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1.
Vet Clin North Am Exot Anim Pract ; 26(1): 281-308, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36402487

RESUMO

Animal physical rehabilitation is one of the fast-growing fields in veterinary medicine in recent years. It has become increasingly common in small animal practice and will continue to emerge as an essential aspect of veterinary medicine that plays a vital role in the care of animals with physical impairments or disabilities from surgery, injuries, or diseases.1 This is true now more than ever because of the increasing advances in lifesaving treatments, the increased lifespan of companion animals, and the growth of chronic conditions, of which many are associated with movement disorders. The American Association of Rehabilitation Veterinarians (AARV) defines APR as "the diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurologic and musculoskeletal systems." Rehabilitation not only focuses on recovery after surgical procedures but also on improving the function and quality of life in animals suffering from debilitating diseases such as arthritis or neurologic disorders. The overall goal of APR is to decrease pain, reduce edema, promote tissue healing, restore gait and mobility to its prior activity level, regain strength, prevent further injury, and promote optimal quality of life. Typically, a multimodal approach with pharmaceutical and nonpharmaceutical interventions is used by APR therapists to manage patients during their recovery. The purpose of this article aims to provide knowledge and guidance on physical rehabilitation to help veterinarians in the proper return of their patients with ZCA safely after injury and/or surgery.


Assuntos
Doenças dos Animais , Animais de Estimação , Medicina Veterinária , Animais , Humanos , Dor/reabilitação , Dor/veterinária , Qualidade de Vida , Animais de Zoológico , Reabilitação , Doenças dos Animais/terapia , Medicina Veterinária/métodos , Medicina Veterinária/tendências
2.
Sensors (Basel) ; 22(21)2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36366088

RESUMO

The aim of this study was to objectively assess and compare gait capacity and gait performance in rehabilitation inpatients with stroke or incomplete spinal cord injury (iSCI) using inertial measurement units (IMUs). We investigated how gait capacity (what someone can do) is related to gait performance (what someone does). Twenty-two inpatients (11 strokes, 11 iSCI) wore ankle positioned IMUs during the daytime to assess gait. Participants completed two circuits to assess gait capacity. These were videotaped to certify the validity of the IMU algorithm. Regression analyses were used to investigate if gait capacity was associated with gait performance (i.e., walking activity and spontaneous gait characteristics beyond therapy time). The ankle positioned IMUs validly assessed the number of steps, walking time, gait speed, and stride length (r ≥ 0.81). The walking activity was strongly (r ≥ 0.76) related to capacity-based gait speed. Maximum spontaneous gait speed and stride length were similar to gait capacity. However, the average spontaneous gait speed was half the capacity-based gait speed. Gait capacity can validly be assessed using IMUs and is strongly related to gait performance in rehabilitation inpatients with neurological disorders. Measuring gait performance with IMUs provides valuable additional information about walking activity and spontaneous gait characteristics to inform about functional recovery.


Assuntos
Pacientes Internados , Traumatismos da Medula Espinal , Humanos , Marcha , Caminhada , Traumatismos da Medula Espinal/reabilitação , Tecnologia
3.
Sensors (Basel) ; 22(21)2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36366149

RESUMO

We propose a framework for optimizing personalized treatment outcomes for patients with neurological diseases. A typical consequence of such diseases is gait disorders, partially explained by command and muscle tone problems associated with spasticity. Intramuscular injection of botulinum toxin type A is a common treatment for spasticity. According to the patient's profile, offering the optimal treatment combined with the highest possible benefit-risk ratio is important. For the prediction of knee and ankle kinematics after botulinum toxin type A (BTX-A) treatment, we propose: (1) a regression strategy based on a multi-task architecture composed of LSTM models; (2) to introduce medical treatment data (MTD) for context modeling; and (3) a gating mechanism to model treatment interaction more efficiently. The proposed models were compared with and without metadata describing treatments and with serial models. Multi-task learning (MTL) achieved the lowest root-mean-squared error (RMSE) (5.60°) for traumatic brain injury (TBI) patients on knee trajectories and the lowest RMSE (3.77°) for cerebral palsy (CP) patients on ankle trajectories, with only a difference of 5.60° between actual and predicted. Overall, the best RMSE ranged from 5.24° to 6.24° for the MTL models. To the best of our knowledge, this is the first time that MTL has been used for post-treatment gait trajectory prediction. The MTL models outperformed the serial models, particularly when introducing treatment metadata. The gating mechanism is efficient in modeling treatment interaction and improving trajectory prediction.


