Physical Medicine and Rehabilitation

Anterior cruciate ligament (ACL) deficient and reconstructed knees display altered biomechanics during gait. Identifying significant gait changes is important for understanding normal and ACL function and is typically performed by statistical approaches. This paper focuses on the development of an explainable machine learning (ML) empowered methodology to: (i) identify important gait kinematic, kinetic parameters and quantify their contribution in the diagnosis of ACL injury and (ii) investigate the differences in sagittal plane kinematics and kinetics of the gait cycle between ACL deficient, ACL reconstructed and healthy individuals. For this aim, an extensive experimental setup was designed in which three-dimensional ground reaction forces and sagittal plane kinematic as well as kinetic parameters were collected from 151 subjects. The effectiveness of the proposed methodology was evaluated using a comparative analysis with eight well-known classifiers. Support Vector Machines were...

Robotic technologies are being employed increasingly in the treatment of lower limb disabilities. Individuals suffering from stroke and other neurological disorders often experience inadequate dorsiflexion during swing phase of the gait cycle due to dorsiflexor muscle weakness. This type of pathological gait, mostly known as drop-foot gait, has two major complications, foot-slap during loading response and toe-drag during swing. Ankle foot orthotic (AFO) devices are mostly prescribed to resolve these complications. Existing AFOs are designed with or without articulated joint with various motion control elements like springs, dampers, four-bar mechanism, series elastic actuator, and so forth. This paper examines various AFO designs for drop-foot, discusses the mechanism, and identifies limitations and remaining design challenges. Along with two commercially available AFOs some designs possess promising prospective to be used as daily-wear device. However, the design and mechanism of ...

Background & Study Aim: Muscle strength, namely the capacity for overcoming the external resistance or counteracting it at the expense of muscular effort, plays an unquestionably essential role in judo competitor’s training. The objective of this study has been knowledge about the values of torques, torque gradient and muscle strength deficit released by knee joint extensors and flexors at rest by judo female competitors, taking up specialist strength training. Material & Methods: Two female study groups were selected: judo female competitors (n = 15); aged 22.20 ±1.32 years, body weight 67.47 ±13.58 kg, competitor seniority 11 ±1.60 years; reference sample (n = 15) non-full-time in any sports discipline female students of the University of Physical Education (AWF) in Wrocław, Poland: aged 22.20 ±1.26 years, body weight 64.33 ±8.25 kg. A study of knee joint extensors and flexors torque was performed at rest. The measurement was made at 30 and 70 degrees. The properties of a lever in...

Posture control appears deeply impaired in patients with severe Acquired Brain Injury (ABI). One of the main goals of neurorehabilitation specialists is to try to assess this neural function in a standardized manner. However, the tests available to evaluate posture control recovery after brain damage were developed for patients with focal neurological signs. We therefore developed a new test, the Trunk Recovery Scale (TRS). To evaluate the inter-rater reliability, internal consistency, external validity, and sensitivity of TRS in patients with ABI. Validation study. We examined 59 patients hospitalized after a brain injury in the Intensive and the Extensive Rehabilitation Units of our hospital. Patients with diagnosis of severe ABI with the capacity to respond to simple verbal orders and with a Level of Cognitive Functioning Scale (LCF scale) ≥ 4. Three raters independently assessed 20 subjects. One of the raters also assessed 39 additional subjects using TRS, Trunk Control Test (TC...

Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain. Controlled laboratory design. Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed. The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach. At baseline, no differences were found betwee...

In stroke, there is paralysis or weakness of one side of the body including upper limb, trunk and lower limb leading to the disturbances in the trunk muscles. Trunk is often neglected part in the stroke rehabilitation, trunk training exercises and Swiss ball exercises results in better recruitment of trunk muscles thus improving sitting balance. To compare the effect of core strengthening exercises on Swiss ball and Conventional exercise, to improve trunk balance in hemiplegic patients following stroke. A total number of 70 subjects were screened as per inclusion and exclusion criteria. The subjects were divided into two groups, Group-A received core strengthening exercises on Swiss ball along with conventional treatment and Group-B received core strengthening exercises along with conventional treatment. Subjects showed improvement in trunk balance following 6 weeks of core strengthening exercises.Post-intervention the TIS, BBA and MBI score of both groups improved but the Group-A i...

