- Email: [email protected]
The distribution of lung ventilation of healthy subjects placed in various positions, by the method of impedance tomography
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
Table 1 A summary of the components and the highest ranked three features.
Table 2 Texture features that differentiate between the clinical groups as listed above.
e431
Introduction/Background Analyze the integrity of sacral area sensory pathways in all its components (A, A␦ and C fibers). We evaluated the relative activation state of each single fiber and correlated these data with the clinical conditions, especially the AIS (American spinal cord injury association Injury Score), to define the grade of SCI completeness. Material and method We examined 25 patients affected by acute post-traumatic SCI and admitted between June 2015 and 2016. Lesion level: 10 quadriplegic (all incomplete) and 15 paraplegic patients (8 complete, 7 incomplete); average age 36.2 y (12–71); time between traumatic event and evaluation < 1 y. Examination: AIS grading; evaluation of sensory fibres with the technological ® device Neurometer ; we analysed the pudendal nerve (Penis Dorsal nerve in male and Superficial Perineal nerve in female). Results In 3 of the 8 AIS A patients we found out a residual activity of sensory fibres (normal activity of C fibres and inactivity of A fibres) showing a discrepancy in AIS score between clinical and instrumental findings (discomplete lesions). Accidentally we found out that this typical sensory fibres activation pattern (observed in 13 of 25 patients) was also associated with non-responder, highgrade neuropathic pain (NRS 8–10/10). Conclusion The presence of a discomplete lesion could lead to a different rehabilitation programme; early identification of patients presenting a typical fibers activation pattern associated with neuropathic pain could give us the opportunity to design a tailored therapy before the onset of chronic pain and overactivities; could the neuromodulation of inactive A fibers be a new therapeutic target? Keywords Sensory; Pain; Fibers Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1004
C1.04 Physical and rehabilitation medicine diagnostics as related to organ systems and body functions – Diagnosis and assessment of functions of the cardiovascular, haematological, immunological, and respiratory systems ISPR8-0799 Conclusion Ultrasound texture features can differentiate between upper trapezius tissue in patients with active and latent MTrPs, and can differentiate these clinical groups from healthy tissue. Ultrasound should be further explored as a clinical diagnostic modality for differentiating MPS patients. Keywords Musculoskeletal conditions; Diagnosis of neurological; Musculoskeletal and movement related functions Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1003 ISPR8-0628
Preliminary data of a neuroselective study of sensory pathways in spinal cord injured (SCI) patients
M. Zarbo ∗ , M. Spinelli , A. Leo , M.G. Ricchiuti , L. Frediani ASST Grande Ospedale Metropolitano Niguarda, Unità Spinale Unipolare, Milan, Italy ∗ Corresponding author. E-mail address: [email protected] (M. Zarbo), [email protected] (M. Spinelli)
The distribution of lung ventilation of healthy subjects placed in various positions, by the method of impedance tomography K. Grigoriadis 1,∗ , M. Micha 2 , G. Konstantopoulou 1 , A. Grigoriadou 3 , A. Armaganidis 1 1 ATTIKON University General Hospital, Second Department of Critical Care Medicine, Athens, Greece 2 ATTIKON University General Hospital, Physical Medicine and Rehabilitation, Athens, Greece 3 TEI of Central Greece, Physiotherapy, Lamia, Greece ∗ Corresponding author. E-mail address: [email protected] (K. Grigoriadis) Introduction/Background Impedance tomography is a modern method for real time monitoring of the air distribution during lung ventilation, as it can record the changes of lung impedance during breathing and via a mathematical processing creates a visual image representing the changes of lung ventilation. The aim of this study is to record the percentage distribution of lung ventilation in healthy subjects, in several positions. The results of this study can be used for explaining the fluctuations of oxygenation in cases
e432
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
