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Introduction: Ehlers–Danlos Syndrome (EDS) is a hereditary and heterogeneous syndrome that affects conjunctive tissue, due to collagen production compromise. Hypermobile EDS (hEDS) is the most common subtype of this syndrome and can cause shoulder joint instability, which can lead to chronic pain and significant functional impairment.

Methods: A case report of a patient with hEDS followed in our local health unit was made. The authors describe their clinical insight regarding the case, as well as the rehabilitation program the patient was submitted to.

Results: Female patient, 32 years old. Functionally autonomous in every daily living activity. Clinically diagnosed with hEDS in 2013, after reporting bilateral shoulder instability. The patient presented herself in a Physical and Rehabilitation Medicine consultation, 6 months after being submitted to the third surgical intervention of the right shoulder. She presented an overall limited range of motion, decreased muscle strength and positive apprehension and drawer tests. An extensive rehabilitation program was prescribed, focusing on joint mobilization, dynamic stabilizers strengthening and proprioceptive training. After 12 weeks, the patient presented reduced shoulder pain and a better functional status.

Conclusion: hEDS compromises the integrity of the static and dynamic stabilizers of the shoulder. Clinical management of these cases involves a multidisciplinary approach with early and adequate rehabilitation care treatments.

Walking is for humans an essential task in our daily life. However, there is a huge (and growing) number of people who have this ability diminished or are not able to walk due to motor disabilities. In this paper, a system to detect the start and the stop of the gait through electroencephalographic signals has been developed. The system has been designed in order to be applied in the future to control a lower limb exoskeleton to help stroke or spinal cord injured patients during the gait. The brain–machine interface (BMI) training has been optimized through a preliminary analysis using the brain information recorded during the experiments performed by three healthy subjects. Afterward, the system has been verified by other four healthy subjects and three patients in a real-time test. In both preliminary optimization analysis and real-time tests, the results obtained are very similar. The true positive rates are $54.8\%$ and $56.1\%$ respectively. Regarding the false positive per minute, the values are also very similar, decreasing from 2.66 in preliminary tests to 1.90 in real-time. Finally, the average latencies in the detection of the movement intentions are 794 and 798ms, preliminary and real-time tests respectively.

Robot-assisted training provides an effective approach to neurological injury rehabilitation. To meet the challenge of hand rehabilitation after neurological injuries, this study presents an advanced myoelectric pattern recognition scheme for real-time intention-driven control of a hand exoskeleton. The developed scheme detects and recognizes user’s intention of six different hand motions using four channels of surface electromyography (EMG) signals acquired from the forearm and hand muscles, and then drives the exoskeleton to assist the user accomplish the intended motion. The system was tested with eight neurologically intact subjects and two individuals with spinal cord injury (SCI). The overall control accuracy was $98.1\pm 4.9\%$ for the neurologically intact subjects and $90.0\pm 13.9\%$ for the SCI subjects. The total lag of the system was approximately 250ms including data acquisition, transmission and processing. One SCI subject also participated in training sessions in his second and third visits. Both the control accuracy and efficiency tended to improve. These results show great potential for applying the advanced myoelectric pattern recognition control of the wearable robotic hand system toward improving hand function after neurological injuries.

Motor rehabilitation based on the association of electroencephalographic (EEG) activity and proprioceptive feedback has been demonstrated as a feasible therapy for patients with paralysis. To promote long-lasting motor recovery, these interventions have to be carried out across several weeks or even months. The success of these therapies partly relies on the performance of the system decoding movement intentions, which normally has to be recalibrated to deal with the nonstationarities of the cortical activity. Minimizing the recalibration times is important to reduce the setup preparation and maximize the effective therapy time. To date, a systematic analysis of the effect of recalibration strategies in EEG-driven interfaces for motor rehabilitation has not yet been performed. Data from patients with stroke (4 patients, 8 sessions) and spinal cord injury (SCI) (4 patients, 5 sessions) undergoing two different paradigms (self-paced and cue-guided, respectively) are used to study the performance of the EEG-based classification of motor intentions. Four calibration schemes are compared, considering different combinations of training datasets from previous and/or the validated session. The results show significant differences in classifier performances in terms of the true and false positives (TPs) and (FPs). Combining training data from previous sessions with data from the validation session provides the best compromise between the amount of data needed for calibration and the classifier performance. With this scheme, the average true (false) positive rates obtained are 85.3% (17.3%) and 72.9% (30.3%) for the self-paced and the cue-guided protocols, respectively. These results suggest that the use of optimal recalibration schemes for EEG-based classifiers of motor intentions leads to enhanced performances of these technologies, while not requiring long calibration phases prior to starting the intervention.

