Aim The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction.

Design Clinical practice guideline underpinned by systematic review and expert consensus.

Data sources A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015.

Eligibility criteria for selecting studies Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury.

Summary Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9–12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used.

https://bjsm.bmj.com/content/bjsports/50/24/1506.full.pdf

Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

The Human Spine in Health and Disease

Background Stroke is among the leading causes of acquired disability in the United States, affecting nearly 800,000 Americans annually The identification of more effective treatments for hemiparesis has been recognized as a top research priority Intelligent, motor-driven devices for rehabilitation, or rehabilitation robotics, represent an exciting frontier with considerable potential to address these concerns Purpose This article presents a state of the science review regarding selected robotic technologies that are representative of current robot-aided rehabilitation strategies, the evidence surrounding their efficacy, barriers to widespread dissemination, and technologies in development Methods Narrative Review Conclusions Based on this synthesis, we suggest that robotic rehabilitation tools are neither the standard of care, nor entirely experimental, but rather a clinically innovative therapy of some utility

The use of robots in stroke rehabilitation: A narrative review.

Researchers have explored a variety of neurorehabilitation approaches to restore normal walking function following a stroke. However, there is currently no objective means for prescribing and implementing treatments that are likely to maximize recovery of walking function for any particular patient. As a first step toward optimizing neurorehabilitation effectiveness, this study develops and evaluates a patient-specific synergy-controlled neuromusculoskeletal simulation framework that can predict walking motions for an individual post-stroke. The main question we addressed was whether driving a subject-specific neuromusculoskeletal model with muscle synergy controls (5 per leg) facilitates generation of accurate walking predictions compared to a model driven by muscle activation controls (35 per leg) or joint torque controls (5 per leg). To explore this question, we developed a subject-specific neuromusculoskeletal model of a single high-functioning hemiparetic subject using instrumented treadmill walking data collected at the subject’s self-selected speed of 0.5 m/s. The model included subject-specific representations of lower body kinematic structure, foot-ground contact behavior, electromyography-driven muscle force generation, and neural control limitations and remaining capabilities. Using direct collocation optimal control and the subject-specific model, we evaluated the ability of the three control approaches to predict the subject’s walking kinematics and kinetics at two speeds (0.5 and 0.8 m/s) for which experimental data were available from the subject. We also evaluated whether synergy controls could predict a physically realistic gait period at one speed (1.1 m/s) for which no experimental data were available. All three control approaches predicted the subject’s walking kinematics and kinetics (including ground reaction forces) well for the model calibration speed of 0.5 m/s. However, only activation and synergy controls could predict the subject’s walking kinematics and kinetics well for the faster non-calibration speed of 0.8 m/s, with synergy controls predicting the new gait period the most accurately. When used to predict how the subject would walk at 1.1 m/s, synergy controls predicted a gait period close to that estimated from the linear relationship between gait speed and stride length. These findings suggest that our neuromusculoskeletal simulation framework may be able to bridge the gap between patient-specific muscle synergy information and resulting functional capabilities and limitations.

/pdf/muscle-synergies-facilitate-computational-prediction-of-1ad6xjl3y0.pdf

Muscle Synergies Facilitate Computational Prediction of Subject-Specific Walking Motions.

EXECUTIVE SUMMARYBackgroundStroke is a leading cause of long-term disability, and rehabilitation, involving repetitive, high intensity, task-specific exercises, is the pathway to restoring motor skills. Robotic assistive devices are increasingly being used and it is hoped that with robotic devices,

Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: a systematic review.

Background: There has been a growing interest in the use of robotic therapy to improve walking ability in individuals following stroke. Objectives: The aim of this retrospective study was to compare conventional physiotherapy (CP) with robotic training (RT) combined with CP and to measure the effects on gait, balance, functional status, cognitive function, and quality of life in patient with stroke. Methods: We retrospectively identified 107 cases of new cerebral stroke. They were allocated into 2 groups. In the RT group (n = 36), patients received RT (Lokomat; 2 times per week) combined with CP (3 times per week) for at least 30 sessions. In the CP group (n = 71), patients received a program at least 30 sessions, 5 times per week. The evaluation parameters included modified Ashworth Spasticity Scale (MASS), Brunnstrom Recovery Scale (BRS), Functional Independence Measure (FIM), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Short Form-3...

