Beyond the Self-Reports: A Review on Objective Pain Measurement and Its Implications.

Current methods of pain measurement are inadequate in capturing the complexity of the pain experience. This limitation arises mainly because these methods tend to overlook the multiple dimensions of pain during assessment, heavily relying on self-reported measures, which inherently have their drawbacks. Self-reported measures aim to gauge the pain severity experienced by an individual, based solely on their perception of the most intense pain sensation. However, these measures are prone to various biases and may not accurately reflect the actual pain experienced. To overcome these limitations, a new system of pain assessment is necessary, which minimizes subjective involvement and provides a more accurate representation of pain. The 'Pain Calculator' is a newly developed tool that has demonstrated promising accuracy in measuring somatic pain in the low back region. This tool effectively overcomes the subjective biases characteristic of the self-reported measures and provides a reliable and clinically feasible alternative to the existing pain assessment tools.

Multidisciplinary Team Working in Rehabilitation Medicine: Advantages and challenges.

Healthcare is delivered in a very complicated environment where numerous variables affect the patient related outcomes. A multidisciplinary team that places a high priority on patient satisfaction and healthcare quality can help to simplify and manage the environment of complex healthcare delivery. The foundation of rehabilitation treatments is a multidisciplinary team approach to provide interventions and care for the patients. Regardless of the population studied, multidisciplinary rehabilitation has been shown to be more effective than therapy delivered by individual therapists in a number of different populations. Due to the patient's complex impairments, a team-based approach is necessary for assessments and facilitates coordinated care planning in the rehabilitation settings. The aim of this paper is to offer a narrative review of the advantages and challenges of multidisciplinary team working. The key components of teamwork in rehabilitation are the individualization of patient care and effective team communication.

Mobile health: Is your next rehabilitation's specialist in your pocket?

The past few decades have witnessed an unprecedented surge in health-related mobile applications. However, most of these applications primarily focus on lifestyle domains such as sleep, fitness, and nutrition. A notable stride in this landscape involves the emergence of applications catering specifically to rehabilitation needs. This expert review aims to provide an encompassing overview of the wide spectrum of apps available for both assessment and rehabilitation. It delves into the existing constraints associated with these tools and deliberates on the potential avenues for future advancements and integration for future advancements and integration. The transformative potential of this mobile, affordable, and user-friendly technology in reshaping the field of rehabilitation sciences will be highlighted. This article underscores how harnessing these innovations can elevate accessibility and effectiveness in the rehabilitation processes, leading to improved overall outcomes and wellbeing.

Fat but Fit: How physical fitness can mitigate the cardiovascular risks of obesity?

Obesity has long been recognized as a major independent risk factor for cardiovascular diseases (CVD). However, intriguing paradoxes such as the "obesity paradox" and the "fat but fit" phenomenon have been associated with it. The "fat but fit" paradigm suggests that overweight or obese individuals might face a lower risk of developing cardiovascular disease if they possess high levels of physical fitness. In other words, higher fitness levels may mitigate the negative impact of obesity on cardiovascular risk, leading to a reduction in overall mortality due to CVD. The evidence surrounding this paradox is conflicting, highlighting the necessity for further research. The complex relationship between physical fitness, obesity, and cardiometabolic health is influenced by individual and environmental factors. Consequently, it becomes imperative to conduct more studies to comprehend this intricate interplay fully. To address this issue, it is important to focus on formulating strategies that promote the maintenance and enhancement of cardiorespiratory fitness in overweight and obese individuals. Moreover, including fitness evaluations in comprehensive risk stratification can significantly improve clinical decision-making.

Multimodal approach to address the multifaceted nature of Chronic Musculoskeletal Disorders: Bridging the gap between research and clinical practice.

Musculoskeletal (MSK) disorders encompass various conditions impacting bones, muscles, tendons, ligaments, and nerves. An estimated 1.71 billion individuals globally have MSK disorders, causing disability and reduced quality of life. Literature contradicts the notion that musculoskeletal pain and disability solely arise from physical impairments; psychological, behavioural, and social factors contribute significantly. These facets influence pain perception and chronic impairment development. Common interventions-medication, exercise, manual and hydrotherapy, electro-thermal modalities, behavioural and alternative therapies-address pain individually, yet lack the comprehensive response required. In contrast, a multimodal approach combines diverse therapies tailored to individual needs. It ensures lasting symptom relief, prevents recurrence, and improves function. Although proven effective, clinical implementation of this approach remains limited. This mini-review discusses the reasons behind this gap, underscores multimodal approach importance, and enlightens rehabilitation professionals on its potential for managing chronic musculoskeletal issues.

