Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “REHABILITATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,027 records · Page 57Linked to original sources
PubMed1999

Health-related quality of life improves following pulmonary rehabilitation and lung volume reduction surgery.

STUDY OBJECTIVES: To evaluate changes in health-related quality of life (HRQL) as assessed by the Medical Outcomes Study Short Form 36-item questionnaire (SF-36) after pulmonary rehabilitation and lung volume reduction surgery (LVRS). DESIGN: Prospective cohort study. PATIENTS: Nineteen patients with severe emphysema who underwent pulmonary rehabilitation in preparation for LVRS. INTERVENTIONS: Pulmonary rehabilitation followed by bilateral sequential LVRS. MEASUREMENTS AND RESULTS: HRQL assessed by the SF-36 was measured at baseline, after pulmonary rehabilitation, and 6 months after LVRS. One-way analysis of variance with repeated measures demonstrated no significant change from baseline in any of the eight domains after pulmonary rehabilitation. Scores for only one domain, vitality, improved significantly after LVRS compared with scores after pulmonary rehabilitation. However, significant improvements over baseline scores were demonstrated after combined preoperative pulmonary rehabilitation and LVRS in the domains of physical functioning, role limitations due to physical problems, social functioning, and vitality. Pulmonary rehabilitation contributed most to the overall improvements in role limitations due to physical problems, whereas LVRS contributed mainly to the overall improvements in physical functioning, social functioning, and vitality. CONCLUSIONS: Patients with severe emphysema experience significant improvements in both physical and social health status as assessed by the SF-36 after combined pulmonary rehabilitation and LVRS. Each intervention makes unique and complementary contributions to the overall improvements in HRQL.

Aged↗
PubMed1998

Hospital-based rehabilitative care versus outpatient services: effect on functioning and health status.

PURPOSE: The goal of this clinical trial was to examine the long-term impact of rehabilitative care on the health status of patients diagnosed with a disabling disorder. METHOD: Study patients consisted of first-time hospitalizations from diagnostic groups commonly admitted for inpatient rehabilitation, including nervous, circulatory, and musculoskeletal disorders or injury. Patients were randomly assigned to inpatient rehabilitation (n = 43) or to outpatient follow-up (n = 42) in which the usual medical services were provided but no scheduled rehabilitative therapies were offered. Specific objectives of the study were to determine the effects of impatient rehabilitation on: (1) functional ability, (2) health and mental health status, (3) personal adjustment, and (4) family function. Cost and use of health-care resources were descriptively assessed. RESULTS: Analysis of covariance found no significant treatment effects, either at 6 months or at 1 year, for any of the variables under study. In addition, there were no differences between groups in their use of nursing homes, length of hospital stay, mortality, or in the number of hospital readmissions or clinic visits during the first year after hospital discharge. Use of rehabilitation services and cost of care was significantly higher than outpatient services. The findings were consistent with previous studies for most outcomes, with the major exception being functional improvements. Contrary to earlier studies, rehabilitation was not found to effectively produce lasting functional outcomes. However, study conditions may not have fully corresponded to those of previous studies, and further research is needed. The patient sample was representative of a full inpatient service and therefore more heterogeneous than samples reported in prior studies, but the small sample size (due to reductions in the number of admitted patients to the rehabilitation unit during the course of the study) precluded subgroup analysis of diagnostic groupings. CONCLUSION: The findings suggest that hospital-based rehabilitative care does not have lasting benefits, and that alternative care or supportive follow-up by a subacute-care facility may be needed to assist patients in maintaining functional gains and health benefits.

Adult↗
PubMed2005

A simple and easy home-based pulmonary rehabilitation programme for patients with chronic lung diseases.

