Semi-Immersive Virtual Reality Exercise Therapy for Upper Limb Rehabilitation in Patients With Spinal Cord Injury Using the Leap Motion Controller

In this article, we present a case study involving a patient with spinal cord injury (SCI), resulting in tetraplegia and subsequent loss of upper limb function. The subject of our study was a 23-year-old woman with incomplete tetraplegia stemming from a cervical spinal cord injury. Our primary objective was to enhance hand function and grip strength. Throughout the intervention, we observed substantial enhancements in hand function, range of motion, and muscle power. Notably, the patient exhibited a favorable response to the therapy, demonstrating commendable adherence and active participation. To create an optimal training environment tailored to the patient's needs, we employed the Unity 3D game engine in conjunction with a Leap Motion controller sensor. This combination facilitated the development of a semi-immersive virtual training environment. The utilization of this technology aimed to simulate a conducive training atmosphere for the rehabilitation of hand function. Based on our study outcomes, we advocate for the incorporation of leap motion-related exercises in the treatment of hand functional loss and weakness. The promising results observed in this case study prompt the recommendation for further large-scale studies to validate and substantiate our findings. Such investigations would contribute to the establishment of evidence-based practices and enhance the understanding of the efficacy of Leap Motion technology in addressing upper limb impairments associated with spinal cord injuries.

Clinical awareness and knowledge of breast cancer-related lymphedema among a group of psychiatrists in Turkey - An online survey

BACKGROUND

The point-of-view and role of physiatrists are important in the clinical care of breast-cancer-related-lymphedema (BCRL) patients to set up management and rehabilitation strategies.

AIM

The aim of this study was to determine the awareness and knowledge of BCRL among a group of physiatrists regarding its causes, symptoms, treatment, and management in Turkey.

SUBJECTS AND METHODS

The participants were asked to answer a 10-min web survey, including 19 questions. In addition to their demographical and logistic properties, the questionnaire elicited data on the knowledge, education, and awareness of the physiatrists on the diagnosis and treatment of BCRL.

RESULTS

In total, 127 female and 44 male physiatrists completed the survey. Also, 71% of the participants were aged between 31 and 50 years, mostly working in metropoles and tertiary hospitals for more than 5 years. Further, 63.7% of the participants expressed that they had knowledge about BCRL; however, detailed knowledge of lymphedema treatment was low, as 67.9% of the physiatrists reported that they had no comprehensive information about complete-decongestive-therapy. Nearly half of the participants did not believe that once lymphedema has clinically manifested, a patient can eventually be treated for BCRL. Also, 87% of the participants had attended less than two educational events related to BCRL in the past 5 years. In all, 94.7% of the physicians determined a great need for education and awareness of the current literature about BCRL.

CONCLUSION

The awareness and knowledge of lymphedema is moderate but detailed information, knowledge, and education about lymphedema and its treatment are low among a group of physiatrists. With the growing number of breast cancer survivors, physiatrists' awareness and education about BCRL are crucial to improve the quality of care of patients.

The assessment of usability of pain medical device by physiatrists and physiotherapists: A Delphi survey

When developing a new medical device, it is essential to assess the usability of such a device through various stakeholders.This study assessed the usability of pain medical devices through a Delphi survey administered to physiatrists and physiotherapists.A Delphi survey was conducted on the problems and improvements in hardware and software for a panel consisting of 10 physiatrists and 10 physiotherapists. A total of 3 rounds of surveys were conducted, and the third round of survey was confirmed through a Likert scale (1 = strongly agree to 5 = strongly disagree).The 2 groups generally had a common perception of the problems and improvements in pain medical devices. However, the physiatrist group mostly identified problems such as linking patient information, whereas the physiotherapist group deemed hardware problems such as device weight or connection cables as being more important (mean [standard deviation]; physiatrist, hardware 2.90 [0.93], software 2.28 [0.91] / physiotherapist, hardware 3.04 [0.84], software 3.03 [1.13]).To date, analysis has not been conducted by dividing the focus of various stakeholders using pain medical devices. The difference in view of the usability of these 2 stakeholder groups should be considered when improving the hardware or software of pain medical devices in the future. Further research is warranted to investigate other stakeholders such as patients and device developers to improve the devices.

Impact of Musculoskeletal Limitations on Cardiac Rehabilitation Participation

Background: To help clarify a potential barrier to cardiac rehabilitation (CR) participation we sought to examine the association between musculoskeletal limitations (MSLs) and CR enrollment and participation. Methods: Consecutive CR eligible individuals hospitalized for a cardiac event (myocardial infarction, percutaneous coronary intervention, and/or coronary artery bypass graft) between the months of November 2007 and May 2008, were asked to complete a mailed survey within 2 weeks after hospital discharge, assessing demographic factors, Patient Health Questionnaire (PHQ-9), participation in CR and MSLs through a validated MSLs screening tool. CR enrollment rates were compared between patients with and without MSLs. Results: Three hundred and twenty-one (37%) of patients contacted responded to our survey, including 228 males (71%), with a mean age 68 ± 10.8 years, of whom 98% were Caucasian. Eighty-two percent of responders reported a musculoskeletal disorder at the time of hospital discharge. Arthritis was the most frequent diagnosis (45%). Muscle or joint pain sufficient to limit the ability to do moderate exercise was reported in 52% of the respondents. Problems with balance affected 37%, of whom 45% reported a fall within the previous year. No significant difference in CR enrollment was observed in respondents with and without MSLs [OR = 0.98, 95% CI (0.88-1.09), p = 0.750]. Similar results were found when severity and number of MSLs were taken into account. However, we found that when compared to those without MSLs, the presence of MSLs was associated with lower CR participation (OR = 0.80, 95%, CI: 0.65-0.97, p = 0.0252). Conclusion: Despite a high prevalence of MSLs among CR-eligible patients, we found no association between MSLs and CR enrollment. However, patients with MSLs attended significantly fewer CR sessions as compared to patients without them. CR programs should consider providing additional support and interventions to patients with MSLs in order to optimize their adherence to prescribed CR sessions.

