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  • Arbeitsmedizin
  • Rehabilitation
  • Strömungsmechanik
  • Springer  (48)
  • Bundesarbeitsgemeinschaft für Rehabilitation
  • Sage Publications
  • 1995-1999  (48)
Collection
Keywords
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  • Springer  (48)
  • Bundesarbeitsgemeinschaft für Rehabilitation
  • Sage Publications
  • VCH  (1)
Years
Year
  • 1
    ISSN: 1432-1068
    Keywords: Flexor tendons ; Hand ; mobilization ; Rehabilitation ; Splint
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a serie of 34 consecutive patients with a traumatic section of the flexor tendons of the hand eventually associated to a collateral artery or a nerve lesion. In all cases the surgery was made urgently in the operating room and followed by a Kleinert's early motion protocol. The results evaluation was based on the criterions of Tubiana. We have 75.9% of good and very good results and 24.1% of bad results. These results are comparable to the litterature. Most of the authors emphasise the importance to take these lesions in charge urgently, and to follow them regularly.
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  • 2
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    Der Hautarzt 50 (1999), S. 2-4 
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Dermatologie ; Prävention ; Rehabilitation ; Key words Dermatology ; Prevention ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The political activities concerning the health care system in recent months have made the chronic crisis involving dermatological rehabilitation clinics in Germany more apparent. While dermatology has continual to evolve in acute care clinical facilities, no critical analysis of dermatological rehabilitation clinics has occurred. A commonly accepted, standardized document defining precisely the goals of dermatological rehabilitation as well as the appropiate ways to measure the quality of the treatment and its results is not available. An expert panel appointed by the responsible working group of the Bavarian public health care system succeeded in defining mandatory structural requirements which will soon be obligatory for all Bavarian dermatological rehabilitation clinics. In the future, a general concept for the medical care of patients with chronic dermatological diseases on the appropiate level – ambulatory or hospital – has to be established. A close cooperation between clinicians working in acute care facilities and dermatologists in ambulatory practices could, at least in the long run, result in establishing local and national centers of competence for diagnosis, therapy, prevention, and rehabilitation of chronic dermatological diseases.
    Notes: Zusammenfassung Die gesundheitspolitischen Maßnahmen der letzten Monate haben die chronische Krise der dermatologischen Rehabilitation in Deutschland umso deutlicher hervortreten lassen. Während sich die Dermatologie an den Akutkliniken ständig weiterentwickelt hat, hat eine kritische Auseinandersetzung an den dermatologischen Reha-Kliniken in der Vergangenheit so gut wie nicht stattgefunden. Bislang fehlt ein allgemein akzeptiertes standardisiertes Vorgehen, das die dermatologischen Rehabilitationsziele genau definiert und die notwendigen Anforderungen bezüglich Struktur-, Prozeß- und Ergebnisqualität beschreibt. Die erst jüngst im Auftrag des Verbandes der Arbeitsgemeinschaft der Krankenkassenverbände in Bayern von einer Expertenkommission erarbeiteten und demnächst für alle bayerischen dermatologischen Reha-Kliniken verbindlichen Voraussetzungen im Rahmen der Strukturqualität sind ein begrüßenswerter Anfang. Notwendig für die Zukunft ist die Formulierung eines Gesamtkonzeptes für die stadiengerechte ambulante und stationäre medizinische Versorgung chronischer Dermatosen. Langfristiges Ziel könnte, in enger Zusammenarbeit mit Akutkliniken und Dermatologen in der Praxis, der Aufbau regionaler und überregionaler Kompetenzzentren für die Diagnose, Therapie, Prävention und Rehabilitation chronischer Dermatosen sein.
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  • 3
    ISSN: 1433-7347
    Keywords: Key words Knee ; Arthroscopy ; Meniscectomy ; Rehabilitation ; Physical therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract To evaluate the effect of physiotherapy after partial arthroscopic meniscectomy, we performed a prospective, randomised and partially blinded study. This pilot study was performed from October 1996 to June 1997. The control group received the standard treatment, consisting of verbal and written advice and exercises. The physiotherapy group performed exercises according to a dynamic protocol under the supervision of a physiotherapist. During a 3-week period, nine treatment sessions were given of 30 min each. Twenty patients, who had undergone arthroscopic meniscectomy without any other pathology of the knee, were randomised into two groups of ten patients each. The effects of therapy were evaluated by a blinded observer. We measured the distance and height of one-leg jumps (hops), the VAS pain scale, the Tegner and Lysholm scores and the SARS/FORS score. Recovery and satisfaction with the treatment were also evaluated. The effect measurements were performed at 7 (T1), 14 (T2), 21 (T3) and 28 days (T4) following surgery. Statistical analysis was performed with the Student’s t-test. The physiotherapy group showed significantly better results than the control group regarding the SARS score, the hop test and the distance jumps. Moreover, the measurements showed clear progression in favour of the physiotherapy group. In conclusion, exercising under the supervision of a physiotherapist led to high patient satisfaction and good functional rehabilitation after partial arthroscopic meniscectomy.
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  • 4
    ISSN: 1433-7347
    Keywords: Key words Cartilage defect ; Patella ; Periosteum ; Transplantation ; Rehabilitation ; Continuous passive motion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Fifty-seven consecutive patients (33 men and 24 women), with a mean age of 32 years (range 16–53 years), who suffered from an isolated full-thickness cartilage defect of the patella and disabling knee pain of long duration, were treated by autologous periosteal transplantation to the cartilage defect. The first 38 consecutive patients (group A) were postoperatively treated with continuous passive motion (CPM), and the next 19 consecutive patients (group B) were treated with active motion for the first 5 days postoperatively. In both groups, the initial regimens were followed by active motion, slowly progressive strength training, and slowly progressive weight bearing. In group A, after a mean follow-up of 51 months (range 33–92 months), 29 patients (76%) were graded as excellent or good, 7 patients (19%) were graded as fair, and 2 patients (5%) were graded as poor. In group B, after a mean follow-up of 21 months (range 14–28 months), 10 patients (53%) were graded as excellent or good, 6 patients (32%) were graded as fair, and 3 patients (15%) were graded as poor. Altogether, nine of the fair or poor cases (50%) were diagnosed with chondromalacia of the patella. Our results, after performing autologous periosteal transplantation in patients with full-thickness cartilage defects of the patella and disabling knee pain, are good if CPM is used postoperatively. The clinical results using active motion postoperatively are not acceptable, especially not in patients with chondromalacia of the patella.
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  • 5
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Stroke Unit ; Verlaufsuntersuchung ; Mortalität ; Rehabilitation ; Key words Stroke unit ; Follow up ; Mortality ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary This is a report of an interdisciplinary approach to diagnosis and treatment of stroke, combining a stroke unit and rehabilitation in one clinic. This series contains unselected patients from a narrow surrounding. Mean age of 559 patients was 68.7 years (median 70 years). 25% of patients had an initial Barthel index of 〈30, 20% presented with TIA’s and PRIND’s. 9% suffered from cerebral hemorrhage. The unbroken chain of care allowed a relative short length of stay in the acute care (9.4 days) without prolonging the rehabilitation phase. The one month mortality was 6.7%, one year mortality 18.3%. Discharge to a nursing home was necessary in 5.4%. Overall more than 90% of our patients have been treated continuously in our clinic. Combining modern diagnostics with early onset rehabilitation seem advantageous.
    Notes: Zusammenfassung In dieser Arbeit werden die Ergebnisse einer interdisziplinären Schlaganfalldiagnostik und -behandlung mit Stroke Unit und Rehabilitation in einer Klinik dargestellt anhand eines wenig selektionierten Patientenkollektives mit engem regionalen Bezug. Das Durchschnittsalter der 559 Patienten betrug 68,7 Jahre (Median 70 J.). Der Anteil der Patienten mit einem Barthel-Index 〈30% betrug 25%. TIA und PRIND hatten 20% der Patienten, 9% litten an einer Blutung. Durch die ununterbrochene Behandlungskette ließ sich eine vergleichsweise niedrige durchschnittliche Verweildauer von 9,4 Tagen im Akutbereich ohne eine Verlängerung der Rehabilitation erreichen. Die Mortalität nach einem Monat betrug 6,7%, nach einem Jahr 18,3%. In ein Pflegeheim wurden 5,4% der Patienten entlassen. Über 90% wurden durchgehend in unserer Klinik behandelt. Nach unserem Eindruck hat sich die Kombination moderner Diagnostik und sofort einsetzender Behandlung mit rehabilitativem Schwerpunkt bewährt.
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  • 6
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Schlaganfall ; Rehabilitation ; Anschlußheilbehandlung ; Key words Stroke ; Postacute rehabilitation ; Deficit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A standardized postacute inpatient rehabilitation program (Anschlußheilbehandlung) after stroke is well established in Germany. Yet the needs of patients being admitted to an Anschlußheilbehandlung (AHB) are not completely known. Therefore sociodemographic data, handicap, impairment and neuropsychologic deficits in 200 stroke patients were evaluated before admission to an AHB with different scores (Barthel, modified Rankin Score, NIHSS, HAWIE-R, Wilde, etc.). About half of the patients were still working prestroke. Most patients suffered from several vascular risk factors, which were insufficiently treated, and about a third of the patients had cerebrovascular disease prior to this stroke. At admission to the rehabilitation program the group of patients with severe neurological deficits was small. In average the disability was rather moderate (Rankin=2,6). Mainly gait and finger dexterity were handicapped. Functional impairment was outweighed by neuropsychological deficits.
    Notes: Zusammenfassung Die Anschlußheilbehandlung (AHB) ist ein fester Bestandteil der postakuten Rehabilitation nach einem Schlaganfall. Zwar gibt es genaue Vorgaben zur AHB von Seiten der Kassen- und Rentenversicherungsträger, unklar ist jedoch, welche Patienten in eine AHB eingewiesen werden, welche Störungen sie noch aufweisen und welche Anforderungen sie an eine AHB stellen. Prospektiv wurden 200 Patienten untersucht, die nach einem Schlaganfall an einer AHB teilnahmen. Neben relevanten soziodemographischen und medizinischen Daten wurden verschiedene neurologische (Barthel, modifizierter Rankin Score, NIHSS u.a.) und neuropsychologische (Teile des HAWIE-R, BAT, Wilde u.a.) Meßinstrumente verwendet. Über die Hälfte der Patienten, die in eine AHB nach einem Schlaganfall eingewiesen wurden, stand noch im aktiven Erwerbsleben. Viele Patienten litten unter unzureichend behandelten Risikofaktoren und hatten bereits vaskuläre Vorerkrankungen bevor sie den aktuellen Schlaganfall erlitten. Die neurologischen Störungen waren eher moderat, wohingegen durchschnittlich ganz erhebliche neuropsychologische Leistungseinbußen bestanden.
