PMR Buzz Magazine_April 2022.pdf

PMR
BUZZ
Volume 2, Issue 3, April 2022
Contributors:
• Dr. Ravi Gaur, Associate Professor,
Department of PMR, AIIMS, Jodhpur.
• Dr. Navin BP, Assistant Professor,
Department of Neurorehabilitation,
NIMHANS, Bengaluru.
• Dr. Mahima Agrawal, Assistant Professor,
Department of PMR, JLN Medical
College, Ajmer.
• Dr. Harleen Uppal, Associate Professor,
Dept. of PMR, AIIMS, Nagpur.
• Dr. Vinay Goyal, Associate Professor,
Dept. of PMR, AIIPMR, Mumbai.
Editor & Contributor:
• Dr. Mrinal Joshi, Director & Professor
(PMR), Rehabilitation Research Centre,
SMS Medical College, Jaipur.

Moderate effect of ankle foot orthosis versus ground reaction ankle foot
orthosis on balance in children with diplegic cerebral palsy.
Sanad, Doaa Ahmed
Prosthetics and Orthotics International: February 2022 - Volume 46 - Issue 1 - p 2-6
Abstract
Background
The children with diplegic cerebral palsy (CP)
commonly have abnormal alignment of lower
extremities affecting their abilities of keeping balance.
Orthoses are one of the many approaches that can be
prescribed to improve balance and walking in diplegic
children.
Objective
This study was conducted to assess the moderate effect
of solid ankle foot orthosis (AFO) vs. the ground
reaction ankle foot orthosis (GRAFO) on balance in
children with diplegic CP.
Study design
A randomized controlled trial.
Methods
Thirty children with spastic diplegic CP from both
genders participated in this study; their ages were
between 6 and 9 years. They were divided randomly
into two study groups of equal numbers; the first study
group A received the regular physical therapy program
besides wearing the AFO for successive three months.
The second study group B received the regular physical
therapy program besides wearing the GRAFO for
successive 3 months. All childrens' balance was
evaluated before starting the treatment program and
after 3 months by using the Biodex balance system
(anteroposterior and mediolateral stability indices).
Results
There were significant improvement of all stability
indices in both groups (P < 0.05), with significant
difference between groups when comparing post-
treatment mean values of the measured indices in favor
to study group B (P < 0.05).
Conclusion
The GRAFO achieved more balance control in children
with spastic diplegic CP compared with solid AFO.
1

2
Non-rigid lumbar supports for the management of non-specific low back
pain: A literature review and meta-analysis.
Paul Gignoux, Charlotte Lanhers, Frédéric Dutheil, Laura Boutevillain, Bruno Pereira, Emmanuel Coudeyre.
Annals of Physical and Rehabilitation Medicine. 2022 Jan;65(1): 101406
Abstract
Background
Clinical practice guidelines for non-specific low back
pain do not recommend the use of non-rigid lumbar
supports (NRLSs) despite the publication of several
positive randomized controlled studies.
Objective
We conducted a systematic review with meta-analysis
to assess the efficacy of NRLSs in the treatment and
prevention of non-specific low back pain.
Methods
We searched for reports of randomized controlled
trials in PubMed, Cochrane Library, EMBASE, Science
Direct and Pedro databases. Data were analyzed by
disease stage (acute, subacute, and chronic) and type of
prevention (primary and secondary). The analysis of
methodological quality involved the Physiotherapy
Evidence Database (PEDro) scale.
Results
Of the 1581 records retrieved, only 4 full-text articles
were included, with 777 patients: 378 in the NRLS
group, and 348 in the control group. NRLSs conferred
greater amelioration of disability (effect size -0.54, 95%
CI -0.90; -0.17) and pain (-0.29, -0.46; -0.12) than
standard management. Insufficient data prevented a
comparison of the efficiency for acute, subacute and
recurrent low back pain as well as meta-regression of
responder phenotypes (sociodemographic and other
patient characteristics).
Conclusion
We demonstrated the overall efficacy of NRLSs for
both disability and pain. However, further studies are
needed to assess which patients can benefit the most
from lumbar supports based on patient phenotype and
the characteristics of low back pain.

