Spinal muscular atrophy (SMA) is an autosomal recessive disorder with symptoms of progressive skeletal muscular atrophy which requires multidisciplinary medical care. The advent of nusinersen treatment has created a paradigm shift in rehabilitation treatment for SMA. However, the principles of rehabilitation remain the same for the respiratory, musculoskeletal, gastrointestinal, and speech and nutrition care which are all required. Patient education based on multiple sources of easily available evidence-based information has improved quality of life and has changed treatment goals. Functional assessment is critical before rehabilitation is commenced. In general, SMA patients are classified as “nonsitter,” “sitter,” and “walker.” This review provides an update on rehabilitation provided in contemporary SMA centers.

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in the treatment of hematologic cancers such as leukemias, lymphomas, and myeloma and for other hematologic disorders such as primary immunodeficiency, aplastic anemia, and myelodysplasia. Allo-HSCT entails a conditioning regimen of frequent high-dose chemotherapy in combination with total body irradiation, followed by infusion of donor-harvested bone marrow or peripheral blood stem cells. As an aggressive and demanding medical therapy that profoundly impacts patient quality of life (QOL), allo-HSCT is associated with numerous treatment-related physical, psychological, and psychosocial side effects. The procedure can result in decreased respiratory and balance function, skeletal muscle strength, and exercise capacity. Thus, as physical exercise has been shown to positively affect physical and psychosocial function and QOL in allo-HSCT patients, it is a recommended intervention for improving essential functions and offsetting lost exercise capacity after the procedure. Furthermore, recent evidence has shown that physical exercise can influence survival rate and mortality in allo-HSCT patients. This review provides an overview of the current research on the effectiveness of physical exercise for allo-HSCT patients.

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This article is meant as an update on the previous articles published about the International Society of Physical and Rehabilitation Medicine (ISPRM). It reflects the current organizational structure and describes its core activities. Strengths, weaknesses, opportunities, and threats of the society are analyzed to define a strategic plan for the future of ISPRM. Key activities like ISPRM World Congresses, the foundation of the Journal of ISPRM and the creation of a certification project are described. The article reports also about the external relationship of ISPRM with different organizations and in particular with the World Health Organization and with the United Nations.

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Elective orthopedic surgeries are often deferred or declined due to concern about the patient's elevated body mass index (BMI). The study team conducted a literature review of studies focusing on the relationship between BMI and outcomes of elective orthopedic surgical procedures. The literature review found that overweight and obese patients have similar gains in function and pain reduction as do patients with normal weight, with adverse perioperative outcomes more evident in the higher levels of obesity. These data suggest a need to review the current policies concerning surgical eligibility based on BMI. These data suggest that restrictions of surgical procedures based on BMI may be too restrictive and should be revised based on the current literature.

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Context: Approximately 600,000 new cases of cancer are estimated to occur in Brazil over the 2-year period of 2018–2019, and the world economic impact of cancer was $895 billion dollars in 2008. Aims: To perform an analysis contemplating the clinical profile, impact, and direct medical costs of an outpatient rehabilitation program for patients who have undergone breast cancer surgery. Settings and Design: A partial economic analysis was performed from the perspective of a Brazilian public hospital. Subjects and Methods: An observational study was conducted using data from a retrospective cohort of patients who had undergone breast cancer surgery. These patients had their first rehabilitation appointment between August 2015 and July 2016. Statistical Analysis Used: Pearson's Chi-square test or Fisher's exact test, Student's t-test, Fisher's F-test analysis of variance, or the nonparametric Kruskal–Wallis test. Post hoc tests were conducted to check for differences between the pairs of categories. The nonparametric Kolmogorov–Smirnov test evaluated the data normality. All hypothesis testing used a significance level of 5%. Results: A total of 132 patients underwent the referred rehabilitation program. The goal of total rehabilitation was achieved in approximately 70% of cases. There was improvement in patients' quality of life in most Short-Form Health Survey-36 dimensions. The program's direct cost had an overall median per patient of R$ 7235.32. Conclusions: The study found good results in the indicators of clinical outcome and quality of life. The costs were reported from a partial evaluation point of view and may contribute to future full evaluations.

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Purpose: In elderly patients with collagen disease, walking ability tends to decrease due to treatment with corticosteroids and long-term hospitalization. The purpose of this study was to investigate the factors related to independent walking in elderly patients with collagen disease. Methods: A total of 65 inpatients, aged ≥65 years with collagen disease, were enrolled in this cross-sectional study. Factors such as independent walking, knee extension muscle strength, one-leg standing (OLS) time, and the Geriatric Nutritional Risk Index (GNRI) were evaluated. Independent walking was evaluated using the functional independence measure (FIM). Patients were divided into the physical assistance group (1–4 points on the FIM) and the no physical assistance group (5–7 points on the FIM). Logistic regression analysis was performed, and cutoff values were calculated. Results: Of the 65 patients, 24 were allocated to the physical assistance group and 41 were allocated to the no physical assistance group. The logistic regression analysis showed the OLS time (odds ratio [OR] = 1.373, 95% confidence interval [CI]: 1.115–1.691, P < 0.01) and GNRI ([OR] = 1.076, 95% [CI]: 1.007–1.150, P < 0.05) as parameters that were associated with a probability of walking independence. Furthermore, according to the receiver operating characteristic curve analysis, the cutoff value for the OLS time was 4.1 s (sensitivity 75.6; specificity 91.7; area under the curve [AUC] = 0.906) and that for the GNRI was 81.7 (sensitivity 61.0; specificity 79.2; [AUC] = 0.713). Conclusions: Altogether, the OLS time and GNRI may be factors related to independent walking in elderly inpatients with collagen disease.