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  • 7
    ISSN: 1434-3924
    Keywords: Schlüsselwörter ; Rehabilitation ; Humane Fibroblasten ; Zyklische mechanische Dehnung ; Zellproliferation ; Key words ; Rehabilitation ; Human fibroblast ; Cyclic strain ; Cell proliferation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Experimental and clinical studies document the benefits of early controlled motion and loading in the treatment of musculoskeletal injuries. At the cellular level, dynamic strain plays a key role in cell stimulation and organization of the extracellular matrix. Although the positive effects of physical strain on tendon tissue are well known, little knowledge exists as to how mechanical strain affects tendon cells. The aim of the present study was to investigate in vitro the influence of cyclic strain on cell proliferation of human tendon fibroblasts. Human tendon fibroblasts from patellar tendon were cultured on silicone dishes. Cyclic biaxial strain was applied to the dishes in their long axis with third passage cells. A 5% strain magnitude and a frequency of 1 Hz were applied. The time of applied strain varied between 15, 30 and 60 min. After the fibroblasts were put under strain, the cells were tested for proliferation after 6, 12 and 24 h using incorporation of 5-bromo-2′-deoxy-uridine. As a control, cells were grown on silicone dishes but did not receive any strain. A biphasic response in proliferation was observed for the 15- and 60-min strain periods. At 6 and 24 h the proliferation was increased compared to the controls. The proliferation was decreased at 12 h. After a strain duration of 30 min the proliferation was inferior to that of the controls at all times measured. Application of mechanical stress to tendon fibroblasts results in an alteration of cellular proliferation, depending on the stress time. This study will contribute to an understanding of the cellular mechanism underlying the mechanical stimulation of tendon and ligament healing.
    Notes: Klinische und tierexperimentelle Studien haben den positiven Einfluß einer frühfunktionellen Behandlung nach Verletzungen des Binde- und Stützgewebes gezeigt. Dehnung ist dabei der zentrale Stimulus für reaktive Prozesse auf zellulärer Ebene. Zyklische mechanische Dehnung führt zu einer Reihe von Reaktionen, die für die Adaption von Zellen und Geweben an unterschiedliche Belastungen und für den Heilungsprozeß von Bedeutung sind. Ungeklärt ist jedoch, wieviel Dehnungsstreß notwendig ist. Ziel dieser Studie war, den Einfluß der Dauer von definierter zyklischer Dehnung auf die Zellproliferation von humanen Fibroblasten zu untersuchen. Fibroblasten wurden dazu aus Patellarsehnen isoliert und auf Silikonschalen kultiviert. Die Silikonschalen mit Zellen der 3. Passage wurden mit einem elektromechanischen Stimulationsgerät zyklisch mechanisch in der Längsachse gedehnt. Eine Dehnungsamplitude von 5% und die Frequenz 1 Hz wurden für alle Experimente gewählt. Die Dauer der zyklischen Dehnung wurde mit 15, 30 und ¶60 min verändert. Nach insgesamt 6, 12 und 24 h wurde der Versuch beendet. Zur Quantifizierung der Zellproliferation wurde die DNA-Synthese, d. h. der ¶Einbau von 5-Bromo-2′-deoxy uridine¶(BrdU) in die DNA gemessen. Als Kontrolle dienten humane Fibroblasten auf Silikonschalen ohne mechanische Dehnung. Nach 15 und 60 min zyklischer Dehnung zeigte sich ein biphasischer Verlauf hinsichtlich der Zellproliferation. Nach 6 und 24 h war eine Zunahme der Zellproliferation im Vergleich zu 12 h vorhanden. 30 min zyklische mechanische Dehnung hatte im Vergleich zur Kontrolle dagegen keinen positiven Einfluß auf die Zellproliferation. Zyklische mechanische Dehnung führt in Abhängigkeit von der Streßdauer zu Veränderungen bei der Zellproliferation. Die längere Streßdauer induziert potentiell Reaktionen, die eine protektive Wirkung für die Zellproliferation haben. Die zelluläre Streßantwort basiert jedoch auf komplexen Prozessen, deren Regulation und Modulation noch nicht geklärt sind. Das Verständnis der zellulären Reaktionen auf mechanische Dehnung ist von grundlegender Bedeutung für eine funktionelle Behandlung von Sehnen- und Bandverletzungen.
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  • 8
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Dentale Implantate ; Rehabilitation ; Kopf-Hals-Tumoren ; Periimplantäre Weichgewebe ; Key words Dental implant ; Rehabilitation ; Head and neck tumors ; Peri-implant hard and soft tissues
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In a prospective study, the influence of the status of the peri-implant hard and soft tissues on the success of enosseous dental implants in tumor patients was assessed. Out of 59 tumor patients with 261 implants, treated between July 1988 and August 1996, a pool of 23 patients with 99 implants provided with dentures for at least 1 year was obtained. Eighteen of these patients suffered from a squamous cell carcinoma of the oral cavity. Seventeen patients underwent preoperative radiation (40 Gy). A total of 68 out of 99 implants were inserted into autologous bone transplanted to reconstruct the mandible. In order to assess the peri-implant hard and soft tissues, the Hygiene Index, the Sulcus Bleeding Index, the Gingiva Index, the pocket-probing depth, the peri-implant bone resorption, and the periotest were used. The results in the tumor patients were compared with the results in a pool of nontumor patients. Tumor patients had significantly worse peri-implant parameters than nontumor patients. The peri-implant pocket-probing depth proved to have significant influence on the success rate. The overall success rate was 77.8%.
    Notes: Zusammenfassung Im Rahmen einer prospektiven Studie sollte der Einfluß des Zustands der periimplantaren Hart- und Weichgewebe auf den Implantationserfolg bei Tumorpatienten untersucht werden. Aus 59 Tumorpatienten, die zwischen Juli 1988 und August 1996 mit 261 Implantaten versorgt worden waren, wurde ein Zielkollektiv von 23 Patienten mit 99 Implantaten ermittelt, die mindestens 1 Jahr prothetisch versorgt waren. 18 dieser Patienten litten an einem Plattenepithelkarzinom der Mundhöhle. 17 Patienten wurden präoperativ mit einer Dosis von 40 Gy radiiert. 68 von 99 Implantaten standen in zur Unterkieferrekonstruktion transplantiertem autologem Knochen. Zur Beurteilung der periimplantären Hart- und Weichgewebssituation wurden der Hygieneindex, der Sulcusblutungsindex, der Gingivaindex, die parodontale Sondierungstiefe, der periimplantäre Knochenabbau und das Dämpfungsverhalten der Implantate herangezogen. Das Kollektiv der Tumorpatienten wurde mit einem Kollektiv gesunder Implantatpatienten verglichen. Tumorpatienten zeigten eine signifikant schlechtere Situation bezüglich der erhobenen periimplantären Parameter als gesunde Implantatpatienten. Ein signifikanter Einfluß auf den Implantationserfolg konnte nur für die periimplantäre Taschentiefe nachgewiesen werden. Im Zielkollektiv lag die Erfolgsquote bei 77,8%.
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  • 9
    ISSN: 1573-9686
    Keywords: Rehabilitation ; Neurological control systems ; Bioinstrumentation ; Biomechanics ; Spasticity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract We report the use of a mechatronic device for assessing arm movement impairment after chronic brain injury. The device, called the “Assisted Rehabilitation and Measurement Guide,” is designed to guide reaching movements across the workspace, to measure movement and force generation, and to apply controlled forces to the arm along linear reaching paths. We performed a series of experiments using the device in order to identify the contribution of active muscle and passive tissue restraint to decreased active range of motion of guided reaching (i.e., “workspace deficits”) in a group of five chronic, spastic hemiparetic, brain-injured subjects. Our findings were that passive tissue restraint was increased in the spastic arms, as compared to the contralateral, nonparetic arms. Active muscle restraint, on the other hand, was typically comparable in the two arms, as quantified by measurements of active arm stiffness at the workspace boundary during reaching. In all subjects, there was evidence of movement-generated weakness, consistent with a small contribution of spasticity to workspace deficits. These results demonstrate the feasibility of mechatronic assessment of the causes of decreased functional movement, and could provide a basis for enhanced treatment planning and monitoring following brain injury. © 1999 Biomedical Engineering Society. PAC99: 8719La, 8719St, 8780Vt, 8719Nn, 8719Ff
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  • 10
    ISSN: 1615-3146
    Keywords: Disuse ; Hypokinesia ; Atrophy ; Limb-Immobilisation ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Rehabilitation didn't get much attention in animal research as compared to disuse atrophy that has been widely investigated over the years. We therefore performed a combined morphometrical and biochemical study on the effect of recovery from hind-limb immobilization on the tibia and the serum of rats. The experiments were carried out on 42 young Sprague-Dawley male rats. In one group of 32 rats the left hind-limb was immobilized for 2 weeks and then remobilized for another 2 weeks. Another group of 10 rats served as controls. Total body weight was partially restored. Tibia weight (fresh, dry and ash) showed on the other hand no tendency to improve. Serum triglycerides, urea, creatinine, albumin and calcium that were found to be reduced during immobilization returned to normal values during the rehabilitation period. Serum phosphorus that remained normal during limb disuse rose to above normal values in the remobilization phase. Serum alanine aminotransferase levels changed from low to normal. Serum alkaline phosphatase showed a rebound phenomenon from low to above-normal. Both muscle aspartate aminotransferase and bone alkaline phosphatase that were low during immobilization returned to normal in response to rehabilitation. We conclude that biochemical alterations are fast and tend to become fully corrected. Overcoming weight loss is a much slower process and it is unclear whether weight ever returns to pre-atrophic values.
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  • 11
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Rehabilitation ; pneumologische ; Pneumologie ; Rehabilitation ; Lungenerkrankungen ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema Asthma bronchiale, Lungenemphysem, entzündliche Erkrankungen des gesamten Respirationstrakts und alle Krankheiten, die zu chronischer Ateminsuffizienz führen, stellen die Hauptindikationen für die pneumologische Rehabilitation dar. Dazu zählen auch die in der letzten Zeit in das Zentrum besonderen Interesses gerückten Schlafatemstörungen. Die pneumologische Rehabilitation, die hierzulande historisch institutionell mit allen Maßnahmen der Tuberkulosebehandlung eng verbunden war und heute diagnostisch wie therapeutisch hervorragend ausgewiesen ist, hat eine lange und segensreiche Tradition zur ganzheitlichen Behandlung von Lungenerkrankungen unterschiedlichster Genese. Auch wenn unbestritten ist, daß in manchen Bereichen der Rehabilitation in den letzten Jahrzehnten das Anspruchsdenken von Patienten zu- und die Bereitschaft zu Mitarbeit und Eigenverantwortung eher abgenommen haben, dürfte dies für Lungenkranke vermutlich am letzten zutreffen. Die vorliegende Arbeit ist zugleich ein Appell, bei notwendigen sozialpolitischen Korrekturen Augenmaß zu bewahren. Gerade bei Lungenerkrankungen muß man einen „langen Atem” haben, um neben allen anderen therapeutischen Maßnahmen so schwierige Ziele wie Raucherentwöhnung oder den richtigen Umgang mit Sauerstoffinhalationstechniken zu erreichen und zur Gewohnheit zu verfestigen. Über Rehabilitationsindikationen, -ziele, -maßnahmen und -erfolge wird an dieser Stelle berichtet.
