Rehabilitation Medicine

Rehabilitation Medicine

  • Heinz Lohrer added an answer:
    Any research to Osgood Schlatter syndrome rehabilitation?

    I'm working on my thesis to define a protocol for the rehabilitation of Osgood Schlatter syndrome. Are there people who study this syndrome? Is there someone who has the references? Thanks

    Heinz Lohrer · Sportmedizinisches Institut Frankfurt am Main e.V.

    Dear Marco,

    we performed an ESWT study on M. Schlatter:


  • Bruce Taubman added an answer:
    Are mild TBI pediatric patients usually tested with head-shaking at 1-2 weeks as standard practice?
    If one can perform 'Head-Shake Test' (HST) to examine Vestibular deficit after a child has suffered concussion, specially during the acute stage (1 week post injury)? Will there be any risks involved? I suppose child can feel dizzy due to the repetitive head shake but again it is REQUIRED to shake the head to stimulate the vestibular canals. Need suggestions.

    Bruce Taubman · The Children's Hospital of Philadelphia
  • Neha Parikh added an answer:
    Can anyone help with treatment for Dermatomyositis?
    I have a patient who has dermatomyositis for the last four years. She is on steroids since then, but has lot of side effects. She has tried alternative medicine too but there was no change. Whenever her rheumatologist tries to reduce her dose of steriods, her CPK levels increase and she has to increase the dose again. She has developed lot of severe tightness in her calves and has difficulty walking too. Shes thinking of looking into stem cell therapy too. I am giving her physical therapy for her calf and also general flexibility. What else could help?

    Thank you all for your inputs.

  • Loh Ping Yeap added an answer:
    Can anyone give me advice on conservative treatment of lesions in TFCC due to overburden and delayed recovery?

    The TFCC with its discus, ulna-carpal joint and ligaments is crucial for stability and mobility of the wrist. Due to its anatomic complexity it is submitted to delayed generation when it is injured.

    Expected lesions in the TFCC in young pregnant woman are due to overburden of extension-pronation stance of wrist after a long bicycle-trip.


    Loh Ping Yeap · Kyushu University

    Last time when I worked in Hand therapy team, we fabricate TFCC splint to support the wrist joint, splint provide a more rigid support and limit the wrist pronation/supination. Subsequently change to the TFCC soft strap (as mentioned by others) during day time.

    Other than exercises mentioned by other authors, the exercise programme include the use of Exercise ball for wrist stability training. You may check the research paper by Marc Garcia-Elias regarding the exercise ball.

    good luck.

  • Vasilios Garatziotis added an answer:
    Can paraplegia be categorised under neuromuscular diseases?
    W hat is the exact definition of neuromuscular disease? Genetic conditions as muscular dystrophy and myopathies, cerebral palsy are considered as neuromuscular disease but is acquired spinal cord injury come under the definition of neuromuscular diseases.
    Vasilios Garatziotis · Technological Educational Institute of Athens


  • Jan-Paul van Wingerden added an answer:
    Why does the primary somatosensory cortex change in (some) chronic pain patients?
    There is a vast amount of literature on how the somatosensory cortex changes in chronic pain. What is less clear is WHY this happens. What is the purpose. What is the brain attempting to perceive? Pain is a means, not a goal, so creating pain sensations cannot be the purpose. Then what is? Do we consider this a physiological or pathological response?
    Jan-Paul van Wingerden · Spine & Joint Centre

    Dear Rosi,

    I agree with your perspective! This approach to how the mind works might provide therapeutic entrances, or explain why some interactions work.

    We collect psychosocial data to a small extend. We could though implement specific questions in this area for future patients. (500-700 per year)........

  • Saddam Kanaan added an answer:
    Is Kinisiotape a science or an art?

    I can see more PT are incorporating KT in their treatment and I can see it on athletes in different competitions. However, there is a lack of  evidence of KT effectiveness.

    Saddam Kanaan · Jordan University of Science and Technology

    Apparently from your input we still studying the KT and we should wait for more studies, before assuming effectiveness of KT. Looking forward to see your results on the cortical excitability, it seems interesting study. 

