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Background: Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by severe pain and functional impairment. Graded Motor Imagery (GMI) and Mirror Therapy (MT) have emerged as potential non-invasive treatments; this review evaluates the effectiveness of these therapies in reducing pain, improving function, and managing swelling in CRPS patients. Methods: A systematic review was conducted including randomized controlled trials (RCTs) that investigated GMI and MT in CRPS patients. This review was registered in PROSPERO (CRD42024535972) to ensure transparency and adherence to protocols. This review included searches of PubMed, Cochrane, SCOPUS, and Web of Science databases. Out of 81 studies initially screened, 6 were included in the final review. Studies were assessed for quality using the PEDro and RoB-2 scales. The primary outcomes were pain reduction, functional improvement, and swelling reduction. Results: Graded Motor Imagery (GMI) and Mirror Therapy (MT) reduced pain by an average of 20 points on the Neuropathic Pain Scale (NPS) and resulted in functional improvements as measured by the Task-Specific Numeric Rating Scale (NRS). GMI also contributed to some reduction in swelling. MT, particularly in post-stroke CRPS patients, showed significant pain reduction and functional improvements, with additional benefits in reducing swelling in certain studies. However, the included studies had small sample sizes and mixed designs, which limit the generalizability of the findings. The studies varied in sample size and design, with some risk of bias noted. Conclusions: Graded Motor Imagery (GMI) and Mirror Therapy (MT) have proven to be effective interventions for managing Complex Regional Pain Syndrome (CRPS), with significant improvements in pain reduction and functional recovery. These non-invasive treatments hold potential for integration into standard rehabilitation protocols. However, the small sample sizes and variability in study designs limit the generalizability of these findings. Future research should focus on larger, more homogeneous trials to validate the long-term effectiveness of GMI and MT, ensuring more robust clinical application. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Chronic ankle instability is mainly characterized by symptoms such as muscle weakness, intermittent pain, and repeated sprains, which seriously affect exercise and daily life. Loss of proprioception, prolongation of fibular reaction time, and weakening of valgus force may be the main symptoms of chronic ankle instability, so exercise intervention can effectively improve the symptoms related to ankle instability. Meta-analysis was used to quantitatively evaluate the effect of balance training on the rehabilitation intervention of chronic ankle instability, providing a reliable theoretical basis and practical basis for chronic ankle instability patients to scientifically formulate exercise prescriptions. METHODS: The randomized controlled trial of balance training on symptom rehabilitation and dynamic equilibrium of patients with chronic ankle instability was retrieved on CNKI, VIP, Web of Science, and PubMed. The literature was published from the inception to November 23, 2022. Two reviewers were included to evaluate the quality of the included literature based on the physical therapy evidence scale. The primary outcome measure is the Self Functional Rating Scale, and the secondary outcome measure is the Star Shift Balance Test, both of which are continuous variables. Forest mapping, meta-regression, subgroup analysis, sensitivity analysis, and publication bias evaluation were performed on the included literature using RevMan 5.3 and Stata-SE 15 software. RESULTS: (1) A total of 18 articles of randomized controlled trials were screened and 641 patients with chronic ankle instability were included in the study. Overall, the methodological quality of the literature was relatively high. (2) Meta-analysis results showed that balance training improved the functional rehabilitation effect of chronic ankle instability patients (SMD=0.82, 95% CI:0.41-1.23, P < 0.000 1). Meta-regression exhibited that intervention time might be the main reason for heterogeneity (P=0.008). (3) The subgroup analysis results revealed that 6 weeks of intervention (SMD=0.98, 95% CI:0.31-1.65, P=0.03), more than 3 interventions per week (SMD=0.87, 95% CI:0.30-1.44, P=0.003), and each intervention time less than 20 minutes (SMD=0.89, 95% CI:0.61-1.66, P < 0.000 1) were the best rehabilitation plans to improve the functional rehabilitation effect of chronic ankle instability patients. (4) Meta-analysis results also showed that balance training improved the stretching degree of the anterior side (SMD=0.56, 95% CI:0.31-0.80, P < 0.05), posterior inner side (SMD=0.88, 95% CI:0.45-1.32, P < 0.05), and posterior outer side (SMD=0.84, 95% CI:0.22-1.46, P < 0.05) of the star shift balance test. CONCLUSION: Current clinical evidence shows that balance training can improve ankle instability symptoms and elevate dynamic equilibrium ability in chronic ankle instability patients. It is recommended to intervene more than 3 times a week, with each intervention lasting less than 20 minutes, to achieve better rehabilitation effects. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spinal cord injury is a serious hazard. Walking dysfunction affects the patients’ quality of life most. Researches on assisted-walking with exoskeleton robots on patients with spinal cord injury have become increasingly active. OBJECTIVE: To map scientific researches of exoskeleton-assisted walking after spinal cord injury using the CiteSpace software, and to discuss the state of art, cutting-edges in the past 10 years, and trends of research in this field, in hope of providing insights for future investigations and clinical applications. METHODS: Using the Web of Science core database to conduct subject term search by Boolean logical operators, the language English was selected, search strategy: TS=“spinal cord injury OR SCI” AND “walk OR walking” AND “robot OR exoskeleton OR (exoskeleton-assisted walking) OR EAW”. The knowledge graph software CiteSpace 6.2.R4 was used to de-emphasize the high-quality literature. The high-quality literature obtained after reweighting was subjected to visualization analysis of hotspots and international frontier trends, such as the number of publications, country/research institution cooperation, high-influence authors/literature co-citation, keyword co-occurrence/clustering/emergence, and the scientific knowledge graph was mapped. RESULTS AND CONCLUSION: (1) A total of 544 high-quality articles were included, and the number of articles and total citation frequency in this field have shown an increasing trend in the past 10 years. (2) The top 3 countries in terms of number of publications are the USA, China, and Italy, and the top 3 research institutions are the U.S. Department of Veterans Affairs, the U.S. Veterans Health Administration, and the Swiss Federal Institute of Technology Domian. (3) The authors with the highest citation frequency (167) and betweenness centrality (0.13) are Professor Esquenazi A, University of Pennsylvania, USA, showing a high influence in this field. (4) The analysis of the top 5 cited documents in terms of citation frequency and betweenness centrality shows that: the current research on walking rehabilitation for spinal cord injury patients equipped with powered exoskeleton devices focuses on the judgment of the safety of walking rehabilitation training in real-life environments such as institutions and homes, analysis of the advantages and disadvantages of walking rehabilitation training, design of individualized training programs, and the advantages and disadvantages of the application of powered exoskeleton devices in assisted walking for patients with complete loss of locomotor function in thoracic vertebrae and the segments below, the factors affecting the effectiveness of assisted walking, and the potential for application. (5) In recent years, research in this field has focused on individuals, gait, powered exoskeleton, body weight support, functional electrical stimulation, rehabilitation, assistive technology, ambulation, recovery, and so on. (6) Early research in this field was mostly applied to stroke patients, and the frontier includes weight loss support, reciprocating gait orthosis, functional electrical stimulation and other technical means. Spinal cord injury exoskeleton-assisted walking rehabilitation research has shown an upward trend in recent years, and the focus of attention to the development of adaptive control as the mechanism of the medical lower extremity exoskeleton equipment, safety enhancement, the application of the potential to tap into the cutting-edge direction of the change, the research and detection means on the joint function of the near-infrared spectroscopic imaging and other highend technologies, focusing on the quality of life of the patient to enhance the ability of athletic training, and to improve the body’s structure of the field of the future hotspots and the frontier of the research. [ABSTRACT FROM AUTHOR]

