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On 2 December 2020 the World Health Organization (WHO) announced key findings from the newly released “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019” published in The Lancet (1), promoting the upcoming WHO Rehabilitation Need Estimator aligned with these global estimate data. Using data from the 2019 Global Burden of Disease, Injuries, and Risk Factors Study (2), the estimates were based on the prevalence and years of life lived with disability (YLDs) of 25 diseases and impairments selected as amenable to rehabilitation. The Lancet paper presents the headline number that, globally, 2.41 billion individuals live with conditions who could benefit from rehabilitation. Musculoskeletal disorders contributed the most to this total, with a prevalence of 1.71 billion people. The Lancet paper discusses implications for the field of rehabilitation and for country-level rehabilitation priority-setting and decisions on programmes to address rehabilitation needs. The objective of this paper is to put this milestone study of global estimates of rehabilitation need into an historical perspective, and, in particular, to reflect on its implications for the WHO’s broader agenda, “Rehabilitation 2030: A Call for Action”, and for Physical and Rehabilitation Medicine more generally. This paper also briefly elaborates the opportunities for the European Academy of Rehabilitation Medicine (EARM) to contribute to the WHO’s Call for Action. EARM members EARM members collaborating in this paper (in alphabetical order): Jari Arokoski (University of Helsinki, Helsinki, Finland), Mercè Avellanet (Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra), Kristian Borg (Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden), Helena Burger (University Rehabilitation Institute, Ljubljana, Slovenia), Maria Gabriella Ceravolo (“Politecnica delle Marche” University, Ancona, Italy), Joaquim Chaler (EUSES, Universitat de Girona-Universitat de Barcelona, Barcelona, Spain), Anne Chamberlain (University of Leeds Faculty of Medicine, Leeds, UK), Richard Crevenna (Medical University of Vienna, Vienna, Austria), Thierry Deltombe (CHU UCL Namur site Godinne, Yvoir, Belgium), Jean-Pierre Didier (Université de Bourgogne, Dijon, France), Gabor Fazekas (National Institute for Medical Rehabilitation, Budapest, Hungary), Joan García Alsina (Hospital Universitario de Bellvitge. Barcelona, Spain), Christoph Gutenbrunner (Hannover Medical School, Hannover, Germany), Elena Ilieva (Medical University of Plovdiv, Bulgaria), Alvydas Juocevicius (Klaipeda University, Klaipeda, Lithuania), Jaro Karppinen (Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland), Jolanta Ewa Kujawa (Medical University of Lodz, Lodz, Poland), Jorge Lains (Rehabilitation Medicine Center for the Central Region, Rovisco Pais, Tocha, Portugal), Antti Malmivaara (National Institute for Health and Welfare, Helsinki, Finland), Angela McNamara (National Rehabilitation Hospital, Dublin, Ireland), Xanthi Michail (University of West Attica, Athens, Greece), Rory J. O’Connor (University of Leeds, Leeds, UK), Jean Paysant (Regional Rehabilitation Institute, Nancy, France), Brigitte Perrouin-Verbe (University of Nantes, France), E. Diane Playford (University of Warwick, Coventry, UK), Konstantina Petropoulou (National Rehabilitation Center, Athens, Greece), Hans Rietman (University of Twente, Enschede, The Netherlands), Cecilie Røe (Institute of Clinical Medicine at the University of Oslo, Oslo, Norway) Gilles Rode (Université de Lyon, Lyon, France), Bengt H. Sjölund (University of Southern Denmark, Odense, Denmark), Britt-Marie Stålnacke (Umeå University, Umeå, Sweden), Katharina Stibrant Sunnerhagen (Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden), Guy Vanderstraeten (Ghent University Hospital, Ghent, Belgium), Anthony B. Ward (Staffordshire University, Stoke on Trent, UK), Mauro Zampolini (USL Umbria 2, Foligno, Italy).

