Reproducibility and reliability of performance indicators to evaluate the therapeutic effectiveness of biofeedback therapy after elbow surgery: An observational case series.

Electromyographic biofeedback (EMG-BF) therapy provides information on the state of contraction of the targeted muscles and relaxation of their antagonists, which can facilitate early active range of motion (RoM) after elbow surgery. Our aim in this study was to calculate the minimum detectable change (MDC) during EMG-BF therapy, initiated in the early postoperative period after elbow surgery.This study is an observational case series. EMG-BF of muscle contraction and relaxation was provided during active elbow flexion and extension exercises. Patients completed 3 sets of 10 trials each of flexion and extension over 4 weeks. The total range of flexion-extension motion and scores on the Japanese Society for Surgery of the Hand version of the disability of the arm, shoulder, and hand questionnaire and the Japanese version of the Patient-Rated Elbow Evaluation were obtained at baseline and weekly during the 4-week intervention period. A prediction formula was developed from the time-series data obtained during the intervention period, using the least-squares method. The estimated value was calculated by removing the slope from the prediction formula and adding the initial scores to residuals between the measured scores and predicted scores individually. Systematic error, MDC at the 95th percentile cutoff (MDC95), repeatability of the measures, and the change from the baseline to each time-point of intervention were assessed.The MDC95 was obtained for all 3 outcome measures and the range of values was as follows: RoM, 8.3° to 22.5°; Japanese version of the Patient-Rated Elbow Evaluation score, 17.6 to 30.6 points; and disability of the arm, shoulder, and hand questionnaire subscale: disability and symptoms score, 14.2 to 22.9 points.The efficacy of EMG-BF after elbow surgery was reflected in earlier initiation of elbow RoM after surgery and improvement in patient-reported upper limb function scores. The calculated MDC95 cut-offs could be used as reference values to assess the therapeutic effects of EMG-BF in individuals.

Standardization of rehabilitation program for post-apoplectic limb spasm treated by Tongjing Tiaoxing tuina and scalp acupuncture with physical therapy.

BACKGROUND: Tong Jing Tiao Xing tuina (TJTX) is a Chinese massage method. Excising with scalp acupuncture (ESA) is a treatment combining scalp electroacupuncture with physical therapy (PT), and yinao fujian formula (YNFJ) is a Chinese oral herbal granule medicine. The combination of the 3 methods is called the "Zhishen Tiaoxing" (ZSTX) rehabilitation program, which is used as an alternative of limb spasm after stroke. There is little available evidence demonstrating its safety and efficacy. METHODS: This will be a subject-blind, randomized controlled trial conducted in 3 medical centers. It will strictly follow the Standards for Reporting Interventions in Clinical Trials of Acupuncture, 2010. We will recruit 316 patients with limb spasm after stroke, 200 from the Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China, 80 from the Second Affiliated Hospital of Heilongjiang University of Chinese medicine, Harbin, China, and 36 from Huashan Hospital of Fudan University, Shanghai, China. A block randomization sequence stratified by centers will be generated using SAS Version 9.2 software (SAS Institute, Cary, NC, USA), which was performed at the Guangdong Provincial Hospital of Chinese Medicine's Key Unit of Methodology in Clinical Research. The treatment group is treated with TJTX (once a day), ESA (once a day), and oral YNFJ (twice a day). The control group will be treated with PT. Two groups of patients will be treated 5 sessions a week for 4 weeks, and there will be 6-month follow-up. The outcome evaluators will be blinded to patient grouping. The primary outcome will be modified Ashworth scales. The secondary outcome indexes will be the simplified Fugl-Meyer assessment scale, surface electromyogram root mean square value, modified Barthel index, stroke-specific quality of life scale, health scale of traditional Chinese medicine, visual analogue scale (VAS), and the Hamilton depression scale. DISCUSSION: The Randomized Controlled Trial (RCT) mainly aim to evaluate the effectiveness and safety of traditional Chinese medicine rehabilitation program, by comparing the treatment of ZSTX with the PT for the treatment of limb spasm after stroke. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR 1900024255. Registered on July 3, 2019.

Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center.

Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.

Caring Models in Geriatric Rehabilitation: An Integrative Review.

To promote excellence in care, person centered care based on humanistic values are essential. This integrative literature review summarizes the current research on the use of a caring model or approach in rehabilitation wards for elderly and explores the issues or benefits on patient's care or on patient-nurse interactions.

[The potential of general magnetic therapy for the treatment and rehabilitation (a review)].

