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Operationsverfahren sowie Liegezeiten und Altersgrenzen haben sich in den letzten Jahren bei hüftendoprothetischer Versorgung geändert. Während sich Krankenhäuser immer mehr spezialisieren und Patienten teilweise bereits nach 3–4 Tagen in die Anschlussrehabilitation entlassen, muss die nachversorgende Rehabilitationsklinik einen differenzierten Behandlungspfad vorhalten, um den unterschiedlichen Anforderungen und Bedürfnissen zwischen Fast-Track-Chirurgie und Orthogeriatrie gerecht zu werden.

Statement of problem Whether oral rehabilitation with dental implants in patients with Down syndrome leads to an increased complication rate is unclear. Purpose The purpose of this systematic review was to determine the effectiveness of dental implants placed in patients with Down syndrome and whether the condition is a risk factor or contraindication for dental implant placement. Material and methods Searches were conducted in 6 databases, including the non–peer-reviewed literature, up to February 2021 by 2 independent reviewers according to established inclusion and exclusion criteria to answer this question: Is Down syndrome a risk factor or contraindication for oral rehabilitation with dental implants? Results A total of 655 studies were initially found in the databases. Five were included in this systematic review, all of which were observational studies. A total of 50 patients with 186 implants were evaluated, with a reported effectiveness of 79.1%. The risk of bias assessment determined that 3 of the 5 studies had a high risk of bias. Conclusions Treatment with dental implants in patients with Down syndrome is a suitable option, but more complications are to be expected than with patients without this condition. Controlled studies with better methodological design and less risk of bias should be developed to improve the scientific evidence for the treatment of these patients.

Мета дослідження – розробити і обгрунтувати комплексну методику розвитку витривалості школярів середніх класів засобами велотуризму. Матеріал і методи. В даному дослідженні приймали участь велотуристи 12-13 років Липкуватіської загально–освітньої школи l-lll ступенів (9 спортсменів склали експериментальну групу, 9 – контрольну). Для визначення функціональних можливостей школярів середніх класів застосовувались наступні проби і тести: Гарвардський степ-тест, проба Штанге, проба Генчі, проба Серкіна. Розроблено методику розвитку витривалості, яка передбачає застосовування комплексу засобів велотуризму. Комплекс складається з 2-х частин: комплексна дистанція «тріал і фігурне водіння велосипеда» і велопохід. Тріал являє собою дистанцію довжиною 100-200 м. з природними та штучними перешкодами (крутий схил; яр; піщані; заболочені та інші важкопрохідні дільниці; струмки; калюжі; стовбури дерев, що лежать, тощо) по вузькому коридору (до 1,5м), утвореному природними і штучними обмеженнями (стрічки між деревами або стійками тощо). Фігурне водіння велосипеда передбачає застосування наступних перешкод: «Щілина», «Змійка між стійками», «Коридор», «Колія», «Коло», «Вісімка», «Ворота», «Кільце», «Перенесення предмету», «Зигзаг», «Гойдалка», «Змійка між фішками», «Стоп-лінія. Фініш». Особливістю походу є те, що окрем розвитку витривалості, він вирішував завдання виховного та освтнього характеру шляхом ознайомлення з цікавими місцями Слобожанщини, зустрічами з цікавими людьми тощо. Результати. Показано, що авторська методика комплексного розвитку витривалості, що поєднує засоби фігурного вождіння та велопоходу, є більш ефективною у порівнянні з традиційною методикою розвитку витривалості школярів середніх класів, яка містить виключно подолання дистанцій; виявлено, що застосування комплексної методики розвитку витривалості школярів середніх класів сприяє підвищенню часу затримки дихання за пробами Штанге, Генчі, Серкіна, а також зменшенню ЧСС спокою, ЧСС після стандартного навантаження та підвищенню якості відновлення працездатності. Висновок. Розроблена методика може застосовуватись в підготовці юних велотуристів.

The purpose of the study is to analyze changes of the cardiopulmonary system indicators of hospitalized patients with respiratory diseases and underwent physical therapy. Materials and methods. The study was performed as a prospective case series study design. The study involved patients hospitalized with pneumonia, exacerbation of COPD and asthma, who had no contraindications to undergoing physical therapy. A total number of patients were 273 persons; 140 of them with pneumonia, 96 persons with exacerbation of COPD, 37 persons with asthma. Conducted surveys, anthropometric studies, clinical tests and instrumental studies. Results. COPD patients with acute exacerbation had a lower level of functional status of the cardio-respiratory system than patients with pneumonia or exacerbation of asthma. We found the lowest rates of excursion of the chest, blood saturation, VC, FEV1, PEF and higher than normal inhale rate. In addition, COPD patients did not experience statistically significant improvement during the assessment period in the majority of the analyzed parameters, except excursion of the chest and inhale rate. Conclusions. Acute exacerbation of COPD has a significant impact on the health of patients and significantly reduces the functional state of the respiratory system. The hospitalization period is not sufficient for full recovery. The rehabilitation of such patients should continue after discharge from the hospital.

A method is described for the verification and correction of a digital scan of a complete-arch implant-supported prosthesis for a completely edentulous patient. The technique provides an efficient way to integrate a highly accurate and precise scan of an implant index cast with a digital intraoral implant scan by using a computer-aided design and computer-aided manufacturing (CAD-CAM) software program. This method allows dental professionals to validate and, if necessary, correct the implant positions in the scan without the need for a conventional impression.

The most suitable elevated vacuum (EV) pressure may differ for each individual prosthesis user depending on suspension needs, socket fit, prosthetic components, and health. Mechanical and physiological effects of EV were evaluated in an effort to determine the optimal vacuum pressure for three individuals.Instrumented EV sockets were created based on the participants' regular EV sockets. Inductive distance sensors were embedded into the wall of the socket at select locations to measure limb movement relative to the socket. Each participant conducted an activity protocol while limb movement, limb fluid volume, and user-reported comfort were measured at various socket vacuum pressure settings.Increased socket vacuum pressure resulted in reduced limb-socket displacement for each participant; however, 81-93% of limb movement was eliminated by a vacuum pressure setting of 12 (approximately -9 inHg). Relative limb-socket displacement by sensor location varied for each participant, suggesting distinct differences related to socket fit or residual limb tissue content. The rate of limb fluid volume change and the change in socket comfort did not consistently differ with socket vacuum pressure, suggesting a more complex relationship unique to each individual.Practitioners may use individual responses to optimize socket vacuum pressure settings, balancing mechanical and physiological effects of EV for improved clinical outcomes.

