scholarly journals Effect of Goal Directed Physiotherapy vs a Goal Directed Home Program in AtRisk Infants: A Randomized Clinical Trial

2021 ◽  
Vol 4 (3) ◽  

Background: Goal directed physiotherapy is a task oriented therapy based on neurodevelopmental principles used in rehabilitation process. The aim of this study is to compare the neurodevelopmental effects of early goal directed physiotherapy with a detailed goal directed home program in infants with risk. Methods: Forty at-risk infants (18 male, 22 female, median age 5.69 mo) were assigned to early goal directed physiotherapy and detailed goal directed home program group randomely. Both early goal directed physiotherapy and detailed goal directed home program continued for 12 weeks. The outcome measures were Hammersmith Infant Neurological Examination, Alberta Infant Motor Scale and Goal Attainment Scale. Results: Significant difference was found in Hammersmith Infant Neurological Examination in early goal directed physiotherapy group (p<0.05) whereas no difference was found in Alberta Infant Motor Scale and Goal Attainment Scale between the groups (p>0.05). In all test results the effect size of early goal directed physiotherapy was more than detailed goal directed home program. Conclusions: According to our results, though Hammersmith Infant Neurological Examination results are better in the early goal directed physiotherapy group, it can be concluded that if parents had good, attainable and eligible guidelines received from the physiotherapist, detailed goal directed home program is also a useful approach in rehabilitation programs of infants with risk.

2021 ◽  
Vol 28 (3) ◽  
pp. 1-11
Author(s):  
Ehab Georgy

Background/aims Stroke early supported discharge services were introduced to provide a comprehensive stroke specialist therapy input, while reducing cost of acute care. Early supported discharge services resulted in better health-related outcomes. A consensus has not yet been established regarding specific early supported discharge patient characteristics and clinical profile. The main aim of this study was to establish evidence to support the development of an early supported discharge patient profile (demographics and clinical) and eligibility criteria to enable early supported discharge services achieve their purposes of reducing post-stroke disability and institutionalisation rates. This article outlines the relationship between early supported discharge patients' clinical profiles and clinical outcomes, in terms of disability, goal attainment and institutionalisation rates. Methods A retrospective review of data was implemented to determine whether specific early supported discharge patients' clinical profiles and characteristics correlate with clinical outcomes. Data were collected for patients admitted to the Suffolk Stroke Early Supported Discharge Service between August and October 2016, comprising patients' demographics and clinical profiles, including stroke type, Barthel Index and Modified Rankin Scale. Performance data were collected at the end of the early supported discharge service including therapy frequency and intensity, as well as clinical outcomes including the Goal Attainment Scale. Results Data were collected for 53 patients. Data were analysed for all patients in three groups: goals not achieved; goals achieved; and goals achieved to a higher level), according to the Goal Attainment Scale. A Chi-square test showed no significant difference with regard to sex and stroke side (P=0.27). Analysis of variance revealed no significant difference in age. Conversely, results showed a significant association between goal attainment and the stroke subtype, severity and length of hospital stay. Conclusions Specific clinical characteristics and disease profiles correlate with functional outcomes and could influence goal attainment and functional status. A specific patient cohort seems to benefit the most from early supported discharge services in terms of optimised functional outcomes and recovery.


2019 ◽  
Vol 34 (1) ◽  
pp. 51-60
Author(s):  
Amanda Claire Wallace ◽  
Penelope Talelli ◽  
Lucinda Crook ◽  
Duncan Austin ◽  
Rachel Farrell ◽  
...  

Background. OnabotulinumtoxinA injections improve upper-limb spasticity after stroke, but their effect on arm function remains uncertain. Objective. To determine whether a single treatment with onabotulinumtoxinA injections combined with upper-limb physiotherapy improves grasp release compared with physiotherapy alone after stroke. Methods. A total of 28 patients, at least 1 month poststroke, were randomized to receive either onabotulinumtoxinA or placebo injections to the affected upper limb followed by standardized upper-limb physiotherapy (10 sessions over 4 weeks). The primary outcome was time to release grasp during a functionally relevant standardized task. Secondary outcomes included measures of wrist and finger spasticity and strength using a customized servomotor, clinical assessments of stiffness (modified Ashworth Scale), arm function (Action Research Arm Test [ARAT], Nine Hole Peg Test), arm use (Arm Measure of Activity), Goal Attainment Scale, and quality of life (EQ5D). Results. There was no significant difference between treatment groups in grasp release time 5 weeks post injection (placebo median = 3.0 s, treatment median = 2.0 s; t(24) = 1.20; P = .24; treatment effect = −0.44, 95% CI = −1.19 to 0.31). None of the secondary measures passed significance after correcting for multiple comparisons. Both groups achieved their treatment goals (placebo = 65%; treatment = 71%), and made improvements on the ARAT (placebo +3, treatment +5) and in active wrist extension (placebo +9°, treatment +11°). Conclusions. In this group of stroke patients with mild to moderate spastic hemiparesis, a single treatment with onabotulinumtoxinA did not augment the improvements seen in grasp release time after a standardized upper-limb physiotherapy program.