This paper was designed to describe the main characteristics of general magnetic therapy and the mechanisms underlying its biological and therapeutic action. Special attention is given to the extensive application of this method in the routine clinical practice. The publications in the current scientific literature are reviewed in order to evaluate the potential of general magnetic therapy as a component of the combined treatment of various somatic pathologies, rehabilitation of the patients after surgical intervention with special reference to the management of the patients presenting with the oncological problems. The data suggesting good tolerability and high therapeutic effectiveness of the physiotherapeutic method under consideration.

Efectividad de la imaginería o práctica mental en la recuperación funcional tras el ictus: revisión sistemática / Effectiveness of motor imagery or mental practice in functional recovery after stroke: a systematic review

Introducción: En las últimas décadas han surgido diferentes métodos de tratamiento rehabilitador para pacientes con hemiparesia. Uno de ellos es la práctica mental (PM) del movimiento, consistente en la evocación de un movimiento o gesto por parte del sujeto con el fin de aprender o mejorar su ejecución. A pesar de que las técnicas de neuroimagen han demostrado que durante la PM se ejecutan patrones de activación neuronal similares a los que aparecen durante el movimiento, es necesario demostrar su efectividad clínica en la rehabilitación y recuperación funcional de pacientes. Desarrollo: Para ello, entre diciembre de 2011 y octubre de 2012 se realizó una búsqueda sistemática en las principales plataformas bibliográficas y bases, seleccionándose 23 ensayos clínicos referentes a distintos protocolos de PM en pacientes con hemiparesia. Conclusiones: La PM es efectiva cuando se combina con terapia convencional en la recuperación funcional del miembro tanto inferior como superior, así como para el entrenamiento de actividades y gestos cotidianos. Dada la heterogeneidad de los estudios en cuanto a la técnica de evocación mental, el volumen de entrenamiento, los sujetos incluidos…, se necesitan más estudios para determinar el tipo de paciente y el protocolo ideal de tratamiento

Introduction: In recent decades, many stroke rehabilitation methods have been developed. Mental practice (MP) is a dynamic state in which the subject evokes an imaginary representation of a motor action or skill in order to learn or perfect that action. Although functional imaging has shown that MP produces similar cortical activation patterns to those of movement, the clinical effectiveness of such methods in rehabilitation and functional recovery has yet to be demonstrated. Development: Systematic search of all clinical studies published in the main scientific databases between December 2011 and October 2012 concerning mental practice in stroke rehabilitation. We selected 23 clinical trials testing different MP protocols in patients with hemiparesis. Conclusions: MP is effective when used in conjunction with conventional physical therapy for functional rehabilitation of both upper and lower limbs, as well as for the recovery of daily activities and skills. Owing to the heterogeneity of the studies with regard to the intervention protocol, specific imagery technique, time spent practicing, patient characteristics, etc., more studies are needed in order to determine the optimal treatment protocol and patient profile

Rehabilitation - a new approach. Part four: a new paradigm, and its implications.

This editorial proposes changes in healthcare services that should greatly improve the health status of all patients with disability. The main premises are that: rehabilitation usually involves many actions delivered by many people from different organisations over a prolonged period; specific rehabilitation actions cover a wide range of professional activities, with face to face therapy only being one; and the primary patient activity that improves function is practice of personally relevant activities in a safe environment. This editorial argues that: rehabilitation should occur at all times and in all settings, in parallel with medical care in order to maximise recovery and to avoid loss of fitness, skills and confidence associated with rest and being cared for; hospitals and other healthcare settings should adapt the environment to encourage practice of activities at all times; and that measuring rehabilitation, whether in research or for re-imbursement, should not simply consider face-to-face 'therapy time' but must include: all the other important activities undertaken by the team; 'structures' such as the appropriateness of the environment; and a process measure of the time spent by patients undertaking activities.

Rehabilitation - a new approach. Part two: the underlying theories.

This editorial considers how healthcare systems should approach the problems associated with ongoing, persistent symptoms and limitations on a person's ability to undertake activities. It starts from the premise, established in the first editorial, that the current reliance on the biomedical model of health and illness is no longer 'fit for purpose', and is one major cause of current difficulties within the health service. Among other problems, it may lead to the marginalisation of rehabilitation services, especially when resources are limited. This editorial describes and then highlights the implications of the holistic, biopsychosocial model of illness. It also outlines the rehabilitation process, demonstrating its similarity to the process used by medical services, with the primary difference being the centre of attention: disease for medical service, disability for rehabilitation services. The model of rehabilitation emphasises: the importance of being patient-centred and goal-directed in rehabilitation; the need for liaison by the team and learning by the patient; and that the patient needs to be encouraged and enabled to practice wanted activities.

