Positioning and function of secondary general hospital in community rehabilitation of disabled persons-a case study of a secondary general hospital in Changsha city

Objective:the positioning of secondary hospitals in the community rehabilitation work system and the status of community medical rehabilitation ser-vices for the disabled in Changsha were clarified through investigation and study of the 2019 income of a second-ary general hospital in Changsha.Suggestions from var-ious parties were integrated to provide feasible ideas for expanding the role of secondary hospitals in community rehabilitation.Methods:the 2019 income of a secondary general hospital in Changsha was statistically analyzed,a community rehabilitation questionnaire was designed,and a field survey was carried out focusing on 19 issues including rehabilitation service items,rehabilitation facil-ities and equipment,and the satisfaction of rehabilitation practitioners.Results:in the total hospitalization expenses of a secondary general hospital in Changsha city in 2019,rehabilitation physiotherapy expenses accounted for 7%,and drug treatment expenses accounted for 25%.In addi-tion,in the survey of community rehabilitation service sat-isfaction for the disabled,the difference between the very dissatisfied and very satisfied groups was statistically sig-nificant(P<0.05).Conclusion:taking a secondary gener-al hospital in Changsha city as an example,the treatment methods in secondary general hospitals are still dominated by traditional drug therapy,and the disabled are not sat-isfied with community rehabilitation services.Therefore,rehabilitation treatment projects to meet the rehabilitation needs of the disabled should be promoted in hospitals.

Cardiovascular rehabilitation in patients aged 70-year-old or older:benefits on functional capacity,physical activity and metabolic profile in younger vs.older patients

Background The benefits of exercise-based cardiac rehabilitation(EBCR)programs in post-acute myocardial infarction(AMI)patients have been demonstrated.Our aim was to assess the impact of EBCR in³70-years-old vs.younger post-AMI patients.Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol,twice a week during 6-12 weeks.We evaluated changes in several outcomes based on pre-and post-CRP assessments.Results Of a total of 1607 patients,333(21%)were³70-years-old.After the EBCR,an overall improvement on functional capacity,daily physical activity,lipid profile,body mass index,glycated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-pro-BNP)and C-reactive protein was observed in both younger and older patients(P<0.05).Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement,but a larger reduction in NT-pro-BNP.In the multivariate analysis,only improvements on daily physical activity and HbA1c were dependent on age.Conclusion As their younger counterparts,older patients,significantly improved functional capacity,metabolic parameters and level of daily physical activity after EBCR.

Tango-Therapy: An Alternative Approach in Early Rehabilitation of Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disorder of central nervous system (CNS), characterized by the presence of multifocal demyelination plaques with characteristic symptoms as fatigue, balance disorder, reduced endurance in gait and decrease in quality of life. The study supposed that the motor treatment through dance could represent useful therapeutic option, together with other treatments already in use such as the pharmacological and physiotherapy one. We included 9 person (6 male and 3 female) affected by relapsing-remitting multiple sclerosis (RRMS) with an expanded disability status scale (EDSS) score less than 3, underwent rehabilitation treatment with Argentine Tango (Riabilitango&reg;method). The study lasted twenty months, considering a sixty-minute session a week. The aim of the study was to verify the real improvement of quality of life, fatigue, balance disorder and gait endurance due to the dance treatment. We collected outcomes data of Short Form 36 (SF-36) in physical function (PF) (45.56 ± 21.42 vs. 69.44 ± 23.64), vitality (VT) (45.00 ± 7.90 vs. 67.77 ± 6.18), social function (SF) (54.00 ± 13.86 vs. 75.11 ± 6.25), general health (GH) (32.22 ± 5.06 vs. 54.11 ± 5.20);Modified fatigue impact test scales (MFSI) (3.56 ± 3.72 vs. 37.22 ± 3.88);Berg balance scale (BBS-it) (33.89 ± 4.12 vs. 45.11 ± 3.51);Six Minute Walk Test (6mWT), in distance (m) (352.89 ± 174.56 vs. 397.22 ± 174.83), oxygen saturation in arterial blood (%SpO2) (87.67 ± 3.35 vs. 91.78 ± 5.92) and beast per minute (bpm) (82.67 ± 13.08 vs. 72.67 ± 10.52). We found statistically significant (p In conclusion, despite the small sample size included, the results confirm that Riabilitango&reg;significantly leads to better functional performances in person affected by RRMS with EDSS less then 3, finding benefits in terms of quality of life. Data suggest that integration between dance treatment method and the pharmacological, could represent the useful approach.

An Integrated Rehabilitation Model: An Ideal Framework for Limiting Health Care Costs

The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.

