rehabilitation

Cognitive impairment (CI) is one of the main features of multiple sclerosis (MS). Cognitive rehabilitation (CR) programs are crucial for improving cognition and computer-assisted cognitive rehabilitation is considered as an effective method for cognition rehabilitation. To assess the effects of computer-based cognitive rehabilitation program on cognition in patients with multiple sclerosis (MS).

We performed a comprehensive search in PubMed, Scopus, Web of Science, EMBASE, and Google Scholar databases along with gray literature up to September 2021. Randomized clinical trials, articles had been published in the English language. We evaluated the risk of potential bias via the Cochrane Collaboration's tool for assessing the risk of bias. Standardized mean difference (SMD) was calculated.

The preliminary search retrieved 2302 articles by literature search, after deleting duplicates 2248 remained.  Eight articles remained for meta-analysis. Totally, 235 patients in intervention group and 192 in control group were evaluated. Mean age ranged from 43.5-52 years. The SMD of PASAT (Paced Auditory Serial Addition Test) (Case-control) test was 0.35 (95%CI:0.1-0.66) (I2:24.4%, P=0.2). The SMD of SDMT (Case-control) test was 0.07 (95%CI:-0.18-0.33). The SMD of PASAT before and after intervention in case group was 0.68 (95%CI:0.45-0.91) (I2:40%, P=0.15). The SMD of SDMT before and after intervention in case group was 0.44 (95%CI:0.21-0.66) (I2:40%, P=0.15).

The results of this systematic and meta-analysis showed that computerized cognitive rehabilitation program is effective in improving PASAT score.

Context: 

Some researchers proved new and persistent symptoms lasting for weeks and even months after COVID that is named “long-COVID” or “post-COVID syndrome.” It appears that occupational therapists (OTs) have a significant role in managing the symptoms of long COVID, with the aim of enhancing patients' ability to perform daily activities and improving their overall well-being. The objective of this study was to conduct a scoping review study of reputable databases to identify the various ways in which OTs can manage long COVID from the onset of symptoms.

Evidence Acquisition: 

To identify relevant documents, the following databases and search engine were searched from 2019 to 2023 in the English language: PubMed, Scopus, ISI, and Google Scholar. Keywords used for search include (("occupational therapy") AND (("post-COVID") OR ("long-COVID"))) AND ((intervention) OR (exercise)), of which 45 articles were found, and a total of 22 were chosen according to the predetermined criteria.

A diverse array of interventions in OT can be useful for the management of post-COVID symptoms, as mentioned in the 22 studies found as the search result, including energy management education, pulmonary rehabilitation, sleep hygiene, stress and fatigue management, and work simplification.

Occupational Therapist offers a distinctive viewpoint on health conditions that arise in human life, and its interventions can be utilized to enhance health, self-management, and quality of life (QOL).

Fear of falling (FOF) is a critical and highly prevalent neuropsychological disorder in stroke patients, confining the individual in mobility, activities of daily living, and communication. Screening and detecting FOF is crucial in effective and efficient rehabilitation management. Considering that none of the questionnaires that assess the FOF in patients with stroke are single-item, the present study was conducted to design and validate a single-item scale (FOF rating scale [FOF-RS]) for a faster and step-by-step screening of the FOF in stroke patients. Also, considering the impact of psychosocial factors such as anxiety and depression on the fear of falling in these patients, they were controlled in this study.

In a cross-sectional study, 180 participants suffering post-stroke symptoms were recruited from public and private rehabilitation clinics, including Rafideh Hospital, Loqman Hospital, Tajrish SHohada Hospital, Nizam Mafi Clinic, Hasti Clinic, and Iran Rehabilitation Faculty Clinic through convenience sampling in Tehran City, Iran. Sampling was conducted within 3 months, between December 2021 and March 2022. The cut-off point and validity indicators were computed for FOF-RS, considering FES-I (falls efficacy scale-international) as a criterion measure.

Based on receiver operating characteristics curve analysis, the resulting cut-off point for the FOF-RS (>3) had a satisfactory level of specificity (82.30) and sensitivity (77.61). Also, the positive predictive value and negative predictive value were 32.8 and 97.1, respectively. 

The FOF-RS has an adequate level of diagnostic accuracy and may well be used as a fast tool for screening FOF. Besides, it could assess step-by-step protocols in chronic stroke patients.