3
Pregnancy, labor, and delivery outcomes of women with and without
spinal cord injury.
McLain AB, Zhang L, Troncale J, Chen YY, Kalpakjan C
J Spinal Cord Med. 2022 Feb 2:1-9.
Objectives
Compare outcomes in pregnant women with and
without Spinal Cord Injury (SCI).
Design
Case study and inception cohort comparison.
Setting
Community, primary care/referral center and
university practice.
Participants
Twenty-eight pregnant women (12 with SCI (=PW-
SCI) and 16 without SCI (=PW-AB)) were enrolled. Six
PW-SCI left study and six completed data collection
and were matched, by age, parity, and race, with 12
PW-AB (1:2 ratio, respectively). Final analysis included
18 (78%) subjects.
Interventions
Not applicable.
Main Outcome Measures
Utilizing standardized, templated medical records
(published by NIH/NICHHD and DHHS) and self-
report, prospective, longitudinal and retrospective
details of pregnancy, labor and delivery
experiences/complications were recorded for all
women and their neonates. Data collection included
vital signs, urinalysis, pregnancy-related
conditions/complications (i.e. UTIs, hyperglycemia),
and labor, delivery, fetal outcomes. For PW-SCI,
demographics, occurrences of autonomic dysreflexia
(AD), pressure sores, worsening SCI conditions (i.e.
spasticity, bladder spasms, lost independence) were
recorded.
Results
PW-SCI had statistically greater (P < .05) UTIs than
PW-AB (three (50%) to 0 (0%), respectively). One PW-
SCI (17%) reported pressure sores and one AD. Three
(50%) PW-SCI and 4 (33%) PW-AB experienced a
complication at delivery. Newborn mean birth weight
(2854 g vs 3578 g; P = 0.12), and length (49.3 vs 45.8 cm;
P = 0.32) were lower for PW-SCI than PW-AB. Head
circumference was significantly less for PW-SCI than
PW-AB (30.3 vs 34.5 cm; P = 0.04).
Conclusions
Women with SCI tend to have more complicated
courses of pregnancy, labor and delivery and smaller
newborns than non-SCI peers. Neonatal head
circumference is significantly smaller.

4
Modulation of Metacognitive Confidence Judgments Through Provision of
Performance Feedback in Moderate to Severe Traumatic Brain Injury.
Chiou KS, Klecha H, Jones M, Dobryakova E.
Journal of head trauma rehabilitation. 2022 Mar 26;37(2):71-8.
Abstract
Objective
Traumatic brain injury (TBI) may result in
metacognitive impairments. Enhancing memory in
healthy adults can improve metacognitive accuracy, but
it is unclear whether such interventions apply to
individuals with TBI. This study examined the effects of
manipulating target memory experiences on
metacognitive accuracy in TBI.
Participants
Fourteen community-dwelling adults with TBI and 17
healthy controls.
Main Measures
Memory was manipulated through performance
feedback (monetary, nonmonetary, or none)
presented during a word-pair learning task.
Recognition of the word pairs was assessed, and
metacognition was evaluated by retrospective
confidence judgments.
Results
Both groups demonstrated greater recognition
performance for items learned with nonmonetary
feedback. Healthy individuals demonstrated improved
metacognitive accuracy for items learned with
nonmonetary feedback, but this effect was not seen in
individuals with TBI. A notable (but statistically
nonsignificant) effect was observed whereby adults
with TBI overestimated performance for items learned
with monetary feedback compared with other
feedback conditions.
Conclusion
Provision of feedback during learning enhances
recognition performance. However, target memory
experiences may be utilized differently after injury to
facilitate confidence judgments. In addition, the type of
feedback provided may have different effects on
metacognitive accuracy. These results have
implications for rehabilitative efforts in the area of
memory and metacognition after injury.

5
Poststroke aphasia treatment: A review of pharmacologic therapies and
noninvasive brain stimulation techniques.
Capizzi AN, Woo JE, Magat E.
The Journal of the International Society of Physical and Rehabilitation Medicine. 2022 Jan 1;5(1):1.
Abstract
Aphasia is a common complication of stroke, often
causing significant morbidity. To the authors'
knowledge, no stroke recovery practice guidelines
incorporating pharmacologic or noninvasive brain
stimulation (NIBS) therapies for poststroke aphasia
(PSA) exist. The aim of this article is to provide a
comprehensive review of the evidence regarding
pharmacologic and NIBS treatment in PSA. An
exhaustive single database search assessing treatment
for PSA was performed from 2010 to 2020, resulting in
1876 articles. Articles evaluating either pharmacologic
management or NIBS were included. Case reports,
case series, original research, systematic reviews, and
meta-analyses were allowed. Pharmacologic treatment
studies included were represented by the following
medication classes: cholinergic, dopaminergic, gamma-
aminobutyric acid agonists and derivatives, N-methyl-
D-aspartate receptor antagonists, serotonergic, and
autonomic agents. NIBS treatment studies regarding
transcranial direct current stimulation (tDCS) or
repetitive transcranial magnetic stimulation (rTMS)
were evaluated. No strong evidence was found for any
medication to improve PSA. However, the benefit of a
medication trial may outweigh the risk of side effects as
some evidence exists for functional recovery.
Regarding NIBS, weak evidence exists for the
treatment effect of tDCS and rTMS on PSA. While
additional research is needed, the literature shows
promise, especially in chronic phase of stroke when
traditional treatment options may be exhausted. More
evidence with larger studies and standardized study
design is needed.
Keywords: Aphasia, stroke rehabilitation, transcranial
direct current stimulation, transcranial magnetic
stimulation

