Found 304 abstracts.
#1 TRANSCUTANEOUS STIMULATION IN THE TREATMENT OF OVERACTIVE BLADDER ABOUT A CASE
Dalal Radjaa MILOUDI, SARA ZOUAOUI, MOHAMED KEHLI
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Abstract
Title
TRANSCUTANEOUS STIMULATION IN THE TREATMENT OF OVERACTIVE BLADDER ABOUT A CASE
Background and Aims
we report a case of bladder hyperactivity treated by neurostimulation of the posterior tibial nerve The clinical course depends on the early management.
Methods
The patient was hospitalized at the PRM level where clinical and paraclinical examinations were carried out: •Clinical Review: “Irritative Spine Research”; Muscle Review; Neurological Spasticity Assessment; Functional Disability Assessment” Neurological and perineal clinical examination •a voiding schedule •Ultrasound with post-urination residue measurement Finally, a urodynamic assessment was carried out during the second hospitalization with cystomanometry, sphincterometry and debimetry with residue measurement returning in favor of an overactive bladder causing urinary leakage. high pressure urination with a low flow rate testifying to a vesico-sphincter dyssynergy.
Results
The patient is supported: •Treatment of irritating spines and spasticity. •rehabilitation protocol adapted to paraparesia •Treatment with anticholinergic and alpha-blocker. •Intermittent self-urinary catheter •Transcutaneous stimulation sessions (or TENS), with an electrode positioned behind the inner malleolus and the second 10 cm above (10Hz, 0.5 to 15mA approximately). 01 session per day of 20 minutes during12 weeks. The evolution was marked by a net decrease in the frequency of urinary leakage at 01 times per 15 days. Vesico-sphincter disorders are extremely common and harmful in the neurological patient. •Importance +++ of their screening, monitoring and management adapted. The urinary schedule, residue measurements, screening of factors favoring. •Prescription of suitable complementary examinations. •Tibial stimulation appears to be an effective treatment for patients with HV in patients with a neurological bladder. the technique is safe, without major complications reported in the literature. Tibial stimulation may be proposed at the beginning of HV treatment in latest EAU recommendations.
Conclusion
Associated with perineal rehabilitation, stimulation of the posterior tibial nerve - or internal popliteal sciatic nerve (SPI) - seems to become a serious alternative to taking medication in cases of overactive bladder, with or without urinary incontinence.
Keywords
Transcutaneous stimulation tibal nerve, of overactive bladder
#4 CLINICAL PERFORMANCE OF ULTRASOUND SHEARWAVE ELASTOGRAPHY IN CARPAL TUNNEL SYNDROME
Jaemin Kim
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CLINICAL PERFORMANCE OF ULTRASOUND SHEARWAVE ELASTOGRAPHY IN CARPAL TUNNEL SYNDROME
Background and Aims
To evaluate the effectiveness of Shearwave elastography(SWE) in diagnosing Carpal tunnel syndrome(CTS).
Methods
We recruited a normal control group and patients with CTS, performing nerve conduction studies(NCS) and electromyography(EMG) and ultrasound examinations of the median nerve on both wrists. Wrists were categorized into control and CTS groups based on NCS/EMG results using the AANEM classification. Data on pain intensity(NRS), BCTQ-SS/FS(Boston Carpal Tunnel Questionnaire – symptom severity/Functional Status scale), NCS/EMG findings, and ultrasound cross-sectional area(CSA) at the carpal tunnel inlet were collected. SWE measurements assessed the median nerve\'s elasticity in the longitudinal view around the carpal tunnel inlet.
Results
The study encompassed 99 wrists from the 50 patients, comprising 48 normal wrists and 51 wrists with CTS. Based on severity, the classification included 22 mild, 20 moderate, and 9 severe cases. Comparing CSA, CTS wrists had significantly larger CSA compared to normal control wrists (13.63 ± 3.09 mm² vs 8.95 ± 2.49 mm², p<.001). While the normal group had significantly smaller CSA compared to the mild, moderate, and severe CTS groups (p<.001). When comparing elasticity, the CTS group had significantly higher elasticity compared to the normal control group (106 ± 47.22 kPa vs. 60.96 ± 21.8 kPa, p<.001). The normal group had significantly lower elasticity compared to the CTS groups, but there was no significant difference in elasticity among the different severity levels within the CTS group. When using the CSA x elasticity value for analysis, the severe group had significantly higher values compared to the mild group (p = .006). The ROC analysis for predicting severe cases yielded a cut-off value of 1225.97 (sensitivity 0.78, specificity 0.73, accuracy 0.77).
Conclusion
SWE can aid in diagnosing CTS, with higher specificity and accuracy when combined with CSA measurements. This combination is particularly useful in screening and diagnosing severe CTS cases requiring surgical treatment.
