|CHAPTER 7: THE ORGANIZATIONS OF PHYSICAL AND REHABILITATION MEDICINE IN
|Year : 2019 | Volume
| Issue : 2 | Page : 104-106
6.1 Scientific background of physical and rehabilitation medicine: Biosciences in rehabilitation
Kristian Borg1, Christoph Gutenbrunner2, Boya Nugraha2
1 Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
2 Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany
|Date of Web Publication||11-Jun-2019|
Prof. Kristian Borg
Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Borg K, Gutenbrunner C, Nugraha B. 6.1 Scientific background of physical and rehabilitation medicine: Biosciences in rehabilitation. J Int Soc Phys Rehabil Med 2019;2, Suppl S1:104-6
|How to cite this URL:|
Borg K, Gutenbrunner C, Nugraha B. 6.1 Scientific background of physical and rehabilitation medicine: Biosciences in rehabilitation. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2019 Aug 20];2, Suppl S1:104-6. Available from: http://www.jisprm.org/text.asp?2019/2/2/104/259350
| Introduction|| |
The scientific background of some medical specialties is relatively easy to define as they are all limited to a specific organ. This is not the case for Physical and Rehabilitation Medicine (PRM). PRM is based on a biopsychosocial model of disability and according to the PRM-Section and Board of the European Union of Medical Specialists-PRM), PRM is defined as “an independent medical specialty concerned with the promotion of physical and cognitive functioning, activities (including behavior), participation (including quality of life), and modifying personal and environmental factors. It is, thus, responsible for the prevention, diagnosis, treatments, and rehabilitation management of people with disabling medical conditions and comorbidity across all ages.” This means that science within the medical specialty of PRM ranges from basic research on biological mechanisms of disease and interventions to studying societal aspects of participation. Consequently “from cell to society” was chosen the motto of the 16th European Congress of PRM in Brugge, Belgium in 2008 and became the basis of the ISPRM topic list for International PRM Conferences., Thus, scientific studies within PRM ranges from molecular to social science studies using different approaches and methods, including randomized controlled trials as well as qualitative studies. For that reason, science in PRM is performed by scientists with different professional training.
This subchapter focuses on biosciences in rehabilitation. The biosciences in rehabilitation identify targets for biomedical interventions to optimize body function and structure. Biosciences itself refer to study in basic science which includes molecule, genetic, neurobiology, physiology, and others to understand the pathomechanism, monitoring, and evaluation of diseases. Biosciences in rehabilitation include study pathomechanism of disease, injury, repair mechanism, and the effect of treatment. Biosciences in rehabilitation range from molecules (including genetics), animal model and human subjects both healthy and patients.
According to Nugraha et al. Biosciences in rehabilitation are described as “basic sciences that aim to explain body injury, adaptation and repair from the molecular to the cellular, organ system and organism level; and to identify targets for biomedical interventions to improve body functions and structures.”
| Molecules and Genetics in Biosciences in Rehabilitation|| |
Research findings in elucidating pathomechanisms have become an important part of the scientific field in PRM. For example, the role of immune cells in multiple sclerosis, regulation of pain by nonneuronal cells and inflammation, and mast cells in neuropathic pain. Even current trends include the microRNAs to be biomarkers of neurodegenerative disorders. These researches will support the deep understanding of pathomechanism of diseases and in the end, will lead to the best and effective treatment for the patients.
| Animal Experiment in Biosciences in Rehabilitation|| |
Animal model in the medical field is one of research series of translational medicine. Debates still and will occur when it comes to the relevant conclusions, due to the differences between animal and human. However, the animal model is important to the development and assessment novel therapies: Researches in animal model in rehabilitation include studies about pathomechanism of diseases and rehabilitation intervention both in healthy animal and diseases model. In animal model, the observations of the studies not only in alteration due to interventions at molecule level but also at functioning level, for example, gait analysis in animal stroke models and multiple sclerosis among others. For examples, animal model in rehabilitation includes research in stroke, and multiple sclerosis.
| Human Experiment in Biosciences in Rehabilitation|| |
As aforementioned, research in biosciences in rehabilitation is very diverse. It includes study pathomechanism in human experiment. One example for this is to study biomolecular mechanisms of pain and in particular what factors are involved in the development of chronic generalized pain.,,, Understanding changes at the molecular level may also help to develop effective interventions or treatments (such as aerobic exercise).
