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Current Issues.
Volume 1 Issue 1
Short Communication Month : 08 (2017)
Usage of Mobile Devices to Help People Suffering From Peripheral
Arterial Disease Upkeep a Healthy Life
Paulino D
A large group of people, particularly the elderly, are affected
by Peripheral Arterial Disease (PAD), which causes a progressively
reduction of the person’s physical fitness. According to the best
treatment practices, the Centro Hospitalar de Trás-os-Montes e Alto
Douro (CHTMAD) is running a treatment program based on the
execution of supervised exercises, including periodic walks. The key
factors to the management of the exercise’s progression are the control
of the beginning and magnitude of the pain, how often the patients with
PAD must stop on their walks, and how much time they must wait for
the pain to fade. To support the management of this treatment program
we are developing an electronic system, based on mobile devices and
a webservice, to help the persons with PAD to control the quality and
quantity of their walks. The system is a platform for the PAD patients
to register and monitor their status and progressions, and for the health
professionals to supervise their patients.
Review Article Month : 08 (2017)
Cardiovascular Adaptations to Upright and Supine Prolonged Exercise:
Heart Rate Modulation as a Factor of Cardiovascular Drift
Luna Rizzo
The interactive effects of posture and exercise on cardiovascular
drift remain controversial despite scientists have conducted extensive
studies addressed to this topic. For example, changes in posture at
rest are associated with significant changes in Left Ventricular (LV)
filling and Stroke Volume (SV). A transition from the supine to the
upright position produces a decrease in LV end-diastolic pressure and
volume and SV [1,2]. The results of previous studies of the alterations
in LV end-diastolic volume during exercise in the supine position have
varied [3]. There is general theory that end-systolic volume is smaller
during exercise than at rest [3], most scientists have observed an
exercise-induced increase in SV, although others have not [1]. LV stroke
volume increases markedly during the transition from rest to exercise in
the upright position and is almost as great as during supine exercise
[1]. It has been found that, after exercise, the Heart Rate (HR) changes
showing an initial dramatic decrease followed by a gradual decrease to a
steady state level, which maintains itself elevated above the level of preexercise
baseline for a period relatively extended [4]. Many studies have
reported that when generally the body position changes from upright to
supine, cardiac sympathetic nerve activity decreases while vagus nerve
activity increases[5]. If, during recovery from exercise, a reciprocal
change in the activity of the two autonomic nervous system divisions
occurs, a decrease of post-exercise HR elevation would be stimulated by
the supine position via a prevalence of vagus nerve activity, compared
to the upright position. The gravitational force plays an important
role on the transition from the supine to the upright position. In fact,
the distribution of blood volume in the body is markedly influenced
by this force. It has been observed that, adjustments of arterial blood
pressure to compensate the postural perturbation, are achieved in a
complex manner through a number of reflex mechanisms [6]. Recent
studies have reported that, effects of post-exercise include a reduction
in arterial blood pressure, are related to body position 4. However,
mechanisms involved in the post-exercise hypo tension and why this
event occurs, remain unclear so far. This could be addressed to body
position differences, i.e. supine and sitting, during the period after
exercise. To date, several studies have been conducted on this argument
to ascertain and clarify what mechanisms are responsible and involved
in the cardiovascular drift responses to posture changes. Certain
mechanisms remain still unclear despite few attempts have been made
to evaluate different theories on these. The purpose of the present
manuscript is to discuss and try to clarify how a change in posture
affects the cardiovascular responses during recovery from exercise
Review Article Month : 08 (2017)
An Investigation of the Fluid Replacement Effects on Cardiovascular Drift
Responses to Strenous Prolonged Exercise
Luna Rizzo
The replacement fluid ingested immediately after exercise provides
the hydration for the next exercise. Limiting fluid ingested before
exercise can cause problems to the thermoregulation body process
during the following exercise if that fluid is not adequate. The loss of
water from the body due to sweating is a function related to the combined
effects of exercise intensity and environmental conditions (temperature,
humidity, wind speed). In humans, the sweating can exceed 30 g per
minute (1.8 kg per hour). The loss of water through sweating comes from
all compartments of body fluids, also including the blood volume. This
will cause easily an increase in the concentration of electrolytic in body
fluids. Despite, the effect of dehydration on cardiovascular function and
thermoregulation, the extent to which exercise performance is impaired
by a fluid deficit remains unclear. Although some data indicate that
drinking improves athletic ability in executing events of short duration
(1 hour) in temperate climates, other data suggest that this might not
be the case [1]. The maintenance of glucose concentrations in blood is
necessary to optimize the performance of the exercise. In conclusion,
the fluids replacement for the body is important to maintain normal
hydration, and minimize risk of injury from heat and impairment of
exercise performance during exercise. During the exercise lasting more
than 1 hour carbohydrates should be added to the solution of fluid
replacement to maintain the concentration of glucose in the blood
and to increase exercise time to fatigue. The concentration of glucose
in the fluid ingested depends on whether there is a primary need for
energy or hydration. This review paper is focused on mechanisms
of cardiovascular drift (CVdrift) to maintenance and replacement
fluid therapy during strenous prolonged exercise. Many aspects are
treated in the manuscript. The emerging topics treated in this review
paper also include:cardiovascular responses and adaptations to acute
exercise, heart rate adaptations during different time of the day in elite
athletes, hydration status and improvement of performance, effects of
dehydration and hyperthermia on CVdrift. The literature on the topic
appears to be vast and address many important factors of interest for
the performance development occurred in dehydration condition and it
is necessary to be known for the preservation of the athletes ‘health and
performance enhancing
Volume 2 Issue 1
Research Article Month : 11 (2018)
The Effectiveness of Kinesiotaping to Reduce the Incidence of Shoulder
Impingement Syndrome in Baseball Pitchers who PerformRepetitive Overhead
Movements: A Systematic Review
Karen Coker
Shoulder Impingement (SIS) is one of the common causes of
shoulder pain in overarm athletes and accounts for almost one third
of shoulder injuries in baseball players. Kinesiotape (KT) is a stretch
tape, which is used as an intervention for SIS with positive results. This
systematic review evaluates current research evidence on the effects of
kinesiotaping and determines whether KT should be considered when
making decisions regarding injury prevention for baseball pitchers.
