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Rehabilitation Strategies (rehabilitation + strategy)
Selected AbstractsSimultaneous feedforward recruitment of the vasti in untrained postural tasks can be restored by physical therapyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2003Sallie M. Cowan Abstract Background and purpose: Physical therapy rehabilitation strategies are commonly directed at the alteration of muscle recruitment in functional movements. The aim of this study was to investigate whether feedforward strategies of the vasti in people with patellofemoral pain syndrome can be changed by a physical therapy treatment program in a randomised, double blind, placebo controlled trial. Subjects: Forty (25 female, 15 male) subjects aged 40 yrs or less (27.2 ± 7.8 yrs). Methods: Subjects were allocated to either a placebo treatment or a physical therapy intervention program. The postural challenge used as the outcome measure was not included in the training program. Electromyography (EMG) onsets of vastus medialis obliquus (VMO), vastus lateralis (VL), tibialis anterior and soleus were assessed before and after the six week standardised treatment programs. Results: At baseline the EMG onset of VL occurred prior to that of VMO in both subject groups. Following physical therapy intervention there was a significant change in the time of onset of EMG of VMO compared to VL with the onsets occurring simultaneously. This change was associated with a reduction in symptoms. In contrast, following placebo intervention the EMG onset of VL still occurred prior to that of VMO. Conclusion and discussion: The results indicate that the feedforward strategy used by the central nervous system to control the patella can be restored. Importantly, the data suggest that this intervention produced a change that was transferred to a task that was not specifically included in the training program. Furthermore, the change in motor control was associated with clinical improvement in symptoms. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Prospective blinded comparison of surface versus wire electromyographic analysis of muscle recruitment in shoulder instabilityPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2009Anju Jaggi Abstract Background.,This pilot study assesses level of agreement between surface and fine-wire electromyography (EMG), in order to establish if surface is as reliable as fine wire in the diagnosis and treatment of abnormal muscle patterning in the shoulder.,Method.,Eighteen participants (11 female) with unstable shoulders were recruited after written consent and ethical approval. Anthropometric information and mean skinfold size for triceps, subscapular, biceps and suprailiac sites were obtained. Triple-stud self-adhesive surface electrodes ('Triode'; Thermo Scientific, Physio Med Services, Glossop, Derbyshire, England) were placed over pectoralis major (PM), latissimus dorsi (LD), anterior deltoid (AD) and infraspinatus (IS) at standardized locations. Participants performed five identical uniplanar standard movements (flexion, abduction, external rotation, extension and cross-body adduction). After a 20-minute rest period, a dual-needle technique for fine-wire insertion was performed and the standard movements were repeated. An experienced examiner in each technique reported if muscle activation patterns differed from agreed normal during any movement and were blinded to the other test results. Sensitivity, specificity and Kappa values for level of agreement between methods were calculated for each muscle according to the method of Altman (1991).,Results.,Fifteen participants were successfully tested. Sensitivity, specificity and Kappa values between techniques for each muscle were PM (57%, 50%, 0.07), LD (38%, 85%, 0.22), AD (0%, 76%, ,0.19) and IS (85%, 75%, 0.6). Only IS demonstrated high sensitivity and specificity and a moderate level of agreement between the two techniques. There was no correlation between skinfold size and agreement levels.,Conclusion.,The use of surface EMG may help to classify types of shoulder instability and recognize abnormal muscle patterns. It may allow physiotherapists to direct specific rehabilitation strategies, avoiding strengthening of inappropriate muscles. It has a reasonable degree of confidence to evaluate IS but may have poor sensitivity in detecting abnormal patterns in PM, LD and AD. Further work is required to see if investigator interpretation may have been a factor for the poor level of agreement. Copyright © 2008 John Wiley & Sons, Ltd. [source] The social causes of inequality in epilepsy and developing a rehabilitation strategy: A U.K.