Another example for biosciences in rehabilitation intervention and related to molecular genetic research has, during the last decade, increased the accuracy of diagnosis as well as intervention in many of the conditions seen in PRM. Furthermore, genetic research has revealed that people with different genotypes have different potential for brain plasticity including physical and cognitive functions which underlines the notion of the need for tailored rehabilitation programs. People with different genotypes will react differently on physical and cognitive training and sometimes also react differently to pharmacological treatment. It is also important to recognize that the reverse, i.e., that the genetic expression is influenced by epigenetic factors which, in turn, may be influenced by physical activity and most probably also of different aspects of participation.
Increased knowledge of genetics and pathophysiology has led to easier ways of diagnosing disorders of the motor unit, for example, muscular dystrophy and has led to adequate advice for exercise improving the prognosis. Thus, the recommendation of physical activity in Duchenne muscular dystrophy has changed to that physical activity now is recommended.
In multiple sclerosis the knowledge of pathophysiology has led to pharmacological intervention resulting in dampening of the inflammatory activity and thus, in many cases, a better prognosis with amelioration of function, activity, and participation and thus, a possibility of more tailored rehabilitation programs.
Increased understanding of structural and functional effects of brain lesions, especially by means of modern techniques, i.e., modern neuroimaging have paved the way for improved prediction and individualized treatment interventions targeting modifiable determinants of outcome after stroke and traumatic brain injury.
Cardiovascular prevention and the development of thrombolysis have led to the improvement of stroke prognosis both for ischemic and hemorrhagic stroke as well prevention of stroke for example during atrial fibrillation. The insights of a somatic background for poststroke depression has led to more active treatment with an increased ability for rehabilitation to increase activity and participation of the individuals going through poststroke rehabilitation.
Another focus on biosciences is on understanding adaptation and repair mechanisms. This includes, for example, mechanisms of muscular adaptation to training and electrical stimulation and of sprouting von nerve axons after traumatic nerve lesions. It also concerns the mechanisms of tissues to react to thermal stimuli or biomolecular mechanisms of peripheral pain sensitization at the level of pain receptors. Last but not least functional adaptation of the whole organism after exercise and other physical treatment is relevant for the understanding of treatment in PRM. Last but not least, understanding the different mechanisms of neuroplasticity, have been useful to further develop treatments for patients with brain lesions, such as in the forced-induced exercises and mirror therapy.,
From these selected examples, it can be stressed that biosciences in rehabilitation become more and more relevant for the field of PRM. It will enable researchers to understand the pathomechanism of diseases related to disability as well as to develop innovative PRM treatments. In PRM congresses, this sector is continuously growing; however, it needs to be developed further and closely linked to the other areas of the PRM scientific field.
| Summary|| |
The scientific field of PRM in biosciences in rehabilitation is diverse, which includes molecular, animal model, and human subjects. The understanding of disease mechanisms will help the development of effective treatment, monitoring, and evaluation of diseases.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gutenbrunner CW, Chamberlain MA; Union Europeenne des Medecins Specialistes SoPRM, European Board of PRM, Academie Europeenne de Medecine de R, European Society for P, Rehabilitation M. White book on physical and rehabilitation medicine in Europe. Europa Medicophys 2006;42:292-332.
Gutenbrunner C, Ward AB, Li LS, Li J, Guzman M, Fialka-Moser V, et al.
Spectrum of topics for world congresses and other activities of the international society for physical and rehabilitation medicine (ISPRM): A first proposal. J Rehabil Med 2013;45:1-5.
Nugraha B, Paternostro-Sluga T, Schuhfried O, Stucki G, Franchignoni F, Abdul Latif L, et al.
Evaluation of the topic lists used in two world congresses (2015 and 2016) in physical and rehabilitation medicine. J Rehabil Med 2017;49:469-74.
