Measuring outcomes in acute neurorehabilitation in General Hospital setting - our experience.

In General Hospital setting, where varieties of patients are included in neurorehabilitation process, set of multidisciplinary functional tests were established, as a routine in daily work. Tests were done by physiotherapists and occupational therapists who were members of rehabilitation team. Our aim was to select the tests which can be used as a routine and are applicable for different neurological impairments in daily work. Tests were applied to inpatients admitted to the Medical, Trauma, Neurology and Neurosurgery wards in the Rashid Hospital, DOHMS, Dubai. Fifty inpatients with different neurological impairments admitted to totally 8 wards, were tested in the beginning of rehabilitation process and on discharge from the hospital. Nine tests were used as standardized tests for measuring motor, cognitive, focal impairment, ADL activities and disability: Motricity Index, Trunk Control Test, Standing Balance score, Functional Ambulation Categories test, Mini Mental State Examination, Canadian Neurological Scale, Action Research Arm test, Bartel Index and Functional Independent Measurements. FIM, Motricity Index and Trunk Control Test were applicable for all tested patients, with required adaptation for different neurological conditions within the same score. Other tests were not applicable for all patients as routine, but there were very useful for certain number of patients as a measurement of functional improvement. It is very important to have proper setup of tests, which are simple, reliable and valid for measuring impairment, disability and handicap and which can be used as standardized part of assessment protocol. Also, they must be applicable for different neurological impairments to monitor treatment progress. Combination of tests performed by different professionals and comprehensive approach of all team members is very important for measuring outcomes in rehabilitation and evaluating patient's impairment and disability. Proper hospital setup, optimal number of staff, good communication and team work are leading to better outcome in neurorehabilitation process.

Osteoarthritis, application of physical therapy proceduers.

Osteoarthritis (OA) is a group of overlapping disorders, which may have different aetiology but similar biological, morphologic and clinical outcome. In osteoarthritis, process will not encompass the joint cartilage only, but the entire joint, including sub-hondral bone, ligaments, capsule, and sinovial membrane and surrounding muscles. Osteoarthritis is a multi-factor disorder of sinovial joints, which occurs as result of mechanical and biological factors, which destabilise normal hondrocyte function, partitioning of cartilage, extra-cellular matrix and sub-hondral bone. The earliest changes, which are restricted to the joint cartilage surface only, do not cause any subjective feeling. The pain in arthrosis occurs (or re-occurs) a bit later, Diagnosis will be determined based on clinical exam as well as signs and symptoms present. Symptomatic and functional treatment of osteoarthritis as one of rheumatic disorders must be taken throughout years, sometimes throughout a lifetime. It encompasses application of many medications and physical therapy procedures.

Extracorporeal shock wave therapy in orthopaedic diseases.

The application of extracorporeal shock wave therapy (ESWT) as a treatment for different orthopaedic conditions has experienced a rapid increase over the last several years. However the mechanism of action and the therapeutic effect is not clear. The aim of this study was to review the literature about the efficacy of ESWT in the treatment of plantar fasciitis, lateral epicondylitis, shoulder painful disorders and non-union fractures. Only randomized controlled studies published in the last 5 years were retrieved from electronic database and manual search. Results on efficacy of ESWT are controversial. Studies that have claimed therapeutic benefit did not fulfill scientific criteria and controlled randomized trials were not able to confirm significant improvement after treatment with ESWT.

The effects of McKenzie and Brunkow exercise program on spinal mobility comparative study.

This study encompassed 64 participants with symptoms of low back pain, 33 in McKenzie group and 31 in Brunkow group. Patients attended exercise program daily and they were asked to do the same exercise at home--five times a day in series of 5 to 10 repetition each time, depending of stage of disease and pain intensity. All patients were assessed for the spinal motion, before and after the treatment. All parameters for spinal movements showed improvement after exercising McKenzie program for lower back pain with a significant difference of p<0.01 for all motions. Also, in Brunkow group, all of the parameters showed statistically significant improvement at the end of treatment in relation to pre-treatment values, with significant difference of p<0.01 for all motions. Statistically comparison between McKenzie and Brunkow difference in score at the end of the treatment showed statistically significant improvement in McKenzie group, for extension, right and left side flexion, while flexion score didn't show statistically significant difference. McKenzie exercises seemed to be more effective than Brunkow exercises for improvement in spinal motion. Both, McKenzie and Brunkow exercises can be used for spinal mobility improvement in patients with lower back pain, but is preferable to use McKenzie exercises first, to decrease the pain and increase spinal mobility, and then Brunkow exercises to strengthen the paravertebral muscles.

Risk factors of fall in elderly people.

Falls are the leading accidental cause of death among elderly people in their homes. Falls and their consequences are the primary reason in 40% of admissions to hospitals for people older than 65 years. The study population consisted of 77 randomly selected patients of both genders older then 65 years. Each patient was tested in his/her home and was completely informed about the methodology and the goals of investigation. Based on the exclusion criteria, three patients were excluded from the study, which means the investigation was conducted on 27 males (35.06%) and 50 females (64.94%) with the average age being 71.23 +/- 5.63 years. For each patient, a specially prepared questionnaire about risk factors was filled in. The sum of affirmative answers represented a relative index of fall risk. All patients were evaluated through Folstein's Mini-Mental State Examination Test that is suitable for on-sight use in patient's home. The score value over 20 excludes dementias, delirium, schizophrenia and affective disorders. Considering the values of the risk factor, scores obtained by the questionnaire and MMSE test scores, statistically significant differences were found between males and females (p < 0.005, respectively p < 0.01), "fallers" and "non-fallers" (p < 0.001, respectively p < 0.01), while considering the relation to the way of living (alone or with family), there were no statistically significant differences (p > 0.05).