Effects of a 12-wk resistance exercise program on skeletal muscle strength in children with burn injuries.

The posttraumatic response to burn injury leads to marked and prolonged skeletal muscle catabolism and weakness, which persist despite standard rehabilitation programs of occupational and physical therapy. We investigated whether a resistance exercise program would attenuate muscle loss and weakness that is typically found in children with thermal injury. We assessed the changes in leg muscle strength and lean body mass in severely burned children with >40% total body surface area burned. Patients were randomized to a 12-wk standard hospital rehabilitation program supplemented with an exercise training program (n = 19) or to a home-based rehabilitation program without exercise (n = 16). Leg muscle strength was assessed before and after the 12-wk rehabilitation or training program at an isokinetic speed of 150 degrees /s. Lean body mass was assessed using dual-energy X-ray absorptiometry. We found that the participation in a resistance exercise program results in a significant improvement in muscle strength, power, and lean body mass relative to a standard rehabilitation program without exercise.     

Quelques considérations sur l'enseignement de la médecine physique et de la réhabilitation

Particularly since World War II physical medicine and rehabilitation have assumed a growing importance. The efforts of the Canadian Association of Physical Medicine and Rehabilitation, following a survey of Canadian universities, to increase the theoretical and practical teaching of physiatrics are emphasized. It is considered important that the teaching of physical medicine and rehabilitation should be carried out concurrently with other medical and surgical teaching programs. Paramedical and auxiliary rehabilitation personnel should participate in the teaching program. The number of hours devoted to physiatrics should be increased, and the medical student should be permitted to choose physical medicine and rehabilitation as a part of his internship program.     

"A disease of frozen feelings": ethically working on emotional worlds in a Russian Orthodox Church drug rehabilitation program

In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue that "frozen feelings" is better understood as the unsocial emotional worlds many drug users experience, and that rehabilitation in this church-run program particularly focuses on the cultivation of an emotional world that supports sociality. This is done, I argue, by means of ethically training rehabilitants to learn how to control and manage their emotional worlds, and in so doing, rehabilitants become new moral persons better able to live in the social world.     

Effects of a Brief Intervention on Retention of Patients in a Cardiac Rehabilitation Program

This intervention assessed the effects of a brief intervention on dropout rate in a cardiac rehabilitation program. One hundred thirty five patients were recruited from a cardiac rehabilitation program and randomized to either a control or intervention group. The intervention group participated in four sessions of motivational interviewing and stress management-relaxation in addition to standard cardiac rehabilitation. The control group underwent cardiac rehabilitation alone. Patients who completed the intervention completed an average of 30 sessions while those who dropped out of the intervention completed about six (p < 0.001). Anxiety and depression measured at baseline were the primary predictors of dropout. Patients in both the intervention and controls groups who completed cardiac rehabilitation improved the distance walked, quality of life and decreased anxiety.     

A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation

Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.     

The NHV Rehabilitation Services Program Improves Long-Term Physical Functioning in Survivors of the 2008 Sichuan Earthquake: A Longitudinal Quasi Experiment

Background

Long-term disability following natural disasters significantly burdens survivors and the impacted society. Nevertheless, medical rehabilitation programming has been historically neglected in disaster relief planning. ‘NHV’ is a rehabilitation services program comprised of non–governmental organizations (NGOs) (N), local health departments (H), and professional rehabilitation volunteers (V) which aims to improve long-term physical functioning in survivors of the 2008 Sichuan earthquake. We aimed to evaluate the effectiveness of the NHV program.

Methods/Findings

510 of 591 enrolled earthquake survivors participated in this longitudinal quasi-experimental study (86.3%). The early intervention group (NHV–E) consisted of 298 survivors who received institutional-based rehabilitation (IBR) followed by community-based rehabilitation (CBR); the late intervention group (NHV–L) was comprised of 101 survivors who began rehabilitation one year later. The control group of 111 earthquake survivors did not receive IBR/CBR. Physical functioning was assessed using the Barthel Index (BI). Data were analyzed with a mixed-effects Tobit regression model. Physical functioning was significantly increased in the NHV–E and NHV–L groups at follow-up but not in the control group after adjustment for gender, age, type of injury, and time to measurement. We found significant effects of both NHV (11.14, 95% CI 9.0–13.3) and sponaneaous recovery (5.03; 95% CI 1.73–8.34). The effect of NHV-E (11.3, 95% CI 9.0–13.7) was marginally greater than that of NHV-L (10.7, 95% CI 7.9–13.6). It could, however, not be determined whether specific IBR or CBR program components were effective since individual component exposures were not evaluated.

