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PubMed2005

Rehabilitation of orthopedic and rheumatologic disorders. 1. Osteoporosis assessment, treatment, and rehabilitation.

UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient with osteoporosis and addresses the clinical presentation, assessment, medical management, and rehabilitation approaches to a patient with an acute vertebral fracture. It is part of the study guide on osteoporosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with postmenopausal osteoporosis. OVERALL ARTICLE OBJECTIVE: To summarize the clinical evaluation, medical management, and rehabilitation strategies in women with postmenopausal osteoporosis and acute vertebral fracture presentation.

Alendronate↗
PubMed1989

A caring perspective on rehabilitation after myocardial infarction. A theoretical framework and a suggestion for a rehabilitation programme.

Several rehabilitation models after myocardial infarction (MI) have been developed during recent years, usually with a biomedical perspective. The MI client is a biopsychosocial human being and therefore a multifactorial approach built on holistic care may offer an efficient rehabilitation process. This includes increased social support and decreased life stress for the MI client in order to obtain an adaptive coping capacity for a life style change. Health care professionals are required with specialised knowledge about how and why to care for an MI client. The present theoretical framework provides a basis for building a multifactorial rehabilitation with a caring perspective.

Adaptation, Psychological↗
PubMed2005

Recruitment of ethnic minority patients to a cardiac rehabilitation trial: the Birmingham Rehabilitation Uptake Maximisation (BRUM) study [ISRCTN72884263].

BACKGROUND: Concerns have been raised about low participation rates of people from minority ethnic groups in clinical trials. However, the evidence is unclear as many studies do not report the ethnicity of participants and there is insufficient information about the reasons for ineligibility by ethnic group. Where there are data, there remains the key question as to whether ethnic minorities more likely to be ineligible (e.g. due to language) or decline to participate. We have addressed these questions in relation to the Birmingham Rehabilitation Uptake Maximisation (BRUM) study, a randomized controlled trial (RCT) comparing a home-based with a hospital-based cardiac rehabilitation programme in a multi-ethnic population in the UK. METHODS: Analysis of the ethnicity, age and sex of presenting and recruited subjects for a trial of cardiac rehabilitation in the West-Midlands, UK. PARTICIPANTS: 1997 patients presenting post-myocardial infarction, percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. DATA COLLECTED: Exclusion rates, reasons for exclusion and reasons for declining to participate in the trial by ethnic group. RESULTS: Significantly more patients of South Asian ethnicity were excluded (52% of 'South Asian' v 36% 'White European' and 36% 'Other', p < 0.001). This difference in eligibility was primarily due to exclusion on the basis of language (i.e. the inability to speak English or Punjabi). Of those eligible, similar proportions were recruited from the different ethnic groups (white, South Asian and other). There was a marked difference in eligibility between people of Indian, Pakistani or Bangladeshi origin. CONCLUSION: Once eligible for this trial, people from different ethnic groups were recruited in similar proportions. The reason for ineligibility in the BRUM study was the inability to support the range of minority languages.

Aged↗
PubMed1995

Physical rehabilitation and violence: initiatives of the National Institute on Disability and Rehabilitation Research.

The paper presents an analysis of violence-related data from the National Spinal Cord Injury Database within the context of violence-related projects of the U.S. Department of Education's Office of Special Education and Rehabilitative Services. The National Spinal Cord Injury Database is managed by the Spain Rehabilitation Center at the University of Alabama at Birmingham, which is one of 13 Model Spinal Cord Injury Care System centers funded under a grant from the U.S. Department of Education's Institute on Disability and Rehabilitation Research. There are 1,732 cases of spinal cord injury (SCI) due to violence enrolled in the database. This enrollment provides a longitudinal sample, an analysis of which shows that African American individuals and persons of Hispanic origin represent an increasing percentage of new cases, and that an increasing percentage of individuals within these populations is incurring SCI as a result of violence.

Adult↗
PubMedDate not supplied

[Intraesophageal pressure during esophageal speech in laryngectomized patients rehabilitated or no rehabilitated for oral communication].

