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   2021| April-June  | Volume 4 | Issue 2  
    Online since June 8, 2021

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Outcomes after acute inpatient rehabilitation following epilepsy surgery: A case series
David Sherwood, Alan Tran, Benjamin Gill, Benjamin Westerhaus, Alexandra Arickx, Patrick Landazuri, Sarah Eickmeyer
April-June 2021, 4(2):77-81
Objective: To describe functional outcomes following discharge from an acute inpatient rehabilitation facility (IRF) in patients following epilepsy surgery, comparing laser interstitial thermal therapy (LITT) versus surgical resection for epilepsy. Design: Retrospective case series. Setting: Academic tertiary hospital. Participants: Eight patients who received LITT (n = 3) or surgical resection (n = 5) for epilepsy. Interventions: Acute inpatient rehabilitation. Main Outcome Measures: Functional independence measure (FIM), seizure incidence, discharge destination. Level of Evidence: IV. Results: The epilepsy cohort demonstrated a FIM change of 38.88 (vs. national average 29.55), average length of stay (LOS) of 15.13 days (vs. 13.38 days), and LOS efficiency was 3.4 (vs. 2.68). No patients in the epilepsy cohort were discharged to acute care hospital compared to a national average of 9.82%. Eighty-seven percent in the epilepsy cohort discharged to home (vs. 77%) and 12.5% to skilled nursing facility (vs. 11.90%). Between the subset who received LITT and those who received surgical resection, there was no statistically significant change in mean total FIM change (43.7 vs. 36), FIM efficiency (5.3 vs. 2.2), or FIM change in subset measures of memory (0.5 vs. 0.25) or problem solving (0 vs. 0.8). There was no statistical significance between groups in adverse events, including seizure. Conclusions: Outcome measures in this population appear to be consistent with national outcome measures for other IRF diagnoses. This suggests that acute inpatient rehabilitation should be considered after patients undergo surgical intervention for epilepsy. However, a larger sample size and controlled studies are necessary before generalizations can be made. In addition, no statistically significant functional difference was seen between patients who underwent LITT or surgical resection.
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2019 Sidney Licht lecture: Spasticity and related neuro-orthopedic deformities: A core topic in physical and rehabilitation medicine
Isabelle Laffont
April-June 2021, 4(2):51-57
Neuro-orthopedics refers to limb and spine deformities related to various neurological diseases, mostly in a context of spastic disorders. Physical and rehabilitation medicine (PRM) specialists are familiar with these deformities that often lead to functional consequences. It is crucial in our specialty to focus on their prevention and management. A better understanding of the musculoskeletal and neurological physiopathology underlying these phenomena has enabled physicians to improve their prevention and treatment approaches. The clinical assessment of spastic and neuro-orthopedic deformities, based on a rigorous anatomical and physiological knowledge, is deeply rooted in our PRM clinical examination. The evaluation of their functional consequences relies on a patient-centered approach including detailed analysis of gait and upper limb function. There is an increased relevance of motor nerve blocks, dynamic electromyography, and motion analysis in these indications. The treatment of spasticity and its sequelae is emblematic of PRM care due to an integrative multimodal approach including rehabilitation, pharmacological treatments, local management like botulinum toxin injections, and microinvasive or conventional surgery in a multidisciplinary perspective. Finally, spasticity and neuro-orthopedics represent an incredible field of research for the future of PRM, covering basic science, nonpharmacological and pharmacological studies, surgical procedure improvements, and technological developments (neuromodulation, functional electrical stimulation, and robotics).