Conclusion

Our analysis shows that the NHV improved the long-term physical functioning of Sichuan earthquake survivors with disabling injuries. The comprehensive rehabilitation program benefitted the individual and society, rehabilitation services in China, and international rehabilitation disaster relief planning. Similar IBR/CBR programs should therefore be considered for future large-scale rehabilitation disaster relief efforts.     

Long-term outcome after respiratory rehabilitation.

To determine the long-term effect of respiratory rehabilitation, we followed up for 6 months after discharge 31 consecutive patients enrolled in a multidisciplinary inpatient rehabilitation program lasting 4 to 6 weeks. Of the 31, 24 showed improvement in quality of life (as measured with a previously validated questionnaire) and in functional exercise capacity (as measured with the 6-minute walk test) 2 weeks after discharge. The improvement was sustained for 6 months in 11 of the 24. Other investigators have found higher response rates than those that we report. The differences are likely due to our enrolment of consecutive patients, the length and completeness of follow-up, and the objective measurement of quality of life by an interviewer not associated with the rehabilitation program. Controlled trials of respiratory rehabilitation measuring both costs and benefits are warranted. In the meantime, strategies to maintain the initial improvement seen after rehabilitation should be developed and studied.     

Effects of a comprehensive cardiac rehabilitation program on quality of life and exercise tolerance in women: A retrospective analysis

BACKGROUND: Currently, there are a lack of investigations that have examined the effect of participating in a comprehensive cardiac rehabilitation program on quality of life and physiological measures in women of different ages. The purpose of this investigation was to examine the effect of participating in a comprehensive cardiac rehabilitation program on quality of life, exercise tolerance, blood pressure and lipids in women between 33 and 82 years of age. METHODS: The 126 women participated in a 14-week cardiac rehabilitation program that consisted of 7 weeks of formal supervised exercise training and 7 weeks of unsupervised exercise and lifestyle modification. Physiologic and quality of life outcome measures obtained at the outset and after 14 weeks included: 1) exercise treadmill time; 2) resting and peak systolic and diastolic blood pressure; 3) total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol and Triglycerides; 4) Cardiac Quality of Life Index questionnaire. RESULTS: Significant improvements were found in the following quality of life measures after participating in the cardiac rehabilitation program: physical well being, psychosocial, worry, nutrition and symptoms. No significant differences were seen for any QOL variable between the different age groups. Significant improvements were seen in exercise tolerance (+21%) and high density lipoprotein (+5%). CONCLUSION: Cardiac rehabilitation may play an important role in improving quality of life, exercise tolerance and high density lipoprotein cholesterol levels in younger and older women with underlying cardiovascular disease.     

Community based rehabilitation program for people with musculoskeletal conditions

Community based rehabilitation program in people with musculoskeletal conditions was evaluated using Dartmouth COOP Functional Health Assessment Charts/WONCA (COOP/WONCA charts). The program consisted of educative and training protocol in a primary healthcare setting. It had two parts, both with six visits, in the first part three times a week and in the second part once a week. Clients with musculoskeletal conditions (N = 204) were included if they agreed to take active part in the rehabilitation process. The first part of the program was completed by 77 clients, and complete program by 52 subjects. Positive changes on the COOP/WONCA charts were achieved by more than 50% of the subjects that completed the program, in all categories but Social Activities. The program proved effective in terms of short-term evaluation with COOP/WONCA charts in those that complete the program. The high dropout rate and long-term efficiency have yet to be investigated.     

A set of rehabilitation measures for compensating emotional stress

The physiological mechanisms of an integrated rehabilitation program and its constituent rehabilitation techniques, namely, local rhythmic thermal impulses; rapid autogenic regulation (RAR); and a session of slow, deep breathing, were studied in apparently healthy subjects who had experienced emotional stress. Mental arithmetic under the conditions of a time deficit with a reprimand was used as a model of emotional stress, which caused a number of rearrangements in the cerebral activity of the subjects, including enhanced β activity in the right frontal area and depression of slow EEG waves in the posterior cerebral areas, and promoted sympathetic influences and hemodynamic impairment. The set of rehabilitation measures, which was designed to affect the body as a whole, promoted the restoration of the initial cortical bioelectrical activity and autonomic status of the subjects. The mechanisms of each rehabilitation technique included in the program were determined.     

