Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review.

Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.

Physiotherapy Programmes Aided by VR Solutions Applied to the Seniors Affected by Functional Capacity Impairment: Randomised Controlled Trial.

Modern technologies are presently harnessed in response to a complex challenge of providing physiotherapeutic management in older adults. Fully immersive virtual reality (VR) solutions are acknowledged to viably enhance the overall effectiveness of traditional physiotherapeutic methods. A total of 60 community-dwelling older adults (over 75 years of age) were recruited for the study protocol. They were subsequently randomly split into four equally sized study groups (VR, CVR, OCULUS, and the classic programme group (OTAGO), and the physiotherapy sessions were pursued in the subjects' homes for 3 weeks, 3 times a week, for 30 min in each group. At the first measurement point, respective study groups differed significantly in functional performance, as expressed in gait (POMA G) and individual static balance. The post hoc analysis indicated significantly higher scores in POMA G for the classic programme group vs. the results of the VR and CVR groups. On the other hand, the OCULUS group held significantly higher scores in individual balance and TUG, as compared to the other groups (p < 0.001). Making use of a virtual reality (VR) environment in the physiotherapeutic management of community-dwelling older adults appreciably enhanced individual functional performance, especially in terms of static balance. Physiotherapy management aided by VR technology solutions offers a viable alternative to traditional physiotherapeutic regimens (e.g., OTAGO programme) in enhancing individual functional performance. The innovatively self-designed VIRTUAL REALITY COMPREHENSIVE REHABILITATION ROOMS (VRCRR) solution may help out in pursuing a complex physiotherapy programme on an individual basis within one's own home environment.

Frailty Syndrome-Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature.

Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients' condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes.

Validation of FES-I and Short FES-I Scales in the Polish Setting as the Research Tools of Choice to Identify the Fear of Falling in Older Adults.

Fear of falling is associated with a clear hazard to individual self-reliance, reduced physical activity, as well as a sense of shame and loss of self-confidence. The present study aimed to complete the applicable translation and validation protocol for the Falls Efficacy Scale-International (FES-I) tool, following its prior adaptation to ensure full compatibility with the Polish setting. The FES-I questionnaire, along with its abridged version, was translated in line with the recommended standards of the MAPI Institute, taking into account both the cultural fabric and pertinent language specifics of the country. The survey was attended by 740 individuals (N = 740; 463 women, 277 men), over 60 years old. All respondents were required to complete both the FES-I and FES-I (Short) questionnaires twice, following an intervening period, and subsequently had their responses statistically assessed. The FES-I questionnaire, along with its abridged version, may be recommended as an effective assessment tool for addressing the fear of falling issue among the older adults, consequently allowing the teams of attending physicians, physiotherapists, psychologists, or psychiatrists to complete an unambiguous diagnosis, with a view to helping the patients overcome this particular type of anxiety.

The Evolution of Effort-Reward Imbalance in Workers during the COVID-19 Pandemic in France-An Observational Study in More than 8000 Workers.

(1) Background: The effects of lockdown repetition on work-related stress, expressed through Effort-Reward Imbalance (ERI), during the COVID-19 pandemic are poorly documented. We investigated the effect of repetitive lockdowns on the ERI in French workers, its difference across occupations, and the change in its influencing factors across time. (2) Methods: Participants were included in a prospective cross-sectional observational study from 30 March 2020 to 28 May 2021. The primary outcome was the ERI score (visual analog scale). The ERI score of the population was examined via Generalized Estimating Equations. For each period, the factors influencing ERI were studied by multivariate linear regression. (3) Results: In 8121 participants, the ERI score decreased in the first 2 lockdowns (53.2 ± 0.3, p < 0.001; 50.5 ± 0.7, p < 0.001) and after lockdown 2 (54.8 ± 0.8, p = 0.004) compared with the pre-pandemic period (59 ± 0.4). ERI was higher in medical than in paramedical professionals in the pre-pandemic and the first 2 lockdowns. Higher workloads were associated with better ERI scores. (4) Conclusions: In a large French sample, Effort-Reward Imbalance worsened during the COVID-19 pandemic until the end of the 2nd lockdown. Paramedical professionals experienced a higher burden of stress compared with medical professionals.

Pisa syndrome: Pathophysiology, physical rehabilitation and falls risk.

BACKGROUND: Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE: An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS: A narrative literature review, augmented with the authors' own experience in physical rehabilitation management. RESULTS: As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS: sA comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions.

Functional capacity and dual-task cost in the institutionalized older adults, both affected and unaffected by mild cognitive impairment.

