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Meeting rehabilitation needs of persons with disabilities in an emergency medical response: a role for physiotherapy?
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
controversies regarding working mechanisms and efficacy of the two principal modalities of shock wave therapy, focused and radial, (i.e. fESWT and rESWT), abound. Purpose: To clarify some of the most common misconceptions regarding fESWT and rESWT. Methods: A systematic review of the literature was performed studying the mechanism of action of the two types of ESWT. The clinical results and functional outcomes were compared for various musculoskeletal indications. Results: Contrary to prevailing opinion, (i) most of the available fESWT devices generate pressure waves rather than true shock waves, (ii) both fESWT and rESWT devices can generate cavitation and, (iii) there is no evidence suggesting that fESWT is superior to rESWT except for deep indications such as pseudoarthrosis of the femur or avascular hip necrosis. Conclusion(s): Both fESWT and rESWT are safe and highly effective treatment modalities for musculoskeletal pathologies, with no proven superiority of one modality over the other. Both are effective for superficial indications such as plantar fasciopathy, Achilles tendinopathy, lateral epicondylitis and calcifying tendinitis of the shoulder while fESWT is preferential for deep bony indications such as pseudoarthrosis of the femur or avascular hip necrosis. Implications: This study clarifies some of the most common misconceptions regarding fESWT and rESWT in the literature. Keywords: Extracorporeal shock wave therapy; ESWT; Tendinopathies Funding acknowledgements: None. Ethics approval: Ethics approval was not required for this study. http://dx.doi.org/10.1016/j.physio.2015.03.1279 Research Report Poster Presentation Number: RR-PO-03-04-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 MEETING REHABILITATION NEEDS OF PERSONS WITH DISABILITIES IN AN EMERGENCY MEDICAL RESPONSE: A ROLE FOR PHYSIOTHERAPY? S. Schnabel Alice-Salomon University for Applied Sciences, Berlin, Germany Background: With the ongoing civil wars in Syria and Gaza, humanitarian organisations face the problem of providing appropriate health care for people with chronic diseases. Rehabilitation needs of persons with pre-existing disabilities and disaster-related disabilities have only been addressed in emergency medical responses after the Convention on the rights for persons with disabilities came into force in
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2008 and after the earthquake in Haiti in 2010. Humanitarian organisations started to involve physiotherapists who dealt with the rehabilitation needs of persons with disabilities. The involvement of rehabilitation specialists in emergency medical responses seemingly indicated a shift from only focusing on the acute emergency medical response to including longterm recovery. Purpose: The study was undertaken to explore whether there is a potential role of physiotherapists in post-disaster responses according to the epidemiology of injuries and chronic diseases. Further it was investigated if physical rehabilitation can be discussed within the context contemporary emergency medical assistance and in the light of the Convention on the Rights for People with Disabilities. Methods: This study is a narrative review that synthesises literature searched in the field of the allied health professions, medicine and social sciences in the databases PubMed, Web of Knowledge and CINAHL. Additionally, experience reports from non-governmental organisations and professional bodies such as the Chartered Society of Physiotherapy were included. Results: An examination of injury pattern in post-disaster and violent conflict settings as well as medical needs associated with the recent increase in non-communicable diseases indicate a need to include physical rehabilitation in emergency medical responses. In accordance with the Convention on the rights for people with disabilities physical rehabilitation has to be included in all spheres of their lives in order to meet their needs. Conclusion(s): Physical rehabilitation should take increasingly part of mainstream emergency medical responses in future post-disaster and violent conflict settings on the basis of the rehabilitation needs identified in this study as well as achieving an inclusive humanitarian approach by including persons with disabilities and physiotherapists into disaster response planning and preparedness. Implications: The research shows that people with disaster-related and disaster non-related disabilities cannot be excluded in an emergency medical assistance. With the current situation in Syria and Palestine, studies and experience reports from medical organisations show that there is an increased number of people with non-communicable diseases that will become an emergency if it is not monitored and managed by rehabilitation teams beforehand. Thus, the results can be translated into practice, education and policy by bringing global health priorities on to the agenda of physiotherapy students, raising awareness among physiotherapists and making rehabilitation as part of the emergency medical response. Implementing rehabilitation teams post-disaster will help people with disaster-related disabilities to mange their disability and for people with disaster non-related disabilities to prevent it from becoming an emergency. This would reduce the burden of disability for society on a national and global scale. Involving rehabilitation teams would strengthen the profession in areas of the world where physiotherapy is not
