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# Physical Therapy/ Rehabilitation Science - Science topic

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Questions related to Physical Therapy/ Rehabilitation Science
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Some researchers are of the opinion that isokinetic contractions are too isolated to be used in functional rehabilitation, while others believe that isokinetic rehabilitation provides unique advantages during the rehabilitation process.
Dear Leon,
first of all a great question !
Looking sincerely at the relevance of a specific intervention , I always focus on the corresponding goals, which demand various levels of action. For example a very general question: Can then patient climb stairs? Answer: Yes or no -just by observation.
Once the questions get more specific, the evaluation becomes more specific. So what about arthrokinematics ? This will demand a highly skilled manual therapist.
So what about neuromuscular performance ? This can be started by detailled funtion tests, but needs to be further assessed by testing systems with higher standardisation etc. To me this implements isokinetic systems and several other devices as well.
And by the way one could drive your relevance question even further: How in the world do most people test only concentric performance ? Isn't eccentric activation more relevant ? Isokinetic systems can not be operated by pulling up programms and one test for all just clicking OK? To me, this is why you ask about relevance ? There are so many specific aspects in testing for specific questions and goals. It is up to all of us users worldwide to move on into a finetuned way of using isokietic systems.
We work with three diffrent isokinetic systems for over 30 years. We are clinicians who have a clear picture of the relevance & limitations of isokinetic systems.
Also there have been many moves towards the enhancement of quality application. Unfortunately very little of this is found in the mainstream of scientific publications. Many great scientific groups start great research projects,
but once it comes to details such as isokinetic test designs & parameters it's like travelling back 30 years.
Manuela
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I ask because infrared therapy seems to be a controversial modality in physical therapy management
Marginal effects have been observed. There is also a strong placebo effect.
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i have treated the both and didn't really noticed any big difference. its just the size of the incision which will make the pt feel more pain. unfortunately, i couldn't find any articles regarding pt management for such case and i do believe sooner or later this case should undergo for research.
Yes i also agree that there is gap in research to find out the post surgery pulmonary complication which i think might have a difference in outcomes.
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I am working on a case study entitled the effect of osteopathy treatment and its effect on the pregnant women suffering from carpal tunnel syndrom. It is a comparison study relating to the benefits of osteppathy vs physical therapy vs traditional medicine. And concluding at the end with a comparison between alternative medicine (osteo or physio) vs traditional medicine of their effects.
Hi Khalil,
Since the pathophysiology of Carpal Tunnel Syndrome (CTS) remains the same in pregnant women and non-pregnant women, I think you will be able to use a broad range of articles for your case study. In both situations, CTS is caused by changes in the carpal tunnel anatomy that lead to an elevation of pressure causing compression of the median nerve (1). These causes are multifactoral and can be classified as anatomic, occupation and systemic (whereby pregnancy can be a systemic cause of CTS) (1). However, an important note is already been made by Bart de Swaef, due to the abnormality in hormone balance in pregnant women, it may be more difficult to resolve the cause of CTS in this population.
• Comparison between manual therapy and electrophysical modalities on patients with mild and moderate CTS on the following clinical outcomes; nerve conduction, pain severity, symptom severity and functional status. Conclusion: Both therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in individuals with CTS. However, the results regarding pain reduction, subjective symptoms, and functional status were better in the manual therapy group. https://www.ncbi.nlm.nih.gov/pubmed/28395984
• Since you want to investigate traditional medicine as well; a RCT of surgery vs. steroid injection for CTS. In this article it was concluded that surgery resulted in better symptomatic and neurophysiologic outcome in patients with idiopathic CTS compared to steroid injection. https://www.ncbi.nlm.nih.gov/pubmed/16567731
• Since you are interested in the effect of osteopathy on CTS: an article about anatomy, cause, signs and treatment from an osteopathic perspective. http://jaoa.org/article.aspx?articleid=2094358
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Hello everybody!
I´d like to use kubios software on my mac to analyze the hrv-data from a 24h record with firstbeat´s bodyguard 2...
Is there a way to do that without the firstbeat-server, just on the mac?
Christian
Hi Matej!
You can't import raw data on your Mac without an server-account of cubios...
If you are using a PC, there is no problem. Just get the software for free...
Enjoy!
Best regards
Chris
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Procedure, Reliability, Validity
Hi Shakil:  I spoke to two of my colleagues involved in the force sensing table project and they suggested you could email them directly.  Dr. Jay Triano can be contacted at jtriano@cmcc.ca, and Dr. Sam Howarth can be contacted at showarth@cmcc.ca.  Both of these gentlemen can be found on Researchgate as well.  Good luck with your project.
