Qigong exercise could reduce upper limb lymphedema and improve blood flow in breast cancer survivors

Poster Presentation: PO-1261This journal suppl. entitled: Abstracts: 7th World Congress of the International Society of Physical and Rehabilitation Medicine ...OBJECTIVE: To investigate the effects of Qigong exercise on upper limb lymphedema, arterial resistance and blood flow velocity in postmastectomy breast cancer survivors. METHOD: Eleven breast cancer survivors with Qigong experience (mean age: 58.3±10.1 years) were assigned to the experimental group and 12 breast cancer survivors without Qigong experience (mean age: 53.8±4.2 years) were assigned to the control group. After baseline measurements were taken, the experimental group performed 18 Forms Tai Chi Qigong exercise for approximately 6 ...published_or_final_versio

Subacute stroke physical rehabilitation evidence in activities of daily living outcomes

Supplemental Digital Content is available in the text Stroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability. To systematically evaluate existing evidence, from published systematic reviews of meta-analyses, of subacute physical rehabilitation interventions in (ADLs) for stroke patients. Umbrella review on meta-analyses of RCTs ADLs in MEDLINE, Web of Science, Scopus, Cochrane, and Google Scholar up to April 2018. Two reviewers independently applied inclusion criteria to select potential systematic reviews of meta-analyses of randomized controlled trials (RCTs) of physical rehabilitation interventions (during subacute phase) reporting results in ADLs. Two reviewers independently extracted name of the 1st author, year of publication, physical intervention, outcome(s), total number of participants, and number of studies from each eligible meta-analysis. The number of subjects (intervention and control), ADL outcome, and effect sizes were extracted from each study. Fifty-five meta-analyses on 21 subacute rehabilitation interventions presented in 30 different publications involving a total of 314 RCTs for 13,787 subjects were identified. Standardized mean differences (SMDs), 95% confidence intervals (fixed and random effects models), 95% prediction intervals, and statistical heterogeneity (I 2 and Q test) were calculated. Virtual reality, constraint-induced movement, augmented exercises therapy, and transcranial direct current stimulation interventions resulted statistically significant (P 0.8) but with considerable heterogeneity (I2 > 75%). Only acupuncture reached “suggestive” level of evidence. Despite the range of interventions available for stroke rehabilitation in subacute phase, there is lack of high-quality evidence in meta-analyses, highlighting the need of further research reporting ADL outcomes

Evidence for early physiotherapy after acute stroke: a scoping review

Neuroscience evidence indicates that early rehabilitation can guarantee better outcomes and quicker cortical re-organization after lesion. Although there are some studies related to the acute stroke physiotherapy intervention, it seems that few consider the evidence that link neuroplasticity and neurorehabilitation. Therefore, understanding the current state of the art of physiotherapy intervention is vital to potentialize the intervention so the enhance neuroplastic window is properly explored. To analyze the physiotherapy's intervention on acute stroke patients, so it reveals the underlined evidence for the selection of the approach and if the neurophysiological mechanisms are associated. This scoping review's methodology follows the Joanna Briggs Institue. A main search was conducted across Pubmed, PEdro and Web of science in December 2020, including only studies in Portuguese or English. Studies included focused on the concept of physiotherapy's intervention in a population of adult acute stroke patients, in an acute care context. Were identified 14 categories of interventions in 37 studies. 62% of studies didn't give any justification for the choic of method and the ones who did, weren't focused on neurophysiological knowledge. A wide range of interventions was found in which only 38% showed justifications that were considered insufficient and imprecise

Reproductive outcomes following robotic myomectomy

Background: To assess pregnancy outcomes of patients following robotic myomectomy.Methods: Retrospective chart review was performed of 336 patients following robotic myomectomy at a university hospital from June 2006 to May 2013. Patients were called to obtain delivery outcomes.Results: Three hundred and thirty-six women had the following: mean age of 41.97 +/- 12.3 years (range 24-55), mean BMI of 24.6 +/- 4.96, mean of 3.37 +/- 3.1 fibroids removed (range 1-21), and mean weight of 352.28 +/- 339.56 grams of fibroids removed. Approximately 66.9% (N=250) provided pregnancy outcome data with 119 (47.6%) attempting pregnancy after surgery. Eighty-three (69.7%) achieved a total of 91 pregnancies. Less than half of these patients underwent cesarean section, and no cases of uterine rupture. Eighty-seven patients had known infertility pre-surgery; 22 underwent intrauterine insemination resulting in 12 pregnancies, and 34 underwent in vitro fertilization resulting in 25 pregnancies. A total of 53 (60.9%) of patients with infertility achieved 60 total pregnancies.Conclusions: The fertility rate after robotic myomectomy for patients attempting to conceive (69.7%) and for those with known infertility who continued to attempt pregnancy postoperatively (60.9%) were similar. There was a low incidence of complications associated with pregnancies conceived after robotic myomectomy