Assuntos
Toxinas Botulínicas Tipo A , Paralisia Cerebral , Fármacos Neuromusculares , Humanos , Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Espasticidade Muscular , Marcha , Paralisia Cerebral/reabilitação , Resultado do Tratamento
4.
Sensors (Basel) ; 22(21)2022 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-36366250

RESUMO

Neurorehabilitation research in patients with traumatic brain injury (TBI) showed how vestibular rehabilitation (VR) treatments positively affect concussion-related symptoms, but no studies have been carried out in patients with severe TBI (sTBI) during post-acute intensive neurorehabilitation. We aimed at testing this effect by combining sensor-based gait analysis and clinical scales assessment. We hypothesized that integrating VR in post-acute neurorehabilitation training might improve gait quality and activity of daily living (ADL) in sTBI patients. A two-arm, single-blind randomized controlled trial with 8 weeks of follow-up was performed including thirty sTBI inpatients that underwent an 8-week rehabilitation program including either a VR or a conventional program. Gait quality parameters were obtained using body-mounted magneto-inertial sensors during instrumented linear and curvilinear walking tests. A 4X2 mixed model ANOVA was used to investigate session-group interactions and main effects. Patients undergoing VR exhibited improvements in ADL, showing early improvements in clinical scores. Sensor-based assessment of curvilinear pathways highlighted significant VR-related improvements in gait smoothness over time (p < 0.05), whereas both treatments exhibited distinct improvements in gait quality. Integrating VR in conventional neurorehabilitation is a suitable strategy to improve gait smoothness and ADL in sTBI patients. Instrumented protocols are further promoted as an additional measure to quantify the efficacy of neurorehabilitation treatments.


Assuntos
Atividades Cotidianas , Lesões Encefálicas Traumáticas , Humanos , Método Simples-Cego , Resultado do Tratamento , Marcha , Lesões Encefálicas Traumáticas/reabilitação
5.
J Med Syst ; 46(12): 94, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36367614

RESUMO

In this brief communication, we reported Telehealth Home-Based Cardiac Rehabilitation (CR) program structure and preliminary outcomes from patients that completed a 12-week program after coronary artery bypass graft surgery (CABG). We aim to advocate the use of Telerehabilitation as a Phase II CR in patients immediately after the CABG. This approach was innovative and encouraging because the patients were still in subacute phase. The program can serve as a continuation of care for the patients after being discharged from a hospital while regaining their functional ability at home. Our preliminary outcomes demonstrated improvements in resting heart rate, activity level, nutrition status, self-efficacy for managing cardiac diseases, muscle strength, endurance and depression. There were no adverse events during the virtual sessions. Patient satisfaction score was high.


Assuntos
Reabilitação Cardíaca , Telerreabilitação , Humanos , Ponte de Artéria Coronária/reabilitação , Atividades Cotidianas , Força Muscular
6.
BMC Infect Dis ; 22(1): 837, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368939

RESUMO

INTRODUCTION: Mortality is elevated after prison release and may be higher in people with HIV and opioid use disorder (OUD). Maintenance with opioid agonist therapy (OAT) like methadone or buprenorphine reduces mortality in people with OUD and may confer benefits to people with OUD and HIV leaving prison. Survival benefits of OAT, however, have not been evaluated prospectively in people with OUD and HIV leaving prison. METHODS: This study prospectively evaluated mortality after prison release and whether methadone initiated before release increased survival after release in a sample of men with HIV and OUD (n = 291). We linked national death records to data from a controlled trial of prerelease methadone initiation conducted from 2010 to 2014 with men with HIV and OUD imprisoned in Malaysia. Vital statistics were collected through 2015. Allocation to prerelease methadone was by randomization (n = 64) and participant choice (n = 246). Cox proportional hazards models were used to estimate treatment effects of prerelease methadone on postrelease survival. RESULTS: Overall, 62 deaths occurred over 872.5 person-years (PY) of postrelease follow-up, a crude mortality rate of 71.1 deaths per 1000 PY (95% confidence interval [CI] 54.5-89.4). Most deaths were of infectious etiology, mostly related to HIV. In a modified intention-to-treat analysis, the impact of prerelease methadone on postrelease mortality was consistent with a null effect in unadjusted (hazard ratio [HR] 1.3, 95% CI 0.6-3.1) and covariate-adjusted (HR 1.2, 95% CI 0.5-2.8) models. Predictors of mortality were educational level (HR 1.4, 95% CI 1.0-1.8), pre-incarceration alcohol use (HR 2.0, 95% CI 1.1-3.9), and lower CD4+ T-lymphocyte count (HR 0.8 per 100-cell/mL increase, 95% CI 0.7-1.0). CONCLUSIONS: Postrelease mortality in this sample of men with HIV and OUD was extraordinarily high, and most deaths were likely of infectious etiology. No effect of prerelease methadone on postrelease mortality was observed, which may be due to study limitations or an epidemiological context in which inadequately treated HIV, and not inadequately treated OUD, is the main cause of death after prison release. TRIAL REGISTRATION: NCT02396979. Retrospectively registered 24/03/2015.