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  • 12
    ISSN: 1573-2649
    Keywords: Quality of Life ; Rehabilitation ; Social Support ; Stroke
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Adaptation to stroke requires complex, long-term change in stroke survivors' lives. This study aimed at identifying those factors that influence quality of life (QOL) of geriatric stroke survivors 1–3 years post-discharge. The objectives were: to describe the overall quality of life of stroke survivors; to examine the relationships between sociodemographic variables, neurological variables, functional status, social support, perceived health status, depression, and overall QOL; and to determine the best predictors of QOL. Data were collected on 50 stroke survivors using a cross-sectional design and standardized questionnaires, including the Quality of Life Index, the Functional Independence Measure, the Social Support Inventory for Stroke Survivors and the Centre for Epidemiologic Studies Depression Scale. The overall quality of life of the study participants was low. The most important predictors of QOL were depression, marital status, quality of social support, and functional status. Depression was the strongest predictor of QOL. By employing a multi-dimensional perspective, this study confirmed that adaptation to stroke involves much more than physical function. Thus, rehabilitation programs for this group would be more effective if they are based upon a holistic approach.
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  • 13
    ISSN: 1437-7772
    Keywords: Key words Plastic surgery ; Rehabilitation ; Microsurgery ; Reconstructive surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 14
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    Trauma und Berufskrankheit 1 (1999), S. S46 
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Unfallversicherung ; Prävention ; Rehabilitation ; Entschädigung ; Key words Accident insurance ; Prevention ; Rehabilitation ; Compensation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract With the addition of the seventh section – legally required accident insurance – to the social code on 1 January 1997, the system of legal accident insurance that has been in place in Germany for over a hundred years was recognized by the legislator and impressively confirmed. The legal bases of prevention, rehabilitation and compensation have been updated, tightened up and developed further to take account of the results of legal precedents. The task of prevention now also includes the prevention of occupational health hazards. Rehabilitation after occupational accidents and illnesses will continue to be pursued with all appropriate means and complemented by individual new elements based on the legally required health insurance. The framework for compensation has been changed only in small points and with due consideration for the principle of compensation for damages, and in parts even expanded. The self-determination and participation rights of the insured persons have been consolidated, and especially in the data protection sector. Any rights already acquired by insured persons remain unaffected by the new law.
    Notes: Zusammenfassung Mit der Einfügung des 7. Buchs – Gesetzliche Unfallversicherung – in das Sozialgesetzbuch zum 1. Januar 1997 ist das über 100jährige System der gesetzlichen Unfallversicherung in Deutschland durch den Gesetzgeber als bewährt anerkannt und eindrucksvoll bestätigt worden. Die rechtlichen Grundlagen der Prävention, der Rehabilitation und der Entschädigung wurden aktualisiert, gestrafft und unter Einbeziehung der Ergebnisse der Rechtsprechung fortentwickelt. Der Auftrag zur Prävention umfaßt nun erstmals auch die Verhütung arbeitsbedingter Gesundheitsgefahren. Die Rehabilitation nach Arbeitsunfällen und Berufskrankheiten wird weiterhin mit allen geeigneten Mitteln erfolgen und durch einzelne neue Elemente in Anlehnung an die gesetzliche Krankenversicherung ergänzt. Der Rahmen der Entschädigung wurde unter Beachtung des Schadenersatzprinzips nur unwesentlich verändert und teilweise sogar erweitert. Die Selbstbestimmungs- und Beteiligungsrechte der Versicherten wurden besonders auch im Bereich des Datenschutzes gestärkt. Erworbene Rechte der Versicherten werden durch das neue Recht nicht berührt.
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  • 15
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    Trauma und Berufskrankheit 1 (1999), S. 419-421 
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Gesetzliche Unfallversichung ; Rehabilitation ; Asbestose ; Key words Obligatory accident insurance ; Rehabilitation ; Asbestosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Due to long latency periods, the frequency of malignancies in Germany due to asbestos exposure is expected to climax during the coming years. The occurrence of nonmalignant (fibrogenic) results of asbestos inhalation is also steadily increasing. According to German law, accident insurance companies are required to take all possible measures to reduce or eliminate any damage to workers’ health resulting from conditions in the workplace as soon as possible and to ease the consequences and hinder any worsening of such conditions. According to a statement issued by the Hauptverband der gewerblichen Berufsgenossenschaften (HVBG) in 1998, the effectiveness of clinical treatment for asbestos maladies has been proven. The incidence of disease resulting from asbestos inhalation can be reduced and patients’ quality of living sustained or improved, but the incidence of malignancies must still be further reduced and improvements made in early diagnosis.
    Notes: Aufgrund der langen Latenzzeit wird in den nächsten Jahren der Höhepunkt der asbestbedingten Malignomerkrankungen in Deutschland erwartet. Darüber hinaus unterliegen die nicht-bösartigen (z. B. fibrogenen) Asbestinhalationsfolgen einer stetigen Progredienz. Nach §26 SGB VII hat der Unfallversicherungsträger mit allen geeigneten Mitteln möglichst frühzeitig den durch den Versicherungsfall verursachten Gesundheitsschaden zu beseitigen oder ¶zu bessern, seine Verschlimmerung zu verhüten und seine Folgen ¶zu mildern. Anläßlich eines 1998 vom HVBG veröffentlichten Forschungsvorhaben konnte die Effizienz von stationären Heilverfahren bei Asbestoseversicherten nachgewiesen werden. Im Rahmen der komplexen Asbestoserehabilitation werden der Progredienz der Asbestinhalationsfolgen entgegengewirkt sowie die Lebensqualität erhalten bzw. gesteigert. Darüber hinaus müssen die Inzidenz bösartiger Erkrankungen gesenkt bzw. die Frühdiagnostik gefördert werden.
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  • 16
    ISSN: 1435-0130
    Keywords: Key words Fibula ; Jaws ; Osseointegrated implants ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  From December 1989 to September 1997 21 patients were treated for mandible reconstruction and 10 for maxilla reconstruction using the fibular flap. The age of patients ranged from 25 to 64, the length of the bone grafts from 7 to 25 cm. In 16 cases osseointegrated implants were used for denture rehabilitation; in 3 cases the reconstruction involved the TM joint. In the maxilla the fibula flap was used to reconstruct extreme atrophy of the alveolar process in 4 cases; to reconstruct a previous hemimaxillectomy in 3 cases and post-traumatic bone loss in 3 cases. Bone fixation was obtained by K-wires in 4 cases and miniplates in the remaining 27. The TM joint was reconstructed with an osteochondral graft from the second metatarsal head or an ear cartilage graft sutured on top of the fibula. In one case the homologous condyle conserved after tumor resection was used. The flaps were bone only (12 cases), bone plus muscle (15 cases) and osteocutaneous (4 cases). Average follow-up was 3–4 years. Twenty-eight flaps had no complications, with good functional and morphological results. One flap was lost because of infection, 1 flap was lost after 3 years due to a recurrence of malignancy; 1 flap had a segmental bone necrosis because partial devascularization occurred after hemostasis to stem major bleeding. Seventy-nine fixtures were placed, 47 into the new mandibles and 32 into the reconstructed maxillae. All implants have been well osseointegrated, except 1 removed at the time of surgery because of poor primary stability. Sixteen patients have had an implant-supported prosthesis. In our experience fibula is one of the most versatile flaps for jaw reconstruction, especially when osseointegration is planned or the TMJ and the maxilla need to be reconstructed.
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  • 17
    ISSN: 1436-0578
    Keywords: Schlüsselwörter Schlaganfall ; Infrastruktur ; Thrombolyse ; Rehabilitation ; Key words Stroke ; Infrastructure ; Thrombolysis ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary New therapeutic approaches for the treatment of stroke require new strategies for early diagnosis, fast transportation to the hospital, immediate diagnostic procedures, recommendations for therapy and early rehabilitation. Systemic thrombolysis can only be performed in a setting of optimal infrastructure. The implementation of stroke units leads to a measurable improvement of long term prognosis i.e. significantly more patients may live independent after their stroke.
    Notes: Zusammenfassung Neue therapeutische Erkenntnisse bei der Behandlung des Schlaganfalls machen neue Konzepte zu Früherkennung, raschem Transport in die Klinik, strukturierter Diagnostik, Akuttherapie und frühem Einsatz der Rehabilitation notwendig. Insbesondere die systemische Thrombolyse mit dem Drei-Stunden Einschlußfenster bzw. die lokale Thrombolyse mit dem Sechs-Stunden Einschlußfenster kann nur bei optimaler Infrastruktur erfolgversprechend eingesetzt werden. Die Einrichtung spezialisierter Einrichtungen zur Behandlung des akuten Schlaganfalls in Form von Stroke Units führt zu einer deutlichen Verbesserung der Prognose, so daß die Rate der Patienten, die nach dem Schlaganfall ein unabhängiges Leben führen können, nachweislich zunimmt.
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  • 18
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Arbeitstherapie ; Soziotherapie ; Schizophrenie ; Rehabilitation ; Chronisch Kranke ; Prospektive Untersuchung ; Key words Work therapy ; Sociotherapy ; Schizophrenia ; Rehabilitation ; Chronically ill patients ; Prospective study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Within the framework of a study on vocational rehabilitation of the mentally ill, we examined 83 schizophrenic outpatients enrolled in a work therapy program. The course of illness and rehabilitation was documented over a 3-year period by means of annual follow-up examinations. The sample comprised 44 men and 39 women with an average age of 35 years (SD±8,5). The majority were chronically ill patients with a history of frequent and long psychiatric hospitalization. After 3 years, 22% of the patients were integrated into the general labor market, 26% had sheltered employment, 23% were still in work therapy, and 29% were unemployed. Besides the patients’ subjective expectations, early introduction of rehabilitative measures and a favourable course of illness were found to be predictors of a successful rehabilitation leading to vocational integration. Outpatient work therapy is a contemporary, effective organizational form of sociotherapy. It may contribute to improved vocational competence and integration, reduced psychiatric hospitalization and stabilized psychopathology.
    Notes: Zusammenfassung Im Rahmen einer Studie zur Arbeitsrehabilitation psychisch Kranker untersuchten wir 83 schizophrene Patienten, die ambulant an Arbeitstherapie teilnahmen. Durch jährliche Nachuntersuchungen wurden Krankheits- und Rehabilitationsverläufe über 3 Jahre dokumentiert. Stichprobe sind 44 Männer und 39 Frauen, die im Mittel 35 Jahre alt (std±8,5) sind. Mehrheitlich handelt es sich um chronisch psychisch Kranke, die in der Vorgeschichte mehrfach und lange psychiatrisch hospitalisiert waren. Drei Jahre nach Beginn der Studie sind 22% der Patienten auf dem allgemeinen Arbeitsmarkt integriert, 26% sind in beschützten Arbeitsverhältnissen tätig, 23% verbleiben in der Arbeitstherapie. 29% der Untersuchten sind am Ende der Untersuchung beschäftigungslos. Es wurde eine Verbesserung der Arbeitskompetenz, eine Stabilisierung des psychischen Befundes, schließlich ein Rückgang weiterer Hospitalisierung beobachtet. Neben den subjektiven Erwartungen der Betroffenen erweisen sich ein früher Rehabilitationsbeginn und ein benigner Krankheitsverlauf als Prädiktoren für ein günstiges Rehabilitationsergebnis. Ambulante Arbeitstherapie erscheint als eine zeitgemäße, in ihrer Effektivität mehr und mehr belegte Organisationsform der klinischen und außerklinischen Soziotherapie. Es darf allerdings nicht verkannt werden, daß sie gerade in der Behandlung chronisch Schizophrener lediglich als einer von mehreren Bausteinen fungiert und daß die Integration dieser Patienten in den allgemeinen Arbeitsmarkt nur bei einem kleinen Teil der Patienten erfolgreich angestrebt werden kann.
