Pub Date : 2022-01-01DOI: 10.4103/jisprm.jisprm-000138
F. Tan, J. Strakowski, F. Chiou-Tan
Introduction: The objective of this paper is to demonstrate changes in the sonographic appearance of muscles in region of the neck with cervical movement from neutral anatomic position to right rotational torsion. Methods: Sonographic images were obtained in a 56-year-old healthy female. Muscles selected are common targets for botulinum toxin A injection in treatment for cervical dystonia. Sonographic images were obtained with the transducer placed over the muscle of interest with the neck in both anatomic-neutral and right-rotated positions. Cine loop video was also recorded at each site to track muscles throughout torsion. Results: The results show that in rotational torsion, (1) the brachial plexus becomes difficult to view due to anisotropy when examining the scalenes. The relationship between the anterior and middle scalenes and brachial plexus becomes less distinct with cervical rotation beyond neutral position. (2) The positional relationship of the sternocleidomastoid (SCM) and the ipsilateral splenius capitus is altered. (3) The jugular vein changes from collapsed to distended in the contralateral SCM view. (4) The position of the trapezius is not altered significantly. Conclusion: The sonographic appearance of soft tissue structures about the neck differs significantly with cervical movement from an anatomic neutral position to a position of right torsion. Knowledge of the dynamic positional changes of the muscles in this region in relation to each other, as well as the neurovascular structures, with cervical movement and torsion can potentially improve diagnostic assessment as well as accuracy of interventional procedures.
{"title":"Ultrasound visualization of torsional anatomic changes in the neck: Applications to cervical rotational torticollis","authors":"F. Tan, J. Strakowski, F. Chiou-Tan","doi":"10.4103/jisprm.jisprm-000138","DOIUrl":"https://doi.org/10.4103/jisprm.jisprm-000138","url":null,"abstract":"Introduction: The objective of this paper is to demonstrate changes in the sonographic appearance of muscles in region of the neck with cervical movement from neutral anatomic position to right rotational torsion. Methods: Sonographic images were obtained in a 56-year-old healthy female. Muscles selected are common targets for botulinum toxin A injection in treatment for cervical dystonia. Sonographic images were obtained with the transducer placed over the muscle of interest with the neck in both anatomic-neutral and right-rotated positions. Cine loop video was also recorded at each site to track muscles throughout torsion. Results: The results show that in rotational torsion, (1) the brachial plexus becomes difficult to view due to anisotropy when examining the scalenes. The relationship between the anterior and middle scalenes and brachial plexus becomes less distinct with cervical rotation beyond neutral position. (2) The positional relationship of the sternocleidomastoid (SCM) and the ipsilateral splenius capitus is altered. (3) The jugular vein changes from collapsed to distended in the contralateral SCM view. (4) The position of the trapezius is not altered significantly. Conclusion: The sonographic appearance of soft tissue structures about the neck differs significantly with cervical movement from an anatomic neutral position to a position of right torsion. Knowledge of the dynamic positional changes of the muscles in this region in relation to each other, as well as the neurovascular structures, with cervical movement and torsion can potentially improve diagnostic assessment as well as accuracy of interventional procedures.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"16 - 20"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41837672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/2349-7904.351321
{"title":"Invited Presentatio","authors":"","doi":"10.4103/2349-7904.351321","DOIUrl":"https://doi.org/10.4103/2349-7904.351321","url":null,"abstract":"","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70587678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/jisprm.jisprm-000145
I. Jiménez, Melina Longoni Di Giusto, C. Castillo, D. Ramos-Usuga, K. Tansey, J. Arango-Lasprilla
Objectives: To describe the current state of pulmonary rehabilitation of patients with Spinal Cord Injury (SCI) in Latin America (LA) during the COVID-19 pandemic. Methods: 468 rehabilitation professionals working with SCI patients from 20 countries in LA answered an online survey related to their training, qualifications, medical practices, and resources. Results: Less than half of pulmonary rehabilitation professionals reported working with SCI patients. Of these, more than half indicated that they had not received training in pulmonary rehabilitation of these patients and did not feel qualified to provide this kind of care. In fact, only 23.4% of those surveyed indicated treating patients with SCI who require mechanical ventilation. Around 60% of providers reported having a multidisciplinary team trained and qualified to practice pulmonary rehabilitation in patients with SCI. Finally, the majority indicated having less than 5 beds to carry out this practice. Conclusions: This manuscript highlights the limited professional training and resource availability in LA to assist patients with SCI requiring pulmonary rehabilitation and provides recommendations to improve the current situation.