The objective of this study was to assess evidence for the efficacy and effectiveness of Chinese qigong exercise in rehabilitative programs among cardiac patients. Thirteen databases were searched through to November 2010, and all controlled clinical trials on Chinese qigong exercise among patients with chronic heart diseases were included. For each included study, data was extracted and validity was assessed. Study quality was evaluated and summarized using both the Jadad Scale and the criteria for levels of evidence. Seven randomized controlled trials (RCTs) and one non-randomized controlled clinical trial (CCT) published between 1988 and 2007 met the inclusion criteria. In total, these studies covered 540 patients with various chronic heart diseases including atrial fibrillation, coronary artery disease, myocardial infarct, valve replacement, and ischemic heart disease. Outcome measures emerged in these studies included subjective outcomes such as symptoms and quality of life; and objective outcomes such as blood pressure, ECG findings, and exercise capacity, physical activity, balance, co-ordination, heart rate, and oxygen uptake. Overall, these studies suggest that Chinese qigong exercise seems to be an optimal option for patients with chronic heart diseases who were unable to engage in other forms of physical activity; however, its efficacy and effectiveness in cardiac rehabilitation programs should be further tested.

The sense of touch is important to human to understand shape, texture, and hardness of the objects. An object under grip, i.e. object exploration by enclosure, provides a unique pressure distribution on the different regions of palm depending on its shape. This paper utilizes the above experience for recognition of object shapes by tactile image analysis. The high pressure regions (HPRs) are segmented and analyzed for object shape recognition rather than analyzing the entire image. Tactile images are acquired by capacitive tactile sensor while grasping a particular object. Geometrical features are extracted from the chain codes obtained by polygon approximation of the contours of the segmented HPRs. Two-level classification scheme using linear support vector machine (LSVM) is employed to classify the input feature vector in respective object shape classes with an average classification accuracy of 93.46% and computational time of 1.19 s for 12 different object shape classes. Our proposed two-level LSVM reduces the misclassification rates, thus efficiently recognizes various object shapes from the tactile images.

The aim of modeling musculoskeletal systems is to understand the mechanisms of locomotion control in terms of neurophysiology and neuroanatomy. The complexity and unique nature of neuromuscular systems, however, make control problems in these systems very challenging due to several characteristics including speed and precision. Thus, their investigation requires the use of simple and analyzable methods. Consequently, taking into account the central pattern generator’s (CPG) function, we attempted to create a structured chaotic model of how human joints and muscles interact for the purpose of facilitating gait and rehabilitation in patients with incomplete spinal cord injury. The four muscle groups used in this model are gluteus, and hip flexor groups for flexion and extension of the hip joints as well as hamstring muscles and vasti muscles for flexion and extension of the knee joint. The results indicate that the output of the chaotic model of muscle and joint interactions in a healthy state would be chaotic, while in the incomplete spinal cord injury state, it would remain a fixed point. For model rehabilitation, afferent nerve stimulation is used in a CPG model; based on the modeling results, by applying coefficients of 1.98, 2.21, and 3.1 to the values of Ia, II, and Ib afferent nerves, the incomplete spinal cord injury model state is changed from a fix-point to periodic in a permanent fashion, suggesting locomotion with rehabilitation in our model. Based on the results obtained from the chaotic model of muscle and joint interactions as well as the comparisons made with reference papers, it can be stated that this model has acceptable output while enjoying simple computations and can predict different norms.