INTENSIVE REHABILITATION—Recent Experience in a Chronic Disease Hospital

An intensive rehabilitation program for persons with severe physical disabilities was carried on over a two-year period in a 35-bed unit at Rancho Los Amigos Hospital, a chronic disease hospital.Eighty-five patients were released (69 adults, 16 children) from the program after an average stay of six and a half months. Seventy-one per cent of these were discharged to their homes and the remainder were transferred to convalescent wards so much improved that they required less care, even worked on the grounds.Over half of the adult patients discharged to their homes became employed, not counting the women who resumed housework.The average hospitalization for patients in the same hospital without this program is three and a half years. Thus, despite a much higher cost per day for the patients in the intensive rehabilitation program, the total cost is about $7,640 less per patient discharged from the hospital.In addition the shorter period in hospital helps meet the ever-increasing demand for chronic disease beds.     

Evaluating the sustainability of mine rehabilitation programs in China

Social, economic, and environmental restorations are important concerns in mine rehabilitation programs. Nonetheless, limited attention has been given to the social and economic evaluation of mine rehabilitation programs in developing countries with fast‐growing economies and large populations. To evaluate the social, economic, and environmental sustainability of mine communities before and after mine rehabilitation programs, we placed the study in China, which has experienced large‐scale mine closures resulting from resource depletion. By adopting an integrative model, sustainability cube, we evaluated social, economic, environmental, and overall sustainability (the combination of social, economic, and environmental) of its mine rehabilitation program—the national mine parks (reengineering closed mines as tourist parks, which constitutes the mine rehabilitation program) at the community level before and after the park establishment. Our results indicate that the implementation of national mine parks has improved the overall sustainability of local communities; the sustainability scores of the economic and environmental sectors increased significantly, while the sustainability score for the social sector decreased (mainly due to increased emigration after mine shutdown). We provide suggestions to improve social sector performance in mine rehabilitation programs, aiming to further enhance overall sustainability after mine closure.     

Resultados de un programa de rehabilitación domiciliaria tras hospitalización en pacientes con fractura de cadera

IntroductionHip fracture is one of the most frequent disabling injuries, presenting serious complications during the acute and subacute phase. Rehabilitation at home, after hospital discharge, allows rapid functional recovery. The objective of this study is to evaluate the possible usefulness of a home rehabilitation program in patients with hip fracture integrated in a Hospital at Home Unit.MethodsRetrospective study that consecutively included patients accepted for home rehabilitation treatment between September 9, 2019 and December 31, 2021 in the Hospital at Home Unit of the Hospital Universitario de la Ribera, Alzira, Valencia. Demographic, clinical, functional and quality of care variables were collected.ResultsTwo hundred twenty-four subjects were included. The mean age was 84.6 (SD 7.7) years, with 66% women and 34% men, with 32% of patients diagnosed with dementia in one of its degrees of severity. The mean hospital stay was 8.4 (SD 4.1) days and 6.5 (5.3) days in the Hospital at Home Unit rehabilitation program. 90% of the patients included in the program reached the therapeutic goal outlined during hospital admission.ConclusionsThe home rehabilitation of patients with hip fracture contributes to a functional recovery of the patient in a shorter time. Further studies are necessary to confirm the results obtained.     

International symposium on peripheral nerve repair and regeneration and 2nd club Brunelli meeting

Recent findings on the antioxidant effects of pretreatment with α-lipoic acid (α-LA) on the crush injury of rat sciatic nerve confirm the possible usefulness of α-LA administration in humans with peripheral nerve injuries. We discussed this issue in relation with our recent results in which the combined employment of α-LA and γ-linolenic acid with a rehabilitation program for six weeks reduced sensory symptoms and neuropathic pain in patients with compressive radiculopathy syndrome from disc-nerve root conflict in comparison with patients submitted to rehabilitation program alone for six weeks.     

Study protocol: EXERcise and Cognition in Sedentary adults with Early-ONset dementia (EXERCISE-ON)

