Introduction:Stroke leaves many people with upper limb impairments which significantly affect function and Quality Of Life (QOL). Most studies report outcomes at the impairment and activity level. Less attention has been paid to real-life use of the affected upper limb in daily activities. Self-reported measures of performance of activity in daily life using the affected upper limb is important to obtain as people may have minimal deficits on impairment and activity level outcomes yet still have significant difficulties performing self-care and other Activities of Daily Living (ADLs). These difficulties have an important impact on QOL. Discovering easy clinical measures that are associated with the ability to perform ADLs in the long-term is vital as this can lead to more effective care planning by providers, more realistic expectations for survivors, and more efficient allocation of time and resources. Objective:This exploratory study investigated the association between affected upper limb movements from the Upper Extremity Fugl-Meyer Assessment (UEFMA) as well as grip and grasp items from the Action Research Arm Test (ARAT) measured within thirty days post stroke and the self-care domain of the EuroQol-5D-5L measured at six months post stroke. These higher-level affected arm movements require some degree of corticospinal tract function which is a known predictor of functional outcome. Methods:Baseline clinical and six-month EuroQol-5D-5L data were obtained from sixty participants who completed a randomized clinical trial that evaluated robotically facilitated virtual reality for the upper limb in the subacute period post stroke. Cross tabs were used to quantify the association between the baseline ability to perform higher level affected arm movements and the ability to wash and dress oneself at six months post stroke using the self-rated EuroQol-5D-5L health related QOL measure. Results:The ability to perform higher level affected arm movements that require some degree of corticospinal tract function within thirty days post stroke was significantly associated with self-care at six months post stroke in a group of moderate to severely impaired individuals with stroke. Discussion:We propose easy to assess hand, wrist, and arm movements that may be effective clinical tools to project independence with self-care in the long term in similar populations.
Background: Low-intensity Continuous Ultrasound (LICUS) therapy heals soft tissue injuries. It alleviates acute and chronic musculoskeletal pain by activating multiple healing processes through its diathermic and mechanotransducive properties. Diclofenac has been FDA-approved as a Non-Steroidal Anti-Inflammatory Drug (NSAID). It is an analgesic and anti-inflammatory drug available in oral and topical forms. Adding 2.5% diclofenac sodium to ultrasound coupling gel can be used to deliver LICUS in addition to the analgesic effects of diclofenac sodium without altering the diathermic and acoustic effects of the ultrasound penetration with no undesired adverse effects. Objective: To determine the effects of adding 2.5% diclofenac sodium to standard aqueous ultrasound gel on the ultrasound coupling and diathermic properties of a long duration Sustained Acoustic Medicine (SAM) treatment. Methods: In a two-phase study, first, the acoustic and diathermic changes were determined in bovine tissue during 4-hour-long SAM stimulation at 1 cm, 2 cm, and 5 cm with aqueous and 2.5% diclofenac ultrasound coupling patch. Then, in the second phase, the heating profiles were recorded with and without 2.5% diclofenac gel in 54 healthy adult subjects at the forearm and calf during the SAM treatment. Result: The addition of 2.5% diclofenac sodium significantly increased coupling gel density, acoustic impedance, and signal propagation (p<0.0001) with little or no effect on the diathermic profiles at 1 cm, 2 cm, and 5 cm depth. The coupling gel with 2.5% diclofenac sodium sustained the therapeutic ultrasound intensity longer than the aqueous coupling gel (5.5 cm relative to 4.5, p<0.0009). No significant diathermic difference was recorded on the calf and forearm skin with a 2.5% diclofenac ultrasound gel coupling patch. Conclusion: Adding 2.5% diclofenac sodium to ultrasound gel increases acoustic impedance, improves ultrasound signal coupling into deep tissue, and provides longer sustained deep tissue heating without negatively impacting the diathermic profile during SAM treatment.