Kuntoutus ◽  
2020 ◽  
Vol 43 (1) ◽  
pp. 7-21
Author(s):  
Maarit Karhula ◽  
Tuija Heiskanen

Kelan järjestämien tuki- ja liikuntaelinsairaus (tules) -kuntoutuskurssien toteutusta ja toimivuutta, asiakaslähtöisyyttä ja kuntoutujan roolia sekä kuntoutuksen vaikutuksia kuntoutujan arkeen tarkasteltiin Kelan MUUTOS-hankkeen tules-kuntoutuksen tutkimuksessa. Tässä artikkelissa syvennetään tutkimuksen yhtä keskeistä teemaa, kuntoutuksen ja kuntoutumisen tavoitteiden asettamista ja tavoitteen saavuttamista tukevaa kuntoutus- ja kuntoutumisprosessia. Artikkelin tavoitteena on kuvata, millaisia tavoitteita tules-kuntoutuksessa on, miten tavoitteet ohjaavat kuntoutusta ja kuntoutumista sekä miten hyvin tavoitteet saavutettiin kuntoutuksen aikana. Monimenetelmällisen tutkimuksen aineistoina olivat kuntoutujille ja palveluntuottajille suunnatut kyselyt, kuntoutujien ja palveluntuottajien ryhmähaastattelut sekä kuntoutujien Omat tavoitteeni -lomakkeet. Kuntoutujien kyselyyn vastasi 1839 kuntoutujaa, joista laitosmuotoiseen kuntoutukseen oli osallistunut 1441 kuntoutujaa ja avomuotoiseen kuntoutukseen 398 kuntoutujaa. Palveluntuottajien kyselyyn vastasi 26 palveluntuottajaa. Kuntoutujien ja palveluntuottajien ryhmähaastatteluja toteutettiin molempia 10. Kuntoutujien omat tavoitteet -lomakkeita analysoitiin 75, ja niissä oli yhteensä 161 tavoitetta. Määrälliset ja laadulliset aineistot analysoitiin ensin erikseen ja tämän jälkeen teemoittain yhdistettiin ja luotiin monimenetelmällisen aineiston perusteella tulkinnat.Tavoitteet painottuvat fyysisen toimintakyvyn edistämiseen, työelämään nivoutuvia tavoitteita asetetaan vähän. Tavoitteet ohjaavat kuntoutuskurssien sisältöjen rakentumista vaihtelevasti. Avomuotoiseen kuntoutukseen osallistuneet kuntoutujat saavuttivat tavoitteensa keskimäärin hieman heikommin (T-lukuarvo 46) kuin laitosmuotoiseen kuntoutukseen osallistujat (T-lukuarvo 49). Tavoitteet koetaan tärkeäksi osaksi kuntoutusprosessia. Kuntoutujien omien tavoitteiden tulisi kuitenkin ohjata nykyistä selkeämmin kuntoutujien toimintaa koko kuntoutusprosessin ajan. Tavoitteiden työelämäyhteyttä tulisi vahvistaa, jotta kuntoutujien tavoitteet kiinnittyisivät vahvemmin työelämään ja tules-kuntoutuskurssit tukisivat työkykyä nykyistä enemmän. AbstractDo client’s own goals guide MDSs rehabilitation process?The multi-perspective information on the implementation of Kela (the Social Insurance Institution of Finland)-provided musculoskeletal disorders (MSDs) rehabilitation courses, the client’s role in the rehabilitation, and the effects of rehabilitation on the person’s everyday life were produced in the MSDs rehabilitation study. This article deepens one theme of the study, the goals of the rehabilitation and the rehabilitation process, which support achieving the goals. The aim of the article is to describe what kind of goals MDSs rehabilitation exist, how goals guide rehabilitation, and how goals were achieved during rehabilitation. The study applied mixed methods and a multi-perspective approach. The data included questionnaires and group interviews of rehabilitees and rehabilitation professionals, combined with the rehabilitees’ Goal Attainment Scale (GAS) forms. A total of 1,839 respondents answered the questionnaire for rehabilitees, with 1,441 respondents having taken part in inpatient rehabilitation and 398 in outpatient rehabilitation. The service providers’ questionnaire yielded 26 responses. In addition, ten group interviews were conducted both with rehabilitees, and with service providers. A total of 75 personal goal forms were analysed, presenting 161 goals.Promoting physical functioning was the most frequent goal, only few goals related to work life. There was variation of how the goals of the rehabilitation courses guide the content of the courses. The goals were achieved weaker in the outpatient rehabilitation (t-score 46) than in inpatient rehabilitation (t-score 49). Goal-oriented activities were considered important, but the rehabilitees’ personal goals should better guide their own activities throughout the process. Furthermore, the connection of the rehabilitation to the working life should be strengthened. If the goals are linked more closely to work, they would support working capacity to a greater extent than currently.Keywords: musculoskeletal disorders (MSDs) rehabilitation, Goal Attainment Scale, mixed methods, goals of the rehabilitation


