Physical Medicine and Rehabilitation

Anterior cruciate ligament (ACL) deficient and reconstructed knees display altered biomechanics during gait. Identifying significant gait changes is important for understanding normal and ACL function and is typically performed by statistical approaches. This paper focuses on the development of an explainable machine learning (ML) empowered methodology to: (i) identify important gait kinematic, kinetic parameters and quantify their contribution in the diagnosis of ACL injury and (ii) investigate the differences in sagittal plane kinematics and kinetics of the gait cycle between ACL deficient, ACL reconstructed and healthy individuals. For this aim, an extensive experimental setup was designed in which three-dimensional ground reaction forces and sagittal plane kinematic as well as kinetic parameters were collected from 151 subjects. The effectiveness of the proposed methodology was evaluated using a comparative analysis with eight well-known classifiers. Support Vector Machines were...

Robotic technologies are being employed increasingly in the treatment of lower limb disabilities. Individuals suffering from stroke and other neurological disorders often experience inadequate dorsiflexion during swing phase of the gait cycle due to dorsiflexor muscle weakness. This type of pathological gait, mostly known as drop-foot gait, has two major complications, foot-slap during loading response and toe-drag during swing. Ankle foot orthotic (AFO) devices are mostly prescribed to resolve these complications. Existing AFOs are designed with or without articulated joint with various motion control elements like springs, dampers, four-bar mechanism, series elastic actuator, and so forth. This paper examines various AFO designs for drop-foot, discusses the mechanism, and identifies limitations and remaining design challenges. Along with two commercially available AFOs some designs possess promising prospective to be used as daily-wear device. However, the design and mechanism of ...

Background & Study Aim: Muscle strength, namely the capacity for overcoming the external resistance or counteracting it at the expense of muscular effort, plays an unquestionably essential role in judo competitor’s training. The objective of this study has been knowledge about the values of torques, torque gradient and muscle strength deficit released by knee joint extensors and flexors at rest by judo female competitors, taking up specialist strength training. Material & Methods: Two female study groups were selected: judo female competitors (n = 15); aged 22.20 ±1.32 years, body weight 67.47 ±13.58 kg, competitor seniority 11 ±1.60 years; reference sample (n = 15) non-full-time in any sports discipline female students of the University of Physical Education (AWF) in Wrocław, Poland: aged 22.20 ±1.26 years, body weight 64.33 ±8.25 kg. A study of knee joint extensors and flexors torque was performed at rest. The measurement was made at 30 and 70 degrees. The properties of a lever in...

as a special issue and supplement of the Journal of Rehabilitation Medicine. Gutenbrunner, Ward, and Chamberlain's (2007) supplement was written with the intent of stating the position of physical and rehabilitation medicine (PRM) in Europe. It defines the specialty, its work, the competencies of its practitioners and its relationships to other medical disciplines and allied health professionals. It also aims to ensure that PRM is seen as a European specialty, where high quality practitioners working within excellent standards of care can practice in accord with evidence-based medicine, as well as within the context of their different national practices. In doing so, the supplement describes training and skills of PRM specialists. It also provides the underlying principles of specialized rehabilitation, which will allow policymakers, health planners, medical and paramedical colleagues to identify how PRM works and how it can assist the process of allowing people with disabilities to participate fully in society.

Posture control appears deeply impaired in patients with severe Acquired Brain Injury (ABI). One of the main goals of neurorehabilitation specialists is to try to assess this neural function in a standardized manner. However, the tests available to evaluate posture control recovery after brain damage were developed for patients with focal neurological signs. We therefore developed a new test, the Trunk Recovery Scale (TRS). To evaluate the inter-rater reliability, internal consistency, external validity, and sensitivity of TRS in patients with ABI. Validation study. We examined 59 patients hospitalized after a brain injury in the Intensive and the Extensive Rehabilitation Units of our hospital. Patients with diagnosis of severe ABI with the capacity to respond to simple verbal orders and with a Level of Cognitive Functioning Scale (LCF scale) ≥ 4. Three raters independently assessed 20 subjects. One of the raters also assessed 39 additional subjects using TRS, Trunk Control Test (TC...