Patients’ Expectations in a Geriatric Rehabilitation Ward: Matching with Actual Outcomes

Aim: Person-centered care is a core issue in rehabilitation;the study aims at: 1) enquiring the outcome expectations of patients in a geriatric rehabilitation ward;2) matching outcome expectations with actual outcomes. Methods: Expectations of 186 patients [79.4 (8.7) years, 70% females] analyzed through a questionnaire. 80.6% of patients were discharged home;functional recovery = 17.7 (22) points in Barthel Index total score, and 5 (4.2) points in Barthel Index walking subscore;also conditions with nursing needs improved significantly. Results: Patients’ expectations were coded as: functional (31.4%), overall (29.6%), and clinical improvement (21.5%), discharge home (7%);no answers or explicit lack of expectations (7.5%). Walking ability recovery differed according to outcome expectations. Highest improvements were achieved by patients wishing clinical improvement, followed by those expecting functional or overall improvement (5 points) [p = 0.009 (Welch)/p = 0.041 (Brown- Forsythe)];worst improvement in walking ability (2.8 points) were got by patients faulting or declaring explicit failure of expectations. Conditions with nursing needs improved most in those expecting clinical improvements [p = 0.029 (Brown-Forsythe)], and less in case of expectation default. No further matching was found. Conclusions: Improvement in actual outcomes matched expected improvements in two circumstances: recovery in walking ability and in conditions with nursing needs. The high yield of different favorable outcomes may have masked the statistical significance for correspondence between actual and expected results. Special attention is worthy towards patients short of expectations, as their actual outcomes result poorer.

Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms

Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.

Appropriateness of a Physiotherapic Treatment Protocol for the Axillary Web Syndrome, Applied in a Territorial Rehabilitation Service: Description of a Clinical Case

The “Axillary web syndrome” (AWS) is an early complication following breast cancer surgery with axillary lymph nodes dissection. Case Report: The patient is a 69-year-old woman, retired ex-employee, with outcome surgery right axillary lymphadenectomy with shoulder pain and functional limitation with diagnosis AWS it where it was recommended the physiotherapy. The patient had improvement in terms of shoulder function and pain and quality of life. Conclusions: The description of the clinical case afflicted with AWS and the treatment protocol applied, highlighted the good performance of the results, notably as concerns patient’s quality of life. This result could represent a starting point for creating clinical trials aimed at building appropriate rehabilitation route in territorial rehabilitation services.

Regional Interdependence: A Practical Guidance in Rehabilitation Clinic—Part 2

Background: This work has the purpose of describing a well standardized therapeutic path in reference to the article “Regional Interdependence: A model that needs to be integrated in the functional evaluation and Physiotherapy treatment—Part. 1,(doi.org/10.4236/ojtr.2016.43010)” in the form of practical guidance in reference to Figure A1. The approach we describe provides standardized techniques for each joint regional quadrant in order to be used in rehabilitation clinic. Therapeutic techniques will also be classified according to the type of maneuver as classified in the literature.

Persistent dysexecutive syndrome after pneumococcal meningitis complicated by recurrent ischemic strokes:A case report

Meningitis is a possible complication of pneumococcal infection concerning acute otitis media and sinusitis.It might compromise cognitive function,both for the infection itself and the vascular events that sometimes follow the acute phase.CASE SUMMARY Here we describe the case of a 32-year-old female patient admitted to the emergency room due to extensive pneumococcal meningitis as a consequence of sinus outbreak.She presented with extensive laminar ischemic damage in the acute phase,resulting in severe cognitive and behavioural impairment.Four years of follow-up,through neuropsychological assessments and neuroradiological investigations,demonstrated the presence of subsequent vascular events,3 months and 2 years after onset.CONCLUSION The case is discussed in light of scientific knowledge of the long-term outcomes of this pathology in order to potentially improve diagnosis and promote better outcomes.

Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects

AIM: To assess the long-term effects of physical activity on irritable bowel syndrome(IBS) symptoms and on quality of life, fatigue, depression and anxiety.METHODS: Seventy-six patients from a previous randomized controlled interventional study on increased physical activity in IBS were asked to participate in this long-term follow-up study. The included patients attended one visit in which they filled out questionnaires and they underwent a submaximal cycle ergometer test. The primary end point was the change in the IBS Severity Scoring System(IBS-SSS) at baseline, i.e., before the intervention and at follow-up. The secondary endpoints were changes in quality of life, fatigue, depression and anxiety.RESULTS: A total of 39 [32 women, median age 45(28-61) years] patients were included in this followup. Median follow-up time was 5.2(range: 3.8-6.2) years. The IBS symptoms were improved compared with baseline [IBS-SSS: 276(169-360) vs 218(82-328), P = 0.001]. This was also true for the majority of the dimensions of psychological symptoms such as disease specific quality of life, fatigue, depression and anxiety. The reported time of physical activity during the week before the visit had increased from 3.2(0.0-10.0) h at baseline to 5.2(0.0-15.0) h at follow-up, P = 0.019. The most common activities reported were walking, aerobics and cycling. There was no significant difference in the oxygen uptake 31.8(19.7-45.8) m L per min per kg at baseline vs 34.6(19.0-54.6) m L/min per kg at follow-up.CONCLUSION: An intervention to increase physical activity has positive long-term effects on IBS symptoms and psychological symptoms.

