7.1

Rehabilitation in neurological diseases

Stroke rehabilitation is a major area of interest for a rehabilitation journal and many papers dealt with this topic. Three randomized controlled trials (RCTs) in stroke patients were published. Yavuzer et al. showed that Playstation EyeToy Games, when combined with a conventional stroke rehabilitation program, can potentially enhance upper extremity-related motor functioning in subacute stroke patients. Ferrante et al. won the Europa Medicophysica -SIMFER 2007 Award for their study in post-acute stroke patients, which showed that rehabilitation including FES cycling was more effective in promoting muscle strength and motor recovery of the lower extremities than therapist-assisted rehabilitation alone. Tests on an larger number of patients are needed before FES cycling can be generally proposed. Eser et al. demonstrated that balance training combined with a conventional rehabilitation program does not provide additional benefit in terms of lower extremity motor recovery, mobility and activity level. A multicenter cohort (prospective) study by Denti et al. suggested that rehabilitation in elderly stroke patients can be effective for improving function and favorably affecting discharge destination. In fact, age per se appears to predict outcome to a lesser extent than other clinical covariates, such as functional and cognitive status at admission and social situation. Several studies analyzed gait in stroke patients. Oken and Yavuzer found that, to better interpret quantitative gait data and to offer appropriate rehabilitation programs, clinicians should consider that spatio-temporal and kinematic asymmetry might vary according to age, motor recovery level and walking speed of hemiparetic patients after stroke. A paper from Nigeria by Hamzat and Kobiri focused on walking with a cane: their findings indicate that post-stroke individuals who used a cane as a walking aid had poorer balance and less social participation than their age-matched counterparts who walked unaided. As balance improved, participation also improved in both groups, suggesting that prescription of a cane for post-stroke individuals should be carefully considered, especially if the goals of rehabilitation include restoration of balance functions and social participation. General topics on stroke rehabilitation were also considered. Bilge et al. suggested that the remission of post-stroke depression is associated with improved functional recovery. Early diagnosis and effective treatment of depression will improve the rehabilitation outcome of stroke patients. Finally, Treger et al. proposed a feasibility study of the Reo Therapy System, which was found to be appreciated by patients, but further research is necessary in order to identify the most efficient balance of Reo Therapy and traditional therapy methods.

Rehabilitation of various other neurological diseases was studied. Vinci and Gargiulo looked at compliance with ankle-foot-orthoses (AFOs) in Charcot-Marie-Tooth (CMT) disease and found that compliance is poor: patients with CMT discard AFOs because the appliances attract attention to their disability, are not essential for their limited daily walking, and are uncomfortable; the authors suggest that prescription of AFOs be accompanied with psychological support and that more comfortable and cosmetically acceptable solutions for the problem of footdrop be sought. Zambito et al. demonstrated that children with foot deformities and clinical evidence of occult spinal dysraphism should undergo neurophysiological assessment in order to obtain early diagnosis and to avoid ineffective foot surgery. Cattelani et al. focused on traumatic brain injury (TBI) subjects and concluded that defective-type behavior—summarily termed as apathy—can explain the unsatisfying community integration of TBI subjects and best explains the similarities with subjects presenting with a higher intellectual disadvantage (mild intellectual disability patients). The multidisciplinary approach to the complex community integration process of TBI subjects might consider the high frequency of apathy as a primarily target of community integration management. Finally, Lokk focused on Parkinson disease from the perspective of caregiver (CGs) strain, concluding that CGs bear strain and burden in many psychosocial and somatic domains, despite satisfactory general well-being independent of disease duration; the longer the disease duration, the more the impact on certain domains of CGs burden.