The approach of physiatrists to low back pain across Europe

BACKGROUND

Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists.

OBJECTIVE

The present study aimed to investigate the approaches of physiatrists to low back pain across Europe. Preferences, tendencies, and priorities in the diagnosis, management, and treatment of LBP, as well as the epidemiological data pertaining to LBP in PRM practice were evaluated in this Europe-wide study.

METHODS

The study was conducted under the control of the European Society of Physical and Rehabilitation Medicine (ESPRM) Musculoskeletal Disorders Research Committee. A total of 576 physiatrists from most European countries participated in the survey.

RESULTS

The results show that physiatrists frequently deal with patients with LBP in their daily practice. Most patients are not referred to other departments and are treated with various conservative methods. Less than one-fifth of patients are primarily referred for surgery. The physiatrists believe that a clear diagnosis to account for cases of low back pain is rarely established. The most common diagnosis is discopathy. History and physical examination remain the most valuable clinical evaluation tools for low back pain according to physiatrists. Less than half the patients require a magnetic resonance imaging. Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for low back pain. Exercise, back care information, and physical therapy are the preferred conservative treatments. More than half of the physiatrists offer interventional treatments to patients with low back pain.

CONCLUSION

The present study is a preliminary report that presents the attitudes of European physiatrists in the management of low back pain. Further researches are warranted to standardize the conservative management of LBP.

John C. Carapanayiotis (1909-1999): the Greek radiologist and pioneer of physiatry in Greece

John C. Carapanayiotis was specialized in physical medicine and rehabilitation in the USA in 1948, at a time when the medical world in post-war Greece was ignorant of this specific medical specialty, and the political, economic and social backdrop was incapable of accepting and understanding the wealth of scientific knowledge that he was trying to introduce. At this point it should be noted that the specialty of Physical Medicine and Rehabilitation was established in Greece in 1973. John C. Carapanayiotis was a member of the American Congress of Physical Medicine during the 1950's. In the same period, he expressed interest, on behalf of the New York University, in the establishment of a Physical Therapy Clinic in Greece, which would be granted unlimited funding by the Marshal Plan. His efforts clashed constantly with the backward mentality of his time, with the entrenched conservatism and with the bureaucratic red tape. Unfortunately, he was far ahead of his time and was condemned to the same fate as all other visionaries and pioneers in the way that his knowledge and scientific background were not put into practice for decades to come.

The Impact of Commercial Health Plan Prior Authorization Programs on the Utilization of Services for Low Back Pain

STUDY DESIGN

An observational study.

OBJECTIVE

The aim of this study was to evaluate the impact of a health plan's prior authorization (PA) programs for low back pain (LBP) in a non-Medicare population by assessing changes in pre-surgical nonoperative care; lumbar fusion trends; and overall back surgery rates compared with another health plan with a similar program and national benchmarks. The PA programs require mandatory physiatrist consultation before surgical evaluation, with subsequent additional LBP surgery PA.

SUMMARY OF BACKGROUND DATA

LBP is prevalent and concern exists that spinal fusion is overutilized for LBP.

METHODS

Annual rates of lumbar fusion trended over 6 years, and analysis of changes in standardized costs for LBP-related services among a 501-member subset who underwent lumbar fusion before and after program implementations, during the period January 1, 2008, through December 31, 2013, among commercial members aged 18 and 65 years enrolled in a health maintenance organization with commercial membership averaging >500,000 annually.

RESULTS

After initiation of the physiatrist PA in December 2010, lumbar fusions decreased from 76.27/100,000 in 2010 to 62.63/100,000 in 2011 with subsequent increases to 64.24/100,000 and 73.84/100,000 in years 2012 and 2013. For members who had lumbar fusion, per-member, pre-surgical costs increased by $2,233 with the physiatrist PA and an additional $1,370 with implementation of the LBP surgery PA (March 2013). Spinal injections and inpatient admissions were the greatest contributors to the overall increase in costs. The physiatrist and LBP surgery PA programs were also associated with lengthening of LBP episodes ending in surgery by 309 and 198 days.

CONCLUSION

Mandatory referral to a physiatrist before surgical evaluation did not result in persistent reduction in lumbar fusions. Instead, these programs were associated with the unintended consequence of increased costs from more nonoperative care for only a transitory change in the lumbar fusion rate, likely from delays due to the introduction of both PA programs.

LEVEL OF EVIDENCE

3.