Physical Medicine and Rehabilitation

Review of Musculoskeletal Injury Prevention in Female Soccer Athletes Abstract Purpose of Review This paper aims to review the recent literature regarding the prevention of musculoskeletal injuries in female soccer athletes. Recent Findings Female soccer players are at risk for many musculoskeletal injuries, mostly involving the lower extremities, due to anatomic, hormonal, and biomechanical factors. Various programs are available that target overall injury prevention, as well as specifically the prevention of anterior cruciate ligament (ACL), ankle, and overuse injuries. The Fédération Internationale de Football Association (FIFA) 11+ is the most well-studied program for overall injury prevention and has been shown to have modest but significant effects in injury incidence. Prevention of ACL injuries is also well studied, and multiple programs have been shown to significantly reduce incidence, especially in youth athletes. Fewer current studies are available regarding ankle and overuse injuries. Summary Musculoskeletal injury prevention programs are available for female soccer players and may be effective in decreasing the incidence of certain injuries. There are clear differences in injury patterns in females compared to males, and further research is needed to specifically look at injury prevention in this population.

Patellar Tendinopathy in Athletes Abstract Purpose of Review This review discusses the current practice of evaluation and treatment of patellar tendinopathy with emphasis on rehabilitation. Recent Findings The latest studies revolve primarily around implementation of isometric and heavy slow resistance (HSR) exercises in the rehabilitation of patellar tendinopathy rather than the traditional rehabilitation method of eccentric exercise. Summary Patellar tendinopathy is a common injury of the inferior anterior knee seen in athletes but predominantly in jumping athletes. Onset is insidious and frequently noted in a loaded position with knee flexion. Physical exam finds tenderness along the patellar tendon with pain recreated while squatting. Treatment initially includes conservative measures such as guided physical therapy, medical therapy, and modalities. If recalcitrant, injections may be warranted, or rarely surgery may be considered.

Extracorporeal Shockwave Therapy in Lower Limb Sports Injuries Abstract Purpose of Review To outline current evidence on the use of ESWT for the treatment of lower limb sports injuries. Recent Findings There is growing evidence to support the use of extracorporeal shockwave therapy (ESWT) for a variety of musculoskeletal conditions in the general population. However, research focused on the use of ESWT specifically for lower extremity injuries in the athletic population is more limited. Athletes represent a subgroup of patients that may benefit from ESWT. Compared with injections or surgical interventions, athletes undergoing ESWT often are able to continue sports participation with fewer limitations in activity during treatment. Summary The review identifies considerable variability in study design and treatment protocols that affect the overall quality of evidence. Sports participation was allowed in most studies. One case of plantar fascia tear was identified during ESWT treatment; this injury was self-limited. Most studies report pain-relieving and/or functional benefit with the use of ESWT for common lower extremity tendinopathies, plantar fasciitis, and medial tibial stress syndrome. This review highlights the need for further investigations on optimal methods of ESWT use in athletes given the high prevalence of lower extremity injuries and favorable safety profile for treatment.

A Review of Hip-Spine Syndrome Abstract Purpose of Review This review is aimed at summarizing our current understanding of hip-spine syndrome. In particular, the review discusses the clinical assessment and diagnosis of commonly implicated conditions to help a practitioner realize an efficient and organized approach to the evaluation and management of pain in the setting of hip-spine syndrome. Recent Findings While initially described as the concurrent presence of hip osteoarthritis and lumbar spinal stenosis, the catalog of diagnoses associated with hip-spine syndrome has expanded and includes femoroacetabular impingement, acetabular dysplasia, hip osteoarthritis, sacroiliac joint-mediated pain, facet arthropathy, and lumbar spinal stenosis. There is a limited body of evidence describing clinical findings and treatment recommendations when these diagnoses present concurrently. From the available literature, it seems that patients may be successfully managed with a multimodal approach, although absolute resolution of symptoms is not always plausible. Summary In the context of hip-spine syndrome, identification of a primary pain generator or etiology, when present, is important to guide successful management. Lingering symptoms may persist and can suggest the presence of a more co-dependent relationship between the hip and the spine (so-called complex hip-spine syndrome). Further research is needed to clarify the influences that underlie hip-spine syndrome, particularly in these more complex cases, and in turn better define diagnostic and treatment algorithms.

Rehabilitation Considerations in Pediatric Brain Tumors Abstract Purpose of Review The goal of this paper is to provide an evidence-based update for rehabilitation providers to guide rehabilitation treatment plans during the care of children with brain tumors across the lifespan. Recent Findings Brain tumors are the most common solid tumors in children, and overall the second most common cancer type in children. In 2016, the World Health Organization (WHO) revised classification of these tumors to incorporate molecular parameters. Rehabilitation providers have a role throughout the continuum of care in this population, providing preventative, restorative, supportive, and palliative rehabilitation. Summary There remains a paucity of pediatric specific literature related to rehabilitation in pediatric brain tumors. Much of what we know related to the rehabilitative care of children with pediatric brain tumors is extrapolated from research focusing on adults with cancer or those with other acquired brain injuries. However, pediatric cancer patients do benefit from care from a rehabilitative team, which includes a pediatric physiatrist.