Background: Despite many publications on rehabilitation after repair of flexor tendon injuries of the hand, there is no consensus as to which method is superior. It is clear that nonadherence to postoperative therapy adversely affects the outcome after flexor tendon surgery. In the context of a developing country, the most important factor associated with poor outcome is late onset of rehabilitation therapy. An autonomous rehabilitation program is proposed, with the use of a low-cost splint and based on an online illustrative video with the expectation to improve adherence and patient compliance, thus ensuring satisfactory outcome. Methods: Twenty-two consecutive digits of 14 patients after flexor tendon repair in zone II were included. Autonomous early passive mobilization physical therapy and splinting started shortly after surgery, supported by an online available video depicting prescribed exercises; follow-up was continued until postoperative week 20. Patients were evaluated regarding range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) disability scale. Results: Range of motion after 20 weeks according to the scoring system of the American Society of Surgery of Hand was excellent in 4, good in 11, and fair in 4 fingers. The mean total active motion score was 86% (95% confidence interval, 78%-93%). The mean grip strength at final follow-up was 86% of the contralateral hand. The mean QuickDASH score was 12.5 (2.3-31.8). Conclusion: This protocol achieves good results in range of motion and early return of function of the hand. We propose this simple, nonexpensive method to developing countries with less than optimal availability of health care.

We report a 69 year old who suffered a cardioembolic ischaemic stroke on 23 September 2019, which resulted in a left hemiplegia with motor impairment in upper and lower extremities that made impossible for her to use the affected arm in daily living activities. The person commenced her comprehensive physiotherapy programme based on functional electrical stimulation (FES) in Fesia Clinic rehabilitation centre in October 2020. A multifield technology-based FES device was used, which allowed to train different selective movements in isolation and combined with mirror therapy, achieving excellent functional outcomes.

Studies investigating the associations between personality and sports-related concussion are limited. The current study aimed to address this gap by examining whether specific personality dimensions predicted self-reported sports-related concussion outcomes.This study included 1141 undergraduate students ( Mage = 19.47, SD = 2.14, female = 64.5%) who completed a battery of online personality measures and self-reported sports-related concussion items. The self-reported sports-related concussion outcomes included a single diagnosed sports-related concussion incident (i.e., "diagnosed sports-related concussion incidence") and incidents of multiple diagnosed sports-related concussions (i.e., "multiple diagnosed sports-related concussion incidents"). Analyses included splitting data randomly into training and validation data sets. Multivariate logistic regression models were then fit to each data set to determine predictors of sports-related concussion.In both training and validation data sets, extraversion and experience seeking were found to be positively and most strongly associated with both sports-related concussion outcomes, whereas motor inhibition was found to be negatively associated with both outcomes. Additional personality dimensions showed differential relations with each sports-related concussion outcome.The current study highlights the importance of considering personality dimensions in the context of self-reported sports-related concussion outcomes, as there are differential relations between personality dimensions and these outcomes. Thus, prevention efforts for sports-related concussion may benefit from evaluating additional athlete factors, like personality traits.

Context The wall-slide exercise is commonly used in clinic and research settings. Theraband positioning variations for hip exercises have been investigated and used, but Theraband positioning variations for upper extremity wall-slide exercises, although not commonly used, have not been examined. Objective To evaluate the effect of different Theraband positions (elbow and wrist) on the activation of the scapular and shoulder muscles in wall-slide exercises and compare these variations with each other and with regular wall-slide exercises for the upper limbs. Design Descriptive laboratory study. Setting University laboratory. Patients or Other Participants A total of 20 participants (age = 23.8 ± 3 years, height = 176.5 ± 8.14 cm, mass = 75.3 ± 12.03 kg, body mass index = 24.23 ± 4.03) with healthy shoulders. Intervention(s) Participants performed wall-slide exercises (regular and 2 variations: Theraband at the elbow and Theraband at the wrist) in randomized order. Main Outcome Measure(s) Surface electromyographic activity of the trapezius (upper trapezius [UT], middle trapezius [MT], and lower trapezius [LT]), infraspinatus, middle deltoid (MD), and serratus anterior (SA) muscles. Results Regular wall-slide exercises elicited low activity in the MD and moderate activity in the SA muscles (32% of maximal voluntary isometric contraction [MVIC] in the SA), whereas the Theraband-at-elbow and Theraband-at-wrist variations elicited low activity in the MT, LT, infraspinatus, and MD muscles and moderate activity in the SA muscle (46% and 34% of MVIC in the SA, respectively). The UT activation was absent to minimal (classified as 0% to 15% of MVIC) in all wall-slide exercise variations. The Theraband-at-wrist variation produced lower UT:MT, UT:LT, and UT:SA levels compared with the regular wall-slide exercise and Theraband-at-elbow variation. Conclusions In shoulder rehabilitation, clinicians desiring to activate the scapular stabilization muscles should consider using the Theraband-at-wrist variation. Those seeking more shoulder-abduction activation and less scapular stabilization should consider using the Theraband-at-elbow variation of the upper extremity wall-slide exercise.

The aim of the study was to determine whether tibiofemoral contact stress predicts risk for worsening knee pain over 84 ms in adults aged 50-79 yrs with or at elevated risk for knee osteoarthritis.Baseline tibiofemoral contact stress was estimated using discrete element analysis. Other baseline measures included weight, height, hip-knee-ankle alignment, Kellgren-Lawrence grade, and Western Ontario and McMaster Universities Osteoarthritis Index pain subscale. Logistic regression models assessed the association between baseline contact stress and 84-mo worsening of Western Ontario and McMaster Universities Osteoarthritis Index pain subscale.Data from the dominant knee (72.6% Kellgren-Lawrence grade 0/1 and 27.4% Kellgren-Lawrence grade ≥ 2) of 208 participants (64.4% female, mean ± SD body mass index = 29.6 ± 5.1 kg/m 2 ) were analyzed. Baseline mean and peak contact stress were 3.3 ± 0.9 and 9.4 ± 4.3 MPa, respectively. Forty-seven knees met the criterion for worsening pain. The highest tertiles in comparison with the lowest tertiles of mean (odds ratio [95% confidence interval] = 2.47 [1.03-5.95], P = 0.04) and peak (2.49 [1.03-5.98], P = 0.04) contact stress were associated with worsening pain at 84 mos, after adjustment for age, sex, race, clinic site, and baseline pain. Post hoc sensitivity analyses including adjustment for body mass index and hip-knee-ankle alignment attenuated the effect.These findings suggest that elevated tibiofemoral contact stress can predict the development of worsening of knee pain.

Objective To investigate the effect of electromyography (EMG)-driven robotic therapy on the recovery of the hand in a stroke case lasting 9 years. Case An 18-year-old patient with hemiparesis due to the ischemic lesion was admitted to our clinic with hand impairment. Fifteen sessions (5 weeks x 3 times) of robotic rehabilitation were applied with the Hand of Hope. Average EMG (mV) of flexor digitorum superficialis (FDS) muscle, average force (N) and the rate of force development (RFD)(N/s) were also assessed before and after the treatment following the 5th and 10th sessions and at the end of treatment. Also, Fugl-Meyer Assessment of Upper Extremity Scale (FMU-UE), Motor Activity Log (MAL), Canadian Occupational Performance Score (COPM) and Visual Analog Scale (VAS) were used for assessment before and after the treatment. Results The average EMG measured from FDS increased from 0.093-0.133 mV. The average force and average RFD increased from 45.6-97.7 and from 135.6-172.6 respectively. While affected and/or unaffected side force ratio increased dramatically from 54%-82%, the FMA-UE score increased from 56-59. The MAL quality of use score increased from 3.93-4.13. Performance and satisfaction scores of COPM changed from 5.25-7.25 and 4.5-8.25 respectively. VAS score for fatigue changed from 6 to 4. Discussion The improvement achieved 9 years later with 15 sessions of rehabilitation suggests that improvement may be possible for chronic stroke patients.

Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients' work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET.First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes.A randomized controlled trial.Forty-nine participants were randomized to the control group (n = 25) or intervention group (n == 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, "Working Hands-ED," delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group.There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P.05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P.05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P.05).The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace.

Background Given the modest functional outcomes seen after surgical reconstruction and subsequent therapy, increasing attention is being directed to patient satisfaction and psychological aspects of recovery after brachial plexus injury (BPI). Purpose To better understand the recovery course after surgical reconstruction for BPI, we used qualitative interviews and focused on common points of frustration for patients. Study Design Qualitative, interpretive description study Methods We conducted semi-structured interviews with BPI patients who were 6+ months post-surgical reconstruction. The interview focused on the patients’ experience with BPI, focusing on emotional aspects of recovery. Interviews were transcribed and independently coded by 2 researchers. We used inductive and deductive analysis to organize codes into themes. Once thematic saturation was reached, no additional interviews were conducted. Results We interviewed 15 BPI patients at median 13 months after surgery (range: 6-43 months). Our analysis revealed: (1) BPI patients expressed variable degrees of participation during recovery, with the indeterminate state of function making it difficult to adjust to life after BPI. (2) The uncertainty while waiting for improved function is frustrating to BPI patients, with many patients expressing concern for activities and moments they are missing due to injury. (3) While many BPI patients feel left out of decision-making, those who felt engaged in the process expressed less frustration and more acceptance of their status. Conclusion Traumatic BPI patients those who felt engaged in decision-making were more receptive to adjustment to their new state of function. When coordinating multidisciplinary care, measures to encourage patients to feel agency over their outcome and to develop self-management skills have the potential to improve patient satisfaction.

Introduction Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Nino Jesus is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. Objective This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. Patients Fifty-three patients aged between three months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. Methods All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. Results Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. Conclusions The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.

Study design Retrospective cohort study Introduction Service members who have sustained traumatic amputations are typically young and otherwise healthy. Beyond standard care, these individuals desire long, highly active, and relatively pain-free lifestyle, whether that is returning to active duty or transitioning to civilian life. Development of overuse musculoskeletal conditions could have a significant influence on quality of life for Service members with traumatic upper limb amputation. Purpose of the study Compare one-year incidence of overuse musculoskeletal injuries in Service members with different levels of combat-related upper limb amputation to Service members with minor combat-related upper limb injuries. Methods Service members with deployment-related upper limb injury (N = 519), 148 major upper limb amputation (55 with amputation at or above elbow, 93 with amputation below elbow) and 371 minor upper limb injury were included in the study. Outcomes of interest clinical diagnosis codes associated with overuse conditions of the upper limb, neck and upper back, lower limb, low back pain, and all regions combined, one year before and one year after injury. Results Overall, the one-year incidence of developing at least one musculoskeletal overuse condition after upper limb amputation was between 60% and 65%. Service members with upper limb amputations were 2.7 to 4.7 times more likely to develop an overuse upper limb condition, 3.6 to 3.8 times more likely to develop a neck and upper back condition, 2.8 to 4.4 times more likely to develop a lower limb condition, and 3.3 to 3.9 times more likely to develop low back pain as compared those who sustained minor combat-related injuries. No significant differences in the odds of developing a musculoskeletal condition was found between the above elbow and below elbow amputation groups. Conclusions Incidence of secondary overuse conditions is elevated in Service members with upper limb amputation and warrants focused research efforts toward preventative and rehabilitative interventions.

Statement of problem Patients with a mandibular defect can develop mandibular deviation, resulting in a loss of or reduction in occlusal contact and ultimately loss of function. The occlusal ramp is a prosthesis used to help restore the masticatory function of such patients and is used particularly in the maxillofacial rehabilitation of patients with masticatory dysfunction resulting from mandibular deviation. The occlusal ramp is usually attached to a mandibular denture or worn as an independent device placed on the palate corresponding to the mandible that produces the offset. However, evidence of the effects of its use is sparse. Purpose The purpose of this clinical study was to investigate the effects of occlusal ramp use in functional rehabilitation. Materials and methods This study included 10 patients who had received mandibulectomies (5 men and 5 women; mean age 76.7 years, range 67 to 90 years) with deviation of the mandible. An occlusal ramp was fabricated for each participant as part of their maxillofacial prosthetic treatment. Masticatory performance was evaluated before and after the treatment by measuring glucose extraction while masticating a piece of gummy jelly. The Wilcoxon signed-rank test was used for statistical analysis (α=.05). Results The median masticatory performance score, represented as glucose concentration (mg/dL), was 82.45 before treatment and 115.45 after treatment, with an overall improvement of 33.00. Scores differed significantly before and after treatment (P=.005). Masticatory performance for each participant improved in the range of 17.7 to 103.3, highlighting the role that the occlusal ramp played in mastication, although with differing effects in each participant. Conclusions Masticatory performance in participants with mandibular deviation after a mandibulectomy was significantly improved with an occlusal ramp. This suggests the effectiveness of using occlusal ramps in maxillofacial prosthetic treatment for the recovery of masticatory function in patients with mandibular deviation.

Background An important focus of rehabilitation is thereturn to the meningful occupations which may include work and school activities. Purpose The aim of this study is to investigate predictive factors for return to work/study in traumatic brachial plexus injury patients undergoing rehabilitation and to investigate the level of satisfaction with treatment. Study Design Retrospective observational study with at least 1 year of follow-up. Methods One hundred and one individuals with traumatic brachial plexus injury enrolled in this study. Primary outcomes were return to work/study and satisfaction with treatment. A secondary outcome was the self-perception of what influenced return to work. Sociodemographic and related to injury data, rehabilitation interventions, muscle strength, and disability were analyzed as predictors. Associations were investigated using univariable and discriminant analysis and considered a level of significance of P Results Return to work/study occurred in 55% of the patients who participated in this study. Muscle strength discerned those who returned to work. Time interval between trauma and surgery and age were lower in those who returned to work. Thirty-one patients answered the question regarding self-perception of what influenced return to work. They indicated “necessity”, “rehabilitation”, “my desire” and “not become depressed”. Satisfaction was graded between 8.9 and 9.5 in 95% of the cases. Conclusions Return to work/study was related to muscle strength improvement and those who returned were younger and had less time elapsed from trauma. Individual factors and rehabilitation were pointed out as helpful in aiding return to work. Satisfaction with treatment was high. These findings can help to optimize goals in the rehabilitation environment.