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  • 19
    Electronic Resource
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    Der Nervenarzt 69 (1998), S. 737-751 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Schizophrenie ; Pharmakotherapie ; Psychotherapie ; Soziotherapie ; Rehabilitation ; Key words Schizophrenia ; Pharmacotherapy ; Psychotherapy ; Social therapy ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Long-term treatment of patients with chronic schizophrenias requires integration of many therapeutic approaches, co-operation of several professions, and regard for the views of patients and relatives. This review deals with practical aspects of pharmacotherapy, psychotherapy, cognitive resp. psychological treatments, social resp. milieu therapy, rehabilitation, interventions based on the concept of Expressed Emotions (EE), psychoeducation and work with relatives. Continuous neuroleptic treatment is indispensable in most cases to achieve social integration. Indications for adding on antidepressants, lithium, carbamazepine, benzodiazepines and other drugs are discussed, as well as treatment of negative symptoms, depression and management of treatment-resistant symptoms. Psychotherapy needs to regard the possibilities of the patient. In the context of a stable long-term relationship, the patient is supported in experiencing himself as a subject capable of action. Effectiveness of cognitive treatments to date is limited. The best results are achieved by social skills training. Social therapy, which aims at the improvement of functional aspects of the patient, is of paramount importance. Improved possibilities for work rehabilitation are contrasted by difficulties in financing long-term social rehabilitation. Interventions based on the EE concept are highly effective, but are rarely used. Programs that merely convey information without targeting behaviour modification are ineffective. The functions of facilities of treatment in the community are explained, the integrative role of case-management is stressed.
    Notes: Zusammenfassung Die Langzeitbehandlung der chronischen Schizophrenien erfordert die Integration vieler Therapiemodalitäten, die Zusammenarbeit zahlreicher Berufsgruppen und v.a. die Berücksichtigung der Sichtweisen des jeweils Betroffenen und seiner Angehörigen. In dieser Übersicht werden praxisrelevante Aspekte von Pharmakotherapie, Psychotherapie, experimentalpsychologisch begründeten Therapieverfahren, Soziotherapie, Rehabilitation, auf dem Expressed-Emotions-(EE) Konzept aufbauenden Methoden, psychoedukativen Verfahren und der Angehörigenarbeit dargestellt. Eine neuroleptische Langzeitbehandlung ist meist unverzichtbar, um eine anhaltende Besserung der psychischen Funktionen zu erreichen und eine soziale Integration zu ermöglichen. Indikationen für Additiva wie Antidepressiva, Lithium, Carbamazepin, Benzodiazepine und andere Substanzen werden dargestellt. Die Behandlung von Negativsymptomatik und Depression sowie das Vorgehen bei therapieresistenter Symptomatik werden erörtert. Psychotherapeutisches Handeln muß sich an den Möglichkeiten des Patienten orientieren. Im Rahmen eines langfristigen, unerschütterlichen Beziehungsangebotes muß der Betroffene unterstützt werden, sich als aktiv handelndes Subjekt zu erfahren. Die spezifischen Effekte experimentalpsychologisch begründeter Therapieverfahren sind bisher begrenzt. Am günstigsten ist das Training sozialer Fertigkeiten zu beurteilen. Der Soziotherapie als Förderung vorhandener Ressourcen kommt eine übergeordnete Bedeutung zu. Deutlich verbesserte Möglichkeiten beruflicher Rehabilitation kontrastieren mit Finanzierungsproblemen bei langfristiger sozialer Rehabilitation. Verhaltensmodifizierende Interventionen auf Basis des EE-Konzepts sind hochwirksam, werden aber selten angewendet. Reine Informationsvermittlung bleibt ohne Wirkung. Die nichttherapeutische Angehörigenarbeit als selbständiges Aufgabenfeld wird dargestellt. Die Funktion komplementärer Einrichtungen wird erläutert, wobei die integrative Funktion des „case-management” betont wird.
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  • 20
    ISSN: 1432-0932
    Keywords: Key words Chronic low back pain ; Functional restoration ; Rehabilitation ; Intensive ; multidisciplinary treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A functional restoration (FR) program, dealing with a combination of intensive physical and ergonomic training, psychological pain management, and patient education, was tested in two randomized, parallel group studies. In one of these patients following the FR program were compared with a non-treated control group (project A), and in the other with patients on two less intensive treatment programs (project B). A total of 238 chronic low back pain patients participated in the two studies, 106 entering project A and 132 project B. Patients from the two projects were comparable except that the patients in project A were recruited from all over the country, whereas patients in project B all were living in and around Copenhagen. Thirteen patients never started any treatment, and 20 patients (9%) dropped out during the treatment period. Of the 207 who completed treatment, 89% returned a mailed questionnaire 5 years later. This was the case for 55% of the drop-outs. The questions referred to work situation, pain level, activities of daily living, days of sick leave, contact with health care professionals, physical activity, use of medication, and a subjective overall assessment. The results show that in project A the treated group reported significantly fewer contacts with the health care system and significantly fewer days of sick leave over the 5-year follow-up period compared to the control group. In all other parameters, including work ability, there was no statistically significant difference between the two groups. In project B, patients treated in the FR program did significantly better in most measured parameters, except in leg pain, use of pain medication and sport activity, where no significant differences were found between groups. The overall result shows a positive long-term effect of the FR program, but it also shows the necessity of testing a given treatment in different projects and designs, among other things due to statistical variations.
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  • 21
    ISSN: 1434-4726
    Keywords: Key words Radiation-induced deafness ; Rehabilitation ; Cochlear implant
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Radiotherapy of the head and neck can be associated with conductive and/or sensori-neural hearing loss. We report the case of a 67-year-old man who developed complete bilateral deafness caused by labyrinthitis and radiation-induced neuritis of the acoustic nerve after postoperative radiotherapy of a nasopharyngeal carcinoma. Two years postoperatively extensive clinical workup including computed tomography and magnetic resonance imaging showed no recurrence or secondary brain tumors. To facilitate sound perception a Combi 40 cochlear implant was implanted. Because of fibrosis the insertion depth of the stimulating electrode into the scala tympani was limited and therefore a “short electrode version” was used. Six months after implantation the patient had achieved an excellent enviromental sound recognition and moderate speech intelligibility. Present experiences has shown that although radiotherapy can cause damage to the labyrinth and acoustic nerves and central hearing pathways, there may still be surviving auditory nerve fibers that can be stimulated successfully by a cochlear implant.
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  • 22
    Electronic Resource
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    Springer
    Virtual reality 3 (1998), S. 259-266 
    ISSN: 1434-9957
    Keywords: Virtual reality ; Neuroscience ; Neurosurgery ; Assessment ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science
    Notes: Abstract While many virtual reality (VR) applications have emerged in the areas of entertainment, education, military training, physical rehabilitation, and medicine, only recently have some research projects begun to test the possibility of using virtual environments (VEs) for research in neuroscience, neurosurgery and for the study and rehabilitation of human cognitive and functional activities. Virtual reality technology could have a strong impact on neuroscience. The key characteristic of VEs is the high level of control of the interaction with the tool without the constraints usually found in computer systems. VEs are highly flexible and programmable. They enable the therapist to present a wide variety of controlled stimuli and to measure and monitor a wide variety of responses made by the user. However, at this stage, a number of obstacles exist which have impeded the development of active research. These obstacles include problems with acquiring funding for an almost untested new treatment modality, the lack of reference standards, the non-interoperability of the VR systems and, last but not least, the relative lack of familiarity with the technology on the part of researchers in these fields.
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  • 23
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Vordere Kreuzbandruptur ; Konservative Therapie ; Meniskusläsionen ; Key words Anterior cruciate ligament rupture ; Nonoperative treatment ; Rehabilitation ; Meniscal tears
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: In this retrospective study, the meniscal status of 45 patients with conservatively treated complete anterior cruciate ligament (ACL) tears is reported. The ACL injury was initially documented by examination under anesthesia and arthroscopy. Treatment in all cases consisted of a standard protocol of early rehabilitation and bracing. The mean follow-up was 8 years. Twenty-nine (65%) patients showed signs of meniscal pathology at an average of 3 years after the ACL injury during the follow-up period. Rearthroscopy was performed and showed a higher incidence of medial meniscus tears. The most common tear of the medial meniscus was the bucket-handle type, followed by the flap tear and the single longitudinal split of the posterior horn. Secondary reconstruction of the ACL was necessary in 24 patients complaining of the meniscus giving way. The remaining five patients had rearthroscopy 4 years after the ACL injury and a partial meniscectomy and ACL reconstruction was performed. Sixteen patients (35% of the overall sample) had no instability complaints or meniscal pathology during the follow-up period, but discontinued their sporting activities. Results indicate the increasing incidence of meniscal tears during ACL insufficiency. We recommend that patients with ruptures of the ACL should be investigated for meniscal tears and that early ligament reconstruction of the knee and mensical repair or partial meniscectomy should be considered simultaneously.
    Notes: In dieser retrospektiven Studie werden die Meniskusfolgeläsionen von 45 Patienten (Durchschnittsalter 29 Jahre) mit arthroskopisch verifizierter, isolierter Ruptur des vorderen Kreuzbands (VKB) und konservativer Behandlung innerhalb eines Nachbeobachtungszeitraums von 8 Jahren (2–14 Jahre) beschrieben. 65% (29 Patienten) wurden innerhalb eines Zeitraums von durchschnittlich 3 Jahren (0,5–4 Jahre) nach der primären VKB-Verletzung wegen einer auftretenden Meniskussymptomatik rearthroskopiert. Meniskusfolgeläsionen traten beim medialen Meniskus häufiger (59%) als beim lateralen Meniskus (41%) auf. Bei den medialen Meniskusläsionen stand der Korbhenkelriß, gefolgt vom Lappen- und Längsriß des Meniskushinterhorns, im Vordergrund. Bei 24 Patienten (82%) wurde im Zug der Rearthroskopie simultan zur Meniskusteilresektion ein VKB-Ersatz aufgrund einer persistierenden symptomatischen vorderen Kniegelenkinstabilität durchgeführt. Die restlichen 5 Patienten (18%) mußten wegen wieder auftretender klinischer Meniskuszeichen im Durchschnitt 13 Monate (6–18 Monate) nach der ersten Teilmeniskektomie bzw. 4 Jahre (1–6 Jahre) nach Ruptur des VKB erneut arthroskopisch teilmeniskektomiert und ein VKB-Ersatz durchgeführt werden. 35% des Gesamtkollektivs (16 Patienten) zeigten im Nachbeobachtungszeitraum keine Kniegelenkproblematik, gaben aber eine vollständige Einstellung ihrer sportlichen Aktivitäten an. Diese Studie belegt die Zunahme der Inzidenz von Meniskusfolgeläsionen, vornehmlich des medialen Meniskushinterhorns, bei bestehender vorderer Kreuzbandinsuffizienz. Tritt eine Meniskusläsion im Anschluß an eine vordere Kreuzbandinsuffizienz auf, sollte parallel zur Meniskussanierung die Wiederherstellung der Kniegelenkstabilität durch einen VKB-Ersatz erfolgen.
