The impact of rehabilitative services in the lives of adults and children with disabilities

What is the impact of rehabilitative services in the lives of adults and children with disabilities and is their a relationship between amount of treatment and functional gains. This question was asked by Dr. Patel from St. Bartholomew’s Hospital , London , UK in Disability & Rehabilitation, 05/06/2013. Occupational therapy and physical therapy were the primary rehabilitation services received by patients across impairment groups. The authors failed to find enough evidence in the literature to answer these questions and concluded that better systematic reporting of type and quantity of rehabilitation therapies along with functional assessments is needed.

New Evidence for Therapies in Stroke Rehabilitation

A report in Current Atherosclerosis Reports, 05/03/2013 looks at the evidence based in medicine for physical therapy interventions to promote Neurologic rehabilitation post stroke.

The report by Dobkin BH et al. from Department of Neurology, Geffen School of Medicine, University of California Los Angeles, CA, USA shows that persons with serious stroke do return to participation in usual self-care and daily activities as independently as is feasible. The physical and occupational therapy detailed includes progressive task-related practice of skills, exercise for strengthening and fitness, neurostimulation, and drug and biological manipulations. The group also discuss how intensive practice can induce adaptations at multiple levels of the nervous system which lead to neuroplasticity and functional improvement.  The group discuss recent clinical trials to manage walking, reach and grasp, aphasia, visual field loss, and hemi-inattention.

Predicting early retirement after musculoskeletal disease

Outcome measures after a 3-week, multidisciplinary, in-patient rehabilitation programme in Germany predict early retirement in patients with musculoskeletal diseases. Looking at patients undergoing in patient physical and occupational therapy for musculoskeletal disorders (MSDs) in 10 rehabilitation centres in Southern Germany, the outcomes measures that corresponded to early retirement were pain reduction, improvement in spine motility and improvement of muscle strength.

 

Early intensive physical and occupational therapy improves motor abilities post stroke

Early intensive physical and occupational therapy leads to greater improvement in motor abilities post stroke. This conclusion was reached by Lang KC et al. from Emory University, Atlanta, GA, USA writing in Neurorehabilitation and Neural Repair, 04/19/2013. The group looked at 2 groups of post stroke patients  3-9 months and 15 to 21 months post stroke. The groups underwent the same dose and intensity of constraint-induced movement therapy (CIMT) and the outcome measure was the Wolf Motor Function Test (WMFT).

 

Assisted active exercise practice and the HandTutor and ArmTutor

Occupational an physical therapists are using the MediTouch system in combination with active assistance. People with arm weakness can exercise their arms without assistance, but if their arms and hand movement ability is severely impaired, such exercise is difficult and compliance with exercise programs is low. Using the HandTutor and the ArmTutor the occupational therapist and the physical therapist can give the patient “assistance-as needed” to perform the required customized arm or finger a wrist exercise task. This clinical technique is known as active assisted exercise. During active assistance practice the patient actively contributes to the movement, this active exercise contribution is an essential feature of motor sensory and cognitive recovery and allows motor learning and plasticity. This means that the the HandTutor and ArmTutor can be used by patients with very little Active Range of Motion (AROM) as well as by patients with little ROM deficit.

Active assistance therefore allows OT and PT to use the MediTouch and provide their patients with severe deficits in AROM a customized exercise that gives immediate movement feedback and the enjoyment and motivation of video game based rehabilitation.

The MediTouch benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis.

OT and PT therapeutic goals

The MediTouch system is a state of the art targeted rehabilitation system that hones in on specific therapeutic goals. Through the enjoyment and motivation of video game based rehabilitation which gives immediate feedback to the patient, the HandTutor, ArmTutor, LegTutor and 3DTutor address the challenge of impaired movement ability. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

The system benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis. In addition the system is used for physical therapy after shoulder, elbow, hip and knee surgery.

Computer-based cognitive rehabilitation (CBCR) after stroke

Computer-based cognitive rehabilitation (CBCR) effective on improving cognitive function after stroke. This conclusion was reached by occupational therapists from Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. The group publish their results in NeuroRehabilitation, 04/16/2013.

The MediTouch HandTutor and ArmTutor work on improving motor sensory and cognitive movement ability through. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

Who benefits from residential intensive neurorehabilitation as opposed to community therapy in the UK

Answering this question Foy CML et al from the Rehabilitation Services, Brain Injury Centre, Banstead, Surrey, UK and Sutton Hospital, look at patient functional ability following rehabilitation at a mixed therapy and educational residential programme. The clients received 5 hours of education and/or physiotherapy and occupational therapy each day.

BothTBI and nonTBI made clinically and statistically significant improvements in their functional abilities during their neurorehabilitation and benefited from a mixed inpatient neurorehabilitation programme. The movement and functional improvements was predicted by the patients functional abilities at admission and the length of stay. Therefore preinjury and injury variables do give insight into functional recovery in traumatic brain injury (TBI) and non traumatic brain injury (nonTBI) patients.

Intensive physical and occupational therapy improves the functional ability of the arm and hand in chronic stroke

Intensive physiotherapy and occupational therapy in the rehabilitation center and at home improves functional ability in chronic stroke. Published in Restorative Neurology and Neuroscience, 04/11/2013 de Diego C et al from physiotherapy and Occupational Therapy Neurological Center of Sant Cugat del Valles, Spain show that following 8 weeks of daily physical and occupational therapy improved the functional outcome of the upper limb in chronic hemiparesis stroke patients. The training consisted of functional activity training, tactile stimulation, mental imagery and practice of ADL and impairment training at home. The outcome measures used include the Fugl Meyer Assessment (FMA), Motor Activity Log (MAL) and Stroke Impact Scale-16 (SIS-16) scores.

 

Physical and occupational therapy guidelines for treatment of pediatric Traumatic brain injury (TBI)

The second edition of the Guidelines for the Medical Management of Traumatic Brain Injury in Infants, Children and Adolescents is updated from the first edition published in 2003. This 2012 edition edited by Bell MJ et al appears in Critical Care Clinics, 04/09/2013. The team work at the Department of Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh, Department of Neurological Surgery, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA.