Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review.

Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.

The concurrent impact of mild cognitive impairment and frailty syndrome in heart failure.

Pathological processes associated with ageing increase the risk of cognitive deficits and dementia. Frailty syndrome, also known as weakness or reserve depletion syndrome, may significantly accelerate these pathological processes in the elderly population. Frailty syndrome is characterized by decreased physiological function and neuropsychiatric symptoms, including cognitive decline and depressive states. In people with cardiovascular disease, the risk of frailty is 3 times higher. Frailty syndrome is particularly prevalent in severe heart failure, which increases the risk of mortality, increases hospital readmission, and reduces patients' quality of life. In addition, co-occurrence of cognitive impairment and frailty syndrome significantly increases the risk of dementia and other adverse outcomes, including mortality, in the heart failure population.

Early Heart Rate Recovery after a 6-min Walking Test Predicts Clinical Benefits in Patients after Percutaneous Aortic Valve Implantation.

BACKGROUND: It was hypothesized that the time-appropriate return to a resting heart rate (HR) after cessation of exercise could be a marker for predicting outcomes in patients with heart failure (HF). We aimed to evaluate the prognostic value of HR recovery in functional improvement among adults with severe aortic stenosis undergoing percutaneous aortic valve implantation (TAVI). METHODS: We performed a 6 min walk test (6MWT) in 93 individuals before TAVI and 3 months after the procedure. The change in walking distance was calculated. During the pre-TAVI 6MWT, we analyzed the differences between baseline HR, HR at the end of the test, and HR at the 1st, 2nd, and 3rd minute of recovery. RESULTS: After 3 months, 6MWT distances improved by 39 ± 63 m and reached a total of 322 ± 117 m. Multiple linear regression proved the differences between HR after 2 min of recovery and baseline HR in pre-TAVI after a 6MWT was the only significant predictor of waking distance improvement during follow-up. CONCLUSIONS: Our study suggests that analysis of HR recovery after a 6MWT may be a helpful and easy parameter to assess improvements in exercise capacity after TAVI. This simple method can help to identify patients in whom no significant benefit in functional improvement can be expected despite successful valve implantation.

The role of soft tissue mobilization in reducing orofacial and general complaints in a patient with Kimmerle anomaly and temporomandibular joint disorder: A case report.

Background: Kimmerle anomaly belongs to the anatomic varieties of the first cervical vertebra. The clinical pattern is dominated by vascular- and neurogenic-type headaches, dizziness, decreased postural muscle tension, and vegetative symptoms. Clinical Presentation: A 37-year-old woman who suffered from headache and pain in the left temporomandibular joint underwent clinical examination, electromyography of masticatory muscles, temporomandibular joint vibration analysis, cone beam computed tomography, and soft tissue mobilization. Radiologic examination revealed Kimmerle anomaly on the right side of the atlas. Clinical Relevance: Myofascial release decreased the tension within anatomic structures projected to the vertebral artery groove. Better movements of the cervical spine and fewer headaches were noted. Increased cervical and masseter muscle tension were considered the main cause of the ailments. The proprioceptive system of the cervical spine was accepted as a reason for persistent headaches. Soft tissue mobilization revealed positive healing effect in the patient with temporomandibular joint disorder and Kimmerle anomaly. Abbreviations: C1: First cervical vertebra; DC/TMD: Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); BDI: Beck Depression Inventory; PSS: Perceived Stress Scale; NDI: Neck Disability Index; BioEMG: Surface electromyography; sEMG: Surface electromyography; ICC: Intraclass correlation coefficient; T-Scan® III: computer evaluation of dental occlusion; JVA: Joint Vibration Analysis; CBCT: Cone Beam Computed Tomography; TO: Occlusion time; the time from the first contact of the teeth to the maximum intercuspidation; reference value in patient with natural teeth <0.2 s; TDL: Disclusion time to the left; the time from the maximum intercuspidation to obtain complete lack of the teeth contact in lateral movement to the left; reference value in patient with natural teeth <0.4 s; TDR: Disclusion time to the right; the time from the maximum intercuspidation to obtain complete lack of the teeth contact in lateral movement to the right; reference value in patient with natural teeth <0.4 s; NHP: Natural head position; µSv: micro-Sievert; kV: kilovolt; mA: miliampere; cm: centimeter; µm: micrometer; s: second; Hz: Hertz; C1-C2: Segment of atlas and axis; AOD: Atlantooccipital dislocation; RV: Reference value; TrP: Trigger point; VAS: Visual Analog Scale; CN V: Cranial nerve V, trigeminal nerve; OC-C1: Occiput and first vertebra junction.

A New Method of Evaluating the Symmetry of Movement Used to Assess the Gait of Patients after Unilateral Total Hip Replacement.

PURPOSE: We propose a new concept of symmetry, the symmetry function, as a continuous function of the percentage of differences between sides of body movement and normalised throughout the whole range of motion. The method is used to assess the dynamical symmetry of gait of patients after unilateral total hip replacement (asymmetric group) and healthy people (symmetric group) and also to reveal discrepancies between normal and abnormal movement patterns. METHODS: The gait of twelve male patients (49.7 ± 2.8 y), six weeks after unilateral total hip replacement (uTHR), was analysed against the gait of thirteen healthy men (36.1 ± 3.1 y). The speed of healthy men was matched to the speed of the patients. Comparison of the affected limb in uTHR patients with the healthy limb of able-bodied men was carried out on the basis of the highest symmetry values in the sagittal plane. RESULTS: In uTHR patients, the symmetry function provides information on the symmetry of movements in the whole range of motion in contrast to symmetry indices which are calculated for selected parameters or peak values. Research revealed average asymmetric discrepancies for pelvic tilt up to 250% for the entire gait cycle with a peak of approx. 400% at the end of the loading response and terminal swing phases. Asymmetry of gait observed in other joints was below 200% of the mean range of motion. CONCLUSIONS: Regions of the greatest asymmetry in pathological movements are usually different from the region of the greatest range of motion. Therefore, it is insufficient to measure symmetry only for selected regions during motion. The symmetry function is a simple method which can complement other robust methods in time series data evaluation and interpretation.

Assessment of gait after bilateral hip replacement. Case study.

Total hip arthroplasty (THA) is one of the most effective methods of treatment of severe hip osteoarthritis (HOA). In many cases pathological gait patterns persist despite properly conducted surgery and disturb the normal wear of the artificial joint surfaces. The aim of the study was to conduct functional and biomechanical assessment of gait in a patient after bilateral THA due to severe degenerative changes in the hip. The assessment focused on the gait parameters which significantly deviate from a normal gait pattern at various stages of treatment. Physiotherapeutic assessment of the patient included measurements of the range of motion in lower limb joints, the Timed Up and Go test, and pain assessment. Biomechanical assessment involved measurements of spatiotemporal gait parameters and the dynamic range of motion using BTS Smart-E motion analysis system. Although clinical examinations after both the first and second procedure suggested recovery of the patient's physical function, biomechanical assessment of her gait after the second procedure indicated the presence of deviations from a normal gait pattern. Secondary to a limited range of internal/external hip rotation, extension, and abduction, corresponding indices were still in the pathological range.