Plasma brain natriuretic peptide level in older outpatients with heart failure is associated with physical frailty, especially with the slowness domain

ObjectiveTo 决定在血浆大脑 natriuretic 之间的协会在有心失败( HF )和物理脆弱以及与心血管的药的 106 个门诊病人变老的物理 frailty.MethodsTwo 的每个领域的病人的肽( BNP )水平60岁以上为 HF 被就医了或被给了一为 HF 的药方药被包括。物理脆弱用下列五个领域被估计：缓慢，软弱，疲劳，低活动，并且缩小，根据心血管的健康学习。病人们根据脆弱分数被划分成 nonfrailty 和脆弱组。血浆 BNP 水平被测量。6-min 散步测试被执行测量 endurance.ResultsPlasma BNP 在二个组之间是显著地不同的(脆弱组：158.0 &#x000b1；214.7 pg/mL， nonfrailty 组：65.2 &#x000b1；88.0 pg/mL， P &#x0003c；0.01 ) 。Multivariate 逻辑回归分析表明转变木头的血浆 BNP (木头 BNP ) 显著地与物理脆弱被联系(或：1.68， 95% CI：1.11-2.56 ) ，并且木头 BNP 显著地与缓慢领域被联系(走的速度 &#x0003c；1.0 m/s ) 物理脆弱(或：1.75， 95% CI：1.15-2.67 ) 。另外，木头 BNP 否定地被相关到 6 分钟的散步距离(6MWD )(&#x003c1；=&#x02212； 0.37， P &#x0003c；0.01 ) ，当 6MWD 断然被相关到走速度时(&#x003c1；= 0.66， P &#x0003c；0.01 ).ConclusionsPlasma BNP 水平与物理脆弱有关，特别在缓慢领域。耐力可以在在血浆 BNP 水平和走的速度之间的协会干涉。

Osteopathic manipulative treatment and nutrition: An alternative approach to the irritable bowel syndrome

A simple treatment plan for manual therapists is presented based on current evidence-based literature, it is designed to lessen chronic pain and inflammation in the Irritable Bowel Syndrome (IBS). A chronic continuous or intermittent gastrointestinal tract dysfunction, IBS appears due to dysregulation of brain-gut-microbe communication. An overview of its management using Osteopathic Manipulative Treatment (OMT) is described. In IBS OMT focuses on the nervous and circulatory systems, spine, viscera, thoracic and pelvic diaphragms in order to restore homeostatic balance, normalize autonomic activity in the intestine, promote lymphatic flow and address somatic dysfunction. Lymphatic and venous congestion is treated by the Lymphatic Pump Techniques and stimulation of Chapman’s Reflex Points. The food itself, food allergies and intolerance could contribute to symptom onset or even cause IBS. Furthermore the “microbiota” greatly impacts on the bi-directional brain-gut axis communication. This paper also provides appropriate dietary modifications for patients with IBS.

Selective dorsal rhizotomy in cerebral palsy spasticity-a newly established operative technique in Slovenia: A case report and review of literature

BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.

Takotsubo syndrome presenting with left bundle branch block in an octogenarian.Is hyponatremia a pathogeni c“common ground”?

Takotsubo syndrome(TTS)is a cardiovas-cular condition characterized by a transi-ent cardiac dysfunction,generally invol-ving the apical segments of left ventriculum,in ab-sence of significant coronary artery disease.[1]It fre-quently affects postmenopausal women,following physical or psychological stress.[2]TTS often mimicks an acute myocardial infarction(AMI),presenting with symptoms as chest pain,dys-pnea,palpitations and,less commonly,pre-syncope and syncope.

Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Part 1

The Complementary and Alternative Medicine Education (EDUCAM) School of Osteopathy, following the earthquake that occurred in Amatrice-Italy on August 24th 2016, promoted the project “Una mano per la salute” [One hand for health], aimed at giving therapeutic support to the population affected by this cataclysm. A review of the literature in the osteopathic field has been performed to identify a more functional approach to quickly relieve the inhabitants from the shock they suffered, and to identify the techniques with greater effectiveness on the stress axis. The protocol of ten chosen techniques will then be verified later in a pilot study, to check whether and how a protocol of osteopathic manipulative treatment (OMT) might play a clinically relevant role in the management of subjects exposed to extraordinary exogenous stress and post-traumatic stress disorder (PTSD) prevention, in addition to the psychological therapy treatments in use today.