A Comparative Study of Conventional Physiotherapy Versus Robotic Training Combined with Physiotherapy in Patients with Stroke

[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction.

Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction.

[Purpose] This study compared the effectiveness of home exercise alone versus home exercise combined with ultrasound for patients with temporomandibular joint disorders. [Subjects and Methods] This study enrolled 23 female and 15 male patients who were divided randomly into two groups. The home exercise group performed a home exercise program consisting of an exercise program and patient education, and the home exercise combined with ultrasound group received ultrasound therapy in addition to the home exercise program. Pain intensity was evaluated using a visual analogue scale. Pain free maximum mouth opening was evaluated at baseline and 2 weeks after the treatment. [Results] There was no difference between the two groups in baseline values. After the treatment, the visual analogue scale decreased and pain free maximum mouth opening scores improved significantly in each group. Additionally, both values were higher in the home exercise combined with ultrasound group than in the home exercise group. [Conclusion] The combination of home exercise combined with ultrasound appears to be more effective at providing pain relief and increasing mouth opening than does home exercise alone for patients with temporomandibular joint disorders.

/pdf/effectiveness-of-a-home-exercise-program-in-combination-with-4vwtfdi8b2.pdf

Effectiveness of a Home Exercise Program in Combination with Ultrasound Therapy for Temporomandibular Joint Disorders

Aim

The use of biomarkers of osteoarthritis (OA) have potential for early diagnosis, evaluation of disease severity and monitoring treatment. Serum and synovial fluid YKL-40 levels are increased in severe knee OA. Pulsed electromagnetic field (PEMF) therapy is a novel treatment method for OA. However, studies evaluating the PEMF therapy in treatment of knee OA revealed conflicting results. This study was conducted to objectively assess the effect of PEMF therapy in patients with knee OA, by using ultrasonographic measurements and a novel biomarker, YKL-40.



Methods

Forty patients were randomized into two treatment groups. Both groups received conventional physical therapy, while Group 1 received additional PEMF therapy. The patients were asked to rate their pain on a visual analogue scale (VAS) and complete a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnairre. Serum YKL-40 levels were measured, and knee effusion and cartilage degeneration level were evaluated with ultrasonography before and after treatment.



Results

Pre-treatment YKL-40 level was correlated with WOMAC pain subscale (P = 0.032, r = 0.339). VAS and WOMAC scores significantly improved in both treatment groups (P < 0.05). The effusion in the right knee significantly decreased in Group 1. The change in YKL-40 level was not correlated with the change in VAS, WOMAC scores and knee effusion.



Conclusion

This study revealed that adjuvant PEMF therapy has no additional effect on pain in patients with knee OA. Serum YKL-40 level seems to be unuseful for monitoring the treatment in knee OA.

Assessment of pulsed electromagnetic field therapy with Serum YKL-40 and ultrasonography in patients with knee osteoarthritis.

Objectives: Primary hyperhidrosis is an under-recognized condition in children and adolescents. Iontophoresis is the second line of treatment for palmoplantar hyperhidrosis following topical treatment. The studies evaluating the efficacy of iontophoresis in children are limited. We aimed to investigate the efficacy and reliability of tap water iontophoresis in children with primary hyperhidrosis.Methods: Twenty-one patients aged under 18 years, who received iontophoresis for primary palmoplantar hyperhidrosis, were included in the study. In our clinic, tap water iontophoresis was administered at regular intervals, starting with five times per week and decreased to once a week on fifth week. Then maintenance sessions once a week for 6 weeks are recommended. The presence of excessive sweating was scored by visual analogue scale (VAS): “0” as continuation of excessive sweating and “10” as the absence of excessive sweating. The demographic and clinical data were collected from files. Also, patients fu...

Selma Eroğlu

Papers

A Comparative Study of Conventional Physiotherapy Versus Robotic Training Combined with Physiotherapy in Patients with Stroke

Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction.

Effectiveness of a Home Exercise Program in Combination with Ultrasound Therapy for Temporomandibular Joint Disorders

Assessment of pulsed electromagnetic field therapy with Serum YKL-40 and ultrasonography in patients with knee osteoarthritis.

Treatment of primary hyperhidrosis with tap water iontophoresis in paediatric patients: a retrospective analysis