6
Lesion location may attenuate response to strategy training in acute
stroke.
Elizabeth R. Skidmore PhD, OTR/L,Minmei Shih PhD, OTR/L,Lauren Terhorst PhD,Erin E O'Connor MD
PM&R. 2022 Mar;14(3):329-36.
Abstract
Background
Strategy training, a rehabilitation intervention, reduces
disability and improves functional skills associated with
goal-directed behavior. Stroke lesions impacting
selected ventromedial regions of interest associated
with initiation of goal-directed behavior may attenuate
intervention response. If so, strategy training may not
be optimal for people with stroke lesions in these
regions.
Objective
To examine whether ventromedial regions of interest
attenuate changes in disability status attributed to
strategy training.
Design
Secondary analysis of data from two randomized
controlled clinical trials.
Setting
Inpatient stroke rehabilitation.
Participants
People with acute stroke diagnosis and available
diagnostic studies enrolled in inpatient rehabilitation
randomized controlled studies between 2009 and
2017.
Intervention
Participants were randomized to strategy training or a
control condition in addition to the usual care during
inpatient rehabilitation.
Main Outcome Measures
Diagnostic magnetic resonance imaging studies were
retrieved from electronic medical records, and stroke
lesion location was characterized by a neuroradiologist.
Intervention response was defined by Functional
Independence Measure change scores of 22 points or
greater.
Results
Only 186 of 275 participants had diagnostic studies
available; 13 patients showed no apparent lesion on
their diagnostic study. Among 173 cases, 156 had
complete data at discharge (strategy training n = 71,
control n = 85). Twenty-five cases had a lesion within a
region of interest (strategy training n = 14, control n =
11). Intervention response was attenuated in the
strategy training group for those with lesions in regions
of interest [ 2(1, n = 71) = 4.60, P = .03], but not for
those in the control group [Fisher exact test, n = 85, P =
.19).
Conclusions
Lesions in the ventromedial regions of interest may
attenuate response to strategy training.

7
Effects of whole-body vibration therapy on knee osteoarthritis: A
systematic review and meta-analysis of randomized controlled trials.
Chen Guang QI, Chun Sing CH, Simon Kwoon Ho CH, Wing-Hoi CHEUNG RM.
Journal of Rehabilitation Medicine. 2022;54.
Abstract
Introduction
Knee osteoarthritis is a leading cause of disability and
medical costs. The effect of whole-body vibration in
knee osteoarthritis is controversial. The aim of this
study was to assess the effects and safety of whole-body
vibration on pain, stiffness, physical function, and
muscle strength in patients with knee osteoarthritis.
Methods
PubMed, Scopus, Web of Science, Physiotherapy
Evidence Database (PEDro) and EMBASE databases
were searched (date last accessed 1 April 2021) using
the key words “vibration” and “knee osteoarthritis”, to
identify all randomized controlled trials related to
whole-body vibration and knee osteoarthritis.
Outcomes related to pain, stiffness, physical function,
muscle strength, adverse events were included. The
risk of bias and quality were assessed by the Cochrane
Collaboration tool and PEDro scale. A systematic
review and meta-analysis were performed. Subgroup
analysis was performed for low- and high-frequency
interventions.
Results
A total of 14 randomized controlled trials involving 559
patients with knee osteoarthritis met the inclusion
criteria. Nine studies were good-quality trials (PEDro
score=6–8), and 5 studies were fair quality trials
(PEDro score=4–5). Ten studies were included in the
meta-analysis. One study showed negative effects of
whole-body vibration on knee osteoarthritis. The
duration of whole-body vibration ranged from 4 to 24
weeks. Meta-analysis revealed that whole-body
vibration with strengthening exercises has a significant
treatment effect on pain score (standardized mean
difference (SMD) = 0.46 points, 95% confidence
interval (95% CI) = 0.20–0.71, p = 0.0004), the Western
Ontario and McMaster Universities Osteoarthritis
Index (WOMAC-function) (SMD = 0.51 points, 95% CI
= 0.27–0.75, p < 0.0001), Timed Up and Go (TUG) test
(SMD = 0.82 points, 95% CI = 0.46–1.18, p < 0.00001),
extensor isokinetic peak torque (SMD = 0.65 points,
95% CI = 0.00–1.29, p = 0.05), peak power (SMD = 0.68
points, 95% CI = 0.26–1.10, p = 0.001), and extensor
isometric strength (SMD = 0.44 points, 95% CI =
0.13–0.75, p = 0.006). Both low-frequency (10–30 Hz)
and high-frequency (30–40 Hz) whole-body vibration
were associated with significant changes in pain,
physical function, and knee extensor strength (p <
0.05). WBV was not associated with significant changes
in stiffness, balance ability, quality of life, and knee flexor
strength. No adverse events were reported.
Conclusion
Meta-analysis showed that low-frequency and high-
frequency whole-body vibration had additional positive
effects compared with strengthening exercises alone
on pain, knee extensor muscle strength, and physical
function in individuals with knee OA. Whole-body
vibration with strengthening exercises can be
incorporated into treatment protocols.