2022 ◽  
Author(s):  
Thiago Falcão Hora ◽  
Agostinho de Alencar Guerra ◽  
Gerson Otmar Kuhne ◽  
Vinícius de Sousa Alvarenga ◽  
Sabrina Fonseca Oliveira ◽  
...  

Abstract Purpose: Botulinum toxin (BTX) is a neurotoxin produced by the bacterium Clostridium botulinum, in recent decades, BTX has become an important adjunct treatment to neurological or rehabilitative strategies.We aimed to describe the clinical aspects of patients admitted to a rehabilitation hospital who were treated with BTX for spasticity and dystonia. Methods: This was a historical cohort; data was collected from the electronic charts of all outpatients treated with BTX between 2014 and 2016 in the spasticity and movement disorders service of a quaternary, open access, rehabilitation hospital. The inclusion criteria were limb spasticity due to traumatic brain injury (TBI), and stroke; limb tremor; cervical dystonia; and generalized limb dystonia from any cause in addition to pain that limits rehabilitation. We used relatively lower doses than those generally published in the literature. Therapeutic response was determined by the Goal attainment scale (GAS), pain (graded by visual analogue scale ), independence for daily living activities, target joint range of motion (pre- and post-application), and gait analysis (only for walkers patients). Results: A total of 63 patients were enrolled in this study with a mean follow-up of 2 years. There was significant improvement in joint restriction ) with 66.7% of patients reporting improvement in the GAS scale, best improvement occurred with ortheses and limb adjustments. Conclusions: Most patients have improved functionality on the GAS scale after treatment with BTX, which is used as an adjunct therapy in subjects already in rehabilitation programs. The main rehabilitation objectives with the GAS scale were achieved in most patients.


2012 ◽  
Vol 42 (2) ◽  
Author(s):  
Anton Budhi Darmawan ◽  
Dwi Utami Anjarwati

