Rehabilitation Medicine

Rehabilitation Medicine

  • Jessee Moirangthem asked a question:
    Can anyone suggest a good approach for movement therapy for PTSD?

    I am working with a mixed group of adults with post-traumatic-stress-disorder. Since it is my first time with such group I would like to know any clinical or therapy experts what is the most appropriate way to initiate therapy with such groups and if working on the periphery is a better option rather than going to the depth of the trauma.

  • Tawanda Machingura added an answer:
    Can anyone advise me on an effective Psychosocial Rehabilitation Readiness Assessment?

    I am looking for an effective tool to use for determining who is suitable for entry into a mental health rehabilitation facility/ continuing care unit. A standardised tool will be great. We are trying to utilise the facility for those with the best potential to benefit from mental health rehabilitation. Please attach a copy or link to a tool that you may suggest. Thank you for your help.

    Tawanda Machingura

     Dear Stephen Cheung, Ratish Nair, Harshvardhan Singh and Melissa;

    The responses and resources you provided were great!!! Thank you all so much.



  • Jan van de Rakt added an answer:
    Where is the best electrode position for hand rehabilitation after stroke/ Spinal Cord Injury/ hemiplegic patient ?

    i really confused about where is the best place to put the electrode for rehabilitation of hand, which the place for each muscle in hand is complex and have specific movement each. Example, to make circular wrist movement or extension and flexion elbow joint.

    Jan van de Rakt

    What you want to achieve? The Ness Handmaster make it possible to train with the use of FES. The position of the electrode is than always the same and there is an brace of the tone of the flexors and ( Alon) give task=specific exercises. My position of the elctrode was similar with the Ness handmaster , but when i had an chronic stroke patient I know that you must search for the best position


  • Kartik Parelkar asked a question:
    What is the ideal management protocol you would prefer post tympanoplasty ?

    How long do you keep the mastoid dressing in case of post auricular incision.? Also in mastoidectomy cases when do u remove it? 

    When do you start ear drops ? 

    Do you ask your patients to perform valsalva ? When ? 

    Do you remove the gelfoam or allow it to resolve naturally ? 

    When do you repeat the audiogram? 

  • Tamara Rial Rebullido added an answer:
    Is there evidence of altered muscle activity following ACL reconstructive surgery and if so, has this been indicated as a risk of re-injury?

    Our team is looking for evidence that muscle recruitment patterns are altered following ACL reconstructive surgery which may effect scores on tests such as the Bunkie test, outlined by de Witt and Venter in the attached publication.

    Tamara Rial Rebullido

    The author Greg Myer I am sure will know and has a lot of references about that topic. 

  • Chakri Nasr-Eddine added an answer:
    Why is the threshold comparison method not as reliable as loudness comparison method of Rinne's test ?

    There are 2 ways of doing rinne test .which one is preferable and why? 

  • Igor Radun added an answer:
    A question for fatigue researchers: Best paper(s) for showing different findings in lab versus during transportation?

    A question for fatigue researchers:

    Years ago, Dinges mentioned in a talk that much of the research on fatigue in the transportation setting does not yield the same findings as studies done in the lab. It was a side point that he made briefly and so he did not give examples.

    I am looking for the best papers on this subject, preferably meta-analyses of the two situations or a controlled comparison or, failing those, a good review. I know there are some factors present in transportation, but not in the lab, so that is not my question. Rather, I am seeking some hard evidence pointing to a clear difference between the two situations.


    Igor Radun

    Hi Ben,
    Perhaps this (older) review paper could be of some interest to you although it is not exactly what you look for...
    George, C. F. P. (2003). Driving simulators in clinical practice. Sleep Medicine Reviews, 7, 311-320. doi:10.1053/smrv.2001.0233

    This report could be also relevant although it doesn't deal with driver fatigue. They reported that "Despite similar speed profiles surrounding the speed limit signs, there was a statistically significant difference between the speed in the car and in the simulator, with more rapid accelerations and decelerations in the simulator."

    Ahlström C, Bolling A, Sörensen G, Eriksson O, Andersson A (2012). Validating speed and road surface realism in VTI driving simulator III. VTI rapport 745A. Linköping: the Swedish National Road and Transport Research Institute (VTI).

  • Ihsan Ates 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?
    Ihsan Ates

  • Charles Shang added an answer:
    I am using low level laser for management of musculoskeletal disorders. Anyone else using it ?

    Using laser acupuncture instead of or in addition to acupuncture could help people with musculoskeletal disorders.

    Charles Shang

    Professor Margaret Naeser at Boston University School of Medicine has used laser for a variety of neuromuscular disorders

  • Puya Dehgani Mobaraki added an answer:
    Of the three, i.e. Temporalis fascia, perichondrium and fascia lata, which is the best graft material?

    Depending on the type of collagen the one with the closest resemblance to the tympanic membrane should be ideal. Also the type of collagen varies from centre to periphery ie. Annulus in the tympanic membrane. 

    Perichondrium has special advantage compared to the other 2 materials?