Stroke is the leading cause of death worldwide and a major contributor to long-term adult hood disability. Acute stroke care and long-term rehabilitation has improved substantially in the developed countries in the last three decades. 1 Although Pakistani healthcare system has evolved over the years, but the management of stroke both in the acute and rehabilitation phase remains sub-optimal. 2 The awareness of general public and even general practitioners regarding signs and symptoms of an impending/ evolving stroke is inadequate. 2,3 This results in loss of precious time in which patient can report to the hospital and get urgent medical attention. Absence of qualified neurologists and dedicated stroke units make it difficult to offer good acute stroke care as per the established protocols at most of acute medical care facilities in our country. 2 There are only two hospitals in our country which offer thrombolytic therapy (tPa) for a patient having acute ischaemic stroke. Most of the stroke patients in Pakistan are managed by internal medicine physicians and are discharged home without a neurological consult or long-term rehabilitation plan. A coordinated multidisciplinary stroke rehabilitation can result in decreased mortality, reduced number of complications, shorter length of stay and better Quality of life. 4,5 In Pakistan only few stroke patients are provided coordinated post stroke rehabilitation, mainly due to lack of qualified rehabilitation medicine physicians (physiatrists). Large number of qualified physiotherapists (Doctors of Physiotherapy-DPT) are available in the country. The primary job of a DPT is to provide good physical therapy and mobility training. These therapists could become a great resource for coordinated care and rehabilitation of stroke patients, if properly guided and supervised by Physiatrists and Neurologists. Short term and long term rehab care protocols are needed to be developed and followed to ensure best practice. In the absence of a regulatory authority, some of the physiotherapists overstep their mandate by writing prescriptions for the stroke patients in form of multivitamin injections, neuro-tonics and cerebral stimulants, which have no proven role in the management and recovery of stroke. 6 Functional improvement and ultimately community reintegration are main objectives of rehabilitation. Long term, daily physiotherapy at home for months without proceeding toward this goal is of no benefit for patient and family. 7,8 The social network and a supportive family environment in Pakistan is sometimes a hindrance in regaining independence by the stroke patients. Serving the elderly especially, when disabled by an illness like stroke is considered a social obligation and religious duty. The stroke patient in Pakistan has sometimes multiple attendants (mostly close family members) who cater for all his/her needs including transfers from bed to chair, feeding and bladder and bowel care. This over caring attitudes in which the patient is offered attendant care promotes dependency rather than independence and the patient with stroke never learns the compensatory techniques or take charge of his/her own life post stroke. Families of stroke patients must be educated and trained to direct their care in making a stroke patient functional and independent. Another issue is of alternative and complementary medicine. Due to the strong influence of alternative and traditional medicine in the country and a lack of accountability, many stroke patients end up visiting spiritual healers, homeopathy practitioners and even quacks in the quest for finding a cure for their disability. This not only drains them financially but also wastes precious time and energies, which could have been utilized in following a scientifically proven and beneficial stroke rehabilitation programme. Many a times these practitioners offer stroke patients un-proven therapies, herbal remedies and drugs with unknown composition. Even if a patient is fortunate enough to receive good acute care and a coordinated post stroke rehabilitation tries to re-integrate back into the society, he/she faces societal and community barriers. The general attitudes of the Pakistani society towards a person with disability are negative. 9 There are no disabled friendly public toilets and most of the

Intensive care unit (ICU) is the most required area to treat patients who admitted for an unconscious, cardiopulmonary arrest, drowning, poisoning, cerebrovascular accidents, acute post-operative surgery patients etc. for improving their health with various treatment procedures. Physiotherapy is one of the treatment procedures in inside the ICU to regain the patient’s mobility and stability with the use of procedures such as chest physiotherapy, range of motion exercises and early mobilization activities to be used to improve functional capacity, strengthening the muscles with continuous rehabilitation would improve quality of life among patients admitted to respiratory and medical ICUs. In order to practice in the ICU, this study aimed to review the planning and implementation methods of physiotherapy in the area of critical care to suggest the physiotherapy protocol. Initiation of this protocol based assessment and implementation of physiotherapy inside the ICU is safe and benefic...