Assuntos
Infecções por HIV , Transtornos Relacionados ao Uso de Opioides , Prisioneiros , Masculino , Humanos , Metadona/uso terapêutico , Prisões , Tratamento de Substituição de Opiáceos/métodos , Malásia/epidemiologia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Infecções por HIV/tratamento farmacológico , Analgésicos Opioides/uso terapêutico
7.
Cochrane Database Syst Rev ; 11: CD007039, 2022 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36326118

RESUMO

BACKGROUND: Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non-invasive brain stimulation, pharmacological and surgical approaches. OBJECTIVES: To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living.  SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. DATA COLLECTION AND ANALYSIS: One review author assessed titles, with two review authors independently screening abstracts and full-text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB-1 tool, and quality of evidence using GRADE.  A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. MAIN RESULTS: We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch-somatosensory disorders. None addressed stroke-related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non-invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL):  Somatosensory disorders: one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure.  Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention.  Visual perception disorders: no trials measuring ADL compared an intervention with no treatment or control.  In addition, six trials reported ADL outcomes in a comparison of active intervention versus active intervention, relating to somatosensation (three trials), touch (one trial) and vision (two trials).   AUTHORS' CONCLUSIONS: Following a detailed, systematic search, we identified limited RCT evidence of the effectiveness of interventions for perceptual disorders following stroke. There is insufficient evidence to support or refute the suggestion that perceptual interventions are effective. More high-quality trials of interventions for perceptual disorders in stroke are needed. They should recruit sufficient participant numbers, include a 'usual care' comparison, and measure longer-term functional outcomes, at time points beyond the initial intervention period. People with impaired perception following a stroke should continue to receive neurorehabilitation according to clinical guidelines.


Assuntos
Transtornos da Percepção , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Humanos , Atividades Cotidianas , Transtornos da Percepção/etiologia , Transtornos da Percepção/reabilitação , Acidente Vascular Cerebral/complicações , Transtornos da Visão/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Medicine (Baltimore) ; 101(46): e31906, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401420

RESUMO

BACKGROUND: To systematically evaluate the general efficacy of nape acupuncture combined with rehabilitation training for the treatment of post-stroke dysphagia and in the recovery of swallowing function. METHODS: Three English databases (PubMed, Excerpta Medica Database, Cochrane Library) and three Chinese databases (China National Knowledge Infrastructure, Wanfang Data, CQVIP) were searched using the date range January 1, 2001-January 1, 2022. Study Selection: Randomized controlled trials (RCT) of nape acupuncture combined with rehabilitation for the treatment of dysphagia after stroke with appropriate evaluation methods were included in the study. RESULTS: The results indicated that nape acupuncture combined with rehabilitation training led to higher clinical effectiveness (odds ratio (OR) =4.25 and 95% confidence interval (CI)=[2.94, 6.15]), higher videofluoroscopic swallowing study scores(VFSS) (weighted mean difference (WMD)=1.33; 95% CI=[1.09, 1.58]), and lower Standardized Swallowing Assessment (SSA) scores (WMD = -2.57, 95% CI=[-3.51, -1.62]) in patients with post-stroke dysphagia compared with rehabilitation training alone. CONCLUSIONS: This Meta-analysis suggested that nape acupuncture combined with rehabilitation training is more effective in the treatment of dysphagia after stroke than rehabilitation alone.


Assuntos
Terapia por Acupuntura , Acupuntura , Transtornos de Deglutição , Acidente Vascular Cerebral , Humanos , Transtornos de Deglutição/terapia , Transtornos de Deglutição/reabilitação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Deglutição
9.
G Ital Med Lav Ergon ; 44(1): 59-76, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36346300

RESUMO

SUMMARY: Rehabilitation based on Exergame is showing a rapid evolution, with interesting applications for the recovery of mobility, balance, postural control, coordination and fine motor skills, and including home-based training. At present, there are no precise indications for Exergamebased rehabilitation of people over 55 affected by stroke, Parkinson's disease, or multiple sclerosis. This review examines the proposed modalities and the effectiveness of Exergame-based rehabilitation interventions for adults over 55 with stroke, Parkinson's disease or multiple sclerosis, highlighting the limitations, advantages, controversies and impact of this approach. We examined randomized controlled trials published between 2016-2020, with search in the databases of PubMed, Scopus, Cochrane Library, RehabData, selecting 24 studies. The study of patients with chronic or subacute stroke in outpatient treatment, and with small sample sizes, prevails. Wide variability characterizes the rehabilitation methods, the technological platforms used, the type and dose of exercise administered, the outcome measures. The adequacy and efficacy of Exergames remains uncertain in the neurological elderly, and the functional improvement in the neurological adult patient is not yet attested using this type of approach.