Clinical Considerations and Resources for Youth Athletes with Intellectual Disability: a Review with a Focus on Special Olympics International Abstract Purpose of Review This review provides an overview of sports participation by youth athletes with intellectual disability (ID), focusing on activities offered by Special Olympics International (SOI). The review also describes SOI's health initiatives, as awareness of the sports and health activities of SOI is critical for clinicians who serve youth with ID. SOI is the largest global public health organization for people with ID. Recent Findings 2018 is the 50th Anniversary of SOI. For 50 years, SOI has been using the power of sport to break down barriers both on and off the field. From 2016 to 2020, SOI is focusing on Inclusive Health: the inclusion of people with ID in mainstream health policies and laws, programming, services, training programs, research, and funding streams (Special Olympics International 2018). This article summarizes recent SOI efforts in both sports competition and health initiatives. Data collected from SOI's Healthy Athletes Initiative revealed obesity in 31.5% of youth with ID. Data also demonstrated concerns with flexibility in 71.3% of athletes and concerns with muscle strength in 56.5% of athletes. Results from medical coverage of the 2009 Special Olympics Great Britain Summer Games revealed musculoskeletal and skin concerns as the primary reasons for on-site sports coverage medical consultation. Summary Clinicians caring for youth with ID should be aware of the sport opportunities for this population and the health initiatives of SOI. Future research is needed on applying sports' medicine principles to youth athletes with ID. By including this article alongside an article on youth adaptive sports, the field of Pediatric Rehabilitation Medicine is demonstrating its commitment to all youth athletes.

Polypharmacy and Rational Prescribing: Changing the Culture of Medicine One Patient at a Time Abstract Purpose of Review Polypharmacy and the associated concept of potentially inappropriate prescribing (PIP) have well-documented deleterious effects on older adults and other vulnerable groups commonly treated by physiatrists. Addressing the issues of polypharmacy and PIP presents an opportunity to improve health and rehabilitation outcomes. In this article, we review medications commonly initiated and managed by physiatrists such as anticoagulants, antidepressants, neuro-stimulants, and pain medications based on current evidence. We also offer strategies to minimize polypharmacy and PIP by exploring alternative and behavioral approaches to common clinical issues in rehabilitation according to the most recent guidelines. Recent Findings Polypharmacy is associated with a host of undesirable and potentially preventable outcomes including falls, hip fractures, delirium, incontinence, and cognitive impairments. As the number of medications increase, so does the risk of untoward effects. Summary Physiatrists are well positioned to have a positive impact on rational prescribing and polypharmacy given our emphasis on function, familiarity with non-medication treatment modalities, and an embrace of a biopsychosocial orientation.

Delirium: Evaluation and Management Abstract Purpose of Review Delirium is associated with high morbidity, mortality and healthcare costs, and longer inpatient hospital length of stays. The purpose of this review is to summarize the most recent evidence pertaining to the recognition, prevention, and management of delirium to help guide clinicians to make evidence-based decisions in patient care. Recent Findings Delirium is best managed with a multicomponent strategy using standardized tools for early recognition, such as the Confusion Assessment Method (CAM), non-pharmacologic interventions including restoration of the natural sleep-wake cycle with environmental management of light and noise, facilitating early mobility, and providing assistive devices such as eyeglasses and hearing aids. Medical optimization includes recognizing and treating medical problems, ensuring adequate nutrition, avoiding excessive testing and lines/catheters, and avoiding polypharmacy. Despite widespread use, there are insufficient data to support the use of antipsychotics to prevent or treat delirium. Summary A multicomponent strategy using a team-based approach to delirium recognition, prevention, and management employed consistently can improve patient care while reducing healthcare costs.

Pediatric Cardiac Rehabilitation: a Review Abstract Purpose of Review In addition to concerns with physical health and activity levels, children with cardiac conditions can be at risk of neurodevelopmental and socioemotional maladjustment. Children with congenital heart defects requiring surgery early in life are at risk of developmental delays and cognitive impairments, and both children with congenital heart defects and those with cardiomyopathies are at risk of socioemotional concerns. As a result, there is an increasing focus on rehabilitation efforts for these patients, in order to improve both their physical well-being and their adjustment outcomes. However, there are no established standards for rehabilitation programs applicable across children with cardiac conditions, in stark contrast to guidelines for adult patients. The purpose of the present review is to summarize recent studies on pediatric cardiac rehabilitation and describe the structure of our own program, in order to aid with the delineation of future guidelines. Recent Findings Twenty programs for pediatric cardiac rehabilitation were identified and reviewed. We review inpatient, outpatient, and home-based programs, most of which include two to three sessions of exercise training per week for 12 weeks with a focus on improving exercise capacity. We also review emerging cognitive rehabilitation for children with cardiac disorders and discuss a newly developed program at our own institution. Summary A review of past findings, along with recent efforts at our institution, suggests that a structured cardiac rehabilitation program can benefit children by increasing exercise response and physical activity as well as improving developmental, cognitive, and psychosocial outcomes.

Rehabilitation in Children with Disorder of Consciousness Abstract Purpose of Review Consciousness is a state of wakefulness with awareness of self and the environment. Disorder of consciousness (DOC) can result from any type of acquired brain injury (ABI). While children with ABI and DOC are commonly encountered in pediatric rehabilitation settings, research in this population is lacking, necessitating extrapolation from adult literature. Recent Findings Adults and children with DOC who participate in specialized inpatient rehabilitation programs show functional gains during and following the inpatient admission. Here, we present a model for an interdisciplinary rehabilitation program for children with DOC along with data supporting the evaluation and management approaches, where available. Summary Careful, interdisciplinary assessment using appropriate tools as well as a range of pharmacologic and non-pharmacologic interventions supports the rehabilitation and recovery of children with DOC. Additional research focused on children with DOC will be crucial for enhancing the evidence related to this population.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com