Computer hardware and operating systems

By this time in the evolution of cognitive rehabilitation most treatment facilities have a computer-assisted cognitive retraining programme. This programme will generally be housed in the department of neuropsychology, speech and language pathology or occupational therapy. While the debate about the efficacy of computer-assisted cognitive rehabilitation (CACR) programmes continues, many persons are interested in more basic issues such as 'Which computer to buy?' While this initially may appear to be a minimum expense for a department, few people realize that the initial choice of a computer dictates the choice of software for that computer, as well as any other peripheral devices, e.g. video monitor, laser printer, or adaptive hardware equipment. This column will briefly review the three main computer operating systems which are commercially available for institutional and home markets, and discuss positive and negative attributes of each system.     

Rehabilitation des älteren Patienten nach Majoramputation der unteren Extremität

The rehabilitation of older vascular patients after major amputation of lower limbs is very complicated. It is limited by individual patient abilities as a result of multiple chronic conditions and also individual constraints. It is not the functional status or the independent establishment of a prosthesis but the restoration of the opportunity to participate in social life that best defines rehabilitation following major amputation. Rehabilitation goals are primarily self-sufficiency, self-determined living and the correct use of a suitable locomotive device (including appropriate wheelchair provision). The correct use of a prosthesis after amputation in older patients requires not only largely intact sensory perception in the contralateral leg, as well as sufficient muscular strength to allow development even of the upper extremity, but also a sufficient ability to learn. This necessitates an adequate long-term attention span, as well as concentration and mood stable enough to deal with the loss of the limb and simultaneously to generate enough motivation for the long-term process of rehabilitation. Diabetic complications, such as diabetic neuropathy and wound healing deficits, visual loss, deafness, malnutrition, primary and secondary changes in the large joints and cognitive disorders, such as dementia and depression, all have an effect on the rehabilitation outcome. A pre-operative assessment in relation to these domains, current functional limitations and psychosocial factors, should improve the individual’s rehabilitation outcome, as well as improve the selection of prostheses which would increase the value and the use of a prescribed prosthesis.     

新型冠状病毒肺炎疫情期间创伤骨科患者处理要点

新型冠状病毒肺炎疫情严峻,虽一定程度上限制了人员流动,但仍不可避免骨折患者、尤其是低能量损伤老年患者来医院就诊。在此特殊时期,创伤骨科医师应如何在常规的诊疗方式中结合新型冠状病毒肺炎的防控,做好创伤患者围手术期管理,选择合理的术式及麻醉方式,对于患者的预后及疫情的防控至关重要。在做好诊断、治疗、护理、康复等流程的同时,医务人员如何做好自身的防护,避免出现聚集性传播,也是必须要面对的问题。该文从创伤骨科医、护、患三者出发,结合多学科综合干预模式,对当前疫情期间如何做好创伤骨科患者的防治工作进行简要阐述。     

A survey on the current status of burn rehabilitation services in China

Background

In China, there is a very long history of burn wound treatment, but the specialised burn care units were set up only from 1958. With more than 50 years of practice, great achievements have been made in burn wound care and operations in the country. However, in terms of burn rehabilitation, the development appears to be slow. In order to determine the current status of burn rehabilitation services in China, a survey was conducted to various burn centres in China.

Methods

A comprehensive survey was conducted as well as to collect data related to (1) the admissions and staffing of the burn centres; (2) availability of rehabilitation services, number and educational background of specialised personnel dedicated in burn rehabilitation therapy; and (3) the difficulties leading to the lag of the burn rehabilitation services. The survey was sent to the chiefs of 87 burn centres via e-mail and they were requested to fill out the survey questionnaire and to send it back. For those who did not respond within 1 month, a reminder was sent.