Assuntos
Esclerose Múltipla , Doenças do Sistema Nervoso , Doença de Parkinson , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Humanos , Idoso , Doença de Parkinson/reabilitação , Jogos Eletrônicos de Movimento , Modalidades de Fisioterapia , Equilíbrio Postural , Doenças do Sistema Nervoso/reabilitação , Acidente Vascular Cerebral/terapia
10.
Trials ; 23(1): 929, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348372

RESUMO

BACKGROUND: Total hip arthroplasty (THA) is very effective in alleviating pain, but functional deficits persist up to a year following surgery. Regardless of standard physiotherapy programs, significant additional muscular atrophy and weakness occur. Deficits in strength have serious adverse consequences for these patients with respect to physical function, the maintenance of independence, and the requirement for revision surgery. Progressive resistance training in rehabilitation following THA has been shown to significantly enhance muscle strength and function. The fundamental principle is to progressively overload the exercised muscle as it becomes stronger. Different strength training protocols have been used at different times in the postoperative phase, in group or individual practices, with major differences being in center-based and home-based programs with or without supervision. The primary objective of our study is to evaluate whether an early postoperative home-based strength training protocol can improve patient functional outcomes at 3 months and 1 year following surgery. Secondary objectives are the feasibility of the presented protocol for all elective THA patients and its safety. METHODS/DESIGN: This study is a prospective multicenter randomized clinical trial to be conducted in the orthopedic departments of two Slovenian hospitals. In each hospital, 124 patients aged 60 or older with unilateral osteoarthritis, an ASA score between 1 and 3, a signed informed consent form, and no terminal illness disabling rehabilitation participation will be randomly assigned to the intervention or control group. THA with an anterior approach will be performed. All patients will receive current standard physiotherapy during hospitalization. Patients in the intervention group will also learn strength and sensory-motor training exercises. Upon discharge, all will receive USB drives with exercise videos, written exercise instructions, and a training diary. Physiotherapists will perform the assessments (physical tests and the maximal voluntary isometric contraction assessment), and patients will fill out outcome assessment questionnaires (the Harris Hip Score and 36-Item Short Form Health Survey) at baseline and 1, 3, and 12 months after surgery. DISCUSSION: The main purpose of our study is to design a new standardized rehabilitation protocol with videos that will be effective, safe, and accessible to all Slovenian THA patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061993 . Registered on 07 November 2019. Protocol ID: PRT_PhD. Version 1.


Assuntos
Artroplastia de Quadril , Treinamento de Força , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/reabilitação , Estudos Prospectivos , Resultado do Tratamento , Força Muscular , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
11.
Bull World Health Organ ; 100(11): 717-725, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36324557

RESUMO

Considerable progress has been made in saving the lives of children younger than 5 years. Nevertheless, these advances have failed to help all children thrive, particularly children with disabilities. We describe the increasing prevalence of disability among children and adolescents. We evaluate the current situation regarding children with disabilities and rehabilitation in the context of health systems, particularly those in low- and middle-income countries. Within the newborn health agenda, congenital anomalies often require early intervention and rehabilitation. We provide Argentina as an example of a country where rehabilitation for congenital anomalies is integrated into the health system. We argue that congenital anomalies that require rehabilitation have the potential to strengthen rehabilitation systems and policies by: strengthening coordination between primary care and rehabilitation; identifying and understanding pathways that allow families to engage with services; providing human resources for rehabilitation; and building systems and resources that support assistive technology and rehabilitation. We propose ways for countries to prioritize and integrate early identification, referral and care for children with congenital anomalies to strengthen health systems for all. We identify opportunities to expand policy and planning and to design service delivery and workforce strategies through World Health Organization guidelines and frameworks for rehabilitation. We argue that the global health community must act to ensure that rehabilitation services to support functioning from birth are well established, accepted and integrated within health systems, and that disability is prioritized within child health. These steps would strengthen health systems, ensure functioning from birth and make rehabilitation accessible to all.