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  • 24
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Dentale Implantate ; Langzeituntersuchung ; Periimplantäre Weichgewebe ; Rehabilitation ; Kopf-Hals-Tumoren ; Key words Dental implants ; Follow-up examination ; Peri-implant soft tissue ; Rehabilitation ; Head and neck neoplasms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The implantologic rehabilitation of patients after ablative oral tumour surgery and defect reconstruction is carried out generally without strict assessment of the successfulness of the outcome. Therefore 210 dental implants inserted in 58 tumour patients were subjected to regular follow-up examinations for 5 years. The Bone-Lock osseointegrated implant system (Howmedica Leibinger, Freiburg) was used exclusively. The plaque index (Silness and Löe), the sulcus bleeding index (Löe), the pocket probing depth, the width of the passive peri-implant tissue, implant mobility by means of the Periotest method and bone resorption according to X-ray findings were ascertained. At 60–70% of measurement points a passive peri-implant tissue was created. After the beginning of loading, specific adaptation phenomena of tumour patients could be detected. Despite constant plaque accumulation (mean 1.79), the bleeding disposition diminished from maximal 1.83 to 0.71. Corresponding to this finding the pocket probing depths decreased from 5.75 mm to 4.57 mm. The implant mobility (Periotest method: mean 2.25, range –3 to +8.5) showed a decrease in the first 2 years, then the values increased. The mobility depends on the kind of supraconstruction. Ball attachments have the lowest and implant-supported bridges have the highest values. Peri-implant bone resorption showed 1.43 mm as a mean value of all measurements and had a horizontal component of 73–84%. In accordance with this the vertical bone loss was small. After an increase during the first 2 years both values reached a steady state around 2.5 mm. The success rate for all 210 inserted implants is 83.2%. For implants in place for over 365 days the success rate is 93%. Prosthetic restoration in tumour patients can be achieved with osseointegrated dental implants according to the acknowledged international standards.
    Notes: Die implantologische Versorgung von Patienten nach ablativer Tumorchirurgie und Defektrekonstruktion erfolgt meist abseits strenger Maßstäbe der Erfolgsbeurteilung. Deshalb untersuchten wir die von Juni 1990 bis Juni 1996 bei 58 Tumorpatienten enoral gesetzten 210 Implantate regelmäßig nach. Verwendung fand ausschließlich das enossale Bone-Lock-Implantatsystem (Howmedica Leibinger GmbH, Freiburg). Untersucht wurden der Plaqueindex (Silness und Löe), der Sulkusblutungsindex (Löe), die Sondierungstiefe, die Breite der passiven Weichgewebe, die Implantatbeweglichkeit (Periotest) und der Knochenabbau im Röntgenbild. Die Schaffung passiver periimplantärer Weichteile gelang in 60– 70% der Meßorte. Es fanden sich nach dem Belastungsbeginn für Tumorpatienten spezifische adaptive Phänomene. Trotz gleichbleibendem Plaquebefall (Mittel 1,79) kam es im Beobachtungszeitraum (5 Jahre) zu einer deutlichen Abnahme der Blutungsneigung periimplantär von maximal 1,83 auf 0,71. Dem entsprach, daß die Sondierungstiefen von etwa 5,75 mm auf 4,57 mm um gut 1 mm abnahmen. Die mittels Periotest bestimmte Implantatbeweglichkeit (Mittelwert Periotest 2,25) nahm in den ersten 2 Jahren ab und danach wieder zu (Bereich –3 bis +8,5). Sie ist von der Art der Suprakonstruktion abhängig (Druckknopfversorgungen haben den niedrigsten, implantatgetragene Brücken den höchsten Wert). Der Gesamtknochenabbau periimplantär von maximal 1,43 mm im Durchschnitt aller Messungen zeigte eine horizontale Komponente von 73–84% mit einem entsprechend geringen vertikalen Einbruch. Nach einem 2jährigen Anstieg kam es zu einem „steady state.“ Die Erfolgswahrscheinlichkeit für alle 210 gesetzten Implantate liegt bei 83,2%. Für Implantate mit einer Liegedauer von 〉 365 Tagen beträgt sie 93%. Tumorpatienten können mithin implantologisch in einer den anerkannten Standards entsprechenden Weise versorgt werden.
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  • 25
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Rheumatologie ; Rehabilitation ; Qualitätssicherung ; umfassendes Qualitätsmanagement ; Key words Rheumatology ; Rehabilitation ; Quality assurance ; Total Quality Management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Quality assurance in rehabilitation of rheumatic diseases follows two programs, one developed by VDR (Verband Deutscher Rentenversicherungsträger) and the other developed by DGRh (Deutsche Gesellschaft für Rheumatologie). After introducing Total Quality Management to a rehabilitation center quality measurably increased. This improvement has been achieved by goal-directed steps and modification of clinical structures. Up to now patients’ needs and the revision of in-patient treatment have been the central part af these activities. By organizing several special training courses staff has become more content and qualified. New forward-looking perspectives have been worked out in cooperation with other partners.
    Notes: Zusammenfassung Das Qualitätssicherungsprogramm des VDR und die Veröffentlichungen zur Qualitätssicherung der DGRh geben den Rahmen für die externen Qualitätssicherungsmaßnahmen vor. Durch Einführung eines umfassenden Qualitätsmanagements in einer Rehabilitationsklinik konnte die Qualität meßbar gesteigert werden. Die Verbesserungen wurden durch Umsetzung zielgerichteter Maßnahmen und Veränderung von Klinikstrukturen erreicht. Bisher standen Maßnahmen bezogen auf Patientenbedürfnisse und die Aufarbeitung von internen Behandlungsabläufen im Vordergrund. Zur Erhöhung der Mitarbeiterzufriedenheit und -qualifikation wurden rehabilitationsspezifische Fortbildungsreihen durchgeführt. Neue zukunftsweisende Perspektiven konnten gemeinsam mit anderen Partnern entwickelt werden.
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  • 26
    ISSN: 1573-9686
    Keywords: Kinematics ; Kinetics ; Rehabilitation ; Biomechanics ; Generalized center of pressure ; Center of pressure ; Wheelchair propulsion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract The measurement of the center of pressure (COP) has been and continues to be a successful tool for gait analysis. The definition of a similar COP for wheelchair propulsion, however, is not straightforward. Previously, a COP definition similar to that used in force plate analysis had been proposed. Unfortunately, this solution has the disadvantage of requiring a separate COP definition for each plane of analysis. A definition of the generalized center of pressure (GCOP) which is consistent in all planes of analysis is derived here. This definition is based on the placement of a force-moment system, equivalent to the force-moment system at the hub, on a line in space where the moment vector (wrench moment) is parallel to the force vector. The parallel force-moment system is then intersected with three planes defined by anatomical landmarks on the hand. Data were collected using eight subjects at propulsion speeds of 1.34 m/s and 2.24 m/s (1.34 m/s only for subject 1, 0.894 m/s and 1.79 m/s for subject 8). Each subject propelled a wheelchair instrumented with a SMARTWheel. A PEAK 5 video system was used to determine the position of anatomical markers attached to each subject’s upper extremity. The GCOP in the transverse plane of the wrist formed clusters for all subject’s except subject 2 at 1.34 m/s. The clustering of the GCOP indicates that the line of action for the force applied by the hand is approximately perpendicular to the transverse plane through the wrist. When comparing the magnitude of the moment vector part of the wrench with the moment of the force vector of the wrench about the hub, the wrench moment is approximately an order of magnitude smaller. This indicates that the role of the wrist for wheelchair propulsion is primarily to stabilize the force applied by the arm and shoulder. © 1998 Biomedical Engineering Society. PAC98: 8745Dr, 8710+e
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  • 27
    Electronic Resource
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    Zeitschrift für Rheumatologie 57 (1998), S. 345-350 
    ISSN: 0340-1855
    Keywords: Schlüsselwörter ; Qualitätssicherung ; Qualitätsmanagement ; Patientenzufriedenheit ; Prozeßqualität ; Rehabilitation ; Key words Quality management ; process quality ; benchmarking ; patient satisfaction ; rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In the context of the quality assurance program of the German pension insurance institutions, instruments and procedures have been developed in the past few years in order to assess the quality of structure, process, and results of inpatient rehabilitation, as well as patient satisfaction. The routine implementation of these procedures aims at providing rehabilitation hospitals with fast information on shortcomings in their current practice, so that concepts of treatment and – in the long run – effects of rehabilitation can be systematically improved. When the „quality profiles” of rehabilitation hospitals are compared („benchmarking”), paying institutions of rehabilitation could gain information on the cost-quality-ratio of particular hospitals as well as important leads for improving the steering processes of patients and hospitals.  In the present article, results of a first „field-run” of the procedures for measuring patient satisfaction and quality of rehabilitation processes are reported. A comparative analysis of patient satisfaction in four orthopaedic/rheumatologic rehabilitation hospitals showed high degrees of overall satisfaction in all hospitals. In several subdimensions of patient satisfaction, however, significant differences between hospitals were found.  Quality of rehabilitation processes – as assessed by a standardized peer-review – varied substantially between 36 hospitals. Problems of quality were found especially in some dimensions that must be considered as crucial for rehabilitation, e.g., in the history and diagnosis of disabilities, in the consideration of psycho-social problems, or in the assessment of occupational capacities.
    Notes: Zusammenfassung Im Rahmen des Qualitätssicherungsprogramms der Rentenversicherungsträger wurden in den letzten Jahren Instrumente und Verfahren zur Erfassung der Struktur-, Prozeß- und Ergebnisqualität sowie der Patientenzufriedenheit erarbeitet. Durch den routinemäßigen Einsatz dieser Verfahren sollen den Kliniken zeitnah Informationen über etwaige Qualitätsprobleme („Schwachstellen”) zur Verfügung gestellt werden, die eine Weiterentwicklung der Behandlungskonzepte und damit letztlich bessere Rehabilitationsergebnisse ermöglichen sollen. Ein Vergleich der Qualitätsprofile von Rehabilitationseinrichtungen („benchmarking”) kann den Kostenträgern der Rehabilitationsmaßnahmen – neben wirtschaftlichen Gesichtspunkten (Pflegesatz) – außerdem wichtige Hinweise für die Zuweisungs- und Belegungssteuerung liefern. In der vorliegenden Arbeit werden Ergebnisse aus einem ersten Einsatz der Verfahren zur Messung von Patientenzufriedenheit und zur standardisierten Beurteilung der Prozeßqualität vorgestellt.  Bei einer vergleichenden Analyse der Patientenzufriedenheit in vier Rehabilitationskliniken mit orthopädisch/rheumatologischem Schwerpunkt fanden wir insgesamt eine hohe Zufriedenheit mit den Rehabilitationsmaßnahmen. In einigen Bereichen der Zufriedenheit ergaben sich zwischen den Kliniken jedoch signifikante Unterschiede.  Die Prozeßqualität, beurteilt durch ein Peer-Review-Verfahren, variiert zwischen 36 untersuchten Kliniken erheblich. Qualitätsprobleme fanden sich insbesondere in einigen für die Rehabilitation zentralen Dimensionen, so z.B. bei der Anamnese und Diagnostik von Fähigkeits- und Funktionsstörungen, bei der Berücksichtigung psychosozialer Belastungen und bei der sozialmedizinischen Stellungnahme.
