1,721,045 research outputs found
Transcranial Direct Current Stimulation (tDCS) in managing pain and recovery: A clinical case of radial capitellum fracture
Full text linkIntroduction: The management of pain and functional recovery following a radial capitellum fracture poses a significant clinical challenge, especially in individuals whose professions, such as physiotherapy, demand optimal joint functionality. Transcranial Direct Current Stimulation (tDCS) emerges as a potential nonpharmacological intervention for pain management, necessitating exploration in the context of orthopedic injuries.
Case presentation: A 41-year-old male physiotherapist presented with a MASON 2 radial capitellum fracture following a fall, experiencing notable pain (NPRS 6/7) and functional impairment (DASH 45/100, PRTEE 43/100). Conservative management, involving immobilization and potential surgical consideration, was employed, followed by tDCS for pain management. Post-tDCS, significant improvements were observed in pain and functional scores (NPRS to 0, DASH to 14.2, PRTEE to 7), alongside enhancements in range of motion and muscle strength.
Clinical discussion: The application of tDCS showcased notable efficacy in pain reduction and functional improvement, highlighting its potential in augmenting pain management strategies post-fracture. However, the variability in responses and lack of standardized application protocols necessitate further research to optimize its clinical utility. The balance between immobilization for fracture healing and mobilization for preventing stiffness and facilitating recovery was pivotal in managing the fracture and ensuring functional improvement.
Conclusions: This case underscores the potential of tDCS in managing pain and facilitating functional recovery in radial capitellum fractures, warranting further exploration and standardization of its application in clinical practice. The integrated, patient-centric approach, involving interdisciplinary collaboration and personalized care, was crucial in ensuring positive outcomes and provides a framework for managing similar orthopedic case
Role of customized insoles in improving foot biomechanics and posture in individuals with Down Syndrome a scoping review
No full textINTRODUCTION: Down Syndrome (DS) is a genetic disorder that affects approximately 1 in every 700 births worldwide, which is associated with a number of physical and DS patients are frequently affected by musculoskeletal problems related to generalized joint laxity, low muscle tone and high BMI. In particular, musculoskeletal foot disorders and flat feet (FF) are prevalent in DS patients and affect ambulation, foot biomechanics and posture. Foot orthoses (FO) have been proposed as a potential intervention to improve foot function and posture in children and adult affected by Down syndrome, although their effectiveness is unclear. The aim of this study was to map the evidence regarding the efficacy of FO on FF and, broadly, on foot biomechanics and posture in individuals with DS.
EVIDENCE ACQUISITION: Four databases (MEDLINE, Cochrane Central, Scopus, PEDro) were searched until May 2023. Only studies that considered FO were included. All interventions and contexts were considered. No restrictions were applied regarding language, study design and publication type. Grey literature and reference lists of included articles were not identified. The results were presented in numerical and thematic form.
EVIDENCE SYNTHESIS: From 32 initial registrations, 5 studies fulfilled the inclusion criteria. The results showed that FO are effective in improving foot biomechanics and posture. However, the quality of the evidence was generally low and further high-quality studies are needed to confirm these results.
CONCLUSIONS: This is the first scoping review to provide a comprehensive overview on the effectiveness of customized insoles in patients affected by Down syndrome. Customized insoles represent a non-invasive and low-cost intervention able to improve foot function and posture. Currently the quality of the evidence is limited, and further research is needed
A Decision-Making Tool for Prescribing Insoles in Daily Practice Using an Insole Prescription Form
No full textIntroduction
Plantar orthoses are widely used in the prevention and treatment of foot and lower-limb disorders. Plantar orthoses can generally be classified as prefabricated devices; however, many prefabricated devices can be customized. Customized orthotic insoles are usually prescribed with the goal of improving foot function. However, evidence that customized orthoses modify foot function in a predictable and dose-responsive manner is limited, and there is currently no consensus on how orthoses should be prescribed. Consequently, a high variability in orthotic prescriptions by physicians is observed. The aim of this study is to propose an orthotic insole prescription form (INSPECTOR) that is clear, easy, and replicable by all professionals involved.
Methods
All known clinical assessments and tests with high sensitivity and specificity indices, positive and negative predictive value, positive likelihood ratio, and negative likelihood ratio were included in the form.