Des progrès considérables ont été réalisés pour sauver la vie des enfants de moins de cinq ans. Pourtant, ces avancées n'ont pas permis à tous les enfants de s'épanouir, en particulier lorsqu'ils présentent un handicap. Dans ce document, nous faisons état de la prévalence croissante du handicap chez les enfants et adolescents. Nous évaluons la situation actuelle des enfants porteurs de handicap ainsi que leur réadaptation au sein des systèmes de santé, surtout dans les pays à revenu faible et intermédiaire. Dans le cadre du programme de santé néonatale, les anomalies congénitales nécessitent souvent des interventions et une réadaptation rapides. Nous utilisons l'exemple de l'Argentine, un pays où la réadaptation fait partie intégrante du système de santé en cas d'anomalie congénitale. Nous estimons que les anomalies congénitales impliquant une réadaptation sont susceptibles de renforcer les systèmes et mesures en la matière grâce à: l'amélioration de la coordination entre les soins primaires et la réadaptation; l'identification et la compréhension des parcours qui permettent aux familles d'entrer en contact avec de tels services; la mise à disposition de ressources humaines compétentes dans ce domaine; et enfin, grâce au développement des mécanismes et ressources qui soutiennent les technologies d'assistance et la réadaptation. Nous proposons aux pays des pistes favorisant un diagnostic précoce, un transfert et une prise en charge des enfants souffrant d'anomalies congénitales, afin de consolider le système de santé et d'en faire bénéficier l'ensemble de la population. En outre, nous recensons les moyens d'étoffer les politiques et programmes, mais aussi d'élaborer des stratégies de prestation de services et de gestion des effectifs conformes aux lignes directrices et cadres relatifs à la réadaptation formulés par l'Organisation mondiale de la Santé. Selon nous, la communauté sanitaire internationale doit agir pour faire en sorte que les services de réadaptation soient pris en compte, acceptés et intégrés dans les systèmes de santé afin de contribuer au bon fonctionnement dès la naissance, et que le handicap figure parmi les priorités en ce qui concerne la santé infantile. De telles actions renforceraient les systèmes de soins de santé, assureraient un développement optimal dès la venue au monde et rendraient la réadaptation accessible à toutes et tous.


Se han hecho progresos considerables para salvar la vida de los niños menores de 5 años. Sin embargo, estos avances no han permitido que todos los niños prosperen, en particular los niños con discapacidades. En este artículo, se describe la creciente prevalencia de la discapacidad entre los niños y adolescentes. Se evalúa la situación actual de los niños con discapacidad y la rehabilitación en el contexto de los sistemas sanitarios, en particular los de los países de ingresos bajos y medios. Dentro de los programas de salud neonatal, las anomalías congénitas suelen requerir una intervención y rehabilitación tempranas. Se menciona a Argentina como ejemplo de un país en donde la rehabilitación de las anomalías congénitas está integrada en el sistema sanitario. Se argumenta que las anomalías congénitas que requieren rehabilitación tienen el potencial de fortalecer los sistemas y las políticas de rehabilitación mediante: el fortalecimiento de la coordinación entre la atención primaria y la rehabilitación; la identificación y la comprensión de las vías que permiten a las familias participar en los servicios; la provisión de recursos humanos para la rehabilitación; y la creación de sistemas y recursos que apoyen la tecnología de asistencia y la rehabilitación. Asimismo, se proponen mecanismos para que los países den prioridad e integren la identificación, derivación y atención tempranas de los niños con anomalías congénitas, con el fin de fortalecer los sistemas sanitarios para todos. Se identifican las oportunidades para ampliar la política y la planificación y para diseñar estrategias de prestación de servicios y de personal a través de las directrices y los marcos de la Organización Mundial de la Salud para la rehabilitación. Se sostiene que la comunidad sanitaria mundial debe actuar para asegurar que los servicios de rehabilitación para apoyar el funcionamiento desde el nacimiento estén bien establecidos, aceptados e integrados dentro de los sistemas sanitarios, y que se dé prioridad a la discapacidad dentro de la salud infantil. Estas medidas reforzarían los sistemas sanitarios, asegurarían el funcionamiento desde el nacimiento y harían que la rehabilitación fuera accesible para todos.