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
widely available and it would highlight the importance of rehabilitation for people with disabilities. Keywords: Physiotherapy; Disability; Disaster Funding acknowledgements: My Master’s in global health was funded by the Erasmus Mundus Scholarship Programme in international health. Ethics approval: Ethical approval was not needed. http://dx.doi.org/10.1016/j.physio.2015.03.1280 Research Report Poster Presentation Number: RR-PO-21-06-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 DOSE–RESPONSE RELATIONSHIP OF LOCOMOTOR TRAINING IN PATIENTS WITH SPINAL CORD INJURY: PRELIMINARY RESULTS M. Wirz 1,2 , V. Dietz 2 , A. Esclarin 3 , J. Benito 4 , O. Mach 5 , C. Bastiaenen 6 , R.A. de Bie 7 , S. Schneider 8 1 Zurich University of Applied Sciences (ZHAW), Health Department, Institute of Physiotherapy, Winterthur, Switzerland; 2 Balgrist University Hospital, Spinal Cord Injury Unit, Zurich, Switzerland; 3 Hospital Nacional de Parapléjicos, Toledo, Spain; 4 Institut Guttmann, Barcelona, Spain; 5 Berufsgenossenschaftliche Unfallklinik, Rückenmarkverletztenzentrum, Murnau, Germany; 6 Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands; 7 Maastricht University, Health Medicine and Life Sciences, Maastricht, Netherlands; 8 Zurich University of Applied Sciences, Health, Winterthur, Switzerland
Background: A large proportion of patients with spinal cord injury (SCI) regain ambulatory function. However, during the first 3 months most patients are unable to walk without support. To enable ambulatory training at such an early stage the body weight is partially relieved and leg movement assisted by two therapists. A more recent approach is the application of robotic-based assistance, which allows for longer training duration. From the science of motor learning and studies including patients with stroke, it is known that training effects depend on the duration of the training. Longer training results in a better walking function. Purpose: The aim of the present study is to evaluate whether prolonged robot-assisted walking training leads to a better walking outcome in patients with incomplete SCI, who are initially unable to walk independently (i.e. B and C according to the International Standards for Neurological Classification of SCI-ISNCSCI), and whether such training is feasible or is associated with undesirable effects. Methods: Patients from three sites with an acute incomplete SCI (within 60 days after injury) were randomized
to either standard training (session duration 25 minutes) or intensive training (session duration 50 minutes). After 8 weeks of training walking ability (Walking Index for SCIWISCI, scale 0–20: 0 = not able to walk, 20 = able to walk independently), the occurrence of adverse events and the rate of perceived exertion (RPE, scale 1–10: 1 = very light, 10 = very, very hard), as well as patients’ global impression of change (PGIC, scale 0–10: 0 = much better, 5 = no change, 10 = much worse) were compared between groups. Results: Seventeen patients with incomplete SCI were randomly assigned either to standard training (ISNCSCI B: n = 6; C: n = 2) or to intensive training (B: n = 3; C: n = 6). The average duration of training of the standard group was half the length of the intensive group (24.9 ± 0.6 minutes vs. 48.3 ± 3.2 minutes; p = 0.01). Both groups performed an equal number of training sessions within 8 weeks (33.8 ± 6.8 and 34.9 ± 6.0; n.s.). The median WISCI changed from 0 to 4 in the standard group (n.s.) and from 0 to 10.5 (p < 0.05) in the intensive group. However, the group difference after training did not reach statistical significance. The median RPE (standard: 6.5, range 1–10 and intensive: 6, range 1–10; n.s.) and the PGIC (standard: 3.5, range 0–5; intensive: 2.5, range 1–4; n.s.) did not differ between the standard and intensive training groups. Conclusion(s): Longer training using a robotic device is feasible and is not associated with undesirable effects in patients with incomplete SCI. Results show a trend towards a positive dose–response relationship. However, there was a larger proportion of patients with a motor incomplete SCI (i.e. ISNCSCI: C) in the intensive training group. Implications: The duration of a standard training session needs to be re-addressed. Results indicate that more intensive training leads to a better outcome. Keywords: Spinal cord injuries; Locomotor rehabilitation; Robotics Funding acknowledgements: This study is funded by the Balgrist Foundation, Switzerland. Ethics approval: Ethical approval was obtained at each study site. All participants provided written informed consent. http://dx.doi.org/10.1016/j.physio.2015.03.1281
