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A 44-year-old woman suffered a carotid dissection causing a deep and superficial right middle cerebral artery stroke in October 2013, despite undergoing thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted. She then agreed to embark upon a guided self-rehabilitation contract (GSC). This GSC is a moral contract where the physician or therapist identifies specific muscles, particularly hypoextensible and disabling that act as antagonists to functional activities. The physician or therapist then teaches and prescribes quantified daily high-load self-stretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over 4 years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of the days. Each day, she practiced an average of 20 min of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81 ± 2 (mean ± SEM) min/day, and her mean number of active maximal efforts was 285 ± 78/day, for a total daily selfrehabilitation time of over 2 h a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left-hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity). The Modified Frenchay Scale assessment was video-recorded by the clinician at each visit, allowing qualitative and quantitative evaluation of the functional capacities. The two videos of the first and last clinic visits have been uploaded and are available. [ABSTRACT FROM AUTHOR]

A 44-year-old woman suffered a carotid dissection causing a deep and superficial right middle cerebral artery stroke in October 2013, despite undergoing thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted. She then agreed to embark upon a guided self-rehabilitation contract (GSC). This GSC is a moral contract where the physician or therapist identifies specific muscles, particularly hypo-extensible and disabling that act as antagonists to functional activities. The physician or therapist then teaches and prescribes quantified daily high-load self-stretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over 4 years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of the days. Each day, she practiced an average of 20 min of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81 ± 2 (mean ± SEM) min/day, and her mean number of active maximal efforts was 285 ± 78/day, for a total daily self-rehabilitation time of over 2 h a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left-hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity). The Modified Frenchay Scale assessment was video-recorded by the clinician at each visit, allowing qualitative and quantitative evaluation of the functional capacities. The two videos of the first and last clinic visits have been uploaded and are available.

Considerable research has been conducted on the application of functional nano‐fillers to enhance the power generation capabilities of triboelectric nanogenerators (TENGs). However, these additives often exhibit a decrease in output power at higher concentration. Here, a Janus cobalt metal–organic framework‐SEBS (JCMS) membrane is reported as a dual‐purpose dielectric layer capable of efficiently capturing and blocking charges for high‐performance TENGs. The JCMS is produced asymmetrically through gravitational sedimentation, employing spherical CoMOFs within a diluted SEBS solution. Beyond its dual dielectric characteristics, the JCMS showcases exceptional mechanical durability, displaying notable stretchability of up to 475% and remarkable resilience when subjected to diverse mechanical pressures. Consequently, the JCMS‐TENG produces a maximum peak‐to‐peak voltage of 936 V, a current of 42.8 µA, and a power density of 10.89 W m−2 when exposed to an external force of 10 N at a 5 Hz frequency. This investigation highlights the potential of JCMS‐TENGs with unique structures, known for their exceptional energy harvesting capabilities, mechanical strength, and flexibility. Additionally, the promising prospects of easily produced asymmetric structures is emphasized with bifunctionalities for developing efficient and flexible MOFs‐based TENGs. These advancements are well‐suited for self‐powered wearables, rehabilitation devices, and energy harvesters. [ABSTRACT FROM AUTHOR]

OBJECTIVE Restricted mouth opening (trismus) is a common late effect of radiotherapy (RT) in patients (pts) with head and neck cancer. This study aims to reveal whether self-rehabilitation therapy, without any apparatus utilized after RT, has any therapeutic impact on trismus and mouth opening distance (MOD) in head and neck cancer pts. METHODS Fifty-three consecutive pts with squamous cell carcinoma of the head and neck treated with RT ± chemotherapy (ChT) were included in the study. An MOD of less than 35mm was accepted as trismus. Self-rehabilitation exercises were started 3 months after RT and continued for 3 months. The risk factors for trismus and MOD in relation to exercises were determined using univariate and multivariate statistics. RESULTS The median age was 59 years (range: 31-84). Trismus was present in 41.5% of the group as a whole (22 of 53 pts). The MOD for the entire group prior to physiotherapy was 37.33±7.83mm, and it was 38.75±7.66mm after physiotherapy (p=0.035). In multivariate analysis, concomitant ChT (OR=5.648, 95% CI: 1.043-30.596) and time passed after RT of more than 36 months (OR=8.238, 95% CI: 1.410-48.136) were found to significantly increase the risk of trismus. However, when physiotherapy is used, these risk factors lose their significance. CONCLUSION Self-rehabilitation without the use of any apparatus was discovered to be an effective treatment for trismus after RT for the first time. We also discovered that self-rehabilitation improves the MOD values of the entire patient population. [ABSTRACT FROM AUTHOR]

This paper introduces a multiscopic cyber-physical-social system (CPSS) to bridge the gap between independent rehabilitation in physical and cognitive aspects. Specifically, we focus on hand–object interaction (HOI) recognition with visual attention for the block-design test (BDT). The proposed framework utilizes three levels which consist of microscopic, mesoscopic, and macroscopic models. In the microscopic model, a hand-tracking vision captures hand-skeletal data and finger joint angle features, enabling the estimation of physical hand postures. In the mesoscopic model, an egocentric vision with an eye tracker records to hand and eye movements, allowing for the symbolic representation of hand-eye coordination through hand gestures and visual attention focus during the test. An evaluation vision system employs color feature classification in the macroscopic model to determine whether the design matches the given task. Through the first eight designs of WAIS-IV BDT with two scenarios, the system successfully measures human behavior from the physical to the cognitive domain. The experiment involving eight healthy participants investigates the relationship between physical measurement and cognitive evaluation. Regression and correlation analyses between the dominant and non-dominant hands reveal that evaluation indices (task completion time, skewness-kurtosis of hand posture, attention to pattern and blocks) can indicate improvement during BDT. The outcomes of this study have significant implications for clinicians and researchers, providing valuable information that is typically unavailable in clinical settings. The proposed multiscopic CPSS framework holds promise for advancing independent rehabilitation practices. Code and datasets are available online at https://github.com/anom-tmu/bdt-multiscopic.

Exercise rehabilitation and education are important strategies for preventing the progression of diabetic neuropathy-related musculoskeletal deficits. The purpose of this randomized controlled trial was to investigate the effect of an 8-week home-based foot–ankle exercise program using an educational booklet on clinical outcomes (foot muscle strength and functionality; functional balance; diabetic neuropathy symptoms and severity; tactile and vibratory sensitivities; plantar pressure distribution; and foot–ankle, knee, and hip biomechanics during gait). Fifty participants with neuropathy were randomly allocated into an intervention group (59.1 ± 6.4 years, 23.5 ± 4.8 kg/m2, males = 6, females = 19) that performed the exercises for 8 weeks and a control group (56.5 ± 9.4 years, 22.9 ± 3.6 kg/m2, males = 5, females = 20) that received usual care recommendations. Generalized estimating equation method and intention-to-treat approaches were adopted. No significant differences were found for any clinical outcome after 8 weeks. Heel contact area increased in the intervention group compared to controls (p = 0.043, mean difference = 2.7 cm) and heel peak pressure was increased in controls compared to intervention (group effect p = 0.020, mean difference = −64.16 kPa) at 8 weeks. Controls showed increased joint moments for the hip at heel strike (p = 0.007) and for the knee and hip at push off over 8 and 16 weeks (p < 0.001 and p = 0.009, respectively). Although the intervention is easy to perform and showed a good adherence (72%), home-based foot–ankle exercise programs are unlikely to sufficiently modify the main risk factors related to foot ulcers and to change foot–ankle kinematics and kinetics. [ABSTRACT FROM AUTHOR]

Background: Orthopedic manual therapy is currently considered as an alternative approach for treating hip osteoarthritis. However, studies assessing its efficacy in low-income countries in Sub-Saharan Africa are scarce., Objectives: Investigating the effectiveness of Maitland passive joint mobilization (Maitland PJM) compared to self-rehabilitation in patients with hip osteoarthritis in Benin, a low-income country, in Sub-Saharan Africa., Methods: This was a pragmatic, single-blind, two-arm randomized trial involving 66 participants randomly assigned into two groups (Maitland PJM group, n = 33, and self-rehabilitation group, n = 33). Both interventions took 5 weeks. The primary outcome (pain) was evaluated using numerical rating scale. Secondary outcomes (passive hip range of motion, muscles strength, walking, and quality of life) were assessed using goniometry, medical research council, 10 m walk test, and short-form 36. Participants were assessed at baseline, after interventions and 3-month follow-up., Results: Forty-nine patients (Maitland PJM group, n = 22, self-rehabilitation, n = 27) completed the sessions. Within-group analyses showed a significant improvement in body function, walking speed, and quality of life (p < 0.05) after interventions and at 3-month follow-up within both groups. No significant differences in any outcomes were observed between the Maitland PJM and self-rehabilitation groups, after interventions and at the 3-month follow-up (p > 0.05)., Conclusion: Maitland passive joint mobilization and self-rehabilitation similarly improved function, walking speed, and quality of life in Beninese patients with hip osteoarthritis., Trial Registration: PACTR201911553990405., (© 2024 John Wiley & Sons Ltd.)

Abstract Background After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. With the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Box and Block Test (BBT-VR). The aim of this study was to assess the concurrent validity of the BBT-VR among patients with stroke and healthy participants. Methods Twenty-three healthy participants and 22 patients with stroke were asked to perform the classical Box and Block Test (BBT) and BBT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests and reliability of the BBT-VR through correlation on test–retest. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from controller’s 3D position allowed to compute mean velocity (Vmean), peak velocity (Vpeak) and smoothness (SPARC). Results Results showed strong correlations between the number of blocks displaced with the BBT and the BBT-VR among patients with stroke for affected (r = 0.89; p 0.8; p

Background: After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. With the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Box and Block Test (BBT-VR). The aim of this study was to assess the concurrent validity of the BBT-VR among patients with stroke and healthy participants.Methods: Twenty-three healthy participants and 22 patients with stroke were asked to perform the classical Box and Block Test (BBT) and BBT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests and reliability of the BBT-VR through correlation on test-retest. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from controller's 3D position allowed to compute mean velocity (Vmean), peak velocity (Vpeak) and smoothness (SPARC).Results: Results showed strong correlations between the number of blocks displaced with the BBT and the BBT-VR among patients with stroke for affected (r = 0.89; p < 0.001) and less-affected hands (r = 0.76; p < 0.001) and healthy participants for dominant (r = 0.58; p < 0.01) and non-dominant hands (r = 0.68; p < 0.001). Reliability for test-retest was excellent (ICC > 0.8; p < 0.001) and usability almost excellent (System Usability Scale = 79 ± 12.34%). On average participants moved between 30 and 40% less blocks during the BBT-VR than during the BBT. Healthy participants demonstrated significantly higher kinematic measures (Vmean = 0.22 ± 0.086 ms-1; Vpeak = 0.96 ± 0.341 ms-1; SPARC = - 3.31 ± 0.862) than patients with stroke (Vmean = 0.12 ± 0.052 ms-1; Vpeak = 0.60 ± 0.202 ms-1; SPARC = - 5.04[- 7.050 to - 3.682]).Conclusion: The BBT-VR is a usable, valid and reliable test to assess manual dexterity, providing kinematic parameters, in a population of patients with stroke and healthy participants. Trial registration http://www.clinicaltrials.gov ; Unique identifier: NCT04694833, Date of registration: 11/24/2020. [ABSTRACT FROM AUTHOR]

Exercise rehabilitation and education are important strategies for preventing the progression of diabetic neuropathy-related musculoskeletal deficits. The purpose of this randomized controlled trial was to investigate the effect of an 8-week home-based foot–ankle exercise program using an educational booklet on clinical outcomes (foot muscle strength and functionality; functional balance; diabetic neuropathy symptoms and severity; tactile and vibratory sensitivities; plantar pressure distribution; and foot–ankle, knee, and hip biomechanics during gait). Fifty participants with neuropathy were randomly allocated into an intervention group (59.1 ± 6.4 years, 23.5 ± 4.8 kg/m2, males = 6, females = 19) that performed the exercises for 8 weeks and a control group (56.5 ± 9.4 years, 22.9 ± 3.6 kg/m2, males = 5, females = 20) that received usual care recommendations. Generalized estimating equation method and intention-to-treat approaches were adopted. No significant differences were found for any clinical outcome after 8 weeks. Heel contact area increased in the intervention group compared to controls (p = 0.043, mean difference = 2.7 cm) and heel peak pressure was increased in controls compared to intervention (group effect p = 0.020, mean difference = -64.16 kPa) at 8 weeks. Controls showed increased joint moments for the hip at heel strike (p = 0.007) and for the knee and hip at push off over 8 and 16 weeks (p < 0.001 and p = 0.009, respectively). Although the intervention is easy to perform and showed a good adherence (72%), home-based foot–ankle exercise programs are unlikely to sufficiently modify the main risk factors related to foot ulcers and to change foot–ankle kinematics and kinetics.

Abstract Background After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to “maintenance” rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year. Methods One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician’s prescription. The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections. Discussion This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis. Trial registration ClinicalTrials.gov: NCT02202954, July 29, 2014.

Safeguarding the built heritage in the old town of Constantine faces many challenges. The predominance of ordinary inhabited heritage has implied particular practices of appropriation of space. Faced with the public approach to rehabilitation, based on institutionalization and professional expertise, the inhabitants carry out rehabilitation actions on their inhabited spaces, protected according to different methods. This article aims to study these self-rehabilitation practices in the old town of Constantine in order to determine their contribution to the preservation of heritage. These practices refer to heritage representations of different types. They translate modes of interaction of the inhabitants with the inhabited heritage space. [ABSTRACT FROM AUTHOR]

We designed and evaluated a whack-a-mole (WAM) style game (see Figure 1) in a clinical randomized controlled trial (RCT) with reminder-assisted but self-initiated use over the period of a month with 43 participants from a post-lesion pool. While game play did not moderate rehabilitative progress indices of standard neuropsychological control tests, it did significantly improve in-game performance when compared to the control group. Its performance indicators and interaction data were highly accurate in predicting neglect and which hand the patients used for input. Patients found playing beneficial to their rehabilitation and attributed gains in the attention training properties of the game. The game showed potential for bedside assessment, insight support, and motivation by providing knowledge about rehabilitative progress.

BACKGROUND: Stroke recovery studies have shown the efficacy of bimanual training on upper limb functional recovery and others have shown the efficacy of feedback technology that augments error. OBJECTIVE: In a double-blinded randomized controlled study (N = 26), we evaluated the short-term effects of bilateral arm training to foster functional recovery of a hemiparetic arm, with half of our subjects unknowingly also receiving error augmentation (where errors were visually and haptically enhanced by a robot). METHODS: Twenty-six individuals with chronic stroke were randomly assigned to practice an equivalent amount of bimanual reaching either with or without error augmentation. Participants were instructed to coordinate both arms while reaching to two targets (one for each arm) in three 45-minute treatments per week for two weeks, with a follow-up visit after one week without treatment. RESULTS: Subjects’ 2-week gains in Fugl-Meyer score averaged 2.92, and we also observed improvements Wolf Motor Functional Ability Scale average 0.21, and Motor Activity Log of 0.58 for quantity and 0.63 for quality of life scores. The extra benefit of error augmentation over the three weeks became apparent in Fugl-Meyer score only after removing an outlier from consideration. CONCLUSIONS: This modest advantage of error augmentation was detectable over a short interval encouraging further research in interactive self-rehabilitation systems that can enhance error motor recovery. [ABSTRACT FROM AUTHOR]

PurposeTo investigate the beliefs of physiotherapy students (ST), professionals (PT) and physicians (MD) about engaging patients with post-stroke hemiparesis into Guided Self-Rehabilitation Contracts (GSC), to increase their exercise intensity and responsibility level. MethodA survey examining beliefs about post-stroke rehabilitation was completed by first (n = 95), second (n = 105), and third (n = 48) year STs; PTs (n = 129) and MDs (n = 65) in France. ResultsThe belief about whether a patient may exercise alone varied between the professional groups with more STs and MDs finding it acceptable: 62% of PTs vs. 74% of STs (p = 0.005) and 79% of MDs (p = 0.02). For 93% of therapists (STs and PTs together), the caregiver may take part in physical therapy sessions. The appropriate weekly duration of exercises in chronic hemiparesis should be over 5 h for 19% of PTs, 37% of STs, and 51% of MDs (MDs vs. PTs, p < 0.005). After stroke, functional progress through rehabilitation is possible all lifelong for 11% of STs, 19% of PTs (p < 0.05, STs vs. PTs), and 29% of MDs (MD vs. PT, NS). ConclusionsThe strategy of asking patients to perform exercises alone, in the practice or at home, is still not accepted by a large proportion of physical therapy professionals as compared with students or with physicians. Most therapists still see a <5-h weekly duration of exercise as sufficient after stroke. Few therapists are ready to utilize the persistence of behavior-induced brain plasticity regardless of age or delay after the lesion. [ABSTRACT FROM AUTHOR]