Preserving cognitive vitality: Value of cognitive rehabilitation in addressing cognitive deficits in the elderly.

The recent advancements in medical sciences has resulted in not only increasing life expectancy of the elderly but has also improved survival rate in elderly with neurological disorders including those with head trauma . This has resulted in an increasing number of persons with cognitive deficits. Cognitive functions such as executive functioning and memory play an important role in success of a rehabilitation programme and therefore can positively contribute to public health goals. Considering cognitive decline at present has no cure and pharmacological therapies have a limited role, efforts are usually made to delay the onset and progression of cognitive decline and improve quality of life. Literature suggests that active life style, regular exercise, actively performing activities of daily living can have a significant impact on cognitive skills. In addition different models of cognitive rehabilitation and approaches can be integrated into practice to improve cognitive reserve and cause neuroplastic changes to facilitate cognitive function by providing cognitive stimulus and training. Moreover with technological advancements, the computerized cognitive intervention field is growing. This usually integrates conventional cognitive intervention with digital smart devices to provide an engaging and cost effective alternate approach. This review aims to highlight the importance of cognitive rehabilitation and suggest a few evidence based approaches that may be considered by rehabilitation professionals to promote and improve cognitive rehabilitation in Pakistan.

An Overview Of The Management And Rehabilitation Of Dysphagia.

Dysphagia is a medical condition that makes it difficult for a person to eat or swallow. It is estimated that 590 million people worldwide have dysphagia. The causes are varied and include neurological disorders like stroke and motor neuron disease, head and neck cancer, neuromuscular diseases, inflammatory diseases such as dermatomyositis, dementia, cervical spinal cord injury, and anterior vertebral ossification. The assessment and screening of dysphagia consists of a questionnaire-based interview, mealtime observation, and, if deemed necessary by a screening test or instrumental examination by specialists. Treatment is based on the diagnosis, patients' cognition and information gathered by screening and clinical evaluation. Patient's function can be improved only when treatment is comprehensive and includes compensatory feeding using an adjusted swallowing diet, compensatory posture adjustment, and nutritional improvement. We present a brief overview of the assessment and management strategies for dysphagia.

Goal Setting In Medical Rehabilitation: A Narrative Review.

Goal setting is an integral part of rehabilitation and the rehabilitation process. The aim of rehabilitation is to optimize functioning. Therefore, rehabilitation professionals and patients together have to determine mutually which aspects of functioning they should aim at. From a clinical view, a formal procedure for setting goals should help to motivate patients, ensure cooperation of rehabilitation team members, help to identify relevant blind spots and provide a system to monitor patient changes. Applying goalsetting in rehabilitation represents a purpose in its own right, as it serves to strengthen the autonomy of patients and is a valuable tool to integrate personal motives, attitudes, meanings into the rehabilitation process. There is evidence that the introduction of goal setting into rehabilitation practice could enhance health-related quality of life and emotional states, especially self-efficacy. Mixed results have been reported regarding the patient motivation as well as activities and participation outcomes.

Task Oriented Training For Stroke Rehabilitation: A Mini Review.

Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT.

An overview of injury prevention for soccer players in Pakistan: A sports rehab perspective.

Soccer (football) is one of the most popular weight-bearing sports in the world, which involves activities such as jumping, running and turning. Soccer related injuries have the highest incidence in all sports and are more common in young amateur players. The most important modifiable risk factors include neuromuscular control, postural stability, hamstring strength and core dysfunction. The International Federation of Football Association introduced FIFA 11+; an injury prevention programme for reduction in the rate of injuries in amateur and young soccer players. It focusses on the training of dynamic, static and reactive neuromuscular control, proper posture, balance, agility and control of the body. This training protocol is not being used in Pakistan at amateur level who neither possess the resources, nor the knowledge or proper guidance in risk factor assessment, prevention, and subsequent sport injury management. In addition, the physicians and rehabilitation community are not much familiar with it except for those directly involved in sports rehabilitation. This review highlights the importance of including FIFA 11+ training programme in the curriculum and faculty training.

Role of Vitalstim® In The Management Of Patients With Dysphagia: A MiniReview.

