Integrated Thermal Rehabilitation: A New Therapeutic Approach for Disabilities.

A mutual link between somatic and visceral neural pathways is known in medicine. This study addresses therapeutic effectiveness of an integrated rehabilitative approach of thermal aquatic environment, combined with neuromuscular manual stimulation, on activation of afferent sensory visceral and somatic efferent neuronal motor pathways in different pathologies of neuromuscular motor and respiratory systems. The study included 63 patients subjected to a protocol consisting of hydroponic treatment, hydrokinesitherapy associated with ozonized vascular pathway, and mud therapy associated with cardiorespiratory treatment performed in aquatic environment and aided by neuromuscular manual therapy. The therapeutic protocol consisted of rehabilitation sessions 5 days a week for 2 months. The outcome measures were spirometry tests and the following evaluation instruments: Tinetti Gait and Balance assessment scale, Functional Independence Measurement, visual analogue scale, and the EQ-5D-5 L instrument. The tests were applied before and after the protocol completion. The findings demonstrate a general increase in patients' everyday living autonomy and quality of life, with a particular improvement in respiratory function tests. We conclude that the integrated thermal approach holds promise in therapeutic rehabilitation of disabilities.

Rehabilitation of Neuromotor Disabilities in Aquatic Microgravity Environment.

The aquatic environment has a high potential in rehabilitation treatment of acute lesions and in chronic diseases. The Safe Bearing Back method is proposed to stimulate the reorganization of deteriorated sensory neuromotor skills. The aim of the present study was to verify the effectiveness and the long-term maintenance of the benefits of a specific thermal rehabilitation training in neuromotor and neurological disabilities. Seventy four patients were evaluated using the Functional Independence Measure (FIM), Tinetti Gait-Balance Scale (TIN), and Visual Analog Scale (VAS) for pain. In addition, a general health index was developed, conceived as a linear combination, with unit weights, of the normalized FIM, TIN, and VAS indicators. Measurements were made at T1 (baseline before treatment), T2 (after a five-month treatment, which was the end of treatment), and T3 (6 months after the end of treatment). Self-sufficiency, walking ability, and subjective pain perception were improved after the treatment. The improvement tapered off during the six-month-long follow-up, but the patients' condition remained well compared with the baseline level before the implementation of the treatment program. We conclude that hydrokinesitherapy with the Safe Bearing Back method demonstrates is clearly effective in the immediate and medium-term rehabilitation of neuromotor diseases.

Effects of Manual Somatic Stimulation on the Autonomic Nervous System and Posture.

Low back pain frequently involves a multifactorial etiology and requires medical attention. The aim of the study was to assess the associations among pain, posture, and autonomic nervous system function in patients with low back pain, using neuromuscular manual therapy versus a generic peripheral manual stimulation (back massage therapy). Twenty young patients with low back pain were enrolled into the study. The patients were randomly divided into two groups: treated with neuromuscular manual therapy performed after a specific structural evaluation and treated with back massage therapy. Both groups performed eight sessions of 30 min each, once a week for two months. There were three main time points of the assessment: during the first, the fourth, and the last eighth session. In each of these three sessions, data were collected before onset of session (baseline), 5 min from onset, at end of session, and 5 min after the end. All patients were subjected to stabilometric evaluation and were assessed on a visual analogue scale to quantify postural and pain changes. Tabletop capnography and pulse oximetry were used to monitor autonomic changes. The findings were that the improvement in posture and pain reduction were appreciably better in patients subjected to neuromuscular manual therapy than in those subjected to back massage therapy, with a comparable autonomic response in both groups. In conclusion, the study demonstrates that posture modification was significantly more advantageous in patient treated with neuromuscular manual therapy.