Strength training is recommended for children with cerebral palsy. However, it is difficult for moderately impaired children with cerebral palsy, who require crutches for ambulation, to participate in this type of training. The purpose of this study was to investigate whether whole-body vibration training is an effective method of strengthening in a moderately impaired child with cerebral palsy. [Subject and Methods] This report describes an 8-year-old Japanese boy with cerebral palsy, who was ambulatory with crutches. The subject participated in physical therapy twice a week for 5 weeks. Whole-body vibration training was selected to complement the standing practice. The patient's crutch-walking ability, gross motor function, and spasticity were evaluated. [Results] The number of steps and walking duration were reduced in a 5-m walk test with crutches and gross motor function was improved. Further, the spasticity was reduced. [Conclusion] Whole-body vibration training is an effective physical therapy intervention in moderately impaired children with cerebral palsy, who are unable to walk without crutches.

Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain. Controlled laboratory design. Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed. The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach. At baseline, no differences were found betwee...

The benefits of a functional electrical stimulation (FES) gait programme were assessed in a group of 6 incomplete spinal cord injured subjects. Measurements were made of quadriceps spasticity, lower limb muscle strength, postural stability in standing, spatial and temporal values of gait, physiological cost of gait and independence in activities of daily living. The subjects were assessed before commencement of the programme and after a period of gait training using FES. The benefits derived as a result of the FES gait programme included a reduction in quadriceps tone, an increase in voluntary muscle strength, a decrease in the physiological cost of gait and an increase in stride length.

In stroke, there is paralysis or weakness of one side of the body including upper limb, trunk and lower limb leading to the disturbances in the trunk muscles. Trunk is often neglected part in the stroke rehabilitation, trunk training exercises and Swiss ball exercises results in better recruitment of trunk muscles thus improving sitting balance. To compare the effect of core strengthening exercises on Swiss ball and Conventional exercise, to improve trunk balance in hemiplegic patients following stroke. A total number of 70 subjects were screened as per inclusion and exclusion criteria. The subjects were divided into two groups, Group-A received core strengthening exercises on Swiss ball along with conventional treatment and Group-B received core strengthening exercises along with conventional treatment. Subjects showed improvement in trunk balance following 6 weeks of core strengthening exercises.Post-intervention the TIS, BBA and MBI score of both groups improved but the Group-A i...

A new family of rehabilitation techniques, termed Constraint-Induced Movement Therapy or CI Therapy, has been developed that controlled experiments have shown is effective in producing large improvements in limb use in the real-world environment after cerebrovascular accident (CVA). The signature therapy involves constraining movements of the less-affected arm with a sling for 90% of waking hours for 2 weeks, while intensively training use of the moreaffected arm. The common therapeutic factor in all CI Therapy techniques would appear to be inducing concentrated, repetitive practice of use of the more-affected limb. A number of neuroimaging and transcranial magnetic stimulation studies have shown that the massed practice of CI Therapy produces a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected limb. The CI Therapy approach has been used successfully to date for the upper limb of patients with chronic and subacute CVA and patients with chronic traumatic brain injury and for the lower limb of patients with CVA, incomplete spinal cord injury, and fractured hip. The approach has recently been extended to focal hand dystonia of musicians and possibly phantom limb pain.

The purpose of this study was to compare the shoulder and elbow joint loads during the tennis serve. Two synchronised 200 Hz video cameras were used to record the service action of 20 male and female players at the Sydney 2000 Olympics. The displacement histories of 20 selected landmarks, were calculated using the direct linear transformation approach. Ball speed was recorded from the stadium radar gun. The Peak Motus system was used to smooth displacements, while a customised inverse-dynamics program was used to calculate 3D shoulder and elbow joint kinematics and kinetics. Male players, who recorded significantly higher service speeds (male=183 km hr-1 : female=149 km hr-1) recorded significantly higher normalised and absolute internal rotation shoulder torque at the position when the arm was maximally externally rotated (MER) (male=4.6% and 64.9 Nm: female=3.5% and 37.5 Nm). A higher absolute elbow varus torque (67.6 Nm) was also recorded at MER, when compared with the female players (41.3 Nm). Peak normalised horizontal adduction torque (male=7.6%: female=6.5%), normalised shoulder compressive force (male=79.6%: female=59.1%) and absolute compressive force (male=608.3 N: female=363.7 N), were higher for the male players. Players who flexed at the front knee by 7.6˚, in the backswing phase of the serve, recorded a similar speed (162 km hr-1), and an increased normalised internal rotation torque at MER (5.0%), when compared with those who flexed by 14.7˚. They also recorded a larger normalised varus torque at MER (5.3% v 3.9%) and peak value (6.3% v 5.2%). Players who recorded a larger knee flexion also recorded less normalised and absolute (4.3%, 55.6 Nm) peak internal rotation torque compared with those with less flexion (5.6%, 63.9 Nm). Those players who used an abbreviated backswing were able to serve with a similar speed and recorded similar kinetic values. Loading on the shoulder and elbow joints is higher for the male than female players, which is a reason for the significantly higher service speed by the males. The higher kinetic measures for the group with the lower knee flexion means that all players should be encouraged to flex their knees during the backswing phase of the service action. The type of backswing was shown to have minimal influence on service velocity or loading of the shoulder and elbow joints.