The behavioral transition from an entirely unflighted-to-flighted, female yearling American crow (Corvus brachyrhynchos) in captivity in a specially designed exhibit was documented at the Binghamton Zoo at Ross Park in Binghamton, NY. Upon arrival, the focal crow had no complete primary feathers or retrices and had been in captivity since fledging. She apparently had never flown successfully and was using her legs and an abnormal body orientation to cushion her landing on the ground. In a social and physical environment with 3 flying companion crows and staggered perches, she developed and appeared to “practice” routines that ultimately resulted in her recovering normal body posture and flight ability. The crow’s practice routine was recorded during daily observations using an ethogram of social and locomotor behaviors. Both enclosure design and the social environment may have provided an ideal setting for the self-motivation of practice and this recovery. Attention to the potential for such practice could facilitate rehabilitation in individuals for whom rehabilitation was not thought possible. [ABSTRACT FROM PUBLISHER]

This qualitative study examines the emotional, mental, and therapeutic effects of the role of care workers on mentor prisoners in the Magen Prison (Mind and Body Center) – a male prison for the mentally ill – and analyzes the perceived connection between these emotional processes and their self-rehabilitation. Semi-structured interviews were conducted with all prisoners operating as mentor prisoners in the Magen prison between the years 2012 and 2014 and then thematically analyzed. The main findings of the study show that the role of care worker is perceived by the mentor prisoner as: (a) promoting their ability to find positive existential meaning in their life; (b) significantly contributing to their rehabilitation; (c) having a positive impact on their relationship with the prison staff. It is therefore evident that the provision of support contributes to the development of feelings of responsibility and empathy among mentor prisoners, helping them to manage their own sense of frustration and despair and facilitating cooperation between them and the staff. On a practical level, we recommend that prison systems integrate a maximum number of prisoners with potential for rehabilitation in peer-mentoring programs and similarly beneficial activities. [ABSTRACT FROM AUTHOR]

The demand for physical medicine and rehabilitation services has risen significantly. Immediate rehabilitation is not always readily available which may compromise patients' functional recovery. Here, we describe a rare subtalar dislocation case and how an unsupervised home-based rehabilitation program allowed functional recovery. A 49-year-old male presented to the emergency department with an injury to the right ankle which resulted from a 3-meter height fall with his foot in plantar flexion and inversion. Clinical and imaging findings confirmed a diagnosis of a rare case of subtalar dislocation. The post-injury AOFAS Ankle-Hindfoot Scale score was 24/100 points. After six weeks of immobilization, a patient-tailored home-based rehabilitation program was prescribed. Adherence to our home-based rehabilitation program was critical to allow a range-of-motion improvement and functional recovery. Delaying rehabilitation may lead to long-term functional impairments. Thus, acknowledging the post-acute period as critical to initiate rehabilitation is mandatory. When outpatient rehabilitation settings are not readily available due to high demand, comprehensive patient education, and home-based rehabilitation programs may constitute effective alternative interventions. We demonstrate the significant improvement obtained with an early patient-tailored home-based rehabilitation program in range-of-motion and functional outcomes in a case of medial subtalar dislocation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Moita Gonçalves et al.)

