Effects of a Verbal Intervention for Head and Neck Posture on Lumbar Lordosis Angles in Healthy Young and Older Adults: a Preliminary Study

Background Postural rehabilitation plays an important role in the treatment of non-specific low back pain. Although pelvic inclination has been widely used to improve lumbar lordosis, the effect of cervical anterior inclination on lumbar lordosis in young and older adults, in sitting and standing posture is still unclear. This preliminary study was designed to examine the influence of changing the cervical anterior angle on the lumbar lordosis angle, through alterations of the head position under the natural sitting and standing conditions, aiming to provide a basis for establishing a new postural rehabilitation strategy.Methods Thirty-eight older (68.4 ± 5.9 years old) and 36 young (24.0 ± 2.2 years old) healthy adults participated in this study. The four spinal regional angles - cervical anterior angle, thoracic kyphosis angle, lumbar lordosis angle, and pelvic foreword inclination angle were measured in standing and relaxed sitting postures to determine the effects of a postural cueing, “inclining head backward and performing chin tuck”, for the head and neck posture on lumbar lordosis angle.Results In the standing posture, the pelvic foreword inclination angle in the older group was significantly smaller (P <0.001) than that in the young group, and increased significantly (P <0.001) post the postural cueing. In addition, the thoracic kyphosis angle in the standing (P = 0.001) and sitting (P = 0.003) positions was significantly reduced post the postural cueing. However, the lumbar lordosis angle post postural cueing increased significantly in both the standing position (P <0.001) and sitting position (P <0.001).Conclusion The results suggest that increasing the cervical anterior angle can indeed increase the lumbar lordosis angle, and the cervical anterior inclination can be used as an alternative to pelvic foreward inclination to improve the lumbar lordosis angle. Furthermore, the change of head and neck posture can reduce the thoracic kyphosis angle, making it possible to establish a new non-invasive body posture rehabilitation strategy.(approval number TJUS2019032)

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.

More Conservative Rehabilitation Strategy within Postoperative 6 Month for All-Inside Reconstruction Compared with Anatomical Reconstruction of Anterior Cruciate Ligament may be able to Achieve Better Stability: Based on the Study of Graft Maturity

Background: Individualized rehabilitation based on graft maturity is necessary to optimize patient function and prevent graft re-injury. But there is a lack of studies on graft maturity in the all-inside single-bundle anterior cruciate ligament reconstruction.Hypothesis/Purpose: Compared to the difference in graft maturity, functional scores, and stability between all-inside and anatomical single-bundle anterior cruciate ligament reconstruction, it was assumed that the stability of all-inside reconstruction is relatively insufficient, and its graft maturity is worse than the anatomical reconstruction.Study Design: Randomized controlled clinical trial.Methods: Fifty-four patients were recruited in this study and randomly assigned to the all-inside reconstruction group (n = 27) and the anatomical reconstruction group (n = 27) using the same rehabilitation strategy. The Tegner, International Knee Documentation Committee, and Lysholm score were recorded at postoperative 3rd, 6th, and 12th month to assess functional recovery. Magnetic resonance imaging was conducted to measure the Signal/Noise quotient (SNQ) of the intra-articular graft to observe the maturity. Stability was assessed using GNRB relaxation measuring instrument at the postoperative 12th month.Results: The graft SNQ of the all-inside group was significantly higher than that in the anatomical group during the postoperative 6th month (p < 0.05). There was no statistical difference in graft SNQ between the two groups at postoperative 3rd and 12th month (p > 0.05). Both groups exhibited the graft’s highest SNQ in the middle region, followed by the proximal region, and the lowest was the distal region. Functional scores improved significantly in both groups and had no statistical difference (p > 0.05). The stability recovered well in both groups during the postoperative 12th month, but the GNRB relaxation was higher in the all-inside group (p < 0.05). There was no correlation between functional scores and graft maturity in the two groups (p > 0.05).Conclusions: All-inside reconstruction graft maturity is inferior to the anatomical reconstruction during postoperative 6th month, which may cause relatively insufficient stability of all-inside reconstruction compared with anatomical reconstruction under the same rehabilitation strategy. A more conservative rehabilitation strategy for all-inside reconstruction around the postoperative 6th month may achieve better stability.

Ischaemic Lumbosacral Plexopathy after Embolization of Type 2 Endoleak -- Progress and Functional Outcome

An endoleak is a complication that can occur after an endovascular aneurysm repair. We report a rare case of ischemic lumbosacral plexopathy post embolization of type 2 endoleak, including its presentation, neurological progress, rehabilitation strategy and functional outcome.