Analysis of human movements is an important category of research in biomedical engineering, especially for the rehabilitation purpose. The movement of limbs is investigated usually by analyzing the movement signals. Less efforts have been made to investigate how neural that correlate to the movements, are represented in the human brain. In this research, for the first time we decode the limb movements by fractal analysis of Electroencephalogram (EEG) signals. We investigated how the complexity of EEG signal changes in different limb movements in motor execution (ME), and motor imagination (MI) sessions. The result of our analysis showed that the EEG signal experiences greatest level of complexity in elbow flexion and hand-close movements in ME, and MI sessions respectively. On the other hand, the lowest level of complexity of EEG signal belongs to hand-open and rest condition in ME, and MI sessions, respectively. Employing fractal theory in analysis of bio signals is not limited to EEG signal, and can be further investigated in other types of human’s bio signals in different conditions. The result of these investigations can vastly been employed for the rehabilitation purpose.

Analysis of human movements is an important category of research in biomedical engineering, especially for the rehabilitation purpose. The human’s different movements are usually investigated by analyzing the movement signals. Based on the literatures, fewer efforts have been made in order to investigate how human movements are represented in the brain. In this paper, we decode the movements’ directions of wrist by complexity analysis of Magnetoencephalography (MEG) signal. For this purpose, we employ fractal theory. In fact, we investigate how the complexity of MEG signal changes in case of different wrist movements’ directions. The results of our analysis showed that MEG signal has different level of complexity in response to different movement’s directions. The employed methodology in this research is not limited to the analysis of MEG signal in response to wrist movement, however, it can be applied widely to analyze the influence of different factors (stimuli) on complex structure of other brain signals such as Electroencephalography (EEG) and fMRI signals.

Analysis of human ability to move the body (hand, feet, etc.) is one of the major issues in rehabilitation science. For this purpose, scientists analyze different signals govern from human body. Electromyography (EMG) signal is the main indicator of human movement that can be analyzed using different techniques in order to classify different movements. In this paper, we analyze the complex non-linear structure of EMG signal from subjects while they underwent three exercises that include basic movements of the fingers and of the wrist, grasping and functional movements, and force patterns. For this purpose, we employ fractal dimension as indicator of complexity. The result of our analysis showed that the EMG signal experiences the greatest complexity when subjects think to press combinations of fingers with an increasing force (force pattern). The method of analysis employed in this research can be widely applied to analyze and classify different types of human movements.

Frequently used zone 2 flexor tendon repair splints are reviewed and classified according to the Amercian Society of Hand Therapists' Splint Classification System. These splints both restrict and mobilise digital motion and fall into two main groups: (1) splints that incorporate the wrist and digital joints as primary joints to allow predetermined increments of early passive or active motion at both the wrist and digital joints; and (2) splints that include the wrist as a secondary joint and the digital joints as primary joints, allowing early passive or active motion at digital joints but not at the wrist.

For 30 years, silicone oil has been used for the management and rehabilitation of the injured hand. Its benefits accrue from its providing a non-irritant, bland, air-free medium in which the hand can undergo early movement, which prevents drying out of the tissues and helps in the separation of necrotic and infected tissue. It has been reported, however, that the silicone oil might act as a reservoir for nosocomial infection after two patients developed epidemic methicillin-resistant Staphylococcus aureus (EMRSA) infections.

Since no firm guidelines exist with regard to open and/or infected wounds and the continued use of the same oil, a prospective study was set up to study the bacterial colonisation of the silicone oil. Thirty-five consecutive patients were entered into the study. The oil for each patient was changed each week but if any wound became clinically infected the oil was changed earlier. Treatment was continued until the wound was healed or until the treatment was stopped by the referring doctor.

Bacteriology swabs taken from the wound and the oil before each treatment and from the oil after each treatment were analysed for bacterial colonisation. The results indicated that while bacteria were transferred into the oil from the wound, the inoculum was small and had no effect on wound healing. There was no evidence that wounds were being re-infected from the oil. The conclusion was that silicone oil remains a safe medium in which to exercise injured hands.

Introduction: This study aims to gain a better understanding of current practice for the surgical management and rehabilitation of flexor tendon injuries in Australia, with the intent of establishing common guidelines for training of young surgeons.

Methods: A survey was distributed to the membership of the Australian Hand Surgery Society to determine whether a consensus could be obtained for: suture material and gauge; core and epitenon suture techniques; sheath and pulley management; and post-operative protocols for primary flexor tendon repair.