BACKGROUND: Mild cognitive impairment (MCI) affects 10-20% of the individuals over the age of 65; this proportion being higher in the institutional care facilities than within a general population. AIM: To assess whether dual-task cost in the individuals affected by MCI depends exclusively on gait, or possibly some other functional capacity components might also come into play, as compared to the healthy controls also remaining in the institutional care. METHODS: The study was conducted in five nursing facilities, involving 88 subjects in total, i.e. 44 subjects affected by MCI (mean age of 83.8 years; 34 women (77.3%) and 10 men (22.7%), and 44 healthy controls (mean age 81.67 years; 38 women (84.4%) and 7 men (15.6%). Cognitive functions were assessed through Mini-Mental State Examination (MMSE), while gait by Timed Up and Go Test (TUGT). Gait speed was calculated by the 10 Meter Walk Test, and the fear of falling with the Falls Efficacy Scale International. Dual tasks were assessed by TUGTMAN (Timed Up and Go Test Manual) and TUGCOG (Timed Up and Go Test Cognitive). Dual Task Cost (DTC) of TUGTMAN and TUGTCOG was established. Statistical analyses were completed with STATISTICA Package v. 10. RESULTS: Individuals affected by MCI differed significantly from the unaffected ones with regard to their gait test results, when assigned a single-task activity, and dual-task activities, as well as in the gait speed. Dual Task Cost Manual (DTCMAN) in the MCI group was significantly higher, as compared to the subjects unaffected by MCI. Around 25% of the variance of DTCMAN result regarding the MCI group was accounted for by gait performance in the single-task conditions (TUGT). In the case of Dual Task Cost Cognitive (DTCCOG), this value equalled to approx. 10%. A 1% change in DTCMAN corresponded to approx. 0.5 s change in TUGT, whereas a 1% change in DTCCOG entailed approx. 0.35 s change in TUGT walking time. CONCLUSION: Individual functional capacity affected the dual-task performance, especially the motor-motor tasks. Dual-task cost in the subjects affected by MCI was significantly reduced, being more dependent on the gait speed in the motor-motor tasks, which entailed visual memory, than in the motor-cognitive tasks.

[Resuscitation of a pregnant woman]. / Resuscytacja krqzeniowo-oddechowa kobiety ciezarnej.

Most pregnant women have little interest in thinking about the prospect of death. Mortality related to the pregnancy itself is rare, occurring in an estimated 1 of every 30 000 deliveries. Although cardiopulmonary arrest rarely occurs in pregnant women, it is important that the health care team knows the appropriate actions to take in such an event, to promote positive outcomes for both mother and fetus. We discuss important pathophysiological alterations during pregnancy and, including recommendations in the available literature, we present a standardized protocol for life support for mother. Perimortem cesarean section is rarely required, but it is important topic for two reasons. First, there is a clear imperative to promptly decide and act when PMCD is indicated. As in all emergency care, knowledge must precede the crisis rather than await it. Second, indications for PMCD have broadened considerably since 1980s, and the procedure may attain a more prominent role in the future. We believe that prompt cesarean delivery is the key to maternal and infant survival in such cases.

[The analysis of patients with body traumas treated in the Military Medical Academy's Second Clinical Hospital of the Medical University of Lodz]. / Analiza pacjentów z obrazeniami ciala, leczonych w Uniwersyteckim Szpitalu Klinicznym nr 2 (USK 2) im. Wojskowej Akademii Medycznej Uniwersytetu Medycznego w Lodzi.

According to recent WHO reports, body traumas are ranked third with respect of frequency of occurrence right after cardiovascular diseases and tumours, and are considered one of the major medical problems. Trauma is a kind of energy (mechanical, thermal or chemical) affecting the human body. After crossing the threshold of tissue endurance, an injury or damage occurs. A common problem of all the centres that treat traumas is a reliable and comparable assessment of injury severity. Constant improvement of the trauma scores, contributes to increased objectivity of the assessment of injury severity and makes trauma research easier. To a large extent, commonness of the scores enables the exchange of experiences with respect to treating patients after trauma. An ideal scale should be reliable, easy to use, and most of all commonly used, thus enabling the employment of a common "traumatologic" language. In the following research, the test group was comprised of 137 adult patients including 113 men (82%) and 24 women (18%). Most patients were aged from 20 to 60 years, that is, in the productive age. Appropriate trauma treatment results in the reduction of the costs of hospitalisation time of those patients and their recovery. An accident or worse still death of a young person is not only a personal tragedy for the family. It is also a big economic loss for the society which results from "lost years of life" and thus "lost years of work". Quick and appropriate treatment, done in a proper centre with appropriately trained staff and highest quality equipment will allow not only to reduce the victim's suffering and return to their daily life, but also minimise the social costs connected with disability pensions, benefits and compensations. Most injuries happened at work--61% were probably due to haste but most of all not complying with occupational health and safety regulations, which all employees should know and comply with. It involves doctors writing a sick note for the injured which undoubtedly involves much bigger losses for the employer and social costs in a form of increased premiums for healthcare plans. The most common mechanism of the injuries was self-injury (66.7%). In the study population, even 87% of the victims suffered from isolated body injuries. As is apparent from the analysed data, one should provide money for short-term health care, i.e. up to 2 days. The average treatment time for the study population was 4 days, with the maximum of 23 days. Most patients (60%) were brought by emergency medical services.