Results

There are totally 39 (44.8%) burn centres responding to our survey. These centres were geographically distributed in nearly 70% of the administrative provinces in China; hence, the results could well represent the current burn care system. Most centres have recognised the importance of rehabilitation therapy and remarkable improvements of outcome in burn patients have been achieved. There are a very huge number of burn patients that need rehabilitation therapy, but most centres face the problems of shortage of rehabilitation therapists, which apparently could lead to the difficulties in delivering a quality rehabilitation programme for patients. Although the time of rehabilitation therapy is instituted far earlier than before, it is still not widely accepted in the acute burn care stage. There are more specialists joining the burn centre and becoming members of the professional burn team. However, professional education and training in the burn specialty appear to be sparse. There is room for improvement. Problems that impede the progress of rehabilitation therapy are: lack of rehabilitation knowledge in medical staff as well as the public, the shortage of specialised personnel and relatively low educational background of this team, lack of standard guidelines for rehabilitation treatment instructions and lack of funding from the government.

Conclusion

After 20 years of clinical practice, rehabilitation concepts are well accepted and many forms of rehabilitation techniques are carried out in most burn centres that responded to the survey. Yet, the results also indicate that there is a short history of rehabilitation practice among the burn centres. There is a burning need to enhance the development of rehabilitation services so as to meet the demands of management of severely burned patients in China. Some suggestions are made to improve the current burn rehabilitation services which would include: (1) provide rehabilitation education programmes for burn surgeons, therapists, nurses, as well as patients, families and the public; (2) set up standard guidelines for clinical instruction of rehabilitation therapy; (3) build an interdisciplinary burn team; (4) more investigation and research on the physical and psychological outcomes of burn patients; and (5) implement administrative measures in terms of staffing, funding and offering insurance to burn survivors.     

虚拟现实技术在乳腺癌术后康复训练中的应用进展

阐述了虚拟现实技术概况，虚拟现实技术在乳腺癌患者中的应用方式，用于乳腺癌患者康复训练的效果；总结了虚拟现实技术的优势与不足，旨在为临床更好地应用虚拟现实技术进行乳腺癌术后患肢功能康复训练提供参考。     

Relationship and family breakdown following acquired brain injury: the role of the rehabilitation team

Although the literature documents the considerable problems acquired brain injury causes for the survivor's family and close relationships, and the corresponding significantly inflated rate of separation and divorce, few papers offer practical solutions. The objective of this paper is to respond to this gap in the literature by presenting some of the problems raised for the rehabilitation team when a family separates, and some suggestions for ways in which these problems could be overcome. The literature is reviewed briefly, followed by reflections and suggestions which are based on this review and on clinical experience. The discussion indicates that there are a number of practical dilemmas raised for the rehabilitation team when a family already involved in the rehabilitation process starts to break up. Some specific suggestions for addressing these issues are made; further research is needed to evaluate their effectiveness.     

Bericht über den „4th International Congress on Medical-Legal Aspects of Work Injuries“ in Toronto

European and North American developments in prevention, rehabilitation and ?compensation are briefly reviewed      

Rehabilitationsmanagement der DGUV

The aims of rehabilitation management as offered by the German statutory accident insurance is to increase medical quality, reduce periods of worker disability, overcome interface problems and diminish pension payments. The aims are to be achieved by placing occupational rehabilitation under the guidance of a rehabilitation manager. Certainly the authorized medical examiner can identify with the aims of improving quality and diminishing interface problems, but may feel restricted in his medical freedom by the rehabilitation management physician or by quality assurance measures of the insurance institutions. Standardization of the rehabilitation management procedure for all insurance institutions, as well as information for the authorized medical examiner on all relevant aspects of patients’ occupations, e.g. work profile and employment contract status, would be desirable. For the authorized medical examiner, a positive aspect of rehabilitation management lies in the minimization of reporting, the resolution of intersection problems by the rehabilitation manager, as well as better treatment outcome for patients.     

Review of subject: Ethical conflict resolution based on an ethics of relationships for brain injury rehabilitation

An ethics of relationships for brain injury (BI) rehabilitation is described based on three principles: (1) human relationships are important; (2) human relationships are as important as individual survival; (3) human relationships are important enough to extend throughout the family of humankind. Within the context of this ethics of relationships, ethical conflict resolution (ECR) is offered as a process to address disagreements among those involved in BI rehabilitation. ECR provides a means to arrive at moral decisions in situations in which people disagree about the appropriate course of action because of differing values. ECR recognizes that, although disagreements in BI rehabilitation settings can be associated with multiple other factors, including disturbed self-awareness, emotions, communication, and interpersonal dynamics, such disagreements may also be value-based, either in whole or part. ECR invites the professional team to identify the value-based portion of these disagreements and provides a rational and supportive process to address disagreements. In this discussion of ECR, common and potentially universal areas of ethical concern in BI rehabilitation are identified, as well as potential risks. Specific examples of the application of ECR in cases of vegetative state, coma stimulation, and cognitive rehabilitation are described.     