Abstract Background Square-Stepping Exercise (SSE) is a type of physical-cognitive exercise. Such exercise has been used as an exercise approach in different studies with older adults. This scoping review provides an overview of the protocols and outcomes of studies employing the SSE in older adults. Methods We searched in the PubMed, CINAHL, Scopus, CABI Global Health, and Web of Science databases for articles published between 2006 (first research article published on SSE) to December 2023 that met a robust inclusion criterion. The search yielded 424 articles, and after inclusion criteria being applied, 37 articles were included in the final analysis. Results A total of 37 studies were included in the final analysis. Thirty-three out of the 37 studies focused on apparently healthy older adults, while four were conducted with older adults with neurological disease (i.e., multiple sclerosis, Parkinson’s disease, and stroke). Most studies (n = 25) adopted an experiment (i.e., randomized controlled trial) or quasi-experimental approach, while 12 were classified as non-randomized (i.e., cross-sectional, mixed methods). The studies were conducted in different parts of the globe and adopted three major formats of intervention delivery, namely in-person, online, and home-based. Frequency, SSE session duration and intervention length significantly varied among studies, and reported outcomes were in the domains of physical and cognitive function. Conclusion This review comprehensively described the characteristics of 37 studies employing SSE in apparently healthy older adults and older adults with neurological diseases. The findings demonstrated that SSE has been used by researchers across the globe, adopting a variety of forms of delivery, and to particularly improve physical and cognitive function of different segments of the older adult population. The review further identified important gaps in research, including the restricted outcomes, and the lack of studies combining SSE with more traditional exercise modalities to address potential combinatory effects.

Background: Square-Stepping Exercise (SSE) is a type of physical-cognitive exercise. Such exercise has been used as an exercise approach in different studies with older adults. This scoping review provides an overview of the protocols and outcomes of studies employing the SSE in older adults. Methods: We searched in the PubMed, CINAHL, Scopus, CABI Global Health, and Web of Science databases for articles published between 2006 (first research article published on SSE) to December 2023 that met a robust inclusion criterion. The search yielded 424 articles, and after inclusion criteria being applied, 37 articles were included in the final analysis. Results: A total of 37 studies were included in the final analysis. Thirty-three out of the 37 studies focused on apparently healthy older adults, while four were conducted with older adults with neurological disease (i.e., multiple sclerosis, Parkinson's disease, and stroke). Most studies (n = 25) adopted an experiment (i.e., randomized controlled trial) or quasi-experimental approach, while 12 were classified as non-randomized (i.e., cross-sectional, mixed methods). The studies were conducted in different parts of the globe and adopted three major formats of intervention delivery, namely in-person, online, and home-based. Frequency, SSE session duration and intervention length significantly varied among studies, and reported outcomes were in the domains of physical and cognitive function. Conclusion: This review comprehensively described the characteristics of 37 studies employing SSE in apparently healthy older adults and older adults with neurological diseases. The findings demonstrated that SSE has been used by researchers across the globe, adopting a variety of forms of delivery, and to particularly improve physical and cognitive function of different segments of the older adult population. The review further identified important gaps in research, including the restricted outcomes, and the lack of studies combining SSE with more traditional exercise modalities to address potential combinatory effects. [ABSTRACT FROM AUTHOR]

Objective To analyze the application value of full process nursing management in patients with lumbar disc herniation(LDH). Methods A total of 60 LDH patients who underwent minimally invasive surgery in our hospital from January 2022 to May 2023 were selected and divided into the study group and the control groupaccording to the random number table method, with 30 cases in each group. The control group was given routine nursing, while the observation group was given full-process nursing management. The compliance of two groups of patients with medical compliance after nursing, as well as their psychological status (Self Rating Anxiety Scale, Self Rating Depression Scale scores) and functional status (Oswestry Dysfunction Index score) before and after nursing were compared between the two groups. Results The total score of compliance behavior after nursing in the study group [(22. 99±3. 59) points] was significantly higher than that in the control group [(19. 33±3. 06) points], and the difference was statistically significant (P<0. 05). Compared with before nursing, the scores of self-rating anxiety scale, self-rating depression scale and Oswestry dysfunction index in the two groups were significantly decreased after nursing, and the scores of self-rating anxiety scale. self-rating depression scale and Oswestry dysfunction index in the study group [(46. 25±4. 11), (51. 12±4. 70),(16. 68±2. 82) points were significantly lower than those in the control group [(49. 25± 28),(53. 88±4. 46),(20. 15±3. 07) points]. The differences were statistically significant (P<0. 05). Conclusion The full-process of nursing management for LDH patients can improve their compliance behavior, improve their bad psychology and promote postoperative functional rehabilitation. [ABSTRACT FROM AUTHOR]

A case report of a six-year and five-month-old female admitted with typical symptoms of Rubinstein-Taybi syndrome is presented. Clinical and rehabilitation settings where she acquired her reading, writing, and communication skills are described.Because of her cognitive disabilities, a multidisciplinary and long-term intervention (2014–2020) was necessary. Treatment included orthoptic, psychomotor, logopedic, occupational, and neuropsychological care. Her family and school were involved.Increased attention led to decreased dysfunctional behaviors. Test results are still below average, but there has been significant improvement. Better communication skills resulted from increased phonetic range, improved articulation, lexical-semantic structure, comprehension, and production of sentences. Digital technologies played a significant role in enhancing her communication skills, not just in social interactions but also in school activities. The patient is oriented in time and space with the help of agendas and calendars. She can express her needs and compose concise narratives. As a result of acquiring functional skills, she is better equipped to handle real-life situations, which has led to increased social and family activities.This case report highlights the importance of personalized rehabilitation programs. Obtaining an early genetic diagnosis is crucial for timely tailored rehabilitation, and any delays in this process can hinder progress. [ABSTRACT FROM AUTHOR]

Neuromodulation is an alternative, minimally invasive treatment option that, at times, is used as a last resort for chronic pain conditions that are often refractory to other treatment modalities. Moreover, it offers promising prospects for individuals grappling with the formidable challenges posed by paraplegia and quadriplegia resulting from spinal cord injuries. This review article provides a comprehensive assessment of current treatment modalities specifically tailored for paraplegic and quadriplegic patients. We aim to evaluate the existing surgical and non-surgical interventions while delving into the role of neuromodulation in the restoration of function for individuals afflicted with these debilitating conditions. Additionally, we review the efficacy, limitations, and comparative outcomes of diverse treatment strategies available for the management of paraplegia and quadriplegia. Emphasizing the critical need for effective interventions beyond the initial 24 h surgical window, we elucidate the challenges associated with conventional therapies and their limited success in achieving comprehensive functional restoration. Central to this review is an in-depth exploration of neuromodulation's transformative potential in ameliorating the deficits caused by spinal cord injuries. With a particular focus on spinal cord stimulation (SCS), we analyze and compare the outcomes of neuromodulation modalities and traditional treatment regimens, shedding light on the promising strides made in fostering sensory perception, motor function, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery. Case presentation: The patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon's canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living. Conclusion: A timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb. [ABSTRACT FROM AUTHOR]