BACKGROUND AND AIM: To develop a simple and easy home-based pulmonary rehabilitation programme and investigate its effectiveness. METHODS: Patients with stable chronic lung disease were divided into a rehabilitation group (n = 25) and a control group (n = 18). Rehabilitation consisted of education and 12 weeks of enforced aerobic and muscle-strengthening exercises. Aerobic exercise training was performed mostly by walking based on the functional capacity of the patients assessed by the maximal incremental exercise test. Patients visited hospital every two weeks for evaluation and a new exercise regimen. RESULTS: Five patients dropped out of the rehabilitation group but three were due to development of unrelated diseases, five controls did not co-operate in the second evaluation. After 12 weeks of rehabilitation, exercise capacity (maximum work load and VO2max), exercise endurance, 6-minute walking distance, and quality of life measured by the St. George Respiratory Questionnaire had significantly improved in the rehabilitation group but not in the controls. At a follow-up evaluation one year after the rehabilitation, some exercise parameters were still significantly higher than baseline in the rehabilitation group. CONCLUSIONS: We developed a simple home-based pulmonary rehabilitation programme, which seems to be clinically feasible and effective.

Aged↗
PubMedDate not supplied

Impact of pediatric rehabilitation services on children's functional outcomes.

OBJECTIVES: Relatively little is known about the treatment effectiveness and functional outcomes of pediatric rehabilitation therapies. This study was conducted to gain knowledge of the type and quantity of inpatient rehabilitation services provided to children who received acute inpatient rehabilitation and compare functional gains by age and diagnosis. METHOD: A retrospective cohort design was used. Records of rehabilitation therapies and functional assessments of 814 pediatric patients who received inpatient rehabilitation during 1996, 1997, and 1998 were collected. The admission and discharge item ratings of the WeeFIM instrument were first transformed into interval-level measures of self-care, mobility, and cognition. Parametric analyses were used to compare functional gains across impairment groups and to examine the relationship between amount of treatment and functional gains. RESULTS: Occupational therapy and physical therapy were the primary rehabilitation services received by patients across impairment groups (98% and 99%, respectively). A large proportion of children with traumatic brain injuries also received speech therapy (97%) and psychology services (60%). Across domains (self-care, mobility, cognition), the largest gains were made by children who were older than 7 years and had traumatic injuries. Functional gains were significantly related to the amount of discipline-specific treatment received, after controlling for age, impairment, and functional status at admission. CONCLUSION: Rehabilitation therapy provision in pediatric inpatient rehabilitation varies greatly depending on children's age and the nature of the impairment. Systematic reporting of type and quantity of rehabilitation therapies along with functional assessments before and after hospitalization would allow researchers to track functional changes and study the determinants of functional improvement.

Activities of Daily Living↗
PubMed2001

Intermediate rehabilitation outcome in below-knee amputations: descriptive study comparing war-related with other causes of amputation.

AIM: To asses the intermediate rehabilitation outcome of patients with war-related below-knee amputations and compare it with the patients with other causes of amputation. METHOD: The study comprised 74 patients with below-knee stumps admitted for rehabilitation at the Department of Physical Therapy and Rehabilitation, Split University Hospital, Croatia, in 1994. They were fitted with a preliminary prosthesis, a donation from the Finish Red Cross. The rehabilitation was performed by a professional team and included regular bandaging of the stump, exercises to prevent knee and hip joint contracture, general fitness exercises, standing-up, falling and walking exercises, and electrostimulation of the thigh muscles. The time to reach each rehabilitation phase (walking with 2 crutches, walking with 1 crutch, walking with no crutches) was measured. The satisfaction of the patients with the prosthesis was also assessed at the end of rehabilitation. RESULTS: Among 74 patients with below knee amputation, war trauma was the cause for amputation in 31 patients, and in 6 of them the amputations were bilateral. Patients with war-related below-knee amputations were younger than the patients with amputations related to vascular disease, including diabetes. The rehabilitation time was significantly shorter in patients with war-related amputations (61.1+/-11.4 days to walking with no crutches) compared with patients with vascular disease-related amputations (80.9+/-8.1 days; p<0.001). The satisfaction with the prosthesis was more variable in patients with war-related amputations than in other patients. CONCLUSION: Early physical rehabilitation and replacement of the lost extremity with a preliminary prosthesis is an optimal intervention in below-knee amputations due to war-injury. Special attention should be paid to the psychological support to these patients during rehabilitation therapy.

Aged↗
PubMed2002

Measuring low-vision rehabilitation outcomes with the NEI VFQ-25.