Results: The predominant materials used for core suture are Ticron^TM Suture (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) (34%) and Ethibond^TM Polyester Suture (Ethicon, Somerville, New Jersey, USA) (24%). The two core suture configurations commonly used are the Adelaide (45%) and Kessler (32%) repair. The predominant materials used for epitendinous sutures are 6-0 Prolene^TM Polypropylene Suture (Ethicon, Somerville, New Jersey, USA) (56%), 5-0 Prolene^TM (21%) and 6-0 Ethilon^TM Nylon Suture (Ethicon, Somerville, New Jersey, USA) (13%); and the majority (63%) use a running epitendinous technique. The management of critical pulleys is variable, with 89% prepared to perform some release of A2 and A4 pulleys. Rehabilitation protocols vary widely, with 24% of respondents using the same method for all patients, while 76% tailor their approach to each patient. Some component of active motion was used by most.

Discussion: There exists some consensus on the management of flexor tendon injuries in Australia. However, the management of critical pulleys and methods of post-operative rehabilitation remain varied. For the training of young surgeons, a majority advise a 3-0 gauge braided polyester core suture of four strands, combined with a 6-0 Prolene^TM simple running epitendinous suture for increased tendon repair strength and smooth glide. Trainees should attempt to retain the integrity of the A2 and A4 pulleys. Post-operative rehabilitation should include a component of active flexion.

Background: Proprioception and sensorimotor input are used to treat neurological and joint injuries. Following distal radius fractures (DRF) there is a temporary loss of proprioception that should be addressed. We created a protocol for evaluation, and a treatment plan following wrist surgery that is based on proprioceptive and sensorimotor input. We describe a series of patients undergoing surgery for DRF that were evaluated and treated with these protocols.

Methods: Both evaluation and treatment protocols included comprehensive sensorimotor procedures performed with eyes open and closed. These included Semmes- Weinstein, static and moving 2-point discrimination, vibration, temperature testing, Moberg pick-up- test, stereognosis and proprioception.

Results: A series of twelve patients was evaluated and treated with the protocol following surgical treatment for DRF. Patients demonstrated significant sensorimotor deficits, which improved utilizing the comprehensive sensorimotor treatment protocol.

Conclusions: Further study is necessary to validate the results of this pilot series. Use of proprioception and sensorimotor input may improve outcomes of rehabilitation following DRF.

The use of sequential analysis in clinical rehabilitation research allows a spectrum of analyses in the comparison of two or more treatment protocols. Researchers in rehabilitation medicine are increasingly making use of sequential designs in their clinical investigations. This review serves to highlight the optimal use of the classical sequential designs presented by Armitage and Bross in the mid-twentieth century. A discussion of the limitations of this most basic sequential analysis is presented for the information of clinical researchers considering this study design. Examples of the use of classical and group sequential designs addressing both continuous and dichotomous outcomes are provided, and the advantages and disadvantages of classical and group sequential procedures as compared to fixed sample designs are illustrated with rehabilitation examples. As little literature has been published regarding the application of sequential analysis in clinical rehabilitation trials, clinical pharmacological, and medical trials in addition to medical statistical sources were used in this review.

The purpose is to examine the importance of ipsilateral leg strength in mediating hip fracture disability. Leg strength measures were recorded and analyzed for 4 separate data sets: (1) 35 patients hospitalized for acute hip fractures; (2) 72 hip replacement surgical candidates with prior hip fracture histories; (3) 30 hip fracture patients followed prospectively for six months after hospital discharge; (4) 23 hip fracture cases interviewed two years after hospital discharge. (1) 78% of patients with acute hip fracture exhibited leg weakness on the injured side, and 41% exhibited knee extensor muscle weakness on the injured side; (2) 79% of patients readmitted for hip surgery, had deficient muscle power of the previously fractured leg and 33% had specific evidence of knee extensor weakness; (3) Interlimb knee extensor strength differentials greater than 10%, more commonly due to strength deficits on the injured side than the uninjured side, were present in 80% of cases examined six months post surgery, and affected walking speed. (4) knee extensor strength of the affected leg predicted the subject's walking speed, as did leg strength two years post surgery. The conclusion is that knee extensor strength deficits of the affected leg are common features of hip fracture patients, and may contribute to, or perpetuate, functional disability.