Background: Chronic suppurative otitis media (CSOM) is one infectious disease of the middle ear, most commonly caused by Pseudomonas aeruginosa. A high number of patients come to the ENT outpatient clinic with active benign type of CSOM. The bacteria Pseudomonas aeruginosa is capable of producing biofilm which protects itself from penetration of antibiotics, and therefore creates resistance towards antibiotics and difficult to eradicate. Objective: The aim of this study was to compare the sensitivity levels of chloramphenicol, polymyxin-neomycin, cyprofloxacin and ofloxacine against Pseudomonas aeruginosa in patients with active benign type CSOM in ENT clinic. Method: The method used was across sectional study on 25 patients, from August 2010 until December 2010. Samples were taken withear swab and then put on sensitivity test to chloramphenicol, polymyxin-neomycin, cyprofloxacin andofloxacine using the diffusion disc method. The analysis used in this study was Cochran test. Results: Results showed a significant difference in sensitivity among chloramphenicol (38,70%), polymyxinneomycin(83,87%),cyprofloxacin(90,32%)andofloxacin(58,06%)withp=0,000(p<0,05).PostHocanalysisusing the Mc Nemar indicated that there were significant differences in sensitivity betweenpolymyxin-neomycin to chloramphenicol with p=0,000 (p<0,05), ciprofloxacin to chloramphenicol andciprofloxacin to ofloxacine with p= 0,002, but there were no significant differences between cyprofloxacinto polymyxin-neomycin with p=0,687, polymyxin-neomycin to ofloxacin p=0.057 and ofloxacin tochloramphenicol p=0,109.   There were significant differences in antibiotic ear dropssensitivity to Pseudomonas aeruginosa in patients with active benign type of CSOM. Cyprofloxacin andpolymyxin-neomycin were more sensitive than ofloxacin and chloramphenicol. Keywords: Pseudomonas aeruginosa, active benign type of chronic suppurative otitis media, antibioticear drops.  Abstrak :  Latar belakang: Otitis media supuratif kronik (OMSK) merupakan penyakit infeksi kronik telinga tengah yang sering dijumpai di klinik THT. Penyebab tersering OMSK adalah bakteri Pseudomonasaeruginosa. Pseudomonas aeruginosa mempunyai kemampuan untuk membentuk biofilm yangmelindunginya dari penetrasi antibiotik sehingga menimbulkan resistensi terhadap antibiotik dan sulituntuk eradikasinya. Tujuan: Untuk mengetahui perbandingan tingkat sensitivitas kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin terhadap isolat Pseudomonas aeruginosa padapasien OMSK benigna aktif di klinik THT RSMS. Metode: Metode yang digunakan adalah crosssectional terhadap 29 pasien OMSK di klinik THT RSMS periode bulan Agustus 2010 - Desember2010. Pengambilan sampel dilakukan dengan swab telinga. Uji sensitivitas terhadap kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin dilakukan dengan metode cakram secara difusi.Analisis yang digunakan dalam penelitian ini adalah Cochran dan analisis post hoc. Hasil: Didapatkansensitivitas kloramfenikol sebesar 38,70%, polimiksin-neomisin sebesar 83,87%, ciprofloksasin sebesar90,32% dan ofloksasin sebesar 58,06% dengan p=0,01 (P<0,05), yang menunjukkan adanya perbedaansensitivitas yang bermakna antara kloramfenikol, polimiksin-neomisin, ciprofloksasin dan ofloksasinterhadap Pseudomonas aeruginosa. Analisis post hoc menggunakan Mc Nemar menunjukkan bahwaterdapat perbedaan sensitivitas yang bermakna antara tetes telinga polimiksin-neomisin terhadapkloramfenikol, dan ciprofloksasin terhadap kloramfenikol p=0,000 (p<0,05), serta terdapat perbedaanyang bermakna antara tetes telinga ciprofloksasin terhadap ofloksasin, p=0,002, tetapi tidak terdapatperbedaan yang bermakna antara ciprofloksasin terhadap polimiksin-neomisin, p=0,687, polimiksinneomisinterhadap ofloksasin p=0,057, dan kloramfenikol terhadap ofloksasin p=0,109. Kesimpulan:Terdapat perbedaan sensitivitas yang bermakna tetes telinga antibiotik terhadap Pseudomonas aeruginosa pada pasien OMSK benigna aktif. Ciprofloksasin dan polimiksin-neomisin tetes telinga mempunyai sensitivitas yang lebih baik dibanding ofloksasin dan kloramfenikol. Kata kunci: Pseudomonas aeruginosa, otitis media supuratif kronik, tetes telinga antibiotik 


2019 ◽  
pp. 84-92
Author(s):  
Anh Chi Phan ◽  
Xuan Anh Ngoc Ho

Background: The condylar position discrepancy between centric relation and maximal intercuspation has been still a controversial issue. Aims: To compare the condylar position between centric relation and maximal intercuspation using cone-beam tomography in patients without temporomandibular joints disorder. Materials and methods: To assess the condylar position in centric relation and maximal intercuspation using cone-beam tomography on 40 fifth-year and sixth-year dental students of Hue University of Medicine and Pharmacy without temporomandibular joints disorder. The condylar positions are assessed following Sener classification (2009) and are compared between centric relation and maximal intercuspation using pairedsamples t-test and Mann-Whitney U-test. Results: Among 480 condye-to-fossa measurement pairs, there are 91.2% pairs having difference between two reference position but there is no significant difference. The condylar position at the superior of mandibular fossa has the greatest percentage in both centric relation and maximal intercuspation (43.8% in centric relation and 51.2% in maximal intercuspation). This greatest percentage is followed by the condylar position at posterior of mandibular fossa (32.5% in centric relation and 36.3% in maximal intercuspation). Lastly, the condylar position at the anterior of mandibular fossa has the fewest percentage (23.7% in centric relation and 12.5% in maximal intercuspation). Conclusion: There is no significant difference of condylar position between centric relation and maximal intercuspation in patients without temporomandibular joints disorder. Key words: Condylar position, centric relation, maximal intercuspation, cone-beam tomography