PURPOSE: To evaluate the sensitivity of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) to change in visual abilities after low-vision rehabilitation in two different Veterans Administration (VA) low-vision programs METHODS: Seventy-seven legally blind veterans from the Blind Rehabilitation Center (BRC) at Hines VA Hospital and 51 partially sighted veterans from the Visual Impairment Center to Optimize Remaining Sight (VICTORS) program at the Chicago Health Care Network, West Side Division, were administered the NEI VFQ-25 plus supplement in interview format at admission and discharge. Instructions for administration were modified to have study participants answer all the questions as if they were wearing glasses or contact lenses or were using low-vision devices. Interval measures of person ability and item difficulty were estimated from the patients' responses to 34 of the 39 items on the VFQ-25 plus supplement before and after rehabilitation, by the polytomous rating scale measurement model of Wright and Masters. RESULTS: In VICTORS patients, item order by difficulty before rehabilitation agreed with item order for BRC patients. Visual ability scales are used similarly by different patients with different degrees of low vision. Based on prerehabilitation person measure distributions, VICTORS patients were less disabled, as would be predicted by visual acuity, than were BRC patients. After rehabilitation, estimated item difficulty for 4 of the 34 items decreased significantly in both BRC and VICTORS patients. CONCLUSIONS: The present study demonstrates that the NEI VFQ-25 plus supplement can be used to measure the effects of low-vision rehabilitation; however, only 7 of the 34 items tested are sensitive to change after rehabilitation. Targeted activities, such as reading ordinary print, small print, and street signs are easier to perform for graduates of both programs after rehabilitation. The patients' visual ability also shows improvement in both BRC and VICTORS. Improvement in visual ability is independent of change in difficulty of targeted items. Although this was not a controlled clinical trial, the decrease in difficulty of targeted items may reflect the use of low-vision aids and training to make tasks easier. The change in visual ability may reflect positive outcomes of rehabilitation or may be the consequence of patients' overestimates of their functional ability at the time of discharge.

Adult↗
PubMed2002

[Selection of methods of rehabilitation for hypopharyngeal defects after hypopharyngeal carcinoma removal].

OBJECTIVE: To explore how to repair hypopharyngeal defects after hypopharyngeal carcinoma removal. METHOD: We analysed the methods of stage I rehabilitation for hypopharyngeal defects and deglutitory function in 31 cases carried out hypopharyngeal carcinoma operation in our department from June, 1996 to June, 2001. RESULT: 1 case was performed "zero rehabilitation". In 15 of 17 cases (88.2%) carried out with direct suture rehabilitation, deglutitory function is good. In 6 of 13 cases (46.2%) carried out with tissue graft rehabilitation, deglutitory function is good. In 9 of 14 cases carried out with preserved laryngeal operation synchronously, deglutitory function is good(all direct suture rehabilitation). There were 5 cases with worse deglutitory function(each case occured inhalational error, 2 of them were direct suture rehabilitation and 3 of them were, issue graft rehabilitation). CONCLUSION: Patients obtain a better deglutitory function after direct suture rehabilitation. For total hypopharyngeal defects, stomach/intestines pull-up is superior to myocutaneous flap transposition. For synchronous preserved laryngeal operation, we should pay more attentions in case selection and inhalational error prevention. "Zero rehabilitation" is helpful to enhance the indication of surgical treatment for hypopharyngeal carcinoma.

Adult↗
PubMed2002

[Heart rate variability in patients after coronary artery bypass grafting--early and long term effects of cardiac rehabilitation].

Patients after coronary artery bypass grafting (CABG) have impaired heart rate variability (HRV) parameters. The clinical significance of impaired HRV and the influence of the cardiac rehabilitation on the HRV in this group of patients is not clear. We studied 103 patients (average age 52.2 +/- 7.8) after CABG, divided into group A (72 patients) who underwent cardiac rehabilitation (starting 15 days after the CABG) and group B (31 patients) who did not have rehabilitation. In all patients, a 24 hr ECG (including time and frequency domain HRV) was obtained before the onset of rehabilitation, after completion of the rehabilitation and after 6 months. Before the rehabilitation there were no differences in time-domain HRV between the groups, however frequency-domain HRV values were significantly higher in group A. In group A, the time-domain HRV parameters improved after 21 days of rehabilitation, whereas the frequency domain parameter components remained unchanged. At 6 months, improvement in time and frequency domain HRV parameters was noted, but the parameters were significantly higher in group A. In patients that underwent coronary artery bypass grafting, the cardiac rehabilitation time domain HRV showed improvement in both the short term (21 days) and long run (6 months). However, the frequency domain parameter was only increased over the long run. Cardiac rehabilitation speeds up the improvement of the time domain HRV and frequency domain parameters over long term observation (6 months).

