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PM & R : the Journal of Injury,... Dec 2021Locked-in syndrome is a rare and devastating condition that results in tetraplegia, lower cranial nerve paralysis, and anarthria with preserved cognition, vertical gaze,... (Review)
Review
Locked-in syndrome is a rare and devastating condition that results in tetraplegia, lower cranial nerve paralysis, and anarthria with preserved cognition, vertical gaze, and upper eyelid movements. Although acute management is much like that of any severe stroke, rehabilitation and recovery of these patients have not been previously described. Challenges relevant to this population include blood pressure management and orthostasis, timing and appropriateness of reinstating oral feeding, ventilatory support, decannulation after tracheostomy, bowel and bladder management, vestibular dysfunction, and eye care. Targeted rehabilitation of head, neck, and trunk stability to improve function, and proper fit in an appropriate wheelchair are essential to assist with mobility. Rehabilitation interventions should include a focus on distal motor control and upright tolerance training followed by balance and mobility exercises. In addition, special considerations must be given to developing early methods of communication through use of augmentative systems to call for help and express needs. These systems along with additional technology provide the basis to promote connectivity to family and friends through the use of social media and the internet. Establishment of communication, mobility, and connectivity is essential in promoting independence, autonomy, and improving quality of life. Overall, with specialized rehabilitative care and access to the proper equipment, long-term outcomes and quality of life in these patients can be favorable.
Topics: Humans; Locked-In Syndrome; Quadriplegia; Quality of Life; Stroke; Stroke Rehabilitation; Wheelchairs
PubMed: 33465298
DOI: 10.1002/pmrj.12555 -
Current Opinion in Neurology Oct 2021Rehabilitation for patients with neuromuscular disorders (NMDs) has undisputed health benefits and is potentially therapeutic for targeting impairments, improving... (Review)
Review
PURPOSE OF REVIEW
Rehabilitation for patients with neuromuscular disorders (NMDs) has undisputed health benefits and is potentially therapeutic for targeting impairments, improving quality of life, and enabling activities of daily living. Whilst rehabilitation is commonly prescribed, unequivocal evidence and disease-related guidelines are lacking. This review highlights recent studies of exercise, assistive devices, respiratory management and manual therapy and stretching for patients with NMDs.
RECENT FINDINGS
Randomised controlled trials of neuromuscular rehabilitation are scant, often underpowered and lack a control group. Recent case studies, clinical trials and cohort studies support rehabilitative therapies such as exercise, respiratory muscle training, assistive devices, and manual therapy and stretching, to provide systemic health benefits, with the possibility to retain or improve function. No evidence of overwork weakness or muscle damage have been reported in exercise trials, and rehabilitative exercise programs in many cases lead to positive psychosocial impacts. Tele-rehab is an emerging area of interest, as a response to the COVID-19 pandemic.
SUMMARY
Robust evidence for the benefits of neuromuscular rehabilitation is lacking, and clinical trial quality can be improved. Tele-rehab is a tantalising development to improve access to neuromuscular rehabilitation in both metropolitan and remote settings during and beyond the COVID-19 pandemic.
Topics: Activities of Daily Living; COVID-19; Humans; Pandemics; Quality of Life; SARS-CoV-2
PubMed: 34343140
DOI: 10.1097/WCO.0000000000000974 -
European Journal of Physical and... Dec 2023Until the last update in February 2022, the Cochrane Rehabilitation COVID-19 Evidence-based Response (REH-COVER) action identified an increasing volume of evidence for...
INTRODUCTION
Until the last update in February 2022, the Cochrane Rehabilitation COVID-19 Evidence-based Response (REH-COVER) action identified an increasing volume of evidence for the rehabilitation management of COVID-19. Therefore, our aim was to identify the best available evidence on the effectiveness of interventions for rehabilitation for COVID-19-related limitations of functioning of rehabilitation interest in adults with COVID-19 or post COVID-19 condition (PCC).
EVIDENCE ACQUISITION
We ran the searches on February 17, 2023, in the following databases: PubMed, EMBASE, CENTRAL, CINHAL, and the Cochrane COVID-19 Study Register, applying a publication date restriction to retrieve only papers published in 2022. To retrieve papers published before 2022, we screened the reference lists of previous publications included in the REH-COVER action, covering papers from early 2020 to the end of 2022. This current review includes only randomised controlled trials and concludes the rapid living systematic reviews of the Cochrane Rehabilitation REH-COVER action. The risk of bias and certainty of evidence were evaluated in all studies using the Cochrane Risk of Bias tool and GRADE, respectively. We conducted a narrative synthesis of the evidence. PROSPERO registration number: CRD42022374244.
EVIDENCE SYNTHESIS
After duplicate removal, we identified 18,950 individual records and 53 RCTs met the inclusion criteria. Our findings suggest that the effect of breathing and strengthening exercise programs on dyspnea and physical exercise capacity compared to no treatment in non-severe COVID-19 patients is uncertain. Multicomponent telerehabilitation may slightly increase physical exercise capacity compared to educational intervention in adults with PCC. There is, however, uncertainty about its effect on lung function and physical exercise capacity when compared to no treatment. Finally, the effect of inspiratory muscle training on maximal inspiratory pressure compared to no treatment in adults with PCC is uncertain.
