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Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has now infected over a million people around the world. This pandemic is stressing intensive care unit (ICU) capacity due to critical illness from coronavirus disease 2019 (COVID-19). Survivors of critical illness from acute respiratory syndrome and the prior SARS epidemic suggest that critically ill COVID-19 survivors may experience a wide range of sequelae, resulting in long-lasting physical, cognitive, and psychological dysfunction. Early rehabilitation can mitigate these complications and improve the quality of life. However, early rehabilitation of critically ill COVID-19 patients is challenging due to patients' severity of illness, the need for strict infection control measures, staffing issues, and scarcity of personal protective equipment. During this public health emergency, navigating rehabilitation of critically ill COVID-19 patients is crucial to allow timely transition of patients across different levels of care. Such timely transitions are vital for improving outcomes and freeing ICU and hospital beds within acute care hospitals. In this review, we discuss the challenges and potential solutions for rehabilitation of critically ill COVID-19 patients throughout the continuum of care.

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Since the beginning of 2020, COVID-19 infections have increased exponentially, overwhelming health-care services globally. Survivors of this infection have significant disabilities due to the debilitating weakness and compromised lung function. Unfortunately, rehabilitation services are scarce due to diversion of rehabilitation clinicians to emergency medical care. This manual aims to bridge this gap by providing a self-directed home care and graduated exercise program which does not require any special equipment. The exercises were carefully selected based on research by the authors on self-directed home exercises in frail, elderly patients.

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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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This review systematically evaluates existing evidence for the effectiveness and safety of different rehabilitation interventions for managing fatigue in persons with multiple sclerosis (MS), stroke, traumatic brain injury (TBI), and Parkinson's disease (PD) for improved patient outcomes. A comprehensive literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, PubMed, and the Cochrane Library) databases for published articles up to March 1, 2018. Both reviewers applied inclusion criteria to select potential studies and extracted data independently. Overall, 56 studies (22 systematic reviews/meta-analyses, 32 randomized clinical trials, 2 controlled clinical trials) fulfilled the inclusion criteria for this review. Although existing best-evidence for many interventions is still sparse, the overall findings suggest “strong” evidence for physical activity, cognitive-educational programs, and energy conservation strategies in MS; “moderate” evidence for multidisciplinary rehabilitation in MS; home-based physical activities in stroke and TBI; hydrotherapy in MS and TBI, group-education in stroke and self-management programs in TBI; and mindfulness intervention in MS, stroke, and TBI. There was “low” evidence for exercise in PD and other physical modalities such as yoga and cooling therapy in MS, pulsed electromagnetic devices in MS and stroke; light therapy, and biofeedback in TBI. Effect of other interventions was inconclusive. Despite the available range of rehabilitation interventions for management of fatigue in neurological conditions, there is lack of high-quality evidence for many modalities. More robust research is needed with appropriate study design, timing and intensity of modalities, and associated costs.

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Physical medicine and rehabilitation (PMR) is evolving in low- to middle-income countries. Although established as a separate specialty in Bangladesh 40 years ago, there has been no formal documentation of the history and current state of PMR, or associated disability issues in Bangladesh. The aim of this review is to provide a brief overview of the health-care system in Bangladesh, to discuss the available disability statistics, legislation for persons with disability (PWD), and current system(s) of disability management in the country. The evolution of PMR is presented along with an exploration of future perspectives. Data sources included an online literature search (English language only; 1970–2018) with predefined keywords. Official government websites were examined for disability-related statistics, and informal interviews with Bangladeshi government officials and rehabilitation professionals provided further insights. The reported disability prevalence in Bangladesh varies widely from 5.6% to 16.2%. Currently, there are 130 physiatrists, and over 1400 physiotherapists, 190 occupational therapists, and 200 speech and language therapists. A developing economy, illiteracy, maldistributions of wealth, and a rising prevalence of chronic diseases add to the burden of the existing disability. Legislations have been passed with an aim to protect the rights and dignity of PWD, but there are major barriers in implementing the acts. Social stigmatization of PWD remains largely unaddressed, with low rates of community reintegration. PWD also face mobility barriers and accessibility issues. PMR and other rehabilitation services are improving, but disability management is largely considered a social issue rather than a medical problem. There is a need to involve all stakeholders in disability management to strengthen medical rehabilitation and improve service delivery, while advocating for the rights of PWD.