8
Highly cushioned shoes improve running performance in both the absence
and presence of muscle damage.
Black MI, Kranen SH, Kadach S, Vanhatalo A, Winn B, Farina EM, Kirby BS, Jones AM.
Medicine and science in sports and exercise. 2022 Apr;54(4):633.
Abstract
Purpose
We tested the hypotheses that a highly cushioned
running shoe (HCS) would 1) improve incremental
exercise performance and reduce the oxygen cost (Oc)
of submaximal running, and 2) attenuate the
deterioration in Oc elicited by muscle damage
consequent to a downhill run.
Methods
Thirty-two recreationally active participants
completed an incremental treadmill test in an HCS and
a control running shoe (CON) for the determination of
Oc and maximal performance. Subsequently,
participants were pair matched and randomly assigned
to one of the two footwear conditions to perform a
moderate-intensity running bout before and 48 h after a
30-min downhill run designed to elicit muscle damage.
Results
Incremental treadmill test performance was improved
(+5.7%; +1:16 min:ss; P < 0.01) in the HCS when
assessed in the nondamaged state, relative to CON.
This coincided with a significantly lower Oc (-3.2%; -6
mL•kg-1•km-1; P < 0.001) at a range of running speeds
and an increase in the speed corresponding to 3 mM
blood lactate (+3.2%; +0.4 km•h-1; P < 0.05). As
anticipated, the downhill run resulted in significant
changes in biochemical, histological, and perceptual
markers of muscle damage, and a significant increase in
Oc (+5.2%; 10.1 mL•kg-1•km-1) was observed 48 h
post. In the presence of muscle damage, Oc was
significantly lower in HCS (-4.6%; -10 mL•kg-1•km-1)
compared with CON.
Conclusions
These results indicate that HCS improved incremental
exercise performance and Oc in the absence of muscle
damage and show, for the first time, that despite
worsening of Oc consequent to muscle damage,
improved Oc in HCS is maintained.

9
Jumping stump phenomenon: A case report.
Rombauts M, Duinslaeger E, Peers K, Kiekens C.
Prosthetics and Orthotics International. 2022 Apr 1;46(2):191-4.
Abstract
Case description
The jumping stump phenomenon is a peripherally
induced movement disorder that is due to peripheral
nerve damage. We report on a very resistant case in
which different treatment strategies were applied.
Objectives
To inform physicians about this condition, its
implications, and treatment options.
Study design
Case report of a 52-year-old man with a transtibial
amputation, experiencing very painful involuntary
muscle contractions in the residual limb.
Treatment and outcomes
Various drug treatments, including baclofen, diazepam,
clonazepam, clotiazepam, pramipexole, and pregabalin,
peroneal nerve block, prosthesis modifications, and
physiotherapy were ineffective for our patient.
Botulinum toxin A treatment showed temporary
decrease of symptoms but was not repeated because of
high cost for the patient and his fear of injections. In our
case, tibial nerve neuroma had no ectopic trigger zone,
so local treatment was not indicated. Surgical
interventions, based on contraction location and
muscle tension, were partially successful. Eventually,
due to serious functional and psychological impact, a
transfemoral amputation was performed, with
complete resolution of symptoms but recurrence later
that year. Relapse was correlated with recurrence of
local residual limb pain.
Conclusions
Treating this phenomenon remains challenging because
pathophysiology is still not fully understood, and the
available literature is limited. A multiprofessional and
interdisciplinary treatment approach is recommended,
and botulinum toxin treatment is promising.

10
Relationship Between CT Head Findings and Long-term Recovery in
Children with Complicated Mild Traumatic Brain Injury.
Hansen C, Waller LC, Brady D, Teramoto M.
Brain Injury. 2022 Feb 7:1-0.
Primary objective
Complicated mild traumatic brain injury (C-mTBI)
refers to CT positive patients with clinically mild TBI.
This study investigates the association between CT
head findings at time of injury and recovery of
paediatric patients with C-mTBI.
Research design
Retrospective survey and chart review.
Methods
For paediatric patients with C-mTBI (N = 77), CT
findings associated with corresponding degree and
lengths of recovery from C-mTBI using logistic
regression analysis.
Results
There was a trend that the odds of incomplete
recovery at the time of survey was higher for older
children than for younger children (OR = 1.14, 95% CI
= 0.98–1.32, p = 0.072). There was a trend that the
odds of incomplete recovery (OR = 6.26, 95% CI =
0.97–40.57, p = 0.054) and longer duration for
recovery (OR = 8.14, 95% CI = 0.78–84.46, p = 0.079)
was higher for children with multiple haemorrhagic
contusions than those with single haemorrhagic
contusion. No other imaging patterns predicted degree
or length of recovery with statistical significance (p >
0.05).
Conclusions
Other than the presence of multiple haemorrhagic
contusions, no other pattern of imaging abnormality in
paediatric C-mTBI appears to be associated with
degree or length of recovery. Further studies with
larger cohorts are encouraged.

