scholarly journals PHYSICAL THERAPY FOR PATIENTS AFTER STROKE

2021 ◽  
pp. 18-26
Author(s):  
А. V. Homola ◽  
Ye. V. Prokopovych ◽  
Y. V. Antonova-Rafi

  Abstract. Objectives: to summarize the data on the spread and complications of patients after stroke in Ukraine and in the world, the noted motor and cognitive impairments are the basis of disability; to prove the effectiveness of physical therapy methods for recovery of motor function of patients after a stroke. The strategy of solving the problem consists in reducing the limitations of daily living activities, increased mastering new skills and abilities. Patients are examined using modern tests and scales, which allow summarizing the examination results, and having a high level of reliability. Purpose of the study: the dynamics of the functional motor state of patients after undergoing complex physical therapy. The effectiveness of the methods at the stage of restoration of motor abilities has been substantiated. Methods. Every day at the MDK meeting, communication takes place in accordance with medical ethics and moral principles, the legal norms of the patient and his family. On the basis of the Kiev City Clinical Hospital № 6, the Department of Physical and Rehabilitation Medicine 34 patients were separated in the early recovery period with plegia of the upper limb and divided into two groups: the main and the control one. In the late period after a stroke with spasticity of the upper limb, 26 patients were also divided into two groups. Women age ranges from 35 to 83 years old; men - from 37 to 84 years old. The dynamics of the functional motor state of patients after undergoing complex physical therapy was investigated. Research results. In Ukraine, there are many versions of physical therapy for patients after stroke in the acute and early period. The Ukrainian Stroke Association has created protocols for rehabilitation assistance. Some success has been achieved in the rehabilitation of patients in the acute period. Difficulties arise in the late period of physical therapy, namely, functional motor disorders. This negatively affects the social and everyday activity and the usual activities of patients. The consequences of a stroke are muscular disorders such as a complete absence of voluntary movements (plegia), accompanied by a painful syndrome, loss of balance, coordination during movement. Also, the growing spasticity that forms contractures, there are pain sensations and restrictions in everyday activities. Patients face the problem of muscle spasticity, which interferes with a full-fledged rehabilitation process, becomes an obstacle in the restoration of motor functions, leads to a loss of working capacity, self-care skills, and sharply reduces the quality of life. A physical therapist must own, know and use the methods and means of physical therapy. The use of the international classification of functioning influences the course of work of a multidisciplinary team, aimed at a direct and specific rehabilitation process for the qualitative and complex restoration of the patient's lost motor functions. Conclusion. On the basis of the Kiev City Clinical Hospital № 6, Department of Physical and Rehabilitation Medicine, developed a complex program of physical therapy, for a group of patients after stroke. The multidisciplinary team does not divide life before and after a stroke, it tries, on the basis of evidence-based medicine, an integrated and individual approach to activate an independent life, help and restore the patient's lost functions, compensate and find a way out where others refuse.  

2011 ◽  
Vol 36 (1) ◽  
pp. 39-44
Author(s):  
Josephine Hillan ◽  
Lorraine E Graham

Background: In 2003, the British Society of Rehabilitation Medicine (BSRM) published guidelines on amputee and prosthetic rehabilitation, including those with congenital limb deficiency.Objectives: The aim of the study was to evaluate the service provided by the Regional Disablement Service (RDS) to children with congenital upper limb deficiency, against BSRM guidelines.Study Design: Retrospective chart review.Methods: Chart review.Results: Analysis of the group ( n = 44) showed 52% were male, with 61% of children affected on the left side, and 73% having a transverse deficiency. Compliance to individual aspects of the guidelines varied considerably. Only 14 (32%) of children had met with the multidisciplinary team by the recommended age of six months. Analysis of referral sources and timings suggested that children were initially seen elsewhere and later referred to RDS after consultation with a surgeon.Conclusions: RDS compliance with the BSRM guidelines was variable. Particularly disappointing was the low rate of children and families meeting the multidisciplinary team at an early age (< 6 months). The low rate of early referral prompted us to contact all paediatricians in Northern Ireland highlighting the guidelines, the benefits of early contact with RDS and encouraging referral on diagnosis.Clinical relevanceThis work will be of interest particularly to those involved in treating paediatric amputees. The challenges we face in treating upper limb deficient children in accordance with current guidance may not be unique and our study may prompt other units to consider how best to improve service to this group.