Dysphagia defined as difficulty in swallowing, can result from multiple causes including, Stroke, head injury, Alzheimer, Dementia, Muscular dystrophy, Cerebral Palsy etc. It is associated with neuro-muscular impairments in different age groups. VitalStim® therapy is a relatively new approach to treat dysphagia. It provides neuromuscular electrical stimulation (NMES) of the involved muscles to improve the function of swallowing. This review summarizes the usefulness of VitalStim® in dysphagia, and barriers in its use in Pakistan.

Rehabilitation Perspectives in Long COVID-19.

Long COVID is a term used to describe the persistence of symptoms in people who have had COVID-19 for an extended period. It affects multiple systems including neurological (fatigue, brain fog, attention issues, memory issues), neuromuscular (sarcopenia, myositis, arthritis and myopathy), cardiovascular (myopericarditis, right ventricular dysfunction, vasculitis and aortic, arterial and venous thrombosis) and respiratory (pulmonary fibrosis, pleurisy, pulmonary embolism and pneumonitis). This results in functional impairments which adversely affect the quality of life of patients. The rehabilitation of persons who have experienced long COVID-19, also known as "long haulers," is a relatively new field of study. We have described potential rehabilitation interventions to improve functional capacity and quality of life in patients with long COVID. These rehabilitation interventions include but are not limited to, endurance, flexibility and strength training, pulmonary rehabilitation, task specific exercises to improve Activities of Daily Living (ADL), psychological rehabilitation, medical rehabilitation, pain management and management of dysphagia.

Overview of gait rehabilitation in stroke.

Stroke is the 2nd leading cause of death globally after ischaemic heart disease and is expected to rise more by 2030. The estimated incidence of stroke in Pakistan is about 250/100,000 individuals. Difficulty in walking is present in approximately 80% of stroke survivors. About a quarter of stroke survivors, even after receiving rehabilitation have residual gait impairments requiring assistance in activities of daily life. Almost half of stroke patients after being discharged will have episodes of fall, with majority of these falls occurring in activities like "turning". Gait is one of the key features to participate in community and occupational activities. Therefore, appropriate gait rehabilitation post stroke is crucial for functional independence and community ambulation. There are many approaches to gait rehabilitation based on different models of motor physiology and disease. Augmenting conventional therapies with novel techniques such as utilization of electromechanical means have improved gait rehabilitation in improving functions. The usage of technology in rehabilitation of patients with neurological deficits, is still novel in Pakistan. This review provides an overview of advancements in neurological and gait rehabilitation post stroke.

Fall risk screening and balance rehabilitation in elderly: a missing healthcare intervention in Pakistani healthcare system.

Elderly are one of the fastest-growing population globally and require significant healthcare services due to age-related deterioration in physiological systems. Poor postural control due to aging results in impaired balance leading to increase in frequency of falls, poor quality of life, and rise in disability and mortality rates. In Pakistan, due to lack of awareness, and resources, fall prevention and screening programmes for the elderly are lacking. Regular fall risk screening utilizing balance assessment tools, integration of fall prevention programmes and balance rehabilitation approach as part of elderly healthcare services can serve as tools to lower the incidence of falls in the elderly population of Pakistan. Moreover, integration of latest technology as part of balance rehabilitation can also be considered. The review aims to highlight appropriate strategies for fall risk screening and balance rehabilitation in an effort to promote an important healthcare intervention for elderly in Pakistan.

An overview of biofeedback techniques in mechanical low back pain: effects on sensory integration of balance.

Low back pain is a common musculoskeletal disorder involving the lumbar spine. It affects almost 80% of the world's population and is associated with functional limitations. The reported global prevalence ranges from15-30%. Postural control involves processing the information from sensory stimulus derivative of vestibular, visual, and somatosensory systems in a coordinated manner to precisely regulate center of mass and body positioning. Failure of one or more of these systems, or incorrect processing of sensory information leads to instability or risk of fall. Low back pain can also modify the sensory input for postural control. Biofeedback can be utilized to assist "down-train" elevated muscle activity or to "up-train" weak or inhibited, muscles. Clinicians can use biofeedback to determine if patients are able to relax and evaluate psychophysiological reactions of muscles. Using biofeedback, patients can be educated about physiological processes and how biopsychosocial factors can interact causing recurrent complaints of pain.

Cardiac Rehabilitation for Visceral Obesity: A Multidisciplinary Approach.