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Multidisciplinary management of musculoskeletal pain during pregnancy: A review of literature
Valeska Beatrice Ferreira, Leandro Ryuchi Iuamoto, Wu Tu Hsing
April-June 2021, 4(2):63-69
Introduction: Women may have higher prevalence of musculoskeletal chronic pain than men. Some studies suggest that biomechanical changes during pregnancy are related to elevated chronic pain prevalence. Objectives: The objective of this study is to conduct a review of studies involving strategies in multidisciplinary rehabilitation for musculoskeletal pain management during the pregnancy and the postpartum period. Methodology: The elaboration of the scientific question considered pregnant patients (population), rehabilitation with multidisciplinary team (intervention), without any comparatives, and pain management in any region of the body (outcome). The research was conducted in the databases: Medline (via PubMed) - www.pubmed.com and EMBASE - www.embase.com. Results: A total of 972 articles were found. Only two articles were related to rehabilitation with a multidisciplinary team for the management of pain in pregnant women. These articles were selected based on their relevance and data update. Conclusion: Although the literature has well established the cost-effectiveness of using multidisciplinary strategies for chronic pain control and intervention in its factors, there are no well-defined protocols for the application of these strategies in pregnant women, as shown by the scarcity of studies found on the subject in the bibliographic survey to perform this review. This reinforces the need for further studies with objective assessment parameters that analyze the effectiveness of multidisciplinary approach to musculoskeletal pain control and prevention of chronicity in pregnant women.
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2020 Sidney Licht lecture: The metabolic syndrome and obesity negatively impact function
Lynn H Gerber
April-June 2021, 4(2):58-62
There are important connections between metabolic abnormalities and poor function. This is relevant because the World Health Organization and the Centers for Disease Control and Prevention indicate that we are facing an epidemic of obesity and pre-diabetes/diabetes, which present substantial and challenging health-care concerns. Most of these people have metabolic syndrome (MS), including hypertension, hyperglycemia, obesity, hyperlipidemia, and hypertriglyceridemia. The relationships among function and MS seem intuitive and reasonable. One link could include abnormal energy production and mitochondrial efficiency in the generation of adenosine triphosphate(ATP). Another link might result from insulin resistance and its impact on interfering with glucose uptake. Sedentary behavior with increased waist circumference is associated with obesity and fatigue. In addition, there has been a reported association between sarcopenia and obesity, both associated with reduced function. The health implications include increased all-cause mortality and is thought to be mediated through processes that include inflammation of muscle and MS. Human function is likely to be influenced by physiological and anatomical as well as environmental and personal factors. These factors will be discussed in an effort to integrate them and explain why people with MS have significant functional problems. The premise is that fatigue is frequently reported, negatively impacts activity and exercise tolerance, and may explain why this group of people is so sedentary. We have effective treatments for fatigue that is associated with MS and obesity. Unfortunately, at this time in the history of medicine, the best treatments are behavioral and require patience and commitment. Risks are very low, rewards are high but not instantaneous.
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Impact of the COVID-19 pandemic on physical and rehabilitation medicine in morocco: Results of a national survey
Youness Abdelfettah
April-June 2021, 4(2):70-76
Background: The World Health Organization declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on physical and rehabilitation medicine (PRM) services is unknown. In Morocco, the spread of the COVID-19 pandemic has worried the entire healthcare system. The present study intended to assess the global impact of COVID-19 on PRM patient care and training across Morocco. Setting: We conducted a web-based anonymous survey from April 15, 2020, to May 15, 2020. A 9-item questionnaire was developed to investigate the impact of COVID-19 PRM services. Participants: Practicing PRM physicians and PRM trainees. Results: About 57.5% of PRM physicians consented to participate in the survey. They are mostly based in Casablanca and Rabat. The type of activity indicates that 36% of the respondents are associated with a public institution, 43% with private institutions, 12% with a university hospital, 3% with the military hospital, and 3% with Foundations and Associations. The impact of COVID-19 over activities and the results indicate that a majority of the activities are reduced (79%) because of the prevailing pandemic, 29% is devoted toward participating in COVID-19 patient care, 25% converted to COVID-19 department. The measures undertaken for the continuity of training indicates that several ways were used to carry on training sessions of the staff. Conclusion: Considering beyond the pandemic, rehabilitation and physical medicine should be at the forefront of discussions, carriers to infrastructure, financing as well as implementing care through telehealth along with other approaches needs to end.
