Current issues of disability and rehabilitation of elderly and senile patients with lower limb loss due to vascular pathology

Большинство пациентов с ампутационным дефектом нижних конечностей являются гражданами пожилого возраста с высокой ко- и полиморбидностью, наличием нескольких гериатрических синдромов, что неблагоприятно влияет на прогноз, снижает реабилитационный потенциал, в ряде случаев приводит к развитию сердечно-сосудистых осложнений, ампутации второй конечности, тяжелой инвалидизации и высокой послеоперационной летальности. Ключевым звеном процесса реабилитации инвалидов с культей нижней конечности является обеспечение их функциональным протезом. В статье приведен анализ заболеваемости, первичной инвалидности в период 2015-2019 гг., гендерных, возрастных и клинических характеристик пациентов, проживающих в Санкт-Петербурге, которым выполнена ампутация нижней конечности вследствие сосудистой патологии. Установлено, что отсутствует информация о выживаемости пациентов после проведения ампутации в различные сроки постгоспитального периода в Санкт-Петербурге. Выявлен выраженный дисбаланс между количеством выполняемых ампутаций нижних конечностей ежегодно и количеством обращений инвалидов в бюро медико-социальной экспертизы для обеспечения техническими средствами реабилитации и направлением на первичное протезирование, реабилитацию. The majority of patients with amputation defect of the lower extremities are elderly citizens with high co- and polymorbidity, the presence of several geriatric syndromes, which adversely affects the prognosis, reduces the rehabilitation potential, in some cases leads to the development of cardiovascular complications, amputation of the second limb, severe disability and high postoperative mortality. The key link in the rehabilitation process of disabled people with a lower limb stump is to provide them with a functional prosthesis. The article provides an analysis of morbidity, primary disability in the period from 2015 to 2019, gender, age and clinical characteristics of patients living in St. Petersburg who underwent amputation of the lower limb due to obliterating artery diseases is presented. It was found that there is no information on the survival rate of patients after amputation at various times of the post-hospital period in St. Petersburg. We have identified a pronounced imbalance between the number of lower limb amputations performed and the number of applications of disabled people to the bureau of medical and social expertise for providing technical means of rehabilitation and referral to primary prosthetics.

Team-based rehabilitation after traumatic brain injury: a qualitative synthesis of evidence of experiences of the rehabilitation process

Objective: To synthesize and explore experiences of the rehabilitation process for adults with traumatic brain injury receiving team-based rehabilitation. Data sources: A qualitative evidence synthesis was conducted according to the "Enhancing transparency in reporting the synthesis of qualitative research" (ENTREQ) Guidelines, of qualitative studies published in 5 databases in 2000–21. Study selection and data extraction: Screening, selection of relevant studies, assessment of methodological limitations, systematic qualitative content analysis and assessment of confidence with GRADE-CERQual [AQ5] were carried out by independent researchers. Data synthesis: The 10 included studies revealed how people with traumatic brain injury perceived that they struggled on their own for a long time to adapt their daily life. They experienced that access to team-based rehabilitation was scarce and that the interventions offered were neither individually tailored nor coordinated. A respectful attitude from professionals and individually adapted information facilitated their rehabilitation process. Conclusion: This qualitative evidence synthesis indicates areas for improvement and a need to develop person-centred team-based rehabilitation for adults with traumatic brain injury, in terms of accessibility, coordination, continuity, content and participation. Given the limited opportunities for team-based rehabilitation after hospital discharge, further research is needed to understand how rehabilitation can support the adaptation of daily activities.

