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Biomolecules & Biomedicine Sep 2023Cervical spondylosis is a widespread medical condition that significantly impacts patients' quality of life. Treatment options include surgical and conservative... (Review)
Review
Cervical spondylosis is a widespread medical condition that significantly impacts patients' quality of life. Treatment options include surgical and conservative approaches, with conservative treatment often being the preferred choice. Rehabilitation therapy is an essential component of conservative treatment, and advancements in technology have the way to the development of new physiotherapy techniques. The effectiveness of treatment largely hinges on the patient's ability to improve their dysfunction. This study aims to provide valuable insights into the use of new physical therapy techniques, such as Sling Exercises Training (SET), fascia manipulation, muscle energy technique (MET), and proprioceptive neuromuscular facilitation (PNF), that aid the rehabilitation of cervical spondylosis. By scrutinizing the current research status of these techniques, this study aims to present innovative ideas enhancing the rehabilitation process and outcomes for patients suffering from cervical spondylosis.
Topics: Humans; Quality of Life; Spondylosis; Physical Therapy Modalities; Decompression, Surgical; Muscle Stretching Exercises
PubMed: 37212037
DOI: 10.17305/bb.2023.9049 -
Critical Care Clinics Jul 2023Critically ill patients are at risk of post-intensive care syndrome, including physical, cognitive, and psychological sequelae. Physiotherapists are rehabilitation... (Review)
Review
Critically ill patients are at risk of post-intensive care syndrome, including physical, cognitive, and psychological sequelae. Physiotherapists are rehabilitation experts who focus on restoring strength, physical function, and exercise capacity. Critical care has evolved from a culture of deep sedation and bed rest to one of awakening and early mobility; physiotherapeutic interventions have developed to address patients' rehabilitation needs. Physiotherapists are assuming more prominent roles in clinical and research leadership, with opportunities for wider interdisciplinary collaboration. This paper reviews the evolution of critical care from a rehabilitation perspective, highlights relevant research milestones, and proposes future opportunities for improving survivorship outcomes.
Topics: Humans; Early Ambulation; Bed Rest; Intensive Care Units; Physical Therapy Modalities; Critical Care; Critical Illness
PubMed: 37230552
DOI: 10.1016/j.ccc.2023.01.003 -
European Journal of Physical and... Dec 2023The implementation of regular prolonged, and effective rehabilitation in people with Parkinson's disease is essential for ensuring a good quality of life. However, the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The implementation of regular prolonged, and effective rehabilitation in people with Parkinson's disease is essential for ensuring a good quality of life. However, the continuity of rehabilitation care may find barriers related to economic, geographic, and social issues. In these scenarios, telerehabilitation could be a possible solution to guarantee the continuity of care.
AIM
To investigate the efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in people with Parkinson's disease, compared to at-home self-administered structured conventional motor activities.
DESIGN
Multicenter randomized controlled trial.
SETTING
Five rehabilitation hospitals of the Italian Neuroscience and Rehabilitation Network.
POPULATION
Individuals diagnosed with Parkinson's disease.
METHODS
Ninety-seven participants were randomized into two groups: 49 in the telerehabilitation group (non-immersive virtual reality-based telerehabilitation) and 48 in the control group (at-home self-administered structured conventional motor activities). Both treatments lasted 30 sessions (3-5 days/week for, 6-10 weeks). Static and dynamic balance, gait, and functional motor outcomes were registered before and after the treatments.
RESULTS
All participants improved the outcomes at the end of the treatments. The primary outcome (mini-Balance Evaluation Systems Test) registered a greater significant improvement in the telerehabilitation group than in the control group. The gait and endurance significantly improved in the telerehabilitation group only, with significant within-group and between-group differences.
CONCLUSIONS
Our results showed that non-immersive virtual reality-based telerehabilitation is feasible, improves static and dynamic balance, and is a reasonably valuable alternative for reducing postural instability in people with Parkinson's disease.
CLINICAL REHABILITATION IMPACT
Non-immersive virtual reality-based telerehabilitation is an effective and well-tolerated modality of rehabilitation which may help to improve access and scale up rehabilitation services as suggested by the World Health Organization's Rehabilitation 2030 agenda.
Topics: Humans; Telerehabilitation; Parkinson Disease; Quality of Life; Physical Therapy Modalities; Virtual Reality; Postural Balance
PubMed: 37847247
DOI: 10.23736/S1973-9087.23.07954-6 -
Physiotherapy Theory and Practice Aug 2023This study aims to explore the effects of aquatic strength training on the postural balance and walking function of stroke patients. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aims to explore the effects of aquatic strength training on the postural balance and walking function of stroke patients.
METHODS
A total of 56 chronic stroke patients more than 6 months post-stroke with walking and balance impairments were included in this study. After baseline evaluations, patients were randomly assigned to either the experiment group (n = 29) or control group (n = 27). Patients in the control group underwent conventional hydrotherapy, whereas patients in the experiment group received conventional hydrotherapy combined with aquatic lower extremity strength training. After six weeks of rehabilitation, all patients were evaluated by a blinded assessor, and the functional assessments including: Berg Balance Scale (BBS); Timed Up and Go Test (TUG and mTUG); 2 Minute Walk Test (2MWMT); and Gait analysis.