  • Robyn Capobianco added an answer:
    Can anyone suggest any papers on the use of dynamic ultrasound to determine the effect of kinesiology tape on soft tissue?
    We recently acquired a dyanamic ultrasound machine and are performing some preliminary assessments of soft tissue changes using yoga tune up balls and kinesiology tape. I'm looking for literature to help inform study design.
    Robyn Capobianco · SI-BONE
  • Alexandra Portlock added an answer:
    Are there any recommendations concerning physical activity after hip replacement?
    A patient I follow has a double hip replacement and experiences pain. He refuses to walk for that reason. Isn't walking recommended? Any articles on this subject?
    Alexandra Portlock · Université de Montpellier 1
    Thank you very much!
  • Michael Linowski added an answer:
    Can anyone help me with a questionnaire for the investigation of low back problems in adolescents?
    I need this questionnaire for investigate the low back pain in adolescents. Please send me suggestions for a reliable questionnaire.
    Michael Linowski · Rehabilitation-Education-Pedagogical Centre
    Personally, I use Oswestry Low Back Disability Questionnaire. Quite good measure.
  • Rosi Goldsmith added an answer:
    What exercise program is suitable for a patient with fibromyalgia?
    I would like to include a patient in my walking program. However, he has fibromyalgia and experiences pain in his legs. Can he still gets benefits from walking? What training recommendations would you make?
    Rosi Goldsmith · Integration Massage
    Visual Analogue Scale, often used for patients to rate pain or distress from other symptoms. Can be numerical, with 0 to 10 marks, 0 being no pain, 10 the most pain a person has ever experienced, or smiley face/sad face at ends of the scale.
  • Deborah J Hilton added an answer:
    Does any one have a "healing room" for staff in the hospital?
    Does any one have a "healing room" for staff in their hospital?
    Deborah J Hilton · Deborah Hilton Statistics Online
    I once went to a healing room session and some idiot told me I was possessed given I was upset, that did more harm then good, so much for healing, more like a catastrophe created. I just look at nature if I need healing that is the best medicine.
  • Pao Yen added an answer:
    A chair-bound stroke patient who decided to walk slowly to bathroom 30 times a day shows health improvement after 1 year. How do you explain this?
    The subject male, who is 80+ years of age, has had swallowing disorder plus weak muscles since his stroke(s) which happened 4 years ago. Now, both his skin colour and cognition have improved a lot from a year ago. The main difference from previous years is that he goes to bathroom (10 feet away) about 30 times a day for cleaning and clearing up his throat. He also seems to be ready to talk very soon. I won't be surprised that he can eat again in a few years time. I could explain this phenomena with my Pao's Law of Exercise which is deduced from my taichi healing theory in 2013 (see attached). This is all about the raising of heart rate moderately 30 times a day and each time after the heart rate is increased, he would sit back to his chair and rest. At that instant, the higher heart rate would push blood to all capillaries until heart rate drops too low after a minute or two. If we assume that he would get a 1-minute time interval of good microcirculations for each bathroom visit, he could accumulate 30 minutes in one day. This is exactly the same as doing a 30-minute set of EXTRA slow taichi (for brain and most tissues, but not so true for muscles), or 30 sets of regular speed taichi (for all tissues).