Keywords
Carpal tunnel syndrome; ultrasound; shearwave elastography; electromyography
#5 COMPREHENSIVE REHABILITATION STRATEGIES IN PATIENTS WITH RARE GENETIC SYNDROME: A CASE SERIES AND LITERATURE REVIEW
Fatima Maarouf
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
COMPREHENSIVE REHABILITATION STRATEGIES IN PATIENTS WITH RARE GENETIC SYNDROME: A CASE SERIES AND LITERATURE REVIEW
Case report
Phelan-McDermid syndrome (PMS), also known as 22q13.3 deletion syndrome, is a rare neurodevelopmental disorder characterized by global developmental delay, severe intellectual, language, and physical impairments. PMS is caused by terminal deletions in the 22q13.3 chromosomal region, including SHANK3, a critical gene encoding a structural component of excitatory synapses essential for normal synaptogenesis and neuronal physiology. Alternatively, PMS may result from point mutations in the SHANK3 gene. In this study, we present the latest findings on the rehabilitation of individuals with PMS and discuss how these advances inform the management of chronic congenital genetic disorders. We report three cases from the Medical Genetics Department at Ibn Rochd University Hospital, Casablanca. The patients exhibited common clinical features, including generalized neonatal hypotonia, psychomotor developmental delay, absent speech, intellectual disability, and facial dysmorphism. Chromosomal analysis revealed a normal constitutional karyotype (46, XY). However, CGH-array testing identified significant deletions on chromosome 22. One patient exhibited a 3.2 Mb deletion in the 22q13.31-q13.33 region, involving 50 genes including SHANK3. Another patient had a 1.543 Mb microdeletion in the 22q13.33 region, affecting 42 genes, also including SHANK3. Children with PMS often experience delays in motor milestones due to hypotonia, poor balance, and joint hypermobility. Their gait may be unsteady, with a heightened risk of falls and injuries. Fatigue is common, and some require assistive devices for mobility at home or outdoors. Fine motor impairments further challenge daily activities. Individualized, multidisciplinary rehabilitation programs appear to enhance autonomy and quality of life for PMS patients. Caregivers play a pivotal role in identifying preferences and fostering long-term improvements. However, additional studies involving larger, well-characterized cohorts are necessary to validate these findings and optimize interventions. This report highlights the clinical and genetic heterogeneity of PMS and underscores the importance of tailored rehabilitation strategies in managing its complex manifestations.
Keywords
Phelan-McDermid syndrome (PMS) ; 22q13.3 deletion syndrome ; Rehabilitation ; physical and rehabilitation medicine, physical therapy modalities.
#6 EVALUATION AND MANAGEMENT IN PHYSICAL AND REHABILITATION OF ISOLATED ESSENTIAL ESSENTIAL TREMOR IN YOUNG ADULTS YOUNG ADULTS UNDER 65
BENOSMANI ABDELLATIF, HEBHOUB RACHID
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EVALUATION AND MANAGEMENT IN PHYSICAL AND REHABILITATION OF ISOLATED ESSENTIAL ESSENTIAL TREMOR IN YOUNG ADULTS YOUNG ADULTS UNDER 65
Background and Aims
Essential tremor (ET) is a real disability due to the difficulties encountered in carrying out daily activities. This study consists of making the clinical assessment of tremor [site, the circumstances of occurrence, rhythm, symmetrical or asymmetrical nature, clinical amplitude, 30-second volumetric tests, V5X, 9 HPT test, Archimedean spiral and straight line drawing tests, and the Fahn-Tolosa-Marin scale], and electromyographic assessment for each muscle [frequency, tremor amplitude, duration of contractions, and interval between contractions]. Then, a therapeutic protocol, based on strengthening against resistance of the identified muscles, was adapted and applied, in order to improve the patients\' ET
Methods
A cohort of 30 patients with isolated TE of the upper limbs, were assessed clinically and electromyographically, then put on a 4 weeksmuscle strengtheningprogramme, and assessed by functional tests and scales and EMG at the end of the programme.
Results
The results of the clinical assessment of the ET were compared to those obtained by EMG, thus allowing a precise topographical diagnosis. The clinical and electromyographic improvement of the ET thanks to the therapeutic protocol was noted.
Conclusion
The results of the presentstudyclearlyillustrate the contribution of clinical but especiallyelectromyographicassessment of ET, allowing not only to provide information on the precisetopographicaldiagnosis but also to objectivelyassess the effectiveness of the appliedreinforcement program. This allows us to propose these MPR techniques as another alternative in the treatment of ET.
Keywords
essential tremor, electromyogram, muscle strengthening
#7 A META-ANALYSIS OF THE REHABILITATION EFFECTS OF EMGBFT COMBINED WITH MT ON LOWER LIMB FUNCTION AND ACTIVITIES OF DAILY LIVING IN PATIENTS AFTER STROKE
顺豪 封, 浩 郭
Conference topic: Neurorehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
A META-ANALYSIS OF THE REHABILITATION EFFECTS OF EMGBFT COMBINED WITH MT ON LOWER LIMB FUNCTION AND ACTIVITIES OF DAILY LIVING IN PATIENTS AFTER STROKE
Background and Aims
Lower limb dysfunction is a major problem in stroke patients. To systematically evaluate the rehabilitation effect of Myoelectric biofeedback(EMGBFT) combined with mirror therapy (MT) on lower limb function and daily living ability of stroke patients with hemiplegia.
Results
A total of nine randomized controlled trials involving 750 patients were included. The results showed that compared with the EMGBFT group alone, FMA-LE score [MD=2.82,95%CI (1.45, 4.20),P <0.05] and BBS score [MD=3.68, 95%CI (2.22,) in the combined group were significantly higher than those in the EMGBFT group alone. 5.15), P < 0.05] and MBI scores [MD = 7.21, 95% CI (3.92, 10.50), P < 0.05) were significantly improved; Compared with the single MT group, the combined group had FMA-LE [MD=3.28,95%CI (0.29,6.26),P <0.05], BBS [MD=3.20,95%CI (1.67,4.72),P <0.05] scores and MBI The scores [MD=5.43,95%CI (2.36,8.50),P <0.05] were significantly higher. Compared with conventional treatment group, FMA-LE score [MD=3.73,95%CI (3.23, 4.23),P <0.05] and BBS score [MD=6.18,95%CI (3.09, 9.26),P <0.05] and MBI score [MD= 9.55, 95%CI (2.29,16.80),P <0.05] were significantly increased.
Conclusion
Compared with EMGBFT or MT alone or conventional therapy, EMGBFT combined with MT can improve lower limb motor function, balance function and activity of daily living ability in stroke patients more significantly.
