Stepping towards health: a scoping review of square-stepping exercise protocols and outcomes in older adults.

BACKGROUND: Square-Stepping Exercise (SSE) is a type of physical-cognitive exercise. Such exercise has been used as an exercise approach in different studies with older adults. This scoping review provides an overview of the protocols and outcomes of studies employing the SSE in older adults. METHODS: We searched in the PubMed, CINAHL, Scopus, CABI Global Health, and Web of Science databases for articles published between 2006 (first research article published on SSE) to December 2023 that met a robust inclusion criterion. The search yielded 424 articles, and after inclusion criteria being applied, 37 articles were included in the final analysis. RESULTS: A total of 37 studies were included in the final analysis. Thirty-three out of the 37 studies focused on apparently healthy older adults, while four were conducted with older adults with neurological disease (i.e., multiple sclerosis, Parkinson's disease, and stroke). Most studies (n = 25) adopted an experiment (i.e., randomized controlled trial) or quasi-experimental approach, while 12 were classified as non-randomized (i.e., cross-sectional, mixed methods). The studies were conducted in different parts of the globe and adopted three major formats of intervention delivery, namely in-person, online, and home-based. Frequency, SSE session duration and intervention length significantly varied among studies, and reported outcomes were in the domains of physical and cognitive function. CONCLUSION: This review comprehensively described the characteristics of 37 studies employing SSE in apparently healthy older adults and older adults with neurological diseases. The findings demonstrated that SSE has been used by researchers across the globe, adopting a variety of forms of delivery, and to particularly improve physical and cognitive function of different segments of the older adult population. The review further identified important gaps in research, including the restricted outcomes, and the lack of studies combining SSE with more traditional exercise modalities to address potential combinatory effects.

Enhancing Aesthetics and Functionality of the Teeth Using Injectable Composite Resin Technique.

In order to prepare composite restorations without the requirement for tooth preparation, the injectable composite resin technique uses a clear silicone index in a minimally invasive direct approach to imitate a diagnostic wax-up. This case report features a 34-year-old female patient having aesthetic and functional concerns, notably spacing between the teeth, insufficient tooth visibility, and diastema in the upper anterior region. Upon clinical examination, spacing and midline diastema were observed. The maxillary incisors and canines were to have composite veneers made as part of the treatment plan. A wax-up and transparent silicone index was prepared following the assessment of a try-in of the prepared mock-up. Subsequenty, for restoring the teeth, a clear silicone index was used to inject and polymerize the flowable composite. The desired outcomes included elongated teeth to enhance visibility, closure of diastemas, and reshaping of the canines. Over a 12-month follow-up period, the patient exhibited no signs of soft tissue inflammation or significant wear. The described technique is characterized by its minimal invasiveness, cost-effectiveness, and suitability for definitive and provisional restorations. Desirable results can be achieved by appropriate planning and adhering to a meticulous planning while minimizing tooth structure loss.

The functional secondary effect after an integrated rehabilitative intervention to learn reading and writing in a girl with Rubinstein-Taybi syndrome.

PURPOSE: A case report of a six-year and five-month-old female admitted with typical symptoms of Rubinstein-Taybi syndrome is presented. Clinical and rehabilitation settings where she acquired her reading, writing, and communication skills are described. METHODS: Because of her cognitive disabilities, a multidisciplinary and long-term intervention (2014-2020) was necessary. Treatment included orthoptic, psychomotor, logopedic, occupational, and neuropsychological care. Her family and school were involved. RESULTS: Increased attention led to decreased dysfunctional behaviors. Test results are still below average, but there has been significant improvement. Better communication skills resulted from increased phonetic range, improved articulation, lexical-semantic structure, comprehension, and production of sentences. Digital technologies played a significant role in enhancing her communication skills, not just in social interactions but also in school activities. The patient is oriented in time and space with the help of agendas and calendars. She can express her needs and compose concise narratives. As a result of acquiring functional skills, she is better equipped to handle real-life situations, which has led to increased social and family activities. CONCLUSION: This case report highlights the importance of personalized rehabilitation programs. Obtaining an early genetic diagnosis is crucial for timely tailored rehabilitation, and any delays in this process can hinder progress.