controversies regarding working mechanisms and efficacy of the two principal modalities of shock wave therapy, focused and radial, (i.e. fESWT and rESWT), abound. Purpose: To clarify some of the most common misconceptions regarding fESWT and rESWT. Methods: A systematic review of the literature was performed studying the mechanism of action of the two types of ESWT. The clinical results and functional outcomes were compared for various musculoskeletal indications. Results: Contrary to prevailing opinion, (i) most of the available fESWT devices generate pressure waves rather than true shock waves, (ii) both fESWT and rESWT devices can generate cavitation and, (iii) there is no evidence suggesting that fESWT is superior to rESWT except for deep indications such as pseudoarthrosis of the femur or avascular hip necrosis. Conclusion(s): Both fESWT and rESWT are safe and highly effective treatment modalities for musculoskeletal pathologies, with no proven superiority of one modality over the other. Both are effective for superficial indications such as plantar fasciopathy, Achilles tendinopathy, lateral epicondylitis and calcifying tendinitis of the shoulder while fESWT is preferential for deep bony indications such as pseudoarthrosis of the femur or avascular hip necrosis. Implications: This study clarifies some of the most common misconceptions regarding fESWT and rESWT in the literature. Keywords: Extracorporeal shock wave therapy; ESWT; Tendinopathies Funding acknowledgements: None. Ethics approval: Ethics approval was not required for this study. http://dx.doi.org/10.1016/j.physio.2015.03.1279 Research Report Poster Presentation Number: RR-PO-03-04-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 MEETING REHABILITATION NEEDS OF PERSONS WITH DISABILITIES IN AN EMERGENCY MEDICAL RESPONSE: A ROLE FOR PHYSIOTHERAPY? S. Schnabel Alice-Salomon University for Applied Sciences, Berlin, Germany Background: With the ongoing civil wars in Syria and Gaza, humanitarian organisations face the problem of providing appropriate health care for people with chronic diseases. Rehabilitation needs of persons with pre-existing disabilities and disaster-related disabilities have only been addressed in emergency medical responses after the Convention on the rights for persons with disabilities came into force in
eS1347
2008 and after the earthquake in Haiti in 2010. Humanitarian organisations started to involve physiotherapists who dealt with the rehabilitation needs of persons with disabilities. The involvement of rehabilitation specialists in emergency medical responses seemingly indicated a shift from only focusing on the acute emergency medical response to including longterm recovery. Purpose: The study was undertaken to explore whether there is a potential role of physiotherapists in post-disaster responses according to the epidemiology of injuries and chronic diseases. Further it was investigated if physical rehabilitation can be discussed within the context contemporary emergency medical assistance and in the light of the Convention on the Rights for People with Disabilities. Methods: This study is a narrative review that synthesises literature searched in the field of the allied health professions, medicine and social sciences in the databases PubMed, Web of Knowledge and CINAHL. Additionally, experience reports from non-governmental organisations and professional bodies such as the Chartered Society of Physiotherapy were included. Results: An examination of injury pattern in post-disaster and violent conflict settings as well as medical needs associated with the recent increase in non-communicable diseases indicate a need to include physical rehabilitation in emergency medical responses. In accordance with the Convention on the rights for people with disabilities physical rehabilitation has to be included in all spheres of their lives in order to meet their needs. Conclusion(s): Physical rehabilitation should take increasingly part of mainstream emergency medical responses in future post-disaster and violent conflict settings on the basis of the rehabilitation needs identified in this study as well as achieving an inclusive humanitarian approach by including persons with disabilities and physiotherapists into disaster response planning and preparedness. Implications: The research shows that people with disaster-related and disaster non-related disabilities cannot be excluded in an emergency medical assistance. With the current situation in Syria and Palestine, studies and experience reports from medical organisations show that there is an increased number of people with non-communicable diseases that will become an emergency if it is not monitored and managed by rehabilitation teams beforehand. Thus, the results can be translated into practice, education and policy by bringing global health priorities on to the agenda of physiotherapy students, raising awareness among physiotherapists and making rehabilitation as part of the emergency medical response. Implementing rehabilitation teams post-disaster will help people with disaster-related disabilities to mange their disability and for people with disaster non-related disabilities to prevent it from becoming an emergency. This would reduce the burden of disability for society on a national and global scale. Involving rehabilitation teams would strengthen the profession in areas of the world where physiotherapy is not