(Background) Tranexamic acid (TXA) is widely used in hip and knee arthroplasty to reduce perioperative bleeding. Recently, its use has been expanded to arthroscopic surgery. The purpose of this study was to evaluate the efficacy of preoperative use of TXA in arthroscopic rotator cuff repair (RCR).(Methods) A cohort comprising 129 consecutive patients who underwent arthroscopic primary RCR at our institution was retrospectively investigated according to whether they received TXA (April 2018 to December 2020, TXA group, n=64) or did not receive TXA (April 2016 to March 2018, non-TXA group, n=65). TXA was administered at a dose of 1 g intravenously. Rotator cuff tears were repaired by the suture bridge technique. Videos of the arthroscopic procedures were reviewed and rated for visual clarity using a 10-point numeric rating scale. Arthroscopic procedures were divided into glenohumeral, resection of bursal tissue and acromioplasty, and RCR steps. Each step was rated separately. Age, sex, body mass index, hemoglobin level before and on days 1 and 7 after surgery, operating time, mean arterial pressure, tear size, and number of anchors used for cuff repair were compared between the two groups. (Results) There were no statistically significant differences in the patient demographic data. The operating time was significantly shorter in the TXA group than in non-TXA group (97.8 ± 21.8 min vs 116.2 ± 26.0 min). The clarity of the visual field was similar between the two groups during the glenohumeral phase but was significantly higher in the TXA group during the resection of bursal tissue and acromioplasty and RCR phases. Hemoglobin level was not significantly different between the groups on postoperative day 1 but was significantly higher in the TXA group on day 7.(Conclusion) Administration of a single intravenous dose of TXA improved visual clarity in arthroscopic RCR, decreased the total operating time, and reduced hemoglobin loss on postoperative day 7.

Lateral epicondylitis is degenerative tendinosis of the extensor carpi radialis brevis muscle and is the most common work/sports-related chronic musculoskeletal problem affecting the elbow.This study aimed to evaluate the short term and residual effectiveness of the Kinesio taping method on pain, grip force, quality of life, and functionality.Randomized, double-blinded, controlled study.Subjects were 50 patients diagnosed with chronic unilateral lateral epicondylitis with a symptom duration of at least 12 weeks. During the first four weeks, the study group received a true inhibitor Kinesio taping while the control group received sham taping. In both groups, progressive stretching and strengthening exercises were given as a home program for six weeks. The primary outcome measure was the Numerical Rating Scale (NRS) for self-report of pain intensity; secondary outcome measures were Cyriax resistive muscle test evaluation, maximal grip strength, Patient- Rated Tennis Elbow Evaluation (PRTEE), and Short Form-36 (SF-36). After the treatment, patients were evaluated by the first assessor who was blinded to taping types.There was a significant decrease in NRS scores overtime during the first four weeks in both groups (P.001,) and effect sizes were large. There was no significant difference in Cyriax muscle resistance test maximal grip strength between groups (P.05). However, there was a significant improvement in muscle strength of elbow extension and pronation in the study group detected in the intragroup analysis. Intragroup comparisons also showed a significant improvement in all subunits of the PRTEE and SF-36 except energy/vitality, social functioning, and pain in both groups (P.05) with moderate to high effect sizes. PRTEE pain scores were significantly decreased in the study group compared to the placebo group (P.05, d = 0.48).The effects of Kinesio taping on muscle strength, quality of life, and function in chronic lateral epicondylitis are not superior to placebo. However, NRS scores showed that in the two weeks after Kinesio taping treatment, pain reduction persisted as a residual effect which may improve the exercise adherence and functionality.

Background Shoulder pathology can occur concurrently with a distal radius fracture (DRF) but few studies have examined this population. Purpose The purpose of this study was to expand the understanding of the impact of shoulder pathology on individuals with DRF. Study Design: Mixed Methods Design. Methods A total of 45 participants with a DRF were categorized into a DRF only (n = 29) and shoulder pathology concurrent with DRF (SPCDRF) (n = 16) groups. Quantitative data gathered included demographics, Quick Disabilities of the Arm, Shoulder, and Hand, Tampa Scale of Kinesiophobia-11, Visual Analog Scale, and Compensatory Mechanism Checklist. Qualitative interviews were performed with 7 participants in the SPCDRF group. Within group correlations were analyzed via the Spearman Rank. The Mann Whitney U test was used to compare the two groups. Qualitative analysis was performed to describe the experience of participants in the SPCDRF group. A mixed methods analysis compared quantitative and qualitative data. Results Sixteen participants (35.6%) in the sample presented with shoulder pathology; 6 participants (37.5%) presented at initial evaluation due to the fall; 10 participants (62.5%) developed shoulder pathology due to compensation or disuse. Average number of days to develop shoulder pathology after the DRF was 43 days. SPCDRF participants had significantly greater pain levels (p = .02) and more activity avoidance (p = .03) than the DRF only group. Four qualitative themes emerged: It's difficult to perform occupations and changes had to be made; There is fear and uncertainty; The impact of pain; Tried to be normal but could not Mixed methods analysis found that qualitative data further illuminated quantitative findings. Conclusions Individuals with shoulder pathology concurrent with a DRF may present with higher pain levels and avoid activity more. In addition, they may describe fearfulness in using their injured upper extremity especially if they have high levels of pain. Study Design Mixed Methods Design.

Angeborene Fehlbildungen am menschlichen Bewegungsapparat präsentieren sich klinisch ausgesprochen vielfältig und sehr unterschiedlich in ihren motorischen Auswirkungen. Das Wissen um die orthopädietechnischen Versorgungsmöglichkeiten ist unter den verordnenden Ärzten jedoch oft nicht ausreichend.

Summary Background & aims COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. Methods A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutritional treatment; and patients’ functional status (Barthel index) and health-related quality of life (EQ-5D-5L). Results A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27–89.5) days and a median ICU stay of 24.5 (11–43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed medical nutrition therapy. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. Conclusions This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.

Total flap failure is a devastating complication in head and neck reconstruction. This clinical report describes the rehabilitation of an extensive maxillectomy defect communicating with the midface by using a 2-piece magnet-retained orofacial prosthesis fabricated in heat-processed acrylic resin. The innovative design and choice of material allowed early rehabilitation of a patient receiving palliative care at a resource-constrained tertiary care oncology center. Prosthetic treatment served to reduce the period of hospitalization and helped the patient to resocialize.

This clinical report describes the successful prosthetic rehabilitation of a deficient lower lip in an edentulous patient who had undergone surgery for removal of a squamous cell carcinoma of the anterior floor of the mouth and vestibule. The rehabilitation used a combined approach of an extraoral lip prosthesis joined by 3 magnets to an intraoral implant-retained mandibular resection prosthesis. The outcome demonstrated rehabilitation of the lower third of the face by eliminating loss of fluids and by improving the facial profile, lip contour and competence, esthetics, the patient's eating ability, speech intelligibility, and reported quality of life.