Regional Interdependence: A Model That Needs to Be Integrated in the Functional Evaluation and Physiotherapy Treatment—Part 1

Background: Rehabilitation is increasing the need to use codes in order to make both a functional diagnosis and a therapeutic intervention as correct and targeted as possible. Thus, it is very important to integrate the model of Regional Interdependence (RI) in the classical rehabilitation evaluation methods, since it will be of help for understanding, solving dysfunctional problems, and improving the patient management, which is often difficult given the fact that there is no concordance on functional tests and timing of treatments. The RI should be added to the functional evaluation each time that a patient presents symptoms in a specific location, which interest also distal regions. This is due to the functional and anatomical connections of the myofascial system, vascular, autonomic nervous system (ANS), the peripheral nervous system (PNS) and the neuro-immunoendocrine system. The RI can be summarized into three groups that are correlated when it comes to applying it practically: upper, bottom and front quadrant. Adding the concept of RI to the clinical and therapeutically practice, it would have positive effects on improving the quality of life and allocate better health’s resources. The aim of this paper is to make the functional assessment in clinical practice faster and more standardized.

Hyperbaric Oxygen Therapy: Focus

Hyperbaric oxygen therapy is now an integral part of the current therapeutic arsenal, it is a treatment that has a large number of indications and which concerns several specialties. This development aims to summarize some main indications.

Tremendous Improvement of the Functional Capacity in Patient with Chronic Heart Failure after 12-Weeks of Exercise Training Program

Cardiac rehabilitation is recommended for patients with chronic heart failure (CHF) with preserved, or reduced left ventricular ejection fraction (LVEF). A cardiac rehabilitation program generally includes physical exercise, diet counseling, educational classes on lifestyle changes, and disease management as well as psychosocial support for patients and their families. Exercise training is a core component of the comprehensive cardiac rehabilitation program and is strongly recommended in combination with pharmacological treatment to patients with CHF, due to cardiorespiratory, metabolic, and autonomic cardiac response. Exercise-based cardiac rehabilitation affects positively functional capacity, exercise tolerance, and quality of life in CHF patients. The physical inactivity rate in Arabian Peninsula countries is extremely high, and exercise training of habitually physically inactive individuals should result in marked improvements of physical capacity. We present a case that demonstrates such a significant improvement in the physical capacity of a patient with CHF and a review of literature.

抑郁强度量表环(DISCs):用于脑损伤后抑郁最初评估的简单工具

Objective: To assess the validity, responsiveness, and test-retest reliability of DISCs (Depression Intensity Scale Circles) as a simple screening tool for depression in patients with cognitive or communicative deficits following acquired brain injury. Design: Cohort analysis of consecutive patients entered into an integrated care pathway for screening and management of depression in the context of rehabilitation. Setting: Regional neurological rehabilitation service in the UK. Participants: 114 patients with complex disabilities caused by acquired brain injury (mean (SD) age, 42.8 (14.5) years). Main outcome measures: DISCs (a graphic rating scale depicting six circles with increasing proportion of dark shading), Numbered Graphic Rating Scale (NGRS), Yale single question (“Do you often feel sad or depressed”), Beck Depression Inventory-II (BDI-II), DSM-IV criteria for depression. Results: At initial assessment the DISCs correlated with total BDI-II scores (Spearman ρ= 0.66, P < 0.001), NGRS (ρ= 0.87, P < 0.001), and DSM-IV (ρ= 0.59, P < 0.001).A DISCs score≥2 identified depression (major or minor) according to DSM-IV criteria with 60%sensitivity, 87%specificity, 75%positive predictive value, and 77%negative predictive value. Test-retest reliability after 24 hours (n = 66) showed“excellent”.level of agreement (weighted κ= 0.84). In 45 patients who received intervention for depression, the DISCs showed a significant change in response to treatment (Wilcoxon; P < 0.001). Conclusions: DISCs had acceptable convergent validity, reliability, and responsiveness as a simple graded tool for screening and assessment of depression in patients with complex disabilities following acquired brain injury. It warrants further investigation in patients with more profound language and cognitive deficits for which it is primarily intended.

Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Brief and Useful Guide—Part 2

This work aims to describe a well standardized therapeutic path in reference to the article “Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Part 1 in the form of a practical guide for manual therapist, Open Journal of Therapy and Rehabilitation, Vol. 10, No. 7, July 2018, https://doi.org/10.4236/health.2018.107074”. The osteopathic manipulative treatment (OMT) approach we propose can be complementary to the psychological therapy in use today, and consists of ten standardized techniques directed to the anatomical structures more involved in the stress answer. This protocol was designed to improve and sustain the management of subjects exposed to extraordinary exogenous stress or post-traumatic stress disorder patients (PTSD).