Stroke is the leading cause of death worldwide and a major contributor to long-term adult hood disability. Acute stroke care and long-term rehabilitation has improved substantially in the developed countries in the last three decades. 1 Although Pakistani healthcare system has evolved over the years, but the management of stroke both in the acute and rehabilitation phase remains sub-optimal. 2 The awareness of general public and even general practitioners regarding signs and symptoms of an impending/ evolving stroke is inadequate. 2,3 This results in loss of precious time in which patient can report to the hospital and get urgent medical attention. Absence of qualified neurologists and dedicated stroke units make it difficult to offer good acute stroke care as per the established protocols at most of acute medical care facilities in our country. 2 There are only two hospitals in our country which offer thrombolytic therapy (tPa) for a patient having acute ischaemic stroke. Most of the stroke patients in Pakistan are managed by internal medicine physicians and are discharged home without a neurological consult or long-term rehabilitation plan. A coordinated multidisciplinary stroke rehabilitation can result in decreased mortality, reduced number of complications, shorter length of stay and better Quality of life. 4,5 In Pakistan only few stroke patients are provided coordinated post stroke rehabilitation, mainly due to lack of qualified rehabilitation medicine physicians (physiatrists). Large number of qualified physiotherapists (Doctors of Physiotherapy-DPT) are available in the country. The primary job of a DPT is to provide good physical therapy and mobility training. These therapists could become a great resource for coordinated care and rehabilitation of stroke patients, if properly guided and supervised by Physiatrists and Neurologists. Short term and long term rehab care protocols are needed to be developed and followed to ensure best practice. In the absence of a regulatory authority, some of the physiotherapists overstep their mandate by writing prescriptions for the stroke patients in form of multivitamin injections, neuro-tonics and cerebral stimulants, which have no proven role in the management and recovery of stroke. 6 Functional improvement and ultimately community reintegration are main objectives of rehabilitation. Long term, daily physiotherapy at home for months without proceeding toward this goal is of no benefit for patient and family. 7,8 The social network and a supportive family environment in Pakistan is sometimes a hindrance in regaining independence by the stroke patients. Serving the elderly especially, when disabled by an illness like stroke is considered a social obligation and religious duty. The stroke patient in Pakistan has sometimes multiple attendants (mostly close family members) who cater for all his/her needs including transfers from bed to chair, feeding and bladder and bowel care. This over caring attitudes in which the patient is offered attendant care promotes dependency rather than independence and the patient with stroke never learns the compensatory techniques or take charge of his/her own life post stroke. Families of stroke patients must be educated and trained to direct their care in making a stroke patient functional and independent. Another issue is of alternative and complementary medicine. Due to the strong influence of alternative and traditional medicine in the country and a lack of accountability, many stroke patients end up visiting spiritual healers, homeopathy practitioners and even quacks in the quest for finding a cure for their disability. This not only drains them financially but also wastes precious time and energies, which could have been utilized in following a scientifically proven and beneficial stroke rehabilitation programme. Many a times these practitioners offer stroke patients un-proven therapies, herbal remedies and drugs with unknown composition. Even if a patient is fortunate enough to receive good acute care and a coordinated post stroke rehabilitation tries to re-integrate back into the society, he/she faces societal and community barriers. The general attitudes of the Pakistani society towards a person with disability are negative. 9 There are no disabled friendly public toilets and most of the