Assuntos
Pessoas com Deficiência , Tecnologia Assistiva , Criança , Adolescente , Recém-Nascido , Humanos , Pessoas com Deficiência/reabilitação , Saúde Global , Recursos Humanos , Programas Governamentais
12.
Artigo em Inglês | MEDLINE | ID: mdl-36360749

RESUMO

For the occupational adaptation and social integration of the intellectually disabled, it is helpful to improve their work performance and interpersonal skills. The purpose of the study was to evaluate the effectiveness of horticultural therapy (HT) programs to improve work performance and interpersonal relationships of persons with intellectual disabilities. Based on observations and analyses of how people with intellectual disabilities work, we have developed a 12-session HT program that includes upper limb movements and physical activities to improve hand function. We recruited, with the consent of their legal guardians, 14 (6 males, 8 females) participants who had intellectual disabilities and were working at a sheltered workshop in K-gu, Seoul, South Korea. The program consisted of twelve sixty-minute sessions that were conducted twice a week at a rooftop garden. For pre- and post-evaluation of the program, the survey of functional adaptive behavior (SFAB), interpersonal negotiation strategies, a horticultural job evaluation (self), hand function tests (pegboard, pinch gauge, fingertips), and blood sample tests for physiological indicators of exercise were conducted. Interpersonal negotiation strategies, functional adaptive behaviors, and physical abilities for job behaviors, including agility and grasping of the hand, improved significantly from before to after the program (p < 0.05). A positive result of VEGF (vascular endothermic growth factor) in blood sample tests implies the need for further research on cognitive changes caused by horticultural activities. This study has limitations due to the small number of participants, but the results suggest that low- to medium-intensity horticultural treatment programs using the upper body and hands could be effective for vocational rehabilitation of the intellectually disabled.


Assuntos
Pessoas com Deficiência , Horticultura Terapêutica , Deficiência Intelectual , Desempenho Profissional , Masculino , Feminino , Humanos , Deficiência Intelectual/reabilitação , Reabilitação Vocacional , Pessoas com Deficiência/reabilitação
13.
Dan Med J ; 69(11)2022 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-36331152

RESUMO

INTRODUCTION: The prevalence of cachexia in patients with chronic obstructive pulmonary disease (COPD) is high and associated with reduced quality of life, increased mortality and morbidity. We aimed to test the effect of a high protein diet combined with exercise on fat-free mass (FFM), functional capacity, symptom burden and dyspnoea. METHODS: Outpatients with COPD and severe or very severe (GOLD grade III-IV) disease and malnutrition commencing pulmonary rehabilitation were randomised to a high-protein diet or standard care. FFM was measured by bio-impedance analysis (BIA), mid-upper arm circumference (MUAC) and mid-thigh circumference (MTC), peripheral muscle function by six-minute walking distance (6MWD) and handgrip strength (HGS), symptoms by the COPD Assessment Trial (CAT) and dyspnoea by the Medical Research Council dyspnoea scale and Borg scores; all at baseline and after 12 weeks. RESULTS: Ten out of 13 randomised patients completed the trial. The intervention group was superior to the control group with respect to 6MWD (97 ± 93 m, p = 0.04) at 12 weeks. No differences were observed between the groups in HGS, anthropometrics, symptom burden or dyspnoea. CONCLUSION: In patients with COPD attending rehabilitation, a high protein diet combined with physical exercise had a clinically relevant effect on walking distance. FUNDING: none. TRIAL REGISTRATION: NCT04888182.


Assuntos
Dieta Rica em Proteínas , Doença Pulmonar Obstrutiva Crônica , Humanos , Dispneia/complicações , Dispneia/reabilitação , Tolerância ao Exercício , Força da Mão , Doença Pulmonar Obstrutiva Crônica/complicações , Qualidade de Vida
14.
Artigo em Inglês | MEDLINE | ID: mdl-36361414

RESUMO

The purpose of this work is to study the gap between the research evidence and the clinical practice in the physical rehabilitation of people with cerebral palsy. A review process was performed to (1) identify physical therapies to improve postural control in children with cerebral palsy and (2) determine the scientific evidence supporting the effectiveness of those therapies. A Likert-based survey addressing a total of 43 healthcare professionals involved in pediatric physical therapy departments in Spain was carried out. The discussion was mainly supported by studies of level I or II evidence (according to the Oxford scale). The search process yielded 50 studies reporting 16 therapies. A strong positive correlation between the most used treatments and elevated levels of satisfaction was found. Some well-known but not often used techniques, such as hippotherapy, were identified. The treatment with the highest degree of use and satisfaction-neurodevelopment therapy (Bobath)-and some emerging techniques, such as virtual reality, were also identified. The fact that there is a meaningful gap between clinical practice and the scientific evidence was confirmed. The identified gap brings a certain degree of controversy. While some classic and well-known therapies had poor levels of supporting evidence, other relatively new approaches showed promising results.