Result
The result of this study is a form that guides the clinician step by step toward an appropriate and correct foot prescription.
Conclusions
INSPECTOR has several potential advantages; it is a step-by-step guide for the physician, starting with basic tasks such as anamnesis, functional prognosis, and prescription of the foot orthosis, and ending with the choice of the target area for the foot orthosis and the material to be used. The module lists scientifically validated and internationally recognized tests, making it understandable by professionals in all countries. Finally, it can reduce the differences between prescribed and finished orthopedic insoles, thus avoiding wasting money or material on reconstruction or construction
Integrating the Drucebo Effect into PM&R: Enhancing Outcomes through Expectation Management
No full textDrucebo Effect
A Decision-Making Tool To Prescribe Insole In Daily Practice: Inspector- insole Prescription Form
No full textClosing the Gaps: An Integrative Review of Yoga’s Benefits for Lymphedema in Breast Cancer Survivors
No full textBackground: Dissection of the axillary lymph nodes during surgery for breast cancer with lymph node involvement is burdened by a complication: lymphedema. Approximately half of women undergoing axillary dissection suffer from it, with a notable impact in terms of perceived discomfort, presented quality of life, and alteration of body image. There is also no shortage of problems in the patient’s social and professional life. Methods: The present review aims to select Randomized Controlled Trials (RCTs) present in the literature regarding the effects of yoga as an alternative therapy in patients with breast cancer-related lymphedema. A search of four databases was undertaken: Cochrane, Pubmed, Scopus, and Web of Science. The searches were conducted on 19 May 2024, and updated to 30 June 2024 without date limits. RCTs without language limitations, in any context, and with any yoga variant were considered. Results: The postulated search strings highlighted a total of 69 potentially eligible studies. The study selection system consisted of two levels of screening, (1) abstract selection and (2) full-text selection, for a total of three studies included in the review. The three RCTs included involved mixed treatment sessions in an outpatient setting with a yoga teacher and at home using a DVD. In the various studies, the outcome measures concerned quality of life, ROM, spinal mobility, limb volume, and tissue induration. Conclusions: According to the analysis of the data obtained, yoga as an alternative therapy could be useful if combined with the usual care routine in women with lymphedema related to sensory cancer, in terms of improving physical, professional, and emotional quality of life and reducing symptoms such as fatigue, pain, and insomnia. Furthermore, yoga could bring about a reduction in tissue induration of the limb, greater spinal mobility evaluated in terms of improvement of the pelvic and kyphotic angle, and greater strength in shoulder abduction
Functional approaches in tendinopathy rehabilitation: exploring the role of tendon neuroplastic training
No full textBackground
Achilles and patellar tendinopathies pose significant challenges due to their high prevalence and persistent symptoms, impacting athletes and active individuals alike. Traditional rehabilitation methods, primarily eccentric exercises, have shown limited efficacy, prompting reevaluation of treatment strategies. Emerging evidence suggests that central nervous system sensitization contributes to chronic tendon pain, necessitating interventions that address both tissue pathology and neurophysiological factors. Tendon neuroplastic training (TNT), incorporating heavy slow resistance training (HSR), offers a promising approach by targeting both aspects of tendinopathy.
Methods
A scoping review following the JBI methodology and PRISMA-ScR guidelines was conducted. Eligible studies focused on adults with chronic Achilles or patellar tendinopathy, comparing TNT with traditional load-based rehabilitation methods. Outcome measures included pain reduction, functional improvement, and neuroplasticity markers. Data were extracted and synthesized to assess the effectiveness of TNT in modifying central sensitization and improving clinical outcomes.
Results
Five studies met the inclusion criteria, comprising a randomized controlled trial (RCT), systematic reviews, and a cross-sectional study. RCT findings indicated comparable outcomes between HSR and eccentric exercises for Achilles tendinopathy, with higher patient satisfaction with HSR. Systematic reviews highlighted gaps in direct comparisons and emphasized the need for more studies on HSR. Studies also demonstrated the presence of central sensitization in tendinopathies, complicating treatment and recovery.
