Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial

Background Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups. Methods This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over. Discussion RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy. Trial registration This study is registered as NCT03719859 at ClincialTrials.gov.

RECOMMENDATIONS FOR THE POSITIONING AND THE ESTHETICO-FUNCTIONAL REHABILITATION OF THE RIZIFORM MAXILLARY LATERAL INCISORS

In this article, we aimed to elaborate a universal clinical multidisciplinary protocol in order to facilitate the management of the peg-shaped maxillary lateral incisors, via a case of two upper lateral incisors affected by microdontia. A meticulous clinical analysis, wax up and mock up are crucial to ensure optimal rehabilitation.

Analysis of the scoliosis onset mechanisms for children and optimal rehabilitation interventions through aquatic activities

It is known, certainly, that it is much easier to form a correct attitude than to correct the vicious one, a reason that must determine the approach of prophylactic means of physical therapy and therapeutic swimming. The identification, at an early stage, of the etiological factors responsible for the installation of postural deficiencies, is a determining factor in the management of programs for their maintenance or recovery in children of prepubertal age. The study took place at the Constantinescu Mihai Physiotherapy Office of Suceava and at the Cornișa Botoșani Swimming Complex. It is known that the correct position is formed from childhood, and movement and exercise are the main factors of its construction. In this sense, the paper proposes kinetic recovery and therapeutic swimming programs in order to strengthen the postural status in children during growth and development. In this regard, we have set the following objectives: identification of children with vicious postural attitudes because of the overloads in the prepubertal period and analysis of the scoliosis mechanisms in children of prepubertal age on a vulnerable somato-functional status. Keywords: therapeutic swimming, evaluation, scoliosis, children, analysis,

Aspects of Complex Physical Therapy in Rehabilitation of Patients with Non-Specific Back Pain

Back pain is one of the most common problems encountered by doctors of various specialties-from pediatricians and internists to sports doctors who work with professional athletes. Neck and back pain can occur regardless of age and fitness level. Aim. Creation of the optimal rehabilitation algorithm for the treatment of patients with back pain. Material and methods. 249 patients with confirmed nonspecific back pain were examined, who were divided into five groups for rehabilitation using various methods: physiotherapy exercises, mechanotherapy, K. Lewit manual therapy, postural training, divided into subgroups depending on the phasic and tonic muscles functional state and a group of complex rehabilitation. All patients were examined according to the diagnostic, rehabilitation and diagnostic algorithm developed by the authors with multilevel functional muscle testing. Subsequently, the analysis of the effectiveness of the proposed methods was carried out depending on the musculoskeletal system state. Result. A rehabilitation algorithm has been developed, with the help of which a personalized rehabilitation program is formed depending on the individual characteristics identified during the diagnostic examination. The main causes of nonspecific back pain were identified and methods for their correction were developed. Conclusion. The use of the proposed rehabilitation and diagnostic algorithm simplifies the identification of the causes of pain and allows you to choose the most effective rehabilitation technique.

A Cortico- Basal Ganglia Model for choosing an optimal rehabilitation strategy in Hemiparetic Stroke

To facilitate the selection of an optimal therapy for a stroke patient with upper extremity hemiparesis, we propose a cortico-basal ganglia model capable of performing reaching tasks under normal and stroke conditions. The model contains two hemispherical systems, each organized into an outer sensory-motor cortical loop and an inner basal ganglia (BG) loop, controlling their respective hands. The model is trained to simulate two therapeutic approaches: the constraint induced movement therapy (CIMT) in which the intact is arrested, and Bimanual Reaching in which the movements of the intact arm are found to aid the affected arm. Which of these apparently mutually conflicting approaches is right for a given patient? Based on our study on the effect of lesion size on arm performance, we hypothesize that the choice of the therapy depends on the lesion size. Whereas bimanual reaching is more suitable for smaller lesion size, CIMT is preferred in case of larger lesion sizes. By virtue of the model’s ability to capture the experimental results effectively, we believe that it can serve as a benchmark for the development and testing of various rehabilitation strategies for stroke.

Beyond therapists: Technology-aided physical MS rehabilitation delivery

In the last decade, rehabilitation technology has been developed, investigated, and entered specialized clinical settings. In this chapter, we first discuss the potential of rehabilitation technology to support the achievement of key factors in motor recovery, such as delivering massed practice with good movement quality but also question task-specificity and cognitive motor control mechanisms. Second, we discuss available technology-supported rehabilitation methods for improving gait, balance and fitness, and upper limb function. Finally, we discuss considerations in relation to the professional workforce in order to deliver optimal rehabilitation.

WRIST REHABILITATION WITH MANIPULATOR TO PERFORM PASSIVE AND ACTIVE EXERCISES

The paper characterizes basic dysfunctions and diseases of a human wrist as well as describes the mechanics and pathomorphology of the human hand. The radial-carpal joint was analyzed in terms of his ranges of motion. The results of the analysis, i.e. the number of degrees of freedom for a free hand, are included. The concept of manipulator construction for optimal rehabilitation of the wrist was developed. Expected effects of the exercises, which can be implemented on the designed manipulator, were also described. A comparative analysis of other appliances supporting the rehabilitation of the human upper limb were presented. The main purpose of the designed manipulator was to gain full control of implementation of exercises performed by the patient and to archive and precisely track the progress in the rehabilitation. An important feature of the designed manipulator is its versatility enabling its use for: exercises of both hands (left and right) with the repetitive movements, choose of exercises (active and passive movements), choose of the degree of disability of the patient.