number of BFR treatments was 18 from surgery to first strength measurement, 8 between first and second strength measurements, and 9 between the second and third strength measurements. Peak knee extension torque was lower for the BFR (96 Nm) group than traditional (111 Nm) group at the first strength measurement session (p=0.03) but was similar between groups at the second (118 Nm vs 134 Nm, p=0.1) and third (138 Nm vs 130 Nm, p =0.39) strength measurement sessions. There was no difference among BFR and traditional groups in the change of knee extension peak torque or change in KER between testing sessions. KER was lower at the second strength measurement in the BFR group (0.81) compared to the traditional group (0.90, p=0.02), though no differences existed at the first or third strength measurements. Conclusions: Sequential knee extension strength measurements following ACLR in a young patient cohort demonstrated improvements irrespective of BFR use. There were no differences in the change of strength measures between testing sessions when comparing BFR and traditional rehabilitation groups. Both groups demonstrated similar strength improvements over time, and BFR did not accelerate strength gains compared to traditional rehabilitation. However, as the BFR cohort had lower starting yet similar final strength measurements compared to the traditional rehabilitation cohort, a role for BFR over the long term in at risk patients cannot be excluded.

The Impact of Personality Traits on Patient Satisfaction after Telerehabilitation: A Comparative Study of Remote and Face-to-Face Musculoskeletal Rehabilitation during COVID-19 Lockdown.

This study aimed to evaluate the differences in patient satisfaction between telerehabilitation and traditional face-to-face rehabilitation and to identify the impact of personality traits on patient satisfaction with the remote form of rehabilitation. Eighty participants with musculoskeletal pain were recruited for the study. The telerehabilitation group (n = 40) completed a single remote session of rehabilitation, whereas the traditional rehabilitation group (n = 40) completed a single face-to-face session. After therapy, each participant was asked to complete a tailored satisfaction survey using Google Forms. The Health Care Satisfaction Questionnaire (HCSQ) and the International Personality Item Pool-Big Five Markers-20 (IPIP-BFM-20) were used as outcome measures. Considering the results of patient satisfaction with healthcare service, there were no statistically significant differences between telerehabilitation and traditional rehabilitation groups in the total HCSQ score and its subscales. For the complete HCSQ, agreeableness, conscientiousness, and extraversion were essential predictor variables, accounting for 51% of the variance in patient satisfaction. In conclusion, there were no differences in patient satisfaction between telerehabilitation and traditional rehabilitation groups. In the telerehabilitation group, higher agreeableness levels and lower conscientiousness and extraversion level could predict patients' satisfaction with telerehabilitation.

A Two-year Follow-up Study of Accelerated Functional Rehabilitation Combined with Percutaneous Minimally Invasive Suture in the Treatment of Acute Closed Achilles Tendon Rupture

To explore the effect of fast functional rehabilitation combined with percutaneous minimally invasive suture treatment for acute closed Achilles tendon rupture (ACATR) through 2-year follow-up study.We collected 32 patients with acute closed Achilles tendon rupture operated in our hospital, they were divided into early accelerated functional rehabilitation group(EAFR) and traditional rehabilitation group(TR). AOFAS Ankle Hindfoot Scale (AOFAS), Achilles tendon Total Rupture Score (ATRs) and the Muscle Strength recovery Rate (MSR) were used as follow-up evaluation. No incision-related complications or Achilles tendon rupture re-occurrence in both two groups. ATRS scores and AOFAS scores of the EAFR group were higher than those of the TR group in the 6th and 12th month after surgery, respectively (P<0.05), while no statistical significance in the 24th month when compared the two groups (P>0.05). In the EAFR group, the scores attained in the 12th month were higher when compared with those attained in the 6th month (P<0.05), lower when compared with those assessed in the 24th month (P<0.05). In the TR group, the scores attained in the 24th month were higher than those assessed in the 12th month (P<0.05), no statistical significance between the 6th month and the 12th month after surgery (P>0.05). The rate of muscle strength recovery was higher in the EAFR group in the 12th month after sugery (P<0.05), no statistical significance between the two groups in the 24th month (P>0.05). Percutaneous minimally invasive suture combined with early accelerated functional rehabilitation in treating the ACATR can accelerate the Achilles tendon function recovery without increasing the incidence of complications.