Objectives This scoping review was undertaken to synthetize and appraise the literature on the potential mechanisms of action of functional electrical stimulation therapy in combination with task-specific training (FEST + TST) in the rehabilitation following stroke, spinal cord injury, traumatic brain injury, or multiple sclerosis. Materials and methods The literature search was performed using multiple databases (including APA, PsycInfo, Medline, PubMed, EMBASE, CCRCT, and Cochrane Database of Systematic Reviews) from 1946 to June 2020. The literature search used the following terms: (spinal cord injury, paraplegia, tetraplegia, quadriplegia, stroke, multiple sclerosis, traumatic brain injury, or acquired brain injury) AND (functional electrical stimulation or FES). The search included clinical and preclinical studies without limits to language. Results Of the 8209 titles retrieved from the primary search, 57 publications fulfilled the inclusion and exclusion criteria for this scoping review. While most publications were clinical studies (n = 50), there were only seven preclinical studies using animal models. The results of this review suggest that FEST + TST can result in multiple effects on different elements from the muscle to the cerebral cortex. However, most studies were focused on the muscle changes after FEST + TST. Conclusions The results of this scoping review suggest that FEST + TST can result in multiple effects on different elements of the neuromuscular system, while most research studies were focused on the muscle changes after FEST + TST. Despite the efficacy of the FEST + TST in the neurorehabilitation after CNS injury or disease, the results of this review underline an important knowledge gap with regards to the actual mechanism of action of FEST + TST.

Statement of problem Rehabilitation of edentulous patients with severe maxillary atrophy is a clinical challenge. Although several treatment options are available, the implant-supported overdenture has been widely advocated. However vertical insertion implant-supported overdentures have drawbacks, including wear, aging, and the continuous maintenance of retention systems. Whether an implant-supported overdenture with a horizontal insertion pathway can overcome these problems is unclear. Purpose The purpose of this observational study was to determine the clinical and biological behavior of a new type of implant-supported overdenture with a horizontal insertion pathway over a mean clinical follow-up period of 6 years. Material and methods Ten study participants with an atrophic maxilla underwent rehabilitation with horizontal overdentures supported by 6 implants. Follow-up visits were scheduled at 3 months, 6 months, and annually thereafter. The variables analyzed were implant and prosthetic survival, peri-implant tissue behavior, mechanical complications, and patient satisfaction. Results The follow-up period ranged from 5 to 8 years, mean ±standard deviation 6.3 ±1.2 years. A total of 60 implants and 10 horizontal overdentures were placed. The clinical survival of the implants was 98.3% (mean peri-implant bone loss, 1.3 ±0.4 mm) and was 80% of the prostheses. Overall, mean patient satisfaction as assessed with a visual analog scale was 7.4, with 8.5 for esthetics and 9.5 for function. Conclusions The horizontal implant-supported overdenture provided a functional alternative to conventional prostheses.

We report on changes in the ascending reticular activating system (ARAS) concurrent with the recovery of impaired consciousness following rehabilitation and cranioplasty in a patient with traumatic brain injury (TBI), which were demonstrated on diffusion tensor tractography (DTT). A 34-year-old male patient was diagnosed with a traumatic intracerebral hemorrhage after falling from a height of approximately 7 m and underwent a right frontoparietotemporal decompressive craniectomy and hematoma removal. At 5 months after onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 4. Comprehensive rehabilitative therapy was provided until 14 months after onset, and his GCS score improved to 8. Cranioplasty was performed using auto-bone at 14 months after onset. One month after cranioplasty, his GCS score improved to 12. On the 15-month DTT, the deviated lower dorsal ARAS was restored on both sides, and the right side had become thicker. The right lower ventral ARAS was reconstructed, and increased neural connectivity of the upper ARAS was detected in both the prefrontal cortices. Thus, changes in the ARAS were demonstrated in a patient with TBI during recovery of consciousness following rehabilitation and cranioplasty.

An open-label, randomized, controlled, observer-blinded trial.Repetitive facilitative exercise (RFE) is a movement therapy to recover from hemiparesis after stroke. However, improvement is inhibited by spasticity. Recently, botulinum toxin type A (BoNT-A) injection has been shown to reduce spasticity.To examine the combined effect of an RFE program and BoNT-A treatment on upper-limb spastic paresis in chronic stroke.Forty chronic stroke inpatients with upper-limb spastic paresis (Brunnstrom stage ≥III and Modified Ashworth Scale [MAS] score ≥1) were enrolled. Subjects were randomized into 2 groups of 20 each and received 4 weeks of treatment. The intervention group received RFE and BoNT-A injection; the control group underwent RFE only. Assessments were performed at baseline and at study conclusion. The primary outcome was change in Fugl-Meyer Assessment score for the upper extremity (FMA). The Action Research Arm Test (ARAT), active range of motion, Box and Block Test, and MAS were also evaluated.All participants completed this study. After 4 weeks, the intervention group evidenced a significantly greater increase in FMA score (median 11.0 [range 4-20]) than the control group (median 3.0 [range 0-9]) (P.01, r = 0.79); as well as improvements in the other measures such as ARAT (median 12.5 [range 4-22] vs 7 [0-13]) (P.01, r = 0.6), and MAS in the elbow flexors (median -1.5 [range -2 to 0] vs -1 [-2 to 0]) (P.01, r = 0.45).A high degree of repetitive volitional movement induced by the facilitative technique with concomitant control of spasticity by BoNT-A injection might increase efficiency of motor learning with continuous movement of the affected upper-limb.The combination of RFE and BoNT-A for spastic paresis might be more effective than RFE alone to improve upper-limb motor function and to lessen impairment in chronic stroke.

Resumen La encefalopatia traumatica cronica (ETC) es una enfermedad neurodegenerativa que afecta a personas que han padecido traumatismos craneales repetitivos. No obstante, tambien durante el seguimiento de los pacientes con traumatismo craneoencefalico (TCE) unico se pueden observar cambios respecto de su situacion previa. Presentamos cuatro casos clinicos de pacientes visitados en la consulta externa del Instituto Guttmann entre 2017 y 2019, afectos de secuelas leves de TCE grave y unico que han desarrollado posteriormente una enfermedad neurodegenerativa sin un diagnostico concreto y que pudiesen cumplir criterios clinicos de sindrome de encefalopatia traumatica cronica. Los medicos rehabilitadores son los profesionales con mayor posibilidad de identificar estos pacientes, indicando las exploraciones complementarias necesarias y estableciendo nuevos objetivos de rehabilitacion.

