[Conservative treatment and rehabilitation of shoulder problems]. / Konservative Therapie und Rehabilitation von Schulterbeschwerden.

The shoulder joint has an important influence on arm- and hand function. Therefore, activities of daily living, working and leisure time can be negatively influenced by diseases of the shoulder joint. Problems of the shoulder joint can be induced by muscular dysbalance and poor body posture. There is a strong relationship between shoulder function and body posture. Conservative treatment and rehabilitation of the shoulder joint aims at improving the local dysfunction of the shoulder joint as well as at improving function and social participation. Antiinflammatory and pain medication, exercise, occupational, electro-, ultrasound and shock wave therapy, massage, thermotherapy and pulsed electromagnetic fields are used as conservative treatments. Exercise therapy aims at improving muscular performance, joint mobility and body posture. Occupational therapy aims at improving functional movements for daily living and work. Electrotherapy is primarily used to relieve pain. Shock wave and ultrasound therapy proved to be an effective treatment for patients with calcific tendinitis. The subacromial impingement syndrome can be effectively treated by conservative therapy.

Implementation of the Vienna Hydrotherapy Group for Laryngectomees--a pilot study.

GOALS: Laryngectomy involves several problems for the individual, such as the need to cope with a stoma, adjustment to tracheostomal breathing, and the formation of a voice. Contact with water, resulting in aspiration, may prove fatal for laryngectomized patients in the absence of appropriate aids. The aim of this pilot study was to conduct a hydrotherapy group for laryngectomized patients and to evaluate its feasibility and outcome in relation to the goals of therapy. PATIENTS AND METHODS: Six male patients who had undergone laryngectomy were included in a pilot study. The patients underwent a structured hydrotherapy rehabilitation program (three times a week for 8 weeks), using a special underwater therapy device. The patients' posture was controlled by posturography and their endurance capacity by standard ergometry and the 6-min walk. The parameters of fatigue, expectoration, mobility, elasticity/flexibility, postural control/coordination, and general well being were registered on a visual analog scale (VAS). Quality of life was assessed by having the patients fill out the German version of the SF-36 Health Survey. MAIN RESULTS: Posturograpy findings showed an improvement of two subtests ( p<0.028). Exercise testing showed an improved endurance capacity ( p<0.028). The patients were able to walk a greater distance in the 6-min walking test ( p<0.028). The VAS also showed an improvement of endurance capacity ( p<0.028), fatigue ( p<0.028), expectoration ( p<0.043), mobility of the neck and shoulder ( p<0.027), flexibility ( p<0.027), postural control and coordination ( p<0.028), and general well being ( p<0.028). On the SF-36 Health Survey, the patients were improved in the items "Physical functioning" ( p<0.027), "Vitality" ( p<0.027) "Role-physical" ( p<0.026), and "Social functioning" ( p<0.043). CONCLUSIONS: A hydrotherapy group for laryngectomized patients proved to be safe, feasible, and effective in this pilot study.

Rehabilitation of ligamentous ankle injuries: a review of recent studies.

There are many treatment modalities for ankle rehabilitation. These are reviewed, and the most effective training programme for rapid restoration of ankle movement, strength, endurance, and proprioception is selected.

New drug developments in the Latin Americas (Argentina, Costa Rica, Mexico and Panama).

New drug developments in four Latin American countries, i.e. Argentina, Costa Rica, Mexico and Panama and the United States were compared. In contradistinction to the United States, clinical investigations with newly developed drugs in the four countries are based on contracts between individual investigators and the pharmaceutical industry without governmental interference. There are no adequate facilities to develop new psychoactive preparation in the four Latin American countries. Nevertheless, psychopharmacological practices are essentially the same as in the United States or Canada and all important psychoactive preparations used in the United States are available in the Latin Americas. Some of the newer-thioxanthene, butyrophenone and diphenylbutylpiperidine preparations which are still under clinical investigation in the United States are already available for clinical use in Argentina, Costa Rica, Mexico and Panama. While there is less governmental control than in the United States or Canada, with regard to clinical investigations of drugs or with regard to marketing newly developed preparations, there is no evidence of abuse. Finally, it should be noted that the introduction of psychotropic drugs brought about a new era in psychiatry in the Latin Americas. It becomes increasingly obvious that psychiatry today is practiced on the basis of knowledge derived from clinical impressions and on the basis of findings verified in clinical testings, i.e. on the basis of two different standards. Accordingly, as in Europe and North America, a re-examination of traditional concepts has begun in the Latin Americas. There are indications that biological psychiatry in general, and psychopharmacology in particular, are gaining increasing importance in the Latin Americas. This has led to the creation of a training program in biological psychiatry by the World Health Organization in Montreal, in cooperation with the Division of Psychopharmacology of the Department of Psychiatry at McGill University.