Achilles tendon rupture is a common injury and its incidence is increasing. There is a large body of literature on the subject and much of it debates the influence of management on re-rupture rates. Operative treatment was thought to be superior in reducing the risk of re-rupture. However, it must be balanced against the risks, in particularly wound infection and breakdown, and sural nerve injury. Minimally invasive surgery aimed to reduce wound complications but has frequently been associated with a higher risk of sural nerve damage and irritation. The introduction of functional rehabilitation, which includes early weight bearing and range of motion within an orthosis, has been pivotal in improving outcomes particularly in non-operatively managed patients. More recent evidence suggests that re-rupture rates are now similar between operatively and non-operatively managed patients when incorporating a functional rehabilitation protocol. The publication of the Achilles Tendon Rupture Score, which has been validated specifically for this injury, has been helpful in providing a more detailed picture of post-injury symptoms and function. The studies which have included this as an outcome measure have also shown comparable results between operatively and non-operatively treated patients. [ABSTRACT FROM AUTHOR]

The treatment management of patients with hemifacial microsomia (HM) includes both surgical and nonsurgical approaches and depends primarily on the degree of deformity of the facial and skeletal structures. In this context, the combined efforts of the maxillofacial surgeon, the orthodontist, and the prosthodontist are essential for a satisfactory functional and esthetic outcome. Case presentation: A 31-year-old man presented with a chief complaint of facial asymmetry. The patient had been diagnosed with HM on the right side, with severe external ear deformity, and hypoplasia of the facial muscles and the zygomatic bone. The intraoral examination showed a Class I molar and canine relationship with a reduced horizontal overlap and an occlusal plane canting. The maxillary anterior teeth were severely worn due to traumatic occlusion. Orthodontic treatment in conjunction with combined orthognathic surgery was planned to address the facial asymmetry. Ramus distraction osteogenesis was carried out, followed by conventional presurgical orthodontic treatment. The treatment was completed by prosthetic rehabilitation for the reconstruction of the maxillary teeth and fine occlusal adjustment. Conclusion: The cooperation between the orthodontist, surgeon, and prosthodontist becomes indispensable when treating complex cases of HM. An interdisciplinary approach should be adopted from the start of treatment, promoting integrated customized care. [ABSTRACT FROM AUTHOR]

Our concern has been the development of a Prosthetic-Surgical Guide for implant insertion, aiming to provide superior precision to the clinical stages of implant insertion and prosthesis. This guide supports a more accurate, safe, and tissue-friendly therapeutic plan for the DMA. Apart from the clinical stage of implant insertion into the bone, our designed Prosthetic-Surgical Guide for implant insertion has been clinically used for the precise execution of mucosal stripping (in mucoperiosteal stripping during the implant insertion stage and mucosal stripping for uncovering implants in the prosthesis stage). The outcome was the new Prosthetic-Surgical Guide for implant insertion, a guidance device designed and produced using 3D technology, which made implant-prosthetic rehabilitation safer, being more precise, minimally invasive, intuitive for both doctor and patient, with a significantly reduced risk of infection due to shorter operative times.

Background: Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by severe pain and functional impairment. Graded Motor Imagery (GMI) and Mirror Therapy (MT) have emerged as potential non-invasive treatments; this review evaluates the effectiveness of these therapies in reducing pain, improving function, and managing swelling in CRPS patients. Methods: A systematic review was conducted including randomized controlled trials (RCTs) that investigated GMI and MT in CRPS patients. This review was registered in PROSPERO (CRD42024535972) to ensure transparency and adherence to protocols. This review included searches of PubMed, Cochrane, SCOPUS, and Web of Science databases. Out of 81 studies initially screened, 6 were included in the final review. Studies were assessed for quality using the PEDro and RoB-2 scales. The primary outcomes were pain reduction, functional improvement, and swelling reduction. Results: Graded Motor Imagery (GMI) and Mirror Therapy (MT) reduced pain by an average of 20 points on the Neuropathic Pain Scale (NPS) and resulted in functional improvements as measured by the Task-Specific Numeric Rating Scale (NRS). GMI also contributed to some reduction in swelling. MT, particularly in post-stroke CRPS patients, showed significant pain reduction and functional improvements, with additional benefits in reducing swelling in certain studies. However, the included studies had small sample sizes and mixed designs, which limit the generalizability of the findings. The studies varied in sample size and design, with some risk of bias noted. Conclusions: Graded Motor Imagery (GMI) and Mirror Therapy (MT) have proven to be effective interventions for managing Complex Regional Pain Syndrome (CRPS), with significant improvements in pain reduction and functional recovery. These non-invasive treatments hold potential for integration into standard rehabilitation protocols. However, the small sample sizes and variability in study designs limit the generalizability of these findings. Future research should focus on larger, more homogeneous trials to validate the long-term effectiveness of GMI and MT, ensuring more robust clinical application.

The aim of this work is to present an adaptive serious game based on virtual reality (VR) for functional rehabilitation of the hand after stroke. The game focuses on simulating the palmar grasping exercise commonly used in clinical settings. The system's design follows a user-centered approach, involving close collaboration with functional rehabilitation specialists and stroke patients. It uses the Leap motion controller to enable patient interaction in the virtual environment, which was created using the Unity 3D game engine. The system relies on hand gestures involving opening and closing movements to interact with virtual objects. It incorporates parameters to objectively measure participants' performance throughout the game session. These metrics are used to personalize the game's difficulty to each patient's motor skills. To do this, we implemented an approach that dynamically adjusts the difficulty of the exergame according to the patient's performance during the game session. To achieve this, we used an unsupervised machine learning technique known as clustering, in particular using the K-means algorithm. By applying this technique, we were able to classify patients' performance into distinct groups, enabling us to assess their skill level and adapt the difficulty of the game accordingly. To evaluate the system's effectiveness and reliability, we conducted a subjective evaluation involving 11 stroke patients. The standardized System Usability Scale (SUS) questionnaire was used to assess the system's ease of use, while the Intrinsic Motivation Inventory (IMI) was used to evaluate the participants' subjective experience with the system. Evaluations showed that our proposed system is usable and acceptable on a C-level scale, with a good adjective score, and the patients perceived a high intrinsic motivation. [ABSTRACT FROM AUTHOR]

BackgroundPeripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery.Case presentationThe patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon’s canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living.ConclusionA timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb.

