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Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery.

Abstract Title: Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery. Abstract Source: Disabil Rehabil. 2012 Apr 23. Epub 2012 Apr 23. PMID: 22524794 Abstract Author(s): Norine Foley, J Andrew McClure, Matthew Meyer, Katherine Salter, Yves Bureau, Robert Teasell Article Affiliation: Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute , Parkwood Hospital site, London, Ontario , Canada. Abstract: Purpose: Canada's Best Practice Recommendations for Stroke Care state that a minimum of one hour per day of each of the relevant core therapies be provided to patients admitted for inpatient rehabilitation. We examined whether this standard was met on a single, specialized stroke rehabilitation unit and if amount of therapy was an independent contributor to functional improvement. Methods: One-hundred and twenty-three, consecutive patients admitted to a 30-bed stroke rehabilitation program over a 6-month period with the confirmed diagnosis of stroke, were included. Workload measurement data were used to estimate the amount of therapy that patients received from core therapists during their inpatient stay. A multivariable model to predict Functional Independence Measure (FIM) gains achieved was also developed using variables that were significantly correlated with functional gain on univariate analysis. Results: On average, patients received 37 min of active therapy from both physiotherapists (PT) and occupational therapists (OT) and 13 min from speech-language pathologists per day. Admission FIM, length of stay, total OT and PT therapy time (hrs) were significantly correlated with FIM gain. In the final model, which explained 35% of the variance, admission FIM score and total amount of occupational therapy (OT) emerged as significant predictors of FIM gain. Conclusions: Patients admitted to a specialized rehabilitation unit received an average of 37 min a day engaged in therapeutic activities with both occupational and physical therapists. Although this value did not reach the standard of one hour, total amount of OT time contributed significantly to gains in FIM points during hospital stay. [Box: see text]. Article Published Date : Apr 22, 2012
Therapeutic Actions Occupational Therapy

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Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center†.

Related Articles Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center†. Disabil Rehabil. 2018 Oct 17;:1-6 Authors: Crevenna R, Kainberger F, Wiltschke C, Marosi C, Wolzt M, Cenik F, Keilani M Abstract BACKGROUND: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well. METHODS: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria. RESULTS: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning. CONCLUSIONS: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation. Implications for rehabilitation Cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participation Cancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workability The field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation Interventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum. PMID: 30328719 [PubMed - as supplied by publisher]

Intramuscular innervation of the subscapularis muscle and its clinical implication for the BoNT injection: An anatomical study using the modified Sihler's staining.

Related Articles Intramuscular innervation of the subscapularis muscle and its clinical implication for the BoNT injection: An anatomical study using the modified Sihler's staining. Clin Anat. 2018 Oct 17;: Authors: Cho TH, Kwon HJ, Choi YJ, O J, Won SY, Yang HM Abstract INTRODUCTION: Shoulder pain is commonly associated with spasticity of the rotator cuff muscles including the subscapularis (SSC). The aim of this study was to elucidate the intramuscular innervation pattern of the SSC using the modified Sihler's staining technique in order to facilitate the targeting of botulinum neurotoxin (BoNT) injections to alleviate shoulder spasticity,. MATERIALS AND METHODS: Ten SSC specimens (mean age, 81.5 years) were used in this study. Modified Sihler's staining was used to clarify the muscle and to stain the intramuscular nerves. Their extra- and intra-muscular innervation patterns were examined. RESULTS: The upper subscapular, lower subscapular, thoracodorsal and axillary nerves (USN, LSN, TDN, and AXN) innervated the SSC in 100%, 80%, 20% and 40% of specimens, respectively. There was an anastomosis between the USN and LSN in the central portion of the SSC in more than half of the cases. The USN innervated the overall portion of the muscle. In contrast, the additional branches from the TDN and AXN innervated the inferior SSC portion. The superficial branches of the USN were mostly distributed in the superior SSC portion while the deep branches were distributed in the inferior portion. As a major intramuscular nerve within the SSC, the USN should be targeted by a BoNT injection. Regarding the USN distribution, the aim should be to spread the BoNT injectate within the central SSC portion. For supplementary injection to the AXN, the lateral approach would be more appropriate than alternatives. CONCLUSION: A physician performing a BoNT injection should consider the intramuscular innervation of the SSC portion. This article is protected by copyright. All rights reserved. PMID: 30328146 [PubMed - as supplied by publisher]

Organized Sport Participation From Childhood to Adolescence Is Associated With Bone Mass in Young Adults From the Raine Study.

Related Articles Organized Sport Participation From Childhood to Adolescence Is Associated With Bone Mass in Young Adults From the Raine Study. J Bone Miner Res. 2018 Oct 17;: Authors: McVeigh JA, Howie EK, Zhu K, Walsh JP, Straker L Abstract There is a critical need for longitudinal cohort studies to consider the association of the cumulative exposure of physical activity during childhood and adolescence and bone mass. The aim of this study was to investigate the relationship between organized sports trajectories (that capture distinct and potentially meaningful patterns over critical developmental periods) and bone mass at age 20 years. Participation in organized sport was recorded by parental report at ages 5, 8, 10, 14, and 17 years in 984 offspring (48% female) of a pregnancy cohort (Raine Study). Latent class analysis identified three trajectory classes in each sex. In females, these were "consistent sport participators" (48%), "dropouts" (34%), and "non-participators" (18%); in males, "consistent sport participators" (55%), "dropouts" (37%), and "sport joiners" (8%). Whole-body bone mineral content (BMC) at age 20 years was assessed by dual-energy X-ray absorptiometry (DXA). At age 20 years, after adjustment for covariates measured at age 20 years, including height, lean mass, physical activity, calcium intake, serum 25-hydroxyvitamin D, alcohol, and smoking, males who were "consistent sport participators" had significantly greater whole-body and leg BMC than those who dropped out of sport (p < 0.001), whereas males who joined sports had significantly greater leg BMC than those who dropped out of sport (p = 0.002). Females in the "consistent sport participator" trajectory had significantly greater leg BMC than those who dropped out (all p = 0.004). Participation in organized sport during childhood and adolescence is associated with bone mass at age 20 years. Because attainment of optimal peak bone mass in young adulthood is protective against osteoporosis in later life, this may have long-term skeletal benefits. © 2018 American Society for Bone and Mineral Research. PMID: 30328145 [PubMed - as supplied by publisher]