2020 ◽  
Vol 96 (2) ◽  
pp. 7-12
Author(s):  
T.V. Builova ◽  
D.D. Bolotov

The article describes modern approaches to the organization of rehabilitation in patients with limb amputations and exarticulations: it highlights technology of using the International Classification of Functioning, Disability and Health, as a tool allowing to form rehabilitation diagnosis, rehabilitation prognosis, assess rehabilitation potential, determine the purpose and plan of rehabilitation, as such as to give recommendations at end of rehabilitation course in the process of rehabilitation in patients with amputations. Taking in to account the limitations of mobility and self-service opportunities assessed by the rehabilitation routing scale, we propose a tactics for patients’ transfer from the first to subsequent rehabilitation stages. The presented approach allows to optimize the rehabilitation process and to achieve designed results.


2019 ◽  
Vol 21 (4) ◽  
pp. 8-13
Author(s):  
V E Yudin ◽  
A M Shchegolkov ◽  
V P Yaroshenko ◽  
I G Ovechkin ◽  
E S Kosukhin

Improving the system of medical rehabilitation in the Armed Forces of the Russian Federation is carried out in accordance with the trends of civilian health care, with an emphasis on the specifics of military medicine. It is stated that medical rehabilitation should be carried out by specialists of the multidisciplinary team - a functional association of medical and non-medical professionals in the course of providing assistance in the field of medical rehabilitation. In the future, the activities of the multidisciplinary team will include the definition of a rehabilitation diagnosis using the international classification of functioning. Changing the nomenclature of specialties will require organizing the training (retraining) of specialists in the specialty «Physical and Rehabilitation Medicine» in educational institutions of the Russian Ministry of Defense.


Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 2146
Author(s):  
Manuel Andrés Vélez-Guerrero ◽  
Mauro Callejas-Cuervo ◽  
Stefano Mazzoleni

Processing and control systems based on artificial intelligence (AI) have progressively improved mobile robotic exoskeletons used in upper-limb motor rehabilitation. This systematic review presents the advances and trends of those technologies. A literature search was performed in Scopus, IEEE Xplore, Web of Science, and PubMed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology with three main inclusion criteria: (a) motor or neuromotor rehabilitation for upper limbs, (b) mobile robotic exoskeletons, and (c) AI. The period under investigation spanned from 2016 to 2020, resulting in 30 articles that met the criteria. The literature showed the use of artificial neural networks (40%), adaptive algorithms (20%), and other mixed AI techniques (40%). Additionally, it was found that in only 16% of the articles, developments focused on neuromotor rehabilitation. The main trend in the research is the development of wearable robotic exoskeletons (53%) and the fusion of data collected from multiple sensors that enrich the training of intelligent algorithms. There is a latent need to develop more reliable systems through clinical validation and improvement of technical characteristics, such as weight/dimensions of devices, in order to have positive impacts on the rehabilitation process and improve the interactions among patients, teams of health professionals, and technology.


Author(s):  
María Jesús Muñoz-Fernández ◽  
Esther M. Medrano-Sánchez ◽  
Beatriz Ostos-Díaz ◽  
Rocío Martín-Valero ◽  
Carmen Suárez-Serrano ◽  
...  

Selective sentinel lymph node biopsy (SLNB) represents a minimally invasive surgery in patients with breast cancer. The purpose of this study was to explore the possible effect of an early physiotherapy intervention for the recovery of the upper limb and the surgical scars after SLNB in comparison with usual care. A total of 40 patients were enrolled in either the control group (n = 20) or the experimental group (n = 20). The intervention group performed an early physiotherapy program based on functional exercises, scar manual therapy, and educational tips. The control group received usual care. Shoulder range of motion (ROM), grip strength, upper limb pain and disability (SPADI), scar recovery (POSAS), myofascial adhesions (MAP-BC), quality of life (EORTCQLA-BR-23) and the presence of axillary web syndrome (AWS) and lymphoedema were assessed at baseline and immediately after intervention. A follow-up period of 6 months was performed for lymphoedema surveillance. Between groups significant differences in favor of the intervention were found for ROM (r = 0.43), grip strength (r = 0.32), SPADI (d = 0.45), POSAS (d = 1.28), MAP-BC (d = 1.82) and EORTCQLQ-BR 23 general function subscale (d = 0.37) (p < 0.05 for all variables). Our results suggest that an early physical therapy program seems to be more effective than usual care in women after SLNB. However, results should be interpreted with caution and future randomized trial with a larger sample size is needed.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 838.2-838
Author(s):  
L. Marchenkova ◽  
V. Vasileva