Effect of Extended Care on Functional Rehabilitation of Stroke-Induced Hemiplegic Patients.

Background: We aimed to observe the effect of extended care on improving motor function and activities of daily living of stroke-induced hemiplegic patients. Methods: Patients clinically diagnosed as stroke with hemiplegia and hospitalized in the Neurology Department at Tianjin Haibin People's Hospital, China from 2019 to 2020 were selected. One hundred twenty patients were enrolled and randomly divided into the intervention group (60 patients) and the control group (60 patients). The control group was given routine rehabilitation treatment and care. Based on routine rehabilitation treatment and care, the intervention group was given transitional care. After discharge, the patients were followed up. Barthel indexes (BIs) were collected to evaluate the activities of daily living of patients. The Fugl-Meyer Motor Function Assessment (FMA) was adopted to evaluate the patients' motor function. Results: There was no statistically significant difference in the total BI scores between the two groups of patients at the two time points before intervention and at discharge. The total scores of the intervention group were higher than those of the control group after 1 month and 3 months of discharge, and the difference was statistically significant (P<0.05). There was no statistically significant difference in total FMA scores between the two groups of patients before intervention, indicating comparability. After 3 months of discharge, the total FMA score of the intervention group patients was higher than that of the control group, and the differences were statistically significant (P<0.05). Conclusion: Continuous care can effectively improve motor function and daily living ability of stroke patients with hemiplegia.

Vertical Fracture of the Medial Malleolus With Concurrent Ipsilateral Achilles Tendon Rupture in a Patient With Progressive Collapsing Foot Deformity: A Rehabilitation Dilemma.

A male in his 40s presented with a vertical shear type medial malleolar fracture with an ipsilateral Achilles tendon rupture with a pes planovalgus deformity. Both injuries were diagnosed concurrently on presentation. This is a rare injury pattern with no consensus on optimum management. This is the first case report where pes planus is also described alongside the injuries. The medial malleolar fracture was successfully treated surgically with an open reduction and internal fixation (ORIF) with antiglide plating. Following ORIF, the patient underwent functional rehabilitation for the Achilles tendon rupture. The purpose of this case report is to highlight this infrequent injury pattern, which poses a great therapeutic dilemma. The therapeutic considerations regarding surgical and non-surgical approaches to management are thoroughly presented and discussed.

Neuromodulation's Role in Functional Restoration in Paraplegic and Quadriplegic Patients.

Neuromodulation is an alternative, minimally invasive treatment option that, at times, is used as a last resort for chronic pain conditions that are often refractory to other treatment modalities. Moreover, it offers promising prospects for individuals grappling with the formidable challenges posed by paraplegia and quadriplegia resulting from spinal cord injuries. This review article provides a comprehensive assessment of current treatment modalities specifically tailored for paraplegic and quadriplegic patients. We aim to evaluate the existing surgical and non-surgical interventions while delving into the role of neuromodulation in the restoration of function for individuals afflicted with these debilitating conditions. Additionally, we review the efficacy, limitations, and comparative outcomes of diverse treatment strategies available for the management of paraplegia and quadriplegia. Emphasizing the critical need for effective interventions beyond the initial 24 h surgical window, we elucidate the challenges associated with conventional therapies and their limited success in achieving comprehensive functional restoration. Central to this review is an in-depth exploration of neuromodulation's transformative potential in ameliorating the deficits caused by spinal cord injuries. With a particular focus on spinal cord stimulation (SCS), we analyze and compare the outcomes of neuromodulation modalities and traditional treatment regimens, shedding light on the promising strides made in fostering sensory perception, motor function, and patient satisfaction.