Xi-Qing Pan, Jin-Hui Liu, Jiang-Li Zhang, An Chai, Feng Li, Lei Shu, Wei Zhao Department of Joint Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, People’s Republic of ChinaCorrespondence: Jin-Hui Liu, Department of Joint Surgery, Third Hospital of Shijiazhuang, No. 15 Tiyu South Street, Shijiazhuang, Hebei, 050011, People’s Republic of China, Tel +86 13191872146, Fax +86 31185990628, Email jinhuiauliu6@126.comObjective: In this study, we aim to examine the effects of osteotomy under varying posterior slope angles on knee joint function recovery following knee arthroplasty.Methods: We conducted a retrospective analysis from September 2015 to September 2018 on 240 patients who underwent knee arthroplasty three years previously. The study participants were categorized based on changes in the angle of the posterior slope before and after surgery: Group 1, > 5°; Group 2, 3°– 5°; Group 3, 0°– 3°; Group 4, − 3°– 0°; Group 5, < − 3°. All participants were affected with knee osteoarthritis. The Knee Society Clinical Rating System (KSS) knee function score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) knee function score, Visual Analogue Scale (VAS) pain score, and postoperative complications were measured 3 years after surgery.Results: The level of pain experienced by the patients decreased significantly than before, with pain scores ranging from 1.0– 3.0, and there was a statistical difference between groups (H = 93.400, P

Objective To explore the effect of Zhuang medicine ironing therapy combined with Zhuang medicine external application in the early rehabilitation of patients after anterior cruciate ligament reconstruction. Methods Totally100 patients who underwent arthroscopic anterior cruciate ligament reconstruction were selected as the study subjects. All patients underwent arthroscopic single-bundle reconstruction with autogenous semitendinosus tendon and gracilis tendon. They were randomly divided into observation group and control group, with 50 cases in each group. The patients in the control group were given routine training combined with Zhuang medicine ironing therapy; On the basis of the control group, the observation group was treated with Zhuang medicine external application. The pain, knee joint swelling and range of motion were observed from the 2nd, 5th and 7th day after operation, and effect of treatment was evaluated and compared between two groups. Results At the 7th day after operation , the score of Visual Analogue Scale (VAS) and degree of knee joint swelling in the observation group were lower than those in the control group, respectively(P＜0. 05). Better improvement of range of active knee flexion motion and knee extension motion were observed in the observation group compared with those in the control group at 7 days after operation(P＜0. 01). Conclusion Zhuang medicine ironing therapy and external application may effectively relieve knee pain, reduce swelling, improve the range of motion of knee joint after arthroscopic anterior cruciate ligament reconstruction. The combination treatment of Zhuang medicine is beneficial to the recovery of knee joint function. (目的 观察壮医药熨联合壮医敷贴治疗在前交叉韧带重建术后患者早期康复中的应用效果。方法 选取2022年1月—12月行关节镜下前交叉韧带重建术患者100例为研究对象, 分为观察组和对照组, 各50例, 对照组患者给予常规的训练联合壮医药熨方法; 观察组在对照组的基础上联合壮医敷贴治疗。观察两组干预后膝关节功能康复效果。分别于术后第2天、第5天和第7天观察膝关节疼痛、肿胀缓解情况, 比较两组干预前后膝关节主动屈伸活动范围改善情况, 评价干预效果。结果 术后第7天, 观察组VAS评分低于对照组, 膝关节肿胀度小于对照组, 差异有统计学意义(P＜0. 05); 术后第7天, 观察组膝关节主动屈曲范围及膝关节伸展范围改善幅度优于对照组, 差异有统计学意义(P＜0. 01)。结论 关节镜下前交叉韧带重建术后患者早期功能康复中应用壮医药熨联合壮医敷贴治疗, 能有效缓解膝关节疼痛, 减轻肿胀, 改善膝关节活动度, 有利于膝关节功能的恢复。)

Abstract Background Chronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA’s Stepped Care Model to meet veterans’ pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management. Objectives The Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans’ pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation. Methods A sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO. Results Of 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20–9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p

This article presents a case study on the management of an ectopic permanent lateral incisor in a child's chin. The study focuses on an 11-year-old child who had a lower permanent incisor that had erupted outside the mandibular bone, causing aesthetic and psychological issues. The treatment involved extracting the affected tooth, suturing the wound, and administering antibiotics. The study highlights the importance of addressing aesthetic, psychological, and functional concerns to promote the well-being and overall development of the patient. The article also discusses early dental trauma and its socio-cultural considerations in Côte d'Ivoire, as well as the inclusion of permanent central incisors with root anomalies resulting from such trauma. Furthermore, it explores the known and unknown causes of eruption defects in upper central incisors. [Extracted from the article]

Context: Hip pain is associated with reduced hip muscle strength, range of movement (ROM), and decreased postural stability. Singleleg squat is a reliable and valid method to measure dynamic balance. Objective: To evaluate the influence of physical characteristics and use of a decline board on squat performance in a hip pain population. Design: Cross-sectional study setting. Clinical Patients: In total, 33 individuals scheduled for arthroscopic hip surgery were matched with 33 healthy controls. Interventions: Hip and ankle ROM, hip strength, and trunk endurance were assessed, along with knee and trunk kinematics during squat on flat and 25° decline surfaces. Main Outcome Measures: Between-group and surface differences in alignment, between-group strength and ROM, and associations between alignment and physical characteristics were assessed and determined using mixed model analysis of variance and Pearson R. Results: The hip pain group had significantly less strength and ROM for all directions except abduction strength and ankle dorsifiexion (P > .02). No differences existed between lire 2 groups for trunk (P < .70) or knee displacement (P < .46) during squat on either surface. When the 2 groups were combined (n = 66), decline squat significantly reduced knee medial displacement in both limbs by approximately 1 cm (P < .01). Decline squat reduced uxink lateral movement on 1 side only (P = .03). Reduced knee displacement during decline squat showed fair association with less hip-extension strength (r = -29), hip-flexion strength (r = -.25), and less dorsifiexion (r = -.24). Strength and range were not associated with trunk displacement. Conclusions: Decline squat reduced medial knee and lateral trunk displacement regardless of hip pain. Reductions may be greater in those with lesser hip muscle strength and dorsifiexion. Use of a decline board during squat for improving knee and trunk alignment should be considered as a goal of exercise intervention. [ABSTRACT FROM AUTHOR]