The BIT LExoChair wheelchair for motion assistance was designed as a solution with a modular design for user’s locomotion mobility with the aim of assisting autonomy, exercising, and rehabilitation, with activities in design, experimental validation, and implementation that are summarized in the main listed references [1-11], as referring to the patent files [1,2]. This mini-review is based on illustration from the references papers as summary of the work and results in developing the BIT LExoChair wheelchair towards practical market availability in a near-future.
Background: Obesity is a major public health concern. Objective: To analyze effects of a rehabilitation program on adult obese in Cotonou. Methods: It was a prospective, cross-sectional, descriptive and analytical study, conducted from January to June 2016 (06 months), on 122 adult obese subjects, recruited in some gymnastics clubs and the Department of Physical Medicine and Rehabilitation of the CNHU-HKM of Cotonou. A program of physical activity were done during 20 sessions. Clinical and biological parameters were evaluated in these subjects before and after the program. Comparing the beginning and ending values of those parameters, their evolution were evaluated. Results: Most of these patients were females (94.26%) aged 46.3 ± 9.70 years. Their mean BMI was 37.26 ± 5.04 kg/m2 with an android obesity (45.9%) or a mixed one (54.1%). The fat mass index (FMI) was 47.95 ± 7.56%. Hypercholesterolemia (59.02%) and hypertriglyceridaemia (9.02%) were observed at the beginning of the program. At the end of the rehabilitation program, anthropometric parameters of patients were improved more markedly than those of lipids. No clinical or biological parameters studied were significantly associated with patient’s BMI and FMI changes (p>0.05). Conclusion: The exercise program has shown encouraging results and is therefore interesting to be applied to a larger population in underdeveloped countries.
Objective: Measure the incidence of Diabetes Mellitus (DM)/pre-diabetes among patients with hand nerves entrapment syndromes. Design: Prospective cross sectional. Settings: Outpatient. Participants: 412 patients presented with unilateral or bilateral hand numbness suspecting Carpal Tunnel Syndrome (CTS). Exclusion criteria: Cervical spine or hand trauma history, nerve injury history. Interventions: Each patient was subjected to the following; demographic data including occupation, body mass index, detailed medical history including DM history. Neck exam including Spurling test. Full neurological exam. Main outcome measures: Upper extremities Nerve conduction studies and electromyography of segment pointing muscles. Laboratory testing including glycosylated hemoglobin (HgA1c), liver and kidney functions. Cervical spine MRI if possible. Results: Mean age 59.4 ± 11.123. All patients were right-handed, Male 37.1%, female 62.9%, Mean body mass index (BMI) 32.2 ± 8.2. majority were manual workers (55.1%). HgA1c <5.5 has the fewest patients (7.3%), highest number of patients with HgA1c 5.5-6.0. significant relation between HgA1c categories and sensory CTS p=0.001 and sensory motor CTS p=0.001. No significant relation between HgA1c categories and demyelinating pathology p=0.123 but significant with demyelinating axonal pathology p=0.017. Significant relation between HgA1c and Guyon canal syndrome p=0.001 and polyneuropathy p=0.001. No significance between HgA1c and cervical radiculopathy p=0321. Conclusions: High incidence of DM and pre-diabetes among patients with hand nerve entrapment: CTS, Guyon syndrome together with polyneuropathy. EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels.
The incidence of oral cancer in Brazil is considered one of the highest in the world. In surgical treatments, where part of the maxilla, mandible, and tongue is removed, the maxillofacial prosthesis is used as a rehabilitation treatment. It is considered that patients undergoing surgical treatment of head and neck, when prostheticized, will present an improvement in the quality of life. Objective: To relate the demographic, lifestyle, and clinical aspects to the Physical, Psychological, Social Relations and Environment domains of the WHOQOL-bref quality of life instrument in cancer patients treated surgically and rehabilitated with maxillofacial prostheses. Method: This is a retrospective observational study, consisting of medical records of 189 patients, aged over 18 years, of both sexes, rehabilitated with prostheses. spreadsheet, comorbidities, of between the non-parametric
Even though we don’t know exactly which smokers will develop CVD from smoking, the best thing all smokers can do for their hearts is to quit. Smokers who quit start to improve their heart health and reduce their risk for CVD immediately. Within a year, the risk of heart attack drops dramatically, and even people who have already had a heart attack can cut their risk of having another if they quit smoking. Within five years of quitting, smokers lower their risk of stroke to about that of a person who has never smoked. However, studies have reported that smoking increases the risk of CVD beyond the effects of smoking on other risk factors. In other words, the risk attributable to smoking persisted even when adjustments were made for differences between persons who smoke and nonsmokers in levels of these other risk factors.