Assuntos
Paralisia Cerebral , Terapia Assistida por Cavalos , Criança , Humanos , Paralisia Cerebral/reabilitação , Lacunas da Prática Profissional , Modalidades de Fisioterapia , Equilíbrio Postural
15.
Br Dent J ; 233(9): 801-805, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36369571

RESUMO

Head and neck cancer (HNC) and its treatment can have a significant impact on physical and psychosocial wellbeing. A multidisciplinary team (MDT) approach is critical to reduce the potential acute, long-term and late effects of treatment by optimising function at baseline, supporting people during treatment and with rehabilitation post treatment. The key focus for speech and language therapists is to support the holistic needs of people with a focus on speech, swallowing, voice and mouth opening. Effective management is reliant on working with MDT members and interventions are implemented against the background of robust multidimensional baseline evaluation. There have been significant advances in treatment modalities for both primary and recurrent HNC. These include highly conformal radiotherapy modalities, including: image-guided radiotherapy; parotid-sparing and dysphagia-optimised intensity-modulated radiotherapy; and the introduction of intensity-modulated proton therapy, as well as immunotherapy, transoral robotic surgery and surgery with advanced reconstructive techniques. Such treatment advances coupled with a changing patient demographic means that people with HNC are now living longer. However, this is not always without consequences and late treatment effects are a new challenge facing MDTs, requiring high levels of support and rehabilitation.


Assuntos
Transtornos de Deglutição , Neoplasias de Cabeça e Pescoço , Humanos , Deglutição , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/psicologia , Transtornos de Deglutição/reabilitação , Transtornos de Deglutição/terapia , Neoplasias de Cabeça e Pescoço/complicações , Recidiva Local de Neoplasia , Fala , Trismo/etiologia , Trismo/reabilitação , Trismo/terapia
17.
BMC Musculoskelet Disord ; 23(1): 983, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376952

RESUMO

BACKGROUND: Bracing and exercise methods were used in scoliosis rehabilitation and proven effective. There was little evidence about the efficacy of insoles on scoliosis. OBJECTIVE: This study aimed to investigate the effects of 3D personalized insoles on curve magnitude, postural stability, and quality of life (QOL) in moderate adolescent idiopathic scoliosis (AIS) patients. METHODS: Thirty-six volunteers with adolescent idiopathic scoliosis, who had moderate curves (20°-45°), were randomly divided into the experimental and control groups. The control group received traditional rehabilitation with bracing and exercises, and the experimental group received the insole interventions in addition to traditional rehabilitation. The outcome measures were Cobb angle, angle of trunk rotation (ATR), postural stability, and quality of life (Scoliosis Research Society-22 questionnaire). Measurements were conducted at baseline examination, two months and six months. RESULTS: After two and six months of treatment, the Cobb angle and ATR in both groups were significantly decreased as compared with the baseline (p < 0.05), but no significant group difference in Cobb angle and ATR was found in the study (p > 0.05). There was a significant difference in the sagittal balance index at six months compared to the control group (p < 0.05), and a significant difference in the coronal balance index was observed at six months compared to baseline in the experimental group (p < 0.05). Quality of life did not change in either group (p > 0.05). CONCLUSION: Combining bracing with exercise in patients with moderate AIS is effective. 3D personalized insoles cannot reduce the Cobb angle and angle of trunk rotation of patients with moderate AIS but might have the potential to improve postural stability.


Assuntos
Cifose , Escoliose , Humanos , Adolescente , Escoliose/reabilitação , Qualidade de Vida , Resultado do Tratamento , Braquetes , Terapia por Exercício/métodos
18.
Age Ageing ; 51(11)2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36413590

RESUMO

BACKGROUND: according to the revised sarcopenia definition proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2) and revised definition of the Asian Working Group for Sarcopenia (AWGS2019), handgrip strength (HGS) and chair stand test (CST) can be used interchangeably as initial diagnostic measures. OBJECTIVE: to assess the agreement between sarcopenia prevalence, using either HGS or CST, and their association with adverse outcomes in geriatric rehabilitation inpatients. METHODS: REStORing health of acutely unwell adulTs is an observational, longitudinal cohort of geriatric rehabilitation inpatients. Cohen's kappa (κ) was used to assess the agreement between sarcopenia prevalence (no, probable and confirmed and severe sarcopenia) according to EWGSOP2 and AWGS2019 using either HGS or CST. Associations between HGS and CST and readmission, institutionalisation and mortality were assessed by binomial regression. RESULTS: patients (n = 1,250, 57% females) had a median age of 83.1 years (interquartile range: [77.5-88.3]). There was no agreement between probable sarcopenia prevalence using HGS or CST for EWGSOP2 and AWGS2019, respectively (HGS: 70.9% and 76.2%; CST: 95.5% and 98.4%; κ = 0.08 and 0.02). Agreement between confirmed and severe sarcopenia prevalence using either HGS or CST was strong to almost perfect. HGS was associated with 3-month institutionalisation and 3-month and 1-year mortality, whereas CST was not associated. CONCLUSIONS: HGS and CST cannot be used interchangeably as diagnostic measures for probable sarcopenia in geriatric rehabilitation inpatients. CST is not useful to predict adverse outcomes in geriatric rehabilitation inpatients.