{"title":"The state of spinal cord injury respiratory rehabilitation in Latin America","authors":"I. Jiménez, Melina Longoni Di Giusto, C. Castillo, D. Ramos-Usuga, K. Tansey, J. Arango-Lasprilla","doi":"10.4103/jisprm.jisprm-000145","DOIUrl":"https://doi.org/10.4103/jisprm.jisprm-000145","url":null,"abstract":"Objectives: To describe the current state of pulmonary rehabilitation of patients with Spinal Cord Injury (SCI) in Latin America (LA) during the COVID-19 pandemic. Methods: 468 rehabilitation professionals working with SCI patients from 20 countries in LA answered an online survey related to their training, qualifications, medical practices, and resources. Results: Less than half of pulmonary rehabilitation professionals reported working with SCI patients. Of these, more than half indicated that they had not received training in pulmonary rehabilitation of these patients and did not feel qualified to provide this kind of care. In fact, only 23.4% of those surveyed indicated treating patients with SCI who require mechanical ventilation. Around 60% of providers reported having a multidisciplinary team trained and qualified to practice pulmonary rehabilitation in patients with SCI. Finally, the majority indicated having less than 5 beds to carry out this practice. Conclusions: This manuscript highlights the limited professional training and resource availability in LA to assist patients with SCI requiring pulmonary rehabilitation and provides recommendations to improve the current situation.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"21 - 26"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46387148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/jisprm.jisprm-000152
T. Khoo, A. Fitzgerald
Background: Cancer rehabilitation is gaining recognition in response to treatment advances, with more survivors living with functional impairments. This study aims to describe the outcomes from neuro-oncological rehabilitation within an inpatient neurorehabilitation setting, focusing on patients with malignancy. Subjects and Methods: A review of neuro-oncological admissions from 2009 to 2017 was performed comparing length of stay (LOS), changes in United Kingdom Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) scores, discharge outcome, and survival between patients with benign and malignant diagnoses. Results: One hundred and twenty patients were included (40% with malignancy). Eighteen percent required transfer back to acute setting due to cancer- or treatment-related complications. Having malignancy was associated with a higher rate of acute transfer (34% vs. 7%, x2 = 13.8, P < 0.01). LOS was not significantly different between the two groups (median difference: 5 days, 95% confidence interval [CI]: −8–18, P = 0.187). While UK FIM + FAM change was significantly lower in the malignant group, the corresponding lower UK FIM + FAM efficiency was not (mean difference: 16, 95% CI: 1–31, P = 0.043 and 0.18, −0.42–0.05, P = 0.114, respectively). The median survival in the malignant group was 3.2 months (95% CI: 2.0–8.4), with survival up to 40.4 months. Conclusion: While patient outcomes with benign and malignant diagnoses were similar, the UK FIM + FAM does not capture the full benefit of rehabilitation. Given that patients with malignancy have limited survival, quality of life measures and goal attainment scaling may be more appropriate. Effective and efficient inpatient neuro-oncological rehabilitation in malignancy is deliverable, but collaboration with both oncology and palliative care services is crucial.