CONCLUSIONS
Interventions that are part of comprehensive pulmonary rehabilitation approaches may benefit dyspnea and exercise tolerance in adults with COVID-19 and PCC. The available evidence has several methodological limitations that limit the certainty of evidence and the clinical relevance of findings. Therefore, we cannot provide robust suggestions for practice. While high-quality RCTs are being conducted, clinicians should consider using high-quality evidence from other pulmonary conditions to rehabilitate patients with COVID-19 or PCC using context-specific interventions.
Topics: Humans; Chronic Disease; COVID-19; Dyspnea; Exercise; Physical Therapy Modalities
PubMed: 38214047
DOI: 10.23736/S1973-9087.23.08331-4 -
Developmental Medicine and Child... Feb 2022To compare the effects of physical therapy with hippotherapy versus physical therapy alone on the gross motor function of children and adolescents with cerebral palsy... (Comparative Study)
Comparative Study Meta-Analysis
AIM
To compare the effects of physical therapy with hippotherapy versus physical therapy alone on the gross motor function of children and adolescents with cerebral palsy (CP).
METHOD
Electronic searches were conducted in January 2021. We included controlled trials of the gross motor function of children and adolescents with CP, aged 2 to 18 years. We extracted means, standard deviations, and changes from the baseline to the end of the intervention. We used the Cochrane Collaboration's tool modified by Effective Practice and Organization of Care (EPOC) to assess the methodological quality and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to verify evidence synthesis. We conducted the meta-analysis using Revman 5.3.
RESULTS
A total of 315 individuals from six studies were included. Both groups received physical therapy including strength, aerobic, stretch, and mobility exercises, and neurodevelopmental treatment. Studies presented high risk of bias. Both therapies presented similar effects for Gross Motor Function Measure scores, cadence, stride length, and speed during gait. The level of evidence was very low. The change was greater for the physical therapy with hippotherapy group, but inferior to the smallest real difference or the minimal detectable change.
INTERPRETATION
Physical therapy with hippotherapy presented similar effects to physical therapy alone on the gross motor function of children and adolescents with CP. Future studies should include larger sample sizes and studies with low risk of bias.
Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Equine-Assisted Therapy; Exercise Therapy; Humans; Neurological Rehabilitation; Outcome Assessment, Health Care; Physical Therapy Modalities
PubMed: 34453750
DOI: 10.1111/dmcn.15042 -
Journal of Physiotherapy Oct 2022In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than... (Randomized Controlled Trial)
Randomized Controlled Trial
Ballistic resistance training has a similar or better effect on mobility than non-ballistic exercise rehabilitation in people with a traumatic brain injury: a randomised trial.
QUESTIONS
In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life?
DESIGN
A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement.
PARTICIPANTS
A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury.
INTERVENTION
For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training.
OUTCOME MEASURES
The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months).
RESULTS
After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI -1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT.
CONCLUSION
This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations.
TRIAL REGISTRATION
ACTRN12611001098921.
Topics: Humans; Resistance Training; Quality of Life; Prospective Studies; Exercise Therapy; Brain Injuries, Traumatic
PubMed: 36253280
DOI: 10.1016/j.jphys.2022.09.004 -
Lymphology 2020Lipedema is a chronic and progressive disease of adipose tissue caused by abnormal fat accumulation in subcutaneous tissue. Although there is no known cure for lipedema,... (Meta-Analysis)
Meta-Analysis Review
Lipedema is a chronic and progressive disease of adipose tissue caused by abnormal fat accumulation in subcutaneous tissue. Although there is no known cure for lipedema, possible complications can be prevented with conservative and surgical treatments. One of the conservative treatment options is physiotherapy and rehabilitation (PR). When the literature is examined, few studies focusing on the efficacy of PR were found for this patient group. The purpose of this review is to provide a better understanding of the effectiveness of PR applications by compiling existing studies. A bibliographic PubMed search was performed for published studies regarding PR in lipedema management in June 2019 including the last 58 years (1951-2019). Articles were chosen by reading the abstracts and subsequently data were analyzed by reading the entire text through full-text resources. A total of 15 studies met inclusion criteria. Results document how lipedema patients are benefited by PR and the effectiveness of different types of PR programs. The current review also showed that complex decongestive physiotherapy, gait training, hydrotherapy, aerobic exercise, and resistance exercise training each have value in the management of lipedema. The effects of PR for the treatment of lipedema are variable among studies, although overall PR seems to be effective in lipedema management. Although physiotherapy applications have a potentially important role in the management of lipedema, they should be used in combination with other treatment modalities. More studies with higher quality are needed to fully demonstrate the effect and efficacy of PR in lipedema patients.
