Rehab Centers: The Role of Physical Medicine and Rehabilitation in Haemophiliac Patients.

The role of physical medicine and rehabilitation in haemophiliac patients.

Filed under: Rehab Centers

Blood Coagul Fibrinolysis. 2012 Oct 25;
De la Corte-Rodriguez H, Rodriguez-Merchan EC

Physical medicine and rehabilitation aim to evaluate, diagnose and treat disability in haemophiliac patients, while preventing injury or deterioration. They also aim to maintain the greatest degree of functional capacity and independence in patients with haemophilia, or to return them to that state. Rehabilitation, together with clotting factor replacement therapy, has revolutionized the management of these patients in developed countries and reduced their morbidity/mortality rates. A knowledge of the musculoskeletal signs and symptoms of haemophilia is essential for providing a treatment which is suitable and customized. Physical medicine and rehabilitation techniques, which are based on physical means, are intended to reduce the impact which these injuries and their consequences or sequelae can have on the quality of life of patients with haemophilia. Under ideal haemostatic control conditions (primary prophylaxis), people with haemophilia could achieve good physical condition which will allow them to enjoy both physical activity and a daily life without limitations. Currently, children undergoing primary prophylaxis are quite close to this ideal situation. For these physical activities to be carried out, the safest possible situations must be sought.
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A novel approach to induction and rehabilitation of deficits in forelimb function in a rat model of ischemic stroke.

Filed under: Rehab Centers

Acta Pharmacol Sin. 2012 Oct 29;
Livingston-Thomas JM, Hume AW, Doucette TA, Tasker RA

Aim:Constraint-induced movement therapy (CIMT), which forces use of the impaired arm following unilateral stroke, promotes functional recovery in the clinic but animal models of CIMT have yielded mixed results. The aim of this study is to develop a refined endothelin-1 (ET-1) model of focal ischemic injury in rats that resulted in reproducible, well-defined lesions and reliable upper extremity impairments, and to determine if an appetitively motivated form of rehabilitation (voluntary forced use movement therapy; FUMT) would accelerate post-ischemic motor recovery.Methods:Male Sprague Dawley rats (3 months old) were given multiple intracerebral microinjections of ET-1 into the sensorimotor cortex and dorsolateral striatum. Sham-operated rats received the same surgical procedure up to but not including the drill holes on the skull. Functional deficits were assessed using two tests of forelimb placing, a forelimb postural reflex test, a forelimb asymmetry test, and a horizontal ladder test. In a separate experiment ET-1 stroke rats were subjected to daily rehabilitation with FUMT or with a control therapy beginning on post-surgery d 5. Performance and post-mortem analysis of lesion volume and regional BDNF expression were measured.Results:Following microinjections of ET-1 animals exhibited significant deficits in contralateral forelimb function on a variety of tests compared with the sham group. These deficits persisted for up to 20 d with no mortality and were associated with consistent lesion volumes. FUMT therapy resulted in a modest but significantly accelerated recovery in the forelimb function as compared with the control therapy, but did not affect lesion size or BDNF expression in the ipsilesional hemisphere.Conclusion:We conclude that refined ET-1 microinjection protocols and forcing use of the impaired forelimb in an appetitively motivated paradigm may prove useful in developing strategies to study post-ischemic rehabilitation and neuroplasticity.
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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

J Cardiopulm Rehabil Prev. 2012 Oct 25;
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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Coronary Artery RIsk Management Programme (CARIMAP) Delivered by a Rehabilitation Day-Hospital: IMPACT ON PATIENTS WITH CORONARY ARTERY DISEASE.

Filed under: Rehab Centers

J Cardiopulm Rehabil Prev. 2012 Oct 25;
Sturchio A, Di Gianni A, Campana B, Genua M, Storti M, Di Iasi G, Monaco S, Colella M, Dello Buono A, D?addese E, Capomolla S

PURPOSE:: Previous studies have shown that correct management of different coronary risk factors can reduce coronary event rates. However, significant undertreatment of hyperlipidemia, diabetes, and hypertension is still found during clinical practice. The purpose of this study was to evaluate the effectiveness of an individualized management program to modify coronary disease risk profile. METHODS:: One hundred sixty-eight patients discharged from a cardiac rehabilitation department after acute coronary events were prospectively randomized into 2 management strategies: 84 started usual community care and 84 entered a Coronary Artery RIsk MAnagement Programme (CARIMAP) delivered by the rehabilitation day-hospital. Coronary risk profile, optimized therapy, and management were evaluated after the acute event and again after a followup of 9 ± 4 months in both groups. RESULTS:: Patients accessed the day-hospital an average of 4 ± 1 months (range, 1-13 months) after the acute event. The duration of the CARIMAP was 5 ± 2 months and the individual number of accesses to the day-hospital was 4 ± 3.8. After the CARIMAP, patients received better-optimized therapy (?-blockers 57% vs 85%, P < .0001; angiotensin-converting enzyme inhibitors 54% vs 84%, P < .00001; statins 38% vs 78%, P < .0001; and amlodipine 22% vs 51%, P < .0001) and had a better risk profile (low-density lipoprotein-cholesterol < 100 mg/dL, 30% vs 42%, P < .0001; blood pressure < 140/90 mmHg 63% vs 88%, P < .00001). CONCLUSION:: The CARIMAP of secondary prevention delivered by a rehabilitation day-hospital to patients who had undergone an acute coronary event enabled individually titrated therapy and better control of coronary artery risk factors. HubMed – rehab

 

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