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  • 28
    ISSN: 1432-1262
    Keywords: Key words Dyschezia ; Arismus ; Rehabilitation ; Kinesitherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Une dyschézie peut être causée par une dyssynergie du plancher pelvien qui survient lorsque se produit une contraction paradoxale ou, à l'inverse, un défaut de relaxation de la musculature du plancher pelvien au cours d'un effort de défécation. Certaines formes de training, tel le biofeedback, sont connues pour pouvoir aider certains patients à relácher la musculature striée du plancher pelvien au cours de l'exonération. Le but de notre étude a été de mettre au point un nouveau programme de réhabilitation bimodale en cas de dyssynergie pelvienne qui combine de la kinésithérapie pelvi-périnéale et do biofeedback ainsi que d'évaluer le résultat de ce traitement. Trente-cinq patients (âge: 28 à 64 ans; âge moyen: 42.5 ans) de l'unité ambulatoire de la Clinique de Chirurgie de l'Université de Florence en Italie et un groupe contrôle de 10 sujets de même âge (âge: 31 à 59 ans; moyen d'âge: 45.7) avec des habitudes d'exonération normales et sans trouble de la défécation ont étéétudiés. Les 35 patients étaient symptomatiques pur une dyschézie sans inertie colique et ont été diagnostiqués comme étant porteurs d'une dyssynergie du plancher pelvien (PFD): aucune évidence de lésion organique n'est présente mais tous démontrent, tant à la manométrie que lors d'examens radiologiques, des évidences de fonctions inappropriées du plancher pelvien. Tous les patients ont subi une réhabilitation bimodale à l'aide d'un programme d'entraînement combiné. Une évaluation clinique, une manométrie anorectale digitalisée et une défécographie ont été réalisées une semaine avant et un mois après la fin du traitement de réhabilitation bimodale. Le groupe de contrôle a été soumis à une manométrie et une défécographie. Les résultats ont été comparés à ceux des 35 patients avant et après traitement. Après le programme, tous les 35 patients ont montré une augmentation significative de la fréquence des selles (P〈0.001), une fréquence significativement abaissée de la consommation de laxatifs et de lavements pour induire l'exonération (P〈0.001). Après la réhabilitation bimodale, la manométrie anorectale digitalisée montre des résultats particuliers. La pression de repos du canal anal est augmentée mais pas de manière significative. Les données avant traitement qui montraient une durée réduite de la contraction volontaire maximale comparativement aux témoins étaient retournées à des valeurs normales. Le réflexe recto-anal inhibiteur avec une relaxation incomplète qui était plus bref que chez les contrôles s'est normaliséà la fin du traitement. Toutes les valeurs préthérapeutiques de réflexe anorectal inhibiteur montrent des différences significatives si on les compare à ceux des contrôles. Ces valeurs sont toutefois significativement différentes, particulièrement lorsque les valeurs pré- et postthérapeutiques sont comparées (P〈0.001). Aucune différence n'est retrouvée en ce qui concerne les paramètres de perception rectale et la compliance rectale de même que'en ce qui concerne les données avant et après la réhabilitation bimodale. Les défécographies préthérapeutiques montrent une indentation de la sangle puborectale et un défaut de l'ouverture de l'angle anorectal au cours de l'évacuation lorsque 50% du baryum est retenu. Après la kinésithérapie pelvi-périnéale et le biofeedback, l'indentation disparaït et le réflexe anorectal inhibiteur est allongé au cours de l'exonération (P〈0.001). Aucune différence n'est retrouvée après réhabilitation lorsque ces données sont comparées à celles de sujets contrôles. Le plancher périnéal est significativement abaissé (P〈0.001) qu'avant le début di programme. La technique de réhabilitation bimodale peut être considérée comme une option thérapeutique utile en cas de dyschézie fonctionelle. Les données cliniques et des évaluations manométriques et défécographiques confirment ces observations.
    Notes: Abstract Dyschezia may be caused by pelvic floor dyssynergia, which takes place when a paradoxical contraction or a failure to relax the pelvic floor muscles occurs during attempts to defecate. The aim of our study was to set up a new bimodal rehabilitation programme for pelvic floor dyssynergia, which combined pelviperineal kinesitherapy and biofeedback, and to evaluate the results of this treatment. Thirty-five patients (age range: 28–64 years; mean age: 42.5 years) from the outpatient unit of the Clinica Chirurgica of the University of Florence, Italy, and an age-matched group of 10 healthy control subjects (age range: 31–59 years; mean age 45.7 years) with normal bowel habits and without any defecatory disorders, were studied. The 35 patients were symptomatic for dyschezia without slow colonic transit and had been diagnosed as being affected by pelvic floor dyssynergia. No evidence of any organic aetiology was present but all demonstrated both manometric and radiological evidence of inappropriate function of the pelvic floor. All of the patients underwent bimodal rehabilitation, using the combined training programme Clinical evaluation, computerized anorectal manometry and defecography were carried out 1 week before and 1 week after a completed course in bimodal rehabilitation. The control group underwent manometric and defecographic examination. Their results were compared with those of the 35 patients before and after training. After the programme, all 35 patients had a very significant increase in stool frequency (P〈0.001), while laxative and enema-induced bowel movements had become significantly less frequent (P〈0.001). After bimodal rehabilitation, computerized anorectal manometry showed some peculiar results. Resting anal canal pressure had increased but not significantly. Pre-programme values that indicated a shorter duration (“exhaustio”) of maximal voluntary contraction than found in the controls had returned to normal values. The rectoanal inhibitory reflex (RAIR), with incomplete relaxation, which had been shorter than that of controls, became normal by the end of the rehabilitation. All RAIR parameters were significantly different especially when pre- and post-treatment values were compared (P〈0.001). No differences were found as regards rectal sensation parameters and rectal compliance between those before or after bimodal rehabilitation. Defecographic pre-treatment X-ray films showed indentation of the puborectalis and poor anorectal angle (ARA) opening, at evacuation, with trapping barium of at 50%. After pelviperineal kinesitherapy and biofeedback training, the indentation had disappeared and the ARA had become significantly larger (P〈0.001) during evacuation. No differences were found after rehabilitation, when both were compared with those of controls. The pelvic floor descent was also significantly deeper (P〈0.001) than before the start of the programme. The bimodal rehabilitation technique can be considered a useful therapeutic option for functional dyschezia as shown by our clinical evaluations, manometric data and defecographic reports.
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  • 29
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Neurologie ; Neuropsychologie ; Ambulante/teilstationäre Rehabilitation ; Umfrage ; Behandlung ; Key words Survey ; Neuropsychology ; Neurology ; Rehabilitation ; Out-patient ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Neurological-neuropsychological out-patient rehabilitation in Southern Germany is realized mostly by neurologists and neuropsychologists in out-patient practice. However, profile and quantity of treatment as well as the structure of the health system fail to meet the requirements of out-patient rehabilitation as described in the first part of the study.
    Notes: Zusammenfassung Die Analyse der aktuellen Versorgungssituation im Bereich der ambulanten neurologisch-neuropsychologischen Rehabilitation zeigt, daß vorwiegend niedergelassene Nervenärzte, Neurologen und Neuropsychologen auf diesem Gebiet tätig sind. Der dargestellte Bedarf an ambulanten Rehabilitationsmaßnahmen kann von diesen Behandlergruppen sowohl bezüglich Leistungsumfang als auch Leistungsprofil nur rudimentär abgedeckt werden. Weiterhin erweist es sich, daß bislang keine gesundheitspolitischen und infrastrukturellen Rahmenbedingungen etabliert sind, die die Grundlage einer effizienten ambulanten oder teilstationären neurologisch-neuropsychologischen Rehabilitation bilden.
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  • 30
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Ellenbogen ; Komplexe Fraktur ; Rehabilitation ; Key words Elbow ; Compound fracture ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Fractures of the elbow joint are quite rare compared with the total incidence of injuries to the extremities. However, elbow fractures often result in significant disability. Therefore in a retrospective study, we have evaluated criteria that are of prognostic value for late functional outcome. Sixty-four (10.3%) of 622 patients with closed elbow fractures and 107 (89%) of 119 patients with open elbow fractures underwent a physical examination. The mean follow-up time was 8.2 years. The functional outcome was recorded by a modified score (0 – max. 15) according to Morrey. Epidemiological data from both groups revealed a greater severity and higher degree of injury in open fractures than in closed fractures. In contrast, both groups presented a comparably good functional result. The most significant factor for poor outcome (score 〈5) was identified as nerve lesions. Among all nerve lesions in open fractures, 45% resulted in a functional score of 〈5; in 42% of closed fractures combined with a nerve lesion a similarly poor result was also noted. A second major factor appeared to be the method of primary therapy. An external joint transfixation resulted in a score of 〈5 in 32% of patients that were treated primarily by transfixation. In cases initially treated with open reduction and internal fixation, only 18.5% of open fractures and 3.1% of closed fractures presented a similar low score. According to our results the late functional outcome of elbow fractures depends less on the type of fracture than on the presence of a nerve lesion and the method of primary treatment, which should facilitate early mobilization.
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  • 31
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Neurologie ; Neuropsychologie ; Ambulante/ teilstationäre Rehabilitation ; Umfrage ; Key words Survey ; Neuropsychology ; Neurology ; Rehabilitation ; Out-patient
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary This study presents a survey on the demand for out-patient neurological-neuropsychological rehabilitation. Neurologists working in acute care and in in-patient rehabilitation settings as well as neurologists and neuropsychologists with out-patient practice were asked to rate the demand for and the present means to realize out-patient neuropsychological rehabilitation. The results show a great demand for out-patient rehabilitation. The preferred concept and model of out-patient rehabilitation depends on the setting where the participants of the study work with a tendency to favour flexible programs close to patients’ habitation.
    Notes: Zusammenfassung Dargestellt werden die Ergebnisse einer Umfrage zur ambulanten/teilstationären Rehabilitation bei Kliniken der neurologischen Akutversorgung, neurologischen Rehabilitationskliniken, niedergelassenen Nervenärzten, Neurologen und niedergelassenen Neuropsychologen. Von allen befragten Institutionen wird ein hoher Bedarf an ambulanten/teilstationären Rehabilitationsmaßnahmen artikuliert, wobei sich die bevorzugten Modelle und Konzepte in Abhängigkeit vom stationären und ambulanten Charakter der jeweiligen Institutionen deutlich unterscheiden. Über alle Untersuchungsteilnehmer zeichnet sich ein Trend zur Bevorzugung flexibler, wohnortnaher Angebote ab.
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  • 32
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Charcot-Marie-Tooth-I ; Syndrom ; Therapie ; Rehabilitation ; Molekulargenetische Diagnostik ; Key words Charcot-Marie-Tooth syndrome type I ; Management ; Rehabilitation ; Molecular genetic diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Molecular genetic research on Charcot-Marie-Tooth I syndrome (CMT I) progresses rapidly, still obviously no cure is available for affected individuals. Our aim was to investigate current management in clinical CMT I. 50 patients with Charcot-Marie-Tooth syndrome type I (CMT I) were explored for applied means of therapy and use of health care institutions. We documented the number of annual appointments at a neurologist, orthopaedist and psychologist. Previous admissions to hospitals and rehabilitation centres and surgical procedures were assessed. Practice of physiotherapy, occupational and physical therapy were investigated, also administered orthopaedic devices, mechanical devices and technical modification of car and home. Drugs prescribed were listed and the number of patients seeking advice at para-medical institutions was determined. Degree of medical support did not correlate with severity of disease. We observed that persons with marked disability did not uniformly receive adequate therapy. This was partly due to the responsible physicians, and partly due to lacking cooperation of the patients. Support of affected individuals and counselling to our opinion are to be improved. This would require further evaluation of therapies, establishment and distribution of guidelines, as well as motivation of patients, which might be facilitated by the offer of molecular genetic diagnostics.