背景:随着治疗的进步，癌症康复正在得到人们的认可，越来越多的幸存者患有功能障碍。本研究旨在描述神经肿瘤康复在住院患者神经康复设置的结果，重点是恶性肿瘤患者。研究对象和方法:对2009年至2017年神经肿瘤住院患者的住院时间(LOS)、英国功能独立测量+功能评估测量(UK FIM + FAM)评分的变化、出院结局和良性和恶性诊断患者的生存率进行了回顾。结果:共纳入120例患者，其中恶性肿瘤占40%。由于癌症或治疗相关的并发症，18%的患者需要转回急性环境。恶性肿瘤与较高的急性转移率相关(34%比7%，x2 = 13.8, P < 0.01)。两组间LOS无显著差异(中位差:5天，95%可信区间[CI]:−8-18,P = 0.187)。恶性组中UK FIM + FAM变化明显降低，而UK FIM + FAM效率相应降低(平均差异:16,95% CI: 1-31, P = 0.043和0.18，−0.42-0.05,P = 0.114)。恶性组中位生存期为3.2个月(95% CI: 2.0-8.4)，生存期达40.4个月。结论:虽然良性和恶性诊断的患者结果相似，但英国FIM + FAM并没有获得康复的全部益处。鉴于恶性肿瘤患者的生存有限，生活质量测量和目标实现量表可能更合适。有效和高效的住院恶性肿瘤神经肿瘤康复是可交付的，但与肿瘤和姑息治疗服务的合作是至关重要的。
{"title":"Exploring the value of neuro-oncological rehabilitation within a neurorehabilitation setting","authors":"T. Khoo, A. Fitzgerald","doi":"10.4103/jisprm.jisprm-000152","DOIUrl":"https://doi.org/10.4103/jisprm.jisprm-000152","url":null,"abstract":"Background: Cancer rehabilitation is gaining recognition in response to treatment advances, with more survivors living with functional impairments. This study aims to describe the outcomes from neuro-oncological rehabilitation within an inpatient neurorehabilitation setting, focusing on patients with malignancy. Subjects and Methods: A review of neuro-oncological admissions from 2009 to 2017 was performed comparing length of stay (LOS), changes in United Kingdom Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) scores, discharge outcome, and survival between patients with benign and malignant diagnoses. Results: One hundred and twenty patients were included (40% with malignancy). Eighteen percent required transfer back to acute setting due to cancer- or treatment-related complications. Having malignancy was associated with a higher rate of acute transfer (34% vs. 7%, x2 = 13.8, P < 0.01). LOS was not significantly different between the two groups (median difference: 5 days, 95% confidence interval [CI]: −8–18, P = 0.187). While UK FIM + FAM change was significantly lower in the malignant group, the corresponding lower UK FIM + FAM efficiency was not (mean difference: 16, 95% CI: 1–31, P = 0.043 and 0.18, −0.42–0.05, P = 0.114, respectively). The median survival in the malignant group was 3.2 months (95% CI: 2.0–8.4), with survival up to 40.4 months. Conclusion: While patient outcomes with benign and malignant diagnoses were similar, the UK FIM + FAM does not capture the full benefit of rehabilitation. Given that patients with malignancy have limited survival, quality of life measures and goal attainment scaling may be more appropriate. Effective and efficient inpatient neuro-oncological rehabilitation in malignancy is deliverable, but collaboration with both oncology and palliative care services is crucial.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"27 - 32"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45087641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Ferreira, D. Portugal, N. Silva, C. Peixoto, André Ladeira, C. Matos, L. Prates
Spontaneous muscle ruptures in young adults without previous diseases or risk factors are extremely rare. No previous reports describing simultaneous spontaneous ruptures of multiple muscles in the healthy young adult have been published, emphasizing the lack of protocolized rehabilitation programs. In this article, the authors report a case of simultaneous spontaneous multiple muscle tears in a healthy goalkeeper, proposing a rehabilitation approach. A 19-year-old male goalkeeper presented to the emergency department with intense acute low back pain initiated spontaneously after raising from bed and originating gait difficulties. Magnetic resonance imaging demonstrated muscle ruptures in the left iliacus, piriformis, and paravertebral. Investigation for systemic causes of muscle tears was negative. The patient pursued a customized and phased rehabilitation program for a total of 6 months. In the re-evaluation at the end of the rehabilitation program, the patient presented no pain, had full range of motion and full muscle strength, and presented great stability and coordination. He was referred to sports medicine to pursue reintegration as a goalkeeper with functional sports-specific training. Although no cause for the ruptures was identified, the patients' sports-related activity may lead to microtear formation and trigger spontaneous tears. Thus, sports biomechanics may explain the underlying pathogenesis of these injuries. This case also highlights that an individualized rehabilitation program optimizes activity, participation, and professional reintegration.
{"title":"Rehabilitation of spontaneous muscle ruptures in a healthy young goalkeeper","authors":"E. Ferreira, D. Portugal, N. Silva, C. Peixoto, André Ladeira, C. Matos, L. Prates","doi":"10.4103/jisprm-000140","DOIUrl":"https://doi.org/10.4103/jisprm-000140","url":null,"abstract":"Spontaneous muscle ruptures in young adults without previous diseases or risk factors are extremely rare. No previous reports describing simultaneous spontaneous ruptures of multiple muscles in the healthy young adult have been published, emphasizing the lack of protocolized rehabilitation programs. In this article, the authors report a case of simultaneous spontaneous multiple muscle tears in a healthy goalkeeper, proposing a rehabilitation approach. A 19-year-old male goalkeeper presented to the emergency department with intense acute low back pain initiated spontaneously after raising from bed and originating gait difficulties. Magnetic resonance imaging demonstrated muscle ruptures in the left iliacus, piriformis, and paravertebral. Investigation for systemic causes of muscle tears was negative. The patient pursued a customized and phased rehabilitation program for a total of 6 months. In the re-evaluation at the end of the rehabilitation program, the patient presented no pain, had full range of motion and full muscle strength, and presented great stability and coordination. He was referred to sports medicine to pursue reintegration as a goalkeeper with functional sports-specific training. Although no cause for the ruptures was identified, the patients' sports-related activity may lead to microtear formation and trigger spontaneous tears. Thus, sports biomechanics may explain the underlying pathogenesis of these injuries. This case also highlights that an individualized rehabilitation program optimizes activity, participation, and professional reintegration.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"36 - 40"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49063218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Selb, G. Stucki, Jianan Li, Masahiko Mukaino, L. Li, F. Gimigliano, On behalf of the ISPRM ClinFIT Task Force‡
Introduction: Health systems worldwide are challenged to address the health-care needs of persons with COVID-19. After the immediate need to mitigate the spread of COVID-19 and scale up relevant health-care capacities, one major challenge has emerged – scaling up rehabilitation to address the functioning limitations experienced by COVID-19 patients/survivors. To meet this challenge, the International Society of Physical and Rehabilitation Medicine (ISPRM) endeavors to develop a tool for the assessment and reporting of functioning of COVID-19 patients/survivors – “ClinFIT COVID- 19” to assist health professionals to optimally address patients' health-care needs. The first step in the development process is identifying the International Classification of Functioning, Disability, and Health (ICF) categories that ClinFIT COVID-19 should cover for acute, postacute, and long-term settings. Methods: The multistep process to develop the ClinFIT COVID-19 category list involved the development of a proposed list of ICF categories, a survey of ISPRM members worldwide about the proposed category list, and a postsurvey consultation with the ISPRM ClinFIT Task Force. Results: The final category list for the acute care context contains the seven categories provided to the survey participants (energy/drive functions, sleep, emotional functions, pain, exercise tolerance functions, carrying out daily routine, and walking) plus six categories related to respiration, mobility, and cognition. The postacute and long-term care versions also contain the seven categories plus additional categories relevant for the specific context. The postacute version contains 15 categories and the long-term 16 categories. Conclusions: To advance the next steps, the leaders of ISPRM and the Task Force call national and international societies of rehabilitation professionals to join this coordinated effort.
