Physical Therapist Management of Total Knee Arthroplasty.

A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.

Recuperación de la artroplastia de rodilla a través de la movilización pasiva continua / Recovery from total knee arthroplasty through continuous passive motion

El propósito de este estudio es conocer los efectos de la movilización pasiva continua en pacientes intervenidos de artroplastia total de rodilla. Se desarrolló una estrategia de búsqueda en las bases de datos CSIC, PubMed, Cochrane Library Plus, Dialnet y PEDro con el fin de captar todos aquellos ensayos clínicos, en inglés y español, indexados de enero del 2000 a noviembre del 2014. Se identificaron 537 publicaciones, pero se incluyeron 12 estudios en esta revisión. La valoración de 1.153 pacientes demuestra que no existe una diferencia significativa en la mejora de la amplitud articular, dolor, equilibrio, marcha, cicatrización y estancia hospitalaria utilizando la movilización pasiva continua frente al tratamiento de fisioterapia habitual para la artroplastia total de rodilla. La aplicación de la movilización pasiva continua, a largo plazo, no aporta ningún beneficio en cuanto a la amplitud del rango articular, dolor y mejora de bipedestación y marcha en comparación con el tratamiento convencional de fisioterapia postoperatorio en la artroplastia total de rodilla. A corto plazo se consigue una mejora del rango de movilidad articular a la flexión de la rodilla (AU)

The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion (AU)

Robotics and other devices in the treatment of patients recovering from stroke.

Stroke is the leading cause of permanent disability in the United States despite advances in prevention and novel interventional treatments. Randomized controlled studies have demonstrated the effectiveness of specialized post-stroke rehabilitation units, but administrative orders have severely limited the length of stay, so novel approaches to the treatment of recovery need to be tested in outpatients. Although the mechanisms of stroke recovery depend on multiple factors, a number of techniques that concentrate on enhanced exercise of the paralyzed limb have demonstrated effectiveness in reducing the motor impairment. For example, interactive robotic devices are new tools for therapists to deliver enhanced sensorimotor training for the paralyzed upper limb, which can potentially improve patient outcome and increase their productivity. New data support the idea that for some post-stroke patients and for some aspects of training-induced recovery, timing of the training may be less important than the quality and intensity of the training. The positive outcome that resulted in the interactive robotic trials contrasts with the failure to find a beneficial result in trials that used a noninteractive device that delivered continuous passive motion only. New pilot data from novel devices to move the wrist demonstrate benefit and suggest that successive improvement of the function of the arm progressing to the distal muscles may eventually lead to significant disability reduction. These data from robotic trials continue to contribute to the emerging scientific basis of neuro-rehabilitation.

[Cartilage: from biomechanics to physical therapy]. / Le cartilage : de la mécanobiologie au traitement physique.

OBJECTIVES: To review the current knowledge about the relationship between physical activities, cartilage biology, osteoarthritis and rehabilitation. METHOD: PubMed, Ovid, Cochrane Data base were interrogated for the period 1966-2000. Key words were: chondrocyte, cartilage, osteoarthritis, mechanical stimulation, exercises, physical therapy, rehabilitation. Were reviewed: the mechanical biology of the chondrocytes and the cartilage, the mechanisms of transduction, the metabolic response of the chondrocytes to mechanical stresses; the effects of physical activity and immobilization on the cartilage in animal models, the main studies on the epidemiology of limbs osteoarthritis and clinical trials on rehabilitation. RESULTS: In vitro studies have demonstrated that some molecules are involved in the transduction of mechanical stress into intracellular biological event. Chondrocytes and cartilage are sensitive to mechanical stress and cartilage extracellular matrix synthesis and degradation can be modulated by mechanical events. Applications of cyclic loads usually lead to an enhanced matrix synthesis while static loads usually decrease matrix production. In animal models, intensive physical activity or immobilization lead to cartilage alteration mimicking osteoarthritis. In human, intensive and prolonged physical activities are probably associated with hip and knee osteoarthritis. However, there is evidence that exercise therapy and continuous passive motion have beneficial effects on patients with knee or hip osteoarthritis. Fundamental and clinical studies are still needed to determine if exercise programs could have an effect on chondromodulation. Continuous passive motion could help, in the future, to better understand the relationship between mechanical stimulation and cartilage homeostasis. CONCLUSION: Rehabilitation could be beneficial in the therapeutic management of limbs osteoarthritis. The protocols of rehabilitation should however be more evaluated in controlled trials.

Continuous oscillation therapy for the treatment of pulmonary contusion.

Pulmonary contusion as a result of blunt trauma carries significant morbidity and mortality. In an attempt to improve therapy, a prospective study was performed in which 30 patients were randomized to either receive or not receive continuous oscillation therapy on the Kinetic Treatment Table. Pulmonary contusion was defined by mechanism of injury (blunt trauma secondary to a motor vehicle accident), hypoxemia, and radiographic confirmation. Patients who received continuous oscillation therapy had a significantly higher injury severity score (more severely injured group of patients), yet had a hospital course similar to those patients who did not receive continuous oscillation therapy and had a significantly lower injury severity score.

[A case of cutaneous disorders of the lower limbs due to lymphostasis in a patient with multiple sclerosis. Use of a dynamic phlebologic footboard]. / Un cas de troubles cutanés aux membres inférieurs, conséquence d'une grave hémolymphostase chez un patient avec une sclérose à plaques multiples. Utilisation d'un marchepied hémo-phlébo-dynamique.

Tessari hemo-phlebo-dynamic steps are a passive physiotherapy device which cause the "ankle pump" to work, thereby contributing to venous return in the lower limbs. These steps can be used in phlebology in disorders due to stasis affecting the lower limbs, in orthopedics in functional rehabilitation as preventive treatment in the case of sedentary activities.

The influence of functional electrical stimulation on the properties of vastus lateralis fibres following total knee arthroplasty.

The influence of functional electrical muscle stimulation (FES) on selected properties of vastus lateralis muscle fibres was studied in patients recovering from total knee arthroplasty for osteoarthritis. Prior to surgery, on the average, muscle biopsies from the vastus lateralis could be characterized as having a predominance of Type I fibres which were significantly larger in cross-sectional area than the Type II fibres in the same sample. Following surgery, muscle biopsies from a group of patients (n = 7) which received continuous passive motion and no FES, exhibited a marked increase in the proportion of Type II fibres along with a general atrophy of both the Type I and Type II fibres. Patients receiving passive motion and FES (n = 9) also showed an increase in the relative percentage of Type II fibres. Post-operatively, however, there was no significant reduction in fibre area in the stimulated muscles. These data suggest that FES was effective in attenuating the muscle atrophy associated with total knee arthroplasty but had no influence on those metabolic properties which were related to muscle fibre type classification criteria.

Use of continuous passive motion in pediatric orthopedics.

Continuous passive motion (CPM) was used to maintain or gain hip and knee range of motion in 18 postoperative or postinjury pediatric orthopedic patients. Continuous passive motion was started in the early postoperative period and augmented with physical therapy. The device was well-tolerated in 16 of the 18 patients. In all but one, motion was improved with a progressive decrease in joint pain. In these patients, CPM was found to be a valuable tool in rehabilitation, and did not interfere with traction, open wounds, nursing care, nor external fixation devices.