Assessment of the Transfer of Trace Metals to Spontaneous Plants on Abandoned Pyrrhotite Mine: Potential Application for Phytostabilization of Phosphate Wastes

The abandoned Kettara pyrrhotite mine (Marrakech region, Morocco) is a real source of acid mine drainage (AMD) and heavy metal pollution from previous mining operations—which has spread, particularly because of wind erosion. A store-and-release cover system made of phosphate wastes was built on the site for preventing AMD. To ensure the integrity of this cover and its durability, it is desirable to revegetate it (phytostabilization) with plants adapted to the edaphoclimatic conditions of the region. In this paper, a study was carried out on the spontaneous vegetation around the phosphate cover in order to consider the selection of plants to promote the stabilization of the Kettara mine tailings pond. Nine species of native plants with their rhizospheric soils growing in agricultural soils and tailings from the Kettara mine were collected, and metals (As, Cd, Co, Cu, Pb, Zn, Ni, Cr) were analyzed. The soil analysis showed that the tailings contained high concentrations of Cu (177.64 mg/kg) and Pb (116.80 mg/kg) and that the agricultural soil contained high concentrations of As (25.07 mg/kg) and Cu (251.96 mg/kg) exceeding the toxicity level (Cu > 100 mg/kg, Pb > 100 mg/kg, As > 20 mg/kg). The plant analysis showed low trace metal accumulation in Scolymus hispanicus, Festuca ovina, Cleome brachycarpa, Carlina involucrata and Peganum harmala. These species had a bioconcentration factor (BCF) greater than 1 and a translocation factor (TF) less than 1, demonstrating a high tolerance to trace metals. Therefore, they are good candidates for use in the phytoremediation of the Kettara mine tailings. These species could also potentially be used for the phytostabilization of the phosphate waste cover of the Kettara mine, thus completing the rehabilitation process of this area.

Physiotherapists perceived role in managing anxiety in patients with relapsing-remitting multiple sclerosis: a mixed-methods study

Background Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. Methods A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.

Lonkan tekonivelleikkauksen jälkeinen fysioterapeuttinen ohjaus fysioterapeuttien kuvaamana

Lonkan tekonivelleikkausten sekä leikkauksen jälkeistä fysioterapiaa tarvitsevien määrä kasvaa väestön ikääntyessä. Kuntoutumisen kannalta fysioterapeuttinen ohjaus on tärkeää. Tämän tutkimuksen tarkoituksena oli tarkastella fysioterapeuttien käsityksiä lonkan tekonivelleikkauksen jälkeisestä fysioterapeuttisesta ohjauksesta. Laadullisen tutkimuksen aineistona oli fysioterapeuttisten ohjaustilanteiden (n=7) kuvanauhojen pohjalta tehdyt recall-haastattelut. Aineiston fenomenografisessa analyysissä muodostettiin kolme hierarkkista kuvauskategoriaa, jotka olivat suppeammasta laajempaan: asiantuntijalähtöinen fysioterapeuttinen ohjaus, potilaan yksilöllisyyttä arvostava fysioterapeuttinen ohjaus sekä fysioterapeuttinen ohjaus osana potilaan kuntoutumista. Nämä kategoriat sisälsivät kuusi ohjaustilanteita kuvaavaa teemaa ja niiden variaatiot: potilaan osallistuminen, kehollinen ohjaus, eettisyys ohjaussuhteessa, fysioterapeutin asiantuntijuus, yhteistyö ja terveydenhuoltojärjestelmän eettisyys. Fysioterapeuttisen ohjauksen onnistumisen kannalta kriittiset tekijät fysioterapeuttien ohjauskäsityksissä olivat potilaskeskeisyys, moniammatillinen yhteistyö ja kuntoutumisprosessin jatkuvuus. Abstract Physiotherapists’ perceptions of patient counseling after total hip arthroplasty (THA) The number of total hip arthroplasties is growing due to the fact that THA is a cost-effective procedure moving people quickly from poor to good functional capacity. The aim of the qualitative study was to explore physiotherapists’ perceptions of post-operative patient counseling. The data of this study consisted of seven physiotherapy situations with inpatients in hospital setting. Data were collected by open recall-interviews based on videotapes of patient counseling situations. The data were analyzed according to phenomenographic approach, which revealed three hierarchical categories: therapist-centered patient counseling, patient counseling which values patient’ individuality and patient counseling as part of individual rehabilitation process. Six themes that varied hierarchically in three categories describing different ways of understanding patient counseling were found: patients’ active participation, counseling for movement awareness, ethical counseling relationship, physiotherapy expertise, cooperation, and ethicality of national health care system. The critical variation between categories manifested as patient-centeredness, multiprofessional cooperation and the continuity of rehabilitation process.