Keywords
myoelectric biofeedback，mirror therapy,stroke,Meta-analysis
#8 EFFICIENCY OF REHABILITATIVE INTERVENTIONS BASED ON TREATMENT OUTCOME MEASURES
Marija Pletikosić, Tonko Vlak
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
EFFICIENCY OF REHABILITATIVE INTERVENTIONS BASED ON TREATMENT OUTCOME MEASURES
Background and Aims
A retrospective research study was conducted by reviewing the medical documentation of 1024 patients treated at Department of Physical Medicine and Rehabilitation with Rheumatology at University Hospital of Split (Department). Factors such as age, gender and individual diagnoses were considered from the patients' medical history. Treatment outcome measures provided upon hospitalization and hospital discharge were recorded. The presence of a descriptive assessment of the patient's condition upon discharge was also investigated. The collected data was analyzed using the McNemar test to compare measures taken at admission and discharge within the same group. The objective of this study was to estimate the efficiency of rehabilitative interventions among patients treated at Department, based on treatment outcome measures.
Results
The results indicate a lack of pursuit of treatment outcome measures at Department. Among the 1024 cases, the most common treatment outcome measure, the Barthel Index of Functional Independence (BI), was determined upon admission and discharge in 614 cases (60%) while, it was not determined in 243 cases (24%) of patients. Furthermore, in the discharge summaries of 563 patients (55%), a descriptive assessment of the change in condition is mentioned. Out of the 563 patients for whom such a change was described, only 340 (60.4%) had the BI calculated both at admission and discharge. In as many as 148 (26.3%), the BI was not determined at either admission or discharge.
Conclusion
The study concludes that treatment outcome measures are insufficiently used and inadequately implemented at the Department. The implementation of these measures is limited to a few basic tests and measurements, and even these are not consistently implemented or are implemented incorrectly in a significant number of patients. Improvements are needed to ensure the proper utilization of treatment outcome measures, adherence to protocols, and accurate implementation in order to effectively evaluate patient progress and treatment effectiveness.
Keywords
Rehabilitation Medicine, Outcome Measures, Barthel
#11 CARPAL TUNNEL SYNDROME : MANAGEMENT IN PYSICAL MEDECINE AND REHABILITATION
NAIMA BENZAMOUCHE, LABIBA FADEL, mohamed NAIT ALI, mohamed MEDAOUAR
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CARPAL TUNNEL SYNDROME : MANAGEMENT IN PYSICAL MEDECINE AND REHABILITATION
Background and Aims
Carpal tunnel syndrome (CTS) is a frequent reason for consultation in Physical Medicine and Rehabilitation (PMR) due to its significant impact on grip strength and daily activities. It is the most common entrapment neuropathy, particularly affecting women over 50 years old, with unilateral or bilateral presentations. PMR plays a critical role in the multidisciplinary management of CTS by offering a wide range of therapeutic and ergonomic tools.
Results
The first goal of rehabilitation is to reduce the Pain and Symptoms by Pharmacological interventions (NSAIDs or corticosteroid injections when indicated) and Physical modalities(Ultrasound therapy, TENS, and cryotherapy). The second one is to improve function by Stretching Exercises Focused on the wrist flexors and extensors to enhance flexibility, and Strengthening Exercises to improve grip and fine motor skills. The third one is Prevention of Progression by learning ergonomic recommendations and Therapeutic Education.
Conclusion
The management of CTS in PMR is essential for reducing symptoms, maintaining hand functionality, and improving the quality of life of affected patients. By combining conservative treatments, ergonomic adaptations, and patient education, PMR contributes significantly to long-term functional preservation.
Keywords
carpal, tunnel, pain, flexibility ,Strengthening,
#12 LEFT HEMIPLEGIA SECONDARY TO A POST-COVID STROKE IN AN INFANT: A CASE REPORT.
NAIMA BENZAMOUCHE, LABIBA FADEL, MOHAMED NAIT ALI, MOHAMED MEDAOUAR
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
LEFT HEMIPLEGIA SECONDARY TO A POST-COVID STROKE IN AN INFANT: A CASE REPORT.
Background
Compared to adults, ischemic strokes are very rare in children. Central nervous system (CNS) involvement during post-COVID-19 infections can present with various clinical manifestations, with strokes and encephalopathy being the two main neurological complications observed. Strokes in the pediatric population are characterized by specific clinical presentations, risk factors, and etiologies. Functional prognosis and management differ significantly from those of adult strokes.
Case report
We present the case of a 9-month-old infant with a history of COVID-19 infection two months previously (at the age of 7 months). The infant was admitted to paediatrics for left hemiplegia secondary to an ischaemic stroke with haemorrhagic transformation, and referred to the physical medicine and rehabilitation (PMR) department for further management. Clinical examination on the tenth day after the stroke revealed complete spastic hemiplegia on the left side. Functionally, there was no motor function in the left upper limb, with regression of previously acquired motor skills, including the ability to sit, crawl and stand with support. Walking was impossible. Rehabilitation began with a programme adapted to paediatric hemiplegia, including regular clinical and functional assessments at 3, 6 and 9 months. In the paediatric population, strokes are relatively rare. The occurrence of a stroke during childhood can have a significant impact on psychomotor development. According to the literature, there is an increased risk of stroke following COVID-19 infection in children. Understanding the risk factors and their association with other diseases, such as COVID-19, is essential to guide early diagnosis and potential prevention strategies. Paediatric rehabilitation
Conclusion
The rehabilitation of children after a stroke is different from that of adults. Treatment must be multidisciplinary to improve neuromotor recovery. The rehabilitation protocol must be adapted to the child's needs, the age at which the stroke occurred and the child's environment, with an emphasis on involving parents in the care process.