such as bronchial drainage or for the interpretation of pulmonary ventilation in pathological cases such as scoliosis. Material and method Eight young, non-smoking, healthy volunteers, without a previous respiratory disease, were monitored by impedance tomography. They were placed in the following positions: Sitting, Supine, Trendelenburg, Right Side Lying, Left Side Lying, Prone, Semi-Fowler’s position 30◦ , Semi-Fowler’s position 45◦ , Right Trunk Rotation and Left Trunk Rotation. The recorded data were used to compare the percentage of the air distribution between the anterior and posterior thoracic segment and between same lung (right or left) of each object in each position. Results The anterior-posterior percentage of the air distribution during lung ventilation did not show any remarkable changes in any position and in any angle of head elevation of the bed, while statistically significant differences were detected comparing the percentage of the air distribution in each lung on the lateral decubitus positions and on the trunk rotations (mean ± SD: 9 ± 3.85 P ≤ 0.001, 9.25 ± 4.73 P = 0.001, respectively). Conclusion In normal healthy young individuals, head elevation of the bed does not have any impact on the regional lung ventilation. On the contrary the side lying positions seems to favor the dependent lung and the trunk rotation appears to compress the same to the rotation side lung, with a significant impact on its ventilation. Keywords Impedance tomography; Distribution of lung ventilation; Healthy subjects Disclosure of interest The authors declare that they have no competing interest.
Results Twelve adult hemophiliacs: – 11 patients with hemophilia A (10 cases of severe hemophilia and 1 case of minor hemophilia), – 1 case of severe hemophilia B; the average age of patients is 30.67 years with extremes of 17 and 40 years. Hundred percent of patients were unaware of the importance of self-rehabilitation exercises. Eighty percent were unaware of the risk of the disease’s complication. Sixty percent did not know the importance of rehabilitation in improving life quality. Fifty percent were unaware of the precautions to take in case of acute bleeding. Conclusion The TEP is considered as an essential element in the management of hemophilic patients, but currently remains a very marginal approach in the care process, hence the interest of integrating it into our therapeutic arsenal. Keywords Hemophilia; Therapeutic education; Comorbidity Disclosure of interest The authors declare that they have no competing interest.
Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.1005.
ISPR8-0425
https://doi.org/10.1016/j.rehab.2018.05.1005 ISPR8-0313
Does therapeutic education optimize the rehabilitative management of hemophiliac patients? H. Aboura 1,∗ , Dr. S. Ammor 1 , Dr. A. Sehimi 1 , Dr. K. Tayebi 2 Centre Hospitalo-Universitaire Dr Hassani Abdelkader, Service de Médecine Physique et de Réadaptation, Sidi-Bel-Abbes, Algeria 2 Centre Hospitalo-Universitaire Dr Hassani Abdelkader, Service d’Hématologie, Sidi-Bel-Abbes, Algeria ∗ Corresponding author. E-mail address: h [email protected] (H. Aboura)
1
Introduction/Background Hemophilia is a hemostatic disorder that causes hemorrhages in the joints and muscles. Physical exercise is often put in place to facilitate convalescence after bleeding, and to improve joint function in the presence of arthropathy. An implementation of a personalized therapeutic education program (TEP) for the hemophiliac patient to help them acquire and maintain skills to improve their quality of life and prevent the complications inherent in the disease. Sensitization, information and learning sessions concerning illness, treatment, physiotherapy and self-education were planned and organized in collaboration with fellow hematologists. Objective To assess the contribution of TEP in improving hemophilia patient’s knowledge about disease management and prevention of comorbidities. Material and method Twelve hemophilia patients participated in TEP sessions. Sessions were individual or collective provided by a multidisciplinary team. The educational tool is represented by slides, videos containing information (Arabic and French), diagrams and images. A summary booklet of the main simplified self-exercises to be performed at home and the frequency of their achievement was provided to each patient in order to improve observance and adherence to the program.