La comunicación de malas noticias en el daño cerebral aquirido: ¿mucha ciencia pero tal vez poca complacencia? / Breaking bad news in traumatic brain injury: much science but possibly not enough art?

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[Reflexotherapy in the context of rehabilitative medicine].

The main stages of the history of reflexotheray and its principal methodological aspects are reviewed in the context of the introduction of this approach into rehabilitative medicine. Productive results of such integration find the demonstrative reflection in the defense of 56 theses for the degree of candidate of science and 28 ones for the degree of doctor of science devoted to various aspects of reflexotherapy. The growing tendency toward the more extensive application of non-pharmacological approaches to complementary medicine opens up new prospects for the further development of reflexotherapy in the context of modern health care practices.

Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease.

BACKGROUND: Physical activity has the potential to positively impact upon aerobic and functional ability, and the quality of life of all chronic kidney disease (CKD) patients independent of the stage of the disease process. Physical activity is recommended in a number of national CKD guidelines, but its incorporation into routine care has been slow. The translation of research-led physical activity programmes into an established procedure appears to be a particular obstacle. This study included 263 patients, consecutively referred over a 4-year period, to a pragmatic 12-week renal rehabilitation (RR) programme delivered within a National Health Service (NHS). METHODS: One hundred and thirty-one patients were assessed and started the RR programme. Anxiety and depression were measured using the hospital anxiety and depression (HAD) scale. The self-reported level of fitness was measured with the Duke's activity status index (DASI), and exercise capacity was assessed with the incremental shuttle walk test (ISWT), sit-to-stand transfers in 60 s (STS60), timed up and go (TUAG) and stair-climb descent (SCD) tests. All measures were assessed at baseline and at 12 weeks. Attendance and completion of the RR programme were recorded for all patients. RESULTS: There were significant improvements in exercise capacity and functional ability ranging from 21 to 44%, and significant improvements in anxiety (15%) and depression (29%) in the 77 patients who completed the RR programme. The self-reported level of fitness was found to be significantly associated with completion (P = 0.01), with older participants showing a trend towards being more likely to complete (P= 0.07). Fifty-four patients, out of the 131 patients who commenced the RR programme, failed to complete 12 or more of the 24 scheduled sessions. Patients requiring haemodialysis (HD) treatment constituted the largest number of dropouts/non-completers (49%) in the study. CONCLUSIONS: This study demonstrates that a pragmatically constructed, NHS-delivered exercise-based RR can substantially improve both physical function and mental well-being for the wide range of CKD patients who regularly participated (55%). Compliance/adherence data indicate that this type of rehabilitation programme is particularly well received by pre-dialysis (PD) CKD and post-transplantation patients.

Protocolo modificado de la terapia del movimiento inducido por restricción para un hospital de atención a crónicos y larga estancia / Modified protocol of constraint-induced movement therapy for a chronic and long term care hospital

Introducción. La terapia del movimiento inducido por restricción es una de las pocas terapias de rehabilitación del miembro superior que ha demostrado científicamente que tiene un impacto en las actividades de la vida diaria. El objetivo del ensayo clínico aleatorizado es comprobar si la modificación del protocolo original de la terapia del movimiento inducido por restricción mejora la elegibilidad del protocolo original y mantiene los beneficios del mismo. Material y método. Se realiza un estudio comparativo en una muestra de 32 pacientes que han sufrido un accidente cerebrovascular, divididos de manera aleatoria en un grupo experimental y otro control, para determinar si una modificación del protocolo original de la terapia del movimiento inducido por restricción tiene un impacto significativo en la mejora de las actividades de la vida diaria dentro del tratamiento global de pacientes ingresados en un Hospital de atención a crónicos y larga estancia, el Hospital «Pare Jofré» de la ciudad de Valencia. La técnica es comparada con el tratamiento tradicional de terapia ocupacional. Resultados. Se consigue aumentar la elegibilidad de un 1,6%, hasta un 26,22%. Se observa una mejora funcional en las actividades de la vida diaria por el impacto de la técnica dentro del período ingreso-alta con significación estadística (U de Mann-Whitney 0,001) y una diferencia significativa en los niveles de dependencia entre el grupo experimental y el grupo control, observándose que los pacientes que reciben la técnica tienen menores niveles de dependencia (Chi-cuadrado 0,038) y diferencias estadísticamente significativas para actividades de la vida diaria como la alimentación, el vestido, el aseo personal, la ducha, el uso del retrete las transferencias y el desplazamiento, por lo que podemos decir que se mantienen los beneficios del protocolo original. Conclusión. El protocolo modificado mejora la elegibilidad de los pacientes, así como los resultados de los pacientes en actividades de la vida diaria, tanto en alimentación, vestido, higiene, baño, uso del retrete y transferencias (AU)

