Lateral elbow tendinopathy: Evidence of physiotherapy management

Lateral elbow tendinopathy(LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation.

Slacklining and stroke: A rehabilitation case study considering balance and lower limb weakness

To ascertain the effectiveness of slacklining as a supplementary therapy for elderly stroke patients who are functionally non-progressing. This case study involved an 18-mo prospective observation of the management of an 87-year-old female stroke-patient of the left hemisphere with reduced balance, reduced lower limb muscular activation, hypertonia, and concurrent postural deficits. This entailed the initial acute care phase through to discharge to home and 18-mo final status in her original independent living setting. The introduction of slacklining as an adjunct therapy was made 12 mo post incident. Slacklining involves balance retention on a tightened band where external environmental changes cause a whole-body dynamic response to retain equilibrium. It is a complex neuromechanical task enabling individualized self-developed response strategies to be learned and adapted. This facilitates the innate process of balance retention, lower-limb and core muscle activation, and stable posture through a combination of learned motor skills and neurological system down regulation. Individuals adopt and follow established sequential motor learning stages where the acquired balance skillsare achieved in a challenging composite-chain activity. Slacklining could be considered an adjunct therapy for lower limb stroke rehabilitation where function is compromised due to decreased muscle recruitment, decreased postural control and compromised balance. Initial inpatient rehabilitation involved one-month acute-care, one-month rehabilitation, and one-month transitional care prior to home discharge. A further six months of intensive outpatient rehabilitation was provided with five hourly sessions per week including:supervised and self-managed hydrotherapy, plus one individual and two group falls' prevention sessions. These were supported by daily home exercises. At 12 mo post incident, recovery plateaued, then regressed following three falls. Rehabilitation was subsequently modified with the hydrotherapy retained and the group sessions replaced with an additional individual session supplemented with slacklining. The slacklining followed stages one and two of a standardized five-stage protocol. Self-reported functional progression resumed with improvement by 14 mo which further increased and was sustained 18 mo(Students' t test P < 0.05). Slacklining's external stimulations activate global-body responses through innate balance, optimal postural and potentially down-regulated reflex control. Incorporated into stroke rehabilitation programs, slacklining can provide measurable functional gains.

Exercise for tendinopathy

Tendinopathies are one of the most common sports/musculoskeletal injury in modern western societies.Many physiotherapy approaches have been recommended in the literature for the management of tendinopathy.The most effective treatment in the management of tendinopathy is the eccentric training.Load,speed and frequency of contractions are the three principles of eccentric exercises,discussed in this report.However,eccentric training is not effective for all patients withtendinopathy and the effectiveness of this approach when applied as monotherapy is lower than it is applied as part of the rehabilitation process.For this reason,clinicians combine eccentric training with other physiotherapy techniques such as stretching,isometric and lumbar stability exercises,electrotherapy,manual therapy,soft tissue manipulation techniques,taping and acupuncture in the management of tendinopathies.Further research is needed to find out which treatment strategy combined with eccentric training will provide the best results in the rehabilitation of tendinopathy.

A New Approach to Reducing Mortality from Dengue

In 2009, based on a multicenter study conducted in Asia and Latin Americaand subsidized by the Dengue Control (DENCO) Research Program, the World Health Organization (WHO) proposed a new classification for dengue cases. The purpose of the present study was to evaluate the applicability of the new classification, relative to its previous version [1]. The evaluation, conducted in Campo Grande county, Mato Grosso do Sul state, Brazil, drew on secondary data from referral healthcare centers that assist high-severity dengue patients. A total of 156 medical records of patients with laboratory diagnosis of dengue were investigated. The records covered two epidemic periods: summer of 2006-2007 and summer of 2009-2010. The results showed that 64.6% of cases classified as dengue fever under the 1997 criteria presented manifestations of severity, warranting their reclassification as dengue with warning signs (49) or severe dengue (15) under the 2009 revised criteria. Bleeding, persistent vomiting, and severe, continuous abdominal pain were the most prevalent warning signs, indicative of risk of progression to severe disease. The revised classification was proved less complex than the current version, facilitating the identification of cases and the clinical management of patients.