Adult↗
PubMed2003

[The effect of rehabilitation of flared root canal on the fracture resistance of root and post-core system].

OBJECTIVE: To assess the effect of rehabilitation of flared root canal on the fracture resistance of root and post-core system. METHODS: Thirty-two simulated tooth roots made of polymethyl methacrylate were divided into 4 groups, including the normal root canal group and 3 flared root canal groups. One flared root canal group was rehabilitated by light-cared composite, another group was rehabilitated by amalgam, and the third flared root conal group was not treated. Casting post and core restored every simulated tooth root. Each specimen was embedded in acrylic resin and then fixed in a special jig on the universal load-testing machine. A compressive load was applied at a 90-degree angle to the long axis of the core until fracture, at a crosshead speed of 1 mm/min; the maximum of load was recorded. RESULTS: The means of load in normal root canal group, light-cared composite rehabilitated group, amalgam rehabilitated group, not treated group were 202.92 N, 194.60 N, 146.89 N, 142.09 N. It was shown that the load of normal root canal group is significantly greater than the load of not-treated group (P < 0.01); the light-cared composite rehabilitated group is significantly stronger than the not-treated group (P < 0.01), but there is no significant difference between the light-cared composite rehabilitated group and normal root canal group, and no significant difference between the amalgam rehabilitated group and not-treated group (P > 0.05). CONCLUSION: The rehabilitation of flared root canal using suitable material not only changes the shape of root canal, but also increases the fracture resistance of root canal because of its thicker and stronger root canal wall which obviously improves the fracture resistance of post and core.

Acrylic Resins↗
PubMed1992

[The objectives, failures and new ways in hospital aftercare and rehabilitation].

One of the main aims of oncological aftercare is to improve the transition from acute into chronic medicine, i.e. from curative into rehabilitative treatment. The somatic, psychic, social, professional, and family problems due to the tumour and its therapy have to be eliminated, improved or prevented. Up to now, oncological rehabilitation often was considered an isolated measure. The lack of cooperation between curative and rehabilitative medicine often resulted in the fact that patients in need of aftercare were not sent to appropriate rehabilitation clinics. There was no feed-back between pre- and after-treating doctors. The recommendations of the commission for further development of rehabilitation in the social insurance (VDR), elaborated together with the study-group for rehabilitation and aftercare and the study-group for the protection of the quality standard in oncology, aim at improving the above mentioned target. Active and forward-looking measures should improve the significance of clinical aftercare. The documentation of rehabilitation needs will allow more differentiated rehabilitation measures and long-term evaluation of their success. For a more effective integration of rehabilitative aspects into primary treatment, there is the demand for a closer cooperation between primary care and aftercare.

Aftercare↗
PubMed2003

[The effect of the complex rehabilitation on posture and gait in Parkinson disease].

UNLABELLED: Rehabilitation plays an important role in treatment of Parkinson's disease (PD). The influence of rehabilitation on balance and gait in PD hasn't been widely investigated. There is general agreement about positive influence of rehabilitation on postural instability and prevention of falls, but therapeutic program prevention of falls hasn't been worked out. Ambiguous results of studies indicate necessity of further investigations. MATERIAL AND METHODS: 61 patient were included (H&Y 1, 5-3) and randomly assigned to two groups with and without rehabilitation. The balance test battery included: Functional Reach Test, Balance Performance-Oriented Mobility Assessment (Tinetti), assessment on force platform of quiet standing and active standing with Rhythmic Weight Shifts Test and dynamic task (reaction time, number of hitted targets). Gait was assessed with: timed Up&Go test, 10 m walk, locomotion test and 360 degrees turn. Patients were assessed 3 times, at month intervals. Between 1 and 2 assessment, exercising group took part in 1 month complex rehabilitation, consist of the 28 therapeutic sessions. RESULTS: The group, which took part in rehabilitation significantly improved in quiet standing with closed eyes after rehabilitation in comparison with initial status. All of the rest variables significantly improved in exercising group after rehabilitation both in comparison between evaluations and in comparison with the nonexercising group. CONCLUSIONS: Rehabilitation significantly influences balance and gait of patients with PD.