Background: The training of abdominal muscles has a positive impact on the functional capacity of healthy adults, being applied practically in fields of athletics and fitness through rehabilitation for lower back pain. Objective: The study compares abdominal muscle activity while performing graded isometric exercises on stable and unstable surfaces. The authors also examined perceived stability and comfort for the different surfaces. Methods: A total of 30 young, healthy adults performed 3 graded isometric exercises on a Pilates table, foam roller, and Oov (a newly developed tool). Ultrasound investigation measured transversus abdominis, internal oblique abdominis, and external oblique abdominis thickness during each task, comparing muscle thickness between conditions using general linear modeling. Results: Core abdominal activation was greater on the foam roller than the Oov and Pilates table during crook lying (bilateral leg support). Both Oov and foam roller elicited greater contralateral transversus abdominis and internal oblique abdominis thickness than the Pilates table during tabletop and straight leg raises (unilateral leg exercises). For transversus abdominis only, the foam roller elicited more muscle thickness than the Oov during straight leg raises. The Oov was rated more comfortable than the foam roller. Discussion: Exercises performed on the Oov and foam roller elicit core greater abdominal muscle thickness than those performed on a Pilates table. Unilateral leg exercises in a supine position elicit more contralateral muscle thickness than those with bilateral leg support. Conclusions: These results provide information to support choices in exercise progression from flat stable to more unstable surfaces and from those with bilateral foot support to unilateral foot support. The Oov was more comfortable that the foam roller, and this may help with exercise adherence. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of lumbar dorsal muscle rehabilitation training combined with spinal fine tuning manipulation on functional rehabilitation, hemorheology and quality of life of patients with lumbar disc herniation (LDH). Methods: Using the method of random number table, 120 patients with LDH who were admitted in our hospital from March 2020 to March 2022 were divided into the control group (60 cases, lumbar dorsal muscle rehabilitation training) and the observation group (60 cases, lumbar dorsal muscle rehabilitation training combined with spinal fine tuning manipulation). The clinical efficacy, functional rehabilitation effect,hemorheology and quality of life of the two groups were observed. Results: The total clinical effective rate of the observation group was higher than that of the control group (P＜0.05). 4 weeks after intervention, the Japanese Orthopaedic Association lumbar function (JOA) score of the observation group was higher than that of the control group, and the Oswestry Disability index (ODI) and visual analogue scale (VAS) scores were lower than those of the control group (P＜0.05). 4 weeks after intervention, the waist flexion range of motion (ROM), extension ROM, flexor ROM, flexor muscle strength and extensor muscle strength of the observation group were higher than those of the control group (P＜0.05). 4 weeks after intervention, the whole blood high-shear viscosity, whole blood low-shear viscosity and red blood cell aggregation index of the observation group were lower than those of the control group (P＜0.05). 4 weeks after intervention,the scores of physical function, mental health, vitality, physical pain, social function, general health, emotional function and physiological function of the observation group were higher than those of the control group (P＜0.05). Conclusion: Lumbar dorsal muscle rehabilitation training combined with spinal fine tuning manipulation in the intervention of patients with LDH can improve hemorheology, promote functional rehabilitation, and help improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA's Stepped Care Model to meet veterans' pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management. Objectives: The Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans' pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation. Methods: A sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO. Results: Of 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20–9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p <.003) in the three primary pain outcomes (intensity, interference, catastrophizing), and 12 of 17 secondary outcomes, including physical, psychological, health-related quality of life (HRQoL), acceptance, and mindfulness measures. Discussion: Data suggest that EVP has significant positive outcomes in pain, psychological, physical, HRQoL, acceptance, and mindfulness measures for veterans with chronic pain through non-pharmacological means. Future evaluations of intervention dosing effect and long-term effectiveness of the program is needed. [ABSTRACT FROM AUTHOR]

The brain is highly integrated and thus unilateral injury can impact the contralateral hemisphere. However, further research is needed to clarify the changes in the response of the contralateral homotopic area to ipsilateral injury. We hypothesized that severe unilateral brain injury would be accompanied by contralateral synaptic changes that are related to functional recovery. To test this, we divided rats into sham and experimental groups. In the experimental group, we performed right motor cortex resection. These rats were further divided into three subgroups according to post-injury time: 7 days, 14 days, and 30 days post-injury. Rats in each group were evaluated using a beam walking test to quantify the recovery of motor function, and all rats received an injection of adeno-associated virus-containing green fluorescent protein (GFP). Finally, we conducted morphological and histological analyses to identify synaptic changes. Over time, the behavior of the rats that underwent right motor cortex resection recovered. Furthermore, in contrast to the sham group, the experimental groups exhibited an increase in the spine density and expression of synaptic proteins in layer V of the contralateral motor cortex, which was consistent with the GFP-labeled neurons. Moreover, more immature spines were observed 7 days post-injury. Notably, spine morphology matured from 7 to 30 days, and the increase in Synapsin-1 intensity in layer V peaked 14 days after the resection, whereas PSD-95 intensity continued to increase until day 30. Our findings suggested that following motor function recovery from unilateral brain injury, spine morphology and synaptic proteins change dynamically in the contralateral hemisphere.

Objective: To conduct a quality improvement evaluation of the Empower Veterans Program (EVP), an interdisciplinary pain rehabilitation/functional restoration program option for functional restoration for high‐impact chronic pain, offered in a large metro‐area Veterans Health Administration (VHA) system. Data Sources: VHA Corporate Data Warehouse electronic medical record data for patients treated by EVP between 2015 and 2019. Evaluation Design: This retrospective design first compared EVP patients considered engaged or not engaged in completing treatment in terms of demographic characteristics and post‐treatment changes in clinical measures related to opioid use and mental health. We then compared mortality risk between matched groups of treated and untreated patients with chronic pain and concurrent opioid prescriptions using propensity score matching and Cox proportional hazards methods. "Treated" in the matched groups was defined as any level of EVP participation (i.e., both engaged and not engaged). Data Collection/Extraction Methods: We first identified 1053 EVP patients with 1 year of pre‐and post‐treatment follow‐time and determined their engagement level. From those with chronic pain and prescription opioids, we matched 237 EVP patients to 375 untreated patients. Principal Findings: Engaged patients (57.4% of treated patients), were somewhat older than the non‐engaged (mean age 57.1 vs. 53.7, Cohen's D = 0.30), and achieved lower mean PHQ9 depression scores in the post‐treatment year (9.2 vs. 10.6, Cohen's D = 0.20). Participation in EVP was associated with a 65% lower mortality risk among Veterans with chronic pain and opioid use when compared to the untreated patients: (HR: 0.35, 95% CI: 0.17, 0.75). Conclusions: EVP was associated with a large reduction in mortality risk for Veterans with both chronic pain and opioid use. This result could inform the decision process in a VA station or region when considering providing or expanding access to an interdisciplinary rehabilitation/functional restoration program for chronic pain. [ABSTRACT FROM AUTHOR]