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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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Background: Few studies have examined the use of ergogenic supplements (ESs) by young athletes residing in a sports specialized school. Methods: In this cross-sectional study, 120 students from a sports specialized school (ages 12–19) completed a questionnaire to assess the prevalence of use of ES according to sex, sport, type of supplement, reasons for use, knowledge of supplements, and sources of information. Results: Most athletes were males (55%) and participated in track and field (32%). Mean age was 14.7 ± 1.6 years. Approximately 98% of athletes indicated using one or more supplements. Sport beverages (95.0%), proteins/amino acids (57%), and vitamins (54%) were the most commonly used. Athletes practicing racquet sports were more likely to consume proteins/amino acids every day than those in any other type of sport (P < 0.05). The adjusted odds of using vitamins were 14% (95% confidence interval [CI]: 0.22–3.30) and 71% (95% CI: 0.09–0.96) lower among athletes practicing explosive sports and high intensity, respectively, as compared to those practicing endurance-intensive sports. On the other hand, the odds of using proteins/amino acids was higher for those practicing explosive (adjusted odds ratio [AOR]: 3.48, 95% CI: 1.02–11.86) and high-intensity (AOR: 2.88, 95% CI: 1.00–8.26) sports. Approximately 62% of athletes used supplements to improve performance. Only 8% of athletes were willing to use a prohibited substance to achieve participation in the Olympics. Conclusion: There was a very high prevalence of use of ES in a sports specialized school. Education regarding supplement use is warranted for athletes, coaches, and family.

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Homer's Odyssey, one of the major Greek epic poems, tells the story of the hero Odysseus (or Ulysses in Roman versions) and his journey home to his wife Penelope. An epic poem is a long, narrative poem that is usually about heroic deeds and events that are significant to the culture of the poet. In keeping with this classic storytelling style, we describe the journey that the Upper Limb International Spasticity Study (ULIS) program has taken. The program was started in 2008 and has encountered a number of trials and obstacles along the way. This article sets out the history of development through its 10-year “Odyssey.” We use the benefit of hindsight to discuss how conducting large-scale, international observational studies can inform and influence routine practice in an area as diverse and complex as spasticity rehabilitation. We focus on the clinical pearls found within the now extensive ULIS dataset and how continually building upon the insights from each study can provide a real impetus for change.

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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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Patients with the rare pharyngeal cervical brachial variant of Guillain–Barré Syndrome present with a sudden and progressive onset in weakness of the pharyngeal, cervical, and brachial muscles, but usually make a rapid recovery. However, in a patient with delayed oropharyngeal recovery, early identification of poor clinical and electrophysiological prognostic factors can guide rehabilitation planning to optimize functional outcomes.

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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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Aim: The study aims to evaluate the effectiveness of tibial nerve block with phenol on ankle plantarflexion and inversion spasticity caused by the upper motor neuron lesions. Materials and Methods: A single-center retrospective study was undertaken to assess the effectiveness of tibial nerve block on the spasticity of ankle plantar flexors and invertors in upper motor neuron lesions. Forty-four patients with ankle plantar flexion and inversion spasticity were included in the study. Clinical outcomes were measured before tibial nerve block at 6 and 24 weeks following the treatment. The outcome measures included Modified Ashworth Scale (MAS), the passive range of motion of the ankle dorsiflexion with the knee in a flexed position and with the knee in an extended position. The patients were advised to continue with the pharmacological and nonpharmacological interventions such as medications, splinting, and stretching. Friedman test of differences among repeated measures was conducted from data at 0, 6, and 24 weeks. Results: There was a statistically significant difference between the baseline MAS and ankle passive range of dorsiflexion motions (both with the knee flexed and extended) measured at 6 and 24 weeks following the phenol nerve block of the tibial nerve. Conclusions: This study highlights that phenol nerve block of the tibial nerve helps to reduce the spasticity of the ankles when combined with other pharmacological and nonpharmacological interventions such as splinting and stretching.

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The link between rehabilitation, functioning, and the International Classification of Functioning, Disability and Health (ICF) is nothing new. This is reflected not only in the numerous peer-reviewed papers on applying the ICF in rehabilitation but also in the indispensable role of functioning and the ICF in developing the conceptual descriptions of rehabilitation as a health strategy and of physical and rehabilitation medicine (PRM) as a medical specialty. Since the World Health Organization's (WHO's) Rehabilitation 2030 Call for Action in 2017, functioning and the ICF have gained an even more prominent role in rehabilitation. This paper provides an overview of the current efforts toward strengthening rehabilitation in health systems throughout the world by applying information on functioning in rehabilitation practice, Clinical Quality Management for Rehabilitation (CQM-R), and policy, using the ICF as a reference framework. These initiatives are led by rehabilitation and rehabilitation-related societies and academic institutions in various countries and regions of the world. This paper briefly describes them and puts them into the context of WHO's call for strengthening rehabilitation. It concludes by highlighting lessons learned from these initiatives, introducing Cochrane Rehabilitation as a conduit for promoting the use of ICF in evidence gathering and calling for collaboration from new partners who have not yet been active in promoting ICF implementation. This call for collaboration from the International Society of PRM strives to diversify the representation of contributors and experiences in implementing the ICF in rehabilitation practice, CQM-R, and policy.