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Association of complaints of arm, neck, and shoulders with physical and psychosocial risks factors among computer users of Nigerian bank employees
BA Tella, AM Akinfeleye, SN Oghumu, AR Adeleye
April-June 2021, 4(2):82-89
Background: Complaints of arm, neck, and shoulders (CANS) affects millions of computer users and are thought to be associated with physical and psychosocial risk factors. Assessing the risk factors of these complaints are imperatives for preventive measures in enhancing the effectiveness of clinical interventions, hence this study. Materials and Methods: A cross-sectional survey was conducted among 260 bankers whose major work task involved the use of desktop computers in Surulere Local Government Area, Lagos, Nigeria. Maastricht Upper Extremity Questionnaire (MUEQ) was used to collect the data. The MUEQ contains 95-item in seven main domains assessing physical and psychosocial risk factors with regards to work stations, posture during work, quality of break time, job demands, job control, and social supports. It also asked questions about the quality of the work environments and the occurrence of CANS. Data were summarized using descriptive statistics of frequencies and percentages, while Chi-square statistic tested the association of CANS with physical and psychosocial risk factors at a significance level of P ≤ 0.05. Results: A 70% 1 year prevalence rate of CANS was obtained. Poor body posture was significantly associated with the complaints of shoulder, arm, and elbow (P < 0.05). High job demand was significantly associated with the complaints of the shoulder and lower arm (P < 0.05), while poor work environment was significantly associated with the occurrence of CANS (P < 0.05). Conclusion: Physical and psychosocial risk factors of body posture, job demand, and work environment are associated with the prevalence of CANS among Nigerian bank employees.
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Sarcopenia: Diagnosis, comorbidities, and management
Der-Sheng Han
April-June 2021, 4(2):100-103
Sarcopenia, defined as loss of skeletal muscle mass and function, is attracting more and more public attention in the ageing world. It is associated with many co-morbidities, including frailty, cognitive impairment, depression, cardiovascular diseases, diabetes mellitus, and respiratory diseases, and incurs mortality at the end. Diagnostic consensuses are available, and the elderly at risk are encouraged to take suitable screening tests, such as muscle mass measurement, grip strength, and gait speed. Progressive resistance training is the mainstream to treat sarcopenia, yet, the multi-component exercise program is suggested for the frail elderly.
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Cost of Rehabilitation in Critically Ill COVID-19 Survivors: A Little Goes a Long Way
Poo Lee Ong, Matthew Rong Jie Tay, Shuen Loong Tham
April-June 2021, 4(2):104-106
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Functional outcome and community reintegration of survivors following disasters: A community-based survey in pakistan
Su Yi Lee, Sahibzada Nasir Mansoor, Bhasker Amatya, Tahir M Sayed, Mary P Galea, Fary Khan
April-June 2021, 4(2):90-99
Objective: The objective of the study is to evaluate functional outcomes and community reintegration of disaster survivors in Pakistan. Methods: This was a cross-sectional descriptive study of community-based participants at the Armed Forces Institute of Rehabilitation Medicine, Pakistan. The medical records were screened for eligibility of adults with disaster-related disability. Participants were interviewed in ambulatory clinics using validated measures: Neurological-Trauma Impairment Scale (NIS-Trauma), International Classification of Functioning, Disability, and Health-Generic Set, Community Integration Measure (CIM), Community Integration Questionnaire (CIQ), and EuroQol 5-Dimension 5-Level. Results: Participants were (n = 117, mean age = 35 years) with postdisaster injury up to 17 years; the majority had spinal cord injury (n = 62; 53%) and amputations (n = 44; 38%). At assessment, 80% were independent with mobility (with aids) and 29% with everyday living activities. They reported ongoing fatigue (54.7%), altered sensations (51.28%), and pain (50.43%), but fewer problems with mood and emotions. The impairment severity negatively impacted community activities (NIS-Trauma vs. CIQ: P < 0.001). As impairments improved with time (NIS-Trauma vs. time since injury: P = 0.003), so did community reintegration (time since injury vs. CIQ; P < 0.001) and perceived health status (time since injury vs. EuroQol; P = 0.001). Conclusion: Many participants reported various ongoing disability-related issues; however, majority were dependent with everyday living activities and well adapted in the community. Further robust studies are needed for evaluation of longer-term impact of the disability in disaster victims for the comprehensive healthcare in the community.
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