Keywords
infant, hemiplegia, stroke, covid19, reabilitation
#13 PAINFUL SHOULDER IN HEMIPLEGIA: AN EARLY UPPER LIMB COMPLICATION AND THERAPEUTIC MODALITIES IN PHYSICAL MEDICINE AND REHABILITATION
NAIMA BENZAMOUCHE, LABIBA FADEL, mohamed NAIT ALI, MOHAMED MEDAOUAR
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PAINFUL SHOULDER IN HEMIPLEGIA: AN EARLY UPPER LIMB COMPLICATION AND THERAPEUTIC MODALITIES IN PHYSICAL MEDICINE AND REHABILITATION
Background and Aims
Shoulder pathology is very common at all stages of the development of hemiplegia. Painful hemiplegic shoulder is a multifactorial condition that has a significant impact on rehabilitation and functional outcomes of the upper extremity. Several factors contribute to the development of a painful shoulder in hemiplegic patients: subluxation of the humeral head, complex regional pain syndrome type I, spastic hypertonia, lack of upper limb support and inappropriate manipulation during transfers. The role of the PRM in the management of shoulder pain in patients with hemiplegia.
Results
The characteristic symptom is pain, especially in the early stages of hemiplegia. This pain limits the shoulder's range of motion, reduces the patient's autonomy, especially in the case of regained grip, and compromises the functional prognosis of the upper limb. Treatment in physiotherapy and rehabilitation medicine (PRM) is multimodal and based on preventive measures, occupational therapy, physical means and joint mobilisation. This is often combined with pharmacological measures (use of intrarticular corticosteroid injections, treatment of spasticity, botulinum toxin injections, etc.).
Conclusion
The management of hemiplegic shoulder requires a comprehensive and multidisciplinary approach in PMR. By combining preventive measures, physiotherapy, pharmacological treatments and orthotic prescriptions, the painful shoulder can be effectively managed, maintaining the functional prognosis of the upper limb and improving the patient's quality of life
Keywords
pain, shoulder, hemiplegia, prevention, physiotherapy
#14 BRACHIAL PLEXUS INJURY OUTCOME FOLLOWING REHABILITATION AND NEUROLYSIS
Jelena Marunica Karšaj, Ivan Anzulović, Tatjana Nikolić, Simeon Grazio
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
BRACHIAL PLEXUS INJURY OUTCOME FOLLOWING REHABILITATION AND NEUROLYSIS
Background
Traumatic brachial plexus injury (BPI) is a disabling injury of the upper extremity (UE) and a devastating life-altering event, with pervasive detrimental effects on a patient's physical, psychosocial, and financial well-being often requiring prolonged rehabilitation periods. Surgical intervention is often inevitable to obtain complete restoration of the UE.
Case report
A 33-year-old male was transported to the emergency after being stabbed with a knife in the right supraclavicular region from a random attacker. Examination indicated a 3.5 cm penetrating wound which resulted in superior trunk dissection, pneumomediastinum, and subcutaneous emphysema. Immediate stitching of the gaping wound using suture patterns turned out to be malpractice. Protective posture, deltoid hypotrophy, tiny active shoulder movements were observed on the physiatrist examination. The rehabilitation encompassed the Bobath concept and PNF along with plyometric training. First four months it was performed under the physiotherapist's supervision for five consecutive days, and for the next two months once a week. Active UE abduction up to 45° in standing, hardly capable up to 90° in supine, initial elbow flexion with prone hand, and forward flexion up to 60° were measured by goniometer. Initial NMR revealed compressive edema along the course of C5 and C6 roots with its dislocation. The second revealed the disruption of right C6 in the lateral truncal aspect with nerve retraction. EMNG findings did not show a meaningful recovery. Nine months after BPI, external neurolysis of C5 and C6 roots together with subscapular nerve was performed. Three months after, elbow flexion with hand supine was obtainable up to 140°,and UE abduction up to 160°.
Conclusion
The extensive rehabilitation reached its optimal obtainable level after nine months which was still unsatisfactory in terms of biceps flexion and UE abduction respectively. Complete range of motion of the UE was manageable three months after the surgical reconstruction of BPI.
Keywords
brachial plexus injury, rehabilitation, neurolysis
#15 CHRONIFICATION RISK AND BODILY FUNCTIONAL MEASURES IN LOW BACK PAIN
Thomas Kienbacher1, Gerold Ebenbichler2, Patrick Mair3, Elisabeth Fehrmann4, Julian Dietl1
2 Univ Klinik für PMR, Austria
3 Harvard University, United States
4 Karl Landsteiner Universität, Austria
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CHRONIFICATION RISK AND BODILY FUNCTIONAL MEASURES IN LOW BACK PAIN
Background and Aims
The STarT back screening tool (SBST) validly categorizes the risk of pain chronification which is relevant for prognosis and treatment of back pain according to the biopsychosocial model. This cross-sectional study sought to investigate if low, medium, and high risk SBST chronification groups differ in bodily functional and psychosocial measures and if interactions with patients` age and gender exist. 595 chronic low back pain patients (68 % females, mean age 53 ± 6.7 years) recruited from an outpatient rehabilitation center completed the SBST and well-established reliable function categories, rated visual analogue pain scale, and performed maximum bodily functional measurement testings. Multivariate analyses of variance were calculated for statistical analyses.
Results
Significant between SBST group effects were observed for pain, disability (Roland Morris disability questionnaire, Pain Disability Index), the 5-level European Quality of Life Questionnaire, the Hospital Anxiety and Depression Scale (p < 0,001) but not for the Avoidance-Endurance behaviour. Differences in maximum trunk extension and flexion strength, hand grip strength, and trunk range of motion outcome measures interacted with age and gender but the impact of gender vanished in the high risk SBST group.