A life care plan sets out the full extent of the acquired impairments, likely complications, implications for independence, quality of life, and long-term care needs and then informs the parties about the rationale, including nature, extent, and frequency, for all the goods and services likely to be needed over a person's life span and associated costs. Whether from a clinical or litigation perspective, all life care plans should be founded in good science and preferably methodologically sound evidence-based medical practice. For patients with traumatic brain injury (TBI), a life care plan requires systematic and thorough consideration of multiple dimensions of central nervous system functioning, including not only the more obvious problems of motor, communication, cognitive, and neuropsychiatric impairment but also other issues, such as pain, fatigue, and psychological responses to trauma, impairment, and disability. Some of the major life care plan domains include home and/or facility care, medications, durable medical equipment, and vocational issues. Physicians and life care planners should be aware of common faux pas made in life care plans that can undermine the credibility of a plan as well as a professional's expert testimony. Clinicians-physicians or otherwise-involved either in the development of life care plans or in their critique should have a consistent methodology for reviewing the scientific credibility and foundation of such documents.

Restoring mobility and rehabilitation of gait are high priorities for post-stroke rehabilitation. Cueing using metronomic rhythmic sensory stimulation has been shown to improve gait, but most versions of this approach have used auditory and visual cues. In contrast, we developed a prototype wearable system for rhythmic cueing based on haptics, which was shown to be highly effective in an early pilot study. In this paper we describe a follow-up study with four stroke survivors to inform design, and to identify issues and requirements for such devices to be used in home-based or outdoor settings. To this end, we present a blended user-centred design study of a wearable haptic gait rehabilitation system. This study draws on the combined views of physiotherapists, nurses, interaction designers and stroke survivors. Many of the findings were unanticipated, identifying issues outside the scope of initial designs, with important implications for future design and appropriate use.

Intensive care unit (ICU) is the most required area to treat patients who admitted for an unconscious, cardiopulmonary arrest, drowning, poisoning, cerebrovascular accidents, acute post-operative surgery patients etc. for improving their health with various treatment procedures. Physiotherapy is one of the treatment procedures in inside the ICU to regain the patient’s mobility and stability with the use of procedures such as chest physiotherapy, range of motion exercises and early mobilization activities to be used to improve functional capacity, strengthening the muscles with continuous rehabilitation would improve quality of life among patients admitted to respiratory and medical ICUs. In order to practice in the ICU, this study aimed to review the planning and implementation methods of physiotherapy in the area of critical care to suggest the physiotherapy protocol. Initiation of this protocol based assessment and implementation of physiotherapy inside the ICU is safe and benefic...

Massagli TL, Carline JD: Reliability of a 360-degree evaluation to assess resident competence. Am J Phys Med Rehabil 2007;86:845-852. Objective: To determine the feasibility and psychometric qualities of a 360-degree evaluation of physical medicine and rehabilitation (PM&R) residents' competence.

This study aims to detect the efficacy of a modified complete decongestive therapy program on the improvement of the circumferential measures of the lymphedematous limbs. A prospective observational and interventional study; twenty-six patients with unilateral lymphedema of the extremities both primary and secondary were enrolled. All patients were treated with 6 sessions of complete decongestive therapy on a two-phase program. The first phase consists of meticulous skin care, manual lymphatic drainage, exercises and compression bandages. Phase 2 of self-care program. Circumferential measures of the affected limb were taken as an outcome measure; recorded before and 12 weeks after the application of the decongestive therapy. In both, primary and secondary lymphedema, the modified complete decongestive therapy resulted in a significant reduction (p < 0.05) in the circumference of the affected limb. The circumferential measures of the involved limbs after treatment were (79.69 ± 11.92) and (107.68 ± 24.98), consecutively: comparative to the pretreatment measures of (85.14 ± 7.48) for the upper limbs and (113.71 ± 26.91) for the lower limbs. In conclusion, application of a complete decongestive therapy, per available recourses, in a short course or a modified regimen can help in treating primary and secondary lymphedema of the extremities.