Feasibility of an early progressive resistance exercise program for acute Achilles tendon rupture.

BACKGROUND: Long-term strength deficits are common after Achilles tendon ruptures. Early use of progressive resistance exercises may help reduce strength deficits, but the feasibility of this approach is unknown. The aim was to investigate the feasibility of early progressive resistance exercises regarding patient acceptability and compliance with the intervention. METHODS: We recruited patients with an acute Achilles tendon rupture treated non-surgically. During 9 weeks of immobilisation with a walking boot, participants attended weekly supervised physiotherapy sessions of progressive resistance exercises and performed home exercises, consisting of isometric ankle plantarflexion, seated heel-rise, and elastic band exercises. Acceptability was evaluated using a 7-point Likert scale (1 = very unacceptable and 7 = very acceptable) with feasibility threshold at 80% of the participants rating ≥ 4. Adherence to the exercises was defined as 80% of the participants performing at least 50% of the home exercises. During the intervention, tendon healing and adverse events were monitored. RESULTS: Sixteen participants (mean age 46 (range 28-61), male/female = 13/3) completed the intervention. Pre-injury Achilles tendon total rupture score was 98 (SD 8). All participants rated the acceptability of the exercises ≥ 5 (moderate acceptable to very acceptable) at 9- and 13-week follow-up and 9/16 rated 7 points (very acceptable). Participants performed 74% (range 4-117) of the total prescribed home exercises and 15/16 performed > 50%. One participant was not compliant with the home exercises due to feeling uncomfortable performing these independently. There were no re-ruptures, but one case of deep venous thrombosis. CONCLUSIONS: The early progressive resistance exercise program for treatment of non-surgically treated Achilles tendon rupture was feasible. Future studies should investigate the efficacy of the progressive intervention. TRIAL REGISTRATION: The study was registered at Clinical Trials (NCT04121377) on 29 September 2019. CLINICALTRIALS: NCT04121377 .

Early post-surgical rehabilitation and functional outcomes of a traumatic ulnar nerve injury: a pediatric case report.

Background: Peripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery. Case presentation: The patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon's canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living. Conclusion: A timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb.

[Research progress on early postoperative pain management strategies after arthroscopic anterior cruciate ligament reconstruction].

Objective: To summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction (ACLR), and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR. Methods: The literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed, and the effects of improving postoperative pain were reviewed. Results: Currently, physical therapy and oral medication have advantages such as economy and simplicity, but the effect of improving postoperative pain is not satisfactory, often requires a combination of intravenous injection or intravenous pump, which is also a common way to relieve pain. However, in order to meet the analgesic needs of patients, the amount of analgesic drugs used is often large, which increases the incidence of various adverse reactions. Local infiltration analgesia (LIA), including periarticular or intra-articular injection of drugs, can significantly improve the early postoperative pain of ACLR, and achieve similar postoperative effectiveness as nerve block. LIA can be used as an analgesic technique instead of nerve block, and avoid the corresponding weakness of innervated muscles caused by nerve block, which increases the risk of postoperative falls. Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR, especially the analgesic effects of periarticular injection are more satisfactory. It can also avoid the risk of cartilage damage caused by intra-articular injection. However, the postoperative analgesic effect and timeliness still need to be improved. It is possible to consider combining multimodal mixed drug LIA (combined with intra-articular and periarticular) with other pain intervention methods to exert a synergistic effect, in order to avoid the side effects and risks brought by single drugs or single administration route. LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR. Conclusion: Early pain after arthroscopic ACLR still affects the further functional activities of patients, and all kinds of analgesic methods can achieve certain effectiveness, but there is no unified standard at present, and the advantages and disadvantages of various analgesic methods need further research.

Functional Reeducation in Cognitively Impaired Condition.