Post-Stroke Depression (PSD) is a common and disturbing complication of stroke that affects rehabilitation outcomes. A past history of depression and severe stroke are risk factors for PSD, and thus, more attention should be paid to such patients. Appropriately diagnosing and screening for PSD is important because proper treatment could improve depressive symptoms and disturbed abilities. Treatment for PSD includes psychological care, nutritional care, pharmacotherapy, and exercise. Pharmacotherapy is currently the leading treatment for PSD, but antidepressants are associated with various adverse effects. Psychological and nutritional care can help manage depressive symptoms and exercise has been proven to be an effective treatment associated with fewer contraindications than pharmacotherapy. These non-pharmacological approaches could be expected to expand in clinical practice.
Background and purpose: Prechtl's general movement assessment is a tool to identify infants at risk of abnormal neurodevelopmental outcomes especially cerebral palsy. There is a need for further studies to establish its effectiveness in clinical practice. The main objective of this study was to find the diagnostic accuracy of prechtl's general movement assessment to predict neuromotor outcomes of preterm babies at one year corrected age when done in a standard clinical practice setting. The secondary objective was to find the inter-rater reliability of general movement assessment between two raters in a clinical setting. Methods: 116 preterm infants (55 females and 61 males) born below gestational age 35 weeks participated in this study. Prechtl's general movement assessment was done at two points of time - once between 33 to 40 weeks post menstrual age and later between 3to4 months corrected age. Babies were reassessed at 12 months (+/- 1week) corrected age using the Infant Neurological International Battery and Alberta Infant Motor Scale to identify neuromotor dysfunction. To find the inter-rater reliability, 75 video recordings at preterm/term age and 73 recordings at fidgety age were viewed and rated independently by two raters. Results: Statistical analysis using the Fishers' exact test and Pearson's chi-square test showed significant association (p<.001) between Prechtl's General movement assessment and neuromotor outcomes at one year corrected age. General movement assessment at preterm age and fidgety age showed sensitivity of 85% (each),specificity of 85% & 99%, positive predictive value of 27% & 85 %, and negative predictive value of 98% & 99% respectively in predicting neuromotor outcomes. Substantial agreement was found between two trained raters. Kappa values were 0.78 and 0.72 for assessments done at preterm/term age and three months corrected age respectively. Conclusion: The results suggest that Prechtl's general movement assessment done in routine clinical settings can reliably predict neuromotor outcomes of premature babies at one year corrected age. Thus, it has practical applications to identify premature babies at high risk of abnormal neurodevelopment in infancy.
