[Functional and Aesthetic Rehabilitation of Microtia in Children and Adolescents].

[Functional and aesthetic rehabilitation of microtia in children and adolescents].

HNO. 2013 Aug; 61(8): 655-61
Hempel JM, Braun T, Berghaus A

Microtia leads to a severe functional and aesthetic handicap. Traditionally, the auricle is often reconstructed with cartilage transplants, which is, however, associated with some partially substantial disadvantages. The authors have instead used implants of porous polyethylene for successful ear reconstruction for years, thus, avoiding some of these disadvantages. A significant benefit for the patient is achieved by simultaneous hearing rehabilitation by the implantation of active middle ear prostheses.The authors present their surgical concept which allows functional and aesthetic rehabilitation of microtia in children and adolescents in a single operation. In the respective patient collective, audiometric measurements in quiet and noisy environments were conducted pre- and postoperatively, and health-related quality of life was determined using a validated questionnaire.All patients experienced a substantial hearing gain both in quiet and noisy environments. The evaluation of health-related quality of life showed a significant benefit from the intervention.Functional and aesthetic rehabilitation of microtia with active middle ear implants and ear reconstruction using porous polyethylene leads to good and reliable long-term results and can increase the health-related quality of life of affected children and adolescents. The main advantage of this concept is the possibility of a single procedure. HubMed – rehab

Sleep Enhances Learning of a Functional Motor Task in Young Adults.

Phys Ther. 2013 Aug 1;
Al-Sharman A, Siengsukon CF

Sleep has been demonstrated to enhance simple motor skill learning “off-line” in young adults. Off-line learning refers to either the stabilization or the enhancement of a memory through the passage of time without additional practice. It remains unclear if a functional motor task will benefit from sleep to produce off-line motor skill enhancement. Physical therapists often teach clients functional motor skills; therefore, it is important to understand how sleep impacts learning of these skills.The purpose of this study was to determine if sleep enhances the learning of a functional motor task.A prospective, cross-sectional, repeated measures design.Young, healthy participants (n=24) were randomly assigned to either the sleep or the no-sleep group. The sleep group practiced the novel walking task in the evening and underwent retention testing the following morning, while the no-sleep group practiced the task in the morning and underwent retention testing in the evening. Outcome measures included time around the walking path and the spatio-temporal gait parameters.Only participants who slept after practicing the novel walking task demonstrated a significant off-line improvement in performance. Compared to the no-sleep group, participants in the sleep group demonstrated a significant decrease in the time around the walking path, an increase in tandem velocity, an increase in tandem step length, and a decline in tandem step time.Time-of-day effect and inability to ensure a certain amount of sleep quantity and quality of participants.This study is the first to provide evidence that sleep facilitates learning clinically-relevant functional motor tasks. Sleep is an important factor that physical therapists should consider when teaching clients motor skills. HubMed – rehab

Promoting Neuroplasticity for Motor Rehabilitation After Stroke: Considering the Effects of Aerobic Exercise and Genetic Variation on Brain-Derived Neurotrophic Factor.

Phys Ther. 2013 Aug 1;
Mang CS, Campbell KL, Ross CJ, Boyd LA

Recovery of motor function after stroke involves re-learning motor skills and is mediated by neuroplasticity. Recent research has focused on developing rehabilitation strategies that facilitate such neuroplasticity to maximize functional outcome post-stroke. Although many molecular signaling pathways are involved, brain-derived neurotrophic factor (BDNF) has emerged as a key facilitator of neuroplasticity involved in motor learning and rehabilitation after stroke. Thus, rehabilitation strategies that optimize BDNF effects on neuroplasticity may be especially effective for improving motor function post-stroke. Two potential post-stroke rehabilitation strategies that consider the importance of BDNF are the use of aerobic exercise to enhance brain function and the incorporation of genetic information to individualize therapy. Converging evidence demonstrates that aerobic exercise increases BDNF production and consequently enhances learning and memory processes. Nevertheless, a common genetic variant reduces activity-dependent secretion of the BDNF protein. Thus, BDNF gene variation may impact response to motor rehabilitation training, as well as potentially modulate the effects of aerobic exercise on neuroplasticity. In this perspectives article, we discuss evidence that aerobic exercise promotes neuroplasticity by increasing BDNF production and consider how it might be prescribed to facilitate the acquisition and retention of motor skills for post-stroke rehabilitation. Next, we explore the impact of the BDNF gene val66met polymorphism on motor learning and response to rehabilitation. We conclude that aerobic exercise effects on BDNF and motor learning may be better exploited if aerobic exercise were paired more closely in time with motor training. Additionally, information about BDNF genotype could provide insight into the type and magnitude of effects that aerobic exercise might have across individuals, and potentially help guide an individualized prescription of aerobic exercise to enhance motor rehabilitation post-stroke. HubMed – rehab