ABSTRACT: BACKGROUND: Although the development of early-onset dementia is a radical and invalidating experience for both patient and family there are hardly any non-pharmacological studies that focus on this group of patients. One type of a non-pharmacological intervention that appears to have a beneficial effect on cognition in older persons without dementia and older persons at risk for dementia is exercise. In view of their younger age early-onset dementia patients may be well able to participate in an exercise program. The main aim of the EXERCISE-ON study is to assess whether exercise slows down the progressive course of the symptoms of dementia. METHODS: One hundred and fifty patients with early-onset dementia are recruited. After completion of the baseline measurements, participants living within a 50 kilometre radius to one of the rehabilitation centres are randomly assigned to either an aerobic exercise program in a rehabilitation centre or a flexibility and relaxation program in a rehabilitation centre. Both programs are applied three times a week during 3 months. Participants living outside the 50 kilometre radius are included in a feasibility study where participants join in a daily physical activity program set at home making use of pedometers. Measurements take place at baseline (entry of the study), after three months (end of the exercise program) and after six months (follow-up). Primary outcomes are cognitive functioning; psychomotor speed and executive functioning; (instrumental) activities of daily living, and quality of life. Secondary outcomes include physical, neuropsychological, and rest-activity rhythm measures. DISCUSSION: The EXERCISE-ON study is the first study to offer exercise programs to patients with early-onset dementia. We expect this study to supply evidence regarding the effects of exercise on the symptoms of early-onset dementia, influencing quality of life.Trial registrationThe present study is registered within The Netherlands National Trial Register (ref: NTR2124).     

Getting past the accident: explosive devices, limb loss, and refashioning a life in a military medical center

I describe the refashioning of a sense of self and identity of a junior officer in the U.S. Army who was injured in Iraq. Ethnographic data for this article were collected between July 2006 and January 2008. The setting for this article is the U.S. Armed Forces Amputee Patient Care Program at Walter Reed Army Medical Center. Two models of rehabilitation are contrasted in the rehabilitation program. The first focuses on the refashioning of identity through a sports model of rehabilitation emphasizing physical functioning. The second approaches rehabilitation by emphasizing individual interests and the concern of a person who has a future life to develop. I conclude by arguing that understanding the process of rehabilitation from traumatic injury would benefit from a perspective that melds multiple dimensions, taking into account both the physical body and the social world that patients have inhabited and will inhabit.     

Rehabilitation in paraneoplastic stiff-person syndrome – Case Report

We aimed to share our rehabilitation experience in a patient diagnosed with paraneoplastic Stiff-person syndrome(SPS). A 45-year-old female patient was admitted to neurology with the complaint of widespread painful contractions. EMG was evaluated in favor of SPS. Amphiphysin-antibody was +++ in CSF. Patients’ treatment was arranged and transferred to rehabilitation inpatient-clinic.The patient was included in the rehabilitation program of range of motion,stretching,strengthening, posture&walking exercises, balance&coordination exercises, 5 days/week for 3 months. The patient was screened for breast cancer, diagnosed with invasive breast carcinoma and underwent mastectomy. With the rehabilitation, the patient was mobilized first in the parallel-bar then with tripod-cane in the following months. Significant improvements were found in functional status and quality of life with control of spasticity and mobilization. Although the primary treatment of paraneoplastic SPS is cancer treatment, significant gains have been achieved with rehabilitation. It is necessary to raise awareness of the importance of rehabilitation to physicians who diagnose the disease.     

Vibration assisted rehabilitation in patients with Pompe disease: A case series

The results of three cases with infantile-onset Pompe disease participating in a rehabilitation program with home-based vibration training will be presented. In this retrospective observational case study, the cases participated in the neuromuscular training program “Auf die Beine”, which combines two blocks of intensive, goal directed training with 6 months of home-based whole body vibration (WBV). Assessments by the means of a dual-energy X-ray absorptiometry and grip strength were applied at multiple points throughout the program. Two cases showed an increase in lean mass index of +0.319 kg/m², +0.721 kg/m² and bone mineral content of +0.028 kg/m², +0.031 kg/m² over one year. Additionally physiotherapeutic therapy goals could be achieved. In the remaining child lean mass index did not change, bone mineral content decreased by -0.03 kg. The neuromuscular rehabilitation program “Auf die Beine” has shown to be safe and effective in two of three cases for muscle and bone mass gain as well as in achievement of physiotherapeutic goals. To summarize, WBV is an innovative therapy in a rehabilitation concept, which might be helpful in Pompe disease, but further studies with larger cohorts are needed.     

Liaison psychiatry on a coronary care unit.

This paper presents several of the author's experiences as a liaison psychiatrist on coronary care units. Technological and pharmacological advancements over the past decade have made major contributions toward reducing the psychological stress of patients admitted to these units. The psychiatrist's main liaison role is in assisting with patient education and rehabilitation efforts. Examples are given of a patient education program and reasons for systematic evaluations for such programs. The psychiatrist also can aid in patient rehabilitation efforts carried out in the outpatient clinic. Results are given from an experimental program of group therapy as an adjunct to the treatment of post-myocardial infarction patients. Finally, two case histories are briefly presented which exemplify subjects' serum uric acid and serum cholesterol variability associated with psychological stresses encountered during their hospitalization following a myocardial infarction.