    Some healthy looking people would prefer to spend 3 to 4 hours a day to play 18 holes of golf. This is good but not good enough. If they have chronic diseases, I would suggest that they should play 30 holes, according to my theory.
    Pao Yen · University of California, Berkeley
    I must clarify again. We are not discussing about mobility and muscle cells here. We talked about internal organs. To me, muscle cells in skeletal muscles are easy to handle because they do not have the same microcirculation dilemma problem as in organ cells. Anyway, I checked thru all the interval trainings available to date but they are all for muscles. So, I wrote my own interval training for internal organs (see below). After you read it, you'll understand why some people can get well by doing certain exercises but other people cannot get the same results. The reason is that they don't tell you what they do for the rest of the day. There is a big difference if you just sit or go here and there for the rest of the day. Anyway, let me know your feedback.
  • Lance Goetz added an answer:
    Is anyone aware of any guidelines on the management of osteoporosis in spinal cord injury ?
    Osteoporosis in spinal cord injury
    Lance Goetz · U.S. Department of Veterans Affairs
    There is no LONG TERM proven therapy to prevent the inevitable loss of bone. Bisphosphonates have been shown to help in the early phase. Standing, electrical stimulation and vibration therapy are being studied. The risk of fracture with standing activities is not known but is felt to be very low.
  • Which are the most used and recommeded assessments of mobility in geriatric patients?
    In order to measure dependability in mobility for elderly patients being cared for in community homes or in hospital, which assessments should be used?
    Kristina Areskoug Josefsson · Värnamo Hospital
    Thank you, we regularly use TUG and 6 min walk test, but the DGI is new to me.
  • Nachiappan Chockalingam added an answer:
    Can anyone recommend some pressure insoles for gait analysis in adults?
    I need wireless pressure insoles for a study of gait disorders on elders.
  • Nachiappan Chockalingam added an answer:
    Which standard tool can I use to assess the quality of life of children with disability due to leprosy (peripheral neuropathy)?
    Leprosy is a chronic infectious disease which affects skin and nerve. It is the nerve damage that sets this disease apart from other conditions. When nerve damage is not detected early enough it may lead to permanent damage, as a result deformities (claw hand, ape thumb, foot-drop etc) and sensory loss. When not cared properly these primary impairments can lead to secondary impairments like contracture, wounds etc.. There is no tool I could find the problem faced by children with disability. Can you help me in getting the right to tool to assess the activity and participation level of a children with disability due to leprosy...
  • Michael S Orendurff added an answer:
    What is the most appropriate accelerometer outcome measure to use for clinical populations?
    There is little in the way of evidence using accelerometers in post-surgical cancer patients and their physical activity. One previous study used MET hours but I find this clumsy. I have access to extensive accelerometer data, but would like some input. Do I use "step counts" or "time spent in moderate level activity or above". Also, as some of our patients will not be compliant with wearing for all 7 days, do we take an average per day over the course of the wear period?
    Michael S Orendurff · Orthocare Innovations, LLC
    StepWatch has been used in more than 130 peer-reviewed publications, most of these in pathologic populations who have slow gait often missed by other wearable sensors. Here are two papers using StepWatch in individuals with diagnoses of cancer:

    1. Knols RH, de Bruin ED, Aufdemkampe G, Uebelhart D, Aaronson NK. Reliability of ambulatory walking activity in patients with hematologic malignancies. Arch Phys Med Rehabil. 2009;90(1):58-65.
    2. Winter C, Muller C, Brandes M, Brinkmann A, Hoffmann C, Hardes J, Gosheger G, Boos J, Rosenbaum D. Level of activity in children undergoing cancer treatment. Pediatr Blood Cancer. 2009;53(3):438-443.

    I think you should be very careful in choosing an appropriate monitor, and an appropriate metric. If you pick a monitor that consistently fails to records very slow walking, it will underestimate activity level and you will not see small improvements in recovery after surgery until much later when near normal levels of walking speed and duration return.

    I have been keeping the StepWatch in place on participants using tyvek wrist bands (, that ensures they never forget to put the monitor on. They can shower with it, and replace the velcro strap afterwards, keeping it dry.

    I think recording activity levels for a prolonged period with large participant numbers is necessary for validity. Day to day variance in activity level has not really ever been reported, but for some populations daily CVs of 30% for some measures are common. There is now data on the effect of seasons in those with limb loss.

    Halsne EG, Waddingham MG, Hafner BJ. Long-term activity in and among persons with transfemoral amputation. J Rehabil Res Dev. 2013;50(4):515-530.

    This suggests that 4 days of sampling activity may not be a valid sample of ones activity level, especially if the time course of recovery from surgery takes weeks or possibly months. There is no data here, so you can be the first.
  • Richard W Bohannon added an answer:
    Has anyone used Global Rating Scales to detect minimal clinically important change in exercise/rehabilitation research for people with MS?
    I am planning a small study to determine MCIC in seven outcomes relating to the WHO ICF framework following 12 months engagement in a community-based exercise programme. I am struggling to either find or construct a form of GRS that captures changes in patient-perceived disability in people with a progressive health condition to use as a criterion comparison. For example, do I use the word disability or health?
    Richard W Bohannon · University of Connecticut
    Global rating scales have been used as an anchor to determine minimal clinically important differences in gait speed- an important outcome in its own right. Fulk et al used a global rating scale for patients with stroke. Others have used alternative anchors:
    Paltamaa et al used change in an SF 36 score for patients with MS.
    Alley et al used change in an SF 36 for patients with hip fracture.
    Palombaro et al used change in Timed Up-and Go for patients with hip fracture.

