Rehabilitation Medicine

Rehabilitation Medicine

  • Paul Trégouët added an answer:
    Can anybosy suggest ACL protocol guidelines for rehabilitation for better recovery?

    can any one help me . with recent articles on acl rehabilitation for clinical  practitioner rule

    Paul Trégouët · RTI Surgical

    May I suggest doing some of your own homework before posting such questions.

    I just typed acl rehabilitation protocol into Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/?term=acl+rehabilitation+protocol

    A general web search returned these results: https://www.google.fr/search?q=acl+rehabilitation+protocol+filetype:pdf&ie=utf-8&oe=utf-8&gws_rd=cr&ei=IPuXVI6HL-eE7gb_wYDYDg

  • What is the most important muscle to resistance exercise in rats?

    In the context of ladder training.

    Hi Mohsen Javidi

    Well I can't say if the attached papers and link are good/bad because the subject does not fit with my interest field, please check them.
    With my best regards

  • Sirbu Elena 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.
    Sirbu Elena · West University of Timisoara

    Thank you!

  • Thirumugam M 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...
    Thirumugam M · German Leprosy & Tb Relief Association

    You may modify the FIM (Functional Independence Measure) scale/FISH (Functional Independence Score in Hemophilia) for activity assessment.

  • Filipe Abdalla dos Reis added an answer:
    For chronic plantar fasciitis: let`s describe the risk factors (causes) and link to interventions?

    The major problem on this issue is that "plantar fasciitis" has multifactorial causes and risk factors. The interventions are (or must be) related to those. Suggestion to answers:

    Cause or risk factor: NEURAL (article by Alshami et al. A review of plantar heel pain of neural origin: Differential diagnosis and management. Manual Therapy 13 (2008) 103–111)

    Cause or risk factor: Delayed pronation... and go on

    Filipe Abdalla dos Reis · Universidade Anhanguera-Uniderp

    I think that all comments are very interesting and I attach a paper published in JOSPT for us.

    Hugs 

  • Paul B Gerrard added an answer:
    Does anyone know where to find conversion formulas to convert SF12v1 answers to SF12v2?

    In the SF12v1, four items are 2-level.

    In de SF12v2, those items are 5-level.

    I would like to know how I can convert the answers on the SF12v1 to the SF12v2.

    Paul B Gerrard · New England Rehabilitation Hospital of Portland

    To be frank, I don't think there is a good way to do what you want to do. Here are a couple of options to convert SFv2 to SFv1 (the opposite conversion).

    1. If you can find a study that does some type of item response theory or Rasch analysis on both v1 and v2, you can use the thresholds for the 5 level items and the 2 level items to condense the 5 level items to 2 levels.

    2. If you cannot find this, then you can simply condense 5 levels to 2 levels using pre-specified rules. You can either make these rules up a-priori or you can do some preliminary analysis on the data to see if there are some natural splits in the data (some IRT). This may not a great way to do things, but sometimes you have to do things that aren't great and accept it as a limitation of your study.

  • Dilek Şura Özden 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.
    Dilek Şura Özden · Hacettepe University

    Dear  Francisco García-Muro San José, paper you shared said that ultrasonic imaging can help muscle to improve its theraphy, am I wrong? I am quite interested in this technique to use as a theraphy, if it is possible, I need to get more information then, many thanks for now

  • Mark Scheper added an answer:
    Does anyone know of an established Hand-Myomometry Micro-Fet Placement for testing the posterior head of gluteus medius in a side lying position?

    I am looking for an established micro-fet apparatus placement on the lower extremity during a hip abduction test in side-lie position. I've seen several different methods (a certain number of centimeters vs. a percentage of the leg length). 

    Does anyone have a method that they use that is easy and consistent? 

    Great Thanks! 

    Heidi Moyer, SPT

    Mark Scheper · Academic Medical Center (AMC)

    hi,

    I wouldnt know if there is a real specific best way of assessing that specific muscle function. You could try at looking at the website of CITEC. That a simular device which has a open sourche manual with testing positions.

