Shoulder rehabilitation strategies,guidelines, and practice

Shoulder rehabilitation can best be understood and implemented as the practical application of biomechanical andmuscle activation guidelines to the repaired anatomic structures in order to allow the most complete return to function. The shoulder works as a link in the kinetic chain of joint motions and muscle activations to produce optimum athletic function. Functional shoulder rehabilitation should start with establishment of a stable base of support and muscle facilitation in the trunk and legs, and then proceeds to the scapula and shoulder as healing is achieved and proximal control is gained. The pace of this “flow” of exercises is determined by achievement of the functional goals of each segment in the kinetic chain. In the early rehabilitation stages, the incompletely healed shoulder structures are protected by exercises that are directed towards the proximal segments. As healing proceeds, the weak scapular and shoulder muscles are facilitated in their re-activation by the use of the proximal leg and trunk muscles to re-establish normal coupled activations. Closed chain axial loading exercises form the basis for scapular and glenohumeral functional rehabilitation, as they more closely simulate normal scapula and shoulder positions, proprioceptive input, and muscle activation patterns. In the later rehabilitation stages, glenohumeral control and power production complete the return of function to the shoulder and the kinetic chain. In this integrated approach, glenohumeral emphasis is part of the entire program and is towards the end of rehabilitation, rather than being the entire program and being at the beginning of the program.     

An alternative clinical postural stability test for patients with Parkinson’s disease

We compared the sensitivity and consistency of a new Push and Release Test versus the Pull Test (item 30 of the Unified Parkinson’s Disease Rating Scale; UPDRS) as clinical measures of postural stability. Subjects with Parkinson’s disease and age-matched control subjects participated in 3 protocols investigating: (1) the sensitivity and specificity of the two tests related to the subjects’ balance confidence, as measured by the Activities-specific Balance Confidence (ABC) scale, (2) the inter-rater reliability of the two tests, and (3) the consistency of the perturbation forces applied to the subjects by each balance test. As a test for concurrent validity, the balance tests were also compared with the subjects’ retrospective reports of fall frequency. Compared with the Pull Test, the Push and Release Test was more sensitive to subjects with low balance confidence, but less specific for subjects with high balance confidence. The inter-rater correlations were higher with the Push and Release Test. Examiners applied more consistent perturbation forces to the subjects with the Push and Release Test than with the Pull Test. The Push and Release Test correlated better with self-reported falls. Therefore, the Push and Release Test provided a more sensitive and consistent test of postural stability than the Pull Test. Received in revised form: 2 March 2006     

Facioscapulohumeral muscular dystrophy functional composite outcome measure

Introduction: We developed an evaluator‐administered functional facioscapulohumeral muscular dystrophy composite outcome measure (FSHD‐COM) comprising patient‐identified areas of functional burden for future clinical trials. Methods: We performed a prospective observational study of 41 patients with FSHD at 2 sites. The FSHD‐COM includes functional assessment of the legs, shoulders and arms, trunk, hands, and balance/mobility. We determined the test‐retest reliability and convergent validity compared to established FSHD disease metrics. Results: The FSHD‐COM demonstrated excellent test‐retest reliability (intraclass correlation coefficient [ICC] 0.96; subscale ICC range, 0.90–0.94). Cross‐sectional associations between the FSHD‐COM and disease duration, clinical severity, and strength were moderate to strong (Pearson correlation coefficient range |0.51–0.92|). Discussion: The FSHD‐COM is a disease‐relevant, functional composite outcome measure suitable for future FSHD clinical trials that shows excellent test‐retest reliability and cross‐sectional associations to disease measures. Future directions include determining multisite reliability, sensitivity to change, and the minimal clinically important change in the FSHD‐COM. Muscle Nerve 58 : 72–78, 2018     

经皮封堵器治疗卵圆孔未闭的卒中二级预防——呼吁完成随机临床试验

目前,尚不明确预防原因不明、合并卯圆孔未闭（patent foramen ovale,PFO）患者的卒中或短暂性脑缺血再次发作的最佳措施。众多观察性研究发现,PFO与原因不明的卒中虽密切相关,但在大多数发病的患者中,两者间并未明确因果关系。治疗措施包括：抗血小板聚集或维生素K拮抗剂的药物治疗、经皮封堵术及外科手术修补。     

体部伽玛刀定位系统添加标尺对定位精度的改进

0 引言体部伽玛刀使用CT定位时,定位床与CT床之间存在可变性,可造成定位床位置变化对定位精度有一定影响.为了控制这种可变性保证定位精度,有必要制作一种可量化的测量工具.     

Reimagining care for adolescent and young adult cancer programs: Moving with the times

Literature regarding the development of adolescent and young adult (AYA) cancer programs has been dominantly informed by pediatric centers and practitioners. However, the majority of young adults are seen and treated at adult cancer centers, in which cancer volumes afford the development of innovative supportive care services. Although the supportive care services in adult cancer centers are helpful to AYAs, some of the most prominent and distinct issues faced by AYAs are not adequately addressed through these services alone. This article describes how the AYA Program at Princess Margaret Cancer Centre has collaborated with existing supportive care services in addition to supplying its own unique services to meet the comprehensive needs of AYAs in the domains of: symptom management (sexuality and fatigue), behavior modification (return to work and exercise), and health services (advanced cancer and survivorship). These collaborations are augmented by patient education interventions and timely referrals. The objective of this article was to assist other centers in expanding existing services to address the needs of AYA patients with cancer. Cancer 2016;122:1038–1046. © 2016 American Cancer Society