Intellectual Abilities, as defined in the twelfth edition of the classification manual of the American Association on Intellectual and Developmental Disabilities, are a fundamental part of the rehabilitation process, also understood as functional rehabilitation or the rehabilitation of specific more or less complex functions, in a paradoxical game of mirrors even in the rehabilitation of intellectual functions themselves. Intellectual Disability changes the rules of the game, all the more radically the more severe it is, exacerbating the importance of multidimensional assessment of residual abilities and impaired functions on the basis of which to define realistic goals and choose the tools of rehabilitation and the ways of implementing therapeutic programs in a team effort that consists of the professionals, family and care givers, as well as the disabled person to the extent that he or she is able to actively participate in conducting his or her own rehabilitation.

How to Choose the Appropriate Posterior Slope Angle Can Lead to Good Knee Joint Function Recovery in Total Knee Arthroplasty?

Objective: In this study, we aim to examine the effects of osteotomy under varying posterior slope angles on knee joint function recovery following knee arthroplasty. Methods: We conducted a retrospective analysis from September 2015 to September 2018 on 240 patients who underwent knee arthroplasty three years previously. The study participants were categorized based on changes in the angle of the posterior slope before and after surgery: Group 1, > 5°; Group 2, 3°-5°; Group 3, 0°-3°; Group 4, -3°-0°; Group 5, < -3°. All participants were affected with knee osteoarthritis. The Knee Society Clinical Rating System (KSS) knee function score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) knee function score, Visual Analogue Scale (VAS) pain score, and postoperative complications were measured 3 years after surgery. Results: The level of pain experienced by the patients decreased significantly than before, with pain scores ranging from 1.0-3.0, and there was a statistical difference between groups (H = 93.400, P < 0.001). The KSS score increased, with group 5 having the lowest median score of 78.0 and group 2 having the highest median score of 97.0, and there was a statistical difference between groups (H = 164.460, P < 0.001). The WOMAC score was reduced, with the median score being 24.0, 11.0, 14.0, 20.0, and 26.0, in the five groups, respectively. Group 5 had the highest score, while Group 2 had the lowest score, and there was a statistically significant difference between groups (H = 164.223, P < 0.001). No symptoms such as periprosthetic femoral fracture, prosthetic loosening, or pad wear were detected in patients postoperatively. Conclusion: Osteotomy at various posterior slope angles in total knee arthroplasty impacts postoperative knee function rehabilitation. An excessive increase or decrease in angle can have an impact on the postoperative recovery of knee function.

Ferrostatin-1 facilitated neurological functional rehabilitation of spinal cord injury mice by inhibiting ferroptosis.

BACKGROUND: To seek the potential therapy for spinal cord injury, Ferrostatin-1, the first ferroptosis inhibitor, was administrated in spinal cord injury mice to identify the therapeutic effect. METHODS: Spinal cord injury model was established by a modified Allen's method. Then, ferrostatin-1 was administrated by intraspinal injection. Cortical evoked motor potential and BMS were indicated to assess the neurological function rehabilitation. H&E, Nissl's staining, NeuN, and GFAP immunofluorescence were used to identify the histological manifestation on the mice with the injured spinal cord. Spinosin, a selective small molecule activator of the Nrf2/HO-1 signaling pathway, was administrated to verify the underlying mechanism of ferrostatin-1. RESULTS: Ferrostatin-1 promoted the rehabilitation of cortical evoked motor potential and BMS scores, synchronized with improvement in the histological manifestation of neuron survival and scar formation. Spinosin disturbed the benefits of ferrostatin-1 administration on histological and neurobehavioral manifestation by deranging the Nrf2/HO-1 signaling pathway. CONCLUSIONS: Ferrostatin-1 improved the rehabilitation of spinal cord injury mice by regulating ferroptosis through the Nrf2/HO-1 signaling pathway.

Midterm Outcomes of Operatively and Nonoperatively Managed Achilles Tendon Ruptures in Young Adults.

