Physical Medicine and Rehabilitation

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.

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.

The upper motoneuron syndrome (UMN) is a collective term that refers to different types of motor behaviors produced by patients who have lesions of the descending corticospinal system. Lesions involving the upper motoneuron, its pathways, and its connections can occur at the level of the cortex, internal capsule, brain stem, or spinal cord. The clinical features of UMN have traditionally been classified as "positive" phenomena, referring to overt behaviors generated by various forms of muscle overactivity, and "negative" phenomena, referring to loss of overt behaviors secondary to impaired muscle activation, impaired control of motor behavior, and impaired motor performance. The clinical impact of UMN on patients is broad and tends to limit functional capacity. The negative and positive signs lead to reduced mobility and limb usage.

The article is aimed to introduce the concept of qigong for the physical therapy specialists, defining its  principle differences from conventional physical exercises used in physical therapy. As an example a popular qigong set of Baduanjian is presented in details in its modern version. The article contains bibliography with tested effected of Baduanjian set.

The liver is almost unique in its capacity for regeneration after hepatectomy but the exact mechanisms are not yet fully clarified. Antioxidants have been shown to promote liver regeneration after major hepatectomy. The present study evaluated the ameliorative effect of vitamin E administration on the liver regeneration after different periods of partial hepatectomy (PH) in rats. Fifty-six adult male albino rats were divided into three groups: Control sham operated group; partially hepatectomized group which were divided into three subgroups sacrificed at 1day, 3 days and 7days after the operation respectively; Partially Hepatectomized group with vitamin E pretreatment before PH where the rats were given a daily oral dose of vitamin E until the time of sacrifice of the rats. Immunohistochemical detection of proliferating cell nuclear antigen (PCNA) and labeling index were demonstrated. After PH, the PCNA positive hepatocytes and the PCNA labeling indices were significantly high after the 1 st day and then much decreased after the 3 rd day, to be followed by a slight increase at the 7 th day. Vitamin E pretreatment in PH rats resulted in a decrease in PCNA positive cells and its labeling indices in the 1 st day with a gradual increase in the 3 rd and 7 th days. Vitamin E has an inhibitory effect in the first 24 hours on liver regeneration followed by stimulatory effect at the third and seventh days after PH. These data indicated that vitamin E pretreatment has an important role in regulation and enhancement of liver regeneration after PH.

The upper motoneuron syndrome (UMN) is a collective term that refers to different types of motor behaviors produced by patients who have lesions of the descending corticospinal system. Lesions involving the upper motoneuron, its pathways, and its connections can occur at the level of the cortex, internal capsule, brain stem, or spinal cord. The clinical features of UMN have traditionally been classified as "positive" phenomena, referring to overt behaviors generated by various forms of muscle overactivity, and "negative" phenomena, referring to loss of overt behaviors secondary to impaired muscle activation, impaired control of motor behavior, and impaired motor performance. The clinical impact of UMN on patients is broad and tends to limit functional capacity. The negative and positive signs lead to reduced mobility and limb usage.

More and more physiatrists are interested in learning how to use musculoskeletal ultrasonography in their clinical practice. The possibility of high resolution, dynamic, comparative and repeatable imaging makes it an important diagnostic tool for soft tissue pathology. There is also growing interest to use sonography for guiding interventions such as aspirations and infiltrations. In daily practice these are often done blindly or palpation-guided. To improve the accuracy of interventions, fluoroscopy or computed tomography were traditionally used for guidance. Since sonography is non-ionizing, readily available and relatively low cost, it has become the first choice to guide many musculoskeletal interventions. Ultrasound allows real-time imaging of target and needle as well as surrounding vulnerable structures such as vessels and nerves. Many different techniques are proposed in the literature. Interventions under ultrasound guidance have been proven to be more accurate than unguide...

One innovation currently influencing physical medicine and rehabilitation is brainecomputer interface (BCI) technology. BCI systems used for motor control record neural activity associated with thoughts, perceptions, and motor intent; decode brain signals into commands for output devices; and perform the user's intended action through an output device. BCI systems used for sensory augmentation transduce environmental stimuli into neural signals interpretable by the central nervous system. Both types of systems have potential for reducing disability by facilitating a user's interaction with the environment. Investigational BCI systems are being used in the rehabilitation setting both as neuroprostheses to replace lost function and as potential plasticity-enhancing therapy tools aimed at accelerating neurorecovery. Populations benefitting from motor and somatosensory BCI systems include those with spinal cord injury, motor neuron disease, limb amputation, and stroke. This article discusses the basic components of BCI for rehabilitation, including recording systems and locations, signal processing and translation algorithms, and external devices controlled through BCI commands. An overview of applications in motor and sensory restoration is provided, along with ethical questions and user perspectives regarding BCI technology.

A 2014 World Health Organization (WHO) study reported that almost 27 million people with disability live in Pakistan with fewer than one allied rehabilitation professional per 10,000 people. The current study sought to determine the attitudes toward telerehabilitation via a survey administered to 329 Pakistani rehabilitation professionals. Study results indicate that rehabilitation professionals in Pakistan are knowledgeable about telerehabilitation and Information and Communication Technology (ICT), and are receptive to employing telerehabilitation programs and applications. Therefore, we can infer that the future of telerehabilitation can be bright in Pakistan but requires the attention of policy makers and non-government organizations to launch an appropriate program nationwide. The authors suggest that a range of telerehabilitation services (e.g., consultation, assessment, and therapy) could alleviate the shortage of rehabilitation personnel in Pakistan.

