Rehabilitation of traumatic and non-traumatic spinal cord injuries (SCI)

Kennedy P et al. working at the National Spinal Injuries Centre, Stoke Mandeville Hospital, UK discuss whether patients with traumatic spinal cord injuries and patients with non-traumatic spinal cord injuries benefitted from the same rehabilitation programme. The research published in Spinal Cord, 05/07/2013 found that the two groups has the same rehabilitation outcome. The Needs Assessment Checklist (NAC) was used as the outcome measure. The group concluded that it is effective to admit and rehabilitate patients with injuries resulting from both traumatic and non-traumatic aetiologies in the same specialised in patient and out patient rehabilitation setting.

 

Unraveling the `black box of physical rehabilitation’

How to support professionals to better understand the effective components of inpatient and outpatient physical rehabilitation programmes after acquired brain injury. In addition how out-patient group rehabilitation programmes  and physical and occupational therapy gives brain injury patients the tools they need to change their everyday lives and integrate new routines and habits that contribute to improvements in their everyday lives. These points are discussed by Lexell EM et al. from Department of Rehabilitation Medicine, Skåne University Hospital , Lund , Sweden in Brain Injury, 05/07/2013.

Cost of Total Hip and total Knee Replacement

Costs of Hip and Knee replacement – THA/ TKA

According to the IFHP – International Federation of Health Plans, the U.S. average for all hospital and physician costs including in patient and out patient Physical therapy was $40,364 for hip replacement and $25,637 for knee replacement. The next most expensive country was Australia with a cost of $27,810 for hip replacement and $22,421 for knee replacement.

 

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.

 

Physiotherapy Practice for Stroke Rehabilitation in the UK

Does telling a patient to to be aware of their movements and their performance (internal focus) reduce automaticity and hinder learning and retention in stroke patients?

This question was posed by Johnson L et al from stroke Services, Royal Bournemouth and Christchurch Hospitals NHS Trust, and Royal Bournemouth Hospital, United Kingdom in Physical Therapy, 04/19/2013.

The team aimed to design an experimental study examining the impact of focus of attention on learning post stroke. In order to do this the physiotherapists took video recordings of physiotherapy sessions and analyzed the data for external focus – physical therapists giving guidelines and feedback on performance and internal focus, the - physical therapist telling the patient to think about their movement.

The MediTouch system uses extrinsic feedback – external focus and guidelines during LegTutor open and closed chain customized exercise practice.

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.

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.

Parkinson’s disease (PD) and regulation of amplitude of step length during walking

Is reduced step length and not step length variability central to gait hypokinesia in people with Parkinsons disease PD? Mak MKY et al from Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China writing in Clinical Neurology and Neurosurgery, 04/15/2013 look to answer this question. The researchers compared Parkinson’s disease (PD) patients walking at the same speed as a control group. PD patients and showed that their walking impairment was due to a fundamental problem in regulating the amplitude of step length during walking and not an impairment in step length variability.

 

Home based ongoing physiotherapy improves walking ability post stroke

In order to improve walking ability 6 months after stroke, this study shows that a home exercise impairment based training program was as effective as clinic based outpatient sessions of clinic based locomotor training program LTP – walking training on a treadmill using body-weight support and overground walking training following stroke. Physical therapists at University of Florida, Gainesville, FL, USA, and the Department of Veterans Affairs writing in Neurorehabilitation and Neural Repair, 04/08/2013 therefore concluded that ongoing Physical therapy following inpatient physiotherapy improves walking ability at 6 months post stroke.

Predicting rehabilitation and walking performance post stroke

Writing in the Archives of Physical Medicine and Rehabilitation, 04/05/2013 Dr. Rose DK et al look at the predictive power of the results of Exercise Tolerance Testing and the 6MWT (six minute walk test). The group compare the scores to the number of physical therapy rehabilitation sessions – treadmill and overground Locomotor Training Program (LTP), needed to achieve 20 minutes stepping duration in these patients. ETT is a measure of cardiac performance where as 6MWT is more a measure of neurological impairment and muscular condition.