{"title":"Developing clinfit COVID-19: An initiative to scale up rehabilitation for COVID-19 patients and survivors across the care continuum","authors":"M. Selb, G. Stucki, Jianan Li, Masahiko Mukaino, L. Li, F. Gimigliano, On behalf of the ISPRM ClinFIT Task Force‡","doi":"10.4103/jisprm-000128","DOIUrl":"https://doi.org/10.4103/jisprm-000128","url":null,"abstract":"Introduction: Health systems worldwide are challenged to address the health-care needs of persons with COVID-19. After the immediate need to mitigate the spread of COVID-19 and scale up relevant health-care capacities, one major challenge has emerged – scaling up rehabilitation to address the functioning limitations experienced by COVID-19 patients/survivors. To meet this challenge, the International Society of Physical and Rehabilitation Medicine (ISPRM) endeavors to develop a tool for the assessment and reporting of functioning of COVID-19 patients/survivors – “ClinFIT COVID- 19” to assist health professionals to optimally address patients' health-care needs. The first step in the development process is identifying the International Classification of Functioning, Disability, and Health (ICF) categories that ClinFIT COVID-19 should cover for acute, postacute, and long-term settings. Methods: The multistep process to develop the ClinFIT COVID-19 category list involved the development of a proposed list of ICF categories, a survey of ISPRM members worldwide about the proposed category list, and a postsurvey consultation with the ISPRM ClinFIT Task Force. Results: The final category list for the acute care context contains the seven categories provided to the survey participants (energy/drive functions, sleep, emotional functions, pain, exercise tolerance functions, carrying out daily routine, and walking) plus six categories related to respiration, mobility, and cognition. The postacute and long-term care versions also contain the seven categories plus additional categories relevant for the specific context. The postacute version contains 15 categories and the long-term 16 categories. Conclusions: To advance the next steps, the leaders of ISPRM and the Task Force call national and international societies of rehabilitation professionals to join this coordinated effort.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"4 1","pages":"174 - 183"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46737569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ning Cao, Andrew Packel, Elizabeth Marcy, Kelly Sprik, Erika Harold, Rui Xiao, Alberto Esquenazi
Background: The recovery of independent walking is one of the major goals of stroke rehabilitation; however, due to the current acute inpatient rehabilitation care paradigm, the intensity of walking practice provided has been far below that recommended for motor recovery to occur. A quality improvement initiative was implemented to encourage the physical therapist (PT) to incorporate various robotic gait training devices as part of the standard allotted PT sessions to improve the intensity of gait training.
Materials and methods: After 6 months, a retrospective review was performed to assess the feasibility of the robotic-assisted gait training (RAGT) intervention in limited-ambulatory stroke patients and determine preliminary efficacy of the RAGT program by analyzing Functional Index Measure (FIM) motor gain and accelerometer-based daily step counts in patients who received the RAGT versus a group treated with conventional therapy.
Results: About 30% of limited-ambulatory patients admitted to the stroke rehabilitation unit received consistent integrated RAGT without safety concerns. Compared to those who received conventional treatment, these patients showed greater mean FIM motor gain (32.30 versus 17.88) at discharge (P < 0.005) and higher number of step counts in PT sessions (P < 0.005). Age, gender, or admission FIM motor were not associated with FIM motor gain.
Conclusions: Across a 6-month initial implementation period, RAGT was feasible and was associated with higher repetition of walking practice and also with improved FIM motor scores in limited-ambulatory individuals in an acute inpatient stroke rehabilitation program. However, the frequency of RAGT and the percentage of patients participating need to further improve. Some strategies to address these concerns were identified.