    Puya Dehgani Mobaraki

    Tympanic membrane: temporalis fascia

    Anterior skull base: fascia lata

  • Gregory Zurbay added an answer:
    What is the evidence based duration of rehab intervention for significant clinical change in patients ?

    I want to explore the duration evidence regarding the minimal detectable change clinically or statistically after rehab treatment. if someone do research so after how much time, measurement should be taken, how much intervention and time affects the physiology which bring the real change...

    Gregory Zurbay

    "The first case report of a professional footballer tearing his teres major—an extremely rare injury—is captured in a series of images published in the online journal BMJ Case Reports."

    "He returned to competition level football, with no pain and functional limitation, after 18 days."

    FYI : seems to be quite rapid recovery - considering the circumstance. Again quantification seems fluid - difficult - and possibly benefiting of reexamination.
  • Bastien Fraudet added an answer:
    Does anyone have any experience in electric wheelchair circuits for driving assessment?

    I'm searching for articles explaining protocols for binding a circuit to assess driving for a new intelligent electric wheelchair.

    Bastien Fraudet

    TH X !

  • Mullai Dhinakaran added an answer:
    Which risk factors should we include for prediction of lumbar disc herniation resorption on MRI?

    We're planning a large-scale prospective study on lumbar disc herniation resorption, disc herniation recurrence and pain recurrence.

    The following predictive factors for disc degeneration, herniated disc resorption, recurrence and unsuccessful return to work, etc. came up in our preliminary literature search, and any additional suggestions or ideas would be greatly appreciated. Thank you :)

    Please see attached file for more detailed information.

    General and sociodemographic characteristics: Age, female sex, BMI, smoking, work
    Comorbidities: Hypertension, diabetes mellitus, osteoarthritis, rheumatoid arthritis, osteoporosis
    Mental health factors: Fear-avoidance, depression
    MRI characteristics: Disc containment, herniated disc extent and size, posterior longitudinal ligament intactness degree, modic change, lumbar intervertebral disc degeneration, herniated disc volume, extrusion type herniation, T2WI high signal, caudal migration, annular defect
    Pain-related outcome measures: Duration of symptoms, VAS, ODI, radiating pain, ROM/SLRT, EQ-5D
    Blood/genetic markers: MMPs, COL9A1 gene, COL9A2 gene, COL9A3 gene, IL-1, IL-6, COMT enzyme, serum calcium content, vitamin-D receptor gene
    Injection treatment: Epidural steroid injection, route of injection

    Mullai Dhinakaran

    Leslie J. Waltke, An Overview of Cancer Rehabilitation and Exercise in the Literature:
    Promoting Increased Referrals to Improve Oncology Outcomes.

    link :

  • Ersin Avci added an answer:
    What is the gold standard after abdominal surgery for physical function?

    after abdominal surgery patients have severe problems to maintain their functional status and it is also hard to measure it. now I am working on a physical function test and ı need a gold standart for statistics and measurement.

    Ersin Avci

    Dear Irena,

    Thank you for your long and helpful answer. that are the answers you are looking for;

    1.POD 3 surgery 

    3. mixed surgery (colon resection, hepatectomy, sitoreduktif...vb) 

    I will check your articles ı believe they will be helpful for me.



  • Dartel Ferrari de Lima added an answer:
    In homeless populations, is there a relationship between weight-bearing activity and lower extremity muscle stiffness?

    I wanted to know if there are any flexibility tests I should be looking at to specifically identity if weight-bearing activities (carrying a heavy backpack all day) relates to muscle stiffness, such as lumbar and hamstring muscles. 

    Dartel Ferrari de Lima

    Hi Marina

    I suggest checking out the relationship between weight-bearing and hypertrophy of muscle collagen

  • Remy Verweij added an answer:
    Do you know any article where they compare the subacromial syndrome treatment through a trigger points treatment with other conventional treatments?

    Normally the pain only improve with a trigger points treatment.

    Remy Verweij

    I don't have any expertise on this area. I would like to comment on Ruth Light, pain is never! generated in the muscles but only in the brain. Things like this is the cause of the idea that damage in the body tissue is 1 on 1 related to the experience of pain.

  • Ruth Maria Hendrika Peters 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...
    Ruth Maria Hendrika Peters

    I would also consider qualitative and participatory research methods such as FGDs, interviews and visualisations.

  • Linda Christie Andrea added an answer:
    Is anyone familiar with Strength Training and Range Improvement In Shoulder Joints?

    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) 

    Linda Christie Andrea

    Enclosed you'll find an article from a recent phd-dissertation which might be an answer to what your looking for.

  • 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

    Thank you Francois!

  • Roberto Sandoval added an answer:
    How do I convert raw FIM scores from a sample of patients from their ordinal scale to an interval scale?

     I am looking to convert raw FIM scores from a sample of patients from their ordinal scale to an interval scale so that I can use summary indices that are currently used in the rehab literature.