EFEITOS DO TREINO FUNCIONAL MOTOR NA REABILITAÇÃO PÓS-CIRÚRGICA DO LIGAMENTO CRUZADO ANTERIOR

ABSTRACT Introduction Anterior cruciate ligament injury is one of the most common sports injuries. There has been a rapid upward trend in its incidence in recent years. If treatment is not carried out early, irreversible impairment of joint stability may occur, even leading to degeneration. Objective Investigate the effects of functional exercise training during rehabilitation on motor function after anterior cruciate ligament surgery. Methods 52 cases were selected and randomly divided into traditional rehabilitation training group (n=20) and exercise rehabilitation training group (n=15). The first group had the affected limb fixed in the fully extended position for one week, performing ankle flexion and extension activities in bed every day. The rehabilitation program for the second group was based on progressive muscle training. Physical training contents were added to promote rehabilitation and increase the benefits of individual rehabilitation according to each patient’s living and working needs. Results The difference in time to balance in orthostatic position with unipodal support in the rehabilitation group by functional training was less than in the traditional rehabilitation group; the group that received functional exercise training also achieved a greater distance in the jump. Conclusion Functional exercise training is effective and safe in promoting muscle strength, range of motion, joint stability, proprioception, balance, and lower limb stability. The presented protocol demonstrated improved rehabilitation effectiveness in a shorter rehabilitation period. Evidence Level II; Therapeutic Studies – Investigating the results.

Meta-Analysis of Knee Joint Function Recovery after Anterior Cruciate Ligament Reconstruction by Accelerated Rehabilitation Surgery.

Objective This investigation was undertaken to systematically assess the impact of increasingly rapid recovery treatment on the functional status of the knee following anterior cruciate ligament restructuring. Methods Computer search from the establishment of the database to March 2022 in China Knowledge Network Database (CNKI), PubMed, EMBASE, ScienceDirect, CochraneLibrary, China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM). The control group was given only traditional rehabilitation training, and the observation group was treated with perioperative accelerated rehabilitation surgery intervention randomized controlled trial (RCT). Data for all included studies were extracted by two independent researchers, and the risk of bias for the quality of each included study was assessed by the Cochrane Handbook 5.1.0 criteria. Meta-analysis of the collected data by using RevMan5.4 statistical software. Results A total of 593 articles were retrieved from the computer database and 8 RCT articles with a total of 636 samples were finally included for meta-analysis. According to the Jadad scale, the RCT score of 8 articles was ≥4 points. Meta-analysis was performed on the postoperative VAS scores of the ERAS group and the traditional rehabilitation group, and the heterogeneity test showed Chi2 = 288.60, df = 5, P < 0.00001, and I2 = 99%. There was a statistically significant difference in the postoperative VAS scale between the intervention and the traditional rehabilitation model (P < 0.05). Eight articles reported the effect of accelerated rehabilitation surgery on the recovery of knee joint motion after ACL rehabilitation. After meta-analysis, the heterogeneity test showed Chi2 = 314.98, df = 7, P < 0.00001, and I2 = 98%, and it can be concluded from the analysis that, compared with the traditional rehabilitation model, the enhanced rehabilitation surgery has an effect on the joint function after anterior cruciate ligament reconstruction. The improvement effect was more significant, and the difference was statistically significant (P < 0.05). Four articles reported the effect of enhanced recovery after surgery intervention on the range of motion of the knee joint of patients, the heterogeneity test showed Chi2 = 117.52, df = 2, P < 0.00001, and I2 = 98%, through analysis, and compared with the traditional rehabilitation model and the enhanced recovery. The effect of surgery on the range of motion of the knee joint after ACL reconstruction was more significant, and the difference was statistically significant (P < 0.05). The effect of enhanced recovery after surgery and traditional rehabilitation mode on the incidence of postoperative adverse reactions in patients undergoing ACL reoperation was analyzed. The results of heterogeneity test showed that Chi2 = 1.59, df = 2, P=0.66 > 0.05, and I2 = 98%, and the analysis showed that, compared with the traditional rehabilitation mode, enhanced rehabilitation surgery can significantly reduce the risk of adverse reactions after anterior cruciate ligament reconstruction (P < 0.05). An inverted funnel plot was used to analyze publication bias in studies with quality of life as an outcome measure. The results showed that Egger's test P=0.0005 < 0.001 suggesting that there may be a certain degree of publication bias. Conclusion The existing research evidence shows that accelerating the reconstruction of anterior cruciate ligament can effectively promote the recovery of knee joint function, reduce the pain of patients, and reduce postoperative complications. However, more research is needed to further verify this.