Assuntos
Sarcopenia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Absorciometria de Fóton , Força da Mão , Pacientes Internados , Prevalência , Sarcopenia/diagnóstico , Sarcopenia/reabilitação
19.
PLoS One ; 17(11): e0276219, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413535

RESUMO

OBJECTIVE: Quadriceps weakness is considered the primary determinant of gait function after total knee arthroplasty (TKA). However, many patients have shown a gap in improvement trends between gait function and quadriceps strength in clinical situations. Factors other than quadriceps strength in the recovery of gait function after TKA may be essential factors. Because muscle power is a more influential determinant of gait function than muscle strength, the maximum knee extension velocity without external load may be a critical parameter of gait function in patients with TKA. This study aimed to identify the importance of knee extension velocity in determining the gait function early after TKA by comparing the quadriceps strength. METHODS: This prospective observational study was conducted in four acute care hospitals. Patients scheduled for unilateral TKA were recruited (n = 186; age, 75.9 ± 6.6 years; 43 males and 143 females). Knee extension velocity was defined as the angular velocity of knee extension without external load as quickly as possible in a seated position. Bilateral knee function (knee extension velocity and quadriceps strength), lateral knee function (pain and range of motion), and gait function (gait speed and Timed Up and Go test (TUG)) were evaluated before and at 2 and 3 weeks after TKA. RESULTS: Both bilateral knee extension velocities and bilateral quadriceps strengths were significantly correlated with gait function. The knee extension velocity on the operation side was the strongest predictor of gait function at all time points in multiple regression analysis. CONCLUSION: These findings identified knee extension velocity on the operation side to be a more influential determinant of gait function than impairments in quadriceps strength. Therefore, training that focuses on knee extension velocity may be recommended as part of the rehabilitation program in the early postoperative period following TKA. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000020036.


Assuntos
Artroplastia do Joelho , Masculino , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/reabilitação , Equilíbrio Postural , Estudos de Tempo e Movimento , Marcha/fisiologia , Período Pós-Operatório
20.
Spinal Cord Ser Cases ; 8(1): 86, 2022 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-36347833

RESUMO

STUDY DESIGN: Randomized, controlled single-blind cross over study. This study was registered on ClinicalTrials.gov (NCT02473614). OBJECTIVES: Examine usership patterns and feasibility of MusicGlove for at home hand rehabilitation therapy following chronic spinal cord injury. SETTING: Homes of participants. METHODS: Ten participants with chronic spinal cord injury completed two baseline assessments of hand function. After a stable baseline was determined all participants were randomized into two groups: Experimental and Control. Each group was given a recommended therapy dosage. Following this participants switched interventions. RESULTS: On average participants had higher levels of compliance (6.1 ± 3.5 h.), and completed more grips (15,760 ± 9,590 grips) compared to participants in previous stroke studies using the same device. Participants modulated game parameters in a manner consistent with optimal challenge principles from motor learning theory. Participants in the experimental group increased their prehension ability (1 ± 1.4 MusicGlove, 0.2 ± 0.5 Control) and performance (1.4 ± 2.2 MusicGlove, 0.4 ± 0.55 Control) on the Graded and Redefined Assessment of Strength, Sensibility, and Prehension subtests. Increases in performance on the Box and Blocks Test also favored the experimental group compared to the conventional group at the end of therapy (4.2 ± 5.9, -1.0 ± 3.4 respectively). CONCLUSIONS: MusicGlove is a feasible option for hand therapy in the home-setting for individuals with chronic SCI. Participants completed nearly twice as many gripping movements compared to individuals from the sub-acute and chronic stroke populations, and a number far greater than the number of movements typically achieved during traditional rehabilitation.


Assuntos
Traumatismos da Medula Espinal , Acidente Vascular Cerebral , Humanos , Estudos de Viabilidade , Estudos Cross-Over , Método Simples-Cego , Traumatismos da Medula Espinal/reabilitação
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