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Aphasia is a common complication of stroke, often causing significant morbidity. To the authors' knowledge, no stroke recovery practice guidelines incorporating pharmacologic or noninvasive brain stimulation (NIBS) therapies for poststroke aphasia (PSA) exist. The aim of this article is to provide a comprehensive review of the evidence regarding pharmacologic and NIBS treatment in PSA. An exhaustive single database search assessing treatment for PSA was performed from 2010 to 2020, resulting in 1876 articles. Articles evaluating either pharmacologic management or NIBS were included. Case reports, case series, original research, systematic reviews, and meta-analyses were allowed. Pharmacologic treatment studies included were represented by the following medication classes: cholinergic, dopaminergic, gamma-aminobutyric acid agonists and derivatives, N-methyl-D-aspartate receptor antagonists, serotonergic, and autonomic agents. NIBS treatment studies regarding transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) were evaluated. No strong evidence was found for any medication to improve PSA. However, the benefit of a medication trial may outweigh the risk of side effects as some evidence exists for functional recovery. Regarding NIBS, weak evidence exists for the treatment effect of tDCS and rTMS on PSA. While additional research is needed, the literature shows promise, especially in chronic phase of stroke when traditional treatment options may be exhausted. More evidence with larger studies and standardized study design is needed.

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Introduction: Spasticity is increased, involuntary, velocity-dependent muscle tone that causes resistance to movement. Intrathecal injection of phenol is a form of treatment used in a very selective group of patients with spasticity. Aim: This study aims to highlight current evidence in the treatment of spasticity with intrathecal neurolytic phenol injections. Materials and Methods: A computer-based literature search was performed using MEDLINE, EMBASE, CINAHL, and the Cochrane Library using the following key words: intrathecal, phenol, spasticity, and pain. Results: The search identified 83 articles. Of 16 articles met the inclusion criteria of being specifically relating to the use of intrathecal phenol injections in spasticity. There was a lack of randomized controlled studies addressing intrathecal phenol injections in our search. Conclusions: Intrathecal phenol can be valuable for the treatment of spasticity when adapted for each individual, and used as part of an overall program that includes multidisciplinary team assessment and goal planning.

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Background: Osteoarthritis (OA) of the knee is a significant cause of disability. The current conservative treatment options include physiotherapy, analgesia, intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid, or corticosteroids. Regarding PRP, some meta-analyses studies have been reported. However, these studies focused on the effectiveness of intra-articular PRP when compared to other controls, and none thoroughly investigated the anchored-based effectiveness concerning the minimal clinically important difference (MCID). Objective: We, therefore, conducted this work to address this apparent knowledge gap and to provide objective data that could be used by decision-makers. Methods: Electronic databases were searched to identify relevant publications. We included controlled trials that evaluated the efficacy of PRP for the treatment of OA of the knee. All included studies must have had a minimum follow-up of 24 weeks as well as pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Results: A total of 12 studies, involving 405 patients, were included in this analysis. The primary endpoint of this study was to compare the treatment effect measured by WOMAC scores improvement to MCID. For WOMAC score analyses, the mean difference (MD) between baseline and 6-month scores was utilized. The pooled data established significant functional improvement as demonstrated by MD of 25.5 ± 3.3 (95% confidence interval: 19.1–31.9, P< 0.001). In addition, the overall comparison of MD (25.5) to MCID (7.9) showed that the MD was approximately three-fold higher. Due to the known impact of the baseline scores on the MD, we conducted further analyses comparing MD values to the corresponding MCID for various baseline severity grades (i.e. high, intermediate, and low). The analyses showed significantly higher MD values in all categories. Conclusions: In conclusion, evidence from studies of low-to-moderate methodological quality shows that intra-articular PRP has the potential to provide a clinically meaningful symptomatic benefit for OA of the knee, at least in the short term.

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Background: Rehabilitation techniques have provided encouraging results in achieving functional goals in patients undergoing total hip &/or knee arthroplasty. Aims and Objectives: Current meta-analysis compares hospital-based rehabilitation techniques for improving pain score and functional status of patients undergoing hip and knee arthroplasty. Methods: From 1332 initial articles, 29 randomized controlled trials were included in quantitative synthesis. Results: Higher improvement in oxford knee score [MD = -0.60, 95% CI: -1.69 to 0.48, I2–58%, P = 0.05], 6 minutes' walk test [MD = 22.27, 95% CI: -1.96 to 46.49, I²–53%, P =0.06], mental health [MD = 3.56, 95% CI: -0.62 to -7.74, I²–88%, P < 0.00001] was observed with home as compared to hospital based rehabilitation. Greater cost reduction (P = 0.04) benefits were associated with home-based rehabilitation techniques. Conclusion: Home-based rehabilitation technique is clinical and cost-effective alternative of hospital-based rehabilitation in the patients undergoing knee arthroplasty.

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