Research and exploration of ACL injury repair and reconstruction and application of biomaterials

The choice of anterior cruciate ligament reconstruction graft and the histological outcome of the reconstructed graft have been an important research topic in the field of anterior cruciate ligament repair and reconstruction. Anterior cruciate ligament reconstruction is widely used in clinical applications, including autograft, allograft, xenograft, biomaterial, artificial material and tissue engineering graft. Through clinical trials, this paper evaluates knee joint stability and functional recovery during rehabilitation of patients undergoing anterior cruciate ligament reconstruction using different rehabilitation programs. In order to reveal the role of functional training in knee rehabilitation. Fifty-two patients undergoing arthroscopic anterior cruciate ligament reconstruction were randomly divided into a traditional rehabilitation group, a progressive muscle training group, and a functional rehabilitation group. Different rehabilitation intervention programs were given. Before, 6 months, 12 months, and 18 months postoperatively, through an analysis of functional movement analysis, core stability assessment, knee mobility (ROM), knee stability and other rehabilitation indicators, knee joint stability and functional recovery were evaluated after ligament injury and reconstruction. Statistical analysis of the results. The results showed that there was no significant difference between the three groups before surgery (P > 0.05). The test results were significantly different between the postoperative and preoperative groups (p < 0.01). Functional rehabilitation training can be efficient and effective, and safely improve the patient's postoperative muscle strength, joint mobility, joint stability, and other capabilities. In particular, it has obvious advantages in restoring the athletic ability of the affected knee joint, improving rehabilitation efficiency, and shortening the rehabilitation cycle.

Application of accelerated rehabilitation program for the treatment of intertrochanteric fracture of femur in the elderly

To evaluate the clinical value of accelerated rehabilitation in the treatment of intertrochanteric fracture of femur in the elderly. Eighty elderly patients with intertrochanteric fractures were selected from January 2016 to October 2018, and were divided into accelerated rehabilitation group and traditional rehabilitation group according to different treatment schemes, 40 cases in each group. There were 22 males and 18 females in accelerated rehabilitation group with an average age of (78.5±9.1) years old; 19 males and 21 females in traditional rehabilitation group with an average age of (80.6±8.1) years old. The perioperative blood loss, incidence of complications, hospitalization time, hospital stay, Harris hip score and improved BADL scale were compared between the two groups. Eighty patients were followed up for more than 12 months, with an average follow-up time of (15.4±2.6) months. The total perioperative blood loss in the accelerated rehabilitation group was significantly lower than that in the traditional rehabilitation group(P<0.001). Although the incidence of complications in the accelerated rehabilitation group was lower than that in the traditional rehabilitation group, there was no significant difference between the two groups(P>0.05). The time from admission to operation of the accelerated rehabilitation group(1.48±0.51) days was significantly shorter than that of the traditional rehabilitation group(4.35±1.55) days(P<0.01);the hospitalization time of the accelerated rehabilitation group was(6.4±1.1) days was significantly shorter than that of the traditional rehabilitation group (9.9±1.9) days(P<0.01). At 12 months after operation, there was no significant difference in Harris score between the two groups(P>0.05), and there was no significant difference in modified BADL score between the two groups(P>0.05). The application of accelerated rehabilitation program in elderly intertrochanteric fracture is safe and effective. It can reduce perioperative bleeding, shorten hospitalization time and accelerate the recovery of hip function.

Give me a kiss! An integrative rehabilitative training program with motor imagery and mirror therapy for recovery of facial palsy.

Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no evidence that any rehabilitation approach is more efficacious than another. The purpose of this research was to determine the effects of neurocognitive-rehabilitative approach through mirror-therapy (MT) and motor-imagery (MI), integrated into the traditional rehabilitation with mime-therapy and myofascial-approach. This study was designed as a double-blind, randomized, controlled trial. This study took place from January 2016 to June 2018 at the Unit of Physical Medicine and Rehabilitation of Umberto I Polyclinic Hospital, Rome, Italy. Twenty-two patients were randomized into two groups: the mirror therapy group (N.=11, MT and MI) and the traditional rehabilitation group (N.=11, mime-therapy and a myofascial-approach). Outcome assessments were performed before treatment (T0), after one month (T1=10 session, twice/week), after the second and third months (T2=10 twice/week + 5 of MT+MI one/week and T3=10 twice/week + 5 of MT+MI 1/week), and at the 4-week follow-up (T4=2 months follow-up). The analysis of the functional evaluations show that both groups experienced progressive improvement T0 to T3, with stabilization of the results at the follow-up. There was a significant difference in House-Brackmann-Scale scores between T0 and follow-up in favor of the experimental group. In terms of quality of life (FaCE scale), total scores and social function items improved in both groups from T0 to T3. The experimental group obtained better results with regard to quality of life and emotional depression. The integrated use of MT and MI is efficacious in the rehabilitation of FNP, improving facial physical function. Further studies are needed to determine the predictive factors of the recovery of facial mimic. The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions and perceive the judgments of others remains underexplored. The likelihood of recovering near-normal facial-function after grade VI facial paralysis is low. Procedures, such as the immediate repair of the facial nerve with an interposed donor graft, might improve facial function in patients with partially injured facial nerves.