-based analysisEPILEPSIA, Issue 10 2009Leone Ridsdale Summary A rehabilitation approach has been adopted for many long-term neurologic conditions, but not for epilepsy. The disabilities associated with epilepsy are cognitive, psychological, and social, which are not as readily identified by medical doctors as are physical disabilities. A rehabilitation approach moves the emphasis from a medically driven process to a focus on the personal, social, and physical context of long-term illness. It is suggested that a missed opportunity for education and support for self-management occurs after diagnosis. This results in disadvantage to those whose educational level and knowledge of epilepsy are low. People who do not achieve epilepsy control may then experience higher levels of psychological distress, and a negative cycle of loss of self-efficacy, poor epilepsy control, social disadvantage, and disability. Rehabilitation services have benefited communities surrounding centers of excellence. Not so in epilepsy. Despite centers of excellence, areas with deprivation have higher than national average levels of patients reporting a seizure in the prior year, and higher emergency hospital admissions. Specialists working in partnership with general practitioners (GPs) and practice nurses can do more to increase participation and reduce distress for people with epilepsy. When available, GPs and nurses with special interest in epilepsy promote integrated services. Primary,secondary networks are likely to be more effective in preventing downward drift. This requires evaluation. [source] ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Post-Radical Prostatectomy Pharmacological Penile Rehabilitation: Practice Patterns Among the International Society for Sexual Medicine PractitionersTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009Patrick Teloken MD ABSTRACT Introduction., Despite the fact that there is minimal evidence-based data supporting it, the concept of pharmacological penile rehabilitation following radical prostatectomy (RP) is receiving great attention. Aim., To define attitudes and practice patterns of clinicians who were members of the International Society for Sexual Medicine (ISSM) and/or its affiliated societies. Methods., Members of the ISSM and its regional affiliates were invited to participate in a web-based survey. Main Outcome Measures., Demographic factors, current practice status, and opinions regarding post-RP erectile dysfunction and penile rehabilitation. The statistical methods used included chi-square, Student's t -tests, and logistic regression analysis. Results., Three hundred-one physicians from 41 countries completed the questionnaire (82% were urologists). Sixty-five percent of the responders had formal sexual medicine specialty training, 44% had uro-oncology specialty training, and 60% performed RPs. Eighty-seven percent performed some form of rehabilitation. As part of the primary rehabilitation strategy, 95% used phosphodiesterase type 5 inhibitors (PDE5), 30% used vacuum device, 75% used intracavernosal injections, and 9.9% used intraurethral prostaglandin. Fifty-four percent commenced rehabilitation immediately/just after urethral catheter removal, and 37% within the first 4 months after RP. Neither the number of years in medical practice, clinician age, nor country/region of practice differed between rehabilitation performers and nonperformers. With regard to the primary reason for avoiding rehabilitation: 50% responded said it is the cost; 25% said the fact that it is not evidence-based; and 25% said they were not familiar with the concept. Performing rehabilitation was positively associated with urologic oncology training (P = 0.03), performing RP (P < 0.001), and seeing over 50 post-RP patients per year (P = 0.011). Conclusions., Among ISSM members post-RP penile rehabilitation is widely practiced, commenced early, and based predominantly on PDE5 inhibitors and intracavernosal injections. Clinicians who perform RP or see over 50 such patients per year are the most likely to perform rehabilitation. Cost represents the most common reason for rehabilitation neglect. Teloken P, Mesquita G, Montorsi F, and Mulhall J. Post-radical prostatectomy pharmacological penile rehabilitation: Practice patterns among ISSM practitioners. J Sex Med 2009;6:2032,2038. [source] A geomorphological framework for river characterization and habitat assessmentAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 5 2001J.R. Thomson Abstract 1.,Methods to assess the physical habitat available to aquatic organisms provide important tools for many aspects of river management, including river health monitoring, determination of river restoration/rehabilitation strategies, setting and evaluating environmental flows and as surrogates for biodiversity assessment. 2.,Procedures used to assess physical habitat need to be ecologically and geomorphologically meaningful, as well as practicable. A conceptual methodological procedure is presented that evaluates and links instream habitat and geomorphology. 3.,The heterogeneity of habitat potential is determined within geomorphic units (such as pools, runs, riffles) by assessing flow hydraulics and substrate character. These two variables are integrated as hydraulic units , patches of uniform flow and substrate. 4.,This methodology forms a logical extension of the River Styles framework that characterizes river form and behaviour at four inter-related scales: catchments, landscape units, River Styles (reaches) and geomorphic units. As geomorphic units constitute the basis to assess aquatic habitat availability, and they form the building blocks of river and floodplain systems, intact reaches of a particular River Style should have similar assemblages of instream and floodplain habitat. 5.,An application of the hydraulic unit procedure is demonstrated in gorge, partly-confined and alluvial River Styles from the Manning catchment in northern New South Wales, Australia. Copyright © 2001 John Wiley & Sons, Ltd. [source] | |||||||||||||