11
Assisted Movement With Proprioceptive Stimulation Augments
Recovery From Moderate-To-Severe Upper Limb Impairment During
Subacute Stroke Period: A Randomized Clinical Trial.
Cordo P, Wolf S, Rymer WZ, Byl N, Stanek K, Hayes JR.
Neurorehabilitation and Neural Repair. 2022 Feb;36(3):239-250.
Background
Robotic assisted movement has become an accepted
method of treating the moderately-to-mildly impaired
upper limb after stroke.
Objective
To determine whether, during the subacute phase of
recovery, a novel type of robotic assisted training
reduces moderate-to-severe impairment in the upper
limb beyond that resulting from spontaneous recovery
and prescribed outpatient therapy.
Methods
A prospective, randomized, double-blinded, placebo-
controlled, semi-crossover study of 83 participants.
Over 6- to 9-weeks, participants received 18, 30-min
training sessions of the hand and wrist. The test
intervention consisted of assisted motion, biofeedback,
and antagonist muscle vibration delivered by a robotic
device. Test Group participants received the test
intervention, and Control Group participants received
a placebo intervention designed to have no effect.
Subsequently, Control Group participants crossed
over to receive the test intervention.
Results
At enrollment, the average age (±SD) of participants
was 57.0 ± 12.8 year and weeks since stroke was 11.6 ±
5.4. The average Fugl-Meyer baseline score of Test
Group participants was 20.9, increasing by 10.8 with
training, and in Control Group participants was 23.7
increasing by 6.4 with training, representing a significant
difference (4.4) in change scores (P = .01). During the
crossover phase, Control Group participants showed a
significant increase in FMA-UL score (i.e., 4.7 ± 6.7
points, P = .003) as well as in other, more specific
measures of impairment.
Conclusions
Robotic impairment-oriented training, as used in this
study, can significantly enhance recovery during the
subacute phase of recovery. Spontaneous recovery and
prescribed outpatient therapy during this phase do not
fully exploit the potential for remediating moderate-to-
severe upper limb impairment.

12
Characteristics of the severely impaired hand in survivors of stroke with
chronic impairments.
Barry AJ, Kamper DG, Stoykov ME, Triandafilou K, Roth E.
Topics in Stroke Rehabilitation. 2022 Mar 24:181-91.
Background
Diminished sensorimotor control of the hand is one of
the most common outcomes following stroke. This
hand impairment substantially impacts overall function
and quality of life; standard therapy often results in
limited improvement. Mechanisms of dysfunction of the
severely impaired post-stroke hand are still
incompletely understood, thereby impeding the
development of new targeted treatments.
Objectives
To identify and determine potential relationships
among the mechanisms responsible for hand
impairment following stroke
Methods
This cohort study observed stroke survivors (n = 95)
with severe, chronic hand impairment (Chedoke-
McMaster Hand score = 2–3). Custom instrumentation
created precise perturbations and measured kinematic
responses. Muscle activation was recorded through
electromyography. Strength, spasticity, muscle
relaxation time, and muscle coactivation were
quantified.
Results
Maximum grip strength in the paretic hand was only
12% of that achieved by the nonparetic hand, and only 6
of 95 participants were able to produce any net
extension force. Despite force deficits, spastic reflex
response of the finger flexor evoked by imposed
stretch averaged 90.1 ± 26.8% of maximum voluntary
activation, relaxation time averaged 3.8 ± 0.8 seconds,
and coactivation during voluntary extension exceeded
30% of maximum contraction, thereby resulting in
substantial net flexion. Surprisingly, these hypertonicity
measures were not significantly correlated with each
other.
Conclusions
Survivors of severe, chronic hemiparetic stroke
experience profound weakness of both flexion and
extension that arises from increased involuntary
antagonist activation and decreased voluntary
activation. The lack of correlation amongst
hypertonicity measures suggests that these phenomena
may arise from multiple, potentially independent
mechanisms that could require different treatments.

13
Guideline for the management of neurogenic bowel dysfunction in spinal
cord injury/disease.
Kurze I, Geng V, Böthig R.
Spinal cord. 2022 Mar 25:1-9.
Introduction
Almost all people with spinal cord injury/disease
(SCI/D) suffer from neurogenic bowel dysfunction
(NBD), with a considerable impact on quality of life.
The Association of the Scientific Medical Societies in
Germany (AWMF e.V.) guideline for NBD in SCI/D
aims to provide practice-oriented support for the care
of patients with NBD resulting from congenital or
aquired SCI/D. The guideline describes the diagnosis
and bowel management of NBD in people with SCI/D.
Thus, treatment processes in acute medical care and
rehabilitation as well as for lifelong aftercare are
presented.
Methods
The present guideline was developed under the
leadership of the German-speaking Medical Society for
Paraplegiology in a multiprofessional interdisciplinary
guideline team. To exceed the level of expert
recommendations, consensus was reached within the
framework of a structured nominal group process in
defined steps under neutral moderation considering
the criteria of the German guideline development
instrument (DELBI).
Results
Individual bowel management must be developed on
the basis of an adequate diagnosis and considering the
different lesion types. Due to the multifactorial
influenceability of the intestine and the individual
neurological deficit, a simple to-do checklist is not
effective. Various and complex bowel management
programmes are the basis of the treatment of NBD.
Conclusions
Guidelines can only be successful in so far as they are
applied in everyday life. Of course, the selection and
application of the measures described must always take
into consideration the individual situation of the person
concerned, and the correct application is always a
prerequisite for success.