Effects of Martial Arts on Recovery of Motor Function and Nerve Excitability of Stroke Patients

This study is designed to investigate the effects of Tai Chi exercise on the balance of stroke, standing on one foot, walking and index finger percussion. Sixteen stroke patients who meet the requirements are recruited in the hospital as experimental objects. They are randomly divided into a Tai Chi group (experimental group), a traditional rehabilitation group (control group), with an experimental group of 8 persons, and a control group of 8 persons. Both groups have a 6-month exercise intervention according to the experimental protocol. Before and after the experiment, the exercise function is tested and evaluated using the BERG balance scale, standing up time and walking TUGT, standing on one foot, and DFTT on the index finger. The scores of the Berg Balance Scale after the experiment in the experimental group are significantly higher than before the experiment. There is a significant difference between the two groups before and after the experiment. Martial Arts exercise has a significant increase in the amplitude of motor evoked potentials in patients with stroke and ipsilateral muscle and can effectively improve its nerve excitability.

Dance therapy improves motor and cognitive functions in patients with Parkinson's disease.

To explore the effects of Dance Therapy (DT) and Traditional Rehabilitation (TR) on both motor and cognitive domains in Parkinson's Disease patients (PD) with postural instability. Sixteen PD patients with recent history of falls were divided in two groups (Dance Therapy, DT and Traditional Rehabilitation, TR); nine patients received 1-hour DT classes twice per week, completing 20 lessons within 10 weeks; seven patients received a similar cycle of 20 group sessions of 60 minutes TR. Motor (Berg Balance Scale - BBS, Gait Dynamic Index - GDI, Timed Up and Go Test - TUG, 4 Square-Step Test - 4SST, 6-Minute Walking Test - 6MWT) and cognitive measures (Frontal Assessment Battery - FAB, Trail Making Test A & B - TMT A&B, Stroop Test) were tested at baseline, after the treatment completion and after 8-week follow-up. In the DT group, but not in the TR group, motor and cognitive outcomes significantly improved after treatment and retained after follow-up. Significant changes were found for 6MWT (p = 0.028), TUG (p = 0.007), TMT-A (p = 0.014) and TMT-B (p = 0.036). DT is an unconventional physical therapy for PD patients which effectively impacts on motor (endurance and risk of falls) and non-motor functions (executive functions).

Early Mobilization After Basal Joint Arthroplasty: Preliminary Clinical Results: Level 2 Evidence

There is no financial information to disclose. Traditional rehabilitation for basal joint arthroplasty involves prolonged thumb immobilization prior to initiating motion and strengthening. We hypothesize that early motion following basal joint arthroplasty is safe and will result in equivalent clinical outcomes to traditional rehabilitation. Patients undergoing ligament reconstruction and tendon interposition (LRTI) were randomized to 1 of 2 rehabilitation protocols. All patients were immobilized following surgery in a thumb-spica plaster splint for 2 weeks. The accelerated rehabilitation group (Group 1) was then transitioned into a removable neoprene thumb CMC-wrap with activity as tolerated, while the traditional rehabilitation group (Group 2) were placed in a thumb-spica cast or splint to be worn full-time for an additional 4 weeks. Patients were examined pre-operatively and at 6 and 12-weeks post-operatively. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analog scale for pain (VAS), pinch and grip strength and thumb range of motion. A descriptive analysis was run on data for both groups along with a repeated measure analysis of variance to compare the 2 groups at each time point with significance set at P < 0.05. Twenty seven patients were randomized, 13 in Group 1 and 14 in Group 2. There were no statically significant differences between the two groups with respect to age, preoperative DASH, VAS, pinch or grip strength or thumb CMC range of motion. There were no statistically significant difference between the 2 groups with respect to post-operative DASH, VAS, pinch or grip strength or thumb range of motion at both six and 12 weeks post-operatively. All pre-operative and 12-week post-operative outcomes data are presented in Tables 1 and 2 respectively. There were no intraoperative complications. •Early (12-week) outcomes suggest that early mobilization of patients following CMC arthroplasty does not compromise clinical results, with no significant difference demonstrated in DASH, VAS score, thumb strength or range of motion.•Longer term data and increased sample size will determine the lasting effects of accelerated rehabilitation•An accelerated rehabilitation protocol may offer equivalent clinical results with earlier return to pre-morbid function than traditional rehabilitation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Improvement of Upper Extremity Motor Control and Function After Home-Based Constraint Induced Therapy in Children With Unilateral Cerebral Palsy: Immediate and Long-Term Effects