Background:There is a high prevalence of osteoporosis (OP) among patients of the older age undergoing rehabilitation. Therefore, it is obvious that physicians working in the field of physical and rehabilitative medicine should be well oriented in this medical problem.Objectives:to study the relevance of the problem of osteoporosis (OP) for physicians working in the field of physical and rehabilitation medicine, their awareness of the main methods of diagnosis, treatment and prevention of this disease, as well as the frequency of their use in daily clinical activities.Methods:A cross-type study was carried out using a questionnaire survey. The study included 157 doctors (M-34, F-123) of 8 medical specialties working in 27 specialized medical institutions on the profile of “medical rehabilitation. The questionnaire for doctors consisted of 21 items of special questions.Results:90.45% of the surveyed doctors believed that the problem of OP is relevant for their clinical activities, 100% of the respondents indicated that the presence of OP significantly affects the rehabilitation prognosis and 95.54% - on the degree of effectiveness of medical rehabilitation. According to the respondents, patients with OP make up on average 30.0% [20.0; 50.0] (0-90) of the total flow of patients. 92.36% (145/157) of doctors indicated that they know the risk factors for OP, 98.73% (155/157) - methods for diagnosing OP, 68.79% (108/157) - methods for treating OP, 80.25 % (126/157) - methods of preventing OP, 47.13% (74/157) - what is FRAX. However, 35.01% (55/157) of the respondents considered their level of awareness of the problem sufficient for managing patients with OP. Diagnostic procedures for OP are recommended by all endocrinologists (100%) and the majority of traumatologists (72.73%), gynecologists (66.67) and cardiologists (64.28%), as well as on average half (50%) neurologists and therapists. Endocrinologists (100%), gynecologists (66.67%) and therapists (60%) are mainly involved in the treatment of OP. 32.48% (51/157) of physicians have ever referred their patients to a bone mineral density assessment.Conclusion:Conclusion. The problem of OP is relevant for the clinical activities of specialists in physical and rehabilitation medicine, and there is the need for advanced training on the problem of OP among these specialists.Disclosure of Interests:None declared.


2020 ◽  
Vol 47 (4) ◽  
pp. 427-434
Author(s):  
Mohammed S. El-Tamawy ◽  
Moshera H. Darwish ◽  
Saly H. Elkholy ◽  
Engy BadrEldin S. Moustafa ◽  
Shimaa T. Abulkassem ◽  
...  

BACKGROUND: Cortical reorganization between both cerebral hemispheres plays an important role in regaining the affected upper extremity motor function post-stroke. OBJECTIVES: The purpose of the current study was to investigate the recommended number of contra-lesion low frequency repetitive transcranial magnetic stimulation (LF-rTMS) sessions that could enhance cortical reorganization post-stroke. METHODS: Forty patients with right hemiparetic subacute ischemic stroke with an age range between 50–65 yrs were randomly assigned into two equal groups: control (GA) and study (GB) groups. Both groups were treated with a selected physical therapy program for the upper limb. Sham and real contra-lesion LF-rTMS was conducted for both groups daily for two consecutive weeks. Sequential changes of cortical excitability were calculated by the end of each session. RESULTS: The significant enhancement in the cortical excitability was observed at the fourth session in favor of the study group (GB). Sequential rate of change in cortical excitability was significant for the first eight sessions. From the ninth session onwards, no difference could be detected between groups. CONCLUSION: The pattern of recovery after stroke is extensive and not all factors could be controlled. Application of LF-rTMS in conjugation with a selected physical therapy program for the upper limb from four to eight sessions seems to be efficient.


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