Increased ROM and high patient satisfaction after open arthrolysis: a follow-up-study of 43 patients with posttraumatic stiff elbows.

BACKGROUND: Posttraumatic stiffness of the elbow is a common finding after elbow trauma. Restoration of motion in the posttraumatic stiff elbow is difficult, time consuming, and requires high patient compliance. We have evaluated the long-term effect of an open elbow arthrolysis in the posttraumatic stiff elbow. METHODS: We evaluated 43 patients (14 women, 29 men) with a median age of 47(16-78) years operated with open arthrolysis for a posttraumatic stiff elbow. The median follow-up time was 41(12-204) months. The patients were hospitalized median 12(4-14) days, with daily physiotherapy and NSAID. 36 patients tolerated continuous passive motion (CPM) for 11(0-42) days. 35 patients had a well-functioning brachial plexus anesthesia for median 7(1-18) days. We used the paired 2-tailed T-test in our statistical analysis. RESULTS: Preoperatively the patients had a median flexion of 110(30-160)°, extension 40(10-90)°, and the total flexion-extension sector (F/E) was 50(0-110)°. At follow-up the patients had a median flexion of 132(75-151)° and extension of 23(8-84)°, which indicate a median gain of 42(-50-114)°. The subjective functional scores (Mayo Elbow Score, EQ5D, Q-Dash, and VAS for pain) were satisfying, and most of the patients (81 %) would have done the operation once again knowing the outcome. We had 5 temporary ulnar neuropraxias, one became permanent and in addition ankylotic, one temporary radial neuropraxia, two superficial wound infections, and one transient hematoma. CONCLUSION: Open arthrolysis of the posttraumatic stiff elbow is associated with reliable clinical and functional long-term outcomes.

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)

Changes in diffusion tensor tractographic findings associated with constraint-induced movement therapy in young children with cerebral palsy.

OBJECTIVE: The objective of the study was to determine whether constraint-induced movement therapy (CIMT) could lead to changes in diffusion tensor tractography (DTT) associated with clinical improvement in young children with unilateral cerebral palsy (CP). METHODS: A standardized pediatric CIMT protocol (4weeks, 120h of constraint) was used on 10 children with unilateral CP who were younger than 5years. DTT was performed in five participants before and after the intervention. Clinical outcome was measured by using the Pediatric Motor Activity Log (PMAL), Quality of Upper Extremity Skills Test (QUEST), and self-care domain of the Pediatric Evaluation of Disability Inventory. RESULTS: In two patients, the affected corticospinal tract (CST) visible on pretreatment DTT became more prominent on posttreatment DTT. In one patient, the affected CST was not visible on pretreatment DTT, but was visible on posttreatment DTT. All the clinical outcomes significantly improved in the CIMT group compared with the control group. Changes in the PMAL how often scale (PMAL-HO) score significantly differed between the CIMT and control groups. CONCLUSIONS: Changes in the properties of the affected CST on DTT were accompanied with improved arm function after CIMT in the children with CP. SIGNIFICANCE: CIMT might lead to CST reorganization in young children with CP.

Technologies and combination therapies for enhancing movement training for people with a disability.

There has been a dramatic increase over the last decade in research on technologies for enhancing movement training and exercise for people with a disability. This paper reviews some of the recent developments in this area, using examples from a National Science Foundation initiated study of mobility research projects in Europe to illustrate important themes and key directions for future research. This paper also reviews several recent studies aimed at combining movement training with plasticity or regeneration therapies, again drawing in part from European research examples. Such combination therapies will likely involve complex interactions with motor training that must be understood in order to achieve the goal of eliminating severe motor impairment.

Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty.

BACKGROUND: Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. Although research suggests that Continuous Passive Motion (CPM) should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered. METHODS: In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM) and functional recovery, measured at the end of the active treatment period, 17 days after surgery. Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days), followed by PT alone (usual care) in the first two weeks after hospital discharge. From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation) and regaining RoM in the knee. RESULTS: Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments. CONCLUSION: Although results indicate that prolonged CPM use might have a small short-term effect on RoM, routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered, since neither long-term effects nor transfer to better functional performance was detected. TRIAL REGISTRATION: ISRCTN85759656.

Robot-aided neurorehabilitation: a robot for wrist rehabilitation.

In 1991, a novel robot, MIT-MANUS, was introduced to study the potential that robots might assist in and quantify the neuro-rehabilitation of motor function. MIT-MANUS proved an excellent tool for shoulder and elbow rehabilitation in stroke patients, showing in clinical trials a reduction of impairment in movements confined to the exercised joints. This successful proof of principle as to additional targeted and intensive movement treatment prompted a test of robot training examining other limb segments. This paper focuses on a robot for wrist rehabilitation designed to provide three rotational degrees-of-freedom. The first clinical trial of the device will enroll 200 stroke survivors. Ultimately 160 stroke survivors will train with both the proximal shoulder and elbow MIT-MANUS robot, as well as with the novel distal wrist robot, in addition to 40 stroke survivor controls. So far 52 stroke patients have completed the robot training (ongoing protocol). Here, we report on the initial results on 36 of these volunteers. These results demonstrate that further improvement should be expected by adding additional training to other limb segments.

A paradigm shift in neurorehabilitation.

The practice of neurorehabilitation in the clinic has undergone a paradigm shift as a result of influences from basic and clinical research. I have identified six areas of knowledge that by advancing so rapidly have brought about this paradigm shift: first, the increased understanding of how the CNS is reorganised after training or injury; second, the knowledge of how declarative and procedural memory operates and how this can influence rehabilitation therapy; third, a greater appreciation of the chemical factors that promote learning and neural remodelling; fourth, the fact that computational neuroscience can teach us how complex behaviour can emerge from the interaction of thousands of neurons; fifth, the influence of evidence-based medicine on neurorehabilitation; and sixth, the importance of reliable outcome measures for both injury and treatment. These are young scientific disciplines that offer great opportunities for further research. The complexity of neurorehabilitation will also require greater attention to a substantially neglected problem, the incorporation of techniques that have been proven effective in clinical trials into routine and effective clinical practice.