Conclusion
Pain chronification risk has significant impact not only on psychosocial but on bodily functional measures as well. However, high chronification risk seems to dominate otherwise existing gender associated trunk muscle strength differences in chronic back pain patients. Future randomized controlled trials should focus on the need for individually tailored treatment programs to optimize back pain therapy outcome.
Keywords
chronification risk, bodily measurements, impact
#16 ASSOCIATION BETWEEN BECK DEPRESSION INVENTORY-II SCORE AND CONFIRMATORY ANSWERS OF THE ROLAND MORRIS DISABILITY QUESTIONNAIRE IN THE SAMPLE OF CHRONIC NON-SPECIFIC LOW BACK PAIN PATIENTS
Jelena Marunica Karšaj1, Juraj Jug2, Simeon Grazio1
2 Health center Zagreb - West, Croatia/Hrvatska
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSOCIATION BETWEEN BECK DEPRESSION INVENTORY-II SCORE AND CONFIRMATORY ANSWERS OF THE ROLAND MORRIS DISABILITY QUESTIONNAIRE IN THE SAMPLE OF CHRONIC NON-SPECIFIC LOW BACK PAIN PATIENTS
Background and Aims
Chronic non-specific low back pain (LBP) is a major public health problem that adversely affects the functional ability of working men and women. It is conceptualized according to the biopsychosocial model, and it is generally accepted that psychological and psychosocial factors significantly contribute to the burden and experience of chronic non-specific LBP.
Methods
In our study, we investigated the association between the severity of functional disability and depressive symptoms in the sample of the Croatian working active population with the age distribution from 35 to 65 years with chronic non-specific LBP. The study protocol was approved by the Ethics Committee Sestre milosrdnice University Hospital Center (protocol number 003-06/23-03/003). We performed a cross-sectional study at the University Department of Rheumatology, Physical Medicine, and Rehabilitation from February 2023 to April 2024. Functional disability was measured by the Roland Morris Disability Questionnaire (RMDQ), and depressive symptoms by the Beck Depression Inventory-II (BDI-II). During the routine outpatient visit, included participants completed RMDQ and BDI-II. The analysis of the relationship between the RMDQ answers and the BDI-II total score was performed using the Pearson correlation test and multivariate regression analysis (using the stepwise method).
Results
The data from the total of 203 recruited patients, divided into categories concerning disability score were analyzed. The mean age of 48.59 ± 6.48 was in the lower and the mean of 50.65 ± 7.68 in the higher disability category. Higher BDI-II total scores were associated with confirmatory answers on the 2nd (r=0.277), 3rd (r=0.270), 6th (r=0.303), 18th (r=0.310) and 22nd (r=0.455) question of the RMDQ.
Conclusion
In our sample, the confirmatory answers of RMDQ such as frequent necessity to change position, slow walk pace, need to lie down more often, less sleep and more irritability due to LBP were found to be associated with the higher total BDI-II score.
Keywords
low back pain, disability, depression
#19 PHYSICAL ACTIVITY AND EXERCISE LEVELS AMONG PORTUGUESE PHYSIATRISTS: COMPARISON WITH THE GENERAL POPULATION AND CAREER EVOLUTION
David Cordeiro, Maria Ana Pinheiro, Margarida Freitas, Susana Farinha
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PHYSICAL ACTIVITY AND EXERCISE LEVELS AMONG PORTUGUESE PHYSIATRISTS: COMPARISON WITH THE GENERAL POPULATION AND CAREER EVOLUTION
Background and Aims
Background: Physical activity is widely recognized as essential for maintaining health and preventing chronic diseases. However, sedentary behavior remains prevalent, even among healthcare professionals, who play a crucial role in promoting active lifestyles. Aims: The primary aim of this study was to compare the physical activity levels between Portuguese Physical Medicine and Rehabilitation doctors and the general Portuguese population, based on data from the Special Eurobarometer 525. The secondary objective was to assess the variation in activity levels throughout the doctors' careers.
Methods
A cross-sectional observational study was conducted with physiatrists working in Portugal, both in the public and private sectors. Data collection was carried out through an anonymous online questionnaire, which included the International Physical Activity Questionnaire (IPAQ). Physical activity levels were categorized as low, moderate, or high, and statistical analysis was performed using descriptive statistics and Chi-Square tests.
Results
Among the 210 participants, 123 (58.6%) were female and 87 (41.4%) were male, with a median age of 38 years. The study revealed that physiatrists had higher levels of physical activity compared to the general population, with lower proportions in groups that did not engage in any moderate (33.8% vs. 38.0%) or vigorous (38.1% vs. 49.0%) activity in the previous seven days. However, physical activity decreased with career progression, with the most experienced specialists reporting the lowest levels of exercise. The primary barrier to engaging in physical activity was lack of time (61,0%). No statistically significant differences were observed in physical activity levels based on workplace settings (public vs. private).
Conclusion
Despite exhibiting higher levels of physical activity than the general population, Portuguese physiatrists experience a decline in exercise participation as their careers progress, primarily due to lack of time. Given their role, it is crucial to implement strategies that encourage the maintenance of physical activity throughout their professional journey.
Keywords
physical activity, exercise, physiatrists, doctors
#20 BALANCE IMPAIRMENT AND QUALITY OF LIFE IN MULTIPLE SCLEROSIS PATIENTS
Tadeja Hernja Rumpf1, Eva Ferčec2
2 General Hospital Celje, Slovenia
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BALANCE IMPAIRMENT AND QUALITY OF LIFE IN MULTIPLE SCLEROSIS PATIENTS
Background and Aims
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, often leading to impaired coordination, balance, and mobility. Balance dysfunction is a major risk factor for falls and reduced quality of life (QoL) in MS patients. This study aimed to assess the association between balance disorders and health-related QoL in individuals with relapsing-remitting MS.