This study aims to detect the efficacy of a modified complete decongestive therapy program on the improvement of the circumferential measures of the lymphedematous limbs. A prospective observational and interventional study; twenty-six patients with unilateral lymphedema of the extremities both primary and secondary were enrolled. All patients were treated with 6 sessions of complete decongestive therapy on a two-phase program. The first phase consists of meticulous skin care, manual lymphatic drainage, exercises and compression bandages. Phase 2 of self-care program. Circumferential measures of the affected limb were taken as an outcome measure; recorded before and 12 weeks after the application of the decongestive therapy. In both, primary and secondary lymphedema, the modified complete decongestive therapy resulted in a significant reduction (p < 0.05) in the circumference of the affected limb. The circumferential measures of the involved limbs after treatment were (79.69 ± 11.92) and (107.68 ± 24.98), consecutively: comparative to the pretreatment measures of (85.14 ± 7.48) for the upper limbs and (113.71 ± 26.91) for the lower limbs. In conclusion, application of a complete decongestive therapy, per available recourses, in a short course or a modified regimen can help in treating primary and secondary lymphedema of the extremities.

Corrêa DA, Soares DS, Gonelli PRG, Cesar MC, Sindorf MAG, Crisp AH, Verlengia R, Balbino HF, Lopes CR. Effect of 29 Weeks of Periodized Soccer Training on the Neuromuscular Performance of Soccer Players Under 20 Years of Age. JEPonline 2016;19(4):3241. The purpose of this study was to investigate the effects of 29 weeks of periodized soccer training (linear during pre-season and ondulatory during the competitive period) on the neuromuscular performance of soccer players under 20 yrs of age. Ten regionally ranked male athletes (19.2 ± 1.3 yrs, body mass 71.1 ± 6.8 kg, height 179.0 ± 0.2 cm) participated in this study. The pre-season physical training program lasted 9 wks. The competitive period lasted 19 wks. The assessments were conducted at specific times during training periodization: baseline, 4, 8, and 19 wks. The results showed improvements in squat jump performance and maximal strength during the pre-season and the competitive period, respectively. On the other hand, repeated ...

Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio-and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care.

Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program [ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, ...

The incidence and prevalence of diabetes are increasing, with rapid growth in the aging population. The purpose of this study is to find out the effectiveness of aquatic exercises on glycemic control in elderly patients with type 2 diabetes mellitus.30 subjects who met the inclusion criteria were randomly divided into two groups; Group A (n=15) were under hypo glycemic drugs and aquatic training in Hubbard tank for upper extremity and lower extremity. Group B (n=15) patients have no exercise training during this study, except they are relied upon medications for diabetes. HbA1C was measured pre and post treatment. Statistical analysis was tested with t test at 95% level of significance (p<0.05). The results suggest that there is a significant difference between posttest values of both groups in HbA1C, which indicates that group A is more significant than group B.

Musicians are trained to attend to aural and visual senses, to the detriment of kinesthetic awareness, which often results in unnecessary muscle tension and narrowed attentional focus. The Alexander technique (AT) addresses these concerns by approaching action using a process of whole-body consciousness. Incorporation of AT concepts into skill practice may reduce static tension in playing and result in both prevention of injury and improved quality of performance, but objective evidence of these effects is lacking. This pilot feasibility study was designed to determine if muscle activation, movement kinematics, musical performance, and qualitative self-assessment over the course of a 10- week AT intervention are viable means to assess the efficacy of AT in violinists/ violists. Two groups of collegiate violinists and violists participated: Group A (n=4) participated in weekly 1-hour group AT lessons and kept a personal journal of their progress. Group B (n=3) received no AT lessons....

Background Inertial measurement units (IMUs) offer the ability to measure walking gait through a variety of biomechanical outcomes (e.g., spatiotemporal, kinematics, other). Although many studies have assessed their validity and reliability, there remains no quantitive summary of this vast body of literature. Therefore, we aimed to conduct a systematic review and meta-analysis to determine the i) concurrent validity and ii) test-retest reliability of IMUs for measuring biomechanical gait outcomes during level walking in healthy adults. Methods Five electronic databases were searched for journal articles assessing the validity or reliability of IMUs during healthy adult walking. Two reviewers screened titles, abstracts, and full texts for studies to be included, before two reviewers examined the methodological quality of all included studies. When sufficient data were present for a given biomechanical outcome, data were meta-analyzed on Pearson correlation coefficients (r) or intracl...

Deep vein thrombosis (DVT) is a relatively common disease encountered by physical therapists, especially in the outpatient orthopedic settings. If a DVT is missed by a healthcare professional, a patient is at increased risk for pulmonary embolism, post-phlebitic
syndrome, or chronic thromboembolic. This talk discusses the natural history of DVT, diagnosis of DVT, and clinical prediction rules physical therapists can use to help guide decisions in referring patients for further testing. Finally, 2 clinical cases are discussed.