Adult↗
PubMed2004

[Rehabilitation therapy in early stage following spinal cord injuries].

OBJECTIVE: To investigate the effects of rehabilitation therapy in early stage following spinal cord injury on the patients' activities of daily living (ADL) and functional independence measure (FIM). METHODS: Ninety-two patients with spinal cord injuries were divided into early rehabilitation group (n=48) and control group (n=44) according to the timing of the rehabilitation therapy. Rehabilitation assessment of the patients with Barthel index and FIM was carried out before and 6 months after the rehabilitation therapy respectively for comparison. Different rehabilitation regimens were adopted for specific clinic stage of the patients, lasting for a total of 6 months. RESULTS: Barthel index and FIM score were all improved after the rehabilitation therapy in both of the two groups, but the improvements were more significant in early rehabilitation group (P<0.01). CONCLUSION: Early rehabilitation treatment is crucial for patients with spinal cord injuries in that it improves the patients' motor function, ADL and functional independence after the injury.

Activities of Daily Living↗
PubMed2002

Application of passive transverse forces in the rehabilitation of spinal deformities: a randomized controlled study.

In our centre, physiotherapy and braces are the main approaches in the management of scoliosis and kyphosis as well. If a surgical intervention is necessary patients are guided to the appropriate centre for spine surgery. In order to avoid surgery, we are looking for possibilities to improve the conservative facilities of spinal deformities management. The aim of our study was to find out whether the use of passive transverse forces (PTF) applied on the deformed body is useful in the rehabilitation process of patients with spinal deformities. A randomized controlled study was undertaken including 126 patients with scoliosis treated with our intensive rehabilitation programme and 4 to 6 PTF treatments lasting 20 minutes per treatment. This group had a curvature angle of 38,7 degrees (SD 16,8) thoracic and 32 degrees (SD15,1) lumbar. Average age was 14,8 years (SD2,7). The control group of 126 patients had a curvature angle of 33,1 degrees (SD 16,1) thoracic and 26,9 degrees (SD12,7) lumbar. Average age was 15,2 years (SD2,3). The patients were randomized by the third author in order to have inpatient rehabilitation and PTF or intensive inpatient rehabilitation alone. For the result evaluation we carried out an investigation before and after the intensive inpatient rehabilitation phase of 4-6 weeks long with the surface measuring system (Formetric system). We evaluated the average lateral deviation value, measured in mm, as given out by the system. The value of average lateral deviation in the treatment group decreased highly significantly (p=.00157) with an average improvement of 1.27 mm. The controls also improved comparing the value for the average lateral deviation before and after rehabilitation with an average difference of 0.94 mm, which was not significant in the T-test (p=0.10032). When comparing the treatment group (PTF) without additional braces (n=52) the difference was even bigger with 1.50 mm (p=.0307). The control group without brace showed similar results as the entire control group. Only uncorrected posture can be measured with the Formetric system. When trying to show the possible postural corrections with the help of the Formetric system, more than 50% of the scans show artefacts resulting from the fact that the points necessary for calculating the spinal deviation can no longer be automatically recognized. For this reason also the changes after an intensive inpatient rehabilitation are very moderate, even if they show a significant tendency to postural correction in larger groups. In smaller groups however, we generally only find the nonsignificant tendency to postural correction. Significant values were obtained with additional application of the PTF treatment. This proves the efficacy of passive forces combined with intensive physiotherapy aiming at an active stabilization of the passively mobilized spine. The uncorrected posture is improved significantly by inpatient rehabilitation and PTF, thus the treatment of scoliotic patients with the described methods is superior to inpatient rehabilitation alone.

Adolescent↗
PubMed2004

Short-stay in-patient rehabilitation of elderly patients with chronic obstructive pulmonary disease: prospective study.