Clinical Progress of Acupuncture in the Treatment of ACL after Reconstructive Surgery

Anterior cruciate ligament (ACL) injury of the knee is one of the common sports injuries, and ACL reconstruction is currently the mainstream treatment. However,ACL reconstruction often produces postoperative complications such as swelling, pain, muscle atrophy, joint adhesion and stifness, and timely interventional rehabilitation is needed for patients to recover the expected level. Studies have shown that acupuncture treatment can regulate infammatory factors and related signalling pathways, etc., and has obvious efcacy in joint rehabilitation after ACL reconstruction. The authors collated clinical reports on the use of acupuncture therapy such as general acupuncture, electroacu-puncture, moxibustion with acupuncture, snap needling, and ethnic acupuncture in the rehabilitation process after ACL reconstruction in re-cent years, to explore the feasibility and efectiveness of the intervention of acupuncture therapy, with the aim of providing a more systematic reference for the treatment ofACL injury in the future clinic after surgery

Application of the Fugl-Meyer Assessment (FMA) and the Wolf Motor Function Test (WMFT) in the recovery of upper limb function in patients after chronic stroke: a literature review

Estima-se que de 45 a 75% dos adultos que sofreram um Acidente Vascular Encefálico (AVE) têm dificuldade de utilizar o membro superior (MS) hemiparético nas atividades de vida diária (AVD’s) na fase crônica. Escalas funcionais são utilizadas na prática da reabilitação e em pesquisas para diagnósticos, prognósticos e resposta a tratamentos. As escalas Wolf Motor Function Test (WMFT) e Fugl-Meyer Assessment (FMA) são instrumentos muito citados na literatura. Objetivo: O objetivo deste estudo foi verificar a aplicação das escalas WMFT e FMA na recuperação funcional do membro superior em pacientes pós AVE crônico. Método: Foi realizada uma revisão de literatura com busca nas bases de dados do MedLine (PubMed) de artigos publicados de 2000 a 2013. Adotou-se como estratégia de pesquisa o método (P.I.C.O.). Os descritores utilizados para a pesquisa foram: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND (fugl-meyer assessment OR wolf motor function test). Foi utilizado therapy narrow como filtro de busca. Resultados: Foram encontrados 181 estudos, 89 foram eliminados por não preencherem os critérios de inclusão ou por não apresentarem tema relevante à pesquisa. Após a seleção por título e resumo, 92 artigos foram lidos na íntegra. Destes, 47 foram excluídos por não contemplarem o objetivo da presente pesquisa. No total, 45 artigos foram revisados. Houve predomínio da utilização da ferramenta FMA e verificouse que 80% dos estudos aplicaram esta escala para avaliar respostas a diferentes tipos de terapias. Nestes estudos, a intervenção mais utilizada foi a Terapia de Contensão Induzida (TCI) (25%), seguida pela Terapia Robótica (22,2%). Apesar do WMFT ter sido inicialmente desenvolvido para avaliar os efeitos da TCI, nos dias de hoje verifica-se sua utilização para avaliar a recuperação funcional de pacientes com sequelas de AVE após aplicação de outras técnicas. Em nossa pesquisa, 44,4% dos estudos utilizaram o WMFT, destes, 35% avaliaram os efeitos da TCI, 15% da terapia robótica de MS e 65% usaram diferentes terapias. Conclusão: Em estudos controlados randomizados, a FMA foi a escala mais utilizada para avaliar a recuperação funcional do MS em pacientes com AVE crônico, inclusive após aplicação de terapia robótica. Porém, verificamos que ela não é a escala mais indicada para avaliar os mesmos desfechos após utilização da TCI. Entretanto, a WMFT foi a escala mais utilizada para avaliação funcional após aplicação da TCI e mostrou-se mais sensível que a FMA na terapia bilateral, além de alta aplicabilidade na terapia de realidade virtual.It is estimated that 45-75% of chronic adult stroke patients have difficulty in using the hemiparetic upper limb (MS) in their daily life activities (DLAs). Functional scales are used in the practice of rehabilitation, in the search for diagnoses and prognoses, and in evaluating response to treatment. The Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment (FMA) scales are the instruments most commonly mentioned in the literature. Objective: The aim of this study was to review the use of the WMFT and FMA scales in the recovery of upper limb function in patients after chronic stroke. Method: We searched the MedLine database (PubMed) for articles published from 2000 to 2013. The PICO method was adopted as the search strategy. The descriptors used for the search were: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR thrombosis intracranial embolism) AND (Fugl-Meyer assessment OR wolf motor function test). Therapy/narrow was used as a search filter. Results: We found 181 studies, 89 of which were excluded because they did not meet the inclusion criteria or did not have a topic relevant to the review search. After selection by title and by abstract, 92 articles were fully read. Of these articles, 47 were excluded because they did not fulfil the search objective. All in all, 45 articles were reviewed. FMA is the tool most used and it was found that 80% of the studies applied this scale to evaluate responses to the different therapies. In these studies, the intervention most used was the Constrained Induced Therapy (CIT) (25%), followed by Robotics Therapy (22.2%). Although the WMFT was initially developed to assess the effects of CIT, nowadays this scale is used, after the application of other techniques, to assess the functional recovery of patients with stroke sequelae. In our survey, 44.4% of the studies used WMFT; of these, 35% assessed the effects of CIT, 15% assessed robotic therapy for the upper limbs, and 65% for different therapies. Conclusion: For randomized controlled trials, the FMA scale was more used to assess functional recovery in the upper limbs of chronic stroke patients, even after application of robotics therapy. However, we found that it is not the most appropriate scale to assess the same outcomes after CIT use. WMFT is the scale most widely used for functional assessment after application of CIT; it is more sensitive than FMA for bilateral therapy, and is highly applicable in virtual reality therapy