The objective of the study is to present a historical outline of neuromobilisation and clinical neurodynamics -in Poland and worldwide. Following the development of non-invasive methods of treatment, the knowledge of nervous system mechanics has become more and more extensive. The first record of performing a neurodynamic test goes back to 2800 BC. Many years later, in the first and second half of 20th century, Bragard, Von Lanz and Wachsmuth described three main neurodynamic tests for an upper limb. The biggest worldwide input in neuromobilisation problems development was made by the following scientists: Geoffrey Maitland, Robert Elvey, David Butler, Michael Shacklock and Alf Breig. David Butler and Michael Shacklock definitely represent the key researchers since it is them who, during their cooperation in the period of 1990-1997, made a great input in the origins of neuromobilisation treatment methods. The concept of nervous system mobilisation in Poland was initiated in April 1998 in Zgorzelec, where the first course run by David Butler himself, was held. In the same year Zbigniew Śliwiński published his first two studies in the journal entitled "Manual Medicine". At present trainings, courses and numerous research works, focused on nervous system mechanics, are conducted in Poland. The most recent and worth noting publications are these referring to neuromobilisation effectiveness and performed by the team of Dwornik, Bialoszewski and colleagues.

Osteoporosis is defined by critically low bone mass or a fragility fracture. Physical activity has been proposed as a necessary lifestyle contributor to bone health, however, few exercise programs have demonstrated an ability to notably increase bone mass. The bone response to exercise is highly dependent on the nature of applied mechanical loads. The most osteogenic activities are those that induce high magnitude strains at high rates or frequencies in bone. Under such conditions, only brief loading bouts are required to stimulate a response. Such strains are typically induced by weight bearing impact loading and high-intensity progressive resistance training. To date, high intensity resistance and impact training has not been investigated in postmenopausal women due to a perceived risk of fracture and/or injury. Consequently, the primary aim of the current work was to develop a novel bone specific high intensity resistance and impact training program (HiRIT) for postmenopausal wom...

Updates: https://www.inflammationmastery.com/book-nutrition-functional-medicine
Abstract: Following the optimization of diet and fatty acid balance, the next therapeutic steps in the treatment of pain and inflammation can include the use of vitamin D, chondroitin sulfate, niacinamide, and botanical medicines such as Boswellia. In direct contrast to so-called “anti-inflammatory drugs” which always have significant toxicity, each of these natural treatments has been proven in controlled clinical trials to significantly reduce pain and inflammation without major adverse effects. Chondroitin sulfate has actually been shown to reduce cardiovascular mortality in humans while it safely and effectively ameliorates the pain and inflammation of osteoarthritis. Similarly, vitamin D supplementation has been proven effective in the treatment of hypertension, depression, migraine headaches, polycystic ovary syndrome and in the prevention of type-1 diabetes. By failing to fully cover chiropractic and naturopathic healthcare services, insurance companies which comprise and contribute to the American healthcare system are losing profitability and forcing patients to use drug and surgical treatments that are commonly less effective, more dangerous, and more expensive than the natural treatments described in this paper. Services provided by chiropractic and naturopathic physicians are supported by peer-reviewed research and deserve equitable coverage and status in America’s healthcare system.

Abstract
Despite the introduction of numerous additional tests, such as magnetic resonance or computed tomography, functional tests are a significant facilitation in the assessment of functional disorders. Their good knowledge along with the correct implementation is invaluable for making the right diagnosis. Clinical tests also play a huge role in the differentiation of root diseases, which increases the accuracy of the treatment.

Mimo wprowadzenia licznych badań dodatkowych, takich jak rezonans magnetyczny czy tomografia komputerowa, testy czynnościowe stanowią znaczne ułatwienie w procesie oceny zaburzeń funkcjonalnych. Ich dobra znajomość wraz z prawidłowym wykonaniem jest bezcenna dla postawienia odpowiedniej diagnozy. Testy kliniczne odgrywają także ogromną rolę w różnicowaniu dolegliwości korzeniowych, co zwiększa trafność stosowanego leczenia.

Physiotherapy (also Physical Therapy as referred to by the World Confederation of Physical Therapy) is a health care profession concerned with human function and movement and maximizing potential. It is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. It uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status. It is science-based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery. The exercise of clinical judgment and informed interpretation is at its core.