背景：恢复独立行走是脑卒中康复的主要目标之一；然而，由于目前的急性期住院康复护理模式，提供的行走练习强度远远低于运动恢复所建议的强度。我们实施了一项质量改进计划，鼓励物理治疗师（PT）将各种机器人步态训练设备作为标准配置的PT课程的一部分，以提高步态训练的强度：6个月后，我们进行了一项回顾性研究，以评估机器人辅助步态训练（RAGT）干预在行动不便的脑卒中患者中的可行性，并通过分析接受机器人辅助步态训练的患者与接受常规治疗的患者的功能指数测量（FIM）运动增益和基于加速度计的每日步数，确定机器人辅助步态训练计划的初步疗效：结果：在中风康复科住院的行动不便患者中，约有 30% 接受了一致的 RAGT 综合疗法，没有出现安全问题。与接受常规治疗的患者相比，这些患者在出院时的平均 FIM 运动增益（32.30 对 17.88）更高（P < 0.005），在 PT 疗程中的步数也更高（P < 0.005）。年龄、性别或入院时的 FIM 运动量与 FIM 运动增益无关：结论：在为期 6 个月的初始实施期间，RAGT 是可行的，并且与行走练习的重复次数增加以及急性期住院卒中康复项目中行动不便者的 FIM 运动评分提高有关。然而，RAGT 的频率和参与患者的比例还需要进一步提高。我们提出了一些解决这些问题的策略。
{"title":"Implementing Robotic-Assisted Gait Training in Acute Inpatient Stroke Rehabilitation: A Quality Improvement Initiative.","authors":"Ning Cao, Andrew Packel, Elizabeth Marcy, Kelly Sprik, Erika Harold, Rui Xiao, Alberto Esquenazi","doi":"10.4103/jisprm-000130","DOIUrl":"10.4103/jisprm-000130","url":null,"abstract":"<p><strong>Background: </strong>The recovery of independent walking is one of the major goals of stroke rehabilitation; however, due to the current acute inpatient rehabilitation care paradigm, the intensity of walking practice provided has been far below that recommended for motor recovery to occur. A quality improvement initiative was implemented to encourage the physical therapist (PT) to incorporate various robotic gait training devices as part of the standard allotted PT sessions to improve the intensity of gait training.</p><p><strong>Materials and methods: </strong>After 6 months, a retrospective review was performed to assess the feasibility of the robotic-assisted gait training (RAGT) intervention in limited-ambulatory stroke patients and determine preliminary efficacy of the RAGT program by analyzing Functional Index Measure (FIM) motor gain and accelerometer-based daily step counts in patients who received the RAGT versus a group treated with conventional therapy.</p><p><strong>Results: </strong>About 30% of limited-ambulatory patients admitted to the stroke rehabilitation unit received consistent integrated RAGT without safety concerns. Compared to those who received conventional treatment, these patients showed greater mean FIM motor gain (32.30 versus 17.88) at discharge (<i>P</i> < 0.005) and higher number of step counts in PT sessions (<i>P</i> < 0.005). Age, gender, or admission FIM motor were not associated with FIM motor gain.</p><p><strong>Conclusions: </strong>Across a 6-month initial implementation period, RAGT was feasible and was associated with higher repetition of walking practice and also with improved FIM motor scores in limited-ambulatory individuals in an acute inpatient stroke rehabilitation program. However, the frequency of RAGT and the percentage of patients participating need to further improve. Some strategies to address these concerns were identified.</p>","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"1 1","pages":"168-173"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10821733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70799070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radha Korupolu, A. Stampas, I. Jiménez, Darby Cruz, Melina Longoni Di Giusto, M. Verduzco-Gutierrez, Matthew Davis
Objective: There is heterogeneity in the management of spinal cord injury (SCI) patients requiring mechanical ventilation (MV). This survey's objective was to study the current practices of ventilator management and weaning in adults with SCI. Methods: We conducted a cross-sectional, self-administered global electronic survey of providers caring for adults with SCI on MV. Recruitment was accomplished through direct E-mailing, social media posting and sharing amongst qualifying providers. Respondents were divided into acute care (AC) and rehabilitation (rehab) groups based on their work setting and specialty. Results: Overall, 137 respondents with a majority from North America (50%) were included. Assist Control mode was the most frequently reported mode (33%) in AC and the rehabilitation setting (RS). Most (72%) in AC use predicted body weight (PBW) to determine the tidal volume (VT); it varies widely in the RS. The highest VT (median [interquartile range]) reported by AC was 10 (8–10) cc/kg pbw compared to 13 (10–15) cc/kg pbw (P = 0.001) in the RS. Application of positive end-expiratory pressure and keeping the tracheostomy cuff inflated are commonly reported practices in AC, whereas there is inconsistency with these practices in the RS. Regarding factors to initiate weaning, physicians in the AC mostly relied on arterial blood gas (70%) findings, whereas in the RS, physicians relied on vital capacity (73%). Conclusion: We found significant differences in practices between “AC and RS” and “within RS,” which warrants further investigation of optimal ventilator settings and weaning practices for people with SCI.