    A recent paper ( suggests that when using these indices, the raw data should be first transformed to an equal interval scale via Rasch analysis before applying any of the measures designed to assess rehab efficacy using the FIM, due to the fact that their is no way to quantify that one patient's score (e.g. a 5 on UE dressing) is the same as another patient's score of 5 on the same measure, due to inherent patient differences.

    I was hoping that there was a method someone may know of that could be used to easily accomplish this score transformation for someone with limited knowledge of Rasch analysis and Item Response theory as it pertains to the FIM.

    Roberto Sandoval

    There is no avoding performing a Rasch conversion of the scores, for those measures to be considered valid. Velozo et al. list a conversion table in their publication that you may find useful (motor aspect only). Best

  • Amit Bansal added an answer:
    What is your experience of blood flow restriction training and lower limb rehabilitation?

    In terms of efficacy, %1RM and volume

    Amit Bansal

    Here's a link to a relevant and interesting blog post. Looking forward!

  • Fidelis Terhemen Iyor 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?
    Fidelis Terhemen Iyor

    WHOQOL- bref is the answer

  • Sandra Holowaty added an answer:
    What is your experience on the effectiveness of Memantine on someone with a MMSE of 10 to 20? Is it effective for BPSD?

    Is Memantine a suitable drug for those with lower MMSE scores?

    Sandra Holowaty

    That is great information! It does help!  will definitely take a look at your paper. Thanks you! 

  • Corey Mcgee added an answer:
    Is there any research that describes the prevention and management of hemiplegic shoulder pain in stroke patient?

    best modality, technique and approach

    Corey Mcgee

    Consider the protocol offered by Kondo et al (2001). This focuses on prevention of the the development of hand-shoulder syndrome.

  • Harvey Roy Anderson added an answer:
    Does anyone know of any studies demonstarting a relationship between foot pronation and muscular activity in the extensor chain?

    Does anyone know of any studies demonstarting a relationship between foot pronation and muscular activity in the extensor chain?

    I'm particularly interested in the effect of pronation (or not) on gluteal activation in simple tasks.

    can anyone help please?

    Harvey Roy Anderson

    Thank you very much Oliver Ludwig!

    I shall read through these over the weekend.

    Yes, I'm looking at a number of studes about the relationship between the biomechanics of the foot and its influence on the rest of the body

  • Claudio Gil Araujo added an answer:
    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?
    Claudio Gil Araujo

    Hi you may also consider to use the sitting rising test that was developed in our lab.  The is a video explaining it at YouTube.  The srt scores had been shown to be a good psychotropic of all cause mortality for those aged 51 to 80 years old. This study was published in the European journal of preventive  cardiology.  

  • Jose Luis Hernández-Davó added an answer:
    Can decreased concentric knee flexor time to peak torque reduce the likelihood of lower extremity injuries?

    Can anybody tell me, if time to peak torque in the hamstrings is reduced in a concentric contraction, could it possibly reduce the likelihood of lower extremity injury? I'm aware that the functional (eccentric) aspect has been recently highlighted using isokinetic dynamometry but am interested in the concentric movement. Appreciate any help on this! Thanks  

    Jose Luis Hernández-Davó

    I know two articles in which the rate of torque development in the early time intervals of an isometric maximal voluntary contraction is used as an outcome measure for recovery / return-to-sport decision after ACL injury.  It's not exactly what are you asking for, but I hope you find it interesting.

    + 1 more attachment

  • Matthew S Tenan added an answer:
    Is it allowed to include a time point with a SD of 0 in my RM-ANOVA?

    I am running a repeated measures ANOVA in which I compare 5 time points - 1 before intervention and 4 after. The score of all time points is normalised to the time point before the intervention so that the values basically indicate a change WRT to before the intervention. Now I am not a 100% sure if I then violate any of the ANOVA assumptions if I include the time point before the intervention in the ANOVA as it effectively has a mean of 1 and SD of 0, but in which case I can use the main factor time to find an effect of the intervention. Personally I think this is wrong, but I'd like to know what others think as I have seen it done in several articles. Thanks, mark.

    Matthew S Tenan

    Hi Mark,

    You've already received a number of good answers.  Your intuition is correct.  I would choose to either do a repeated-measures ANOVA (a random subject-level effects ANOVA if you want to get fancy and have the expertise) with the 'raw' measure for all time points or do the 'normalised' (I would call them delta-scores or change scores) data without the first time point. 

    I hope everyone's input it helpful!


  • Taco Johan Blokhuis 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.
    Taco Johan Blokhuis

    Are you still looking for a solution ? We may have a suitable option for you: as a trauma surgeon I am involved in the development of a new amublant device. Please e-mail me for further information,

    kind regards

    Taco Blokhuis

  • Debra Knight 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.

    Debra Knight

    Studies have shown that the 1st 7-10 days is the period of greatest risk for incurring a second concussion.  In mild TBI there is cellular damage as well as micro-structural damage, and it is imperative that we keep external forces to the brain at a minimum to allow healing.  Studies are showing that the younger children require longer time to recover and we need to be conservative with our return to sports and recreational activity that has the potential to cause re-injury.  Best NOT TO SHAKE THE HEAD!!

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