ObjectiveTo investigate the long-term effects of home-based constraint induced therapy (CIT) on motor control underlying functional change in children with unilateral cerebral palsy (CP). DesignRandomized controlled trial. SettingHome based. ParticipantsChildren with unilateral CP (N=45; aged 6–12y) were randomly assigned to receive home-based CIT (n=23) or traditional rehabilitation (TR) (n=22). InterventionsBoth groups received a 4-week therapist-based intervention at home. The home-based CIT involved intensive functional training of the more affected upper extremity during which the less affected one was restrained. The TR involved functional unimanual and bimanual training. Main Outcome MeasuresAll children underwent kinematic and clinical assessments at baseline, 4 weeks (posttreatment), and 3 and 6 months (follow-up). The reach-to-grasp kinematics were reaction time (RT), normalized movement time, normalized movement unit, peak velocity (PV), maximum grip aperture (MGA), and percentage of movement where MGA occurs. The clinical measures were the Peabody Developmental Motor Scales, Second Edition (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), and Functional Independence Measure for children (WeeFIM). ResultsThe home-based CIT group showed a shorter RT (P<.05) and normalized movement time (P<.01), smaller MGA (P=.006), and fewer normalized movement units (P=.014) in the reach-to-grasp movements at posttreatment and follow-up than the TR group. The home-based CIT group improved more on the PDMS-2 (P<.001) and WeeFIM (P<.01) in all posttreatment tests and on the BOTMP (P<.01) at follow-up than the TR group. ConclusionsThe home-based CIT induced better spatial and temporal efficiency (smoother movement, more efficient grasping, better movement preplanning and execution) for functional improvement up to 6 months after treatment than TR.

Rehabilitation Following Arthroscopic Rotator Cuff Repair

The influence of rehabilitation on the outcomes after arthroscopic rotator cuff repair remains unknown. The purpose of this study was to compare clinical results and tendon healing rates following arthroscopic rotator cuff repair utilizing two distinct rehabilitation protocols. Over a thirty-month period, 124 patients under the age of sixty-five years underwent arthroscopic repair of a full-thickness rotator cuff tear measuring <30 mm in width. Postoperatively, patients were randomized either to a traditional rehabilitation program with early range of motion or to an immobilization group with delayed range of motion for six weeks. Clinical outcomes assessment included visual analog pain scale score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), relative Constant score, and strength measurements at six, twelve, and twenty-four months. Tendon integrity was assessed with ultrasonography at a minimum of twelve months postoperatively. There were no significant differences in patient age, tear size, or measures of preoperative function between groups at baseline. Final clinical follow-up was available for 114 subjects (92%). Active elevation and external rotation were better in the traditional rehabilitation group at three months. No significant differences were seen in functional scores, active motion, and shoulder strength between rehabilitation groups at later time points. Functional outcomes plateaued at six or twelve months except for the relative Constant score, which improved up to twenty-four months following surgery. Ninety-two percent of the tears were healed, with no difference between rehabilitation protocols (p = 0.46). Arthroscopic repair of small and medium full-thickness rotator cuff tears results in reliable improvements in clinical outcomes and a high rate of tendon integrity using a double-row repair technique in patients under the age of sixty-five years. There is no apparent advantage or disadvantage of early passive range of motion compared with immobilization with regard to healing or functional outcome.

Early rehabilitation with weight-bearing standing-shaking-board exercise in combination with electrical muscle stimulation after anterior cruciate ligament reconstruction.