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Currently, I am working on a Master thesis project which focuses on the development of a business case within the realm of Telecare. The aim is to deliver a product or service (potentially a game platform) that stimulates children with impaired mobility to improve their physical fitness level. I have found a lot on impaired mobility, games and telecare but no specific articles in which I can see or find a link to physical fitness. If anybody could point me in the right direction that would be greatly appreciated. (I have been searching on Business Source Premier, maybe this is not the right search engine for the topic?).
@Guilliber Carlos Fonseca: Your English was perfectly understandable. :-)
@ Guilliber Carlos Fonseca and Hamdy Elsaid abd elhamed Elnawasry:
Thank you for your article references. I have downloaded them. Having glanced over a few of them I can say with certainty that there are articles that will be of help to me. Thank you very much for your assistance!
Kind regards,
Roy
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A 16 year old football player suffered a knee dislocation. LCL/ACL/PCL tear and lateral meniscus tear. A neurolysis of the peroneal nerve was performed during LCL reconstruction, but patient still has a foot drop without any activation yet. EMG is suppose to be performed this week. I was wondering if anyone had any good research or expertise on time frame of the peroneal nerve? Any help or other information would be appreciated.
Early on what I have found is that utilizing a 2 pad placement with Russian E-stim 2,500 hz 50 pps pulse rate 300 usec width and 4 sec on 12 sec off with a 0.5 sec ramp time for 4 min over the peroneal longus brevus and then over the anterior tibialis each followed by rest for 4 min and then again on for 4 min. Having the patient perform  Active Assistive (with e-stim and/or assistance from the P.T. or towel) to perform Ankle eversion, and then ofcourse move the pads and perform AAROM ankle DF this has helped tremondously. If you have a sEMG unit that is in sync with the e-stim unit with setting and adjusting the threshold for the sEMG to trigger the e-stim that has also worked very well. Or if you have a patterned e-stim unit, I have found that that has worked with  excellent results within one session and very excellent results within 3-5 sessions.  I hope this helps.
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Load bearing activities increase the calcium absorption as it prescribed in all osteoporosis cases. Is there any reliable test to measure the absorption after load bearing exercise? Any supportive articles are appreciated.
Both increased net Ca absorption and increased net bone mineral formation will cause the Ca isotope composition of blood and urine (d44Ca) to shift in a positive direction. This is the natural Ca isotope composition, not anything involving tracers. See, for example:
Channon M, Gordon GW, Morgan JLL, Skulan, JL, Smith, SM, Anbar AD. Using natural, stable calcium isotopes of human blood to detect and monitor changes in bone mineral balance. Bone 2015; 77: 69-74; DOI: 10.1016/j.bone.2015.04.023.
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Is eccentric training an effective treatment approach in the management of tendinopathy?
Dimitri,
Other research suggestions propose that even neuroplasticity may play a role in tendon rehabilitation.
For the 'difficult' patient, it seems that expanded models of clinical reasoning and rehabilitation are required.
George
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In the management of hamstring tendinopathy could be better a training with progressive high-load strenght or general low-load exercise?
In the subacute phase is preferable approach at first with eccentric training or isometric and concentric exercise?
Hi, do you know this recent expert opinion ?
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An 8 years old child experienced upper limb mirror movements after a surgery to correct a bilateral sprengel deformity.
Some of the more related studies include:
1. Investigations into the Association between Cervicomedullary Neuroschisis and Mirror Movements in Patients with Klippel-Feil Syndrome
2. Wildervanck’s syndrome and mirror movements: a congenital disorder of axon migration?
3. Exclusive Lower Extremity Mirror Movements and Diastematomyelia
Aamir
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What are the best patient reported outcome measures for therapeutic taping?
Agree, would be a good idea, What topics? Patient outcomes measures or other topics also?
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Can anyone suggest info or any article about Shoulder Girdle strength training and range improvement protocol on  post  Surgical case of Enchondroma/cortical chondroma lesion on the right proximal humerus With a full thickness tear on the rotator cuff (bursal sided supraspinatus)
Hi Vijay
To help you more effectively I would need more information on what you need; is it muscle strength and/or dynamic control? Are you looking for scapulothoracic- and/or glenohumeral-fcused exercises? To be even more subject-specific on the recommendations - just with more information on the clinical case and outcomes (i.e. to improve pain, restore function, scapulothoracic and/or glenohumeral neuromuscular activity and control).