{"title":"Mechanical ventilation and weaning practices for adults with spinal cord injury - An international survey","authors":"Radha Korupolu, A. Stampas, I. Jiménez, Darby Cruz, Melina Longoni Di Giusto, M. Verduzco-Gutierrez, Matthew Davis","doi":"10.4103/JISPRM-000124","DOIUrl":"https://doi.org/10.4103/JISPRM-000124","url":null,"abstract":"Objective: There is heterogeneity in the management of spinal cord injury (SCI) patients requiring mechanical ventilation (MV). This survey's objective was to study the current practices of ventilator management and weaning in adults with SCI. Methods: We conducted a cross-sectional, self-administered global electronic survey of providers caring for adults with SCI on MV. Recruitment was accomplished through direct E-mailing, social media posting and sharing amongst qualifying providers. Respondents were divided into acute care (AC) and rehabilitation (rehab) groups based on their work setting and specialty. Results: Overall, 137 respondents with a majority from North America (50%) were included. Assist Control mode was the most frequently reported mode (33%) in AC and the rehabilitation setting (RS). Most (72%) in AC use predicted body weight (PBW) to determine the tidal volume (VT); it varies widely in the RS. The highest VT (median [interquartile range]) reported by AC was 10 (8–10) cc/kg pbw compared to 13 (10–15) cc/kg pbw (P = 0.001) in the RS. Application of positive end-expiratory pressure and keeping the tracheostomy cuff inflated are commonly reported practices in AC, whereas there is inconsistency with these practices in the RS. Regarding factors to initiate weaning, physicians in the AC mostly relied on arterial blood gas (70%) findings, whereas in the RS, physicians relied on vital capacity (73%). Conclusion: We found significant differences in practices between “AC and RS” and “within RS,” which warrants further investigation of optimal ventilator settings and weaning practices for people with SCI.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"4 1","pages":"131 - 140"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46624927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/2349-7904.324872
Allison N. Capizzi, K. Horstmann, M. Verduzco-Gutierrez, G. Francisco, Sheng Li
This case describes success using high-dose submotor threshold electrical stimulation (EStim) therapy for the management of dystonia in a chronic stroke patient. The authors find this novel EStim treatment is safe and offers the potential to manage poststroke dystonic movements.