eS1348
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
widely available and it would highlight the importance of rehabilitation for people with disabilities. Keywords: Physiotherapy; Disability; Disaster Funding acknowledgements: My Master’s in global health was funded by the Erasmus Mundus Scholarship Programme in international health. Ethics approval: Ethical approval was not needed. http://dx.doi.org/10.1016/j.physio.2015.03.1280 Research Report Poster Presentation Number: RR-PO-21-06-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 DOSE–RESPONSE RELATIONSHIP OF LOCOMOTOR TRAINING IN PATIENTS WITH SPINAL CORD INJURY: PRELIMINARY RESULTS M. Wirz 1,2 , V. Dietz 2 , A. Esclarin 3 , J. Benito 4 , O. Mach 5 , C. Bastiaenen 6 , R.A. de Bie 7 , S. Schneider 8 1 Zurich University of Applied Sciences (ZHAW), Health Department, Institute of Physiotherapy, Winterthur, Switzerland; 2 Balgrist University Hospital, Spinal Cord Injury Unit, Zurich, Switzerland; 3 Hospital Nacional de Parapléjicos, Toledo, Spain; 4 Institut Guttmann, Barcelona, Spain; 5 Berufsgenossenschaftliche Unfallklinik, Rückenmarkverletztenzentrum, Murnau, Germany; 6 Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands; 7 Maastricht University, Health Medicine and Life Sciences, Maastricht, Netherlands; 8 Zurich University of Applied Sciences, Health, Winterthur, Switzerland
Background: A large proportion of patients with spinal cord injury (SCI) regain ambulatory function. However, during the first 3 months most patients are unable to walk without support. To enable ambulatory training at such an early stage the body weight is partially relieved and leg movement assisted by two therapists. A more recent approach is the application of robotic-based assistance, which allows for longer training duration. From the science of motor learning and studies including patients with stroke, it is known that training effects depend on the duration of the training. Longer training results in a better walking function. Purpose: The aim of the present study is to evaluate whether prolonged robot-assisted walking training leads to a better walking outcome in patients with incomplete SCI, who are initially unable to walk independently (i.e. B and C according to the International Standards for Neurological Classification of SCI-ISNCSCI), and whether such training is feasible or is associated with undesirable effects. Methods: Patients from three sites with an acute incomplete SCI (within 60 days after injury) were randomized
to either standard training (session duration 25 minutes) or intensive training (session duration 50 minutes). After 8 weeks of training walking ability (Walking Index for SCIWISCI, scale 0–20: 0 = not able to walk, 20 = able to walk independently), the occurrence of adverse events and the rate of perceived exertion (RPE, scale 1–10: 1 = very light, 10 = very, very hard), as well as patients’ global impression of change (PGIC, scale 0–10: 0 = much better, 5 = no change, 10 = much worse) were compared between groups. Results: Seventeen patients with incomplete SCI were randomly assigned either to standard training (ISNCSCI B: n = 6; C: n = 2) or to intensive training (B: n = 3; C: n = 6). The average duration of training of the standard group was half the length of the intensive group (24.9 ± 0.6 minutes vs. 48.3 ± 3.2 minutes; p = 0.01). Both groups performed an equal number of training sessions within 8 weeks (33.8 ± 6.8 and 34.9 ± 6.0; n.s.). The median WISCI changed from 0 to 4 in the standard group (n.s.) and from 0 to 10.5 (p < 0.05) in the intensive group. However, the group difference after training did not reach statistical significance. The median RPE (standard: 6.5, range 1–10 and intensive: 6, range 1–10; n.s.) and the PGIC (standard: 3.5, range 0–5; intensive: 2.5, range 1–4; n.s.) did not differ between the standard and intensive training groups. Conclusion(s): Longer training using a robotic device is feasible and is not associated with undesirable effects in patients with incomplete SCI. Results show a trend towards a positive dose–response relationship. However, there was a larger proportion of patients with a motor incomplete SCI (i.e. ISNCSCI: C) in the intensive training group. Implications: The duration of a standard training session needs to be re-addressed. Results indicate that more intensive training leads to a better outcome. Keywords: Spinal cord injuries; Locomotor rehabilitation; Robotics Funding acknowledgements: This study is funded by the Balgrist Foundation, Switzerland. Ethics approval: Ethical approval was obtained at each study site. All participants provided written informed consent. http://dx.doi.org/10.1016/j.physio.2015.03.1281