RESULTS
There were no significant differences (P > .05) between the two groups in all evaluation indexes before rehabilitation. Six weeks after treatments, the results from both groups showed significant improvements compared with those in the baseline evaluations (P < .05). Notably, compared with the control group, BBS, TUG and mTUG, 2MWMT, and Gait analysis including stride length in the non-hemiplegic side, stride length, as well as walking speed and stride frequency in the hemiplegic side in experiment group were markedly improved (P < .05).
CONCLUSION
Aquatic strength training can improve postural balance and lower extremity motor functions in chronic stroke patients.
Topics: Humans; Resistance Training; Stroke Rehabilitation; Postural Balance; Exercise Therapy; Time and Motion Studies; Stroke; Walking; Gait
PubMed: 35285397
DOI: 10.1080/09593985.2022.2049939 -
The American Journal of Sports Medicine Jul 2023Exercises that provide progressive therapeutic loading are a central component of patellofemoral pain rehabilitation, but quantitative evidence on patellofemoral joint...
BACKGROUND
Exercises that provide progressive therapeutic loading are a central component of patellofemoral pain rehabilitation, but quantitative evidence on patellofemoral joint loading is scarce for a majority of common weightbearing rehabilitation exercises.
PURPOSE
To define a loading index to quantify, compare, rank, and categorize overall loading levels in the patellofemoral joint across 35 types of weightbearing rehabilitation exercises and activities of daily living.
STUDY DESIGN
Descriptive laboratory study.
METHODS
Model-estimated knee flexion angles and extension moments based on motion capture and ground-reaction force data were used to quantify patellofemoral joint loading in 20 healthy participants who performed each exercise. A loading index was computed via a weighted sum of loading peak and cumulative loading impulse for each exercise. The 35 rehabilitation exercises and daily living activities were then ranked and categorized into low, moderate, and high "loading tiers" according to the loading index.
RESULTS
Overall patellofemoral loading levels varied substantially across the exercises and activities, with loading peak ranging from 0.6 times body weight during walking to 8.2 times body weight during single-leg decline squat. Most rehabilitation exercises generated a moderate level of patellofemoral joint loading. Few weightbearing exercises provided low-level loading that resembled walking or high-level loading with both high magnitude and duration. Exercises with high knee flexion tended to generate higher patellofemoral joint loading compared with high-intensity exercises.
CONCLUSION
This study quantified patellofemoral joint loading across a large collection of weightbearing exercises in the same cohort.
CLINICAL RELEVANCE
The visualized loading index ranks and modifiable worksheet may assist clinicians in planning patient-specific exercise programs for patellofemoral pain rehabilitation.
Topics: Humans; Patellofemoral Joint; Activities of Daily Living; Patellofemoral Pain Syndrome; Biomechanical Phenomena; Exercise Therapy; Weight-Bearing; Body Weight; Knee Joint
PubMed: 37272685
DOI: 10.1177/03635465231175160 -
The New England Journal of Medicine Feb 2024
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Developmental Neurorehabilitation 2023The aim of the review was to evaluate the evidence regarding the effectiveness of aquatic rehabilitation based on the Halliwick concept (HC) in psychomotor development,... (Review)
Review
The aim of the review was to evaluate the evidence regarding the effectiveness of aquatic rehabilitation based on the Halliwick concept (HC) in psychomotor development, gross motor function and aquatic skills of children with cerebral palsy. We followed PRISMA recommendations, performing a systematic search in PubMed, Science Direct, LILACS, SciELO, and PEDro database. We identified 474 studies; five met the eligibility criteria and were included in the review. Four studies demonstrated a significant improvement in gross motor function and aquatic skills. Social interaction skills were also improved. However, the methodological quality of these studies was limited, and then, research that adopt controlled experimental designs are necessary.
Topics: Child; Humans; Cerebral Palsy; Aquatic Therapy
PubMed: 37728374
DOI: 10.1080/17518423.2023.2259986 -
The American Journal of Occupational... Sep 2023Stroke is a leading cause of disability. Occupational therapy practitioners ensure maximum participation and performance in valued occupations for stroke survivors and...
IMPORTANCE
Stroke is a leading cause of disability. Occupational therapy practitioners ensure maximum participation and performance in valued occupations for stroke survivors and their caregivers.
OBJECTIVE
These Practice Guidelines are meant to support occupational therapy practitioners' clinical decision making when working with people after stroke and their caregivers.
METHOD
Clinical recommendations were reviewed from three systematic review questions on interventions to improve performance and participation in daily activities and occupations and from one question on maintaining the caregiving role for caregivers of people after stroke.
RESULTS
The systematic reviews included 168 studies, 24 Level 1a, 90 Level 1b, and 54 Level 2b. These studies were used as the basis for the clinical recommendations in these Practice Guidelines and have strong or moderate supporting evidence.