Objective Using a feasibility analysis and matched subgroup analysis, this study investigated the implementation/safety/outcomes of a stroke recovery program (SRP) integrating modified cardiac rehabilitation for stroke survivors. Design This prospective cohort study of 783 stroke survivors were discharged from an inpatient rehabilitation facility to an outpatient setting; 136 SRP-participants completed a feasibility study and received the SRP including modified cardiac rehabilitation, 473 chose standard of care rehabilitation (nonparticipants), and a group (n = 174) were excluded. The feasibility study assessed the following: safety/mortality/pre-post cardiovascular performance/pre-post function/patient/staff perspective. In addition to the feasibility study, a nonrandomized subgroup analysis compared SRP-participants (n = 76) to matched pairs of nonparticipants (n = 66, with 10 nonparticipants used more than once) for mortality/pre-post function. Results The feasibility study showed the SRP to have the following (a) excellent safety, (b) markedly low 1-yr poststroke mortality from hospital admission (1.47%) compared with national rate of 31%, (c) improved cardiovascular performance over 36 sessions (103% increase in metabolic equivalent of tasks times minutes), (d) improved function in Activity Measure of Post-Acute Care domains (P < 0.001), (e) positive reviews from SRP-participants/staff. Subgroup analysis showed the SRP to (a) positively impact mortality, nonparticipants had a 9.09 times higher hazard of mortality (P = 0.039), and (b) improve function in Activity Measure of Post-Acute Care domains (P < 0.001). Conclusions Stroke survivors receiving a SRP integrating modified cardiac rehabilitation may potentially benefit from reductions in all-cause mortality and improvements in cardiovascular performance and function.
The main purpose of this mini-review is to present some of the finding on sensor-based rehabilitation robotics and to provide a view on its future prospects. Robotics system using sensors may be categorized as either passive mechanisms, Robotic manipulanda or Robotic exoskeletons. Many studies have demonstrated the effectiveness of rehabilitation using these sensor-based robots. In recent years, various computer technologies have worked together in collaboration in order to obtain better results. The development of sensor-based rehabilitation using machine learning technology can be useful for the accurate evaluation and therapeutic intervention in sensor-based rehabilitation. Thus, sensorbased robotics are evolving into highly accurate and more effective devices. Sensor-based robots could provide better information for building evidence in the rehabilitation field.
Supraspinatus tendinopathy is a common cause of shoulder pain and tendon degeneration in individuals who participate in repetitive overhead activities, such as tennis players or tradespeople. Early diagnosis and treatment of tendinopathies is necessary to prevent chronic sequelae and tendon rupture, which is especially important for groups such as professional athletes and manual workers for avoidance of prolonged downtime.
Background: Neurorehabilitation is facing a unique challenge as COVID-19 circumstances magnify the access and resource barrier in healthcare provision; and are causing disruption in the continuity of care of children with disability. An affirmative action is required as a ‘Disability-inclusive response to the COVID-19 crisis.’ This study thus aimed to determine if Telerehabilitation (TR) model of service delivery is a feasible and effective alternative for pediatric neurophysiotherapy. Methodology: This is a clinical trial conducted on children diagnosed with developmental delay or neurological condition and referred for Physiotherapy at a tertiary care center. Clinical consultation was provided remotely with the use of real time interactive technology. Outcome indicators used were: 1)Timely receipt of physiotherapy services; 2) Child’s clinical outcomes; and 3) Familiy’s acceptability and satisfaction with the provision of TR. Results: With regards to feasibility, the most common issues faced during TR sessions were technical; lack of time with mother; child’s medical illness, etc. Children’s clinical outcomes showed improvement reported as ‘acquisition of developmental skills’ and ‘the use of appropriate functional behaviors to meet their needs’. Families showed satisfaction with TR services however, expressed the need for in-person sessions. Conclusion: In the current scenario, TR may enhance the capacity of families to meet the needs of their child with a disability by connecting them with health care providers, resources and supports; thus ensuring continuity of care. While guidelines to tackle this unprecedented situation continue to develop, TR demonstrates the potential as an alternative rehabilitation strategy thereby ameliorating the impact of social distancing on underprivileged children. However, some psychosocial factors act as barriers to feasibility of TR in pediatric population.