    Alley et al.Meaningful improvement in gait speed in hip fracture recovery. J Am Geriatr Soc 2011; 59: 1650-1657.
    Fulk et al. Estimating clinically important change in gait speed in people with stroke undergoing outpatient rehabilitation. J Neurol Phys Ther 2011; 35: 82-89
    Paltamaa et al. Measuring deterioration in ICF domains of people with multiple sclerosis who are ambulatory. Phys Ther 2008; 88: 176-190.
    Palombaro et al. Determining meaningful changes in gait speed after hip fracture. Phys Ther 2006; 86: 809-816.
  • Margarida Sizenando added an answer:
    Is extracorporeal shockwave therapy in neurological patients a good tool to treat spasticity and improve ROM and tonus ?
    A few papers have been published suggesting that ESWT could work and reduce spasticity in neurological patients- my own experience tells me the same - mechanism of action is not yet established - what can you tell me about?
    Margarida Sizenando · Clinica Margarida Sizenando
    Thank you for all the answers and comments.
  • Panayot Tanchev added an answer:
    How can we prevent falls in patients with rheumatoid arthritis?
    Patients with rheumatoid arthritis are more prone to falls due to their muscle and joint characteristics.
    Panayot Tanchev · Medical University of Sofia
    I agree with the colleagues above as far as exercises, balance training, muscle training,streching, etc. are concerned. Generally speaking, this will be helpful to prevent falls and fractures, respectively. On the other hand, I disagree with the opinion of Mahammadreza Nematollahi that "slow walking speeds can be a major contributor to falls". On the contrary, I advise my patients to be careful when walking, to avoid quick steps and harsh movements, rapid change of direction of walking, etc. The arrangement of their house, living room should be simple, with more free space, less furniture, no slipping carpets, appropriate bathroom flour, etc. This is important too.
  • Vijay Batra asked a question:
    Is there difference between Myositis ossificans & Heterotophic Ossification
    Are they Synonyms
  • Yannick Bleyenheuft added an answer:
    Can anyone suggest how to assess social communication in autistic children?
    I am interested in assessment of social communication of children with autism, but I would like develop alternative assessment methods from questionnaires.
    Yannick Bleyenheuft · Catholic University of Louvain
    Hi I don't know for social communication, but maybye you could be interested to use a questionnaire of social participation. The LIFE-HABIT is a generic questionnaire, validated for pediatric population, and could be used for that purpose. (Noreau et al., 2007).
  • Manisha Rathi added an answer:
    What validated outcome measure or questionnaire could be used to assess the quality of life in the general population?
    I am trying to start a prospective study in a medical exercise facility, which provides pro-active solutions for general health (fitness level, weight management, injury prevention, back pain and sport injury rehab). I am already using basic health screen tools, such as Funcional Movement Sceen (FMS), body composition analysis (Tanita scale) and Astrand Test for VO2 max estimate, but I need a questionnaire to complete this package. Any suggestions?
    Manisha Rathi · Dr. D.Y. Patil Vidyapeeth, Pune
    SF 36
  • Cynthia Johnson added an answer:
    Program management or centralized department: Is there evidence that one results in better patient outcomes?
    Does the structure of disciplines within a healthcare organization/program impact on the outcomes for the patient - decreasing length of stay, better discharge outcomes.
    Cynthia Johnson · Alberta Health Services
    Thanks. What benchmarking instrument do you use? Would it be applicable to acute care, not just a rehabilitation hospital?
  • Cara H O'Connell added an answer:
    Does there exist a standardized way for doing the 2 Minute Walk Test?
    I plan doing a multicentre study on lowerlimb amputees. One of the performance based tests I plan to do is the 2 Minute Walk Test. I wonder if any proposal exists for using a standardized route to easily measure the distance walked? I only found an "8"-shaped route proposed which I really think is good but that needs a lot of space (and I am afraid most of the centers will not be able to provide the space needed).
    I thought of suggesting an oval shaped way to the participating centers but I am not sure if it is problematic if the patients walk one way only for 2 minutes.
    Has anybody has experience in conducting this test with amputees? Is a change in direction possible or would this waste too much time?