Topics: Combined Modality Therapy; Disease Management; Exercise; Exercise Therapy; Humans; Lipedema; Physical Therapy Modalities; Treatment Outcome
PubMed: 33190432
DOI: No ID Found -
Physiotherapy Research International :... Jul 2021To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with shoulder-hand syndrome (SHS) after stroke.
DESIGN
Randomized controlled trial.
SETTINGS
Out-patient rehabilitation center.
METHODS
Thirty-eight SHS patients after stroke, were randomly allocated into two groups; both the groups received a 4-week stroke rehabilitation program, 30 min a day for 5 days a week. Control group patients performed all the exercises of stroke rehabilitation program, while directly visualizing their both limbs. Experimental group patients performed same exercises of stroke rehabilitation program in front of the mirror.
OUTCOME MEASURES
Oedema (figure-of-eight measurement method), pain intensity (0-10 Numeric Pain Rating Scale [0-10 NPRS]), functional activities (Functional Independence Measure [FIM]).
RESULTS
After intervention, both groups showed statistically significant (p < 0.05) improvement for all measures (oedema measurement, 0-10 NPRS and FIM). Improvements were more significant (p < 0.05) in the experimental group with mirror therapy for all three measures compared to the control group. Mean differences between groups were 1.40 cm for oedema measurement, 0.87 for NPRS score and 12.20 for FIM score. At 2-week follow-up, the improvements were sustained.
CONCLUSION
The current study may indicate mirror therapy as an effective central neuromodulatory rehabilitative program to reduce pain, improves functional activities. More distinctively, this preliminary study suggests a decrease in oedema by mirror therapy for SHS after stroke. Improvement of upper limb in SHS after stroke will be more perceptible with the decrease in oedema, being the characteristic sign, following mirror therapy. Clinically, patients during their daily functional activities, shall be more confident to use their upper limb following mirror therapy after reduction in oedema along with pain.
Topics: Edema; Humans; Pain; Physical Therapy Modalities; Recovery of Function; Reflex Sympathetic Dystrophy; Stroke; Stroke Rehabilitation; Treatment Outcome; Upper Extremity
PubMed: 33675672
DOI: 10.1002/pri.1902 -
Physical & Occupational Therapy in... 2020To determine the effects of group-task-oriented training (group-TOT) on gross and fine motor function, activities of daily living (ADL) and social function of children...
To determine the effects of group-task-oriented training (group-TOT) on gross and fine motor function, activities of daily living (ADL) and social function of children with spastic cerebral palsy (CP). Eighteen children with spastic CP (4-7.5 years, gross motor function classification system level I-III) were randomly assigned to the Group-TOT (9 children received group-TOT for 1 hour, twice a week for 8 weeks) or the comparison group (9 children received individualized traditional physical and occupational therapy). The Gross Motor Function Measure (GMFM)-88, the Bruininks-Oseretsky Test of Motor Proficiency 2 edition (BOT-2), and the Pediatric Evaluation of Disability Inventory (PEDI) were administered before and after the intervention, and in the Group-TOT, 16 weeks after the intervention. Children in the Group-TOT showed significant improvements in the GMFM-88 standing and walking/running/jumping subscales, the BOT-2 manual dexterity subscale, and the PEDI social function subscale (p < 0.05); changes were maintained 16 weeks after the intervention ended. In contrast, the comparison group improved in only the BOT-2 fine motor integration subscale (p < 0.05). The findings provide evidence of effectiveness of group-TOT in improving gross and fine motor function, and social function in children with CP.
Topics: Activities of Daily Living; Cerebral Palsy; Child; Child, Preschool; Disability Evaluation; Female; Group Processes; Humans; Male; Motor Skills; Physical Therapy Modalities
PubMed: 31339403
DOI: 10.1080/01942638.2019.1642287 -
The Veterinary Clinics of North... Aug 2022Rehabilitation of the neurologic horse represents a unique challenge for the equine practitioner. Improving postural stability and balance control through improving the... (Review)
Review
Rehabilitation of the neurologic horse represents a unique challenge for the equine practitioner. Improving postural stability and balance control through improving the strength of the spinal stabilizer muscle multifidus remains one of the most promising rehabilitative targets. This muscle can be targeted through the use of physiotherapeutic exercises, various forms of perturbation, and even whole-body vibration. Neuroanatomic localization and diagnosis specificity enable the practitioner to determine suitability for such rehabilitative tasks, and with the advent of evolving strategies and commercially available equipment, the bandwidth for professionally guided programs is continuously being developed and is expected to improve traditional outcomes.
Topics: Animals; Exercise Therapy; Horse Diseases; Horses
PubMed: 35810152
DOI: 10.1016/j.cveq.2022.05.007 -
Journal of Hand Therapy : Official... 2022Invited review. (Review)
Review
STUDY DESIGN
Invited review.
BACKGROUND
Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments.
PURPOSE
The purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder.
METHODS
A search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review.
RESULTS
This review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation.
CONCLUSIONS
The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.
Topics: Humans; Shoulder; Activities of Daily Living; Osteoarthritis; Shoulder Joint; Occupational Therapy
PubMed: 35918274
DOI: 10.1016/j.jht.2022.06.008