Background: Achilles tendon rupture can be treated nonoperatively with functional rehabilitation. However, prolonged immobilization has associated risk of venous thromboembolism (VTE). Early weightbearing may reduce VTE risk, and this was introduced to our rehabilitation protocol. We investigated the prevalence of symptomatic VTE events before and after the introduction of the early weightbearing protocol. Methods: Adults with ultrasonography-confirmed complete tendo-Achilles ruptures between January 2017 and June 2020 were included. Preprotocol, patients were instructed to not weightbear for 4 weeks. In 2018, immediate weightbearing was introduced to the treatment protocol. All patients in both cohorts were given low-molecular-weight heparin for 4 weeks. Patients with symptomatic VTE events were investigated with duplex ultrasonographic scan or chest computed tomography. Two independent anonymized examiners collected data from electronic records. Rates of symptomatic VTEs were compared. Results: A total of 296 patients were included. Sixty-nine patients were managed with the nonweightbearing protocol, and 227 patients were managed with the early-weightbearing protocol. Two patients in each group developed deep vein thrombosis and 1 developed pulmonary embolism in the early-weightbearing group. Rates of VTEs were lower in the early-weightbearing group (1.3% vs 2.9%) but did not reach statistical significance (P =.33). Conclusion: In this cohort we found that symptomatic VTE after nonoperatively treated Achilles tendon rupture was uncommon. We did not demonstrate a reduction in symptomatic VTE between our early weightbearing and nonweightbearing rehabilitation protocols. We believe a larger study may help clarify whether early weightbearing is beneficial in VTE reduction. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to compare the effects of hamstring muscle injection of botulinum toxin type A (BoNT/A) combined with periarticular injection to those of simple periarticular injection alone, in terms of early pain reduction and functional recovery following total knee arthroplasty (TKA). Methods: This study included 40 patients who underwent elective unilateral TKA at our hospital from February 2021 to December 2021. The patients were randomly assigned to either the experimental group (BoNT/A injection into the hamstring muscle + periarticular injection, n = 20 cases) or the control group (0.9% normal saline injection into the hamstring muscle + periarticular injection, n = 20 cases). The preoperative and postoperative 3-day HSS scores were compared between the two groups. Postoperative visual analog scale (VAS) pain scores were observed and compared between the two groups. The Lovett grading method was used to evaluate the postoperative muscle strength of both groups. Additionally, postoperative knee joint pain scores, maximum active flexion angle, and any postoperative adverse reactions were observed and compared between the two groups. Results: The experimental group showed significantly lower VAS pain scores than the control group at 24 h, 48 h, and 72 h after the operation, with a statistically significant difference (P < 0.05). Furthermore, compared to the control group, the patients in the experimental group exhibited larger knee joint active flexion angles at 1 day, 3 days, and 5 days post-operation, also demonstrating a statistically significant difference (P < 0.05). These findings hold scientific significance (P < 0.05). Additionally, the combined administration of BoNT/A hamstring muscle injection with periarticular injection exhibited a low incidence of adverse reactions during the perioperative period and had no significant effect on quadriceps muscle strength. Conclusion: The combination of BoNT/A hamstring muscle injection with periarticular injection effectively alleviates early postoperative pain following TKA and promotes early functional recovery of the knee joint.

The injectable composite resin technique is an indirect/direct method that uses a transparent silicone index for accurate and predictable translation of a diagnostic wax-up into composite restorations without the need for tooth preparation. This case report involves a 22-year-old man who presented with esthetic and functional problems associated with diastemas and insuf- ficient tooth visibility. Clinical examination revealed inadequate canine guidance in lateral excursion. The treatment plan included the fabrication of composite veneers for the maxillary incisors and canines. A wax-up was prepared by simulation of functional movements on an articulator, and a transparent silicone index was prepared after checking a mock-up in the oral cavity. The teeth were restored with flowable composite injected and polymerized through the transparent silicone index. The conventional technique was modified by cutting the silicone index at the gingival margin, using individual mock-ups as space holders, and the use of gingival retraction cords. The final outcomes were elongated teeth for increased visibility, closed diastemas, and reshaped canines for adequate guidance in lateral excursion. A protective splint for night-time wear was fabricated and delivered to ensure long-term stability. The patient did not exhibit any soft tissue inflammation or significant wear during a 24-month follow-up period. The technique described is minimally invasive and inexpensive, and it can be used for definitive as well as translational restorations. The treatment goals are to establish adequate function and esthetics, with advantages including minimal tooth structure loss and cost- effectiveness. Stable and predictable results can be achieved with proper planning and a careful workflow. (Quintessence Int 2019;50: 712--719; doi: 10.3290/j.qi.a43089) index at the gingival margin, using individual mock-ups as space holders, and the use of gingival retraction cords. The final outcomes were elongated teeth for increased visibility, closed diastemas, and reshaped canines for adequate guidance in lateral excursion. A protective splint for night-time wear was fabricated and delivered to ensure long-term stability. The patient did not exhibit any soft tissue inflammation or significant wear during a 24-month follow-up period. The technique described is minimally invasive and inexpensive, and it can be used for definitive as well as translational restorations. The treatment goals are to establish adequate function and esthetics, with advantages including minimal tooth structure loss and cost- effectiveness. Stable and predictable results can be achieved with proper planning and a careful workflow. [ABSTRACT FROM AUTHOR]

Context: Contemporary developments in Global Positioning System (GPS) technology present a means of quantifying mechanical loading in a clinical environment with high ecological validity. However, applications to date have typically focused on performance rather than rehabilitation. Objective: To examine the efficacy of GPS microtechnology in quantifying the progression of loading during functional rehabilitation from ankle sprain injury, given the prevalence of reinjury and need for quantifiable monitoring. Furthermore, to examine the influence of unit placement on the clinical interpretation of loading during specific functional rehabilitation drills. Design: Repeated measures. Setting: University athletic facilities. Participants: Twentytwo female intermittent team sports players. Intervention: All players completed a battery of 5 drills (anterior hop, inversion hop, eversion hop, diagonal hop, and diagonal hurdle hop) designed to reflect the mechanism of ankle sprain injury, and progress functional challenge and loading. Main Outcome Measures: GPS-mounted accelerometers quantified uniaxial PlayerLoad for each drill, with units placed at C7 and the tibia. Main effects for drill type and GPS location were investigated. Results: There was a significant main effect for drill type (P < .001) in the mediolateral (η² = .436), anteroposterior (η² = .480), and vertical planes (η² = .516). The diagonal hurdle hop elicited significantly greater load than all other drills, highlighting a nonlinear progression of load. Only the mediolateral load showed evidence of progressive increase in loading. PlayerLoad was significantly greater at the tibia than at C7 for all drills, and in all planes (P <.001, η² > .662). Furthermore, the tibia placement was more sensitive to between-drill changes in mediolateral load than the C7 placement. Conclusions: The placement of the GPS unit is imperative to clinical interpretation, with both magnitude and sensitivity influenced by the unit location. GPS does provide efficacy in quantifying multiplanar loading during (p)rehabilitation, in a field or clinical setting, with potential in extending GPS analyses (beyond performance metrics) to functional injury rehabilitation and prevention. [ABSTRACT FROM AUTHOR]