A systematic literature search was performed and 27peer-reviewed
articles were included that are related to current practices for preventing
shoulder injury in overhead athletes, biomechanics, the effects of KT on
asymptomatic shoulders and other body partsand KT as an intervention
after shoulder injury. The current research demonstrates that KT alters
the biomechanics of the shoulder and in some cases has been an effective
intervention for shoulder injury. No studies have found KT to have
negative side effects; therefore, its use as an injury prevention technique
is suggestive and should continue to be explored.
Research Article Month : 11 (2018)
Association between Early Rehabilitation for Mechanically Ventilated ICU
Patients and their Walking Independence: A Propensity Score-matched Analysis
Shinichi Watanabe
Background: To examine the association between early
rehabilitation for mechanically ventilated Intensive Care Unit (ICU)
patients and their walking independence.
Methods: Among the 1,024 consecutive patientswho had been
transported to the study facility using ambulance services, newly admitted
to the ICU, and treated with rehabilitation during hospitalization, 236
were included, excluding those meeting the exclusion criteria. The
patients were divided into early rehabilitation and control groups
to retrospectively examine the rate of walking independence, period
needed to achieve such independence, and course-related factors.
Results: On propensity score matching, 78 pairs were selected.
Analysis using the Kaplan-Meier estimator revealed thatthe early
rehabilitation group needed a markedly shorter period to achieve
walking independence. As for course-related factors, there were
significant differences between the groups in the periods from hospital
admission to the initiation of physical therapy andmobilization, as well
as the frequency of delirium.
Conclusion: Early rehabilitation for mechanically ventilated
ICU patients may facilitate earlier mobilization. It may alsoshorten
the period they need to achieve walking independence by preventing
complications, such as delirium.
Research Article Month : 11 (2018)
Reliability, Validity, and Responsiveness of Performance-Based Activity
Level Outcome Measures in Patients after Meniscectomy: A Pilot Study
Eryn Milian
effect of rehabilitation after an arthroscopic partial meniscectomy, the
psychometric properties of that outcome measure and the mechanism
of injury should both be considered. However, the psychometric
properties of many established performance-based measures have not
been studied in this population. The purpose of this study is to establish
the reliability, validity, and responsiveness of the Single-Limb Single
Hop for Distance (SLHT), Single-Limb Crossover Hop for Distance
(CHT), Illinois Agility Test (IAT), Edgren Side Step Test (ESST),
and the Stair Measure Test (SMT) in patients who have undergone a
meniscectomy.
Volume 2 Issue 2
Editorial Month : 12 (2018)
I Have a Question
Casey Chaney
If my basic dental insurance covers my seeing my dentist twice a
year for a checkup for my teeth, why doesn’t my health insurance cover
seeing my physical therapist twice a year for all the rest of my body?
Children are taught from a very young age to regularly brush and
eventually learn about flossing and the importance of visiting the dentist
(usually biannually) in order to maintain good oral health over their
lifetime. For many healthy adults the biannual visit
Volume 3 Issue 1
Research Article Month : 08 (2019)
Neurological and Quality of Life outcomes after Early
Transdisciplinary Rehabilitation Post Stroke: Prospective 2-year
Analysis in Buenos Aires, Argentina
Karina Bustos
The aim of this research was to evaluate the effectiveness of transdisciplinary neurorehabilitation initiated early in post-stroke patients in Argentina.
