A Qualitative Study Exploring Patients’ Experiences of Standard Care or Cardiac Rehabilitation Post Minor Stroke and Transient Ischaemic Attack.

A qualitative study exploring patients’ experiences of standard care or cardiac rehabilitation post minor stroke and transient ischaemic attack.

Clin Rehabil. 2013 Mar 29;
Hillsdon KM, Kersten P, Kirk HJ

Objective:To explore individuals’ experiences of receiving either standard care or comprehensive cardiac rehabilitation post minor stroke or transient ischaemic attack.Design:A qualitative study using semi-structured interviews, alongside a randomized controlled trial, exploring the effectiveness of comprehensive cardiac rehabilitation compared with standard care. Interviews were transcribed verbatim and subjected to thematic analysis.Setting:Individuals’ homes.Subjects:People who have experienced a minor stroke or transient ischaemic attack and who were partaking in a secondary prevention randomized controlled trial (6-7 months post the event, 17 males, five females; mean age 67 years).Interventions:Not relevant.Main measures:Not relevant.Results:Four themes were identified: information delivery, comparing oneself with others, psychological impact, attitudes and actions regarding risk factor reduction. Participants indicated a need for improved information delivery, specific to their own risk factors and lifestyle changes. Many experienced psychological impact as a result of their minor stroke. Participants were found to make two types of social comparison; the comparison of self to another affected by stroke, and the comparison of self to cardiac patients.Conclusion:Comprehensive cardiac rehabilitation was reported to have positive effects on people’s motivation to exercise. Following a minor stroke, many individuals do not recall information given or risk factors specific to them. Downward comparison with individuals who have had a cardiovascular event led to some underplaying the significance of their minor stroke. HubMed – rehab

Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial.

Clin Rehabil. 2013 Mar 29;
Tarakci E, Yeldan I, Huseyinsinoglu BE, Zenginler Y, Eraksoy M

Objective:To determine the effectiveness of group exercise training on balance, functional status, spasticity, fatigue and quality of life in patients with multiple sclerosis.Design:A randomized single-blind controlled study.Setting:University hospital, outpatient physical therapy department.Subjects:Ambulatory patients with multiple sclerosis.Interventions:Exercise group completed a 12-week group exercise programme under the physical therapists’ supervision. Control group was included in the waiting list.Main measures:The primary outcome measures were the Berg Balance Scale, 10-metre walk test, 10-steps climbing test and secondary outcome measures were the Modified Ashworth Scale, Fatigue Severity Scale and Multiple Sclerosis International Quality of Life.Results:Ninety-nine patients completed the study. There were statistically significant improvements for all outcome measures in the group exercise group (n = 51) (p < 0.01). In the control group (n = 48), there were statistically significant negative change in the Berg Balance Scale and 10-metre walk test measures (p = 0.002, p = 0.001) and statistically significant increment only in the Fatigue Severity Scale score (p = 0.002). The Berg Balance Scale score was increased 4.33 in the exercise group, while a decreased of 2.33 in control group. The 10-metre walk test duration (second) was decreased 2.72 in exercise group, while increased 1.44 in control group. In comparing inter-groups changes, both primary and secondary outcome mesures showed significant improvements in favour of the exercise group after the training (p < 0.05).Conclusion:The study demonstrated that supervised group exercise training is effective in improving balance, functional status, spasticity, fatigue and quality of life in moderately affected people with multiple sclerosis, with no worsening of their clinical status. HubMed – rehab

Mirror visual feedback can induce motor learning in patients with callosal disconnection.

Exp Brain Res. 2013 Mar 30;
Nojima I, Oga T, Fukuyama H, Kawamata T, Mima T

Mirror therapy using mirror visual feedback (MVF) has been applied to the stroke rehabilitation of hemiparesis. One possible mechanism of mirror therapy is the functional interhemispheric connectivity between sensorimotor areas via corpus callosum. To test this hypothesis, we investigated the MVF-induced motor learning in 2 patients with callosal disconnection. Callosal connection in patients was evaluated by clinical measures and the interhemispheric inhibition (IHI) using transcranial magnetic stimulation. Both patients suffered from somatosensory cognitive disconnection, and one showed the loss of IHI. Motor training with MVF significantly improved the motor behavior of both patients. Extending our previous study, the results of callosal patients suggested that the visual feedback through a mirror might play the crucial important role for the improvement of motor performance, rather than interhemispheric interaction via corpus callosum. HubMed – rehab

Currents of plate osteosynthesis in osteoporotic bone.

Eur J Orthop Surg Traumatol. 2013 Mar 31;
Lampropoulou-Adamidou K, Karampinas PK, Chronopoulos E, Vlamis J, Korres DS

Osteoporotic fractures are becoming more prevalent with ageing of populations worldwide. Inadequate fixation or prolonged immobilization after non-surgical care leads to serious life-threatening events, poor functional results and lifelong disability. Thus, a stable internal fixation and rapid initiation of rehabilitation are required for faster return of function. Conventional internal fixation attempts to achieve the exact anatomy, often with extended soft-tissue stripping and compression of the periosteum, causing disturbance of the metaphyseal and comminuted fracture’s bone blood supply. This technique relies on frictional forces between bone and plate. Osteoporotic bone might not be able to generate enough torque with the screw to securely fix the plate to bone. Thus, this surgical management have resulted in increased incidence of poor results in elderly, osteoporotic patients. The newly developed locked internal fixators, locking compression plates and less invasive stabilization system, consist of plate and screw systems where the screws are locked in the plate, minimizing the compressive forces exerted between plate and bone. Thus, the plate does not need to compress the bone nor requires precise anatomical contouring of a plate disturbing the periosteal blood supply. These fixators allowed the development of the minimal invasive percutaneous osteosynthesis. Nowadays, locking plates are the fixation method of choice for osteoporotic, diaphyseal or metaphyseal, severely comminuted fractures. HubMed – rehab