7.2

Rehabilitation in orthopedic diseases

Rehabilitation of the sequelae of joint surgery and amputation are frequent clinical situations. Pisoni et al. reported on ICF Core Sets for osteoarthritis as a useful tool in the follow-up of patients after joint arthroplasty, although more research is needed, mainly on data reliability and category definition; even though problems in the administration were encountered, the ICF Core Set permitted better focus on issues and aspects of patient’s everyday life usually not taken into account or not codified in the usual care assessment. Adunsky et al. focused on the discharge hemoglobin values and functional outcome of elderly hip fracture patients undergoing rehabilitation; they found that higher hemoglobin values at discharge were not associated with better postfracture function, as reflected by FIM scores, and that clinically reasonable low hemoglobin levels are not associated with adverse functional outcome of elderly hip fracture patients; so, actively correcting hemoglobin levels, per se, may not result in better functional outcomes in this population. Cook et al. looked at the continental variations in preoperative and postoperative management of patients with anterior cruciate ligament (ACL) repair; over 600 (634) surgeons from six continents completed the survey; variations do exist across continents in the non-operative and postoperative/rehabilitative management of these patients; continental variations and disparate emphases such as activity level, age at injury, and bracing influenced treatment decision making, which could lead to variations in outcomes, costs, and appropriate care. Karanikas et al. found that, after ACL reconstruction, motor task and muscle strength adaptations follow different time patterns, suggesting that a decrease in muscle strength capabilities can be tolerated up to a certain extent by patients during walking and submaximal running; however, when the decrease in muscle strength exceeds a certain threshold, the biological system, being flexible, changes its locomotion strategy. Erjavec et al. found that the exercise stress test is a good predictor of prosthetic fitting in patients with transfemoral amputation; it also anticipates the possibility of cardiovascular complications during rehabilitation programs; combined with the six-minute walk test, the FIM, and age, it may be an important criterion to consider when deciding about the appropriateness of prosthetic fitting. Finally, in another paper on joint rehabilitation Sekir et al. described a functional test battery for evaluating functionality, proprioception, and strength, which they found to be reliable in recreational athletes with functional ankle instability.

Chronic conditions in adults and the elderly, such as chronic low back pain (CLBP) and osteoporosis, are other major topics in rehabilitation. An RCT conducted by Limke et al. evaluated the effects of one set versus two sets of resistance exercises in 100 outpatients with CLBP pain and leg pain and concluded that there were no added benefits for completing a second set of resistance exercises during therapy sessions. Bautz-Holter et al. investigated in a cross-sectional content-validity study in a Norwegian population the ICF Core Set for LBP to determine whether it covered the patients’ problems; they concluded it captures the problems of LBP and adds important aspects to clinical practice in LBP, but that it needs further refinement in order to improve its clinical feasibility. Ordu Gokkaya et al. found significant impaired pulmonary function, aerobic capacity and serious deconditioning for various reasons in osteoporosis patients; therefore, cardiopulmonary function testing should be included in the management of osteoporosis patients and ventilatory muscle training and aerobic exercises may offer a potential therapeutic adjunct to current therapies in this patient group.

Several papers focused on a sometimes neglected, but growingly important field for rehabilitation , that is, adolescent idiopathic scoliosis (AIS). Weiss and Goodall , in a systematic review, evaluated the treatment of AIS according to present evidence and concluded that there is some evidence supporting conservative treatment for AIS, while no substantial evidence was found in prospective controlled studies to support surgical intervention; in light of the unknown long-term effects of surgery, an RCT seems necessary; due to the presence of evidence supporting conservative treatments, conducting an RCT for conservative treatment options seems unethical, however, even if the evidence for conservative treatments is weak in number and length. Negrini et al. won the Europa Medicophysica -SIMFER 2007 Award for a paper on rehabilitation of AIS: the results of exercises and bracing reported in a series of clinical studies showed that, with efficient management of data collection, a set of studies can be developed to determine the efficacy of clinical daily rehabilitation approaches. To conclude our overview of the spine during growth, a cross-sectional study by Giusti et al. reported on the weight of school book bags in South Brazil. The study showed that, due to the higher income of the families of children attending private schools, the type of school equipment the children carried was more costly and heavier, and concluded that these data should be considered in educational campaigns.

7.3

Others

Bertoni et al. reported that nutritional counseling seems to be ineffective and poorly applicable to disabled people, although further studies should be directed towards a treatment program associated with careful screening, motivation analysis, and follow-up in this patient population. Vanden Bossche et al. found that the ischemia/reperfusion syndrome could be an important precipitating factor in the pathogenesis of heterotopic ossification, and that free radical scavengers had a significant inhibitory effect on its development in a rabbit model; the results of this experimental model can be an impetus for further research into the prevention of heterotopic bone formation in humans.