Conclusion
This review supports a comprehensive approach to tendinopathy treatment, integrating strategies addressing both tissue pathology and central sensitization. While HSR within TNT shows promise, further research with standardized protocols and direct comparisons is needed to optimize clinical outcomes
Decision-making in adhesive capsulitis: a comprehensive approach to the diagnosis and management of frozen shoulder
No full textAdhesive capsulitis, or frozen shoulder, presents diagnostic and therapeutic challenges due to its complex progression. This paper proposes a comprehensive approach to manage frozen shoulder, combining patient history, symptom analysis, physical examinations, diagnostic tests, and comorbidity assessments. A structured assessment tool aids healthcare professionals in accurate stage identification, promoting personalized treatment paths from conservative measures to invasive procedures. Emphasizing patient education, this methodology enhances adherence, fostering improved outcomes. This holistic framework aligns with evidence-based practice, ensuring effective diagnosis and management of this multifaceted condition
Harnessing Mirror Neurons: A New Frontier in Parkinson’s Disease Rehabilitation—A Scoping Review of the Literature
Full text linkBackground: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, and bradykinesia. Rehabilitation utilizing mirror neurons leverages the brain’s capacity for action observation (AO) and motor imagery (MI) to enhance motor function. This approach involves patients imitating movements observed in therapists or videos, aiming to improve gait, coordination, and overall quality of life. Mirror neuron activation facilitates motor learning and may decelerate disease progression, thus enhancing patient mobility and independence. Methods: This scoping review aimed to map current evidence on PD therapies employing mirror neuron-based rehabilitation. Databases searched included PubMed, PEDro, and Cochrane. The review included randomized controlled trials (RCTs) and systematic reviews that examined the effects of AO and MI in PD rehabilitation. Results: Five studies met the inclusion criteria, encompassing various rehabilitation techniques focusing on AO and MI. These studies consistently demonstrated positive outcomes, such as reduced disease severity and improved quality of life, gait, and balance in PD patients. The activation of mirror neurons through AO and MI was shown to facilitate motor learning and contribute to improved functional mobility. Conclusions: Although the included studies support the beneficial impact of AO and MI techniques in PD rehabilitation, numerous questions remain unresolved. Further research is necessary to evaluate the potential integration of these techniques into standard physiotherapy routines for PD patients. This review highlights the promise of AO and MI in enhancing motor rehabilitation for PD, suggesting the need for more comprehensive studies to validate and refine these therapeutic approaches
Focal Vibration Therapy for Motor Deficits and Spasticity Management in Post-Stroke Rehabilitation
No full textBackground: Focal mechanical vibration therapy has gained attention as a potential intervention to improve motor function while decreasing spasticity and pain in post-stroke patients. Despite promising results, there remains variability in study designs and outcomes, warranting a review of its clinical efficacy. Methods: A review was conducted to evaluate randomized controlled trials (RCTs) investigating the effects of focal mechanical vibration therapy on post-stroke rehabilitation. Six studies were included, assessing outcomes such as spasticity reduction (using the Modified Ashworth Scale), motor function recovery (Wolf Motor Function Test, Fugl-Meyer Assessment), and pain management (Visual Analog Scale, Numerical Rating Scale). The quality of studies was evaluated using the PEDro scale and RoB-2 tool. An overview review was conducted to provide a comprehensive analysis of the topic. Results: The included studies demonstrated significant reductions in spasticity and improvements in motor function in most patients receiving focal vibration therapy. Notable improvements were observed when focal vibration was combined with other rehabilitation techniques, such as progressive modular rebalancing or robotic rehabilitation. Pain levels were also reduced in several studies. However, differences in vibration parameters (frequency, amplitude), small sample sizes, and short follow-up periods limit the generalizability of the findings. Conclusions: Focal mechanical vibration therapy appears to be an effective adjunct in post-stroke rehabilitation, particularly for reducing spasticity and improving motor function. Although short-term benefits are promising, further research is required to determine long-term efficacy and optimal treatment parameters. This review evaluates the effectiveness of focal vibration therapy in treating motor deficits and spasticity in post-stroke patients. The results suggest its potential to improve these conditions, though further studies with larger sample sizes are needed to confirm its long-term efficacy
- …