Corrêa DA, Soares DS, Gonelli PRG, Cesar MC, Sindorf MAG, Crisp AH, Verlengia R, Balbino HF, Lopes CR. Effect of 29 Weeks of Periodized Soccer Training on the Neuromuscular Performance of Soccer Players Under 20 Years of Age. JEPonline 2016;19(4):3241. The purpose of this study was to investigate the effects of 29 weeks of periodized soccer training (linear during pre-season and ondulatory during the competitive period) on the neuromuscular performance of soccer players under 20 yrs of age. Ten regionally ranked male athletes (19.2 ± 1.3 yrs, body mass 71.1 ± 6.8 kg, height 179.0 ± 0.2 cm) participated in this study. The pre-season physical training program lasted 9 wks. The competitive period lasted 19 wks. The assessments were conducted at specific times during training periodization: baseline, 4, 8, and 19 wks. The results showed improvements in squat jump performance and maximal strength during the pre-season and the competitive period, respectively. On the other hand, repeated ...

Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio-and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care.

Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program [ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, ...

Background: Exergames are increasingly used as an exercise intervention to reduce fall risk in elderly. However, few exergames have been designed specifically for elderly, and we lack knowledge about the characteristics of the movements elicited by exergames and thereby about their potential to train functions important for fall risk reduction. Objective: This study investigates game elements and older players' movement characteristics during stepping exergames, in order to inform exergame design for movement quality in the context of fall preventive exercise. Methods: Fourteen senior citizens (mean age 73 years ± 5.7, range 65-85) played three stepping exergames in a laboratory. Each of the exergames was described with respect to seven game elements (physical space, sensing hardware technology, game graphics and sound, model of user, avatar/mapping of movements, game mechanism and game narrative). Five movement characteristics (weight shift; variation in step length, speed, and movement direction; visual independency) were scored on a 5-point Likert scale based on video-observations of each player and each game. Disagreement between raters was resolved by agreement. Differences in scores for the three exergames were analyzed with a multivariate one-way ANOVA. Results: The Mole received the highest sum score and the best score on each of the five movement characteristics (all p's<.0005). LightRace scored the lowest of the three exergames on weight shift and variation in movement direction (both p's<.0005), while DDR scored lowest on step length variation and visual independency (p<.03 and p<.0005, respectively), and lower than The Mole on speed variation (p<.05). The physical space players used when exergaming and the on-screen representation of the player, affected movement quality positively as indexed by multiple weight shifts and variation in stepping size, direction, and speed. Furthermore, players' movements improved when playing speed affected game progression and when the game narrative was related to a natural context. Conclusion: Comparing differences in game elements to associated differences in game movement requirements provides valuable insights about how to design for movement quality in exergames. This provided important lessons for the design of exergames for fall preventive exercise in senior citizens and illustrates the value of including analyses of movement characteristics when designing such exergames.

The incidence and prevalence of diabetes are increasing, with rapid growth in the aging population. The purpose of this study is to find out the effectiveness of aquatic exercises on glycemic control in elderly patients with type 2 diabetes mellitus.30 subjects who met the inclusion criteria were randomly divided into two groups; Group A (n=15) were under hypo glycemic drugs and aquatic training in Hubbard tank for upper extremity and lower extremity. Group B (n=15) patients have no exercise training during this study, except they are relied upon medications for diabetes. HbA1C was measured pre and post treatment. Statistical analysis was tested with t test at 95% level of significance (p<0.05). The results suggest that there is a significant difference between posttest values of both groups in HbA1C, which indicates that group A is more significant than group B.

Musicians are trained to attend to aural and visual senses, to the detriment of kinesthetic awareness, which often results in unnecessary muscle tension and narrowed attentional focus. The Alexander technique (AT) addresses these concerns by approaching action using a process of whole-body consciousness. Incorporation of AT concepts into skill practice may reduce static tension in playing and result in both prevention of injury and improved quality of performance, but objective evidence of these effects is lacking. This pilot feasibility study was designed to determine if muscle activation, movement kinematics, musical performance, and qualitative self-assessment over the course of a 10- week AT intervention are viable means to assess the efficacy of AT in violinists/ violists. Two groups of collegiate violinists and violists participated: Group A (n=4) participated in weekly 1-hour group AT lessons and kept a personal journal of their progress. Group B (n=3) received no AT lessons....