Background Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing. Purpose To review the diagnostic accuracy of examination tests used in LET. Design Systematic review following PRISMA-DTA guidelines. Methods We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET. Results Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with “unclear” or “high risk” of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%). Conclusions Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies. Systematic review registration PROSPERO ID CRD42020160402

Double-blind randomized controlled trial.Carpal tunnel syndrome (CTS) is a common mononeuropathy that causes pain and disability in the affected hand. Kinesio taping (KT) has been recently proposed as a promising conservative approach in CTS patients.To investigate the effectiveness of KT compared to a sham taping on symptoms and hand function in patients affected by mild CTS.Patients affected by mild CTS with symptoms for at least 8 weeks were enrolled and randomly allocated into two groups: KT group, according to the technique proposed by Kase plus specific exercises; control group, undergoing a sham taping plus specific exercise. All patients performed 2 sessions/week for 5 weeks of exercises of mobilization of fingers and carpal joint. At the baseline, after 5 weeks (T1), and after 6 months (T2), a physician unaware of patients' allocation assessed the Boston Carpal Tunnel Questionnaire (BCTQ) symptom (BCTQ-S) and functional (BCTQ-F) subscales.Forty-two patients (mean age:54.3 ± 15.0 y) were randomly allocated into KT (n = 21) and control group (n = 21). At T1, in both groups we found a significant improvement in hand function and symptoms, as showed by BCTQ-F (KT:4.2 ± 0.7 vs 3.0 ± 0.6, P.001; sham: 2.2 ± 0.3 vs 1.7 ± 0.3, P = .012) and by BCTQ-S (KT: 2.2 ± 0.3 vs 1.7 ± 0.3, P.001; sham: 2.3 ± 0.4 vs 1.9 ± 0.5, P = .007). At T2, only in the KT group there was a significant difference in both sub-items of primary outcome. There were significantly better results in the KT group at T1 and T2.The present study showed that KT compared to a sham taping might be more effective in reducing perceived symptoms in mild CTS patients, reporting a clinically significant difference.KT might be considered as an effective technique combined to rehabilitative treatment in terms of hand function and symptoms in patients affected by mild CTS.

Purpose This study aimed to explore the differences in muscle activity, handwriting legibility, and consistency when using the 4 primary handwriting grip styles: dynamic quadrupod (DQ), dynamic tripod, lateral quadrupod (LQ) and lateral tripod. Study Design and Methods Thirty-four 18-22-year-old participants completed a handwriting legibility test on paper as well as consistency and metrics tests using both surface electromyography and a digital writing tablet. Electromyography was used to measure the activity of 6 muscles associated with handwriting, and the tablet measured stroke duration, length, velocity, and pen pressure. Subjects used each grip style with all protocols and scores were normalized to their native grip. Significance was set at P Results Females had a lower range in legibility scores than males by 3.5% ± 1.7% (p = .046, d = 0.713), but grip style did not impact legibility. The upper trapezius (UT) was more active in the lateral tripod and LQ grips compared to DQ by 16.8% ± 5.2% and by 13.8% ± 5.2%, (p = .007, p = .012, respectively, partial η2 = 0.188). The stroke duration was greater in the LQ grip style than dynamic tripod and DQ grip styles (p = .008, p = .023, respectively; partial η2 = 0.123). Conclusions Lateral grip styles involve more whole-arm, stabilizing movements while dynamic grip styles require fine dexterous movements. Furthermore, females are likely to be able to employ any grip with minimal effect on legibility. For a patient needing guidance in rehabilitation, understanding the differences in grips could aid selection of the optimum grip style to employ based on their muscular control deficits.

Study design Interpretive description study. Purpose In management of patients with flexion tendon injuries, passive, control active and active motion protocols were proposed after repair to minimize tendon adhesion. The purpose of this study was to compare the excursion distance and the tension of Flexor Digitorum Profundus (FDP) during simulated active and passive motion using ultrasonography techniques using normal subjects. Methods Ultrasonographic assessment of FDP tendon of the middle finger was performed at the wrist level on 20 healthy college students using 3 types of treatment protocols: modified Kleinert protocol, modified Duran protocol, and active finger flexion protocol. The excursion distance was measured following the musculotendinous junction of FDP using the B mode ultrasound system. The elasticity of FDP tendon was measured using the shear wave elastography technique. The excursion distance and the elasticity value were compared among 3 protocols using one-way ANOVA analysis. Results Twelve male and 8 female students with mean age of 22.6 ± 1.8 years were invited to join the study. The excursion distance of FDP was 21.82 ± 3.77 mm using the active finger flexion protocol, 8.59 ± 2.59 mm using the modified Duran protocol, and 12.26 ± 2.71 mm using the modified Kleinert protocol. The elasticity was significantly higher in extension position when compared to passive flexion positions, but found lower than active flexion position. Discussion The active finger protocol was found to require strongest tension of the tendon and with longest excursion. There was similar tension generated using both passive motion protocols. The modified Duran protocol appeared to create less excursion upon movements than the modified Kleinert approach using the objective ultrasonic evaluation. It is suggested that if the surgical repair was strong and without any complications, the active flexion protocol might work best to regain tension excursion. However, if there are complex problems involved, then the Kleinert approach or Duran approach would be chosen.

Background:The Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions scale (USER-P-R) is a promising patient-reported outcome measure, but has currently not been validated in a hospital-based stroke population. Objective:To examine psychometric properties of the USER-P-R in a hospital-based stroke population 3 months after stroke onset. Methods:Cross-sectional study including 359 individuals with stroke recruited through 6 Dutch hospitals. The USER-P-R, EuroQol 5-dimensional 5-level questionnaire (EQ-5D-5 L), Patient Reported Outcomes Measurement Information System 10-Question Global Health Short Form (PROMIS-10), modified Rankin Scale (mRS) and two items on perceived decrease in health and activities post-stroke were administered in a telephone interview 3 months after stroke. The internal consistency, distribution, floor/ceiling effects, convergent validity and discriminant ability of the USER-P-R were calculated. Results:Of all participants, 96.9% were living at home and 50.9% experienced no or minimal disabilities (mRS 0-1). The USER-P-R showed high internal consistency (alpha = 0.90) and a non-normal left-skewed distribution with a ceiling effect (21.4% maximum scores). A substantial proportion of participants with minimal disabilities (mRS 1) experienced restrictions on USER-P-R items (range 11.9-48.5%). The USER-P-R correlated strongly with the EQ-5D-5 L, PROMIS-10 and mRS. The USER-P-R showed excellent discriminant ability in more severely affected individuals with stroke, whereas its discriminant ability in less affected individuals was moderate. Conclusions:The USER-P-R shows good measurement properties and provides additional patient-reported information, proving its usefulness as an instrument to evaluate participation after 3 months in a hospital-based stroke population.