Background: Rehabilitation after surgery is a crucial process that governs the final functional outcome. The self-rehabilitation smartphone application Doct'up (Healing SAS, Lyon, France) is designed for patients who have had anterior cruciate ligament (ACL) reconstruction surgery. In France in the spring of 2020, the lockdown mandated due to the COVID-19 pandemic prevented patients from seeing their physiotherapists for 2 months. The objective of this study was to compare the clinical outcomes in two groups of patients who underwent ACL reconstruction surgery: in one group, surgery performed before the lockdown was followed by standard in-person physiotherapy while, in the other, surgery was done just before the lockdown and rehabilitation was performed by the patients themselves using the phone application., Hypothesis: Using a self-rehabilitation smartphone app limits the negative effects of not receiving physiotherapist rehabilitation after ACL reconstruction., Material and Methods: We performed a case-control study involving the retrospective analysis of prospectively collected data from two groups of patients who had undergone ACL reconstruction surgery. Patients in the App group had surgery just before the 2-month COVID-19-related lockdown that started in France on March 17, 2020,and used only the smartphone app for rehabilitation. The standard-care group was composed of matched controls who had surgery 1 year before the cases and received rehabilitation therapy during in-person physiotherapist visits. The ACL reconstruction technique was the same in the two groups. The primary outcome measure was extension lag 6 weeks after surgery. The secondary outcome measures were extension lag 3 weeks and 6 months after surgery, quadriceps muscle activation, knee extension locking 3 and 6 weeks after surgery, and the 6-month rate of surgical revision for cyclops syndrome., Results: We included 32 cases managed using only self-rehabilitation guided by the phone app, and we identified 101 matched controls managed using standard care. We found no significant between-group difference in extension lag after 6 weeks: 9.4% (28/32) vs. 4.6% (87/101), p=0.39. After 3 weeks, the App group had a higher proportions of patients with quadriceps activation (94% [30/32] vs. 73% [74/101], p=0.015) and extension control using canes (78.1% [25/32] vs. 40.6% [41/101], p=0.0002). None of the other measured outcomes differed significantly between the two groups (extension lag after 3 weeks: 12.5% [4/32] vs. 13.8% 14/101]; extension lag after 6 months: 3.2% [1/32] vs. 1% [1/101]; quadriceps activation after 6 weeks: 97% [31/32] vs. 99% [100/101]; extension locking with canes after 6 weeks: 96.9% [31/32] vs. 93.1% [94/101]; extension locking without canes after 3 weeks: 53.2% [17/32] vs. 47.5% [48/101]; extension locking without canes after 6 weeks: 93.7% [30/32] vs. 82.2% [83/101]; and surgery for cyclops syndrome (3.1% [1/32] vs. 1% [1/101])., Discussion: The use of a self-rehabilitation phone app after ACL reconstruction during a COVID-19 lockdown limited the adverse effects of not receiving in-person physiotherapy. The 6-month outcomes were similar to those seen with standard rehabilitation. The study results demonstrate the usefulness of self-rehabilitation after ACL reconstruction surgery. Self-rehabilitation guided by a phone app could be used as a complement to the protocols generally applied by physiotherapists., Level of Evidence: IV, single-centre retrospective case-control study., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: Timed Up and Go (TUG) performance is reduced following stroke. Gait training improves gait-related activities in hemiparetic patients. However, no study has compared the impact of a single overground training session with a treadmill training session on gait-related activities (assessed by TUG). Objective: To compare the immediate effect of a single overground training session versus a single treadmill training session on TUG performance in hemiparetic patients. Methods: In this randomized controlled clinical trial, 56 hemiparetic patients were randomized to 1 or 2 distinct groups: a single gait training session overground (O group) or on a treadmill (T group). Time taken to perform the TUG (in seconds) was assessed before and immediately after the completion of each session. Results: Time taken to perform the TUG decreased significantly, and to a similar extent, in both groups following the training session (O group, 5.9%; T group, 5.2%). Conclusions: An overground training session and a treadmill training session were equally effective in improving TUG performance in hemiparetic patients. Hemiparetic patients should be encouraged to walk regularly overground including turns for 20 minutes without stopping. This is an easy and inexpensive self-rehabilitation method to improve functional gait-related activities involved in the TUG test. [ABSTRACT FROM AUTHOR]

The mineral contamination of peat soils in the oil-production area differs considerably in the places of oil or stratal water spills. The time elapsed since the spill occurred is also an important factor of the changes in the chemical composition of the peat ash. The ash content rises drastically in the oil-contaminated peat, and the peat ash becomes rich in heavy metals (Mn, Ni, and Sr) and lanthanides (La and Ce). The content of K and Fe decreases, and that of P, S, Mg, Ca, Ni, and Pb increases with time at the site of old oil contamination. In the course of the self-rehabilitation of oil-contaminated peat, the content of Cl decreases more intensely than that of the heavier halogen Br. The ash content rises to a lesser extent in the peat contaminated with stratal water. The ash of the salinized peat is enriched in heavy alkaline-earth elements, i.e., Ba and Sr. Although most of the elements are leached with time, the content of Ba and Sr still remains 4-6 times higher than the background one even after long-term (more than 10 years) leaching. The concentrations of halogens rise considerably in the salinized peat, that of Cl in the peat ash decreases by 10 times, and the content of Ba virtually remains the same. [ABSTRACT FROM AUTHOR]