Background: People with lower limb loss fall more frequently than healthy population. One of the risk factors is having trans-tibial amputation [ref:1], [ref:2]. Aim: We studied dynamic balance during perturbed walking in active people after trans-tibial amputation with no severe[for full text, please go to the a.m. URL], 15th Congress of the European Forum for Research in Rehabilitation (EFRR)

Background: Patients after lower limb amputation fitted with prosthesis have to learn how to walk and control the movement of prosthesis. In spite of modern prosthetic components, gait deviations in this population are still frequent. The physiotherapists (PTs) performing gait training have to be able to observe different gait abnormalities, understand their causes and try to improve them by using appropriate physiotherapeutic methods. Clinical gait analysis is part of the standard procedure of fitting a new prosthesis. It is therefore important that there is inter-rater agreement between different PTs. Methods: Fifty subjects after transtibial amputation, who had been amputated at least one year ago were recruited from our outpatient clinic. They had no other neurological or musculoskeletal disorders that might influence their gait, had to be able to walk independently with their prosthesis (walking aids were allowed) and had no problems with the prosthesis. Five PTs performed gait assessment; three of them were randomly selected to observe each patient when they got a new prosthesis. Randomisation was balanced so that each PT observed an equal number of subjects. The percentage of agreement between raters was calculated for each gait parameter (which were all dichotomous). Results: The subjects (43 men, 7 women) were on average 65 years old (range 17-91, median 67 years). The mean time since amputation was 11 years (range 1-66, median 4 years); 18 amputations were due to sequelae of diabetes mellitus, 16 due to injury, nine due to peripheral vascular disease, one due to tumour and six due to other reasons. In six minutes, the subjects walked 40 to 760 metres (mean 287 m, median 280 m). Only in five of the 13 observed gait parameters was the percentage of agreement higher than 80%. There was 100% agreement about functionality of gait and 98% of initial contact, 92% about knee hyperextension, 80% about not loading the prosthesis and 78% about loading it. Agreement about whether there was knee valgus during stance phase was better (88%) than about knee varus (62%). The lowest agreement was about gait rhythm (60%) and equality of step length (54%). Conclusions: Inter-rater reliability of clinical gait analysis in people after transtibial amputation between our PTs is not very satisfactory. It is necessarily to define more precisely what the observed parameters mean; it would also be beneficiary to adjust the assessment form accordingly. Izhodišče: Ljudje z amputacijo spodnjega uda, ki so oskrbljeni s protezo, se morajo naučiti hoje in obvladovanja proteze. Kljub sodobnim protetičnim komponentam so pri tej populaciji nepravilnosti hoje pogoste. Fizioterapevti, ki izvajajo učenje in vadbo hoje, morajo biti sposobni opaziti različne nepravilnosti v vzorcu hoje, poznati njihove vzroke ter poskušati izboljšati vzorec hoje z različnimi fizioterapevtskimi metodami. Klinična analiza hoje je del standardnih postopkov ob predpisu nove proteze. Zato je pomembno, da je zanesljivost med ocenjevalci čim boljša. Metode: V preiskavo smo vključili 50 oseb po transtibialni amputaciji enega spodnjega uda, ki so že vsaj eno leto hodili s protezo, niso imeli nevroloških ali drugih mišično-skeletnih okvar, ki bi lahko vplivale na hojo, so dobili novo protezo in so bili pripravljeni sodelovati. Izključili smo tudi osebe z bolečinami ali ranami na krnu. Ob prejemu nove proteze smo naključno izbrani trije od petih fizioterapevtov Oddelka za rehabiltiacijo bolnikov po amputaciji hkrati opazovali njihovo hojo in vsak na svoj obrazec zabeležili opažene nepravilnosti. Na vsakih 10 bolnikov znotraj vsake skupine smo uporabili vse kombinacije treh terapevtov. Rezultati: V raziskavo smo vključili 50 bolnikov (43 moških in sedem žensk) po transtibialni amputaciji, starih od 17 do 91 let (povprečje 65 let, mediana 67 let). Pri bolnikih je bila amputacija opravljena v obdobju od enega leta do 66 let (povprečje 11 let, mediana 4 leta) pred vključitvijo v študijo. Pri 18 bolnikih je bila amputacija posledica zapletov sladkorne bolezni, 16 bolnikov je bilo amputiranih zaradi poškodbe, devet zaradi perifernega žilnega obolenja, eden zaradi tumorja in šest zaradi drugih vzrokov. V šestih minutah so prehodili od 40 do 760 metrov (povprečje 287 m, mediana 280 m). Trideset jih ni moglo stati na protezi (test stoje na eni nogi % protezi), pet jih je na protezi stalo eno sekundo, po sedem dve oziroma tri sekunde (povprečje je dve sekundi). Skladnost med petimi terapevti je bila zadovoljiva le v petih od 13 opazovanih značilnosti, kljub uporabi dvojiškega točkovanja. Fizioterapevti smo se povsem (100 %) strinjali v tem, ali je hoja funkcionalna ali ni, dobra je bila tudi skladnost glede dostopa na podlago in morebitne prisotnosti hiperekstenzije kolena. Skladnost je bila najslabša glede dolžine korakov, ritma hoje in nagiba trupa na stran amputacije. Zaključek: Skladnost ocenjevanja in prepoznavanja nepravilnosti hoje bolnikov po transtibialni amputaciji med fizioterapevti ni najboljša. Potrebno je bolj natančno opisati, kaj pomenijo posamezne ocene, dobro pa bi bilo tudi prilagoditi obrazec za ocenjevanje.