Background Inertial measurement units (IMUs) offer the ability to measure walking gait through a variety of biomechanical outcomes (e.g., spatiotemporal, kinematics, other). Although many studies have assessed their validity and reliability, there remains no quantitive summary of this vast body of literature. Therefore, we aimed to conduct a systematic review and meta-analysis to determine the i) concurrent validity and ii) test-retest reliability of IMUs for measuring biomechanical gait outcomes during level walking in healthy adults. Methods Five electronic databases were searched for journal articles assessing the validity or reliability of IMUs during healthy adult walking. Two reviewers screened titles, abstracts, and full texts for studies to be included, before two reviewers examined the methodological quality of all included studies. When sufficient data were present for a given biomechanical outcome, data were meta-analyzed on Pearson correlation coefficients (r) or intracl...

with different outcome measures and follow-up periods. Benefits of PEP were found in isolated outcome measures in separate studies with a follow-up period ! 1 month. Concerning long-term effects, the results are contradictory. Conclusion: Prior to widespread prescription of long-term PEP treatment, more research is required to establish the benefit of the technique in patients with COPD.

When I first met Dr Henry Betts, I was not impressed. It was 1987, and I was a new resident in physical medicine and rehabilitation (PM&R) at the Rehabilitation Institute of Chicago (RIC). As a product of the Pritzker School of Medicine at the University of Chicago, I admired the classic triple threat academic, that is, the clinician-educator-researcher. Dr Betts did not fit the bill. He no longer practiced clinical medicine, he was not a researcher, and his educational role as a social and cultural critic was nontraditional to say the least. What did he have to teach me? But he was in fact a triple threat of a different kind: chairman of the department of PM&R at Northwestern University, chief executive officer and medical director of the RIC, and clearly, as I came to understand, a force to be reckoned with.* My initial impressions were wrong. Dr Betts is one of the most visionary leaders I know. If the influence of a life were measured as journals are by their "impact factor," Dr Betts would be in the most elite category. Recently, I sat down with Dr Betts to reflect on his vision of leadership, his decision to pursue PM&R in 1960, when it was nearly invisible, and his perspectives on the specialty over the last 50 years. I wanted to understand how a man of such privileged background became one of our most influential voices for disability, health care, and human rights. Why did he choose these issues as his calling? How did he develop his expansive views of medicine and its role in society, and come to have such influence on public policy and attitudes toward disability? What follows are my reflections about the man and the lessons I learned on leadership by watching him over the last 23 years, enlivened by his own recollections and anecdotes. The organization into a group of aphorisms is my construction, fully recognizing that no life so richly lived can be reduced to a list or an outline. These seem to me, however, the most salient lessons I have learned from my mentor, Dr Henry B. Betts.

Deep vein thrombosis (DVT) is a relatively common disease encountered by physical therapists, especially in the outpatient orthopedic settings. If a DVT is missed by a healthcare professional, a patient is at increased risk for pulmonary embolism, post-phlebitic
syndrome, or chronic thromboembolic. This talk discusses the natural history of DVT, diagnosis of DVT, and clinical prediction rules physical therapists can use to help guide decisions in referring patients for further testing. Finally, 2 clinical cases are discussed.

Background: Total knee arthroplasty (TKA) is an effective surgical treatment for advanced osteoarthritis. TKA must always be associated with postoperative physical rehabilitation provided by a physical therapist in order to restore functionality. As TKA-related health costs increase, an efficient rehabilitation program is needed. However, the physical therapy models for TKA patients are questionable. Objective: The objective of the systematic review is to analyze the evidences that deal with different models of physical rehabilitation and compare the effectiveness of the supervised treatment as well as the in home exercise programs without supervision. Methods/design: The databases Pubmed, Embase, Lilacs, The Cochrane Library, and Trip were searched for randomized clinical trials in any language and publication medium. The outcomes of interest were muscle strength, physical mobility and range of motion, atrophy, joint pain, and quality of life. The Cochrane Handbook for Systematic Reviews of Interventions was used for assessing the methodological quality of the studies. Results: The search returned 1133 studies. Of these, only five were included. Although the studies were heterogeneous, three studies investigated knee flexion range of motion, but this outcome did not differ statistically between groups after six months. Conclusion: In conclusion, the evidence for supervised and unsupervised models of physical therapy for TKA patients is inconclusive because important outcomes have not been investigated, and the pertinent studies have low methodological quality.