Effect of high-intensity interval training on progression of cardiac allograft vasculopathy.

J Heart Lung Transplant. 2013 Jul 29;
Nytrøen K, Annette Rustad L, Erikstad I, Aukrust P, Ueland T, Lekva T, Gude E, Wilhelmsen N, Hervold A, Aakhus S, Gullestad L, Arora S

Cardiac allograft vasculopathy (CAV) is a progressive form of atherosclerosis occurring in heart transplant (HTx) recipients, leading to increased morbidity and mortality. Given the atheroprotective effect of exercise on traditional atherosclerosis, we hypothesized that high-intensity interval training (HIIT) would reduce the progression of CAV among HTx recipients.Forty-three cardiac allograft recipients (mean ± SD age 51 ± 16 years; 67% men; time post-HTx 4.0 ± 2.2 years), all clinically stable and >18 years old, were randomized to either a HIIT group or control group (standard care) for 1 year. The effect of training on CAV progression was assessed by intravascular ultrasound (IVUS).IVUS analysis revealed a significantly smaller mean increase [95% CI] in atheroma volume (PAV) of 0.9% [95% CI -;0.3% to 1.9%] in the HIIT group as compared with the control group, 2.5% [1.6% to 3.5%] (p = 0.021). Similarly, the mean increase in total atheroma volume (TAV) was 0.3 [0.0 to 0.6] mm(3)/mm in the HIT group vs 1.1 [0.6 to 1.7] mm(3)/mm in the control group (p = 0.020), and mean increase in maximal intimal thickness (MIT) was 0.02-0.01 to 0.04] mm in the HIIT group vs 0.05 [0.03 to 0.08] mm in the control group (p = 0.054). Qualitative plaque progression (virtual histology parameters) and inflammatory activity (biomarkers) were similar between the 2 groups during the study period.HIIT among maintenance HTx recipients resulted in a significantly impaired rate of CAV progression. Future larger studies should address whether exercise rehabilitation strategies should be included in CAV management protocols. HubMed – rehab

[Effects of long-term exercise training on left ventricular function and remodeling in patients with anterior wall myocardial infarction.]

Arch Cardiol Mex. 2013 Jul 29;
Rivas-Estany E, Sixto-Fernández S, Barrera-Sarduy J, Hernández-García S, González-Guerra R, Stusser-Beltranena R

To assess the effects of long-term exercise training on the function and remodeling of the left ventricle after myocardial infarction.We studied 90 patients with a first acute anterior-wall myocardial infarction, all received conventional medical treatment. Symptom-limited maximal exercise stress tests, echocardiograms and effort-rest isotopic ventriculographies at 2, 6 and 12 months after myocardial infarction were performed; the follow-up time averaged 36.3±17 months. All patients joined a cardiac rehabilitation program with moderate or intense exercise training lasting at least a year. Of all patients, 41.1% suffered severe left ventricle dysfunction.Ergometric parameters that expressed functional capacity increased significantly (P<.0005) at the sixth month evaluation and remained unchanged after a year. There was significant decrease (P<.01) of exercise myocardial ischemia at 6 months. The variables that measured size and function of left ventricle did not change during evolution. Morbidity amounted to 16.7% and total mortality of the series was 13.3%, with 8.9% of cardiovascular cause.Long-term exercise training showed no deleterious effects on left ventricle function or remodeling and beneficial functional and clinical effects were obtained in these rehabilitated postinfarction patients. HubMed – rehab