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A patient with biventricular heart failure received a total artificial heart (TAH) as a bridge to transplant. He had a complicated hospital course including postoperative bleeding, subarachnoid hemorrhage, and adjustment disorder. After participating in 6 months of a rehabilitation program, his Berg balance score progressed from 8 to 41 and his endurance improved from ambulating 75 feet with a rolling walker and requiring moderate assistance in his activities of daily living on admission to ambulating several times up to 200 feet with modified independent and modified independent with setup for his basic activities of daily living. Since few patients have undergone inpatient rehabilitation with a TAH, this case illustrates significant functional gains that a comprehensive rehabilitation team can provide and major considerations to be aware of to optimize care when working with patients with TAH.

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The presence of aphasia following left hemisphere damage and of spatial neglect following right hemisphere damage are both associated with a significant negative impact on the functional outcome of stroke patients referred to rehabilitation. In aphasia, interpersonal variance in structure-function mapping, and findings related to pragmatics, points to exciting new options for rehabilitation research. In the case of neglect rehabilitation, promising novel options are pointed by experiments showing abolishment of neglect when spatial attention is modulated shortly after stimulus capture (at a stage where perceptual information is maintained in the iconic buffer) and by studies showing amelioration following electroencephalogram-biofeedback treatment aimed to enhance the level of arousal in perilesional cortex.

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Background: Poststroke shoulder pain (PSSP) is a complex phenomenon. Defining the exact etiology would facilitate proper management. Aim: The aim of the study is to identify the different causes of PSSP. Settings and Design: Observational cross-sectional study at institution, university hospital, tertiary level of clinical care. Methods: A total of 30 stroke survivors with PSSP were enrolled in this study. Patients were subjected to neuromuscular clinical examination of the shoulder, and evaluation (spasticity assessment using Modified Ashworth scale and Fugl-Meyer upper extremity scale to assess impairment). The shoulder pain was evaluated using the numerical rating scale and the neuropathic pain diagnostic questionnaire (DN4). Electrophysiological studies (nerve conduction and electromyography) and imaging (plain radiograph and magnetic resonance imaging [MRI]) were done to reveal neuromusculoskeletal causes for PSSP. Results: One or more musculoskeletal cause occurred in all patients. These were rotator cuff tear/tendinopathy (90%), impingement syndrome (90%), bursitis (66.7%), and adhesive capsulitis (50%). Concomitant proximal neuropathies including (upper trunk brachial plexopathy, axillary neuropathy, and suprascapular neuropathy) were found in 40% of PSSP patients. The DN4 questionnaire was positive in only two patients. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS version 20 Chicago, IL, USA). Conclusion: The most common causes of PSSP were the musculoskeletal causes. MRI studies were helpful in revealing the common causes of shoulder pain such as rotator cuff tear and bursitis in those disabled population in whom clinical assessment could be difficult.

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Context: Physical medicine and rehabilitation (PM&R) is often underrepresented and taught inconsistently in medical schools. Medical students' awareness and understanding of disability and PM&R are often poor. Aims: This study aims to study the impact of a week-long structured PM&R clerkship on 3^rd-year medical students' rehabilitation knowledge. Design: This was a retrospective analysis of pre- and post-clerkship multiple choice questions (MCQs). Settings: This was a rehabilitation center within a tertiary care teaching hospital. Participants: Seventy-two 3^rd-year undergraduate medical students who underwent PM&R clerkships between November 15, 2016, and January 15, 2018. Subjects and Methods: At commencement, undergraduates were administered Best of Five MCQs based on the program content. Clerkship components included tutorials, prepared reading materials on PM&R, and exposure to various clinical work of the rehabilitation center. The same MCQs were readministered at the conclusion of clerkship. Results: Postclerkship MCQs saw improved scores in 98.6% of the students. The mean MCQs score improved from 14.44 to 20.01 (23.2% gain). Students, who had previous PM&R observership, scored higher in their preclerkship MCQs (16.06 vs. 13.98; P = 0.001). They fared better in components delving into PM&R work, concepts and roles (7.56 vs. 6.04, P = 0.01), and stroke rehabilitation (2.38 vs. 1.82, P = 0.01). Following clerkship completion, 52% of the students were able to describe PM&R using key rehabilitation concepts/principles, and 76.4% would consider PM&R as their career. Conclusions: The study suggests that a dedicated and structured PM&R clerkship in undergraduate medical curriculum improves PM&R knowledge and awareness among the medical students.

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