The objective of early rehabilitation after anterior cruciate ligament (ACL) reconstruction is to increase the muscle strength of the lower extremities. Closed kinetic chain (CKC) exercise induces co-contraction of the agonist and antagonist muscles. The purpose of this study was to compare the postoperative muscle strength/mass of subjects who performed our new CKC exercise (new rehabilitation group:group N) from week 4, and subjects who received traditional rehabilitation alone (traditional rehabilitation group:group T). The subjects stood on the device and maintained balance. Then, low-frequency stimulation waves were applied to 2 points each in the anterior and posterior region of the injured thigh 3 times a week for 3 months. Measurement of muscle strength was performed 4 times (before the start, and then once a month). Muscle mass was evaluated in CT images of the extensor and flexor muscles of 10 knees (10 subjects) in each group. The injured legs of group N showed significant improvement after one month compared to group T. The cross-sectional area of the extensor muscles of the injured legs tended to a show a greater increase at 3 months in group N. This rehabilitation method makes it possible to contract fast-twitch muscles, which may be a useful for improving extensor muscle strength after ACL reconstruction.

Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study

Objective: To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. Design: Two-group randomized controlled trial with pretreatment and posttreatment measures. Setting: Rehabilitation clinics. Subjects: Thirty-two chronic stroke patients (21 men, 11 women; mean age=57.9 years, range=43—81 years) 13—26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. Intervention: Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. Main measures: Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. Results: There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (P=0.018) more efficiently and depended more on the feedforward control of reaching (P=0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (P<0.0001) and the Functional Independence Measure (P=0.016). Conclusions: In addition to improving functional use of the affected arm and daily functioning, modified constraint-induced movement therapy improved motor control strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.

Effects of Modified Constraint-Induced Movement Therapy on Movement Kinematics and Daily Function in Patients With Stroke: A Kinematic Study of Motor Control Mechanisms

Background and Objective. Motor control of the upper extremity during unilateral and bimanual functional tasks and functional change during daily activities were evaluated in patients with stroke treated with modified constraint-induced movement therapy (mCIMT). Methods. In a pre-post randomized, controlled trial, 30 stroke patients received 2 hours of mCIMT or traditional rehabilitation (TR) for 3 weeks. Motor control of the upper extremity was evaluated using kinematic analysis in unilateral and bilateral tasks. Kinematic variables included spatial and temporal movement efficiency and type of movement control (preplanned control, representing well-learned movement, or feedback-guided control). Functional outcomes were evaluated using the Motor Activity Log (MAL) and the Functional Independence Measure (FIM). Results. Patients receiving mCIMT showed more temporally (P = .013) and spatially (P = .011) efficient movement and more preplanned movement control (P = .009) during the bimanual task, and greater gains in FIM (P = .004) and MAL scores (amount of use: P < .0001, and quality of movement: P = .012) than patients in the TR group. Patients receiving mCIMT produced more ballistic/preplanned reaching movement than did patients receiving TR (P = .023) during the unilateral task; but there were no group differences in temporal or spatial efficiency in unilateral task performance. Conclusions. Relative to TR, mCIMT produced a greater improvement in functional performance and motor control. Improvement of motor control after mCIMT was based on improved spatial and temporal efficiency, apparently more salient during bimanual rather than unilateral task performance. This suggests that bilateral task performance should potentially be emphasized in kinematic study of changes in motor control after mCIMT.

A Randomized Controlled Trial of Modified Constraint-Induced Movement Therapy for Elderly Stroke Survivors: Changes in Motor Impairment, Daily Functioning, and Quality of Life

Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Objective To examine the benefits of modified constraint-induced movement therapy (mCIMT) on motor function, daily function, and health-related quality of life (HRQOL) in elderly stroke survivors. Design Two-group randomized controlled trial, with pretreatment and posttreatment measures. Setting Rehabilitation clinics. Participants Twenty-six elderly stroke patients (mean age, 72y) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident. Interventions Twenty-six patients received either mCIMT (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for a period of 3 weeks. Main Outcome Measures Outcome measures included the Fugl-Meyer Assessment (FMA), FIM instrument, Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The FMA evaluated the severity of motor impairment; the FIM instrument and MAL reported daily function; and the SIS detected HRQOL. Results The mCIMT group exhibited significantly greater improvements in motor function, daily function, and the physical domain of HRQOL than the traditional rehabilitation group. Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group. Conclusions These findings suggest mCIMT is a promising intervention for improving motor function, daily function, and physical aspects of HRQOL in elderly patients with stroke. The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program.