In the early years, Ernest Lawrence Rossi devoted himself to writing a series of books about hypnosis, including casebooks, manuals, and collections of papers. He next began developing a therapeutic approach that was responsive to mind-body interactions in the healing process. Along these lines, he published The Psychobiology of Mind-Body Healing; Mind-Body Therapy; The February Man; Ultradian Rhythms in Life Processes; The Symptom Path to Enlightenment; Dreams, Consciousness, Spirit; and most recently The Psychobiology of Gene Expression. It is in his latest work that Rossi presents the theory and research related to optimizing creativity and brain growth through an integrative approach that combines hypnosis, alternative medicine, and psychoimmunology. This presentation of his ideas represents the culmination of his life's work devoted to treating the mind-body connection in people's experiences. Rossi is based in Los Osos, California, where he maintains a private practice. [ABSTRACT FROM AUTHOR]

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Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands. Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation. Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5. Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes. Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.

• Adherence to the self-rehabilitation program targeting arm function was excellent. • Motor task quality and speed only improved in the self-rehabilitation group. • Improvement of WMFT time was clinically relevant in the self-rehabilitation group. • The difference between both groups was not statistically significant. Botulinum toxin injection (BTI) reduces muscle hyperactivity, but its effect on active upper-limb function is limited. Intensive rehabilitation could optimize the effects; however, outpatient post-stroke rehabilitation is usually not intensive. One solution could be self-rehabilitation. The aim of this randomized controlled trial was to determine the effect of a self-rehabilitation program combined with BTI on upper-limb function in individuals with chronic hemiparesis. In total, 33 outpatients were randomly allocated to receive BTI + self-rehabilitation (R group: n = 17) or BTI alone (C group: n = 16). Outcomes evaluated just before the BTI and 4 weeks later included the Wolf Motor Function Test (WMFT time: primary outcome), Action Research Arm Test, fatigue and quality of life. Change in WMFT did not differ between groups at 4 weeks (WMFT time: −14% for R group, −4% for C group. WFMT score: +12% for R group, 0% in C group). WFMT time and score improved significantly in the R group only (−14%, P = 0.01, and +12%, P = 0.02). In addition, the proportion of patients with improved WMFT time and score was higher in the R than C group (R group: 71% improved score, 77% improved time; C group: 43% improved score, 50% improved time). Also, passive range of shoulder flexion (P = 0.03) and wrist extension (P = 0.01) improved only in the R group. No other variables changed significantly. Compliance was excellent; average daily training time was greater than that prescribed. The addition of a self-rehabilitation program to BTI did not significantly improve functional outcomes more than BTI alone; however, movement quality and speed improved only in the self-rehabilitation group. Participants in the self-rehabilitation group trained more than they were asked to, which suggests that they found the program worthwhile. These clinically relevant findings justify larger-scale studies of the effects of self-rehabilitation to enhance the effects of BTI. Clinical trial: NCT02699762. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this review was to identify the evaluated effects of the use of biofeedback probes used in the self-rehabilitation of the pelvic floor muscles, on the muscle function, symptom severity, quality of life, and compliance/adherence to exercise for women with stress urinary incontinence., Material and Method: A literature review was conducted in March 2020 on the PubMed, PEDro and Science Direct databases., Results: A total of 3 randomised controlled trials (n=167 participants) were included and analysed. The different results found show significant improvements in muscle function with a percentage of 87.5% (P=0.003) of patients improved on the modified Oxford scale, as well as perineometry increasing from 23.06 to 32 (P=0.011). Symptom severity is also improved with a decrease in the number of pads and pad weight in the Pad Test (P<0.005). Concerning quality of life, significant improvements in the King's Health Questionnaire (KHQ) and the Visual Analogue Scale of Psychological Stress were found, with an improvement in the number of patients in each group at the end of the study (P<0.0005). No results showed a superiority of pelvic floor muscle training with a biofeedback probe compared to training alone., Conclusion: This review didn't provide real recommendations for the use of home biofeedback probes as an adjunct to pelvic floor muscle training in women with stress urinary incontinence. She suggests that the use of biofeedback probes wouldn't be more effective than training without them., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to "maintenance" rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year.Methods: One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician's prescription. The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections.Discussion: This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis.Trial Registration: ClinicalTrials.gov: NCT02202954 , July 29, 2014. [ABSTRACT FROM AUTHOR]