    Notes: Zusammenfassung Während in der molekulargenetischen Diagnostik deutliche Fortschritte zu verzeichnen sind, stehen therapeutisch für die hereditäre Neuropathie Charcot-Marie-Tooth (CMT) z.Z. weiterhin lediglich supportive Maßnahmen zur Verfügung. Um zu überprüfen, inwieweit diese Maßnahmen Anwendung finden, bzw. ob eine Optimierung möglich erscheint, untersuchten wir an 50 CMT I Patienten aus dem norddeutschen Raum das Ausmaß ihrer Behinderung sowie die Beratung und Behandlung, die ihnen zuteil wurde. Frequenz von Arzt- bzw. Facharztterminen, Krankenhaus- und Rehabilitationsklinikaufenthalten, operative Interventionen, Krankengymnastik, physikalische Therapie, ergotherapeutische Beratung sowie die Versorgung mit orthopädischen und mechanischen Hilfsmitteln wurden erfaßt. Wir dokumentierten rezeptierte Medikamente und Anwendungen alternativer Heilmethoden. Die Auswirkungen auf das Arbeitsleben wurden registriert. Wir fanden keine Korrelation zwischen Schweregrad der Erkrankung und Art oder Intensität der Behandlung bzw. Versorgung. Nicht in allen Fällen erfolgte ein behinderungsadäquates Management; die Mängel lagen teils in der fehlenden Initiative der Behandelnden, teils in der mangelnden Kooperation der Patienten begründet. Von medizinischer Seite wäre eine verbesserte, effiziente Betreuung der Patienten mit CMT I anzustreben, wofür sich erneute Patientenkontakte, veranlaßt durch das Angebot molekulargenetischer Diagnostik, nutzen ließen.
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  • 33
    ISSN: 1433-7347
    Keywords: Key words Olecranization ; Posterior cruciate ligament ; Strain ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract The posterior cruciate ligament (PCL) restricts posterior translation of the tibia on the femur. Because flexion of the knee increases tension on the PCL, the knee is usually immobilized in extension after PCL repair or reconstruction. Patella-tibial transfixation (olecranization), however, has been proposed to reduce the tension on the PCL without requiring immobilization of the knee. The objective of this study was: (1) to evaluate the distribution of strain in the anterolateral and posterior oblique fiber bundles of the PCLs in eight cadaveric knees before and after olecranization and (2) to measure the patellofemoral contact pressures at various degrees of knee flexion. Olecranization significantly (P 〈 0.05) reduced the strain on the anterolateral fiber bundles of the PCL at 15°–45° of flexion. No significant strain reduction was observed in the posterior oblique fiber bundles. Patellofemoral contact pressures measured from digitized Fuji sensitive film indicated significantly increased contact pressures (P 〈 0.05) following olecranization from 0°–60° of knee flexion. Increased parapatellar soft tissue tightness limited knee flexion to 90° and patella lift-off occurred at 75°. Although olecranization of the patella does reduce strain on the intact PCL within a selected range of motion, the beneficial effect of allowing early motion may be negated by the potentially harmful effects imposed upon the patellofemoral articular cartilage by increased contact pressures.
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  • 34
    ISSN: 1434-4726
    Keywords: Laryngeal carcinoma ; Near-total laryngectomy ; Tracheopharyngeal voice shunts ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This prospective study analyzes the feasibility, oncologic safety and functional utility of Pearson's neartotal laryngectomy with tracheopharyngeal shunt (NTL-TPSS). The procedure was found to give gratifying locoregional control in 30 consecutive advanced T3 and selected T4 tumors involving the larynx (n = 11) and hypopharynx (n = 19) and managed at Kidwai Memorial Institute of Oncology, Bangalore, India. The oncologic “safety” of this technique was established in following examinations, ranging from 18 to 44 months (median, 22.2 months). A locoregional control rate of 74% was obtained. Lung-powered “shunt” speech was acquired with ease in periods ranging from 7 days in speakers deemed “excellent” (15/29) to 20 days in those deemed “satisfactory” (8/29). Except for a single case experiencing temporary aspiration of liquids, patients did not have any swallowing difficulties following removal of nasogastric tubes. The period of hospitalization averaged 22.6 days. The complication rate was 33%, with one patient death (3.3%) occurring. The dynamics of the TPSS were analyzed in selected “speakers” and “non-speakers”, using transcutaneous needle electromyography. Analysis of data supports the possibility of dynamic speech modulation. However, the favored anatomic location and design renders the shunts aspiration-proof rather than demonstrating any active sphincteric action.
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  • 35
    ISSN: 1590-3478
    Keywords: Stroke ; Cerebrovascular disease ; Rehabilitation ; Voluntary workers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario Lo studio è stato condotto per valutare i criteri di selezione e le caratteristiche dei pazienti che accedono alle risorse riabilitative dopo stroke acuto. Dal gennaio 1993 al febbraio 1994 sono stati reclutati in 13 ospedali lombardi 383 pazienti, seguiti con follow-up telefonico 4 mesi dopo l'ammissione allo studio. I dati sono stati raccolti da appartenenti alla Associazione Volontari Ospedalieri. La mortalità a 4 mesi è risultata del 23%. Fattore di selezione primaria per l'accesso alle risorse riabilitative è risultato essere il livello di disabilità. Fattore di selezione secondaria l'età. Le risorse riabilitative non sono risultate di fatto disponibili per i pazienti molto gravi o autosufficienti, queste vengono attribuite preferenzialmente ai pazienti giovani parzialmente dipendenti. Un intervento riabilitativo entro il primo mese è stato disponibile per meno del 50% dei pazienti in cui l'intervento stesso risulta indicato. Le carenze assistenziali per i pazienti anziani e per i lunghi tempi di intervento sottolineano la necessità di nuove modalità organizzative. I dati del presente lavoro indicano inoltre che associazioni di volontariato possono attuare la loro opera anche come osservatori del servizio sanitario. È necessario uno studio più completo per conoscere le reali dimensioni del problema e le caratteristiche cliniche e sociali della popolazione.
    Notes: Abstract The aim of this study was to evaluate the selection criteria and characteristics of the patients who have access to rehabilitation facilities after having experienced an acute stroke. Between January 1993 and February 1994, 383 patients were recruited in 13 hospitals in Lombardy, and telephonically followed up four months after study entry. The data were collected by members of the Associazione Volontari Ospedalieri (Hospital Volunteers' Association). The 4-month mortality rate was 23%. The primary selection criterion for gaining access to rehabilitation facilities was the degree of disability; the secondary factor was age. Rehabilitation facilities were not available to very severely afflicted or self-sufficient patients, but were preferentially made available to young, partially-dependent patients. A rehabilitative intervention within the first month was made available to fewer than 50% of the patients for whom it was indicated. The absence of care for elderly patients and the delay in its availability for those who actually receive it underline the need for new organisational methods. The data presented here also show that voluntary associations can work as observers of the health service. A more complete study is required in order to understand the real dimensions of the problem and the clinical and social characteristics of the population involved.
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  • 36
    ISSN: 1432-0932
    Keywords: Muscle response ; Sudden load ; Posture ; Low back pain ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of “sudden load” on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain patients. The subjects were fatigued by holding a 20% maximum voluntary contraction for 1 min. A functional restoration program was tested for its efficacy in reducing reaction time and EMG amplitude in chronic low back pain patients. Reaction time was longer and EMG amplitude lower in patients than in their matched controls. EMG reaction time and magnitude decreased in patients after a 2-week rehabilitation program, including specific training of coordination and posture control. The results of the modelling showed higher spinal compressive load and lower shear forces when the load was expected than when the load was unexpected. The effect of sudden loads can be exacerbated if a worker is not standing on a flat surface or is fatigued. Chronic low back pain patients have less ability to protect themselves from sudden loads, but they can be trained to improve their response by means of an appropriate rehabilitation program.
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  • 37
    ISSN: 1432-0460
    Keywords: Dysphagia ; Stroke ; Thermal stimulation ; Rehabilitation ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The present study had two purposes. The first was to provide variability data on objectively measured durational parameters of swallowing as accomplished by dysphagic patients secondary to stroke. The second was to examine the short-term effects of thermal application on these same durational measures. The study employed a cross-over design with each dysphagic stroke subject swallowing 10 times in both untreated and treated conditions. Two findings emerged: (1) swallowing durations in the 22 dysphagic stroke subjects were highly variable within and across subjects and have distributions that were nonnormal with nonhomogeneous variances; (2) thermal application reduced duration of stage transition (DST) and total swallow duration (TSD). Implications of these findings are discussed.
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  • 38
    ISSN: 1433-7339
    Keywords: Supportive care ; St. Petersburg ; Rehabilitation ; Quality of life ; Voluntary service ; Reach to recovery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The supportive care programme in St. Petersburg has existed for more than 10 years and works mainly with breast cancer patients. It includes physical procedures, psychotherapy and support given by volunteers of the Hope/Nadezhda Association, who operate in accordance with the Reach to Recovery International Programme. In the last stages the pain relief service is activated and has good results. The Anticancer/Antirak Society in St. Petersburg provides cancer patients with help and information. Our experience with this kind of care is described and some outcomes are reported.
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  • 39
    ISSN: 1432-1459
    Keywords: Hemi-neglect ; Functional recovery ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A study of the effect of specific training for visual neglect on the recovery of motor and functional impairment in stroke patients is reported. Two groups of right hemisphere stroke patients with hemispatial neglect and one group without neglect were assessed by means of three functional and neurological scales (Rivermead Mobility Index, Barthel Index, Canadian Neurological Scale). Three evaluations were made at 0, 2 and 4 months from the beginning of physical rehabilitation. During the first 2 months of physical rehabilitation one of the two groups of neglect patients was randomly assigned to specific training for neglect, and the second group to a general cognitive intervention; during the final 2 months of rehabilitation the types of training were switched in the two groups. The non-neglect patients improved steadily during physical rehabilitation. In contrast, the functional recovery of the two neglect groups was time-locked to the period of the specific training for neglect. At the time of admission, the two neglect groups performed at the same level; after 2 months of rehabilitation, the group with neglect training showed higher functional recovery than the group with only general cognitive intervention. When the latter group received neglect training, there was no longer any difference between the two neglect groups. This pattern was present for both of the functional scales used but not for the neurological scale. Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect.
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  • 40
    Electronic Resource
    Electronic Resource
    Springer
    Brain topography 9 (1996), S. 77-82 
    ISSN: 1573-6792
    Keywords: EEG computer analysis ; EEG mapping ; Ischemic stroke ; Rehabilitation ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Thirty-two patients suffering from a stroke due to a hemispheric infarct and treated in a rehabilitation department were studied for a period of three months. They were regularly assessed by quantified EEG and mapping (three measurements) and by quantitative measurements of their performances in motor ability, activities of daily living and speech (four measurements). No correlation was found between their clinical improvement and the modifications of their EEG. Similarly no correlation was found between the initial EEG data and the clinical outcome.