https://doi.org/10.1016/j.rehab.2018.05.1006
C1.05 Physical and rehabilitation medicine diagnostics as related to organ systems and body functions – Diagnosis and assessment of functions of the digestive, metabolic, and endocrine systems
Is subclinical hypothyroidism linked to lower functional outcomes measured by Functional Independent Measures (FIM)? L. Lan 1,∗ , Y.A. Chou 2 The Prince Charles Hospital, Geriatric and Rehabilitation Department, Brisbane, Australia 2 The Royal Brisbane Hospital, Internal Medicine, Brisbane, Australia ∗ Corresponding author. E-mail address: [email protected] (L. Lan)
1
Introduction/Background Subclinical hypothyroidism (SCH) is a common finding in the cohort of rehabilitation patients. However, there is no reported study on how this population performs in the rehabilitation setting. We hypothesized that patients with SCH may have lower level of rehabilitation gains. The aims of this study are to: (1) quantify the incidence of subclinical hypothyroidism in rehabilitation patients; (2) review functional outcomes of patients with subclinical hypothyroidism; (3) seek correlation between the level of thyroid function and rehabilitation outcomes. Material and method This was an observational retrospective cohort study of all patients receiving rehabilitation over 2 years from Jan 2015 till Dec 2016. Quantitative data were based on thyroid function tests at admission, Chart audits, and Functional Independent Measures (FIM). Data analysis involved an unpaired t-test and logistic linear regression. Results Overall, 653 patients (306 M and 347 F) were included in the study with a mean age of 74 (± 12.8). While 553 patients had a thyroid stimulation hormone (TSH) within normal limits, 100 patients were found to have an abnormal TSH, of which 81 presented with SCH (TSH 4.6∼19.9), 5 with profound hypothyroids (TSH ≥ 20) and 14 with hyperthyroidism (TSH ≤ 0.2). The incidence of SCH was 12.4%. All patients with SCH had improvement in function with an FIM gain 26.9 (± 19.6), compared to 23.8 (± 18.9) of those patients with normal TSH. The efficiency of rehabilitation was similar in both groups. An interesting finding of note was that those with hyperthyroidism had low FIM scores at both admission and discharge however there was no significant difference in reha-
Table 1 A summary of the components and the highest ranked three features.
Table 2 Texture features that differentiate between the clinical groups as listed above.
e431
Introduction/Background Analyze the integrity of sacral area sensory pathways in all its components (A, A␦ and C fibers). We evaluated the relative activation state of each single fiber and correlated these data with the clinical conditions, especially the AIS (American spinal cord injury association Injury Score), to define the grade of SCI completeness. Material and method We examined 25 patients affected by acute post-traumatic SCI and admitted between June 2015 and 2016. Lesion level: 10 quadriplegic (all incomplete) and 15 paraplegic patients (8 complete, 7 incomplete); average age 36.2 y (12–71); time between traumatic event and evaluation < 1 y. Examination: AIS grading; evaluation of sensory fibres with the technological ® device Neurometer ; we analysed the pudendal nerve (Penis Dorsal nerve in male and Superficial Perineal nerve in female). Results In 3 of the 8 AIS A patients we found out a residual activity of sensory fibres (normal activity of C fibres and inactivity of A fibres) showing a discrepancy in AIS score between clinical and instrumental findings (discomplete lesions). Accidentally we found out that this typical sensory fibres activation pattern (observed in 13 of 25 patients) was also associated with non-responder, highgrade neuropathic pain (NRS 8–10/10). Conclusion The presence of a discomplete lesion could lead to a different rehabilitation programme; early identification of patients presenting a typical fibers activation pattern associated with neuropathic pain could give us the opportunity to design a tailored therapy before the onset of chronic pain and overactivities; could the neuromodulation of inactive A fibers be a new therapeutic target? Keywords Sensory; Pain; Fibers Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1004