Methods
A cross-sectional study was conducted at the University Medical Centre Maribor from February to July 2022. Fifty-four MS patients (EDSS 0-6) were assessed using the Modified Mini-Balance Evaluation System Test (modified mini BESTest), Single Leg Stance Test (SLS), and MSQOL-54 questionnaire. Neurological impairment was evaluated using the Expanded Disability Status Scale (EDSS). Data were analyzed using Pearson and Spearman correlation coefficients.
Results
The mean patient age was 46 years, with 71% being female. Most patients exhibited clinically significant balance impairments, confirmed by low scores on the modified mini BESTest (mean: 28/42) and SLS (<20 seconds). A significant positive correlation was found between modified mini BESTest scores and the physical component of QoL (p<0.01). EDSS scores negatively correlated with physical QoL (p<0.01). No significant correlation was observed between balance scores and the mental component of QoL.
Conclusion
Clinically significant balance impairments were present in MS patients, negatively affecting their physical QoL. Balance training should be an integral part of rehabilitation to enhance mobility and independence. Further longitudinal research is needed to assess the impact of rehabilitation on balance and QoL over time.
Keywords
balance, disturbances;, quality, of, life;
#21 DYSTROPHIC EPIDERMOLYSIS BULLOSA IN ALGERIA: A CASE REPORT AND REHABILITATION APPROACH
Abdelghani MILIANI, Labiba FADEL, Afaf BAHLOUL, Mahmoud DIB, Mohammed MEDAOUAR
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
DYSTROPHIC EPIDERMOLYSIS BULLOSA IN ALGERIA: A CASE REPORT AND REHABILITATION APPROACH
Background
Dystrophic Epidermolysis bullosa (DEB) is a rare genetic disease characterized by skin fragility with blistering that occurs spontaneously or following minor trauma such as mild pressure or friction. Children with DEB have a range of disabilities. The most severely affected may suffer from scarring, fibrosis, and contractures affecting any part of the body. Pain can be both acute and chronic, independence in activities of daily living can be significantly limited, and quality of life can be affected. There is currently no cure for DEB, but symptomatic therapies can be provided through a multidisciplinary team(MDT) approach where possible. Physical and rehabilitation medicine (PRM) can be an integral part of MDT. This poster highlights the interest of PRM in the management of deficiencies and disabilities related to this disease.
Case report
We present the case of M K, a 4-year-old child, admitted for the management of recessive dystrophic epidermolysis bullosa. Our initial assessment found: • uncooperative child, malnourished with growth retardation • bullous lesions with generalized scabs, global amyotrophy, • bilateral syndactyly due to synechiae • delayed psychomotor development. EBDASI score at 45/ 88, QOLEB score at 52/ 68 During his stay, the pediatric surgery team performed an esophageal dilation, the child was put on intravenous gentamicin course . Also, the child benefited from physiotherapy and occupational therapy sessions. After 3 months, we noted good wound healing. The child walks without technical aids, this functional progress is reflected by an improvement in the EBDASI scores (28/ 88) and the QOLEB score (31/ 68).
Conclusion
The management of DEB is multidisciplinary, rehabilitation by its means including occupational therapy, physiotherapy and equipment are an integral part. MPR management must be early and continuous in order to maximize functional autonomy and improve the quality of life for these patients.
Keywords
Epidermolysis Bullosa, EBDASI, QOLEB, Algeria
#22 PERIPHERAL EDEMA IN ADVANCED CANCER: ETIOLOGIES, TREATMENTS, AND OUTCOMES – A SCOPING REVIEW
Jegy Tennison
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PERIPHERAL EDEMA IN ADVANCED CANCER: ETIOLOGIES, TREATMENTS, AND OUTCOMES – A SCOPING REVIEW
Background and Aims
Peripheral edema is prevalent in patients with advanced cancer, can impact an individual’s symptom burden and physical functional status negatively, and has been associated with a poor prognosis. The purpose of this review is to address the knowledge gap in characterizing and summarizing the various etiologies, treatments, and outcomes of peripheral edema in patients with advanced cancer.
Methods
An established five-step scoping review framework was employed to identify articles in the English language, with adult patients having concurrent advanced cancer and peripheral edema, which is related to advanced cancer, its treatment, or comorbidities. We searched MEDLINE, Embase, and Cochrane Library from 2010 to June 30, 2023. Two reviewers conducted the initial title and abstract screening and eventually assessed the quality of observational cohort studies. At least two or more reviewers completed the full-text review and data extraction. Only original research primary studies were included.
Results
: Among 426 publications, 31 met the inclusion criteria. These included 10 observational cohort studies (2,128 total patients), 5 case series (79 total patients), and 16 case reports (16 patients). These were broadly categorized to have the following causes of peripheral edema—1) medical conditions (23 studies), 2) medication-related adverse events (7 studies), and 3) procedure-related adverse events (1 study). Most of these (20/30) studies had patients with limited prognosis of days to months survival time. The quality rating was moderate (6/10) to weak (4/10) in observational cohort studies. When treatment was reported in these (7/10) studies, it was guided by the edema pathophysiology (and multi-modal in 3/10 studies).
Conclusion
Recent literature includes limited observational studies, highlighting the unmet need for high-quality research to guide treatment for the multifaceted causes of peripheral edema. It points to the need to standardize edema grading scales and evidence-based tools to identify how edema affects functional status and apply rehabilitation interventions.