BACKGROUND: After laryngectomy for treatment of pharyngeal/laryngeal carcinomas the patients may be rehabilitated, for oral communication, with the esophageal speech. AIM: To study the intra-esophageal pressure during the esophageal speech. PATIENTS AND METHODS: It was measured the intra-esophageal pressure in 25 laryngectomized patients aged 40 to 70 years (median 57 years), 10 rehabilitated with esophageal speech and 15 unable to do so. The manometric method with continuous perfusion was used. The esophageal pressures was measured 3 to 5 cm below the upper esophageal sphincter when the patients tried to speak the vowel "a". Sometimes the air swallowed went to the stomach, with a peristaltic or simultaneous contraction in the esophageal body. RESULTS: During the attempt of esophageal speech the intra-esophageal pressure was higher in patients able to have esophageal speech (26.4 +/- 10.1 mm Hg, mean +/- SD) than in patients unable to do so (13.7 +/- 7.2 mm Hg). The esophageal contraction after a swallow of air was also higher in patients with esophageal speech (45.3 +/- 8.6 mm Hg) than in patients unable to do so (33.8 +/- 13.1 mm Hg). CONCLUSION: Laryngectomized patients rehabilitated with esophageal speech has a higher intra-esophageal pressure during speech than patients unable to do so, what may be consequence of the capacity to retain air inside the esophagus.

Adult↗
PubMed2001

The physical training and rehabilitation program: duration of rehabilitation and final outcome of injuries in basic combat training.

During calendar year 1998, 6% (N = 2,010: men [m] = 670, 3%, women [w] = 1,340, 12%) of soldiers in basic combat training at Fort Jackson, South Carolina (N = 32,251), were unable to continue training as a result of a training-related injury. These soldiers were recommended for the Physical Training and Rehabilitation Program (PTRP) for recovery and rehabilitation. Forty-two percent of recommended soldiers were discharged from the Army rather than assigned to PTRP. The 1,164 (m = 356, w = 808) soldiers assigned to PTRP sustained 1,673 injuries (m = 444, w = 1229). Eighty-three percent of the injuries in PTRP were in the overuse (44%) and stress fracture (39%) categories. Of the 1,164 soldiers assigned to PTRP, 52% (m = 214, w = 386) returned to training. The average (+/- SD) length of stay in PTRP for soldiers returning to duty was 62 +/- 42 days (m = 57 +/- 39, w = 65 +/- 43). Rehabilitation challenges and significant motivational issues presumably contributed to the 52% return to duty incidence for PTRP soldiers.

Adult↗
PubMed2003

[Rehabilitation of war injuries of the upper extremities with peripheral nerve lesions at the and Praxis Clinic for physical medicine and rehabilitation in Sarajevo].

The war injuries are the most frequent multiple, with the difficult distructions of the tissue and the lesions of the peripheral nerves. By the injuries, the lesions of the nerv system represent the delicate problem for the physical medicine and the rehabilitation during the siege of Sarajevo (1992-1995), in the injuries with the lesions of the peripheral nerves, if they are not treated in the frame of the multiple las urgent, they are postponed the operative treatments longer than three months. This is from the aspect of the successfullness, prognostically and therapeutically, the limiting moment. The successfullness of the operative treatment of the lesions of the peripheral nerves significantly depends on that whether the operation was performed incide tree months. The more difficult consequences in these injuries can appear if simultaneously with the taking care of war injuries does not perform adequately surgical treatment adn the in time physical therapy trough the sufficient long time period. On the four year sample was analyzed the success fullness of the rehabilitation of the injuries of the upper extremities with the lesions of the peripheral nerves. Clinically, uniform, we valorized the success fullness of the treatment of all the patients by the marks from 0.5. In the complete sample the excellent success of the rehabilitation we confirmed in more than a half of patients. The better results show the group of the operated patients, in which is performed neuropathia or neurolisis. The capability of the regeneration of the injured peripheral nerves offers the real possibility for extraordinary recovery also in the most difficult injuries, then the preventions of the significant number of the consequences.