Hand, with its all various functions, is essential for functioning in all areas of human life. Any disruption of the arm and the upper limb function, either due to injury or various pathological conditions, is therefore reflected by various major or minor limitations of activities and participation. With the application of splints and small orthotic devices, we want to restore or re-establish optimal functioning of the affected person and increase their quality of life. Roka je zaradi svojih različnih funkcij bistvenega pomena na vseh področjih človekovega življenja. Vsaka okvara roke in/ali zgornjega uda zaradi poškodbe ali različnih bolezenskih stanj se zrcali v različnih, večjih ali manjših omejitvah delovanja in sodelovanja. Z aplikacijo opornic in drobnih ortotskih pripomočkov želimo povrniti ali vzpostaviti čim bolj optimalno delovanje osebe z okvaro roke in/ali zgornjega uda ter ji s tem izboljšati kakovost življenja.

Rehabilitation of a child with complete absence of the upper limb requires a comprehensive team approach. The plan of rehabilitation is prepared and adjusted based on initial and follow-up assessments of functional abilities. It comprises the neurodevelopmental program with a biomechanical approach and later on, development and searching for alternative strategies for activities of daily life. The long-term goal is the independence of the child in all areas of life. In the article, we present a case of a child with bilateral congenital upper limbs dysmelia. He was fitted with body-powered prosthesis for disarticulation in right shoulder. The function of two long fingers, growing out of left shoulder, improved over time. The analysis of his development of daily life activities showed significant delay from six months up to two years in comparison to the normal development. Based on results of evaluation with the Paediatric Evaluation of Disability Inventory (PEDI), he was significantly delayed in the self-care domain (results between 10th to 19th percentile). By the age of 12 years, he was still not able to be independent in some activities of daily life. Rehabilitacija otroka s popolno odsotnostjo zgornjega uda zahteva celostni timski pristop. Načrt obravnave pripravimo in sproti prilagajamo glede na oceno funkcijskega stanja. Zgodnja obravnava vključuje razvojno nevrološko obravnavo z biomehanskim pristopom, kasneje pa obravnava vključuje tudi iskanje in razvijanje nadomestnih strategij za učinkovito izvedbo vsakodnevnih aktivnosti. Dolgoročni cilj je osamosvojitev otroka na vseh področjih življenja. V članku predstavljamo primer otroka z obojestransko prirojeno dismelijo roke, njegov razvoj funkcijskih sposobnosti, opremo s pripomočki in nadomestne strategije pri učenju vsakodnevnih aktivnosti. Opremljen je bil z mehansko protezo za eksartikulacijo v ramenskem sklepu na desni strani. Funkcija dveh prstov, ki sta izraščala iz leve rame, se je postopno izboljšala. Ob vključevanju v programe habilitacije je osvojil večino vsakodnevnih aktivnosti, čeprav z zamudo šest mesecev do dveh let. Glede na rezultate ocene z Vprašalnikom za oceno funkcijskih sposobnosti je na področju skrbi zase (PEDI) pomembno zaostajal za vrstniki (rezultati med 10. in 19. percentilom). Nekaterih veščin ni osvojil niti do starosti 12 let.

Placebo and nocebo effects are effects of inert substances and inactive procedures that are usually used in control groups. Placebo can be any clinical intervention including words, gestures, pills, devices and surgery. Prostheses (mainly prosthetic components) and orthoses can also have placebo effect. All team members have to be aware of this, know the evidence about their effectiveness, be professional and not try to "sell" a product. Placebo in nocebo učinek sta učinka inertnih snovi in neaktivnih metod, ki jih navadno v študijah uporabljamo za kontrolo v kontrolni skupini. Placebo lahko povzročimo z besedami, gestami, s tabletami, pripomočki in z operacijami. Proteze, predvsem njihove komponente, in ortoze imajo tudi placebo učinek. Pomembno je, da se vsi člani tima, ki sodelujemo v procesu oskrbe z njimi, tega zavedamo, poznamo in redno spremljamo dokaze o njihovi učinkovitosti ter se obnašamo profesionalno in ne "prodajamo".