The purpose of this article is to present a concise up-to-date review on effective perioperative pain management in Total Joint Arthroplasty (TJA). Multimodal therapy utilizing a “well-patient” concept and an “opioid stewardship” approach is introduced as a current strategy to address the critical worldwide opioid crisis which may be triggered by orthopaedic surgery in many patients. Adopting a tailored opiate pain management plan utilizing best practice criteria has demonstrated to result in minimal use of opioids during the surgical process while attaining the objectives to relieve suffering, achieve early postoperative mobilization, reduce lengths of hospital stay and produce patient satisfaction
70-y-old constructor right- handed man without significant past medical history, presented by bilateral hand tingling and numbness associated with frequent objects drops for 1 year. No other neurological symptoms, no gait abnormity. The patient continued his labor work with difficulty. After thorough clinical and electrophysical exam; the condition was diagnosed as combined carpal tunnel syndrome and amyotrophic lateral sclerosis (ALS). Carpal tunnel syndrome on top of amyotrophic lateral sclerosis
Many Paralympic athletes have complications of and disorders of motor-organs and viscera with symptoms accompanying impairments. For this reason, medical care for the said athlete during the 2020 Tokyo Paralympic Games will especially be important. Japanese Para-Sports Association has been holding lecture classes on medical management for the Paralympic athletes since 2005. Physicians authorized by The Association are to be dispatched to the 2020 Tokyo Paralympic Games as members of the medical team for the Games. In this report, we would like to mention that the legacy of the 2020 Tokyo Paralympic Games is the promotion of symbiotic society which socially influences not only the persons with impairments but also those without impairments considering the improvement of competitiveness of athletes and the influence on the whole society.
Stroke mechanism of Medullary Infarction (MI) mainly consists of penetrating artery disease (PAD), Large Artery atherosclerotic Occlusive Disease (LAOD) and dissection. The prevalence of stroke mechanism and its correlation with long-term outcome was previously reported. The prevalence of stroke mechanism and its correlation with longterm outcome has been studied. One hundred seven patients with acute isolated medullary infarction including 71 patients with LMI and 36 with MMI from the registration of 3820 consecutive acute ischemic stroke patients were selected. PAD was the most predominant cause and tended to show favorable functional outcome than other two mechanisms. Patients with LAOD showed poor functional outcome one year after onset in both groups of LMI and MMI. Although dissection in LMI exhibited worse functional state in acute phase, it did not show long-term poor outcome. Spontaneous early improvement of luminal narrowing in dissection may contribute to this finding. Atherosclerotic vertebral artery occlusive disease may expose ischemic insults to persistent hemodynamic compromise status. In patients with LAOD, the aggressive medical management or strict control of vascular risk factors should be considered.
Research studies have shown that during locomotion the heel fat pad acts as a shock absorber as the soft tissues undergo repeated loading that is distributed over the heel (calcaneus) [1-4]. The heel pad function is influenced by its material and structural behaviour including morphological and morphometrical attributes associated with its geometry, microstructure, and surrounding soft tissue interface. The thickness of the human heel fat pad on average is 18 mm from the calcaneus to the plantar skin [5]. Belhan and colleagues also measured the thickness of the heel fat pad and reported that the average thickness of the heel fat pad without pain at the point of the medial calcaneal tubercle and the average thickness of the first metatarsal fat pad of the feet without pain at the point of the first metatarsal head were 19.94 mm and 6.75 mm, respectively [6]. It is important to note that the human heel fat pad is inhomogeneous, anisotropic, and has been described as exhibiting non-linear viscoelastic behaviour due to its biphasic nature [7]. In addition, it regulates the transmission of loads to the bones, muscles, and joints of the lower limb during the performance of functional activities of daily living. These activities may range from low rate activities such as standing, walking and running to high rate incidents in the form of sports injuries for example [8].
53-y-old veteran man without previous past medical history, suffered from severe low back pain, misdiagnosed as lumbar disc prolapse.
For a century, it was believed that neuron membrane transmits electric field, that pulse is the information content. Everything inside remain silent. Nerve spike is the foundation of artificial intelligence, neuro medicine, and neuroscience. In recent years, it has been shown using state-of-the-art technology that filaments fire, regulate spike time modulation precisely, redefining cognition. The results are going to change neuroscience fundamentally; it would change the fundamentals of artificial intelligence and brain science.