The Effect of the COVID-19 Pandemic on International Stock Exchanges

It is possible to define the concept of risk in various ways. Risk is the deviation possibility of the realized value from the expected value. It has two components, nonsystematic risk and systematic risk. Despite this, pandemics are risk factors that cannot be anticipated. They have deeply affected economies and financial markets under every condition. The importance of the detection of the COVID-19 pandemic comes from the selection of monetary and fiscal policies to be applied by governments during the rehabilitation process of economies. Equity share markets provide important information regarding the future of a company or economy. The reason for this is that the current value of an equity share is dependent on the deducted calculation of the cash flows of the equity share to be provided in the future. The actual price of the equity share is determined according to supply and demand under market conditions.

Gamification in Stroke Rehabilitation

Stroke rehabilitation aims to improve patients' abilities to realize daily life activities and, consequently, regain their self-confidence and improve independence and quality of life. Gamification can be defined as the application of game-design elements, dynamics, and principles such as competition, narratives, point-scoring, and awards in non-game contexts, including rehabilitation. It has emerged as a therapeutic alternative or complement to traditional rehabilitation to make motor practice more intense and increase a person's motivation, interest, and satisfaction by bringing meaningful and intrinsically motivational playful experiences. Compared to the same amount of conventional therapy, gamification can increase the number of movements and involve safe and intensive rehabilitation exercises, essential for a successful rehabilitation process.

Image Segmentation for Review of Cerebral Apoplexy

Brain computed tomography (CT) provides a medical imaging tool for reviewing cerebral apoplexy. It is of strong clinical significance to study the key techniques for lesion segmentation and feature selection of cerebral apoplexy. Most of the previous research fail to fully utilized the other prior information, or apply to the changing feature analysis on multiple lesion images generated in the rehabilitation process. Therefore, this paper aims to develop an image segmentation method for review of cerebral apoplexy. Based on the correlation between image series, the authors proposed a segmentation method for CT images of cerebral apoplexy, and developed a way to extract and select the changing lesion features, which assists with the diagnosis of cerebral apoplexy rehabilitation. The image segmentation and feature selection results were obtained through experiments, revealing the effectiveness of our method.

Models of injury and practical tips for using imagery in rehabilitation

Athletes’ reactions to injuries are varied and involve not only physical, but also mental responses. The perception of injury and individual diff erences can infl uence the results of rehabilitation. This article presents four models that show these relationships. Special attention is paid to the diffi culties faced by athletes when returning to sp Imagery is a mental training technique recommended in the rehabilitation process. Correct application of this method is thought to be important in recovery. There are several main factors that are considered to aff ect the eff ectiveness of imagery training. Real examples of the use of the technique by injured athletes are useful for understanding what to pay attention to. Our purpose is to show that imagery training can help in an injury situation. ort after injury.

Availability of Special Education Related Services and Incentives for Children with Special Needs in Government Special Education Centres in Punjab: A Survey of Parental Perception

Parents' involvement in the rehabilitation process is very important. Parental views about the availability of related services and incentives are the significant indicators of their required particular needs. The aims of the present study were to evaluate the level of available related services and incentives in special education centers and to highlight their specific and suggestions for improvement of these services for students of four disabilities studying in these centers. A survey was conducted from 2019 to 2020 to collect data about demographic characteristics and information about related services and incentives provided to these special students from their parents and also their suggestions to improve these services. The sample consisted of 36 government special education centers at the Tehsil level, from which 479 questionnaires, filled by the parents of students, were received back. The results emphasized the low education and income of the parents, increasing incidence of disability in the families of special children, lack of available services and incentives in these centers, and acknowledged parental suggestions and recommendations. It was concluded from the survey that future planning of provisions of related services and incentives might be more helpful and effective if based on the requirements and preferences conveyed by parents of special students with four disabilities.