14
End-range Maitland mobilization decreasing pain sensitivity in knee
osteoarthritis: randomised, controlled clinical trial.
Miklo s POZSGAI, Antal Iva n Pe TER, Pe ter THAN, Nelli FARKAS, No ra NUSSER
European Journal of Physical and Rehabilitation Medicine 2022 Jan 05
DOI: 10.23736/S1973-9087.22.06680-1
Background
Pressure pain threshold (PPT) is a widely applied
method for measuring the magnitude of increased
peripheral and central pain sensitivity causing
hyperalgesia in knee osteoarthritis (OA). Although
manual therapy techniques effects positively PPT, the
effect of end-range Maitland mobilization has not been
evaluated in knee OA.
Aim
To investigate the effect of end-range Maitland
mobilization compared to sham manual therapy
technique on PPT and function-related measures.
Design
Randomised, controlled clinical trial.
Setting
Outpatient setting.
Population
Forty women with moderate-to-severe knee OA.
Methods
Twenty patients (n=20) were randomly assigned to
Maitland Group (MG) and twenty patients (n=20) to
Control Group (CG). Patients in MG received single
end-range Maitland mobilization while patients in CG
received sham manual therapy technique. Assessment
was performed at baseline, 30 minutes and after 1-
week period. Outcome measures were PPT locally at
knee and distant at ipsilateral Extensor Carpi Radialis
Longus muscle, general pain during the previous week
using the Visual Analogue Scale (VAS), Timed Up and
Go Test (TUG) time associated with pain measured
with Numerating Pain Rating Scale (NPRS) and strength
of passive resistance of knee at onset of pain.
Results
Despite all outcome measures improved significantly
postintervention, no changes were detected after 1-
week period compared to postintervention in MG. No
change of outcome measures was found also
postintervention and after 1-week period compared to
postintervention in CG. All postintervention results
showed significant improvement in between-group
comparison in favour of MG. However, after 1-week
period, only strength of passive resistance revealed
significant difference in between-group comparison in
favour of MG (P<0.001).
Conclusions
Although end-range Maitland mobilization has an
immediate effect on decreasing peripheral and central
pain sensitivity and improving function-related
measures in knee OA, these changes may not cause
clinically relevant effect based on data measured after
1-week period.
Clinical rehabilitation impact
Investigating the time-course of end-range Maitland
mobilization for determining the optimal treatment
frequency during rehabilitation is suggested in knee
OA.

15
Person-Centered Rehabilitation Model: Framing the Concept and
Practice of Person-Centered Adult Physical Rehabilitation Based on a
Scoping Review and Thematic Analysis of the Literature.
Jesus TS, Papadimitriou C, Bright FA, Kayes NM, Pinho CS, Cott CA.
Arch Phys Med Rehabil. 2022 Jan;103(1):106-120.
Objective
To develop a cross-professional model framing the
concept and practice of person-centered rehabilitation
(PCR) in adult populations, based on a scoping review
and thematic analysis of the literature.
Data sources
Key databases (PubMed, Scopus, Cumulative Index to
Nursing and Allied Health), snowballing searches, and
experts' consultation were the data sources for
English-language empirical or conceptual articles
published from January 2007-February 2020.
Study selection
Two independent reviewers selected adult-based
articles addressing at least 1 of the 6 categories of PCR-
related content, a priori specified in the published
review protocol. From 6527 unique references, 147
were finally included in the analysis. Of those, 26 were
exclusively conceptual articles.
Data extraction
Two independent reviewers extracted textual data on
what PCR entails conceptually or as a practice. No
quality appraisals were performed as is typical in
scoping reviews.
Data synthesis
A thematic analysis produced thematic categories that
were combined into an emergent model (the PCR
Model), which was reviewed by 5 external experts.
PCR was framed as a way of thinking about and
providing rehabilitation services "with" the person.
PCR is embedded in rehabilitation structures and
practice across 3 levels: (1) the person-professional
dyad; (2) the microsystem level (typically an
interprofessional team, involving significant others);
and (3) a macrosystem level (organization within which
rehabilitation is delivered). Thematic categories are
articulated within each level, detailing both the
conceptual and practice attributes of PCR.
Conclusions
The PCR Model can inform both clinical and service
organization practices. The PCR Model may benefit
from further developments including obtaining wider
stakeholders' input, determining relevance in different
cultural and linguistic groups, and further
operationalization and testing in implementation
projects.