Arm↗
PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 5. Cancer rehabilitation: management of pain, neurologic and other clinical problems.

This self-directed learning module highlights new approaches to pain management, postmastectomy treatment, and rehabilitation issues in cancers of specific organ systems. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section discusses management of pain, neuromusculoskeletal compromise, paraneoplastic syndromes, and other clinical problems.

Bibliographies as Topic↗
PubMed1987

[Presentation of a survey scale for neuro-rehabilitation--with a general discussion of current rehabilitation scales].

Presented is a newly developed rehabilitation survey scale for the field of neuro-rehabilitation, in which levels of functioning relative to ten specific and four global functions are documented at set intervalls by means of a five-grade rating scale. Additionally, numerous symptoms or associated phenomena are recorded ungraded. Used in the clinical setting, this scale affords a quick overview of the rehabilitation profile, with relatively little time and effort being required. Scientific evaluation may uncover information on the impact the disorders of specific functions have on global functions, which is relevant primarily in the social context. Also, the scale may be applied in the framework of larger-scale comparative studies. Dealt with in an extensive discussion, our newly presented scale may be accorded a number of advantages over currently used scales, which warrant its introduction. It is the outcome of many years of developmental work and pertaining reliability verifications.

Activities of Daily Living↗
PubMed1994

[The new "Marburg rehabilitation concept". "On the status of exercise equipment within the scope of rehabilitation of patients after surgery of the anterior cruciate ligament"].

The surgical treatment of acute and chronic injuries of the anterior cruciate ligament (ACL) is still incontinous. Different techniques and materials are used to reconstruct and repair this important structure. This causes that the kind of postoperative treatment is even inhomogeneous. Concepts of "early mobilization" correspond to the results of basic research on pathobiomechanical effects of joint immobilization. There is a large variety on the information concerning method, success and length of rehabilitation. The final aim of our research was the development of a new rehabilitation strategy for patients in addition to out-patient physiotherapy. The reconstruction and repair of ACL is in our hospital done by an autograft of patellar tendon, "bone-tendon-bone", in augmentation with a "3-mm-Trevira cruciate ligament prosthesis". In our prospective, controlled and randomized clinical study "group A" (n = 20) practiced in addition to their out-patient physiotherapy twice a week under the direction of a medical doctor and the control of a physiotherapist with the equipment of a fitness-center. "Group B" (n = 20) passed only the out-patient physiotherapy. Both groups were examined regularly with special regard to the active motion of the knee joint, the power and the circumference of the leg. Also the "Marschall-Tegner" and the "Lysholm-Gilquist-Score" were determined. In our study we found that the "New-Marburg-rehabilitation-concept" is an useful supplement to the out-patient physiotherapy. All examined data showed a clear increase in "group A" in comparison to "group B".

Adult↗
PubMed1998

[Social rehabilitation, state of the disease and quality of life. What are the parameters to evaluate rehabilitation of the patient under dialysis in the '90s?].

The parameters used at present by the Piedmont Dialysis and Transplant Register to evaluate rehabilitation and quality of life of the dialyzed patients have been useful in the past, but they will no longer be so in the future, as the typology of the dialyzed patient is changing: the mean age is increasing, patients with high-risk conditions as vasculopathy and diabetes are widely accepted to the treatment. Thus, rehabilitation has to be evaluated not only from a social and professional viewpoint, but also as "illness situation" and "quality of life" and this can be done using the Karnofsky scale and the test of Spitzer: our Register needs to be implemented in the future by such evaluations, to go on giving us useful information about rehabilitation of the dialyzed patients.

Female↗
PubMed1997

Rehabilitation of spinal cord injury in the national rehabilitation center for the disabled of Japan: profile of a spinal service.

