Rehab Centers: Image Guidance Shortens the Learning Curve for K-Wire Placement – an Experimental Study.

Image guidance shortens the learning curve for K-wire placement – an experimental study.

Filed under: Rehab Centers

Int J Med Robot. 2013 Jan 14;
Kraus M, Weckbach S, Jones A, Krischak G, Gebhard F, Schöll H

BACKGROUND: Computer assisted systems in orthopaedic trauma depend in most cases on fixed reference markers. This work evaluated a reference-free image-based guidance system. Outcome parameters were the number of trials needed to achieve an optimal wire position, the radiation and procedure time, and the learning curve. METHODS: Forty artificial proximal femora covered in polyurethane foam were used and randomized in two groups. Each bone was equipped with a target marker at the fovea capitis femoris. Two surgeons each inserted 20?K-wires, 10 with and 10 without assistance from the guidance system. The aim was to bring the tips of the K-wires as close as possible to the target marker. Both procedures were performed under fluoroscopic control. The new guidance system is based on 2D-C-arm images. Following the procedure the result was determined using computed tomography. RESULTS: The same accuracy (P?=?0.34) was achieved with less time (P?=?0.0008) and less radiation (P?=?0.0002) with the guidance system. However, use of the guidance system did shorten the learning curve of both surgeons, leading to a reduced number of trials (P <0.0001). The learning curve of both surgeons was strongly correlated. From the first trial, the performance of both surgeons while using the guidance system, improved over their performance without the guidance system. CONCLUSIONS: The guidance system helped to achieve an optimal K-wire position with less radiation and less time. The major advantage is the ability of the guidance system to be integrated into the workflow and the short and flat learning curve. Copyright © 2013 John Wiley & Sons, Ltd. HubMed – rehab


The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath.

Filed under: Rehab Centers

J Hand Surg Eur Vol. 2013 Jan 11;
Havulinna J, Leppänen OV, Göransson H

In a previous study we found that the strength of a Kessler core suture in the flexor tendon was greater in flexor zone 2 than in zone 3. To further investigate the material properties of the flexor tendon without the influence of a locking suture configuration, we measured the ultimate strength of a simple loop suture in the flexor digitorum profundus tendon in zones 1, 2, and 3. Eight cadaver flexor digitorum profundus tendons were tested in 10 mm increments with a 3-0 polyester suture loop pull-out test in the mid-substance of the tendon. The mean strength in zones 1 and 2 (26.7 N, SD 5.6) was significantly higher than the mean strength in zone 3 (17.7 N, SD 5.4). We conclude that the difference is owing to variations of the structure of the flexor tendon in different sections of the tendon, as the suture configuration was a simple loop without a locking or grasping component.
HubMed – rehab


Evaluation of a brief educational intervention to improve knowledge of sublingual nitroglycerin in cardiac rehabilitation patients.

Filed under: Rehab Centers

Eur J Cardiovasc Nurs. 2013 Jan 11;
Gallagher R, Belshaw J, Kirkness A, Warrington D, Sadler L, Roach K

Objective:This study aimed to evaluate the impact of a brief educational intervention delivered in cardiac rehabilitation (CR) on patients’ knowledge of sublingual nitroglycerin (SLN).Methods:Patients (n=86) commencing CR were provided with a brief educational intervention tailored to deficits identified in an assessment of SLN knowledge using the Sublingual Nitroglycerin Questionnaire, with reassessment at the end of program completion (6-8 weeks).Results:The mean age of patients was 64.95 years (standard deviation (SD) 10.87); 74% were male, 78% were married and 60% had not completed high school. Most (70%) had no prior coronary heart disease (CHD) history and 80% had been referred to CR following percutaneous coronary intervention. SLN knowledge scores increased from baseline to outcome. Patients were significantly more likely to know: the name of their SLN medication (11% increase, p=0.001), the recommended timing between doses (29% increase, p=0.02), the maximum number of doses (27% increase, p=0.005), to have SLN on their person at the time of the interview (25% increase, p<0.001) and to know the interaction between SLN and sildenafil (36% increase, p=0.001). The independent predictors of SLN knowledge included having better knowledge at baseline (?=0.28) and having consulted a general practitioner post discharge and before commencing CR (?=1.48).Conclusion:A brief standardised knowledge intervention, individually tailored to identified deficits in a knowledge screen and delivered during CR, shows promise for improving patient knowledge of SLNs. The role of general practitioners in delivering medication education needs further investigation. HubMed – rehab


Effect of sport-related concussion on clinically measured simple reaction time.

Filed under: Rehab Centers

Br J Sports Med. 2013 Jan 11;
Eckner JT, Kutcher JS, Broglio SP, Richardson JK

BACKGROUND: Reaction time (RT) is a valuable component of the sport concussion assessment battery. RT is typically measured using computers running specialised software, which limits its applicability in some athletic settings and populations. To address this, we developed a simple clinical test of RT (RT(clin)) that involves grasping a falling measuring stick. PURPOSE: To determine the effect of concussion on RT(clin) and its sensitivity and specificity for concussion. MATERIALS AND METHODS: Concussed athletes (n=28) and non-concussed control team-mates (n=28) completed RT(clin) assessments at baseline and within 48 h of injury. Repeated measures analysis of variance compared mean baseline and follow-up RT(clin) values between groups. Sensitivity and specificity were calculated over a range of reliable change confidence levels. RESULTS: RT(clin) differed significantly between groups (p<0.001): there was significant prolongation from baseline to postinjury in the concussed group (p=0.003), with a trend towards improvement in the control group (p=0.058). Sensitivity and specificity were maximised when a critical change value of 0 ms was applied (ie, any increase in RT(clin) from baseline was interpreted as abnormal), which corresponded to a sensitivity of 75%, specificity of 68% and a 65% reliable change confidence level. CONCLUSIONS: RT(clin) appears sensitive to the effects of concussion and distinguished concussed and non-concussed athletes with similar sensitivity and specificity to other commonly used concussion assessment tools. Given its simplicity, low cost and minimal time requirement, RT(clin) should be considered a viable component of the sports medicine provider's multifaceted concussion assessment battery. HubMed – rehab


Comparison of joint space and end point space robotic training modalities for rehabilitation of interjoint coordination in individuals with moderate to severe impairmant from chronic stroke.

Filed under: Rehab Centers

IEEE Trans Neural Syst Rehabil Eng. 2013 Jan 9;
Brokaw E, Holley R, Lum P

We have developed a novel robotic modality called Time Independent Functional Training (TIFT) that provides focused retraining of interjoint coordination after stroke. TIFT was implemented on the ARMin III exoskeleton and provides joint space walls that resist movement patterns that are inconsistent with the targeted interjoint coordination pattern. In a single test session, 10 moderate to severely impaired individuals with chronic stroke practiced synchronous shoulder abduction and elbow extension in TIFT and also in a comparison mode commonly used in robotic therapy called end point tunnel training (EPTT). In EPTT, error is limited by forces applied to the hand that are normal to the targeted end point trajectory. The completion percentage of the movements was comparable between modes, but the coordination patterns used by subjects differed between modes. In TIFT, subjects performed the targeted pattern of synchronous shoulder abduction and elbow extension, while in EPTT, movements were completed with compensatory strategies that incorporated the flexor synergy (shoulder abduction with elbow flexion) or the extensor synergy (shoulder adduction with elbow extension). There were immediate effects on free movements, with TIFT resulting in larger improvements in interjoint coordination than EPTT. TIFTs ability to elicit normal coordination patterns merits further investigation into the effects of longer duration training.
HubMed – rehab



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