16
Autologous Platelet-Rich Plasma Applications in Chronic Pain Medicine:
Establishing a Framework for Future Research - A Narrative Review.
Ferreira-Dos-Santos G, Hurdle MFB, Clendenen SR, Eldrige JS, Qu W.
Pain Physician. 2022 Jan;25(1):15-27.
Background
During the last decades, platelet-rich plasma has been
studied for the treatment of multiple chronic pain
conditions, in addition to being employed in the
enhancement of healing after tissue injury.
Objective
To establish a framework for future research regarding
the utilization of platelet-rich plasma in the treatment
of chronic tissue injuries.
Methods
Preclinical and clinical studies from 2000-2020 relevant
to applications of platelet-rich plasma for the treatment
of chronic pain conditions were extracted from
PubMed and Medline databases. The studies were
analyzed on the basis of the study population, type of
intervention, method of platelet-rich plasma
preparation, the number of treatments administered,
the timeframe of injections, and clinical outcomes.
Results
Although several preclinical studies and double-blind,
randomized trials have shown promising results in the
application of platelet-rich plasma for the treatment of
multiple chronic pain conditions, various studies have
also reported controversial results. Additionally, the
methods employed for obtaining the platelet-rich
plasma have not been standardized between studies,
resulting in different concentrations of blood
components between the preparations utilized.
Moreover, differences between studies were also
found regarding the number of injections administered
per treatment.
Conclusions
Future research addressing the utilization of platelet-
rich plasma in the treatment of chronic pain conditions
should focus on shedding light on the following major
questions: a) Is there a dose-effect relation between the
platelet count and the clinical efficacy of the
preparation?; b) What pathology determinants should
be considered when selecting between leukocyte-
enriched and leukocyte-depleted concentrates?; c)
What is the role of platelet activation methods on the
clinical efficacy of platelet-rich plasma?; d) Is there an
optimal number of injections and time frame for
application of multiple injection treatment cycles?; e)
Does the addition of local anesthetics affect the clinical
efficacy of platelet-rich plasma?; and f) Is there potential
for future platelet-rich plasma applications for the
treatment of neuropathic pain of peripheral origin?