UB Breakthroughs Fall 2012

The UB Breakthroughs newsletter for fall of 2012. This issue contains articles discussing Dr. Sobh's robotics research in the Robotics, Intelligence Sensing and Control (RISC) Laboratory, Dr. Elleithy's and UB's involvement in developing a camera system for a new small unmanned aerial vehicle (UAV), professor Noe's research in Cherokee healing practices and indigenous plant use for cancer and HIV treatment, professor Gary Munch's creation of fonts for the Cherokee Nation's written language, how UB's new transmission electron microscope (TEM) is helping UB collaborate with other research institutions, research projects in biomedical engineering, Dr. Queenan's research on the incorporation of science content and reading comprehension instruction, Dr. Kongar's research on the recycling and remanufacturing of electronic components, Dr. Engelmann's research into plant genetic variation in thermal tolerance, professor Funk's research examining the link between proprioception and pain, Dr. Benjamin's research into international corruption, Director Brett's study in an integrated team treating patients across health disciplines, Dr. Zhang's work in renewable energy and the creation of the Renewable Energy Research Laboratory at UB, Dr. Wu's research analyzing the differences between the US and Chinese financial markets, professor Risom's study in the use of video tutorials to supplement the instruction of instrument skills, and UB's CTech IncUBator program for incubating the creation of high-tech start-up companies

Interventions for improving upper limb function after stroke

Background: Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. Objectives: To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. Methods: Search methods: We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. Selection criteria: We included Cochrane and non‐Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up‐to‐date and comprehensive review and excluded reviews that overlapped with this. Data collection and analysis: Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up‐to‐date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. Main results: Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non‐Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons. Moderate‐quality evidence showed a beneficial effect of constraint‐induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate‐quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions. Moderate‐quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential. Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high‐quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high‐quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands‐on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up‐to‐date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach‐to‐grasp exercise, repetitive task training, strength training and stretching and positioning. Authors' conclusions: Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation. Currently, no high‐quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications

Learning and Teaching after 50 Years of THORAX Surgery

Surgeries are practiced in different areas, and specifically in the thorax described in this chapter, the medical doctors must know in detail the biological structures in which they perform such surgical procedures. Therefore, in this chapter, we refer to the descriptive and topographical anatomy written by French doctors L. Testut and A. Latarjet. In earlier times, for several reasons, the medical surgeon operated all body organs and was involved in resolving the pathology of different areas. Currently and in the future, medical knowledge in thoracic surgery will cover subspecialties specifically divided, for example: assisted video surgery, interventional bronchoscopy, and mediastinoscopies to take mediastinal biopsies using robotic surgery of pulmonary exeresis to shorten the hospitalization period and even the days spent in the intensive care unit