Evaluation of the Clinical Learning Environment in Respiratory Therapy Education: Student Perceptions.

Related Articles Evaluation of the Clinical Learning Environment in Respiratory Therapy Education: Student Perceptions. Respir Care. 2018 Oct 16;: Authors: Alghamdi SM, Siraj RA, Ari A Abstract BACKGROUND: Clinical facilities are essential components not only of health care delivery systems, but also of health care education programs. The clinical learning environment (CLE) is important in training the future health care workforce. Because respiratory therapy (RT) is a practice-based profession, it is essential to integrate clinical education into RT education. RT education programs face several issues with respect to the need for preparing a proper CLE in various clinical settings. The purpose of this study was to determine the perceptions of RT students on the CLE of clinical facilities affiliated with an RT program at an urban state university and to determine the impact of education level on student perception of the CLE of clinical facilities. METHODS: We used an exploratory research design to evaluate the essential aspects of a CLE in RT education. An adapted Clinical Learning Environment Supervision and Nurse Teacher (CLES+T) evaluation scale was utilized to evaluate 34 RT students' perceptions of clinical facilities in RT education; 32 students participated in the survey, with a response rate of 94.1%. RESULTS: Responses included 2 groups of students: second-year undergraduates (68.8%), in which women accounted for 81% and men 19%, and graduate students (31.2%), in which women accounted for 60% and men 40%. Results obtained from the study indicated that both graduate and undergraduate RT students gave high median scores to the CLE, the supervisory relationship, and the role of clinical instructors. A statistically significant difference was obtained between the graduate and undergraduate students regarding multidimensional learning (P = .043). We found that the majority of students positively rated the CLE in RT education. CONCLUSIONS: Education level influenced students' perceptions of the CLE of clinical facilities. Overall, respiratory therapy students rated their CLE experiences as positive and they were satisfied with the clinical instructor and team model. PMID: 30327336 [PubMed - as supplied by publisher]

Successful Management of Pregnancy in a Patient with Systemic Lupus Erythematosus-associated Pulmonary Arterial Hypertension.

Related Articles Successful Management of Pregnancy in a Patient with Systemic Lupus Erythematosus-associated Pulmonary Arterial Hypertension. Intern Med. 2018 Jun 01;57(11):1655-1659 Authors: Kawabe A, Nakano K, Aiko Y, Aramaki S, Onoue T, Okura D, Tanaka Y Abstract Pregnancy in women with systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH) remains a high risk. We successfully managed a pregnancy in a patient with SLE-PAH. A 31-year-old pregnant woman with SLE-PAH had worsening PAH and SLE flare-up during pregnancy and a sudden increase in pulmonary arterial pressure after delivery. SLE-PAH was controlled by continuous intravenous epoprostenol and inhaled nitric oxide therapy combined with high-dose corticosteroids under close hemodynamic monitoring. Women with SLE-PAH should avoid pregnancy. However, in case of a similar event, we recommend our case as a good reference for improving the outcome of pregnancy with SLE-PAH. PMID: 29321410 [PubMed - indexed for MEDLINE]

[Medical care of patients with spasticity following stroke : Evaluation of the treatment situation in Germany with focus on the use of botulinum toxin].

Related Articles [Medical care of patients with spasticity following stroke : Evaluation of the treatment situation in Germany with focus on the use of botulinum toxin]. Nervenarzt. 2017 Aug;88(8):919-928 Authors: Kerkemeyer L, Lux G, Walendzik A, Wasem J, Neumann A Abstract BACKGROUND: Upper limb spasticity is a common complication following stroke. Cohort studies found 19% of post-stroke patients had upper limb spasticity at 3 months and 38% of patients at 12 months. For focal spasticity, intramuscular injections of botulinum toxin are indicated. In Germany, it is assumed that patients with the described indication are undersupplied with botulinum toxin. OBJECTIVE: The aim of the present study is to evaluate the medical care of patients with upper limb spasticity post-stroke with the focus on the use of botulinum toxin as one treatment option. METHODS: A standardized questionnaire was developed and a postal survey of a representative national random sample of 800 neurologists to capture the actual medical care situation. RESULTS: The response rate amounted to 37% (n = 292). 59% of the neurologists surveyed had never used botulinum toxin. In total, 87% of neurologists noticed barriers regarding the use of botulinum toxin, where the amount of the doctor's remuneration in 40% and the lack of reimbursement of costs in off-label use in 60% were the most commonly used answers. The achievement of an advanced training in using botulinum toxin was also stated as a general obstacle for resident neurologists. DISCUSSION: Due to a response rate of 37% for the postal survey a selection bias cannot be excluded. Although botulinum toxin is recommended in the national treatment guidelines, many neurologists do not use botulinum toxin. The reasons can be seen from the barriers described. PMID: 28289789 [PubMed - indexed for MEDLINE]