0000000
Supports patients initiatives programs
In Cerebral Palsy,
In Spasticity,
Abridged Prescribing Information (BACLOF)
Active Ingredient: each tablet of BACLOF contains: baclofen 10, 25 mg, BACLOF liquid contains baclofen 5mg/5ml, 100 ml bottle. Indication: treatment of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant
pain, clonus, and muscular rigidity. Dosage: Tablets: Initiate with a low dosage, preferably in divided doses, administered orally. Increase gradually based on clinical response and tolerability. The maximum dosage is 80 mg daily (20 mg four times a day). When
discontinuing, reduce the dosage slowly. Liquid: adults: One 5ml spoonful (5mg) 3 times a day for 3 days; Two 5ml spoonfuls (10mg) 3 times a day for 3 days; Three 5ml spoonfuls (15mg) 3 times a day for 3 days; Four 5ml spoonfuls (20mg) 3 times a day for 3
days.Elderly:Smalldosesshouldbeusedatthe start oftreatment, the dosebeing titrated graduallyagainst the response,under carefulsupervision.Paediatric population(0to<18years):Adosageof0.75-2mg/kg bodyweight shouldbeused.In children over
ten years of age, however a maximum daily dosage of 2.5mg/kg body weight may be given. Treatment is usually started with half a 5ml spoonful (2.5mg) given 4 times daily. The recommended daily dosages for maintenance therapy are as: 12 months – 2
years: Two to four 5ml spoonfuls (10-20mg), 2 years – 6 years: Four to six 5ml spoonfuls (20-30mg); 6 years – 10 years: Six to twelve 5ml spoonfuls (30-60mg). Contraindications: hypersensitivity to baclofen or any component of this product. Warning and
precautions: Abrupt discontinuation of baclofen has resulted in serious adverse reactions including death; therefore, reduce the dosage slowly when baclofen is discontinued. Neonatal withdrawal symptoms can occur; gradually reduce the dosage and
discontinue baclofen before delivery. Baclofen can cause drowsiness and sedation. Patients should avoid the operation of automobiles or other dangerous machinery until they know how the drug affects them. Advise patients that the central nervous system
effects of baclofen may be additive to those of alcohol and other CNS depressants. Baclofen can cause exacerbation of the following: psychotic disorders, schizophrenia, or confusional states; autonomic dysreflexia; epilepsy. Use with caution in patients with
these condition. Pregnancy & Lactation: Pregnancy: Based on animal data, may cause fetal harm. At recommended oral doses, baclofen is present in human milk. There are no human data on the effects of baclofen on milk production and on breastfed infant.
Interaction: CNS depressants like benzodiazepines, antihistamine, antipsychotic, and alcohol etc., may cause increased sedative effects. Morphine (epidural) may cause hypotension and dyspnea. Laboratory Test Interactions may cause false elevation of
AST (aspartate aminotransferase), alkaline phosphatase, or blood glucose. Adverse reactions: most common drowsiness, dizziness, and weakness. Overdose: Symptoms: Patients may present in coma or with progressive drowsiness, lightheadedness,
dizziness, somnolence, accommodation disorders, respiratory depression, seizures, or hypotonia progressing to loss of consciousness. Treatment: includes gastric decontamination, maintaining an adequate airway and respirations. (Prepared on 23rd Feb
2020. It is recommended to refer full prescribing information before prescription. For further medical information, please write to: Intas Pharmaceuticals Ltd., Corporate House, Near Sola Bridge, SG highway, Thaltej, Ahmedabad-380054, Gujarat, India.
productqueries@intaspharma.com.)
Abridged Prescribing Information (BACLOF LIQUID)
Active Ingredient: each tablet of BACLOF contains: baclofen 10, 25 mg, BACLOF liquid contains baclofen 5mg/5ml, 100 ml bottle. Indication: treatment of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant
pain, clonus, and muscular rigidity. Dosage: Tablets: Initiate with a low dosage, preferably in divided doses, administered orally. Increase gradually based on clinical response and tolerability. The maximum dosage is 80 mg daily (20 mg four times a day). When
discontinuing, reduce the dosage slowly. Liquid: adults: One 5ml spoonful (5mg) 3 times a day for 3 days; Two 5ml spoonfuls (10mg) 3 times a day for 3 days; Three 5ml spoonfuls (15mg) 3 times a day for 3 days; Four 5ml spoonfuls (20mg) 3 times a day for 3
days.Elderly:Smalldosesshouldbeusedatthe start oftreatment, the dosebeing titrated graduallyagainst the response,under carefulsupervision.Paediatric population(0to<18years):Adosageof0.75-2mg/kg bodyweight shouldbeused.In children over
ten years of age, however a maximum daily dosage of 2.5mg/kg body weight may be given. Treatment is usually started with half a 5ml spoonful (2.5mg) given 4 times daily. The recommended daily dosages for maintenance therapy are as: 12 months – 2
years: Two to four 5ml spoonfuls (10-20mg), 2 years – 6 years: Four to six 5ml spoonfuls (20-30mg); 6 years – 10 years: Six to twelve 5ml spoonfuls (30-60mg). Contraindications: hypersensitivity to baclofen or any component of this product. Warning and
precautions: Abrupt discontinuation of baclofen has resulted in serious adverse reactions including death; therefore, reduce the dosage slowly when baclofen is discontinued. Neonatal withdrawal symptoms can occur; gradually reduce the dosage and
discontinue baclofen before delivery. Baclofen can cause drowsiness and sedation. Patients should avoid the operation of automobiles or other dangerous machinery until they know how the drug affects them. Advise patients that the central nervous system
effects of baclofen may be additive to those of alcohol and other CNS depressants. Baclofen can cause exacerbation of the following: psychotic disorders, schizophrenia, or confusional states; autonomic dysreflexia; epilepsy. Use with caution in patients with
these condition. Pregnancy & Lactation: Pregnancy: Based on animal data, may cause fetal harm. At recommended oral doses, baclofen is present in human milk. There are no human data on the effects of baclofen on milk production and on breastfed infant.
Interaction: CNS depressants like benzodiazepines, antihistamine, antipsychotic, and alcohol etc., may cause increased sedative effects. Morphine (epidural) may cause hypotension and dyspnea. Laboratory Test Interactions may cause false elevation of
AST (aspartate aminotransferase), alkaline phosphatase, or blood glucose. Adverse reactions: most common drowsiness, dizziness, and weakness. Overdose: Symptoms: Patients may present in coma or with progressive drowsiness, lightheadedness,
dizziness, somnolence, accommodation disorders, respiratory depression, seizures, or hypotonia progressing to loss of consciousness. Treatment: includes gastric decontamination, maintaining an adequate airway and respirations. (Prepared on 23rd Feb
2020. It is recommended to refer full prescribing information before prescription. For further medical information, please write to: Intas Pharmaceuticals Ltd., Corporate House, Near Sola Bridge, SG highway, Thaltej, Ahmedabad-380054, Gujarat, India.
productqueries@intaspharma.com.)
Disclaimer: The matter content in this infographic is solely for educational purposes only. It does not intend either directly or indirectly expressly or impliedly to promote, propagate, advertise or otherwise endorsing any particular product or brand. The matter content in this infographic does not make any
representation or warranties with respect to the efficacy, accuracy, usefulness or applicability, or fitness, or completeness for any particular purpose. The content has been created by editorial board of PMR buzz with an unconditional educational grant from Intas Pharmaceuticals Pvt. Ltd.. The creators of this
infographic hereby disclaim any and all liability to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this infographics, which is provided as is, and without warranties.

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