Objective: To compare the functional and radiological outcome of combine compression interlocking intramedullary nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in the treatment of elderly patients with intertrochanteric fractures. Methods: As a retrospective cohort study, records of 88 patients with intertrochanteric fractures treated in our hospital from January 1st, 2019 to July 31st, 2021 were retrospectively reviewed. According to treatment records, it included 45 patients treated with InterTan (Group-A) and 43 patients treated with PFNA-II (Group-B). The operation safety and functional rehabilitation of the two groups were compared and analyzed. Results: This study included 88 patients with intertrochanteric fractures (mean [SD] age, 68.72 [0.10] years at baseline), of whom 52 (59.09%) were males and 36 (40.91%) were females. Operation time and intraoperative blood loss in Group-B were less than Group-A, while fracture healing time was shorter in Group-A. The fracture separation distance was measured four weeks after the operation. The widening rate of the fracture line in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). The incidence of complications in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). At three, six and twelve months after the operation, the Harris hip score of the two groups was higher than at discharge (P<0.05), with no significant difference between groups (P>0.05). Conclusions: We found no significant difference in the functional outcome in elderly patients with intertrochanteric fractures treated with InterTan and PFNA-II. Early fracture healing and reduced complication rate however has been noted with InterTan. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of acupoint application combined with staged rehabilitation function training on functional rehabilitation, serum pain factors and bone metabolism markers in patients with femoral neck fracture after operation. Methods:150 patients with femoral neck fracture who were treated in Sichuan Orthopedic Hospital from January 2021 to October 2021 were included. According to the envelope lottery method, the patients were divided into control group (75 cases) and observation group (75cases) The control group received staged rehabilitation function training, and the observation group received acupoint application combined with staged rehabilitation function training. Both groups were intervened for 3 months. After 3 months, the functional rehabilitation, visual pain analogue scale (VAS) score, serum pain factors and bone metabolism markers in the two groups were observed, and the incidence of postoperative complications in the two groups was recorded. Results: 3 months after intervention, Barthel Index and Harris hip score in the two groups were higher than those before treatment, and the observation group was higher than that in the control group (P＜0.05) 1 month after intervention, 2 months after intervention and 3 months after intervention, the scores of visual pain analogue scale (VAS) in the two groups decreased gradually, and the scores in the observation group were lower than those in the control group (P＜0.05) 3months after intervention, bone specific alkaline phosphatase (BALP) and osteoprotegerin (OPG) increased in the two groups, and the observation group was higher than the control group. The levels of tartrate resistant hydrochloric acid phosphatase isomer (TRACP-5b), type I collagen carboxyl terminal peptide β Special sequence (β-CTX) were decreased, and the observation group was lower than the control group (P＜0.05) 3 months after intervention, the levels of bradykinin (BK), prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT) and neuropeptide Y (NPY) in two groups were decreased, and the observation group was lower than the control group (P＜0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P＞0.05) Conclusion: Acupoint application combined with staged rehabilitation function training can promote the postoperative functional recovery of patients with femoral neck fracture and reduce postoperative pain, which may be related to regulating the level of markers related to bone metabolism. [ABSTRACT FROM AUTHOR]

Background: Deficits in calf muscle function and heel-rise performance are common after an Achilles tendon rupture (ATR) and are related to tendon elongation and calf muscle atrophy. Whether early functional mobilization (EFM) can improve calf muscle function compared with standard treatment (ST) with 2 weeks of immobilization and unloading in a plaster cast is unknown. Hypothesis: EFM would lead to superior recovery of heel-rise performance, as demonstrated by more symmetrical side-to-side ankle and knee joint kinematics, compared with ST. Study Design: Cohort study; Level of evidence, 2. Methods: In total, 47 patients with an ATR were prospectively included and treated with open surgical repair and randomized 2:1 postoperatively to either EFM or ST. Overall, 29 patients were treated with a dynamic orthosis (EFM), and 18 underwent ST. At 8 weeks and 6 months after ATR repair, 3-dimensional motion analysis of heel-rise performance was conducted. At 6 months, tendon length and muscle volume were assessed with ultrasound imaging, calf muscle function with the heel-rise test, and patient-reported outcomes with the Achilles tendon Total Rupture Score. Results: At 8 weeks and 6 months, there were no significant group differences between the EFM and ST groups in heel-rise performance, but significant side-to-side differences in ankle and knee kinematics were detected. At 8 weeks and 6 months, both the EFM and ST groups showed a significantly decreased peak ankle plantarflexion angle and increased knee flexion angle on the injured limb compared with the uninjured limb during bilateral heel raises. Linear regression demonstrated that greater atrophy of the medial gastrocnemius muscle (P =.008) and higher body weight (P <.001) were predictors of a decreased maximum peak ankle plantarflexion angle on the injured limb at 6 months. Conclusion: EFM after an ATR repair did not lead to superior recovery of calf muscle function, as assessed by heel-rise performance, compared with ST. Increased knee flexion seemed to be a compensatory strategy for decreased ankle plantarflexion. Medial gastrocnemius atrophy and increased body weight were additional factors associated with a decreased ankle plantarflexion angle. Registration: NCT02318472 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

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Context: Anterior knee pain (AKP) is a common condition, especially in a young active population. The clinical presentations of this condition vary considerably, and therefore, an individualized approach to treatment is needed. Objective: The primary objective of this study was to assess the effect of a novel targeted biomechanical intervention on subjects with AKP. Design: A case series was conducted on 8 participants with AKP. Setting: The study was conducted at the Tygerberg Motion Analysis Laboratory and Tygerberg Physiotherapy Clinic in Cape Town, South Africa. Participants: Eight subjects (5 females and 3 males) diagnosed with AKP were included in this case series. Intervention: Participants received a 6-week subject-specific functional movement retraining intervention. Main Outcome Measures: Three-dimensional hip, knee, and ankle kinematics were used for analysis for each participant preintervention and postintervention. Pain was measured weekly using the Numeric Pain Rating Scale. Two functional scales (Lower-Extremity Functional Scale and Anterior Knee Pain Scale) were used to assess pain and function the preintervention and postintervention. Results: All 8 subjects demonstrated improved pain levels (Numeric Pain Rating Scale) and functional outcomes (Anterior Knee Pain Scale and Lower-Extremity Functional Scale). Seven of the 8 participants (87.7%) demonstrated improvements in their main biomechanical outcome. Conclusion: A subject-specific functional movement retraining intervention may be successful in the treatment of subjects with AKP presenting with biomechanical risk factors. Research on a larger sample is required to further investigate this approach. [ABSTRACT FROM AUTHOR]

The brain is highly integrated and thus unilateral injury can impact the contralateral hemisphere. However, further research is needed to clarify the changes in the response of the contralateral homotopic area to ipsilateral injury. We hypothesized that severe unilateral brain injury would be accompanied by contralateral synaptic changes that are related to functional recovery. To test this, we divided rats into sham and experimental groups. In the experimental group, we performed right motor cortex resection. These rats were further divided into three subgroups according to post-injury time: 7 days, 14 days, and 30 days post-injury. Rats in each group were evaluated using a beam walking test to quantify the recovery of motor function, and all rats received an injection of adeno-associated virus-containing green fluorescent protein (GFP). Finally, we conducted morphological and histological analyses to identify synaptic changes. Over time, the behavior of the rats that underwent right motor cortex resection recovered. Furthermore, in contrast to the sham group, the experimental groups exhibited an increase in the spine density and expression of synaptic proteins in layer V of the contralateral motor cortex, which was consistent with the GFP-labeled neurons. Moreover, more immature spines were observed 7 days post-injury. Notably, spine morphology matured from 7 to 30 days, and the increase in Synapsin-1 intensity in layer V peaked 14 days after the resection, whereas PSD-95 intensity continued to increase until day 30. Our findings suggested that following motor function recovery from unilateral brain injury, spine morphology and synaptic proteins change dynamically in the contralateral hemisphere. • Severe unilateral brain injury results in continuous contralateral synaptic changes. • Contralateral synaptic changes relate to compensation of function recovery. • Contralateral newly formed synapses in response to unilateral brain injury undergo continuous regeneration and elimination. [ABSTRACT FROM AUTHOR]

