Upper Limb Home-Based Robotic Rehabilitation During COVID-19 Outbreak

The coronavirus disease (COVID-19) outbreak requires rapid reshaping of rehabilitation services to include patients recovering from severe COVID-19 with post-intensive care syndromes, which results in physical deconditioning and cognitive impairments, patients with comorbid conditions, and other patients requiring physical therapy during the outbreak with no or limited access to hospital and rehabilitation centers. Considering the access barriers to quality rehabilitation settings and services imposed by social distancing and stay-at-home orders, these patients can be benefited from providing access to affordable and good quality care through home-based rehabilitation. The success of such treatment will depend highly on the intensity of the therapy and effort invested by the patient. Monitoring patients' compliance and designing a home-based rehabilitation that can mentally engage them are the critical elements in home-based therapy's success. Hence, we study the state-of-the-art telerehabilitation frameworks and robotic devices, and comment about a hybrid model that can use existing telerehabilitation framework and home-based robotic devices for treatment and simultaneously assess patient's progress remotely. Second, we comment on the patients' social support and engagement, which is critical for the success of telerehabilitation service. As the therapists are not physically present to guide the patients, we also discuss the adaptability requirement of home-based telerehabilitation. Finally, we suggest that the reformed rehabilitation services should consider both home-based solutions for enhancing the activities of daily living and an on-demand ambulatory rehabilitation unit for extensive training where we can monitor both cognitive and motor performance of the patients remotely.

Patient’s satisfaction with a lower limb prosthesis: a longitudinal study

ABSTRACT This is a descriptive longitudinal study that aimed to verify prosthesis satisfaction of older adults with lower-limb amputation (LLA). In total, This study was composed of 34 older adults with LLA participated of this study. Participant’s satisfaction about the lower-limb prosthesis (LLP), the discomforts, and the embarrassment when use it were evaluated through an interview composed of five questions. The occurrence of falls and the independence in prosthesis management were also evaluated. All variables were collected at the last week of ambulatory rehabilitation discharge and after one and three months. A descriptive and inferential statistical analysis was performed. The level of significance was set at 5% (p <0.05). In total, 80% of participants with transtibial amputation and 78.6% of participants with transfemoral amputation were satisfied with the LLP after three months. Tight prosthesis, walking pain, the embarrassment of using LLP, and the occurrence of falls decreased over time. The independence in prosthesis handling did not change significantly after three months. Participants that used manual locking knee (p=0.040) and/or Solid-Ankle Cushion Heel foot (p=0.017) were more satisfied with LLP. The occurrence of falls reduced (p=0.039) after transfemoral participants started to use the prosthesis. Participant’s satisfaction with the LLP was high and did not change significantly over time.

The impact of SARS-CoV-2 on the accessibility of multidisciplinary diagnostics of neurodevelopmental disorders in Flanders, Belgium

Background Neurodevelopmental disorders start in early childhood and may restrict personal, scholastic, social and professional development and functioning. Early detection and smooth trajectories of diagnostics, rehabilitation and support affect the child's development and opportunities. A specialized multidisciplinary team must do a diagnostic evaluation. While accessibility to multidisciplinary diagnostics for all children in Flanders (Belgium) is problematic in regular times, the lockdown measures taken by the end of March 2020 in response to the SARS-CoV-2 pandemic could amplify this problem. This article aims to explore the impact of lockdown policy measures on the accessibility of multidisciplinary diagnostics of developmental disorders.Methods This “rapid response” study was commissioned by the Flemish authorities, as a follow up of a broader study on accessibility of multidisciplinary diagnostics. A questionnaire with open-ended questions was sent out to respondents of three key types of facilities: the Centers for Ambulatory Rehabilitation, Autism Reference Centers and Centers for Developmental Disorders. Qualitative data were thematically analyzed in an iterative process by researcher triangulation.Results Measures taken in response to the SARS-CoV-2 pandemic negatively impacted on waiting periods which lengthened with at least three months and even longer for certain target groups. Specific guidelines to minimize the risk of virus contamination, impact on planning, time management and the quality of the diagnostic assessments. Respondents reported them as being time consuming, uncomfortable, with an increasing workload and leading to a reduction in the number of daily diagnostic activities. Suggested catching-up strategies were increase of public funding, a less rigid application of regulations and a complete or partial assignment stop.Conclusion The SARS-CoV-2 pandemic reinforced the existing problem of accessibility because of a general shortage of diagnostic capacity. On a shorter term accessibility problems can be tempered by providing “bridging care” during waiting periods. On the longer term, strengthening regional interorganisational collaboration is required, to enhance more efficient and effective diagnostic trajectories in facilities providing adapted services to the needs of the children.