Resumen Objetivo Caracterizacion de una muestra de pacientes hospitalizados por complicaciones de la infeccion COVID-19 con atencion a potenciales determinantes pronosticos de su evolucion e impacto del tratamiento rehabilitador en el desempeno funcional, motor y respiratorio. Metodo Estudio descriptivo, retrospectivo, longitudinal de una cohorte de pacientes ingresados con diagnostico de COVID-19 que requirieron tratamiento rehabilitador en el Hospital Universitario Virgen de las Nieves de Granada desde marzo a junio de 2020, evaluados al ingreso, alta y a los tres meses mediante escalas de condicion fisica (IFIS), valoracion funcional: general (Rankin, Barthel), respiratoria (mMRC, BORG) y marcha (FAC). Resultados Se incluyeron 30 pacientes, edad media 62,8 (54-70) anos, 80% alguna comorbilidad: hipertension 66,7%, obesidad 36,7%, diabetes 33,3%. Estancia hospitalaria media de 45,4 dias, 86,7% requirio Unidad de Cuidados Intensivos (UCI) (29,1 dias), de ellos 76,7% ventilacion mecanica. El 86,7% de los pacientes presentaron alguna complicacion, siendo mayor la polineuropatia/miopatia del paciente critico (83,3% de los pacientes). Al alta, un 80% requirio ayuda para caminar. El indice de funcionalidad mostro una evolucion en «U» al ingreso, alta y a los tres meses (Barthel 93,8; 60,0; 91,6, respectivamente). Se encontro un mayor deterioro funcional (Barthel Conclusion Los ingresos hospitalarios por COVID-19 implican complicaciones a nivel funcional, respiratorio y de la marcha mayoritariamente graves pero reversibles parcialmente a los tres meses con tratamiento rehabilitador. Se describen factores potencialmente pronosticos que merecen estudios prospectivos.

Resumen El tratamiento de las lesiones de los tendones flexores de la mano sigue siendo un problema clinico importante y frecuente. La tasa de adherencias posterior a la tenorrafia de tendon flexor es elevada. A dia de hoy, el tratamiento es la tenolisis quirugica, no siempre con resultados satisfactorios. La hidrodiseccion ecoguiada por ultrasonido es una novedosa tecnica intervencionista que consiste en introducir una solucion para liberar un espacio comprometido o distender y separar mecanicamente estructuras comprimidas o adheridas. Se plantea la hidrodiseccion ecoguiada como una alternativa a la reintervencion o tras fracaso de la cirugia. Describimos el primer caso publicado de hidrodiseccion ecoguiada peritendinosa de adherencias tras lesion de tendon flexor. Proponemos como alternativa a la cirugia o tenolisis, con resultados esperanzadores.

Study Design Case report. Introduction Severe flexure contractures of the hand secondary to upper limb spasticity (ULS) cause pain, palmar hyperhidrosis, ulceration, and nail plate deformities. Nonoperative management includes traditional orthotic devices that can be very painful for severe contractures and Botox injections, which provide a temporary solution. Surgical treatment comprises of soft tissue releases, tendon transfers, and release of the flexor and intrinsic muscles, which can cause permanent functional problems. Case Description In a 28-year-old male, unfit for surgery, we present the first documented case report in literature of flexion contractures of the hand secondary to upper limb spasticity managed using the “Inflatable Carrot” orthosis, where other conservative measures failed. Results At 4 weeks, the pulp to palm distance improved from 0 to 2 cm. At 3 months, the patient regained normal nail plate architecture, improved hand hygiene, reduced infection and pain. The patient reported improved psychological well-being and motivation to engage further with our therapists. Conclusions The inflatable carrot provided an alternative nonsurgical solution for management of flexion contractures of the hand when surgical intervention was not considered in the patient’s best interests. Awareness of this orthosis among hand therapists and surgeons will broaden our armamentarium for this challenging clinical problem.

Retrospective cross-sectional case series.Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ.In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint.Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values.The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29 with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative).The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.

Resumen Objetivo a) Valorar el efecto de la neuromodulacion transcutanea del nervio tibial posterior (NTTP) mas biofeedback sobre la respuesta simpatica cutanea (RSC). b) Evaluar su efecto sobre la sintomatologia clinica. c) Considerar la RSC como una probable prueba neurofisiologica util tanto para el diagnostico como para el seguimiento en pacientes con vejiga hiperactiva (VH). d) Evaluar su coste comparado con otras tecnicas. Material y metodos Estudio prospectivo cuasi-experimental antes y despues a 10 pacientes con VH. Variables de resultado: frecuencia miccional diurna (FMD) y nocturna (FMN), fuerza de los musculos del suelo pelvico medidos por manometria (presion maxima y media) y RSC. Resultados La FMD mejoro de 10,3 ± 5,45 a 5,9 ± 2,42 episodios (p = 0,0050). La FMN mejoro de 2,4 ± 1,5 a 0,6 ± 0,69 episodios (p = 0,0012). La presion maxima vario de 34,7 ± 16,51 a 39,7 ± 3,65 mmHg (p = 0,0195). La presion media de los musculos de suelo pelvico mejoro de 6,6 ± 3,65 a 9,3 ± 5,43 mmHg (p = 0,0333). La RSC se modifico de una hiperexcitabilidad del 100% previo a tratamiento a un 50 ± 14,14% (p = 0,0000). Conclusion La NTTP mas biofeedback podrian modificar la RSC y mejorar la clinica y la manometria en una serie de pacientes con VH. Se reporta por primera vez la probable utilidad diagnostica y pronostica de esta prueba neurofisiologica en VH e hiperactividad del detrusor. Es necesario realizar un estudio con una muestra mas amplia para poder confirmar los prometedores hallazgos observados en este estudio preliminar.

Introduction The purpose of this study was to identify the relation of daily prosthesis usage time (DPUT) of individuals with amputation with quality of life (QoL) questionnaires. Methods The research was carried out on 125 individuals with amputation. Prosthetic-related parameters were searched, as well as demographic data. A generic (Nottingham Health Profile [NHP]) questionnaire and a questionnaire specific to individuals with amputation (Trinity Amputation and Prosthesis Experience Scales [TAPES]) QoL measurements were used. Results Ninety-one males and 28 females with a mean age of 42.4 ± 14.7 years participated in the study. The average DPUT was 11.1 ± 4.4 hrs/d. Study results showed that there was significant correlation between both of the QoL questionnaires (NHP and TAPES) and DPUT. High correlation was determined between DPUT and NHP total score and NHP-Pain, and very high correlation was found between DPUT and NHP-Physical Activity subscale. A moderate negative correlation was found between DPUT and NHP-Energy Level, NHP-Emotional Reaction, NHP-Social Isolation, and NHP-Sleep. A moderate negative correlation was found between DPUT and TAPES-Activity Restriction. A high correlation was found between DPUT and residual limb pain, prosthetic satisfaction, time interval after amputation, and number of prosthetic fittings. A moderate correlation was found between DPUT and walking aids, whereas a poor relationship was shown between phantom pain and DPUT. Conclusions This study showed that "the average DPUT"may be used in terms of short assessment of QoL of individuals with amputation. The outcomes of this study pointed out that especially prosthetic-related parameters affected the QoL in individuals with amputation. In problems resulting from routine assessment and questionnaires having so many items, a single-item question, "the average DPUT,"may be used effectively in a shorter period and is helpful for organizing a rehabilitation program. Clinical Relevance A single-item question, "The average daily prosthesis usage time (DPUT),"be used effectively in a shorter assessment of quality of life of individuals with amputation and is helpful for organizing a rehabilitation program. © Lippincott Williams & Wilkins.