Objective: To evaluate change in functional independence, psychosocial functioning, and goal attainment at discharge from a slow-stream Staged Community-Based Brain Injury Rehabilitation (SCBIR) service in Western Australia, 2011-2020. Methods: Retrospective cohort study of n = 323 adults with acquired brain injury (ABI) enrolled in a post-acute SCBIR service compared against a control cohort of n = 312 with ABI admitted to three non-rehabilitation programs. Outcome measures were the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM), Mayo Portland Adaptability lnventory-4 (MPAI-4), and Goal Attainment Scale. Change in FIM+FAM and MPAI-4 scores and predictors of goal attainment at discharge were evaluated using multilevel mixed-effects regression. Results: Median SCBIR length of stay was 20.5 months. Rehabilitation clients demonstrated clinically significant functional gains at discharge, adjusted mean change = +20.3, p < 0.001 (FIM+FAM). Peak gains of +32.3 were observed after 24-30 months and clinically significant gains were observed 5 years post-admission. Individuals discharged ≤6 months had the smallest functional gains (+12.7). Small psychosocial improvements were evidenced at discharge, mean reduction = - 2.9T, p < 0.001 (MPAI-4) but not clinically significant. 47% of rehabilitation clients achieved their goals at the expected level or higher at discharge. Compared to the control, rehabilitation clients evidenced significantly greater functional gains and psychosocial improvement but lower goal attainment. Significant predictors of goal attainment at discharge were >2 years since injury, higher cognitive function and higher emotional adjustment at admission. Conclusions: Functional recovery after ABI is a gradual and ongoing process. SCBIR is effective for functional rehabilitation post-injury but can be improved to achieve clinically meaningful psychosocial improvement. [ABSTRACT FROM AUTHOR]

Abstract Background The increase in the survival of oncology patients include multiple side effects as cancer-related asthenia and dyspnea, which represents a serious health problem. An implementation of the conventional clinical practice, developed through multimodal physical exercise and functional rehabilitation program intervention, may be useful in controlling dyspnoea. This study aims to evaluate the effects of a multimodal exercise and functional rehabilitation program on fatigue, pain, functional capacity, and quality of life in cancer patients with cancer-related asthenia. Methods This is a protocol for an experimental, prospective, randomised study using a parallel, fixed assignment scheme, with an experimental group and a control group in patients from the oncology hospitalisation unit at the Salamanca University Hospital Complex in Spain, using consecutive sampling to select 50 participants with oncological asthenia who are hospitalised at the time of inclusion. After the baseline evaluation, the participants will be randomised into two groups. Both groups will receive standard clinical practice care and the normal health education program at discharge, but in addition, the participants assigned to the experimental group will also complete a multimodal exercise and functional rehabilitation program lasting one month. The primary outcomes will be basic activities of daily living (Barthel Index) and degree of asthenia (FACT-An scale). Additionally, physical performance will be evaluated with the Short Physical Performance Battery (SPPB), as will the attention and executive functions (Trail-Making Test), fear/avoidance of movement (TAMPA scale), pain (VAS scale), and body composition (waist, hip, brachial, thigh, wrist, and ankle circumferences). Discussion The results of this study may be translated to clinical practice, incorporating a specific autonomy recovery programme into comprehensive rehabilitation programmes of care for cancer patients with asthenia. The current study addresses to improve the conventional clinical practice by proposing a multimodal physical exercise and functional rehabilitation program intervention, which will be implemented by an interdisciplinary team, to try to improve the autonomy of cancer patients with cancer-related asthenia. Trial registration ClinicalTrials.gov; ID: NCT04761289. (February 18, 2021). https://clinicaltrials.gov/ct2/show/ NCT04761289.

Abstract Background The lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20–40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI. Methods Between 2015 and 2018 we applied the diagnostic code “sprain of ankle” (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus. Results The overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p

ObjectiveTo evaluate change in functional independence, psychosocial functioning, and goal attainment at discharge from a slow-stream Staged Community-Based Brain Injury Rehabilitation (SCBIR) service in Western Australia, 2011–2020.MethodsRetrospective cohort study of n = 323 adults with acquired brain injury (ABI) enrolled in a post-acute SCBIR service compared against a control cohort of n = 312 with ABI admitted to three non-rehabilitation programs. Outcome measures were the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM), Mayo Portland Adaptability Inventory-4 (MPAI-4), and Goal Attainment Scale. Change in FIM+FAM and MPAI-4 scores and predictors of goal attainment at discharge were evaluated using multilevel mixed-effects regression.ResultsMedian SCBIR length of stay was 20.5 months. Rehabilitation clients demonstrated clinically significant functional gains at discharge, adjusted mean change = +20.3, p < 0.001 (FIM+FAM). Peak gains of +32.3 were observed after 24–30 months and clinically significant gains were observed 5 years post-admission. Individuals discharged ≤6 months had the smallest functional gains (+12.7). Small psychosocial improvements were evidenced at discharge, mean reduction = −2.9T, p < 0.001 (MPAI-4) but not clinically significant. 47% of rehabilitation clients achieved their goals at the expected level or higher at discharge. Compared to the control, rehabilitation clients evidenced significantly greater functional gains and psychosocial improvement but lower goal attainment. Significant predictors of goal attainment at discharge were >2 years since injury, higher cognitive function and higher emotional adjustment at admission.ConclusionsFunctional recovery after ABI is a gradual and ongoing process. SCBIR is effective for functional rehabilitation post-injury but can be improved to achieve clinically meaningful psychosocial improvement.

Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system. May have individual and dynamic course, with symptoms of varying severity. It takes 4 forms: relapsing-remitting, primary progressive, secondary progressive and relapsing-chronic. Aim of the research: Evaluation of the effectiveness of functional rehabilitation in patients suffering from multiple sclerosis. Material and methods: The research group consisted of 94 people (67 women and 27 men) aged 24-70 years, diagnosed with multiple sclerosis. Study participants went through a four-week process rehabilitation based on functional exercise. In research the survey method was used and the research technique was used proprietary questionnaire. Results: The research confirmed the improvement of physical fitness of patients suffering from multiple sclerosis due to the rehabilitation process. In total, 78.72% of the respondents described their physical condition as better or much better than before rehabilitation. Only a few – 3,19% – considered that rehabilitation did not improve the quality of life. The vast majority of respondents - 70.21% as a result of rehabilitation indicated an improvement in independence in everyday functioning. In 93,62% it influenced a better well-being. Conclusions: A correlation has been demonstrated between the performance of kinesiotherapeutic rehabilitation in patients with multiple sclerosis and the improvement of their physical fitness. A significant difference was found in the degree of satisfaction with one’s own functional state before and after the rehabilitation process.