Thoracic outlet syndrome (TOS) is a well-known compressive neurovasculopathy with various anatomical etiologies. Neurogenic TOS (nTOS) is the most common type of this syndrome, accounting for over 95% of all cases. Conservative treatment plays a significant role in the management of nTOS. However, there are many controversies regarding this theme. Therefore, the optimal treatment method remains unclear. Herein, a narrative review was conducted to gather recent data on the available conservative treatment methods for the management of nTOS.

The outbreak of COVID-19 has been associated with various physical and psychological effects. The role of exercise in strengthening the immune system and reducing inflammation has already been proven. Moderate levels of exercise can enhance overall immunity. Exercise can improve intracellular metabolism and increase cell defense activity by improving inflammatory cytokines, immature B cells, and cytotoxic T cells. Therefore, exercise is known as a defense strategy against respiratory infections. Here the role of exercise in improving respiratory function and physical activity in hospitalized patients with COVID-19 was evaluated. The present study was performed as a randomized clinical trial on 90 hospitalized patients with COVID-19. Both groups received all routine treatments (medication, invasive or non-invasive ventilation, physiotherapy). Then, in the experimental group, standard exercises were provided to improve the patients’ physical condition and exercise capacity. After two weeks and one month later, all indices were measured again in two groups. The results of the present study showed that exercise causes significant changes in indicators such as 6-Minute Walk Test (6MWT) (p=0.001), balance score (p=0.02), and Sf1 score (p=0.05) in two time periods before and after rehabilitation in two groups. Performing standard and defined exercise exercises for patients with the new coronavirus improves the physical activity and respiratory function of patients.

 Parkinson's disease (PD) is a prevalent neurodegenerative condition affecting motor and non-motor functions. This narrative review explores non-pharmacological interventions, focusing on exercise therapy and music therapy.

 For this research, a thorough exploration of databases, including PubMed and Google Scholar, was undertaken to collect pertinent articles from reputable journals. The focus was on non-pharmacological rehabilitation for PD, targeting studies from the past decade with additional references reviewed. Emphasis was on articles addressing music and physical therapy for PD, resulting in the evaluation of 45 articles. Content analysis was employed, allowing for a detailed examination and synthesis of information from the literature.

 The findings underscore the efficacy of exercise therapy, encompassing aerobic, resistance, and balance training, in ameliorating motor symptoms. This includes notable reductions in bradykinesia, rigidity, and postural instability. The positive influences of exercise interventions extend beyond their motor benefits to impacts to cognitive function, mood disorders, and sleep disturbances, presenting a holistic approach to PD management. Music therapy emerges as a promising avenue, especially when integrated with physical activity. Rhythmic auditory stimulation and group singing within the context of music therapy showcase affirmative impacts on motor control, attention, and communication outcomes for individuals with PD.

 In conclusion, this narrative review sheds light on the considerable potential of non-pharmacological interventions, namely exercise therapy and music therapy, for PD rehabilitation. These insights not only contribute to the existing body of knowledge, but also offer valuable guidance for future research directions and clinical applications in the management of PD.

Persons with End Stage Renal Disease (ESRD) experience poor quality of life due to poor physical function. After the transplant, his physical fitness did not improve, ultimately creating a vicious cycle of inactivity, increasing the risk of cardiovascular and other causes of death. A 39-year-old man was diagnosed with ESRD and underwent a renal transplant from a living donor. He underwent early post-operative rehabilitation from day one and continued until he was discharged. The study was conducted at Dr. Cipto Mangunkusumo National Hospital. Persons with ESRD showed significant improvement during the rehabilitation program. On the sixth day, he took a 4-meter walk test in 17.58 seconds and made a good impression. He was then discharged and continued remote rehabilitation until day 14. Physical inactivity leads to decreased survival, increased morbidity, and increased mortality. Early rehabilitation for post-renal transplantation may become a potential intervention to improve a person with ESRD's physical activity and quality of life, especially in Indonesia.

Motivation is the most influential factor in the drive and performance of adolescents with cerebral palsy (CP). As identification and analysis of volition in Iranian adolescents with CP seem to be essential, designing appropriate tools for assessing their motivation is crucial. To achieve this goal, we developed an adolescent motivation inventory-CP (AMI-CP) and evaluated its psychometric properties. 

In the first phase, item generation was conducted. Next, in the second phase, face and content validities of the items were assessed. Moreover, construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A total of 304 adolescents with CP participated in the EFA, while 210 adolescents with CP participated in the CFA. Afterward, convergent and discriminant validities of the inventory were measured. Moreover, reliability was evaluated by calculating Cronbach α, McDonald’s omega, average inter-item correlation, composite, and test re-test reliability. Lastly, the standard error of measurement (SEM) and the minimum detectable change (MDC) were applied.