O impacto das fraturas do quadril no SUS 2008 - 2017: O papel do ortopedista

Objective The present study intends to describe the profile of hospitalization and ambulatory rehabilitation of patients ≥ 50 years old due to hip fracture in the Brazilian Public Health System (SUS, in the Portuguese acronym). Methods This is a cross-sectional study of patients hospitalized due to hip fracture in the SUS between 2008 and 2017. Data included 441,787 hip fracture-related hospitalizations from the hospitalization database of the department of informatics of the Brazilian Unified Health System (SIH/DATASUS, in the Portuguese acronym), and data of patients who underwent rehabilitation from the ambulatory database of the department of informatics of the Brazilian Unified Health System (SIA/DATASUS, in the Portuguese acronym.). Results Most of hip fracture-related hospitalizations (83.5%) happen to people ≥ 50 years old, with an average annual growth of 5.6% in hip fracture-related hospitalizations. The costs for the government have been growing in the same proportion and reached almost BRL 130 million in 2017, although with a 13.6% decrease in average cost per hospitalization. Besides the financial impact, hip fractures result in an in-hospital mortality rate around 5.0% in patients aged ≥ 50 years old. In addition, the percentage of patients that have undergone hip fracture-related rehabilitation increased from 2008 (14.0%) to 2012 (40.0%), and remained stable after that. Conclusions The progressive increase in the incidence of hip fractures shows the financial and social impact, and the need for immediate actions to prevent this rising trend. Hip fractures are a risk for secondary fractures, the prevention is crucial, and the orthopedist plays a central role in this process.

Cardiovascular rehabilitation in Romania

Cardiovascular rehabilitation (CR) is part of cardiovascular prevention and the objectives are the improvement of functional capacity, control of cardiovascular risk factors, adoption of a healthy lifestyle, education and adherence to the recommended therapies, aiming the reduction of the risk of adverse events, disability, cardiovascular mortality and the increase in quality of life. In Romania, CR is delivered only in a in hospital basis, at 2nd phase of rehabilitation in patients, in five dedicated centers that have the necessary equipment and a multidisciplinary team, but an insufficient number of beds compared to a great number of patients with an indication for rehabilitation. Issues related to addressability, adherence, incomplete legislation regarding ambulatory rehabilitation, and lack of recognition of CR as a part of cardiology or internal medicine are still unsolved.

Evaluation of comprehensive ambulatory rehabilitation of people over 60 years of age

Introduction. The provision of adequate health care for a successively growing group of geriatric patients requires taking into account many factors in order to preserve and/or improve their overall health and the related functional capacity. Its crucial aspects include the ability to safely change position and locomotion, as well as the severity of discomfort from the osteoarticular system. Aim. The objective of the present study was to assess the impact of comprehensive ambulatory rehabilitation including tailored endurance training, preceded by an ergospirometry test, on indicators showing the risk of falls and the severity of pain symptoms of patients aged 60 and over, receiving health services at the Outpatient Healthcare Home (DDOM). Material and methods. The study involved 60 seniors during their rehabilitation cycle implemented as part of the services provided to patients at DDOM of the W. Chodźko Institute of Rural Health in Lublin. The tests were carried out in the test-retest model on the first and last day of the kinesiotherapy cycle. The Tinetti scale of the risk of falls, balance and walk and Visual Analogue Scale of the severity of pain sensations (VAS) were utilized in the research. The patient rehabilitation program at the DDOM included adapted systemic kinesiotherapy (endurance training with a load determined according to individual exercise capacity, as determined on the basis of the ergospirometry test) and local kinesiotherapy as well as physical therapy adapted to the needs resulting from the condition of the musculoskeletal system. Results. After completing the rehabilitation cycle, the patients obtained higher scores, compared to the tests carried out before the beginning of the rehabilitation cycle, in the scales of Tinetti Questionnaire. There were also lower results of the respondents in VAS scale used to assess the severity of pain sensations. Conclusions. As a result of the rehabilitation program applied, DDOM patients simultaneously obtained the desired changes in minimizing the risk of falls, improving the ability to maintain balance and fitness while walking, as well as reducing the severity of pain sensation.