OBJECTIVES: To evaluate the effectiveness of a short-stay in-patient rehabilitation programme. DESIGN: Prospective case-control cohort study. SETTING: Regional medical centre, Hong Kong. PATIENTS: One hundred and thirty symptomatic elderly patients with chronic obstructive pulmonary disease who had been treated for an acute respiratory illness in 1998. They were divided into two groups: the conventional treatment group, which received no rehabilitation (n=65), and the rehabilitation group (n=65). INTERVENTION: A short-stay in-patient rehabilitation programme was implemented, which included assessment, patient and caregiver education, an exercise regimen, physiotherapy, occupational therapy, and case conference. MAIN OUTCOME MEASURES: Length of stay, hospital re-admission rate, and admission-free interval. RESULTS: The mean length of stay in the rehabilitation ward was 6.2 days. The rate of hospital re-admission was significantly higher in the conventional treatment group than in the rehabilitation group, both within 28 days of discharge home (relative risk=3.33; 95% confidence interval, 2.32-4.56; P=0.019) and at 100 days after discharge (relative risk=2.47; 95% confidence interval, 1.78-3.48; P<0.001). The admission-free interval was significantly longer in the rehabilitation group than in the conventional treatment group (1.13 years vs 0.86 years; P<0.001). CONCLUSION: A short-stay in-patient rehabilitation programme is effective in reducing hospital re-admission rates. This type of rehabilitation service may be important for elderly patients, as well as for patients with more advanced disease and more functional deficits than others.

Aged↗
PubMed2004

[Early results of rehabilitation after endoprosthetic replacement of the knee joints].

The purpose of this research was evaluation of magnetic field influence of low frequency on the process of rehabilitation of patients after endoprosthesis plasty of knee joints. The research evaluated usefulness of objective and subjective measurement methods to estimate progress of patients rehabilitation after endoprosthesis plasty of knee joints. The object of research were patients after endoprosthesis plasty of knee joints that were accepted for rehabilitation to the Unit of Motion Organs Rehabilitation of the Upper Silesian Rehabilitation Center "Repty" in Ustroń. For the purpose of the rehabilitation process evaluation, the condition of patients was goniometry and the pendulum test were performed twice, i.e. at admission and then at termination of rehabilitation. A modification of the Lysholm Scale and a subjective knee questionnaire (VAS) were also used. On the ground of obtained results one can affirm that important role in therapeutic rehabilitation after endoprosthesis plasty of knee joint, plays adequately matched kinesitherapy, however one cannot confirm any influence of alternating magnetic field of selected parameters. Measurement methods both subjective and objective proved to be useful and effective in evaluation of rehabilitation progress in described cases.

Aged↗
PubMed1988

Assessment for rehabilitation after stroke.

There is some evidence that the rehabilitation of patients who have suffered a stroke may be more successful if conducted in a specialist unit, especially if started soon after the stroke. Departments of Geriatric Medicine are often unable to accept all invitations to take over the rehabilitation of elderly patients who have suffered a stroke. As specialist rehabilitation resources are scarce, it is necessary to be able to distinguish the patients whose outcome will be improved by specialist rehabilitation from those whose recovery (whether good or bad) will not be significantly influenced. Patients with an Edinburgh prognostic score of 5.6 four weeks after the stroke are very likely always to require total nursing care even after specialist rehabilitation. A Guy's Hospital prognostic score of 10 or more seems to indicate that functional independence will be recovered even without specialist rehabilitation. Patients with an Edinburgh prognostic score of 3-4 within the first 4 weeks after the stroke should not be denied specialist rehabilitation; there is evidence, admittedly weak, that it is for them that the benefits may be greatest. A major study is now required to validate the Edinburgh and Guy's prognostic scores prospectively and to test whether it is valid to use them for the triage of elderly patients for specialist rehabilitation. In addition, it is possible that a specialist unit would be better able to help patients with specific 'barriers' to rehabilitation. Adequate tools for the identification and objective assessment of these barriers are essential if this possibility is to be tested.

Cerebrovascular Disorders↗
PubMed1984

[Rehabilitative methods for the laryngectomized patient - new orientation for the practice].