The objective of the study is to present a historical outline of neuromobilisation and clinical neurodynamics -in Poland and worldwide. Following the development of non-invasive methods of treatment, the knowledge of nervous system mechanics has become more and more extensive. The first record of performing a neurodynamic test goes back to 2800 BC. Many years later, in the first and second half of 20th century, Bragard, Von Lanz and Wachsmuth described three main neurodynamic tests for an upper limb. The biggest worldwide input in neuromobilisation problems development was made by the following scientists: Geoffrey Maitland, Robert Elvey, David Butler, Michael Shacklock and Alf Breig. David Butler and Michael Shacklock definitely represent the key researchers since it is them who, during their cooperation in the period of 1990-1997, made a great input in the origins of neuromobilisation treatment methods. The concept of nervous system mobilisation in Poland was initiated in April 1998 in Zgorzelec, where the first course run by David Butler himself, was held. In the same year Zbigniew Śliwiński published his first two studies in the journal entitled "Manual Medicine". At present trainings, courses and numerous research works, focused on nervous system mechanics, are conducted in Poland. The most recent and worth noting publications are these referring to neuromobilisation effectiveness and performed by the team of Dwornik, Bialoszewski and colleagues.

Observational learning (modeling, vicarious learning) is a type of learning, originated from a famous psychologist Albert Bandura at Stanford university in the 1960s, whereby the learner can acquire a new skill and behavior simply by "modeling," which simply means observing and imitating behaviors carried out by another individual (the model). This form of learning needs no reinforcement and trial and error, unlike the case of operant learning, but rather a model is required . Although observational learning is still unpopular in rehabilitation medicine, it originated in the field of psychology and has been studied intensively for about half a century. In clinical psychology, observational learning has already been applied in the technique called therapeutic modeling for obsessive-compulsive disorder and specific phobias, and has been proven effective in inhibiting abnormal behaviors caused by such mental diseases. Here, we will introduce and review what psychology has revealed and studied on observational learning in order to utilize these findings for applying to rehabilitation for motor impairment after brain damage effectively.

Osteoporosis is defined by critically low bone mass or a fragility fracture. Physical activity has been proposed as a necessary lifestyle contributor to bone health, however, few exercise programs have demonstrated an ability to notably increase bone mass. The bone response to exercise is highly dependent on the nature of applied mechanical loads. The most osteogenic activities are those that induce high magnitude strains at high rates or frequencies in bone. Under such conditions, only brief loading bouts are required to stimulate a response. Such strains are typically induced by weight bearing impact loading and high-intensity progressive resistance training. To date, high intensity resistance and impact training has not been investigated in postmenopausal women due to a perceived risk of fracture and/or injury. Consequently, the primary aim of the current work was to develop a novel bone specific high intensity resistance and impact training program (HiRIT) for postmenopausal wom...

Children with attention-deficit/hyperactivity disorder (ADHD) have a continuous pattern of severe and frequent inattention and/or hyperactivity, restlessness, and failure in academic achievement [1,2]. Some researchers suggested that the inappropriate use of cognitive strategies to solve problems and regulate behaviors is associated with attention deficit [3-6]. Behavioral dysregulation, as a difficulty in inhibiting maladaptive behaviors such as hyperactivity, impulsivity inattention, and aggression) [7,8], about equal to the impairment in executive function [9,10]. Executive function is an umbrella term that is used to explain cognitive processes underlying functions such as motor planning, memory, attention, problem-solving, reasoning, response inhibition, cognitive flexibility, multi-tasking, initiating, organization, and monitoring the functions [11]. Researchers believe that some components of executive functions are insufficient in people with ADHD. Especially, these children have more difficulties in attention span, sustained attention, response inhibition, organization, working memory, and motor planning [12,13]. About 47% to 69% of these children have motor disorders [14] including problems in gross and fine motor skills, motor coordination, and motor control, which are mostly related to attention deficit severity and ADHD symptoms [15-18]. Furthermore, accompanying with

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Abstract: Following the optimization of diet and fatty acid balance, the next therapeutic steps in the treatment of pain and inflammation can include the use of vitamin D, chondroitin sulfate, niacinamide, and botanical medicines such as Boswellia. In direct contrast to so-called “anti-inflammatory drugs” which always have significant toxicity, each of these natural treatments has been proven in controlled clinical trials to significantly reduce pain and inflammation without major adverse effects. Chondroitin sulfate has actually been shown to reduce cardiovascular mortality in humans while it safely and effectively ameliorates the pain and inflammation of osteoarthritis. Similarly, vitamin D supplementation has been proven effective in the treatment of hypertension, depression, migraine headaches, polycystic ovary syndrome and in the prevention of type-1 diabetes. By failing to fully cover chiropractic and naturopathic healthcare services, insurance companies which comprise and contribute to the American healthcare system are losing profitability and forcing patients to use drug and surgical treatments that are commonly less effective, more dangerous, and more expensive than the natural treatments described in this paper. Services provided by chiropractic and naturopathic physicians are supported by peer-reviewed research and deserve equitable coverage and status in America’s healthcare system.