The National Rehabilitation Center for the Disabled (hereunder abbreviated NRC) in Japan was established in 1979. It consists of four divisions: the hospital, the rehabilitation training center, the research institute, and the information service section. The spinal unit has been functioning and cooperating corelatively with all of these divisions. There were 1047 patients with a spinal cord injury treated in the 15 years from September, 1980 to August, 1994; consisting of 924 males (88.3%), and 123 females (11.7%). The breakdown of causes of injury were traffic accidents 44.9%, having a fall 14.7%, sports accidents 6.7%, and other causes of spinal paralysis 10.5%. The sites of the spinal cord lesions were cervical 372 (35.5%), thoracic 547 (52.5%), and lumbar spinal cord 128 patients (12.3%). The incidence of complete paralysis in those with a cervical spinal cord injury (SCI) was 68.8%, and for thoracic and lumbar SCI 79% each. The time for completion of activities of daily living (ADL) was 12.0 +/- 1.54 months in those with tetraplegia, and 5.6 +/- 1.71 months for those with paraplegia. The rate of employment for reentry into society was 59% in those with a cervical spinal cord injury, and 74% each in those with a thoracic or lumbar spinal cord injury.

Adolescent↗
PubMedDate not supplied

Horticultural therapy: the 'healing garden'and gardening in rehabilitation measures at Danderyd Hospital Rehabilitation Clinic, Sweden.

OBJECTIVES: Objectives were to review the literature on horticultural therapy and describe the Danderyd Hospital Horticultural Therapy Garden and its associated horticultural therapy programme. DESIGN: The literature review is based on the search words 'gardening', 'healing garden' and 'horticultural therapy'. The description is based on the second author's personal knowledge and popular-scientific articles initiated by her. The material has been integrated with acknowledged occupational therapy literature. SETTING: The setting was the Danderyd Hospital Rehabilitation Clinic, Sweden, Horticultural Therapy Garden. PARTICIPANTS: Forty-six patients with brain damage participated in group horticultural therapy. RESULTS: Horticulture therapy included the following forms: imagining nature, viewing nature, visiting a hospital healing garden and, most important, actual gardening. It was expected to influence healing, alleviate stress, increase well-being and promote participation in social life and re-employment for people with mental or physical illness. The Horticultural Therapy Garden was described regarding the design of the outdoor environment, adaptations of garden tools, cultivation methods and plant material. This therapy programme for mediating mental healing, recreation, social interaction, sensory stimulation, cognitive re-organization and training of sensory motor function is outlined and pre-vocational skills and the teaching of ergonomical body positions are assessed. CONCLUSION: This study gives a broad historic survey and a systematic description of horticultural therapy with emphasis on its use in rehabilitation following brain damage. Horticulture therapy mediates emotional, cognitive and/or sensory motor functional improvement, increased social participation, health, well-being and life satisfaction. However, the effectiveness, especially of the interacting and acting forms, needs investigation.

Agriculture↗
PubMedDate not supplied

Integration of physical medicine and rehabilitation into a medical school curriculum: musculoskeletal evaluation and rehabilitation.

The issue of increasing awareness of the specialty of physical medicine and rehabilitation is a primary concern of physiatrists in both teaching hospitals and private practice. Over the years, exposure to this specialty in medical schools has decreased, although there is simultaneously an increasing awareness of the importance of providing adequate musculoskeletal education for medical students. The authors describe one institution's success at integrating musculoskeletal medicine education, along with exposure to patients with chronic disease and disability. Curriculum content and a unique musculoskeletal skills acquisition test are discussed. Increased exposure to the specialty of physical medicine and rehabilitation in medical school can introduce numerous benefits for both the specialty and musculoskeletal education as a whole.

Clinical Clerkship↗
PubMedDate not supplied

A regional comparison of cardiac rehabilitation personnel. Adherence to the 1995 American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines by Staff Position.