CONCLUSIONS AND RECOMMENDATIONS
Interventions with strong strength of evidence for improving performance in activities of daily living and functional mobility include mirror therapy, task-oriented training, mental imagery, balance training, self-management strategies, and a multidisciplinary three-stages-of-care rehabilitation program. Constraint-induced therapy has strong strength of evidence for improving performance of instrumental activities of daily living. Moderate strength of evidence supported cognitive-behavioral therapy (CBT) to address balance self-efficacy, long-term group intervention to improve mobility in the community, and a wearable upper extremity sensory device paired with training games in inpatient rehabilitation to improve social participation. Practitioners should incorporate problem-solving therapy in combination with CBT or with education and a family support organizer program. What This Article Adds: These Practice Guidelines provide a summary of strong and moderate evidence for effective interventions for people with stroke and for their caregivers.
Topics: Adult; Humans; Activities of Daily Living; Occupational Therapy; Social Participation; Stroke; Stroke Rehabilitation; Practice Guidelines as Topic
PubMed: 37862268
DOI: 10.5014/ajot.2023.077501 -
Physical Medicine and Rehabilitation... May 2024Neural stimulation technology aids stroke survivors in regaining lost motor functions. This article explores its applications in upper and lower limb stroke... (Review)
Review
Neural stimulation technology aids stroke survivors in regaining lost motor functions. This article explores its applications in upper and lower limb stroke rehabilitation. The authors review various methods to target the corticomotor system, including transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. In addition, the authors review the use of peripheral neuromuscular electrical stimulation for therapeutic and assistive purposes, including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and functional electrical stimulation. For each, the authors examine the potential benefits, limitations, safety considerations, and FDA status.
Topics: Humans; Transcranial Direct Current Stimulation; Stroke; Transcutaneous Electric Nerve Stimulation; Stroke Rehabilitation; Transcranial Magnetic Stimulation; Upper Extremity
PubMed: 38514224
DOI: 10.1016/j.pmr.2023.06.008 -
The Lancet. Neurology Oct 2023Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly... (Randomized Controlled Trial)
Randomized Controlled Trial
Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial.
BACKGROUND
Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly shown in people with progressive multiple sclerosis. We aimed to investigate the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive multiple sclerosis.
METHODS
CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA. Patients with progressive multiple sclerosis were eligible for inclusion if they were aged 25-65 years and had an Expanded Disability Status Scale (EDSS) score of less than 7. All had impaired processing speed defined as a performance of 1·282 SD or greater below normative data on the Symbol Digit modalities Tests (SDMT). Participants were randomly assigned (1:1:1:1), using an interactive web-response system accessed online from each centre, to cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. The study statistician created the randomisation sequence that was stratified by centre. Participants, outcome assessors, and investigators were blinded to group allocation. The study statistician was masked to treatment during analysis only. Interventions were conducted two times per week for 12 weeks: cognitive rehabilitation used an individualised, computer-based, incremental approach to improve processing speed; sham cognitive rehabilitation consisted of internet training provided individually; the exercise intervention involved individualised aerobic training using a recumbent arm-leg stepper; and the sham exercise involved stretching and balance tasks without inducing cardiovascular strain. The primary outcome measure was processing speed measured by SDMT at 12 weeks; least squares mean differences were compared between groups using linear mixed model in all participants who had a 12-week assessment. The trial is registered with ClinicalTrials.gov, NCT03679468, and is completed.
FINDINGS
Between Dec 14, 2018, and April 2, 2022, 311 people with progressive multiple sclerosis were enrolled and 284 (91%) completed the 12-week assessment (117/311 [38%] male and 194/311 [62%] female). The least squares mean group differences in SDMT at 12 weeks did not differ between groups (p=0·85). Compared with the sham cognitive rehabilitation and sham exercise group (n=67), differences were -1·30 (95% CI -3·75 to 1·16) for the cognitive rehabilitation plus exercise group (n=70); -2·78 (-5·23 to -0·33) for the sham cognitive rehabilitation plus exercise group (n=71); and -0·71 (-3·11 to 1·70) for the cognitive rehabilitation plus sham exercise group (n=76). 11 adverse events possibly related to the interventions occurred, six in the exercise plus sham cognitive rehabilitation group (pain, dizziness, and falls), two in the cognitive rehabilitation plus sham exercise group (headache and pain), two in the cognitive rehabilitation and exercise group (increased fatigue and pain), and one in the dual sham group (fall).
INTERPRETATION
Combined cognitive rehabilitation plus exercise does not seem to improve processing speed in people with progressive multiple sclerosis. However, our sham interventions were not inactive. Studies comparing interventions with a non-intervention group are needed to investigate whether clinically meaningful improvements in processing speed might be attainable in people with progressive multiple sclerosis.
FUNDING
MS Canada.
Topics: Humans; Female; Male; Cognitive Training; Multiple Sclerosis; Exercise; Exercise Therapy; Cognitive Dysfunction
PubMed: 37739574
DOI: 10.1016/S1474-4422(23)00280-6