Incorporating Species-Conditional Co-Occurrence When Selecting Indicator Species to Monitor Restoration after Mangrove Removal from the Siangshan Wetland, Taiwan

This paper presents an approach for incorporating species-conditional co-occurrence into models used for the selection of marine indicator species. Mangrove invasion within the Siangshan Wetland in Hsinchu, Taiwan, has changed the original structures and functions of habitats for benthic organisms. The Hsinchu City Government ran a large-scale mangrove removal project from October 2015 to March 2016 to restore the wetland. From October 2015 to September 2016, we investigated the biological effects of mangrove removal on benthic crabs and their adjacent habitats. Density, number of species, Shannon–Weaver index (H′) and Palou’s evenness index (J′) were calculated and compared between mangrove and non-mangrove regions. The results showed that values for these attributes in the non-mangrove regions were higher than those of the mangrove regions. After mangrove removal, species returned to their original habitats and the related density increased significantly. Using conditional co-occurrence algorithms, we identified five indicator species (Mictyris brevidactylus, Macrophthalmus banzai, Uca arcuata, Uca lacteal and Uca borealis) with high co-occurrence probabilities, whose population responses provided direct evidence of the benefits of mangrove removal for wetland restoration. The results indicate that mangrove removal is an appropriate habitat rehabilitation strategy for benthic organisms, and that the chosen indicator species may provide valuable ecological information for coastal managers seeking to control the spread of mangroves.

COVID-19 recovery: benefits of multidisciplinary respiratory rehabilitation

Many patients struggle with ongoing symptoms in different domains (physical, mental, cognitive) after hospitalisation for COVID-19, calling out for a multidisciplinary approach. An outpatient multidisciplinary rehabilitation programme, according to a respiratory rehabilitation strategy, was set up for adult patients who were able to attend group sessions during 12 weeks. Results of 22 adult patients with COVID-19, of which 15 had required intensive care, were analysed and some general impressions and challenges of rehabilitation in COVID-19 were reported. Impressive results on physical recovery were determined after 6 weeks and 3 months, with significant improvement of lung function, muscle force and exercise capacity variables. A positive evolution of mental and cognitive burden was present, although less pronounced than the physical recovery. These mental and cognitive consequences seem, next to musculoskeletal and medical complications, the most challenging aspect of rehabilitating patients with COVID-19. These real-world data show feasibility and efficiency of a multidisciplinary respiratory rehabilitation programme after moderate to severe COVID-19 disease.

Social Acceptability of the Bioremediation Technology for the Rehabilitation of an Abandoned Mined-Out Area in Mogpog, Marinduque, Philippines

Rehabilitation of mined-out areas poses great challenge because nutrients are depleted and conditions are not conducive for the conditions necessary for the growth and survival of plants. Proper combination of mycorrhizal fungi, nitrogen-fixing bacteria, compost, and lime to support the growth of trees in the poor soil has been discovered by the University of the Philippines Los Baños National Institute of Microbiology and Biotechnology. Having established a protocol using this formulation, a plant survival rate of 95% was achieved in a bioremediation project implemented by the Institute in a mined-out area in Capayang, Mogpog, Marinduque, Philippines. The social acceptance and adoption of this rehabilitation strategy was determined through a survey interview in the study area with the use of questionnaire. Six factors and nine variables were considered in the assessment. The bioremediation technology was acceptable to the community as indicated by the high percentage of respondents who gave an overall positive response (90%) and who were willing to adopt and recommend it for implementation in other mined-out areas (90%). Binary logistic regression showed that income and distance of residence from the rehabilitation site significantly influenced the respondents’ decision to accept the technology. Future bioremediation initiatives should also consider the participation and acceptance of stakeholders to ensure sustainability. Indigenous and endemic planting materials should be used in rehabiliation.

Conservative rehabilitation for a patient presenting with severe orthostatic hypotension after surgical management of brainstem tumor: illustrative case

BACKGROUND Blood pressure (BP) dysregulation is frequently observed in patients after surgical management of brainstem lesions; however, there has been no standard rehabilitation. Considering the conflicting risks for hypoperfusion and disuse syndrome in these patients, a safe and effective rehabilitative strategy is warranted. OBSERVATIONS A 50-year-old man who had undergone craniotomy for resection of a recurrent dorsal medullary epidermoid cyst developed persistent orthostatic hypotension. It was resistant to physical exercise, pharmacological therapy, abdominal binders, and compression stockings; therefore, it inhibited postoperative rehabilitation. Although the responsible lesion was not clearly visible on the postoperative image, accompanying symptoms, including segmental sensory impairment, implied an improvement in BP control. Although there was a trade-off between the risk of developing disuse syndrome and a delay in functional recovery, the authors decided to continue a conservative rehabilitation strategy rather than increasing the workload. The patient’s BP control was gradually restored by the seventh postoperative week, and the authors proceeded with basic activity training. LESSONS A conservative prognostic prediction-based rehabilitation strategy was applied in this case. The precise evaluation of the accompanying neurological symptoms was helpful in deciding the treatment regimen. The conflicting risks for hypoperfusion and disuse syndrome in such cases must be considered.