Keywords
Edema, Lymphedema, Neoplasms, Quality, Life
#26 TIBIA FRACTURE AFTER TIBIAL CORTEX TRANSVERSE TRANSPORT (TTT) SURGERY: A CASE REPORT
JONGMOON KIM
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
TIBIA FRACTURE AFTER TIBIAL CORTEX TRANSVERSE TRANSPORT (TTT) SURGERY: A CASE REPORT
Background
Diabetic foot ulcers (DFU) are common complications in patients with chronic DM. Approximately 20% of patients with DFU will require lower extremity amputation. Tibial cortex transverse transport (TTT) technique was established based on distraction osteogenesis. It has been applied to severe and recalcitrant DFU and atherosclerosis obliterans.
Case report
. A 71-year-old male with a past medical history of type 2 diabetes mellitus, right middle cerebral artery infarct, hypertension, and hyperlipidaemia, presented with a right 4th toe gangrene. He underwent right tibial cortex transverse transport (TTT) surgery and tiibial cortex transport surgery device was removed 7 weeks after the TTT surgery. He was transferred to inpatient rehabilitation medicine unit 1 week after the removal of external fixator and 8 weeks after TTT surgery. Surgeon allowed partial weight bear on right lower limb with off-loading shoe. After two days of 10 meters ambulation training with walking frame, he complained of worsening pain on right shin area. X-ray of lower leg showed a new fracture extending to the posterior cortex of the tibia shaft.
Conclusion
Inability to control his weight bearing on right lower due to previous stroke and osteopenia & sarcopenia might be the possible factors which lead to tibia fracture. TTT surgery has emerged as an intervention for severe diabetic foot ulcer to reduce amputation rates. To prevent secondary tibia fracture, delayed weight bearing or reduced weight bearing with patellar tendon bearing orthosis should be considered after TTT surgery if patient has risk of fracture, such as elderly, poor balance control, abnormal gait, and sarcopenia.
Keywords
DM, TTT, Tibial fracture, Rehabilitation
#27 OSTEOANABOLIC TREATMENT AFTER MULTIPLE PROXIMAL HUMERAL FRACTURES AND VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMAN
Jelena Marunica Karšaj, Dubravka Sajković, Jelena Marunica Karšaj, Tatjana Nikolić
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
OSTEOANABOLIC TREATMENT AFTER MULTIPLE PROXIMAL HUMERAL FRACTURES AND VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMAN
Background
Osteoporosis is a silent condition until a fracture occurs. Once vertebral and non-vertebral fracture are sustained, the risk of subsequent fracture increases. Our 69-year-old female presented with a frailty fractures cascade after several low-energy falls. She was diagnosed with diabetes mellitus and sarcopenia. Serious height decline and lumbar pain represented red flags which referred her to DEXA. Osteoanabolic treatment should be taken into consideration for high-risk patients.
Case report
Her total lumbar T-score of -1.5 SD was misrepresentative because of degenerative changes and vertebral compressive fracture. Genant II anteriorly wedge-shaped L1 was revealed. Shortly a right proximal humeral fracture (PHF) occured. Due to incompliance, she refused to be treated with antiresorptive therapy prescribed by a physiatrist. Three years later due to a low-impact fall, she sustained an acute L4 fracture and X-ray findings revealed a prior Genant III L3 fracture too. She was treated with calcium and 25(OH)D daily supplementation whom was faithfully compliant with. At this point, the opportunity to be treated by osteoanabolic was missed, because of irregular physiatrist visits due to her concern of fracture restoration. Again the same year a refracture of the left PH occurred. Three months later she fell again and sustained left multi-fragmentary PHF with screw dislocation, instability, and a gap between the plate and diaphysis. Recent DEXA showed false negative readings in the lumbar region due to vertebral compressive fractures (total T score -0.8 SD), and total hip T score -3.2 SD. Range of motion and load exercises were introduced for six months to the point when suboptimal range of motion was obtained.
Conclusion
The patient met criteria for teriparatide treatment 20μg/80μL daily subcutaneously for 2 years after prior 25(OH)D and calcium levels optimization. This instructive case report highlights the importance of earlier osteoanabolic treatment to prevent fracture cascade.
Keywords
osteoporosis, fraility fracture cascade, teriparatide
#28 COMMUNITY BASED REHABILITATION OR COMMUNITY BASED INCLUSIVE DEVELOPMENT ALL OVER THE WORLD
germano pestelli
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
COMMUNITY BASED REHABILITATION OR COMMUNITY BASED INCLUSIVE DEVELOPMENT ALL OVER THE WORLD
Background and Aims
To resume experiences of CBID in some countries in East Europe ,Middle East ,Africa , LAtin America and in Italy from 1999 to 2025.
Methods
Sharing of experiences
Results
To share with collegues the possibility to help people living in developing countries or people with social problems of partecipation to a right way of life.
Conclusion
The aim,the results ,the programs for future
Keywords
Rehabilitation,socialization,partecipation,community,equity
#29 SUICIDAL FRACTURE: A CLINICAL CASE OF NEUROLOGICAL INJURY TO THE SACRAL PLEXUS
Beatriz Afonso, João Rego Diniz, Ines Rocha Bernardo, Joana Reis
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SUICIDAL FRACTURE: A CLINICAL CASE OF NEUROLOGICAL INJURY TO THE SACRAL PLEXUS
Background
Sacral fractures represent 1% of axial skeleton fractures and are often associated with pelvic ring injuries. They usually result from high-energy trauma, such as traffic accidents and falls. The incidence of sacral plexus injury is significantly higher in sacral fractures compared to pelvic and acetabular fractures.