Methods: Consecutive patients with ischemic stroke were analyzed in which neurorehabilitation was initiated before 24 weeks of the acute episode
and followed for at least 24 months after admission to the center. At baseline and every 3 months quality of life (SF-36 instrument) and Functional
Impact (measured by FIM) were evaluated as outcome measures. Demographic and clinical variables were registered at study entry and during
follow up (post-stroke disability, time in rehabilitation, age, sex, related caregiver, work status and educational level). Stepwise regression analysis
and linear correlation was used to evaluate rehabilitation on outcome measures.
Results: 22 patients were included, mean age 62.7 ± 15 years, 6 (27.3%) women, mean time of follow-up 27 ± 3 months. Rehabilitation was
significantly associated with an increase in the quality of life as well as the functional status independently of other variables (p = 0.001, r 0.85 and
p = 0.005, r = 0.80, respectively).
Conclusion: early transdisciplinary rehabilitation used in stroke patients was associated with a significant increase in quality of life and functional
status independently of other variables in included patients
Case Report Month : 08 (2019)
The High-level Mobility Assessment Tool (HiMAT) in Myotonic
Dystrophy type 2: A Case Report
Kim B. Smith
Myotonic dystrophy type 2 (DM2) is a progressive muscular dystrophy with multi-system manifestations and can affect functional mobility, gait,
and balance. Currently, there are few reports of functional outcome measures in this population. This case describes the change in function detected
by the High-level Mobility Assessment Tool (HiMAT) and 30-second Chair Stand Test (CST) in a high-functioning adult female with DM2 after
physical therapy treatment. The patient’s chief complaint was muscular pain and fatigue that affected activities of daily living (ADLs). Multimodal
physical therapy focused on neuromuscular re-education, balance and strength training, patient education, and moderate cardiorespiratory
training. Improvements were observed in manual muscle testing and in single-limb standing balance. A nine-point total improvement was observed
in HiMAT score, and the CST detected a 100% improvement in number of sit-to-stands. The patient returned to prior level of function and was able
to resume ADLs and recreational activities without complaints of muscular pain or fatigue.
Case Report Month : 08 (2019)
Return to Driving In a Patient with Chronic Stroke and Unilateral
Neglect Syndrome
Laura Zajac-Cox
Background and Purpose: Unilateral neglect syndrome is a common issue following stroke correlated with poor prognosis for recovery of
independent functioning including driving. The purpose of this case report is to describe an episode of physical therapy in which a multi-modal
treatment approach was utilized resulting in return to driving for an individual who experienced a right hemispheric ischemic stroke with associated
left unilateral neglect syndrome. An overview of the clinical assessments, plan of care, patient and family centered goal setting, intervention strategies,
and use of the International Classification of Functioning, Disability and Health to guide patient management, are provided.
Case Description: The patient was a 67-year-old male post ischemic stroke. Although this patient was physically high functioning following the
stroke, the presence of unilateral neglect syndrome required him to have assistance with instrumental activities of daily living and precluded him
from driving. Driving was the primary goal identified by the patient and his care partners, therefore the physical therapy plan of care was structured
around skills required for this task such as motor control, visual attention, sensory awareness, and spatial perception.
Outcomes: The patient demonstrated improvement in visuospatial awareness, reaction time and accuracy, attention, sensory awareness and
coordination. Upon re-evaluation, the patient was deemed to be safe to drive with limitations
Volume 3 Issue 2
Research Article Month : 12 (2019)
Somatic Tinnitus and Manual Therapy: A Systematic Review
Bonni Lynn Kinne
Background: In 2016, a systematic review was conducted to examine the effects of physical therapy interventions on individuals with subjective
tinnitus. However, the research study investigated subjective tinnitus that may not have had a somatic origin. In addition, only one of the included
studies specifically assessed the effectiveness of manual therapy.
Objectives: The purpose of this systematic review was to examine the effects of manual therapy techniques on individuals with somatic tinnitus.
Methods: A search was performed using the following databases: CINAHL Complete, ProQuest Medical Library, and PubMed. The search
terms were “somatic tinnitus” OR “somatosensory tinnitus” AND “manual therapy”. An evaluation of the evidence level for each included article
was conducted using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence, and an evaluation of the methodological rigor for
each included article was conducted using criteria adapted by Medlicott and Harris.
Results: A qualitative synthesis was ultimately performed on eight articles. The manual therapy techniques included in this systematic review
were cervical mobilizations, myofascial techniques, osteopathic manipulations, soft tissue techniques, and manual therapy as developed by
the School of Manual Therapy Utrecht. This systematic review also included complementary treatment approaches such as patient education,
therapeutic exercise, transcutaneous electrical neurostimulation, and home exercise programs.
Conclusions: Manual therapy appears to be an effective intervention for individuals with somatic tinnitus, especially if they have co-varying
tinnitus or tinnitus sensitization. In addition, a multimodal intervention approach may be the ideal way in which to positively impact an individual’s
activities of daily living.