Competitive sports for people with disabilities has grown rapidly over the past several decades, and opportunities for participation are increasingly available throughout the spectrum from developmental to elite. The Paralympic Games, seen as the pinnacle sporting event that represents the broader Paralympic Movement, has provided a platform to showcase the abilities of people with disabilities while also serving as a catalyst for disability rights through ensuring integration, equality of opportunity, and accessibility of the built environment. Concurrently, media coverage of the Paralympic Games has led to an increased awareness of opportunities for sport participation for individuals with disabilities and, with it, the adjustment of norms regarding expectations for exercise as a component of preventive health. In addition, there is evidence of the power of sports to stimulate confidence, self-efficacy, and a self-perceived high quality of life for individuals with disabilities above and beyond the basic benefits to cardiometabolic fitness. When taken together, the promotion of health, disability rights, and social integration through sports has the power to transform the lives of those who participate and to further stimulate the expansion of opportunities available to the next generation of athletes with disabilities.

Research on monkeys with a single forelimb from which sensation is surgically abolished demonstrates that such animals do not use their deafferented limb even though they possess sufficient motor innervation to do so, a phenomenon labeled learned nonuse. This dissociation also occurs after neurological injury in humans. Instruments that measure these two aspects of motor function are discussed. The effects of a neurological injury may differ widely in regard to motor ability assessed on a laboratory performance test in which movements are requested and actual spontaneous use of an extremity in real-world settings, indicating that these parameters need to be evaluated separately. The methods used in Constraint-Induced Movement therapy (CI therapy) research to independently assess these two domains are reliable and valid. We suggest that these tests have applicability beyond studies involving a therapy for stroke and may be of value for determining motor status in other types of motor disorders and with other types of treatment. The learned nonuse formulation also predicts that a rehabilitation treatment may have differential effects on motor performance made on request and actual spontaneous amount of use of a more affected upper extremity in the life situation. CI therapy produces improvements in the former, but focuses attention on the latter and, in fact, spontaneous use of the limb is where this intervention has by far its greatest effect. The evidence suggests that this result is driven by use of a "transfer package" of techniques, which can be used with other therapies to increase the transfer of improvements made in the clinic to the life situation. The use of CI therapy in humans began with the upper extremity after stroke and was then extended for the upper extremity to cerebral palsy in young children (8 months to 8 years old) and traumatic brain injury. A form of CI therapy was developed for the lower extremities and was used effectively after stroke, spinal cord injury, and fractured hip. Adaptations of CI therapy have also been developed for aphasia (CI aphasia therapy), focal hand dystonia in musicians and phantom limb pain. The range of these applications suggests that CI therapy is not only a treatment for stroke, for which it is most conunonly used, but for learned nonuse in general, which manifests as excess motor disability in a number of conditions which until now have been refractory to treatment.

Abstract
Despite the introduction of numerous additional tests, such as magnetic resonance or computed tomography, functional tests are a significant facilitation in the assessment of functional disorders. Their good knowledge along with the correct implementation is invaluable for making the right diagnosis. Clinical tests also play a huge role in the differentiation of root diseases, which increases the accuracy of the treatment.

Mimo wprowadzenia licznych badań dodatkowych, takich jak rezonans magnetyczny czy tomografia komputerowa, testy czynnościowe stanowią znaczne ułatwienie w procesie oceny zaburzeń funkcjonalnych. Ich dobra znajomość wraz z prawidłowym wykonaniem jest bezcenna dla postawienia odpowiedniej diagnozy. Testy kliniczne odgrywają także ogromną rolę w różnicowaniu dolegliwości korzeniowych, co zwiększa trafność stosowanego leczenia.

Physiotherapy (also Physical Therapy as referred to by the World Confederation of Physical Therapy) is a health care profession concerned with human function and movement and maximizing potential. It is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. It uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status. It is science-based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery. The exercise of clinical judgment and informed interpretation is at its core.