Summary. A survey of UK medical schools was undertaken to determine the teaching that was being offered on disability and rehabilitation. In general, teaching on this topic appeared fragmented and inadequate but a number of interesting innovations were ...

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.

Introduction: Rehabilitation measures help to restore lost activities, improve quality of life and decrease the long term economic cost of stroke. Realistic goal setting, interdisciplinary team approach and the active participation of both patient and family members are important for the success of stroke rehabilitation. The primary objective of this study is to investigate the effects of intense sensory motor stimulation, given in the form of electrical stimulation, massage and re-education exercise programme, in augmenting recovery in stroke patients. Methods: A prospective single group pre and post test study design was conducted with a total of 29 hemiparetic patients who provided informed consent. All the participants received the therapeutic measures of electrical stimulation, massage and re-education exercises including gait training and ADL retraining until discharge. The Neurological and Functional recovery were measured using Scandinavian Stroke Scale score (SSS) and Functional Independence Measure score (FIM) respectively. Results: An Analysis of variance 'F' Value of 37.31 and 43.94 which are significant at 0.01 level shows that there is a significant difference between scores at admission, discharge and follow up in SSS and FIM scores respectively. The Pearson correlation coefficient 'r' value of 0.62, 0.81 and 0.97 at three time periods suggests that a moderate to strong negative correlation exists between SSS and FIM scores which are significant at 0.01 levels. Conclusion: A significant level of neurological and functional recovery was obtained in the study group during the time of discharge and in the follow up period indicative of effectiveness of intense sensory motor stimulation in augmenting motor recovery in stroke patients.

Motor rehabilitation technologies commonly include virtual environments that motivate patients to exercise more often or more intensely. In this paper, we present a novel virtual rehabilitation environment in which two people work together to prepare meals. The players' roles can be fixed or undefined, and optional challenges can be added in the form of flies that must be swatted away. A preliminary evaluation with 12 pairs of unimpaired participants showed that participants prefer cooperating over exercising alone and feel less pressured when cooperating. Furthermore, participants enjoyed the addition of flies and preferred not to have defined roles. Finally, no significant decrease in exercise intensity was observed as a result of cooperation. These results indicate that cooperation could improve motor rehabilitation by increasing motivation, though the virtual environment needs to be evaluated with participants with motor impairment.

Background: Suspension was considered to be one of the most critical aspects of the prosthetic design and it's a method by which the artificial limb attached to a body. Suspension not only prevents the prosthesis from falling off, but it also avoids pistoning, minimizes shear forces on the skin of stump and enhances axial and rotational stability. Objective: There were no such studies available for Indian population; therefore, the purpose of this study was to evaluate the effectiveness of suspension systems mostly used in Indian conditions (Hip joint and pelvic band, Total Elastic Suspension (TES) and T-Belt). Methods: Ten unilateral Transfemoral amputees participated in this study, and the patients were asked to use three different suspension systems. All the suspension systems were tested in terms of active range of motion at the hip joint, rotational stability/axial rotation, axial pistoning (Radiographic findings of vertical displacement) and the patient's comfort. Results: The results revealed that there was significantly more Range of motion on T-belt whereas less on Hip joint and pelvic band, rotational stability was more stable in TES, higher level of prosthetic satisfaction was on TES and pistoning was very less during the use of hip joint and pelvic band. Conclusions: It can be concluded that even though TES was more stable suspension system for Transfemoral amputees, but overall satisfaction was higher with the hip joint and pelvic band suspension system as it helps to control the axial rotation and pistoning of the stump inside the socket.

Natural disasters can cause significant numbers of severe, disabling injuries, resulting in a public health emergency and requiring foreign assistance. However, since medical rehabilitation services are often poorly developed in disaster-affected regions and not highly prioritized by responding teams, physical and rehabilitation medicine (PRM) has historically been underemphasized in global disaster planning and response. Recent development of the specialties of "disaster medicine" and "disaster rehabilitation" has raised awareness of the critical importance of rehabilitation intervention during the immediate postdisaster emergency response. The World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine has authored this report to assess the role of emergency rehabilitation intervention after natural disasters based on current scientific evidence and subject matter expert accounts. Major disabling injury types are identified, and spinal cord injury, limb amputation, and traumatic brain injury are used as case studies to exemplify the challenges to effective management of disabling injuries after disasters. Evidence on the effectiveness of disaster rehabilitation interventions is presented. The authors then summarize the current state of disaster-related research, as well as lessons learned from PRM emergency rehabilitation response in recent disasters. Resulting recommendations for greater integration of PRM services into the immediate emergency disaster response are provided. This report aims to stimulate development of research and practice in the emerging discipline of disaster rehabilitation within organizations that provide medical rehabilitation services during the postdisaster emergency response.

Background and Aims: Cytomegalovirus (CMV) infection is well known in immunocompromised hosts. However, its incidence and role in immunocompetent subjects is not clear. The aim of our study was to evaluate CMV infection in immunocompetent hosts and its clinical presentations at a Government restructured hospital in Singapore.