Background: There continues to be controversy regarding treatment options for Achilles tendon ruptures (ATR). The aim of our study is to compare outcomes between operatively and nonoperatively managed Achilles ruptures in young adults (age 18-30 years), which has not been previously evaluated. Methods: At a single institution, all patients aged 18-30 years at time of injury who underwent treatment for an acute ATR from 2014 to 2021 were evaluated. Medical records were reviewed to collect demographics, dates of injury and treatment, smoking status, body mass index (BMI), Charlson Comorbidity Index (CCI), rate of deep venous thrombosis (DVT) after treatment, and rate of rerupture. Patients then completed Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) questionnaires. Mann-Whitney nonparametric testing was used to evaluate for any statistical differences in PROMIS scores. Results: Sixty-six operative patients qualified and 28 (42%) participated. Thirty-seven nonoperative patients qualified and 14 (38%) participated. All patients had a CCI of 0. One patient in the operative cohort and 2 in the nonoperative reported active smoking. In the operative and nonoperative cohorts, respectively, the average age was 24.4 and 27.8 years; average BMI 26.5 (SD = 4.8) and 27.3 (SD = 4.3, P = .52); DVT rates 4 (6.1%) and 2 (5.4%); and rerupture rates 2 (3.0%) and 1 (2.7%), respectively. PROMIS scores did not differ in the operative and nonoperative groups: PROMIS PF mean of 60.4 (SD = 9.8) and 62.9 (SD = 9.1), respectively (P = .33); as well as PROMIS PI mean of 44.6 (SD = 5.9) and 43.9 (SD = 6.5), respectively (P = .59). Conclusion: This study should be interpreted with the understanding that we had a considerable loss to follow-up rate. In the study cohort, we found that young adults with ATR may be considered for either operative or nonoperative management. Rates of DVT, rates of rerupture, and PROMIS scores were not dissimilar between the 2 cohorts. Level of Evidence: Level III, retrospective cohort study.

Post Hospital Discharge Functional Recovery of Critical Illness Survivors. Systematic Review.

Background: Millions of people face critical illnesses and need to be hospitalized in an Intensive Care Unit (ICU) annually worldwide. Despite the fact that survival rates of these patients have increased, they develop various cognitive, psychological and functional impairments. This study aims to investigate the significance of the recovery interventions following intensive care unit discharge, the effectiveness of the rehabilitative protocols and their possible deficits. Methods: MEDLINE (PubMed) and Physiotherapy Evidence Database (PEDro) were searched for studies analyzing the recovery potentials post-ICU among adults, who spent at least 48 hours at the ICU. Methodological quality of the studies was assessed via PEDro Scale. Results: Nine randomized controlled trials were included. These took place mainly at specialized rehabilitation gyms as well as patients home environments. Studies analyses showed that treatment group showed improvement in functional ability in relation to control group. Nevertheless, differences between two groups were not statistically significant (P<0.05). The majority of studies assessed cardiorespiratory endurance and muscular strength. Conclusions: The included rehabilitation programs were determined to be effective. Although they didn't prove any statistically significant difference between groups, quality of life enhancements and stress reduction were reported. Hence, new randomized controlled trials are required in order to provide more accurate data on the potential benefits of rehabilitation strategies among post-ICU patients.

Thromboembolic Events During Weightbearing vs Nonweightbearing Accelerated Rehabilitation Protocols for Complete Achilles Tendon Ruptures.