Five factors with 22 items were extracted by EFA, accounting for 50.42% of the variance. The results of model fit indexes confirmed the goodness-of-fit of the final model with 20 items. In addition, the AMI-CP had a Cronbach α value of 0.75 and an intra-class correlation coefficient of 0.94. Moreover, the SEM and MDC of the inventory were 2.63 and 7.31, respectively.

The AMI-CP is a helpful measure of motivation in adolescents with CP. This inventory can enhance the assessment of the CP adolescents’ motivation by evaluating values, interests, personal causation, and physical and social environments.

Few low- or middle-income countries (LMICs) have prioritized the expansion of rehabilitation services. Existing scholarship has identified that problem definition, governance, and structural factors are influential in the prioritization of rehabilitation. The objective of this study was to identify the factors influencing the prioritization and implementation of rehabilitation services in Uganda.

A case study design was utilized. The Prioritization of Rehabilitation in National Health Systems framework guided the study. Data sources included 33 key informant interviews (KIIs) with governmental and non-governmental stakeholders and peer-reviewed and grey literature on rehabilitation in Uganda. A thematic content analysis and concept map were conducted to analyze the data.

Rehabilitation is an unfunded priority in Uganda, garnering political attention but failing to receive adequate financial or human resource allocation. The national legacy of rehabilitation as a social program, instead of a health program, has influenced its present-day prioritization trajectory. These include a fragmented governance system, a weak advocacy coalition without a unified objective or champion, and a lack of integration into existing health systems structures that makes it challenging to scale-up service provision. Our findings highlight the interactive influences of structural, governance, and framing factors on prioritization and the importance of historical context in understanding both prioritization and implementation.

Our findings demonstrate challenges in prioritizing emerging, multi-sectoral health areas like rehabilitation. Strategic considerations for elevating rehabilitation on Uganda’s policy agenda include generating credible indicators to quantify the nature and extent of the population’s need and uniting governmental and non-governmental actors around a common vision for rehabilitation’s expansion. We present opportunities for strengthening rehabilitation, both in Uganda and in similar contexts grappling with many health sector priorities and limited resources.

We aimed to systematically evaluate the most recent evidence regarding the potential short-term and long-term synergistic effects of transcranial direct-current stimulation (tDCS) and cognitive training (CT) on the memory of individuals with mild cognitive impairment (MCI) or dementia and to explore the optimal treatment protocol.

Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive literature search on PubMed, Medline, CINAHL and EMBASE was conducted to identify eligible randomized controlled trials (RCTs) published up to December 2022. The identified studies were summarized and analyzed to examine the efficacy of the combined intervention.

Ten studies involving participants with MCI or dementia were included. Four RCTs with memory-related outcomes were analyzed. A small-to-medium effect size (ES) of 0.28 was found for the short-term effect (95% CI, 0.02%, 0.55%). However, the long-term effect was non-significant, with an ES of 0.17 (95% CI, -0.09%, 0.44%).

The combined intervention appears to effectively mitigate cognitive decline in the short term only. Optimal treatment protocol remains inconclusive due to heterogeneity among studies. More robust evidence is required to determine whether the combined approach can serve as an effective intervention in clinical practice.

Maximum Interincisal Opening (MIO) refers to the greatest distance between the upper and lower incisors when the mouth is opened fully. It is a measure of the range of motion in the temporomandibular joint (TMJ) and can provide insights into the function and health of the jaw. Following maxillofacial surgery, patients frequently experience restricted MIO for several reasons. Effective rehabilitation is essential for restoring both functional and esthetic outcomes. Normal MIO values generally range between 40 to 60 millimeters in adults. However, this can vary based on individual anatomy and age. Conditions leading to decreased MIO include temporomandibular joint disorders, muscle disorders, dental issues, trauma, orthodontic issues, infections, and systemic conditions. If a decrease in MIO is observed, it is often advisable to seek evaluation from a dental or medical professional to determine the underlying cause and appropriate treatment. This article discusses current strategies and advancements in the rehabilitation of MIO in patients who have undergone maxillofacial procedures.