World Health Organization data indicates a marked rise in global obesity, with approximately 30% of the world's population classified as overweight or obese. The contributory factors include unhealthy dietary habits, lack of physical activity, urbanization, and technology dependent sedentary lifestyle. Among the various management approaches, cardiac rehabilitation has evolved from an exercise-only programme for patients with cardiac diseases to a multi-disciplinary individualised intervention plan for risk factor modification, primary and secondary prevention of cardiometabolic diseases. Evidence suggests that visceral obesity is an independent risk factor of morbidity and mortality from cardiometabolic causes. There are multiple training programmes targeting visceral fat oxidation, one of which is high intensity interval training. It appears to be a promising regime, inducing metabolic adaptations in the body. This review summarizes the multidisciplinary cardiac rehabilitation services for the management of visceral adiposity and generalised obesity, its under-utilization and scarcity of local published data, highlighting the need for future research.

A Brief Review of Inpatient Palliative Rehabilitation.

Cancer patients face many challenges that can have a significant impact on their quality of life (QOL). When patients experience multiple functional impairments due to disease or treatment, their QOL and the efficient use of healthcare resources can be compromised. This is particularly true for patients who are nearing the end of their lives, as the physical and emotional burden of cancer can have a profound effect on both the individual and their caregivers. One approach to improving QOL in these patients is through palliative rehabilitation. Despite being an underutilized and understudied resource, palliative rehabilitation has shown promise in helping patients with advanced cancer retain their dignity and sense of control. By maximizing functional independence and reducing symptom burdens, palliative rehabilitation can provide a vital source of support for patients and their caregivers during this challenging time. Inpatient rehabilitation is one way that palliative rehabilitation can be applied in a healthcare setting. While further research is needed to fully understand the benefits of this approach, it is clear that palliative rehabilitation has the potential to play a key role in helping patients and their caregivers navigate the challenges of cancer treatment and end-of-life care. This approach is specific to the USA context but can be applied in other settings where cancer patients require such care.

Bladder Drainage Options For People With Spinal Cord Injury: A Mini-Review.

Neurogenic bladder is one of the negative consequences following a spinal cord injury (SCI). SCI patients who have neurogenic bladder depend on alternative methods to drain urine from their bladder. These include indwelling catheters, reflex voiding , suprapubic tapping and intermittent catheterisation. This review summarizes evidence from the literature of five selected complications (renal failure, urinary tract infections, calculi, urethral stricture, and bladder cancer) that could result from use of the different bladder drainage methods. There is inconsistent evidence to support the superiority of intermittent over indwelling catheterisation on risk of renal impairment, urethral stricture, and renal calculi. Indwelling catheterisations are associated with higher risk of bladder calculi and cancer. Caution needs to be taken when interpreting this review, as many of its findings are from retrospective studies, and more than a decade old. Clinicians need to communicate the evidence to their patients when making the decision on method of bladder drainage.

The role of Augmentative and Alternative Communication in Speech and Language Therapy: A mini review.

Augmentative and Alternative Communication is an aided or unaided means of communication which supports existing communication abilities of an individual or replaces natural speech due to any speech and language disorder. The deficit could be developmental or acquired such as autism spectrum disorder, cerebral palsy, learning difficulties, dysarthria, dyspraxia or due to any acquired neurological condition such as aphasia and other degenerative disorders. Furthermore, it may be due to surgical procedures such as laryngectomy. Alternate means of communication have also been successfully used with COVID-19 patients. These tools may include pictures, symbols, signs or voice output devices. Parents of children with special needs and medical professionals have been reluctant in implementing the approach due to certain misconceptions. The aim of this review is to summarize the current evidence for the use of Augmentative and Alternative Communication with a range of disorders in relation to in relation to Pakistan.

Recent advances in the pelvic floor assessment and rehabilitation of Women with Pelvic Floor Dysfunction.

Pelvic Floor Dysfunctions (PFDs) are a group of disorders characterized by inter-related symptoms of urology, gynaecology, colorectal or general pelvic pain. These mainly cause voiding or defecation disorders, pelvic organ prolapses, sexual dysfunctions and pelvic pain. PFDs adversely impact various domains of women's life including psychological, physical, social and sexual well-being. Pelvic Floor Rehabilitation (PFR) has been recommended as part of a multidisciplinary approach for evaluation and management of the multiple PFDs. The assessment of PFD has improved with utilization of new measurement tools and specific outcome measures for PFDs. PFR is a first-line treatment approach effective for PFDs. However, robust research is needed to test standardised assessment and physical therapy treatment protocols with long term efficacy. In this review, we discuss a range of PFDs, impairment-based classification, recent updates, and advances in the evaluation of PFDs, physical therapy tools and techniques for the treatment of PFDs.