C1.04 Physical and rehabilitation medicine diagnostics as related to organ systems and body functions – Diagnosis and assessment of functions of the cardiovascular, haematological, immunological, and respiratory systems ISPR8-0799 Conclusion Ultrasound texture features can differentiate between upper trapezius tissue in patients with active and latent MTrPs, and can differentiate these clinical groups from healthy tissue. Ultrasound should be further explored as a clinical diagnostic modality for differentiating MPS patients. Keywords Musculoskeletal conditions; Diagnosis of neurological; Musculoskeletal and movement related functions Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1003 ISPR8-0628
Preliminary data of a neuroselective study of sensory pathways in spinal cord injured (SCI) patients
M. Zarbo ∗ , M. Spinelli , A. Leo , M.G. Ricchiuti , L. Frediani ASST Grande Ospedale Metropolitano Niguarda, Unità Spinale Unipolare, Milan, Italy ∗ Corresponding author. E-mail address: [email protected] (M. Zarbo), [email protected] (M. Spinelli)
The distribution of lung ventilation of healthy subjects placed in various positions, by the method of impedance tomography K. Grigoriadis 1,∗ , M. Micha 2 , G. Konstantopoulou 1 , A. Grigoriadou 3 , A. Armaganidis 1 1 ATTIKON University General Hospital, Second Department of Critical Care Medicine, Athens, Greece 2 ATTIKON University General Hospital, Physical Medicine and Rehabilitation, Athens, Greece 3 TEI of Central Greece, Physiotherapy, Lamia, Greece ∗ Corresponding author. E-mail address: [email protected] (K. Grigoriadis) Introduction/Background Impedance tomography is a modern method for real time monitoring of the air distribution during lung ventilation, as it can record the changes of lung impedance during breathing and via a mathematical processing creates a visual image representing the changes of lung ventilation. The aim of this study is to record the percentage distribution of lung ventilation in healthy subjects, in several positions. The results of this study can be used for explaining the fluctuations of oxygenation in cases
e432
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
such as bronchial drainage or for the interpretation of pulmonary ventilation in pathological cases such as scoliosis. Material and method Eight young, non-smoking, healthy volunteers, without a previous respiratory disease, were monitored by impedance tomography. They were placed in the following positions: Sitting, Supine, Trendelenburg, Right Side Lying, Left Side Lying, Prone, Semi-Fowler’s position 30◦ , Semi-Fowler’s position 45◦ , Right Trunk Rotation and Left Trunk Rotation. The recorded data were used to compare the percentage of the air distribution between the anterior and posterior thoracic segment and between same lung (right or left) of each object in each position. Results The anterior-posterior percentage of the air distribution during lung ventilation did not show any remarkable changes in any position and in any angle of head elevation of the bed, while statistically significant differences were detected comparing the percentage of the air distribution in each lung on the lateral decubitus positions and on the trunk rotations (mean ± SD: 9 ± 3.85 P ≤ 0.001, 9.25 ± 4.73 P = 0.001, respectively). Conclusion In normal healthy young individuals, head elevation of the bed does not have any impact on the regional lung ventilation. On the contrary the side lying positions seems to favor the dependent lung and the trunk rotation appears to compress the same to the rotation side lung, with a significant impact on its ventilation. Keywords Impedance tomography; Distribution of lung ventilation; Healthy subjects Disclosure of interest The authors declare that they have no competing interest.
Results Twelve adult hemophiliacs: – 11 patients with hemophilia A (10 cases of severe hemophilia and 1 case of minor hemophilia), – 1 case of severe hemophilia B; the average age of patients is 30.67 years with extremes of 17 and 40 years. Hundred percent of patients were unaware of the importance of self-rehabilitation exercises. Eighty percent were unaware of the risk of the disease’s complication. Sixty percent did not know the importance of rehabilitation in improving life quality. Fifty percent were unaware of the precautions to take in case of acute bleeding. Conclusion The TEP is considered as an essential element in the management of hemophilic patients, but currently remains a very marginal approach in the care process, hence the interest of integrating it into our therapeutic arsenal. Keywords Hemophilia; Therapeutic education; Comorbidity Disclosure of interest The authors declare that they have no competing interest.
Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.1005.
ISPR8-0425
https://doi.org/10.1016/j.rehab.2018.05.1005 ISPR8-0313
Does therapeutic education optimize the rehabilitative management of hemophiliac patients? H. Aboura 1,∗ , Dr. S. Ammor 1 , Dr. A. Sehimi 1 , Dr. K. Tayebi 2 Centre Hospitalo-Universitaire Dr Hassani Abdelkader, Service de Médecine Physique et de Réadaptation, Sidi-Bel-Abbes, Algeria 2 Centre Hospitalo-Universitaire Dr Hassani Abdelkader, Service d’Hématologie, Sidi-Bel-Abbes, Algeria ∗ Corresponding author. E-mail address: h [email protected] (H. Aboura)
1
Introduction/Background Hemophilia is a hemostatic disorder that causes hemorrhages in the joints and muscles. Physical exercise is often put in place to facilitate convalescence after bleeding, and to improve joint function in the presence of arthropathy. An implementation of a personalized therapeutic education program (TEP) for the hemophiliac patient to help them acquire and maintain skills to improve their quality of life and prevent the complications inherent in the disease. Sensitization, information and learning sessions concerning illness, treatment, physiotherapy and self-education were planned and organized in collaboration with fellow hematologists. Objective To assess the contribution of TEP in improving hemophilia patient’s knowledge about disease management and prevention of comorbidities. Material and method Twelve hemophilia patients participated in TEP sessions. Sessions were individual or collective provided by a multidisciplinary team. The educational tool is represented by slides, videos containing information (Arabic and French), diagrams and images. A summary booklet of the main simplified self-exercises to be performed at home and the frequency of their achievement was provided to each patient in order to improve observance and adherence to the program.
https://doi.org/10.1016/j.rehab.2018.05.1006
C1.05 Physical and rehabilitation medicine diagnostics as related to organ systems and body functions – Diagnosis and assessment of functions of the digestive, metabolic, and endocrine systems
Is subclinical hypothyroidism linked to lower functional outcomes measured by Functional Independent Measures (FIM)? L. Lan 1,∗ , Y.A. Chou 2 The Prince Charles Hospital, Geriatric and Rehabilitation Department, Brisbane, Australia 2 The Royal Brisbane Hospital, Internal Medicine, Brisbane, Australia ∗ Corresponding author. E-mail address: [email protected] (L. Lan)
1
Introduction/Background Subclinical hypothyroidism (SCH) is a common finding in the cohort of rehabilitation patients. However, there is no reported study on how this population performs in the rehabilitation setting. We hypothesized that patients with SCH may have lower level of rehabilitation gains. The aims of this study are to: (1) quantify the incidence of subclinical hypothyroidism in rehabilitation patients; (2) review functional outcomes of patients with subclinical hypothyroidism; (3) seek correlation between the level of thyroid function and rehabilitation outcomes. Material and method This was an observational retrospective cohort study of all patients receiving rehabilitation over 2 years from Jan 2015 till Dec 2016. Quantitative data were based on thyroid function tests at admission, Chart audits, and Functional Independent Measures (FIM). Data analysis involved an unpaired t-test and logistic linear regression. Results Overall, 653 patients (306 M and 347 F) were included in the study with a mean age of 74 (± 12.8). While 553 patients had a thyroid stimulation hormone (TSH) within normal limits, 100 patients were found to have an abnormal TSH, of which 81 presented with SCH (TSH 4.6∼19.9), 5 with profound hypothyroids (TSH ≥ 20) and 14 with hyperthyroidism (TSH ≤ 0.2). The incidence of SCH was 12.4%. All patients with SCH had improvement in function with an FIM gain 26.9 (± 19.6), compared to 23.8 (± 18.9) of those patients with normal TSH. The efficiency of rehabilitation was similar in both groups. An interesting finding of note was that those with hyperthyroidism had low FIM scores at both admission and discharge however there was no significant difference in reha-