Nevertheless, I am pointing you some full-papers papers that you can find here in RG on specific exercises, protocol's effectiveness, scapula involvement in multiple shoulder injuries, reasoning algorithms and assessment overview with focus on dynamic control. Although they are not focused on 'post surgical case of enchondroma/cortical chondrorma' lesion I believe they can contribute to your question.
I hope it helps you and keep us posted with your progresses.
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ASIA is commonly used, however difficult to grade a muscle when it is spastic. Measures like FMA, Brunnstrome stages are available for cerebral lesions. They may not be appropriate here due to difference in pathology behind movement deficit.
I would encourage you to do a search on rehabmeasures.org  If you entered the search term spinal cord injury - the site will come up with researched outcome measures and give you the validity, cut off scores etc.
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I've found some article on Pubmed (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882994/) but I was thinking specifically to core stability muscle (I had a patient in my clinical internship that was not able to maintain the seated position due to fatigue)
Andrea,  May I suggest a couple article of interest that you may find helpful with pragmatic, clinical applications?  Journal of Rehabilitaion Research & Development (JRRD) Vol 48 Number 5,2011  Decreased Central fatigue in multiple sclerosis patients after 8 weeks of surface functional electrical stimulation.  Ya-Ju Chang, PhD, et.al.  This is an open source article and for further information Dr. Chang's email is yjchang@mail.cgu.edu.tw
An additional article of note is from J Rehabilitation Medicine 2009; 41:674-680.  Functional electrical stimulation-assisted cycling of patients with multiple sclerosis:  biomechanical and functional outcome-pilot study.  Johann Szecsi, MD, et.al.  which suggests that more significantly impaired MS patients may benefit to a greater extent from this type of intervention than those with less functional disability.  A problem as I see it with this study, despite its promising results is that the treatment period ws only 6 sessions total over two weeks.  Even in a health population, this is insufficient for physiological changes of any significance in muscle structure or physiology.  There were improvements in spasticity however that resulted in qualitative improvement in cycling performance.  Professionally, I have seen FES associated with cycling or applied for therapeutic exercise used to great effect to manage tone, with the secondary benefit of promoting better dynamic recruitment and motor coordination by diminishing the increase in tone of the antagonist in response to attempted activation of the primary mover.
I have used the FES cycle described in the second article which has tremendous flexibility and utilization.  It is equipped with up to twelve FES leads that are programmed to time stimulation of select proximal to distal muscles with the cycling activity (for arms or legs) as well as the ability to use the stimulator as a stand alone for therapeutic and functional activities.  The stimulator has a wide range of pulse widths, amplitude and frequency settings that can be individualized for each patient and each stimulation target.  This unit also has the capacity to record and collect session data  discretely and longitudinally for quantitative analysis of performance over time.  The primary us of the cycle (and its development) was for individuals with SCI who would benefit physiologically from exercise, but who were unable to do so without FES and robotic support.  There is a considerable body of research and evidence of support for this type of intervention in that population.  Given the association of spinal cord pathology and disability among patients with MS, perhaps the broad literature for FES cycling in SCI has application in a number of ways to patients with MS.
Looking at devices not associated with cycling, you may want to check this article out; Neuromodulation. 2014 Jan;17(1):75-84; discussion 84. doi: 10.1111/ner.12048. Epub 2013 Apr 19.  A feasibility study to investigate the effect of functional electrical stimulation and physiotherapy exercise on the quality of gait of people with multiple sclerosis.  Taylor P1, Barrett C, Mann G, Wareham W, Swain I.   It is a nice crossover study that shows greater benefit of footdrop and gluteal stimulation for patients with unilateral footdrop who are functioning at a less disabled level that the patients discussed above.   In this study the addition of FES was shown to have added value compared to PT only.
Additionally, single channel FES devices may have significant impact among the MS population who are higher functioning (Walkaide, BIoness L300, Odstock to name three) by providing timed sensorimotor stimulation for issues related to foot drip whether from primary motor weakness, decreased sensory input or dynamic recruitment and tonic issues.
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Polypharmacy is a common finding among older adults with multiple chronic conditions. Medication interactions could lead to potentially serious adverse drug events. Moreover, adverse drug events could be mistaken for a new disease symptom resulting in additional medication prescription. Since PTs usually see older adults with multiple chronic conditions, it is important to assess for polypharmacy and its associated adverse drug reactions as part of the plan of care. Do you know of any evidence in the primary literature investigating this particular role of PTs and its effect on patient care?