This study aimed to assess the feasibility of delivering a brief physical activity (PA) intervention to community rehabilitation clients. Participants were randomized to receive one session of stage-of-change-based PA education and counseling in addition to written educational material, or education material alone. Outcomes were measured at baseline and 3 months; the primary outcome was feasibility, measured by the percentage of those who were eligible, consented, randomized, and followed-up. A total of 123 individuals were both eligible and interested in participating, 32% of those screened on admission to the program. Forty participants consented, and 35 were randomized, with mean age 72 years (SD = 12.2). At baseline, 66% had recently commenced or intended to begin regular PA in the next 6 months. A total of 30 participants were followed-up. It is feasible to deliver education and counseling designed to support the long-term adoption of regular PA to community rehabilitation clients. Further refinement of the protocol is warranted (ACTRN12617000519358).

Study Design: Prospective cohort design. Background: Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking. Purpose of the Study: To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals. Methods: Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed. Results: 104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service. Conclusion: Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.

Background Acute flexor tendon injuries are challenging injuries for patients, surgeons, and therapists alike. There is ongoing debate about the optimal timing and amount of therapy after these injuries. Purpose We sought to investigate the relationship between hand therapy utilization and reoperation rates after flexor tendon repair and quantify reoperation rates and costs associated with flexor tendon repair. We hypothesize there will be an inverse relationship between the number of hand therapy visits and later reoperation rates and a positive correlation between reoperation rates and total cost of care. Study Design A retrospective cohort study of patients undergoing primary flexor tendon repair was pursued. Methods A commercially available database was utilized to access insurance claims data for 20.9 million patients in the US from 2007 to 2015. Patients undergoing primary flexor tendon repair were included and followed for one year. Patients with fractures, vascular injuries, or digit replantation were excluded. We studied post-operative rehabilitation utilization, reoperation rates, and costs. Chi-Square tests and multivariable logistic regressions were used to assess the relationship between therapy utilization and reoperation rates and costs. Results The one-year reoperation rate was 11.4 percent at a median time of 100.0 days amongst 1,129 patients undergoing primary tendon repair. In multivariable analysis, age between 30 and 59, male sex, and utilization of over 21 therapy sessions were associated with increased odds of reoperation. Mean insurance reimbursement one year following primary flexor repair was $14,533 per patient but $27,870 if patients went on to reoperation. Conclusion Continued therapy utilization after primary flexor tendon repair is an independent predictor of reoperation need. These findings may help surgeons counsel patients who require a large number of visits after flexor tendon repair on when to revisit surgical options.

Background Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking. Purpose The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and post pollicization Study Design Case Report Methods A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb and Grasp Assessment of Pinch (T-GAP). Results Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP post pollicization and intervention. Conclusions A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and post pollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.

STUDY QUESTION Do women with polycystic ovary syndrome (PCOS) have a greater risk of adverse pregnancy complications (gestational diabetes, preeclampsia, cesarean section, placental abnormalities) and neonatal outcomes (preterm birth, small for gestational age, prolonged delivery hospitalization) compared to women without a PCOS diagnosis and does this risk vary by BMI, subfertility and fertility treatment utilization? SUMMARY ANSWER Deliveries to women with a history of PCOS were at greater risk of complications associated with cardiometabolic function, including gestational diabetes and preeclampsia, as well as preterm birth and prolonged length of delivery hospitalization. WHAT IS KNOWN ALREADY Prior research has suggested that women with PCOS may be at increased risk of adverse pregnancy outcomes. However, findings have been inconsistent possibly due to lack of consistent adjustment for confounding factors, small samples size and other sources of bias. STUDY DESIGN, SIZE, DURATION Massachusetts deliveries among women ≥18 years old during 2013–2017 from state vital records linked to hospital discharges, observational stays and emergency department visits were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) and the Massachusetts All-Payers Claims Database (APCD). PARTICIPANTS/MATERIALS, SETTING, METHODS PCOS was identified by ICD9 and ICD10 codes in APCD prior to index delivery. Relative risks (RRs) and 95% CI for pregnancy and delivery complications were modeled using generalized estimating equations with a log link and a Poisson distribution to take multiple cycles into account and were adjusted a priori for maternal age, BMI, race/ethnicity, education, plurality, birth year, chronic hypertension and chronic diabetes. Tests for homogeneity investigated differences between maternal pre-pregnancy BMI categories ( MAIN RESULTS AND THE ROLE OF CHANCE Among 91 825 deliveries, 3.9% had a history of PCOS. Women with a history of PCOS had a 51% greater risk of gestational diabetes (CI: 1.38–1.65) and a 25% greater risk of preeclampsia (CI: 1.15–1.35) compared to women without a diagnosis of PCOS. Neonates born to women with a history of PCOS were more likely to be born preterm (RR: 1.17, CI: 1.06–1.29) and more likely to have a prolonged delivery hospitalization after additionally adjusting for gestational age (RR: 1.23, CI: 1.09–1.40) compared to those of women without a diagnosis of PCOS. The risk for gestational diabetes for women with PCOS was greater among women with a pre-pregnancy BMI LIMITATIONS, REASONS FOR CAUTION PCOS was defined by ICD documentation prior to delivery so there may be women with undiagnosed PCOS or PCOS diagnosed after delivery included in the unexposed group. The study population is limited to deliveries within Massachusetts among most private insurance payers and inpatient or observational hospitalization in Massachusetts during the follow-up window, therefore there may be diagnoses and or deliveries outside of the state or outside of our sample that were not captured. WIDER IMPLICATIONS OF THE FINDINGS In this population-based study, women with a history of PCOS were at greater risk of pregnancy complications associated with cardiometabolic function and preterm birth. Obstetricians should be aware of patients’ PCOS status and closely monitor for potential pregnancy complications to improve maternal and infant perinatal health outcomes. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the NIH (R01HD067270). S.A.M. receives grant funding from NIH, AbbVie and the Marriot Family Foundation; payment/honoraria from the University of British Columbia, World Endometriosis Research Foundation and Huilun Shanghai; travel support for attending meetings for ESHRE 2019, IASP 2019, National Endometriosis Network UK meeting 2019; SRI 2022, ESHRE 2022; participates on the data safety monitoring board/advisory board for AbbVie, Roche, Frontiers in Reproductive Health; and has a leadership role in the Society for Women’s Health Research, World Endometriosis Research Foundation, World Endometriosis Society, American Society for Reproductive Medicine and ESHRE. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

Research Objectives Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA. To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA. Design A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence. Setting N/A. Participants N/A. Interventions N/A. Main Outcome Measures N/A. Results Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity. Conclusions The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA.