Journal of rehabilitation medicine. Clinical communications最新文献

Objective: To evaluate the effects of personalized exposure in vivo on level of physical activity and quality of life in patients with painful diabetic neuropathy.

Design: Randomized, single-case, ABC design.

Subjects: Twelve patients with painful diabetic neuropathy, age > 18 years, diabetes mellitus type II, Clinical Neurological Examination score > 5, Diabetic Neuropathy Symptom Score ≥ 1 and Douleur Neuropathique 4 Questions score ≥ 3.

Methods: The treatment consists of an Intensive screening, followed by an 8-week exposure in vivo intervention specifically adapted to the needs/risks of patients with painful diabetic neuropathy, and 6-months follow-up. Outcome measures included daily and non-daily measures of physical activity, quality of life, metabolic parameters, disability, depression, general and painful diabetic neuropathy-related anxiety, pain intensity and pain catastrophizing.

Results: Due to high drop-out rates (n = 6 during screening, n = 2 during treatment, n = 1 after treatment), only 3 participants completed the study. Slight, but non-significant, changes in physical activity and disability were observed. In quality of life, no changes were observed.

Conclusion: Analysis of the reasons for the high drop-out rate indicate that exposure in vivo may have added value in patients with painful diabetic neuropathy only for those patients: (i) whose daily life functioning is impaired mainly by the painful diabetic neuropathy; (ii) in whom painful diabetic neuropathy-related fears are exaggerated and irrational; (iii) in whom specific activities evoke the painful diabetic neuropathy-related fears; (iv) whose spouse and healthcare providers are involved in the treatment; and (v) who are willing to change their daily behaviour. Further research is needed into this subject.

Cancer itself can have lifelong devastating effects, but radiation treatment can often also result in long-lasting neurological and musculoskeletal complications, leading to subsequent severe functional impairments. Physiatrists caring for the cancer rehabilitation population must be able to recognize and treat radiation-induced peripheral nerve injuries. This report presents a rare case of radiationinduced obturator neuropathy in a patient with recurrent cervical cancer.

Objective: To evaluate the effect of whole-body vibration training on working-age people on haemodialysis.

Design: Consecutive case series study.

Subjects: Seventeen working-age participants on maintenance haemodialysis were enrolled.

Methods: A 12-week whole-body vibration training programme, including different postures, was designed. The study evaluated and compared physical fitness, including a list of tests such as the 5-repetition sit-to-stand test, hand grip test, 2-min step test, and 8-foot up-and-go test; modified Berg balance scale; static and dynamic balance function; and quality of life, using a quality of life questionnaire before and after the training.

Results: All physical fitness parameters, except grip strength on the left side, improved after whole-body vibration training. For balance, the modified Berg balance scale demonstrated enhanced scores for equilibrium, with eyes closed on a stable surface and eyes open on an unstable surface, and movement velocity under the fast condition along the left and right directions (p=0.011). No significant improvements in quality of life were found.

Conclusion: Whole-body vibration exercise training enhanced physical fitness and static and dynamic balance control in working-age participants on haemodialysis.

Objective: To elucidate the characteristics of recovery progression during long-term rehabilitation after moderate-to-severe traumatic brain injury.

Methods: Longitudinal changes in consciousness, swallowing disorders, activities of daily living, and psychological and behavioural status were studied in 7 patients with moderateto-severe traumatic brain injury, using scores of the National Agency for Automotive Safety & Victim's Aid (NASVA score), Glasgow Coma Scale (GCS), Dysphagia Severity Scale (DSS), Eating Status Scale (ESS), Functional Independence Measure (FIM), Cognitive-related Behavioural Assessment (CBA), and Neuropsychiatric Inventory (NPI). Scores were collected every month until discharge (median 359 days after injury), or until the study end date for those patients who remained hospitalized (432 days).

Results: Patients were qualitatively classified into those who improved well in the early phase, in terms of consciousness, swallowing, and activities of daily living, and those with less or delayed improvement. Psychological and behavioural difficulties appeared to remain less improved than the other functions for longer periods in many patients. Statistical comparisons that included all 7 patients revealed a significant improvement in NASVA score, GCS, DSS, and ESS, but not in FIM, CBA, and NPI at discharge/at the last measurement compared with scores at admission.

Conclusion: Swallowing function is more responsive to long-term rehabilitation in patients with moderate-to-severe traumatic brain injury, while neuropsychiatric and behavioural difficulties tend to persist for longer periods.

Objective: To investigate the factors predicting oral feeding ability following acute stroke.

Methods: This retrospective study compared patients admitted to a stroke care unit in 2 groups: an oral intake group and a tube feeding group. The groups were evaluated for 28 items and initial blood investigation tests, and the results compared. Logistic regression analysis was used to identify the clinical variables significantly associated with oral feeding ability.

Results: A total of 255 stroke patients (162 in the oral intake group and 93 in the tube feeding group) were admitted to the stroke care unit. Significant differences were observed between the 2 groups for 20 items. Logistic analysis found that the following variables were significant in the prediction model: age, date of initiation of oral feeding, stroke recurrence/patient deterioration during hospitalization, and date of initiation of occupational therapy.

Conclusion: Factors associated with achieving oral intake among stroke care unit patients were: young age at time of admission; starting oral intake early; no stroke recurrence/patient deterioration during hospitalization; and achieving rehabilitation of daily activities early during the physical function recovery stage.

Objective: To report the functional outcomes of two patients with morbid obesity (> 250 kg) who received in-reach rehabilitation after hospitalization for sepsis in Sydney, Australia.

Case reports: A retrospective review of hospital charts was performed with the informed consent of both patients. Body mass index, demographics, length of stay, functional status at admission and discharge, medical comorbidities, social history, hospital course, equipment needs, therapy methods used, and discharge disposition were compared.

Results: Both patients had a positive outcome. Function improved in case 1, from requiring hoist transfers, to mobilizing 80 m with 2 assistants. The patient was transferred to a subacute rehabilitation facility, but did not make any gain in Functional Independence Measure. Function improved in case 2, from requiring 2 assistants to walk with a frame, to walking independently with a 4-wheeled walker. The patient was discharged home from the acute hospital, with a minimal Functional Independence Measure gain of 8. Both patients lost approximately 45 kg during acute hospitalization.

Conclusion: These case reports demonstrate that in-reach rehabilitation can play an important role in the functional recovery of morbidly obese patients hospitalized with severe sepsis. This report also highlights the need for preventive interventions to reduce avoidable acute hospital presentations and to prevent functional decline.

Platypnea-orthodeoxia syndrome, characterized by dyspnoea and arterial desaturation while upright, is a rare complication of acute respiratory distress syndrome. We report here 2 patients with COVID-19 pneumonia, who were diagnosed with platypnea-orthodeoxia syndrome during commencement of rehabilitation, 18 and 9 days respectively after admission to the intensive care unit. Both patients presented with normocapnic hypoxaemia. One patient required mechanical ventilation with supplemental oxygen during intensive care, while the other required high-flow nasal oxygen therapy. The manifestations of platypnea-orthodeoxia syndrome were most prominent during physiotherapy, when verticalization was attempted, and hindered further mobilization out of bed, including ambulation. This report describes the clinical manifestations of platypnea-orthodeoxia syndrome and the rehabilitative strategies carried out for these 2 patients. The platypnea-orthodeoxia syndrome in these patients resolved after 65 and 22 days respectively from the day of detection. This report highlights this potentially under-recognized phenomenon, which may be unmasked during rehabilitation of patients with COVID-19 pneumonia. Good functional outcomes were achieved with a combination of verticalization training with supplemental oxygen support, respiratory techniques training and progressive endurance and resistance training, whilst awaiting resolution of the platypneaorthodeoxia syndrome.

Introduction: Spinal and bulbar muscular atrophy is a progressive neuromuscular disease that leads to muscle weakness and reduced physical function. Benefits of physical therapy for people with spinal and bulbar muscular atrophy have not been reported in the literature.

Case report: A 62-year-old male patient with spinal and bulbar muscular atrophy reported falling, difficulty walking and completing upright tasks, and showed clinical signs of low baseline function on examination. Transportation challenges made it difficult for this patient to attend frequent one-on-one physical therapy sessions.

Interventions and outcomes: A minimally supervised home-based exercise intervention was chosen with the goal of safely improving his functional capacity. The 5-visit clinical intervention, spread over 10 months, provided 3 exercise modules: seated-to-standing postural alignment and core muscle activation; upright functional and endurance training; and balance training and rhythmic walking. Post-intervention the patient had increased lower extremity muscle strength, improved balance, and reduced self-reported fatigue.

Conclusion: Home-based exercises were well tolerated with no increase in creatine kinase. Multiple clinical measures of strength and function improved, possibly related to the patients' excellent motivation and compliance with the programme. Promising utilization of a minimally supervised home-based programme is described here.

With the increasing popularity of extreme conditioning programmes, athletes and patients are searching for new, engaging, high-intensity, total-body workouts. The sport of Hooverball is increasingly used as a workout. First devised in the USA in 1929 to keep President Hoover physically fit, Hooverball has experienced increasing popularity in the past 15 years. The game is scored like tennis and played like volleyball, with players throwing and catching a heavy medicine ball over a volleyball net. Players use complex, multi-joint, explosive movements, featuring torsion, flexion and extension to absorb the forces involved. This paper reports a case of a Hooverball player who presented with a knee injury. The paper also reviews the origins of the sport, and its increase in popularity related to the increasing prominence of extreme conditioning programmes. A literature review, and common Hooverball-related injuries, are presented. Clinical recommendations are set out for patient safety, injury prevention and game coverage, including a prehabilitation strategy for players prior to engaging in this revived and growing sport.

We report a case of a Chinese man who developed retroperitoneal haemorrhage almost 1 year after surgery for pelvic fracture (1). To the best of our knowledge, this type of delayed haemorrhaging is rarely observed in clinical practice. We also review the literature to identify the common causes of retroperitoneal haemorrhage in patients undergoing surgery for pelvic fracture and to examine the aetiology of this case.