The anterior cruciate ligament (ACL) tear and its subsequent reconstruction surgery can lead to many complications, such as strength deficit and muscle size reduction. Heavy load resistance training is an established method for improving muscle mass and strength but may be intolerable by patients recovering from ACL injuries due to its vigorous modality. Blood flow restriction (BFR) training is a novel technique which has been recognized as a promising alternative strategy, causing physiological adaptations with lower levels of resistance training and joint loading. Given the growing popularity of blood flow restriction, this narrative review seeks to explore the impact of BFR training on various facets of post-ACL reconstruction rehabilitation, comparing it to non-BFR training. A thorough literature search was conducted, and the effect of BFR training were examined on muscle strength, muscle size, pain, function, balance, comfort, willingness to use, bone mineral density, return to sport and ACL graft laxity. The results of this review suggests that BFR training post-ACL reconstruction may offer advantages in terms of muscle strength, muscle mass, bone mineral density, balance, knee joint pain, and function when compared to non-BFR training. However, there is a high variability in methodologies across existing studies, necessitating high-quality research with standardized methodologies and protocols to enable more effective application of BFR training in rehabilitation settings.

Dynamic knee valgus (DKV) is one of the faulty lower limb movements that cause increased patellofemoral joint stress and patellofemoral pain (PFP) occurrence. This systematic review investigates the effect of active and passive proximal interventions on DKV in patients with PFP.

An online search was conducted in Cochrane Library, PubMed, Springer, Science Direct, and Scopus databases. The search was limited to the period of 2000 to 2022. The included articles were screened in three stages according to the eligibility criteria. The quality of articles was assessed based on the Downs and Black checklist and was then classified into three categories as follows in terms of quality: High, medium, and low.

Overall, 8 articles were included in this systematic review. Four articles were related to hip strengthening exercises, 2 articles to strengthening exercises combined with movement retraining, and 2 articles to brace and strap. In strengthening exercises, 2 articles did not demonstrate a significant effect in reducing DKV. In contrast, 2 articles reported a reduction in DKV after hip strengthening exercises. Two articles of strength training combined with movement retraining reported reductions in DKV. In the passive intervention, only 1 article reported a reduction in DKV. 

Both active and passive proximal interventions have the potential to modify DKV and can be used in the prevention and treatment of PFP protocols; however, active interventions stimulate proprioception and facilitate muscle recruitment.

Proprioceptive neuromuscular facilitation (PNF) stretching is considered a clinically effective way to enhance muscle properties; however, rare information exists about its effect on muscle flexibility and strength of the patients with stroke. To investigate the efficacy of PNF exercise on lower extremity muscle flexibility and strength after stroke.

Twenty-four men with stroke were chosen for the current study and assigned to two groups, PNF (n=12, mean age=59.3) and control group (n=12, mean age=58.7). Both groups received conventional rehabilitation three times a week for two months, while the PNF group received an additional 20-minute contract-relax (CR) method of PNF exercises during each session. Gastrocnemius and hamstring flexibility have been measured pre- and post-intervention by wall lunge and active straight leg raising (aSLR) tests, respectively. Additionally, hamstring and quadriceps strength has been measured pre- and post-intervention by a hand-held dynamometer. A 2×2 mixed repeated measure analysis of variance (ANOVA) was utilized to analyze data.

Significant interaction of time x group was found for hamstring flexibility (F=33.24, P<0.01) and strength (F=23.86, P<0.01). Post hoc analysis indicated that aSLR (effect size=0.75) and hamstring strength (effect size=0.67) significantly increased in the PNF group. No significant interactions or main effects were observed for gastrocnemius flexibility and quadriceps strength. 

The results indicate that eight weeks of PNF stretching improves hamstring muscle flexibility and strength in patients with stroke. However, future studies have to confirm the prolonged effects of PNF exercise.

Patients with experienced stroke have suffered from long-term disability, especially in their distal upper extremities. Physiotherapy programs are considered a proper treatment to overcome the complications caused by stroke. The use of robots in physiotherapy is also considered a newfound procedure as an alternative to conventional methods.

This study aimed to describe a feasibility test on a physiotherapy robot and evaluate the efficacy of the proposed device.

In this experimental study, a 4-degrees-of-freedom robot was designed and fabricated for hand physiotherapy, which was tested on 17 and 4 post-strokes in the passive and active modes for the best efficiency. Additionally, the patient’s hand spasticity was measured according to the Modified Ashworth Scale pre- and post-usage of the device.

A total of 12 of 17 individuals could do the exercises and follow the instructions without any problem, and 8 of 12 individuals had a decrease in their spasticity. All 4 patients in active-assisted mode could fulfill the activity. 

Physiotherapy based on a robot-assisted is considered a promising method with effective treatments for post-stroke patients, which can be a good alternative to routine methods of physiotherapy. However, more tests are needed to determine the rate of functions’ restoration.