The trauma of paediatric and adolescent brain injury: issues and implications for rehabilitation specialists

The purpose of this article is to define critical issues facing rehabilitation specialists providing services to children or adolescents with a brain injury and their families. These issues will be identified as they evolve temporally-from the period immediately after the injury to many years post-trauma. As the young person heals, the focus of the issues and the recommendations (based on both the clinical experience of the authors as well as the extensive body of literature already in existence) will change from those more appropriate to rehabilitation specialists working in the medical environment to those employed in education and the psychosocial realm. However, the boundaries between these realms, because of the all encompassing nature of the injury, are fluid. Finally, the purpose of this article is also to establish the need for rehabilitation specialists who are educated about traumatic brain injury; who are well versed in the physical, cognitive and emotional sequellae of the injury; who recognize the unique needs and expectations of this population and are willing to adjust; and who are willing to face the challenge that their clients face.     

Assessment of upper extremity impairment,function, and activity after stroke: foundations for clinical decision making

The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common UE impairments and how to assess them are briefly discussed. Although multiple UE impairments are typically present after stroke, the severity of one's impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed to optimize the provision of stroke rehabilitation services.     

重视骨质疏松性骨折后康复治疗

近些年,随着人口老龄化的加剧,骨质疏松性骨折的发病率随之上升,全球范围对骨质疏松性骨折防治的关注度也大大提高.目前,越来越多的研究认为对于骨质疏松性骨折的治疗,除了常规的骨折相关治疗和抗骨质疏松症药物干预之外,康复治疗也是影响骨折愈合非常重要的一环.但是,长期以来领域内的临床医生对骨质疏松性骨折后的康复治疗还存在认识程...     

Overview of our 13-year-long experience with cochlear implants

Authors give account of their 13-year-old experience of cochlear implantation. Their results with different devices as well as some observations regarding fitting and rehabilitation are also discussed.     

Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club

This consensus article reviews the various aspects of the non-pharmacological management of osteoporosis, including the effects of nutriments, physical exercise, lifestyle, fall prevention, and hip protectors. Vertebroplasty is also briefly reviewed. Non-pharmacological management of osteoporosis is a broad concept. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the post-fracture rehabilitation. The present document is the result of a consensus, based on a systematic review and a critical appraisal of the literature. Diets deficient in calcium, proteins or vitamin D impair skeletal integrity. The effect of other nutriments is less clear, although an excessive consumption of sodium, caffeine, or fibres exerts negative effects on calcium balance. The deleterious effects of tobacco, excessive alcohol consumption and a low BMI are well accepted. Physical activity is of primary importance to reach optimal peak bone mass but, if numerous studies have shown the beneficial effects of various types of exercise on bone mass, fracture data as an endpoint are scanty. Fall prevention strategies are especially efficient in the community setting, but less evidence is available about their effectiveness in preventing fall-related injuries and fractures. The efficacy of hip protectors remains controversial. This is also true for vertebroplasty and kyphoplasty. Several randomized controlled studies had reported a short-term advantage of vertebroplasty over medical treatment for pain relief, but these findings have been questioned by recent sham-controlled randomized clinical studies.     

Rehabilitation im TraumaNetzwerkD DGU

Rapid re-entry of an insured person into working life, preferably to their former post, as well as a reduction in the associated costs take priority in any rehabilitation management. The current article looks at the factors which jeopardize prompt re-entry into working life, which lie primarily with the insured person, a lack of knowledge on the part of the therapist regarding workplace demands, a lack of or inadequate involvement of the employer, as well as a lack of, late or inadequate intervention on the part of the accident insurer. Measures to address these problems are also discussed. In addition, the following important requirement is examined: rehabilitation management must be worthwhile, particularly from a financial perspective.     