Introduction. Constraint-induced movement therapy is one of the few therapies for upper limb rehabilitation that has been scientifically proven to have an impact on daily life activities. The purpose of this clinical trial is check whether the modification of the original protocol of constraint- induced movement therapy improves the eligibility restrictions of the original protocol and maintains the benefits. Material and methods. We performed a comparative study on a sample of 32 patients who had suffered a stroke. They were randomly divided into an experimental group and a control group to determine if a modification of the original protocol of constraint-induced movement therapy has a significant impact on improvement in daily living activities within the overall treatment of patients admitted to a chronic care, long stay, hospital, that is, the Hospital “Pare Jofre” of the city of Valencia. The technique was compared with the traditional treatment of occupational therapy. Results. Eligibility is increased from 1.6% to 26.22%. We observed functional improvement in activities of daily living with statistical significance (Mann-Whitney U Test: 0.001) and a significant difference in levels of dependence between the experimental and control group. It has been observed that patients receiving the technique have lower levels of dependency (Chi-square 0.038) and statistically significant differences for activities of daily life, such as eating, dressing, personal hygiene, showering, use of toilet, transfers and movements from one place to another, so we can say that the benefits of the original protocol are maintained. Conclusions. Eligibility is increased with this modified protocol and it has better results in activities of daily living, such as feeding, dressing, hygiene, bathroom, use of the toilet and transfers (AU)

Toward a convergence of regenerative medicine, rehabilitation, and neuroprosthetics.

No effective therapeutic interventions exist for severe neural pathologies, despite significant advances in regenerative medicine, rehabilitation, and neuroprosthetics. Our current hypothesis is that a specific combination of tissue engineering, pharmacology, cell replacement, drug delivery, and electrical stimulation, together with plasticity-promoting and locomotor training (neurorehabilitation) is necessary to interact synergistically in order to activate and enable all damaged circuits. We postulate that various convergent themes exist among the different therapeutic fields. Therefore, the objective of this review is to highlight the convergent themes, which we believe have a common goal of restoring function after neural damage. The convergent themes discussed in this review include modulation of inflammation and secondary damage, encouraging endogenous repair/regeneration (using scaffolds, cell transplantation, and drug delivery), application of electrical fields to modulate healing and/or activity, and finally modulation of plasticity.

[Preparation for and care after medical rehabilitation using the example of psychosomatic rehabilitation]. / Vorbereitung und Nachbereitung der medizinischen Rehabilitation am Beispiel der psychosomatischen Rehabilitation.

For successful reintegration into working life after inpatient medical and psychosomatic rehabilitation, it is necessary that treatment efforts prior to inpatient rehabilitation treatment, during the medical care itself, and after rehabilitation are distributed appropriately. Ideally, in addition to adequate psychotherapeutic treatment by established therapists/doctors, preparation for the upcoming rehabilitation should concentrate on helping patients lose their fear and also to shed light upon the objectives of a psychosomatic rehabilitation with special emphasis on vocational rehabilitation. Shortly after psychosomatic rehabilitation, aftercare supports, in particular, the transfer of the rehabilitation results and reintegration into working life. However, only a fraction of the patients are reached by this aftercare offer. For rehabilitation, patients with special job problems, migrants, or long-term unemployed persons, case management is proposed, should aftercare not be sufficient.

[Needs in rehabilitation and rehabilitative care of new target groups. Immigrants in psychosomatic rehabilitation]. / Die Bedarfsfrage in der Rehabilitation und die Versorgung neuer Zielgruppen. Migranten in der psychosomatischen Rehabilitation.

Treatment of patients with migration background in psychosomatic rehabilitation is gaining in importance. Cultural differences and increased barriers are considered the most important causes for the inferior effective treatment results in psychosomatic rehabilitation and a higher percentage of pensions due to impairment. We discuss perspectives in psychosomatic rehabilitation which not only focus on the migration background as the main cause for inferior effective treatment results, but place greater focus on typical barriers of this patient group. For this reason, the need for more integrative and adapted forms of psychosomatic rehabilitation becomes more evident. Psychosomatic rehabilitation can be adapted by introducing case management, psychosomatic aftercare, and outpatient information groups.