Background: Achilles tendon rupture can be treated nonoperatively with functional rehabilitation. However, prolonged immobilization has associated risk of venous thromboembolism (VTE). Early weightbearing may reduce VTE risk, and this was introduced to our rehabilitation protocol. We investigated the prevalence of symptomatic VTE events before and after the introduction of the early weightbearing protocol. Methods: Adults with ultrasonography-confirmed complete tendo-Achilles ruptures between January 2017 and June 2020 were included. Preprotocol, patients were instructed to not weightbear for 4 weeks. In 2018, immediate weightbearing was introduced to the treatment protocol. All patients in both cohorts were given low-molecular-weight heparin for 4 weeks. Patients with symptomatic VTE events were investigated with duplex ultrasonographic scan or chest computed tomography. Two independent anonymized examiners collected data from electronic records. Rates of symptomatic VTEs were compared. Results: A total of 296 patients were included. Sixty-nine patients were managed with the nonweightbearing protocol, and 227 patients were managed with the early-weightbearing protocol. Two patients in each group developed deep vein thrombosis and 1 developed pulmonary embolism in the early-weightbearing group. Rates of VTEs were lower in the early-weightbearing group (1.3% vs 2.9%) but did not reach statistical significance (P = .33). Conclusion: In this cohort we found that symptomatic VTE after nonoperatively treated Achilles tendon rupture was uncommon. We did not demonstrate a reduction in symptomatic VTE between our early weightbearing and nonweightbearing rehabilitation protocols. We believe a larger study may help clarify whether early weightbearing is beneficial in VTE reduction. Level of Evidence: Level III, retrospective cohort study.

A pessoa com demência: contributos de enfermagem de reabilitação na promoção da independência funcional / The person with dementia: contributions of rehabilitation nursing in promoting functional independence

Enquadramento: O presente relatório assenta no percurso formativo do Estágio de Natureza Profissional com uma componente de investigação, realizado nos Cuidados de Saúde Primários, e dedicado fundamentalmente aos problemas decorrentes do envelhecimento, sensíveis às competências da prática da Enfermagem de Reabilitação. A idade avança e muitas vezes a presença de doenças crónicas, como a demência e a DPOC, culminam na limitação e na incapacidade da pessoa se manter independente no seu dia-a-dia, fruto de um declínio funcional, desde: perda de força muscular, alteração do padrão da marcha, diminuição da flexibilidade, perda de agilidade, alteração da coordenação sensória-motora, diminuição da mobilidade articular e comprometimento do equilíbrio. Impõem-se assim medidas que promovam a manutenção e, ou, a melhoria da funcionalidade da pessoa idosa no seu contexto de vida, sendo para tal os cuidados de Enfermagem de Reabilitação um recurso importante. Assim, é abordada a reabilitação no âmbito dos Cuidados de Saúde Primários, sintetizando o papel do EEER na comunidade e as áreas de intervenção ao logo do processo formativo. Sendo a demência uma patologia de grande impacto na funcionalidade da pessoa, neste trabalho aprofunda-se esta problemática através da realização de um estudo de investigação. Metodologia: Para responder aos objetivos do estágio recorreu-se à exploração de conceitos e questões através de uma abordagem critico-reflexiva do percurso formativo na busca pelo desenvolvimento de competências, sustentado nas teorias de enfermagem e bibliografia atual. No âmbito da investigação, foi realizado um estudo quase-experimental de grupo único, com o objetivo de avaliar os efeitos de um programa de Reabilitação funcional motora, no utente com demência moderada em contexto domiciliário. A amostra incluiu 18 pessoas, os quais foram alvo de intervenção do EEER durante 10 semanas, com um total de 20 sessões, numa periodicidade de 2 a 3 vezes por semana. Resultados: A realização do ENP, possibilitou o desenvolvimento e adquisição de competências Comuns e Específicas em Enfermagem de Reabilitação e de Mestre. Relativamente ao programa de intervenção, as avaliações realizadas demonstraram indícios de melhoria global da funcionalidade da pessoa, nomeadamente numa maior independência no autocuidado, melhoria da mobilidade e locomoção, aumento da força muscular global, e melhoria do equilíbrio estático e dinâmico, apresentando ganhos em saúde sensíveis aos cuidados do Enfermeiro de Reabilitação. Conclusões: Os cuidados de Enfermagem de Reabilitação podem ser um contributo para a manutenção e mesmo melhoria da capacidade funcional da pessoa com limitações funcionais, mesmo com patologia crónica como a demência.

