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   Table of Contents - Current issue
October-December 2022
Volume 5 | Issue 4
Page Nos. 119-164

Online since Friday, December 16, 2022

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A look at the frontier of rehabilitation at the 16th international society of physical medicine and rehabilitation 2022 world congress p. 119
Thadeu Costa, Thomas Helfenstein, Marta Imamura
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Nutrition management across the stroke continuum of care to optimize outcome and recovery p. 121
Anne Holdoway, Ethem Murat Arsava, Stephen A Ashford, Emanuele Cereda, Rainer Dziewas, Gerard E Francisco
Stroke and the resulting long-term disability impose a substantial socio-economic burden. Stroke survivors have nutritional challenges at many stages along their care pathway, and the role of nutritional therapy and medical nutrition in stroke recovery is often overlooked. Appropriate nutrition is a prerequisite for optimizing short-term outcome and recovery from stroke and should be integral across the continuum of care, with management intervention if needed. Nutrition should be reviewed as part of the care for all people post-stroke. If nutrition support is required, it should be initiated at the acute phase and adjusted according to the ability to eat and drink throughout the care pathway. A range of complications arising post-stroke including malnutrition, dysphagia, sarcopenia, and pressure injuries can be prevented or improved by timely appropriate nutritional therapy. This also improves physical and mental function, increases strength and mobility which facilitates effective neurorehabilitation, reduces the risk of infection and pressure injuries, promotes wound healing, and improves the quality of life. An appropriately trained nutrition specialist or dietitian should assess and monitor the individual, but all members of the multidisciplinary team have a role in delivering, monitoring, and supporting the nutritional status and changing needs of the stroke survivor. This review by authors from multidisciplinary fields in stroke care is a consensus based on serial, open discussion meetings. The review explores the interrelationship between malnutrition, sarcopenia, nutrition, and pressure injuries, and seeks to raise awareness among all health professionals who manage the stroke survivor, of the supportive role of nutritional therapy.
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Insights and future directions on the combined effects of mind-body therapies with transcranial direct current stimulation: An evidence-based review p. 129
Ingrid Rebello-Sanchez, Karen Vasquez-Avila, Joao Parente, Kevin Pacheco-Barrios, Paulo S De Melo, Paulo E P Teixeira, Kian Jong, Wolnei Caumo, Felipe Fregni
Mind-body therapies (MBTs) use mental abilities to modify electrical neural activity across brain networks. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that modulates neuronal membrane potentials to enhance neuroplasticity. A combination of these treatment strategies may generate synergistic or additive effects and thus has been more commonly tested in clinical trials, fostering a novel yet promising field of research. We conducted a literature search in four different databases including only randomized clinical trials (RCTs) that tested the combination of MBTs with tDCS. Ten studies (n = 461) were included. Combined protocols included meditation/mindfulness (8/10), biofeedback (1/10), and hypnosis (1/10). The RCTs were heterogeneous with regard to population, design, and types of outcomes. Based on the findings of this search, we provide here a content description, methodological and practical insights, and future directions for the field. We hope this review will provide future authors with information to facilitate the development of trials with improved protocols.
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Rehabilitation length of stay among traumatic paraplegics – A retrospective analysis p. 149
Mohit Kishore Srivastava, Anil Kumar Gupta, Ganesh Yadav, Dileep Kumar, Sudhir Ramkishore Mishra, Sugandha Jauhari
Introduction: In patients with traumatic spinal cord injury (SCI), a complex interplay of sociodemographic and injury-related factors can impact on outcomes such as rehabilitation length of stay (r-LOS), functional status, and discharge following rehabilitation procedures. Every year 2.55 lakhs of people suffer from SCI globally. Objectives: To describe the r-LOS in patients with traumatic paraplegia and associated correlates. Materials and Methods: A retrospective study was conducted among traumatic paraplegics admitted in the rehabilitation unit of a government tertiary care hospital of Lucknow, Uttar Pradesh, between January 1, 2016, and December 31, 2017. All medical records of traumatic paraplegics fulfilling the inclusion criteria were used for data extraction and analysis. A data-gathering instrument was developed and was thereafter used to capture the relevant information from the patients' individual medical records. Results: Mean and median duration of r-LOS was 98.4 ± 37.2 and 98.3 (31.3) days, respectively. Significant predictors were age, employment status, location of residence, operation, and complications at/during hospitalization (P < 0.05). More than half (55.6%) of the traumatic paraplegic patients were of neurological category A. Among those who had r-LOS > 98 days, 94.2% had pressure ulcers in the sacral region, followed by 85.7% ischial and majority were grades 3 and 4. Conclusion: The most common cause of injury was falls from height. Pressure ulcer was the most common complication of paraplegics. Age, employment status, and location of residence were the epidemiological factors, while the history of operation and pressure ulcers were the clinical factors affecting the length of hospital stay.
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Medico-surgical management of the spastic equinovarus foot deformity in adults: A retrospective series of 622 patients p. 156
Thierry Deltombe, Thomas Gavray, Olivier Van Roy, Delphine Wautier, Thierry Gustin
Objective: This study aimed to determine the frequency of spastic equinovarus foot (SEF) treatments. Materials and Methods: the medical files of 622 patients treated for SEF were reviewed. Results: SEF resulted from stroke in 66%. The most frequent pattern was equinovarus in 56%, knee recurvatum in 55%, and claw toes in 41%. Patients benefited from surgical treatment in 59%, including neurotomy in 22%, tendon surgery in 12%, and a combined surgery in 25%. Conclusion: Surgery was performed in 59% of the cases. The type of treatment was influenced by the preoperative diagnostic nerve block assessment.
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Amputate or not amputate? A fibular hemimelia case report p. 161
Ana Rita Raposo, Armanda Lobarinhas
Fibular hemimelia is the most frequent congenital defect of the long bones. It has a wide spectrum of clinical and radiological presentations ranging from minor hypoplasia to complete absence of the fibula. Treatment options range between orthotic support, limb reconstruction, and amputation. In the current article, we present a complex clinical case of a young patient with fibular hemimelia. The patient presented a dysmetria of the lower limbs of 21 cm, also an equinovalgus foot position, and several malformations of the foot and toes. She walked with adapted orthosis and crutches, which was proved difficult for her, and esthetically undesirable. Due to the impairment on her quality of life, she was referred initially to bone-lengthening surgery. However, this surgery did not obtain satisfactory results, in both esthetic and functional levels. Hence, the patient was referred to amputation, with a better outcome after. In this clinical case, and reviewing the current literature, we aim to reflect on the implications of the different surgical options in the treatment of fibular hemimelia, and the role of physical medicine and rehabilitation in the functional recovery of these patients. We invite readers to reflect on some questions: Is amputation the best treatment in cases of serious fibular hemimelia? Should a bone-lengthening procedure be attempted before amputation? Should the amputation be delayed? To amputate or not to amputate?
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