    I look forward to your recommendations and I am curious on your experiences!
    Cara H O'Connell · Central Carolina Hospital
    Benefits of the 2-Minute Walk Test
    Vol. 16 •Issue 16 • Page 6
    Geriatric Function
    Benefits of the 2-Minute Walk Test
    By Carole Lewis, PhD, PT, MSG, MPA, GCS, and Keiba Shaw, EdD, MPT, MA

    This article was very explicit in the protocol they used.
    ... Conducting the Test
    Administration of the 2MWT is similar to the 6- and 12-minute walk tests, with the exception that a hallway or corridor shorter than 100 feet may be used. In most instances, a 25 meter hallway is adequate. To control for training effects, practice trials should be conducted prior to actual test administration and encouragement needs to be standardized.11 To minimize the effects of pacing, the test administrator should not walk directly beside the individual.7,8 Individuals should be given the instruction to walk as far as they can, stopping to rest if needed. The distance walked in meters is recorded at the end of two minutes.
  • Wolfgang Seger added an answer:
    In which ways do you measure/ record 'work status' with your patients/ clients?
    Which scales/ instruments/ questions do you use to record work status?
    Wolfgang Seger · Medical Health Advisory Board of Social Health and Long Term Care Insurances in Lower Saxony / Germany
    Please see attachment
    Criteria for a workplace anamnesis
  • Javier Orquin added an answer:
    Is there an instrument to assess the proprioceptive mechanisms of athletes?
    Many authors use a force platform for balance ability of athletes. But do we know if there is an improvement of proprioceptive sensory receptors in our joints and muscles?
    Javier Orquin · Universidad Católica San Antonio de Murcia
    Thank you very much for your answers. I'd like to meet some study to investigate the response of nervous (mechanical reflex measure), but I just find balancing studies. Could you give me some literature? any citation?
  • Safaa A. Mahran added an answer:
    What then is/are the best treatment option(s) for cluneal nerve syndrome and can it be isolated?
    What then is/are the best treatment option(s) for cluneal nerve syndrome and can it be isolated?
    Safaa A. Mahran · Assiut University
    dear Daniel , the following site could be helpful :
  • Mohamed Sakel added an answer:
    What is the connection between EQ score and work ability?
    Is there a suggested cut-off in EQ-score, for having work ability and/or not being at sick leave? I´m looking for references.
    Mohamed Sakel · University of Kent
    EQ-5D is used as a generic measure of "Health related Quality of life" with >100 versions to cater for language variations eg Canadian English vs US English. It's used to establish 1 aspect of Health Economic Evaluation of new intervention eg a drug. I've used this in 2 multi-national RCT. Insensitivity is more than outlined by the above comments eg

    1) Mobility could be either "no problem in walking" / some problem / no problem. 100s of possibilities exists in between !! Also, walking is not synomimous to mobility. This contradics WHO- ICF Clasification of functioning that Rehab Medicine & others have embraced as the fundamental principle inarticulating impact of human illness.
    2)EQ-5D measurs "health status" in 5 domain each having 3 possible respons so a human being could have 3 to the power 5 possible health status. That's rather a reductionist to say the list.

    3)I've assessed EQ-5D on about 100 occasions. It varies on so many variables including mood ( cuurent & past), social factors, cognitive impairment, the the other EQ ( Emotional Quotient) & importantly fluctuates. Typically, the reserach asks the EQ over the preceeding 4 weeks.

    4) There is danger in using EQ-5D since this is used to calculate cost-Qualy which sets a threshold to decide whether an intervention is considered "cost-efective" ie value for money. So, policy makers can deprive a worthy intervention & dysqualify a good one. Usually, so save expenditure.

    5) As a practicing neurorehab consultant, I can attest to the view expressed by KT above. Employability depends on a multitude of factors which are mostly out side EQ-5D. And, going back to the domain 1 ie mobility-------u may not walk but be very mobile. That's part of "reasonable adjustments" provision for the employer & is enshrined in statutory Law within Disability Discrimination Act ( DDA). Well, Prof S Hawkinge did a space jump ! How many of us able bodied would be "physically" fit for that.!

    I wish u well in your dissertation.

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