Aerobic Exercise Intensity Assessment and Prescription in Cardiac Rehabilitation: A Joint Position Statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation.

Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation.

Filed under: Rehab Centers

Eur J Prev Cardiol. 2012 Oct 26;
Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, Urhausen A, Williams MA

Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients’ groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a ‘range-based’ to a ‘threshold-based’ aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
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Physical Rehabilitation of Patients in Intensive Care Units Requiring Extracorporeal Membrane Oxygenation: A Small Case Series.

Filed under: Rehab Centers

Phys Ther. 2012 Oct 25;
Rahimi RA, Skrzat J, Reddy DR, Zanni JM, Fan E, Stephens RS, Needham DM

Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy, shortly after ICU admission, improves physical function and reduces healthcare utilization. Recently, there is increasing interest and utilization of Extracorporeal Membrane Oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients. We describe three patients with respiratory failure requiring ECMO who received physical rehabilitation to illustrate and discuss relevant feasibility and safety issues.
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What Does It Take? Comparing Intensive Rehabilitation to Outpatient Treatment for Children With Significant Pain-Related Disability.

Filed under: Rehab Centers

J Pediatr Psychol. 2012 Oct 26;
Simons LE, Sieberg CB, Pielech M, Conroy C, Logan DE

OBJECTIVES: This study compared outcomes between day hospital pain rehabilitation patients and patients engaged in outpatient multidisciplinary pain treatment. METHODS: This study included 100 children who presented for an initial tertiary care pain clinic evaluation. 50 patients enrolled in intensive day hospital pain rehabilitation and 50 patients pursued outpatient multidisciplinary treatment. Across 2 time points, children completed measures of functional disability, pain-related fear, and readiness to change and parents completed measures of pain-related fear and readiness to change. RESULTS: Across both treatment modalities, patients and parents reported improvements. Patients enrolled in intensive pain rehabilitation had significantly larger improvements in functional disability, pain-related fear, and readiness to change. Parents of day hospital patients reported larger declines in child pain-related fear and increased readiness to change compared with their outpatient counterparts. Discussion For patients with high levels of pain-related disability and distress, intensive pain rehabilitation provides rapid, dramatic improvements in functioning.
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Vestibular rehabilitation following the removal of an acoustic neuroma: a systematic review of randomized trials.

Filed under: Rehab Centers

Head Neck Oncol. 2012; 4(2): 59
Passier L, Doherty D, Smith J, McPhail SM

An acoustic neuroma (also known as a vestibular schwannoma) is an intracranial tumour of the vestibular nerve that is commonly treated by surgical resection. Following resection of an acoustic neuroma, patients may experience a range of symptoms that include deficits in gaze stability, mobility and balance. Vestibular rehabilitation may be useful in reducing the severity and minimizing the impact of these symptoms.To systematically review the clinical trial evidence for the effectiveness of vestibular rehabilitation interventions following resection of an acoustic neuroma and provide a concise synthesis useful for informing clinical rehabilitation of this patient population.Electronic databases including Cochrane, PubMed, CINAHL, Embase and AUSThealth were searched with no time restriction. Search terms included combinations of MeSH terms (‘acoustic neuroma’ ‘vestibular schwannoma’ ‘acoustic neurinoma’ ‘acoustic neurilemoma’ ‘acoustic neurilemmoma’ or ‘acoustic schwannoma’) and (‘rehabilitation’ ‘physiotherapy’ ‘physical therapy’ ‘adaptation’ ‘habituation’ ‘balance’, ‘exercise’ or ‘gaze stability’).Randomized clinical trials of rehabilitation approaches following surgical research of acoustic neuroma among adults were included. Studies with mixed populations that included bilateral vestibular loss or vestibular dysfunction of central or unknown aetiology were excluded. The 591 hits were screened by title, abstract and then full text by two independent researchers who reached a consensus on the eligibility of each study (a third researcher was available to arbitrate but was not required). Six clinical trials fulfilled the inclusion criteria.The characteristics of each study including the trial design, sample, intervention, outcome measures and summary of results were extracted and tabulated.Methodological quality was assessed independently by two researchers using the physiotherapy evidence database scale. The heterogeneity of both interventions and outcome measures did not allow a valid meta-analysis.There is some evidence to support the use of adaptation exercises for this clinical group. Clinical trial evidence does not support the use of habituation exercises alone, although when combined with adaptation exercises and balance and gait training, habituation exercises may have some benefit. Further research is required to determine the optimal combination of vestibular rehabilitation interventions, as well as the volume and timing of interventions.
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