Author(s):  
H Eyigor ◽  
E A Cetinkaya ◽  
D T Coban ◽  
G Ozturk ◽  
Ö Erdem

Abstract Objective External dacryocystorhinostomy is thought to cause mucociliary dysfunction by damaging the mucosa, in turn affecting ciliary activity and mucus quality. This study investigated the effect of external dacryocystorhinostomy on sinonasal function. Methods Patients scheduled for unilateral external dacryocystorhinostomy who underwent endoscopic nasal examination and paranasal sinus computed tomography were included in this study. A saccharine test was performed on the planned surgical side and the mucociliary clearance time was determined. The sinonasal quality of life was measured in all patients, pre-operatively and at six months post-operatively, using the Sino-Nasal Outcome Test-22. The Lund–Kennedy endoscopic score was also determined in all patients, both pre- and post-operatively. Results The study comprised 28 patients (22 females and 6 males). A statistically significant difference was found between the pre- and post-operative saccharine test results (p = 0.006), but not between the pre- and post-operative Sino-Nasal Outcome Test-22 scores (p > 0.05). Conclusion This study is one of only a few to investigate the effect of external dacryocystorhinostomy on sinonasal function. The results showed that external dacryocystorhinostomy impairs mucociliary clearance. The surgical procedure is well tolerated and does not significantly change nasal symptom scores.


2021 ◽  
Vol 11 (8) ◽  
pp. 687
Author(s):  
Valentina Varalta ◽  
Paola Poiese ◽  
Serena Recchia ◽  
Barbara Montagnana ◽  
Cristina Fonte ◽  
...  

Background: Parkinson’s disease (PD) is characterized by motor and cognitive dysfunctions that can usually be treated by physiotherapy or cognitive training, respectively. The effects of consecutive physiotherapy and cognitive rehabilitation programs on PD deficits are less investigated. Objective: We investigated the effects of 3 months of physiotherapy (physiotherapy treatment group) or consecutive physiotherapy and cognitive (physiotherapy and cognitive treatment group) rehabilitation programs on cognitive, motor, and psychological aspects in 20 PD patients. Methods: The two groups switched programs and continued rehabilitation for another 3 months. The outcomes were score improvement on cognitive (Montreal Cognitive Assessment, Frontal Assessment Battery, Trail Making Test, Verbal Phonemic Fluency, Digit Span, and Rey Auditory Verbal Learning), motor (Unified Parkinson’s Disease Rating Scale-III, Berg Balance Scale, Two-Minute Walking Test, and Time Up and Go), and psychological (Beck Depression Inventory and State-Trait Anxiety Inventory) scales. Results: Between-group comparison revealed a significant difference in functional mobility between the two rehabilitation programs. Improvements in walking abilities were noted after both interventions, but only the patients treated with consecutive training showed better performance on functional mobility and memory tasks. Conclusion: Our findings support the hypothesis that consecutive physiotherapy plus cognitive rehabilitation may have a greater benefit than physiotherapy alone in patients with PD.


1995 ◽  
Vol 13 (2) ◽  
pp. 127-140 ◽  
Author(s):  
Richard Jupe ◽  
Donald K. Shipley ◽  
William Z. Hudson ◽  
Joseph T. Wanna ◽  
Linda C. Greear

Two bolts of cotton duck fabric that meet military specifications and the purchasing guidelines described by the National Institute of Standards and Technology (NIST) for use as a substrate in "Test Methods for Quantifying the Propensity of Cigarettes to Ignite Soft Furnishings" were tested with smoldering cigarettes to determine the effect of inter-bolt variations on cigarette ignition propensity test outcome. The test was designed around an ASTM method that calls for the control of all known test variables, except for those inherent to the fabric's manufacture. The ignitability of each fabric was determined by testing two sets of 48 replications for each of two experimental cigarettes. The two bolts of cotton duck fabric showed a statistically significant difference in ignitions, independent of environmental and experimental fac tors. Two additional bolts of cotton duck #4 were analyzed. Cigarette ignition test results and the physical parameters of the additional bolts offer evidence that the NIST specifications are difficult to meet and further that test results are extremely sensitive to fabric properties.


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