Background and aims: To study possible interrelations of clinical and functional parameters with ultrasonographic findings of shoulders of hemiplegic stroke patients. This would assist in determining the need for a possible ultrasound evaluation of hemiplegic shoulders. Methods: Prospective case series were studied in the Department of Geriatric Medicine and Rehabilitation, at a university-affiliated referral hospital. We studied a total of 26 consecutive stroke patients with hemiplegic shoulders undergoing a standard rehabilitation course. Hemiplegic shoulders were studied by ultrasound and scored for the number of pathological (positive) findings. Shoulder scores were correlated with various clinical and functional parameters (Ashworth score, Fugl-Meyer score, Functional Independence Measure) as non-dependent variables. Results: No correlation was found between any of the parameters we have studied and the ultrasonographic score, except for shoulder pain (p = 0.012). A regression analysis documented painful shoulder (p = 0.002) and spasticity (p = 0.039) as significantly associated with higher ultrasonographic scores. Conclusions: Ultrasound investigation of hemiplegic upper extremities does not interrelate with any of the parameters associated with rehabilitation outcome and should be reserved for those suffering painful and spastic hemiplegic shoulders.

With socio-economic development, there is growing concern about one's own health problems. The traditional view was that in cases of medical treatment, rehabilitation has a lower risk or even no risk compared to other forms of medication. However, that is not the case. Rehabilitation, like surgery, also has a high risk. The main source of risk comes from nonstandard rehabilitation operation on diseases without clear diagnosis. This article presents a case study of a patient with cervical spine disease with intracranial arterial aneurysm diagnosis and treatment, to explore the potential of rehabilitation medicine and examine the risk of physician–patient conflicts.

Purpose: The present study was undertaken to find out the relationship among outcome variables as well as association between dependent variables with physical characteristics in low back pain (LBP) patients. Correlations between outcome variables [pain, back pressure changes (BPC), abdominal pressure changes (APC), walking, stairs climbing, stand ups, quality of life (QOL) and sexual frequency] of all LBP subjects before and after treatment were assessed. Regression analysis was used to estimate baseline BPC and APC of LBP subjects from their baseline demographic characteristics (age, height, waist circumference, systolic blood pressure, and pulse rate) and severity of pain. Methods: A total of 141 nonspecific chronic LBP patients were recruited. After baseline recording, all subjects were given trunk stabilization training for 20 regular days. After training, the follow-up was done at a gap of each 15 days up to 6 months (180 days). At the last follow-up session (180th day), the outcome variables were recorded again. Findings: The present study found an inverse relation between pain and muscle functions (BPC: r = -0.36; p < 0.01 and APC: r = -0.26; p < 0.01). This study also showed that BPC was more inversely related with the pain than APC. Conclusions: This study concludes that physical strength (BPC and APC) of LBP subjects is more closely associated with the pain than the functional ability (walking, stairs climbing and stand ups). This study also estimated (baseline or before treatment) BPC and APC in LBP subjects from their physical characteristics and pain severity.

Background: Meniscal strain patterns are not well understood during dynamic activities. Furthermore, the impact of ACL reconstruction on meniscal strain has not been thoroughly investigated. The purpose of this study was to characterize ACL and meniscal strain during dynamic activities and investigate the strain difference between ACL-intact and ACL-reconstructed ligament conditions. Methods: ACL and medial meniscal strain were measured in-vitro during gait, a double leg squat, and a single leg squat. For each activity kinematics and muscle forces were applied to seven cadaveric specimens using a dynamic knee simulator. Testing was performed in the ACL-intact and ACL-reconstructed ligament conditions. Results: Both the ACL and meniscus had distinct strain patterns that were found to have a significant interaction with knee angle during gait and double leg squat ($P<0.05$). During gait, both tissues experienced lower strain during swing than stance (ACL: 3.0% swing, 9.1% stance; meniscus: 0.2% swing, 1.3% stance). Meniscal strain was not found to be different between ACL-intact and ACL-reconstructed conditions ($P>0.05$). Conclusions: During dynamic activities, the strain in the meniscus was not altered between ACL ligament conditions. This indicates that meniscal mechanics after ACL reconstruction are similar to a healthy knee. These results help further the understanding of osteoarthritis risk after ACL reconstruction.