You have to know what and who is in front of you and suspend prejudice. Patients will engage with denial to deal with painful emotions and that is survival also for some. If you can make a good relationship and trust is there then all good.
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People with chronic obstructive pulmonary disease have sedentary life style due to the clinical course of their disease.Although there is current update on physical activity measurement tool, has anyone have used motivational stratergies to improve physical activity in those patients?
Dear Shakila,
Currently, I am working on the 'Rehabilitation, Sport and Active lifestyle' (ReSpAct) study. This is a multicenter, longitudinal cohort study in The Netherlands that evaluates a physical activity and sport stimulation program. The program aims to stimulate an active lifestyle in persons with a physical disability and/or chronic disease subsequent to the rehabilitation period.
Also patients with COPD have the opportunity to participate in the program when receiving treatment in a hospital or rehabilitation center that offers the program. An important part of the program consists of tailored counseling based on motivational interviewing (MI). These counseling sessions are offered by a 'Sports Counseling Center' within the hospital of rehab center.
Patients receive one face-to-face conversation and four telephone counseling calls by a counselor. During patient contact, the counselor makes use of MI. With the different conversations, patients are supported and guided in maintaining an active lifestyle in the home environment. The stages of change serve as the basis of the conversations and help the counselor to guide patients in their process of physical activity behavioural change.
The first publication on the ReSpAct study can be found here:
We are currently working on an article with a more detailed description of the program.
Other interesting publications on a similar physical activity and sports stimulation program based on tailored counseling are:
van der Ploeg HP, Streppel KR, van der Beek AJ, et al. Successfully improving physical activity behavior after rehabilitation. Am J Health Promot. 2007;21(3):153-59.
van der Ploeg HP, Streppel KR, van der Beek AJ, et al. Underlying mechanisms of improving physical activity behavior after rehabilitation. Int J Behav Med. 2008;15(2):101-08.
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Power density represents the actual Laser/LED incident power in watts on the tissue and the spot size area (output power divided by irradiated area), while energy density represents the therapeutic dose incident on target tissue and represents the product of output power and exposure time, divided by irradiated area.
Hi Rodolfo. Glad to be helpfull. BTW in the past I served as one of the editors of CIE international Vocabulary of radiometric terms. There is a great mess among life scientists and even optical and lighting engineers about using correct standard terms. A propos, energy density is simply lux (lm/sq.m) and not lux/sq.m as I wrote
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I am looking for studies on SSTMS showing it's effects on quadriceps shortening . The SSTMS could be of any type. The effects should preferably on the length of the quadriceps  muscle .Please include  any experiences and / or studies .
Hi Reda!
You cannot lengthen or shorten a muscle with SSTMS but you might be able to change the patient’s experience. I enclose an article about stretch, hopefully you will find it interesting.
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Dear Reda
J Orthop Res. 2008 Jun;26(6):793-9.
Reliability of the Ely's test for assessing rectus femoris muscle flexibility and joint range of motion.
Peeler J1, Anderson JE.
Abstract
Rehabilitative protocols and orthopadic research are significantly influenced by the ability to perform reliable measures of specific physical attributes or functions. The hypothesis was that the Ely's test for evaluating rectus femoris flexibility and joint range of motion (ROM) is a reliable clinical tool. Participants (n = 54) were between the ages of 18 and 45, and had no history of trauma. Three clinicians with orthopedic expertise assessed quadriceps flexibility and joint ROM using pass/fail and goniometer scoring systems. A retest session was completed 7 to 10 days later. Statistically, Kappa values for pass/fail scoring (intrarater $\bar {X}=0.52$, interrater $\bar {X}=0.46$) and ICC values (intrarater $\bar {X}=0.69$, interrater $\bar {X}=0.66$) for goniometer data both indicated that the Ely's test demonstrated only moderate levels of intra- and interrater reliability. Measurement error values (SEM = 4 degrees , ME = 4 degrees , and CV = 3%) and Bland and Altman plots (with 95% Limits of Agreement) further demonstrated the degree of intrarater variance for each examiner when executing the Ely's test in a clinical setting. Results call into question the statistical reliability of the Ely's test, and provide clinicians with important information regarding the reliability limits of the Ely's test when used to clinically evaluate flexibility and joint ROM in a physically active population. More research is required to determine the variables that may confound statistical reliability of this orthopedic technique that is commonly used in a clinical setting to assess function about the thigh region.
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When a person who weighs 60 kilograms is standing on a flat surface how much percentage of his body weight is applied at different regions of the foot, such as heel, metatarsals, and toes?