The rehabilitation of the laryngectomee has not only a functional aspect, i.e. restoration of voice and treatment of physical complaints, but also requires social readjustment and mastering of psychological problems. The most important part of functional rehabilitation is the acquisition of an effective substitute voice. A critical review of the various methods of voice restoration reveals that esophageal speech is still to be preferred, because it is independent of any aids. The Singer-Blom voice prosthesis appears to be superior to the vocal fistula of Staffieri because of its smaller aspiration risk and less complications. Regarding electromechanical speech aids some recent publications by several authors have outlined probable improvements in this field. For the treatment of physical complaints a suction pump, an inhalor and a humidifier are necessary in every case as well as gauze aprons for the protection of the tracheostoma, an ointment for skin care and (for patients wearing a tracheostomy tube) a set-up for cleaning the tube. This indispensable basic equipment may be complemented by a shower shield, a swimming tube, an alarm bell and a respiration tube for emergencies. Efforts at social rehabilitation have two directions: (1) Support of social reintegration by eliminating ignorance, prejudices and anxieties of relatives and friends; (2) preservation of employment or procurement of a new job. The task of psychological rehabilitation is to cope with the abnormal depressive reaction which is to be expected in about half of the patients; psychological rehabilitation begins with intensive counselling before surgery and goes hand in hand with a quick and complete functional and social rehabilitation; its main goal is the restoration of selfconfidence in the patient. These multiple rehabilitation tasks can only be accomplished by close cooperation with the speech therapist, the social services, the employment office and the employer, the insurance companies and possibly with the psychotherapist. The laryngectomee associations and special rehabilitation centers offer valuable help, but the ENT-specialist does have a key position as an advisor and coordinator within the rehabilitation process.

Humans↗
PubMed1993

Factors predicting improvements in lipid values following cardiac rehabilitation and exercise training.

BACKGROUND: Cardiac rehabilitation and exercise training improve prognosis following major cardiac events, partly by improving coronary risk factors, including plasma lipids. Only limited data are available to define predictors of lipid improvements following aggressive nonpharmacologic therapy with cardiac rehabilitation. METHODS: We studied 237 consecutive patients from two institutions who were enrolled in outpatient phase 2 cardiac rehabilitation and exercise programs. By univariable and multivariable analyses, we assessed the impact of numerous clinical variables, including indexes of obesity, age, gender, lipid concentrations, exercise capacity, and psychological factors, on improvements in plasma lipid values with cardiac rehabilitation. RESULTS: Coronary risk factors improved following cardiac rehabilitation, including levels of low-density lipoprotein cholesterol (-4%; P < .05), high-density lipoprotein cholesterol (7%; P < .0001), and triglycerides (-13%; P < .0001); body mass index (-2%; P < .0001); percentage of body fat (-5%; P < .0001); and exercise capacity (26%; P < .0001). By both univariable and multivariable analyses, corresponding dyslipidemic baseline values were the strongest predictors of improvements in levels of low-density lipoprotein cholesterol (univariable: r = .51, P < .0001; multivariable: t = 8.5, P < .0001), high-density lipoprotein cholesterol (univariable: r = .37, P < .0001; multivariable: t = 6.6, P < .0001), and triglycerides (univariable: r = .36, P < .0001; multivariable: t = 6.8, P < .0001). By multivariable analyses, reductions in body mass index (t = 4.6, P < .0001) and older age (t = 4.0, P < .0001) were strong independent predictors of reduction in triglyceride values following cardiac rehabilitation. However, low baseline triglyceride values were independently associated with improvements in both low-density and high-density lipoprotein cholesterol levels. Using a model incorporating 13 clinical variables, improvements in lipid values with cardiac rehabilitation were only modestly predictable with the variables assessed, accounting for only 30% to 40% of the improvements in lipid values. CONCLUSIONS: (1) Coronary risk factors markedly improved following cardiac rehabilitation and exercise training. (2) Improvements in lipid values are modestly predictable. (3) Those patients with the worst baseline lipid values had the most improvements in lipid values following cardiac rehabilitation. However, patients with combined hyperlipidemia and low levels of high-density lipoprotein cholesterol are likely to require drug treatment.

Adult↗