Simultaneous bilateral anterior shoulder dislocation: report of two cases and review of the literature

Bilateral shoulder dislocations are rare and almost always occur in the posterior direction. Simultaneous bilateral anterior shoulder dislocation is even rarer and only a few cases are stated in the literature. The most interesting part of a bilateral shoulder dislocation is about its injury mechanism as a synchronous and simultaneous force is needed to result in it. In cases of epilepsy or electrocution, the mechanism is different and the forceful contractions of the selective group of muscles result in the dislocation. This article reports two cases of bilateral simultaneous anterior shoulder joint dislocation that occurred after a road side accident and after an episode of convulsion in an epileptic patient. The dislocations were diagnosed early and reduced immediately with a proper postreduction rehabilitation. During their follow-up, both patients had satisfactory functional outcome. This article emphasizes on the importance of shoulder examination in road side accident victims and epileptic patients. All orthopedic surgeons and emergency physicians should be aware of such unusual possibilities to have an early diagnosis and treatment.An early reduction and appropriate rehabilitation can provide satisfactory functional outcome. This article also briefly discusses the injury mechanisms, diagnoses and treatments of bilateral shoulder dislocation as reported in the literature.     

Isokinetic Muscle Testing: Is It Clinically Useful?

The use of computer-driven muscle-testing devices has become increasingly popular during the past two decades. This expensive equipment allows evaluation of muscles and muscle groups in an isokinetic manner. Isokinetic muscle testing is performed with a constant speed of angular motion but variable resistance. Isokinetic dynamometers have been shown to produce relatively reliable data when testing simple, uniaxial joints, such as the knee, as well as when testing the spine in flexion and extension. Isokinetic strength data are generally not helpful in the diagnosis of orthopaedic abnormalities. Isokinetic testing can be helpful during the rehabilitation of orthopaedic patients, since it allows easy monitoring of progress. It also enables the patient to work on muscle rehabilitation in a controlled manner at higher speeds than are possible with more conventional exercise equipment. An isokinetic rehabilitation program can be easily tailored with concentric and eccentric components that closely resemble muscle actions during occupational and sports activities.     

The evolution of the clinician-scientist model of neurological rehabilitation

Over the past three or four decades two treatment technologies have been evolving in parallel, recently to some extent merging. The first of these technologies is behaviour analysis, with its emphasis on identification and manipulation of variables external to the individual as controlling agents. The second is neurological rehabilitation, with a characteristic focus of resources on recovery of function following neurological damage. The histories of both of these technologies are similar in that they emerged from basic laboratory research with non-human subjects, followed by extension of findings to research with humans, culminating in widespread formal application of results. The past 5 years have seen a convergence of behaviour analytic and neurological rehabilitation techniques resulting in major shifts in treatment service delivery systems. We briefly chronicle the emergence of these two technologies from their basic underpinnings through world-wide use. Further, discussion is provided describing our and others' experience with the combining of behaviour and neurological rehabilitation. Finally, we give an account of an innovative neurological rehabilitation service delivery system designed to deliver effective cost-efficient treatment in the patient's natural environment. Implicit in the design and implementation of this real-world model of rehabilitation is the combination of behavioural technology and neurological rehabilitation towards the achievement of functional outcomes which endure. Our purpose in the above is to provide an introduction to present use and future potential of behaviour analytic methodologies and technologies in rehabilitation.     

Early fitting of artificial limbs to amputated lower limbs

Specific rehabilitation of patients with amputated lower limbs is first of all rehabilitation to walk with a prosthesis (artificial limb). After 20 years of practice of prosthetic early fitting for lower limbs amputees using practice prosthesis, the authors suggest that this technique is still up-to-date. The taking charge of amputated patients by a specialised team is an important element if one wants to achieve a good functional result. A rehabilitation milieu, where the new amputee is with a large number of patients with the same pathology, also constitutes a framework that is reassuring as well as stimulating and allows the patient to imagine the situation in which he/she can find himself/ herself a few weeks later.