{"title":"Electrical stimulation therapy as treatment for poststroke dystonia","authors":"Allison N. Capizzi, K. Horstmann, M. Verduzco-Gutierrez, G. Francisco, Sheng Li","doi":"10.4103/2349-7904.324872","DOIUrl":"https://doi.org/10.4103/2349-7904.324872","url":null,"abstract":"This case describes success using high-dose submotor threshold electrical stimulation (EStim) therapy for the management of dystonia in a chronic stroke patient. The authors find this novel EStim treatment is safe and offers the potential to manage poststroke dystonic movements.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"4 1","pages":"156 - 158"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49060156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Despite increasing evidence of the benefits of cancer rehabilitation worldwide, the nature of cancer rehabilitation programs is not well described in Australia and New Zealand. We report findings of a pilot survey highlighting the current service delivery of cancer rehabilitation programs and health professionals' perspectives on barriers and facilitators to implementation of cancer rehabilitation programs. Methods: A cross-sectional pilot survey of rehabilitation health professionals in hospital and ambulatory care settings in Australia and New Zealand, evaluating current availability of cancer rehabilitation programs, health professional workforce, core components delivered, and barriers and facilitators to provision and delivery of cancer rehabilitation programs. Results: Respondents (n = 60) included rehabilitation physicians and advanced trainees, with a majority of respondents working in non-dedicated cancer rehabilitation programs in Australia and New Zealand. Most rehabilitation programs being provided to cancer patients are led by rehabilitation physicians, followed by allied health. The most common tumor streams referred include central nervous system, hematological, and breast cancers. Patients are most frequently referred during posttreatment phase. The core components of rehabilitation programs include management of complications and provision of education (mood, exercise, and fatigue management), with exercise prescription comprising mainly strengthening exercises, mobilization, and gait training. Common barriers for adequate service delivery included inadequate funding and lack of appropriate staffing with expertise, while most common facilitators identified were encouraging better collaboration and integration of rehabilitation within acute cancer care services and specialty teams and increased enthusiasm and engagement of staff with leadership skills. Conclusion: The pilot survey identified current service provision among rehabilitation programs providing care to cancer patients and highlighted preliminary gaps and facilitators to the implementation of formal cancer rehabilitation programs. These findings need further confirmation in a larger study to assess further outcome measures and the impact of barriers and facilitators for care quality. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified.
{"title":"Cancer rehabilitation in Australia and New Zealand: A pilot cross-sectional survey","authors":"K. Song, B. Amatya, F. Khan","doi":"10.4103/jisprm-000131","DOIUrl":"https://doi.org/10.4103/jisprm-000131","url":null,"abstract":"Objective: Despite increasing evidence of the benefits of cancer rehabilitation worldwide, the nature of cancer rehabilitation programs is not well described in Australia and New Zealand. We report findings of a pilot survey highlighting the current service delivery of cancer rehabilitation programs and health professionals' perspectives on barriers and facilitators to implementation of cancer rehabilitation programs. Methods: A cross-sectional pilot survey of rehabilitation health professionals in hospital and ambulatory care settings in Australia and New Zealand, evaluating current availability of cancer rehabilitation programs, health professional workforce, core components delivered, and barriers and facilitators to provision and delivery of cancer rehabilitation programs. Results: Respondents (n = 60) included rehabilitation physicians and advanced trainees, with a majority of respondents working in non-dedicated cancer rehabilitation programs in Australia and New Zealand. Most rehabilitation programs being provided to cancer patients are led by rehabilitation physicians, followed by allied health. The most common tumor streams referred include central nervous system, hematological, and breast cancers. Patients are most frequently referred during posttreatment phase. The core components of rehabilitation programs include management of complications and provision of education (mood, exercise, and fatigue management), with exercise prescription comprising mainly strengthening exercises, mobilization, and gait training. Common barriers for adequate service delivery included inadequate funding and lack of appropriate staffing with expertise, while most common facilitators identified were encouraging better collaboration and integration of rehabilitation within acute cancer care services and specialty teams and increased enthusiasm and engagement of staff with leadership skills. Conclusion: The pilot survey identified current service provision among rehabilitation programs providing care to cancer patients and highlighted preliminary gaps and facilitators to the implementation of formal cancer rehabilitation programs. These findings need further confirmation in a larger study to assess further outcome measures and the impact of barriers and facilitators for care quality. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"4 1","pages":"146 - 155"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47742122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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