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The Advanced HEART FAILURE Patient
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Eran Kalmanovich, Philippe Gaudard, François Roubille
In clinical trials, exercise training in patients with HFrEF demonstrated a wide range of clinical and physiological benefits, including improved quality of life and exercise capacity, favorable effects on neurohumoral, inflammatory, metabolic, and autonomic function, and improvement in endothelial, skeletal muscle, and cardiac remodeling.69–71 Most of these trials have focused on patients with advanced HF by definition, with LVEF ≤25%, demonstrating also a modest improvement in survival and hospitalization rates.72 A recent Cochrane review reported that exercise-based rehabilitation has no short-term (up to 12 months) effect on mortality but reduces risk of hospitalization and yields improvements in quality of life. It was suggested that exercise training might reduce mortality in the longer term and that the benefits of exercise may depend on age, gender, and HF severity.73 Due to these findings, we recommend that patients take part in a rehabilitation program as part of a comprehensive treatment program. Exercise training is further discussed in Chapter 11.
Pain
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Jarred Williams, Katie Seabaugh, Molly Shepard, Dana Peroni
The multidisciplinary rehabilitation program described for humans by Volker et al. (2016) utilized a team comprised of a rehabilitation physician, an occupational therapist, a social worker, a psychologist, and a physical therapist. When dealing with horses, the veterinarian wears all these hats. They diagnose the injury (physician), understand the desired function of the patient (occupational therapist), predict the interaction between pasture-mates and owner (social worker), assess the demeanor of the horse (psychologist), and create a controlled exercise program (physical therapist).Most commonly, veterinarians balance stall rest and paddock turnout, deciding between hand walking and tack walking and fine-tuning rehabilitation timelines. Intermixed within these programs is the encompassment of additional rehabilitation techniques.
Functional Rehabilitation
Published in James Crossley, Functional Exercise and Rehabilitation, 2021
A functional trainer can manage persistent pain by: Regulating emotional responses to movementTaking time to ‘explain pain’Helping to manage painful activities Training should expose clients to pain patterns whilst avoiding triggering pain, by applying: Graded exposureIntelligent variation Exercise can be prescribed to address sensor-motor dysfunctions resulting from persistent pain, including: Mapping drillsInhibition exercisesActivation exercises These drills can be incorporated into a functional exercise program. Details on how to structure a rehabilitation program are presented later in this section.
Effects of music therapy on mood, pain, and satisfaction in the neurologic inpatient setting
Published in Disability and Rehabilitation, 2023
Leah J. Mercier, David M. Langelier, Chel Hee Lee, Brenda Brown-Hall, Christopher Grant, Stephanie Plamondon
Traditionally, high-intensity neurorehabilitation is performed in hospital and involves a combination of physical, occupational, speech, and/or recreational therapy [6]. The goals of any rehabilitation program are to improve functional independence, reduce activity limitations, and to facilitate participation in important life roles [7,8]. In the acute neurorehabilitation setting, pain and low mood have the greatest potential to negatively impact rehabilitation participation [9,10]. While pharmacologic management is often appropriate for managing these symptoms, especially when severe, non-invasive and non-pharmacologic strategies should not be underestimated. Music therapy (MT) is a potentially novel approach shown to improve mental state and functioning for a variety of disorders including depression, generalized anxiety, and dementia as well as reduce anxiety in patients with asthma, osteoarthritis, and those undergoing medical procedures [10–15]. Recent reviews have also demonstrated reductions in postoperative pain and anxiety, decreased consumption of sedatives and analgesics, and increased patient satisfaction in hospitalized patients receiving MT [12–14,16]. Therefore, MT may offer a unique adjunct strategy to manage pain and low mood in neurorehabilitation patients [17].
Effectiveness of medical rehabilitation in persons with back pain – lessons learned from a German cohort study
Published in Disability and Rehabilitation, 2022
David Fauser, Nadine Schmitt, André Golla, Julia-Marie Zimmer, Wilfried Mau, Matthias Bethge
In our study, we found some plausible explanations indicating that the estimated effects in favor of our controls are methodologically induced and subject to systematic bias. Based on these explanations, we can derive implications for future cohort studies to be considered in analyzing the effectiveness of complex and already implemented interventions. Firstly, we assume that a deterioration of health and pain led to the application and utilization of a medical rehabilitation program in many of our rehabilitation cases, and that this deterioration was not reflected in our baseline data. We observed that half of our participants who started a rehabilitation program in the further course of the study reported pain grade I and II. We assume that these patients experienced a clear deterioration in self-rated work ability and health over time that may have triggered an application of a medical rehabilitation, but we do not know when this health impairment occurred. However, if there was deterioration after the baseline survey, and if it was the reason for the use of medical rehabilitation, then the sample characteristics of the baseline survey did not reflect the characteristics of the treated persons at the beginning of the rehabilitation measure.
Understanding transitions in care for people with major lower limb amputations from inpatient rehabilitation to home: a descriptive qualitative study
Published in Disability and Rehabilitation, 2022
Marija Radenovic, Kamille Aguilar, Anne B. Wyrough, Clara L. Johnson, Shirley Luong, Amanda C. Everall, Sander L. Hitzig, Steven Dilkas, Crystal MacKay, Sara J. T. Guilcher
In Ontario, Canada, patients are referred to an inpatient rehabilitation facility by a physician and services provided in hospital are publicly funded. There is considerable variation in the models of service delivery for amputation rehabilitation. All participants in this study had inpatient rehabilitation at one facility, where 15–20 patients are admitted per month. To be eligible for rehabilitation, individuals need to be medically stable to participate in a rehabilitation program to optimize functional abilities either with or without a prosthesis. Rehabilitation services are provided by an interdisciplinary team of health care providers including physical therapists, occupational therapists, rehabilitation assistants, nurses and physicians (attending physician and physiatrist) with consultation with social work, psychology, wound care and prosthetics as required. Patients are discharged from rehabilitation when they are functionally independent with or without a prosthesis and have reached their rehabilitation goals or an appropriate discharge destination has been found to meet their care needs. Prior to discharge, patients are encouraged to make a trial home visit to their discharge location for a weekend. On discharge, they are provided with educational materials and a home exercise program. Patients have routine follow-up visits with an interdisciplinary team.