Framing: This report is based on the formative course of the Professional Internship with a research component, carried out in Primary Health Care, and dedicated fundamentally to the problems arising from aging, sensitive to the capabilities of rehabilitation nursing practice. Age advances and often the presence of chronic diseases, such as dementia and COPD, culminate in the limitation and inability of the person to remain independent in his daily life, resulting from a functional decline, for instance: loss of muscle strength, change in gait pattern, decreased flexibility, loss of agility, alteration of mental-motor coordination, decreased joint mobility and impaired balance. Therefore, measures are needed to promote the maintenance and, or, improvement of the functionality of the senior citizen in their life context, and rehabilitation nursing care is an important resource. Rehabilitation in the scope of Primary Health Care is addressed, synthesizing the role of the EEER in the community and the areas of intervention at the end of the formative process. Since dementia is a pathology of great impact on the person's functionality, this work deepens this problem through the realization of a research study. Methodology: To respond to the objectives of the internship, we used the exploration of concepts and questions through a critical-reflexive approach to the formative path way in the search for the development of capabilities, supported by nursing theories and current bibliography. In the scope of the research, a single-group near-experimental study was conducted with the objective of evaluating the effects of a motor functional rehabilitation program on users with moderate dementia in the home context. The sample included 18 people, who were the target of EEER intervention for 10 weeks, with a total of 20 sessions, at a frequency of 2 to 3 times a week. Results: The performance of the ENP, allowed the development and acquisition of Common and Specific competencies in Rehabilitation and Master Nursing. Regarding the intervention program, the evaluations showed evidence of overall improvement in the person's functionality, namely a greater independence in self-care, improvement of mobility and locomotion, increased overall muscle strength, and improvement of static and dynamic balance, presenting health gains sensitive to the care of rehabilitation nurses. Conclusions: Rehabilitation Nursing care can be a contribution to the maintenance and even improvement of the functional capacity of the person with functional limitations, even with chronic pathology such as dementia.

Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans.

BACKGROUND: Chronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA's Stepped Care Model to meet veterans' pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management. OBJECTIVES: The Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans' pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation. METHODS: A sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO. RESULTS: Of 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20-9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p < .003) in the three primary pain outcomes (intensity, interference, catastrophizing), and 12 of 17 secondary outcomes, including physical, psychological, health-related quality of life (HRQoL), acceptance, and mindfulness measures. DISCUSSION: Data suggest that EVP has significant positive outcomes in pain, psychological, physical, HRQoL, acceptance, and mindfulness measures for veterans with chronic pain through non-pharmacological means. Future evaluations of intervention dosing effect and long-term effectiveness of the program is needed.

A comparison of functional and radiological outcome of combine compression antegrade intertrochanteric nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in elderly patients with intertrochanteric fractures.

Objective: To compare the functional and radiological outcome of combine compression interlocking intramedullary nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in the treatment of elderly patients with intertrochanteric fractures. Methods: As a retrospective cohort study, records of 88 patients with intertrochanteric fractures treated in our hospital from January 1st, 2019 to July 31st, 2021 were retrospectively reviewed. According to treatment records, it included 45 patients treated with InterTan (Group-A) and 43 patients treated with PFNA-II (Group-B). The operation safety and functional rehabilitation of the two groups were compared and analyzed. Results: This study included 88 patients with intertrochanteric fractures (mean [SD] age, 68.72 [0.10] years at baseline), of whom 52 (59.09%) were males and 36 (40.91%) were females. Operation time and intraoperative blood loss in Group-B were less than Group-A, while fracture healing time was shorter in Group-A. The fracture separation distance was measured four weeks after the operation. The widening rate of the fracture line in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). The incidence of complications in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). At three, six and twelve months after the operation, the Harris hip score of the two groups was higher than at discharge (P<0.05), with no significant difference between groups (P>0.05). Conclusions: We found no significant difference in the functional outcome in elderly patients with intertrochanteric fractures treated with InterTan and PFNA-II. Early fracture healing and reduced complication rate however has been noted with InterTan.