PURPOSE: The American Association of Cardiopulmonary Rehabilitation (AACVPR) established guidelines for cardiac rehabilitation (CR) personnel regarding educational degree attainment, licensure, and certification. New England hospital-based CR personnel were surveyed by staff position to determine their adherence to these guidelines. METHODS: The New England Hospital-Based CR Program Questionnaire was designed to obtain information regarding program characteristics and personnel credentialing. Initially, 117 program directors agreed to participate, and 108 returned completed questionnaires for a response rate of 92.3%. RESULTS: Of the CR programs surveyed, 41% were within hospitals containing 101 to 250 beds, whereas most of those providing inpatient (66.6%) and outpatient (82.4%) CR enrolled less than 200 patients annually. Overall, 40.7% of personnel (n = 450) by staff position reported that they met the minimum recommendations, whereas 7.0% (n = 470) met the preferred AACVPR recommendations. Registered nurses (n = 67) and physical therapists (n = 58) were most compliant with the minimum guidelines: 89.6% and 84.5%, respectively. In contrast, 10.9% of the program directors/coordinators (PD/C; n = 128) met the minimum qualifications, and 5.5% met the preferred AACVPR qualifications. Most PD/C had Advanced Cardiac Life Support Certification (84.4%), but few (18%) attained American College of Sports Medicine (ACSM) certification. CONCLUSIONS: Overall, compliance of New England hospital-based CR personnel with the AACVPR minimum/preferred guidelines for educational degree and certification was lacking, as was acquisition of ACSM certification. The effect of these findings on the future status of recommended and required CR personnel qualifications for hire merits attention.

Cardiac Rehabilitation↗
PubMed2005

Antiplatelet and anticoagulant medication usage during stroke rehabilitation: the Post-Stroke Rehabilitation Outcomes Project (PSROP).

Secondary prevention of strokes is an important issue during the admission to the inpatient rehabilitation facility (IRF). There are many clinical practice guidelines with strong levels of evidence that address the secondary prophylaxis of strokes. The Post-Stroke Rehabilitation Outcomes Project (PSROP) database was used to describe the frequency that antiplatelet and/or anticoagulant medications are prescribed for the secondary prophylaxis of a stroke. Of the 1,161 participants in the PSROP, 890 (76.66%) had nonhemorrhagic strokes. Of the participants with nonhemorrhagic strokes, 169 (18.99%) did not receive any antiplatelet or anticoagulant medication. Of 717 participants who did not have an embolic event, 140 (19.5%) did not receive a salicylate, antiplatelet agent, or warfarin. Of 173 participants who had an embolic event, 29 (16.8%) did not receive a salicylate, antiplatelet agent, or warfarin. Unless patients have any medical contraindications to these medications, they should receive these evidence-based treatments for secondary stroke prophylaxis. As more stroke survivors receive antiplatelet and/or anticoagulant medications, it is more likely that the incidence of recurrent strokes will decrease.

Aged↗
PubMed2000

[Nursing home rehabilitation, functional independence and quality of life: a pilot study of somatic nursing home rehabilitation patients].

In a pilot study of 18 patients the relation between nursing home rehabilitation, functional independence and quality of life was examined. Furthermore, measurement instruments and study design were evaluated. Nursing home rehabilitation proved to be associated with (partially significant) improvement in functional independence and quality of life. Provided the inclusion of a control group and an observation period of adequate duration, study design and measurement instruments seemed to be appropriate for application in a multicenter study.

Aged↗
PubMedDate not supplied

Outcomes from stroke rehabilitation in Veterans Affairs rehabilitation units: detecting and correcting for selection bias.

This paper addresses the issue of statistical selection bias in multivariate models of functional gain estimated from observational data. Stroke patients from 20 high-volume Veterans Affairs Medical Centers (VAMCs) with acute and subacute inpatient rehabilitation treatment units were observed. Their gains in overall, motor, and cognitive functional status were measured with the use of the Functional Independence Measure (FIM). In estimating multivariate models of FIM gain during rehabilitation using these observational data, we found statistically significant evidence of selection bias, along with considerable differences in inferences between standard multivariate analyses and our selectivity-corrected models. Our results demonstrate the importance of detecting and correcting for statistical selection bias when one uses nonexperimental data to study gains in functional status.

Activities of Daily Living↗