Staun-Ram E, Miller A. Effector and regulatory B cells in multiple sclerosis. Clin Immunol 2017;184:11-25.
Ji RR, Chamessian A, Zhang YQ. Pain regulation by non-neuronal cells and inflammation. Science 2016;354:572-7.
Kaur G, Singh N, Jaggi AS. Mast cells in neuropathic pain: An increasing spectrum of their involvement in pathophysiology. Rev Neurosci 2017;28:759-66.
Karnati HK, Panigrahi MK, Gutti RK, Greig NH, Tamargo IA. MiRNAs: Key players in neurodegenerative disorders and epilepsy. J Alzheimers Dis 2015;48:563-80.
Barré-Sinoussi F, Montagutelli X. Animal models are essential to biological research: Issues and perspectives. Future Sci OA 2015;1:FSO63.
Ding Q, Triggs WJ, Kamath SM, Patten C. Short intracortical inhibition during voluntary movement reveals persistent impairment post-stroke. Front Neurol 2018;9:1105.
Tai YS, Yang SC, Hsieh YC, Huang YB, Wu PC, Tsai MJ, et al.
Anovel model for studying voltage-gated ion channel gene expression during reversible ischemic stroke. Int J Med Sci 2019;16:60-7.
Loy BD, Fling BW, Horak FB, Bourdette DN, Spain RI. Effects of lipoic acid on walking performance, gait, and balance in secondary progressive multiple sclerosis. Complement Ther Med 2018;41:169-74.
Nugraha B, Korallus C, Gutenbrunner C. Serum level of brain-derived neurotrophic factor in fibromyalgia syndrome correlates with depression but not anxiety. Neurochem Int 2013;62:281-6.
Nugraha B, Korallus C, Kielstein H, Gutenbrunner C. CD3+CD56+natural killer T cells in fibromyalgia syndrome patients: Association with the intensity of depression. Clin Exp Rheumatol 2013;31:S9-15.
Koca TT, Berk E, Seyithanoǧlu M, Koçyiǧit BF, Demirel A. Relationship of leptin, growth hormone, and insulin-like growth factor levels with body mass index and disease severity in patients with fibromyalgia syndrome. Acta Neurol Belg 2018. Available from: https://doi.org/10.1007/s13760-018-01063-6
[Epub ahead of print].
Kerr JI, Burri A. Genetic and epigenetic epidemiology of chronic widespread pain. J Pain Res 2017;10:2021-9.
King M, Kelly LP, Wallack EM, Hasan SM, Kirkland MC, Curtis ME, et al.
Serum levels of insulin-like growth factor-1 and brain-derived neurotrophic factor as potential recovery biomarkers in stroke. Neurol Res 2019;41:354-63.
Gondin J, Brocca L, Bellinzona E, D'Antona G, Maffiuletti NA, Miotti D, et al.
Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: A functional and proteomic analysis. J Appl Physiol (1985) 2011;110:433-50.
Menorca RM, Fussell TS, Elfar JC. Nerve physiology: Mechanisms of injury and recovery. Hand Clin 2013;29:317-30.
Hung CY, Tan CH. TRP channels in nociception and pathological pain. Adv Exp Med Biol 2018;1099:13-27.
Crum EO, Baltz MJ, Krause DA. The use of motor learning and neural plasticity in rehabilitation for ataxic hemiparesis: A case report. Physiother Theory Pract 2019:1-10. doi: 10.1080/09593985.2019.1566941. [Epub ahead of print].
Stewart JC, Cramer SC. Genetic variation and neuroplasticity: Role in rehabilitation after stroke. J Neurol Phys Ther 2017;41 Suppl 3:S17-23.
Guo F, Xu Q, Abo Salem HM, Yao Y, Lou J, Huang X, et al.
The neuronal correlates of mirror therapy: A functional magnetic resonance imaging study on mirror-induced visual illusions of ankle movements. Brain Res 2016;1639:186-93.
Austin MW, Ploughman M, Glynn L, Corbett D. Aerobic exercise effects on neuroprotection and brain repair following stroke: A systematic review and perspective. Neurosci Res 2014;87:8-15.