[Suicide attempts with a violent method: Experience of a transdisciplinary psychiatric ward combining psychiatric and somatic care]. / Prise en charge des tentatives de suicide graves : expérience d'un service transdisciplinaire de psychiatrie.

INTRODUCTION: Suicide is the second leading cause of death in young adults. Suicide attempts by violent methods predict later completed suicide and premature mortality. Suicide prevention is a major public health issue in this specific population. The French Student Health Foundation (FSEF) developed a psychiatric ward that includes psychiatric and somatic approaches. This transdisciplinary unit provides mixed psychiatric and rehabilitation treatments for those persons who have attempted suicide and have severe somatic injuries. METHODS: We conducted a retrospective study including all subjects admitted into the transdisciplinary unit from 1st January 2011 to 31 December 2017, after a suicide attempt by jumping from a height, in front of a moving object, or by crashing of a motor vehicle. Data was obtained from the medical and administrative records of the clinic. RESULTS: In total, 215 persons were admitted into the transdisciplinary unit after a suicide attempt by a violent mean. Among them, 91.6% had jumped from a height, 7.4% had jumped in front of a train or a metro and 0.9% had crashed a motor vehicle. They were on average 25.5years old and 50.2% were men. 45.1% had a diagnosis of schizophrenic disorders and 34.4% of mood disorders. A total of 35.6% presented at least one previous suicide attempt, and among them 40.3% had previously attempted suicide with a violent mean. Substance abuse, mostly alcohol and/or cannabis, featured in 40.8% of subject history. The subjects hospitalised in the transdisciplinary unit had multiple, severe injuries: 78.1% had spine fractures, 69.8% had lower limb fractures, 47.9% had pelvic fractures and 43.3% had upper limb fractures. Moreover, 25.5% of them had sacral root damages. The length of stay averaged 184days and varied in a large range (less than a month to more than two years). The Activities of Daily Living scores were higher than 3 (out of a maximum score of 4) reflecting an important need of assistance. These scores decreased significantly during the hospitalisation for dressing, feeding, continence and locomotion but remained high for comportment and communication. At discharge, the physical sequelae were still important: 61% of people hospitalised had pain that required step 2 or 3 analgesics, 44% had analgesics for neuropathic pain, 80% had lower limb impairments, most often with walking limitation, and 26% had continence disorders. The psychotropic treatments at discharge were related to the psychiatric disorders observed and included 42% antidepressants, 63% neuroleptics and 16% mood stabilizers. CONCLUSION: This study highlights the severity of the somatic and psychiatric disorders affecting people who are admitted into this transdisciplinary unit. These subjects who have attempted suicide require particular care with multidisciplinary management in order to promote their rehabilitation, reintegration and prevent a suicide reattempt.

Actual experience of the training effect of Baduanjin on patients with hemiplegic limb dysfunctions after cerebral infarction: A qualitative study.

AIM: To explore the actual experience of training effect of Baduanjin on patients with hemiplegic limb dysfunctions after cerebral infarction through semistructured interviews and promote Baduanjin training application in clinical and community settings. DESIGN: This qualitative study was conducted using the conventional content analysis approach. METHODS: Twenty-five patients with hemiplegic limb dysfunctions after cerebral infarction were recruited as participants by applying purposive sampling method between September 2017-December 2020 in the physical therapy department of a rehabilitation hospital affiliated with Fujian University of Traditional Chinese Medicine in China. Semistructured interviews were conducted after patients participated in Baduanjin training for 6 weeks. Data were analysed using qualitative content analysis method of Graneheim and Lundman. RESULTS: Three major themes were identified after analysis, namely improving functions of hemiplegic limbs, improving the condition of the entire body and the feelings of practice. The participants indicated that Baduanjin could improve the limb functions and general conditions of hemiplegic patients. Their experience in practicing Baduanjin was generally positive, and they were willing to continue practicing.