    If not than i would suggest that you use the percentage method above the exact inches protocol. This accounts for anatomic variation. I use this a lot in my research.

    Good luck

  • Shiraz Jamal Khan 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?
    Shiraz Jamal Khan · Hayatabad Medical Complex

    Did you be any chance screen her for malignancy. They may come late at times and may stay occult for a long time. Symptoms may dictate but at times there may be none. Non responsiveness may mean this.

  • Karl Bechter added an answer:
    How would you distinguish Central Sensitization of pain (CS) from Complex Regional Pain Syndrome (CRPS) for injury-induced pain?

    Both appear to involve allodynia, hyperalgesia. Do they both also involve reduced threshold for pain, peripheral and central hyperexcitability, recruitment of other sensory motor pathways, convergence and increased brain receptive field size for pain? What clinical features would you use to distinguish them diagnostically?

    I am writing up a case report of manual therapy for what appears to be centrally sensitized pain and wonder if I can cite relevant literature from both topics? I am seeking to develop a hypothesis of the mechanism, since I do not find research on similar treatments.

    I realize CS also includes whole body pain, such as from fibromyalgia, osteoarthritis, and pain not associated with peripheral injury such as migraine. I am specifically referring to injury-induced pain.

    Thank you for clarification and any suggestions!

    Karl Bechter · Universität Ulm

    Differentiating central from peripheral pain seems to me often impossible because both is most frequently present, although it has been proven, that exclusive central pain can be elicited. The anatomical distribution of symptoms in fibromyalgia syndromes and in neuroinflammation may be explained on the one hand by the nerves and neuronal connectivity, but an intriguing idea according to my opinion is an own hypothesis from unexpected observations in severe depression and chronic pain syndrome treated with CSF filtration: pain and depression disappeared within days, before being chronic for long time (catamnesis of 15 years now in one case). This suggested that CSF itself is signaling. The CSF outflow pathways demonstrated a distribution all over brain and spinal nerves and therefore the appearance can involve the whole body (with only minor asymmetries) depending from CSF flow mechanisms (compare my recent short paper and the previous hypothesis), both needing much more scientific work.

  • Je-Hyun Yoo added an answer:
    Are you with or against arthroscopic management for the meniscal pathology, for example like degeneration in people over 50 years old? and why?

    Lots of authors see that in old age the main cause of pain is osteoarthritis not degenerated meniscus, so what would you do with that meniscus?

    Je-Hyun Yoo · Hallym University Sacred Heart Hospital, Anyang, South Korea

    Arthroscopic management is generally useful and effective in the well-selected patients over 50 years. The main problems in these patients are degenerative meniscal tear or chondral damage (chondromalacia.). We can treat degenerative meniscal tear and grade II-III chondromalacia effectively.

    However,only arthroscopic treatment is inadequate for chronic meniscal root tear with degeneration and III-IV chondromalacia. Especially, meniscal root tear is at high risk of retear due to low healing potential after arthroscopic fixation regardless of the method.  Accordingly, we perform HTO after arthroscopic debridment  in active patients with chronic meniscal root tear accompanied by grade III-IV chondromalacia, and think that this method is very effective. 

  • Marco Rampazzo 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

    Marco Rampazzo · University of Padova

    If you want my mail is rampazzomarco@gmail.com

    if you could collaborate with me I would be very grateful

  • 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.
    Thanks.

    Vishwa
    Bruce Taubman · The Children's Hospital of Philadelphia
  • 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

    YES, I CAN BE HEREDITARY/GENETIC DISEASE...E.G HEREDITARY SPASTIC PARAPLEGIA...    http://www.sp-foundation.org/understanding-hsp-pls/hsp/

  • 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)........

  • 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!
  • 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 · Lund University
    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.
  • 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 (paperwristbands.com), 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.
  • 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?

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