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  • 41
    ISSN: 1432-1459
    Keywords: Rehabilitation ; Spinal cord lesions, incomplete
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine the factors affecting the outcome of patients with incomplete spinal cord lesions, a retrospective study was performed of all such patients (n = 49) admitted to the neurorehabilitation unit of the National Hospital for Neurology and Neurosurgery, London, over a 2-year period. Disability on admission and discharge as measured by the Functional Independence Measure (FIM), change in disability, presence or absence of neurological recovery, patient age, level of the lesion and length of inpatient stay were the main outcome measures. Data were complete on 39 patients. There were 20 patients with cervical myelopathy, 15 with intrinsic cord abnormalities including syrinxes, 7 with spinal cord infarcts and 7 with other conditions such as tropical spastic paraparesis and hereditary paraparesis. Age ranged from 17 to 88 years (mean 53). Mean duration of stay was 40 days and the duration was related to the diagnosis. Nineteen of the patients made some neurological improvement, while all but one improved on the FIM. This functional gain did not correlate with the patients' age, initial disability or level of the lesion, but was related to the length of stay in the unit, and neurological improvement. We conclude that the needs of patients with progressive incomplete spinal cord lesions due to neurological disease differ from those of patients with acute traumatic spinal cord lesions and are best managed in a neurological rehabilitation unit. Efficacy appears to be related to neurological recovery and the duration of rehabilitation. This study underlines the value of combined neurological and rehabilitation. expertise in the management of this patient group and the need to incorporate both disciplines in planning service provision.
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  • 42
    ISSN: 1432-1076
    Keywords: Myelomeningocele ; Psychosocial ; Rehabilitation ; Social ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to recognize the possible psychological advantages when children with a severe CNS disorder like myelomeningocele (MMC) are given very early rehabilitation treatment. One hundred and seven newborns with MMC seen between 1971–1992 were prospectively analysed with respect to two different therapeutic approaches. The children born during the period 1971–1980 did not receive very early therapeutic rehabilitation treatment, whereas those born during the period 1981–1992, received this treatment. In the latter group, special attention was paid to support an improvement in the difficult relationship between the parents and the child with MMC as well as between parents and caregivers. The following statistically significant differences between the two treatment programmes were found: (1) all children achieved independent locomotion at 5 years, in the very early intervention group, compared to only 35% (P〈0.001) in the group without this programme. Orthopaedic operations in the first-mentioned group were markedly reduced; (2) urological surgery decreased drastically in the group with very early urodynamic rehabilitation. Thus, there were 0.6 operations per patient in the older group, but only 0.06 operations per patient in the younger one (P〈0.001); (3) normal schooling was reached by 76% (22/29) and social continence by 80% (23/29) of the children with very early interventional therapy. In the older group only 54% reached normal schooling (P〈0.05) and 29% social continence (P〈0.001). The very early co-ordinated medical and physiotherapeutic rehabilitation treatment of children with MMC usually reduces the psychosocial stress and improves the quality of life of these children and of their families.
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  • 43
    ISSN: 1433-7339
    Keywords: Radiotherapy ; Chemotherapy ; Maxillectomy ; Prosthodontics ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae has become an often overlooked priority of the treatment team. We describe a philosophy of management of the cancer patient that specifically emphasizes the prevention and treatment of oral complications associated with cancer therapy. These concepts and principles are based on treatment protocols and ongoing clinical research at The University of Texas M. D. Anderson Cancer Center in Houston, Texas.
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  • 44
    Electronic Resource
    Electronic Resource
    Springer
    Supportive care in cancer 3 (1995), S. 428-431 
    ISSN: 1433-7339
    Keywords: Rehabilitation ; Self-concept ; Breast forms ; Breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract After mastectomy restoration of body symmetry, a very important aspect of coping with daily life, may be achieved either using breast forms that are suspended in a brassière or by a new system in which breast forms are attached by adhesive strips to the thorax walls. The system promises free and easy movement, favourable effects on lymphoedema, and improvements with respect to dressing. Brassières are not necessarily needed. The influence of improved prosthetics on patients' self concept and well-being was investigated. A group of 67 patients after unilateral mastectomy tested custom breast forms and self-adhesive breast forms. Using the Frankfurter Selbstkonzeptionsskalen (Frankfurt Self-Concept Scales), plus additional questions concerning problems after mastectomy, self-concept was assessed before study and after 3 months. Analysis of variance with repeated measures revealed significant differences with respect to the scale Social Contact and Relations (FSKU). Most patients were better satisfied with epicutaneous self-adhesive breast forms. The weight and type of movement of the selfadhesive breast forms were considered natural, and adhesive strips were well tolerated. A total of 78% were able to wear more fashionable clothing. Breast reconstruction became less important for 62%. The new concept of self-adhesive breast forms is an improvement with respect to social and psychological rehabilitation.
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  • 45
    ISSN: 1432-0932
    Keywords: Low back pain ; Rehabilitation ; Physical fitness ; Psychological pain management ; Occupational medicine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Several new studies have indicated that an active approach to patients with chronic disabling low back pain (LBP) seems effective. Some of these studies emphasize the importance of dealing with the patient's total situation in comprehensive multidisciplinary programs — the bio-psycho-social model. However, these programs are expensive. The aim of this study was to evaluate the rehabilitation outcome from three different active programs in terms of: (1) return-to-work rate, (2) days of sick leave, (3) health-care contacts, (4) pain and disability scores, and (5) staying physically active. The subjects included 132 patients randomized to the study, of whom 123 started one of the treatment programs. They had all had at least 6 months of chronic LBP. The patients were randomized into one of three programs: group 1 — a full-time, intensive 3-week multidisciplinary program, including active physical and ergonomic training and psychological pain management, followed by 1 day weekly for the subsequent 3 weeks; group 2 — active physical training, twice a week for 6 weeks, for a total of 24h; group 3 — psychological pain management combined with active physical training, twice a week for 6 weeks, also for a total of 24h. The results presented here are based on data collected 4 months following treatment, which shows an 86% response rate. The initial examination and the follow-up evaluation were performed by a blinded observer. The results show that 4 months after treatment, the intensive multidisciplinary program is superior to the less intensive programs in terms of return-to-work rate, health-care contacts, pain and disability scores, and staying physically active. In conclusion, it seems that although the multidisciplinary program is initially expensive compared to the less intensive programs, the savings in sick pay, early retirement pensions, and health care contacts make it economically worthwhile. Long-term follow-up will show whether this effect continues.
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  • 46
    ISSN: 1434-9949
    Keywords: Ankylosing Spondylitis ; Spinal Mobility ; Rehabilitation ; Exercise ; Follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Long-term effects of three or four-week inpatient physiotherapy and exercise courses were studied in 141 adult patients with ankylosing spondylitis (AS). Eight cervical and thoracolumbar range of motion (ROM) measurements and straight leg raise test, vital capacity (VC) and fitness index were measured at the beginning and end of an intensive course and 15 months later. All nine mobility measurements, vital capacity and fitness index were significantly improved after the course. Fifteen months later only chest expansion and vital capacity had significantly deteriorated from the baseline, while CR, FFD and fitness index were still significantly better. Disease duration did not influence treatment results. We conclude that it is possible by means of intensive rehabilitation courses to prevent for more than one year deterioration of spinal function and fitness in AS patients irrespective of disease duration.
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  • 47
    ISSN: 1590-3478
    Keywords: Bibliometrics ; Research ; Neurology ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario La riabilitazione è scarsamente rappresentata nella letteratura neurologica sulle patologie che causano disabilità. Gli Autori hanno interrogato la banca-dati Medline nella ricerca degli articoli pubblicati fra il Gennaio 1991 ed il Giugno 1994 sotto le parole-chiave Stroke, Parkinson's disease, Multiple Sclerosis, Brain injury, Ataxia e Dementia. È stato poi eseguito un incrocio con la parola-chiave secondaria Riabilitazione. La prima ricerca ha prodotto 27724 articoli mentre la seconda ne ha prodotti 1272 (4.6%). Nel 1992 il Journal of Citation Reports (JCR) ha attribuito alle Riviste che hanno pubblicato articoli con tema riabilitativo un Impact Factor (IF) medio di 0.7–2.8 (mediana 1.8), pari al 31–90% (a seconda della parola-chiave principale: mediana delle percentuali 68%) dell'IF medio attribuito alle Riviste che hanno pubblicato soltanto articoli su temi non riabilitativi. In questo studio è stato definito come peso della letteratura il prodotto del numero di articoli per l'IF delle rispettive Riviste (IF=0 per le Riviste non censite dal JCR). A seconda delle diverse patologie neurologiche, il peso della letteratura riabilitativa variava fra 0.1 e 7% (mediana 2%) del peso della letteratura non riabilitativa. I risultati suggeriscono che la Neurologia sia ancora riluttante ad affrontare la sfida che le pone la disabilità.
    Notes: Abstract Rehabilitation is under-represented in the neurological literature on disabling diseases. A Medline search was conducted to retrieve the articles published between January 1991 and June 1994 under the main headings of Stroke, Parkinson's disease, Multiple sclerosis, Brain injury, Ataxia and Dementia. These were then combined with the sub-heading Rehabilitation. The former search yielded 27724 articles, the latter 1272 (4.6%). In 1992, the Journal of Citation Reports (JCR) assigned to Journals publishing rehabilitation papers an average Impact Factor (IF) of 0.7–2.8 (median 1.8): that is, 31–90% (depending on the various main headings, median 68%) of the average IF given to Journals publishing non-rehabilitation papers. In the present study, the weight of the literature was defined as the product of the number of articles multiplied by the IF of the corresponding Journal (IF=0 for non-JCR Journals). Across the various neurologic conditions, the weight of the Rehab literature was 0.1–7% (median 2%) of the weight of the non-Rehab literature. The results suggest that neurology is still reluctant to face the disability challenge.
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  • 48
    Electronic Resource
    Electronic Resource
    Springer
    Documenta ophthalmologica 90 (1995), S. 99-105 
    ISSN: 1573-2622
    Keywords: Visual Impairment ; Rehabilitation ; Visual performance ; Visual assessment ; Visual functions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The last two decades a shift took place from substitutional/compensatory training to utilisation of residual vision regarding rehabilitation of the visually impaired. Some of the visually impaired are able to use their visual perception nearly as complete as normal seeing people in spite of a severe visual disability. On the other hand, people with nearly normal functions can be severely visually handicapped. To illustrate this, two cases are presented. The first case is a man, aged 47 years, with a juvenile macular degeneration on both eyes. In spite of a very low visual acuity of less then 0.05, he finished an university education and he is able to maintain himself very well in a leading position in a scientific environment, by using adequate low vision devices. Also for his leisure activities, as photography and speed skating, he relies upon visual perception. The second case is a woman, aged 30 years, with nearly normal visual functions, who is not able to read for longer periods caused by conflicting information from the body- and eye movements, and the visual input. This causes sickness during reading. She is unable to use books for her study and is working with recordings on tape. The results of a comprehensive visual assessment will be related to the specific low vision devices and its use.
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