Case report
A 31-year-old woman was admitted to the emergency room following a suicide attempt, after falling 5 meters onto a hard surface while in an upright position. CT scans revealed fractures of the first to seventh right costal arches, a comminuted sacral fracture with bilateral multiple foraminal disruption (“H” fracture), and a right calcaneus fracture. The patient underwent L4-L5 percutaneous fixation, while other fractures were treated conservatively. During the Physical Medicine and Rehabilitation (PM&R) assessment, she exhibited a full and painless passive range of joint motion, muscle strength of 5/5 (MRC scale) bilaterally in C5-D1 and L2-S1 myotomes, preserved tactile and prick sensitivity in C5-S2 dermatomes, and symmetrical reflexes with no muscle tone changes. Neurourological examination showed abolished clitoral-anal and anal reflexes, 0/5 voluntary anal contraction, absent S3-S5 prick sensitivity and endoanal sensitivity bilaterally, and decreased muscle tone. She was catheterized due to urinary incontinence and a lack of bladder sensitivity. Rehabilitation included respiratory kinesitherapy, active polysegmental joint mobilization, pelvic floor reeducation with neuromuscular electrostimulation, electromyographic biofeedback, progressive perineal and abdominal muscle strengthening, sensory stimulation of hypoaesthetic regions, bowel and bladder training with tibial nerve stimulation, bladder sensitization, and intermittent urination. After discharge, she was referred for outpatient follow-up in PM&R to continue monitoring and rehabilitation.
Conclusion
Sacral plexus injury may go undiagnosed acutely due to trauma severity and pain affecting neurological examination. However, it must be ruled out in sacral spine trauma. Injury to the parasympathetic fibers of S2-S4 leads to an areflexic bladder with urinary incontinence, constipation, external anal sphincter dysfunction, and anal incontinence.
Keywords
Sacral plexus injury; Rehabilitation
#30 A NOVEL MINIMAL INVASIVE TECHNIQUE FOR THE TREATMENT OF OSTEOCHONDRAL LESIONS OF THE KNEE – CASE REPORT
João Tocha, Cláudia Correia, Afonso Braz, Frederico Moeda, Jorge Barbosa
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
A NOVEL MINIMAL INVASIVE TECHNIQUE FOR THE TREATMENT OF OSTEOCHONDRAL LESIONS OF THE KNEE – CASE REPORT
Background
Chondral and osteochondral knee injuries are common, especially in young or athletic individuals, leading to pain, functional impairment, and potentially accelerating osteoarthritis development. To date, when physiotherapy fails, surgical intervention is the only described treatment for this condition.
Case report
A 45-year-old female, originally from Cape Verde, recreational medium-distance runner, presented in Physiatry consultation with left knee pain, rated 8/10 in Visual Analog Scale (VAS), with 1,5 years’ duration, referred to the posterior region, worsening after walking, running and sometimes just with orthostatic position, and improving with rest. Physiotherapy provided minimal relief. Physical exam was notorious for pain in palpation of the outer aspect of the left knee, McMurray’s test positive for external meniscopathy and a doubtful Apley’s test. An MRI scan was request, revealing a grade IV/IV osteochondral defect on the posterior load-bearing zone of the external tibial plateau (6 x 7 mm) with subchondral cystic edema (image 1 and 2). Due to patient reluctance for surgery, it was agreed to proceed with 5cc intra-articular leucocyte-poor PRP under ultrasound guidance, followed by a 2cc intra-osseous injection into osteochondral lesion under fluoroscopic control, preceded by contrast injection to confirm PRP retention (image 3). The patient experienced complete symptom relief for 1.5 months post-procedure, with later recurrence at a much lower frequency and intensity, reaching a maximum VAS score of 2.5/10 at 6 months follow-up.
Conclusion
Although there are some promising studies in literature on intraosseous combined with intra-articular PRP in gonarthrosis, to the authors’ knowledge, there are no references regarding using this procedure in osteochondral focal defects. This clinical case may pave the way for further larger-scale studies in order to understand the viability and effectiveness of this treatment, as well as to establish protocols for the number of injections, platelet concentration and candidate patients.
Keywords
Osteochondral injury, Knee, Platelet-rich-plasma, intra-osseous
#31 CASE REPORT OF A CHRONIC TENNIS LEG INJURY - A SIMPLE UNDESCRIBED MINIMAL INVASIVE APPROACH
João Tocha, Humberto Lemos, Pedro Faria, Xavier Melo, Jorge Barbosa
Conference topic: Sports medicine rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CASE REPORT OF A CHRONIC TENNIS LEG INJURY - A SIMPLE UNDESCRIBED MINIMAL INVASIVE APPROACH
Background
Tennis leg describes a calf muscle injury caused by rupture of the medial head of the gastrocnemius muscle at the musculotendinous junction (MTJ). While acute cases usually resolve with conservative care, optimal treatment for chronic injuries remain undefined, especially when surgery is not a proper option. To the authors’ knowledge, there are no references in the literature regarding regenerative medicine strategies for chronic tennis leg injury, so the aim of this presentation is to demonstrate that orthobiological therapies can be effective in such cases.
Case report
A 45-year-old female, recreational long-distance runner, came to a Physiatry appointment with a history of pain in her right calf whenever she ran short distances, for the last 2 years, making her reduce her sports activity. She experienced a right calf trauma 2 years ago, while running, resulting in edema and bruising in her medial sural region, which reabsorbed within weeks. An office ultrasound showed a myoaponeurotic defect in the deep surface of medial gastrocnemius with hyperechogenic surrounding tissue. A plan of rehabilitation was proposed, which she followed for 2 months, with no significant improvement. It was then decided to perform intra-lesional infiltration of 3 cc of leukocyte-rich Platelet Rich Plasma. She was advised to rest from running for the first 2 to 3 weeks and then gradually return to activity as tolerated. During the reassessment at 3 and 6 months, the patient reported complete pain relief and the ability to run 10-15 km pain-free.
Conclusion
Our case contributes to chronic leg tennis management by presenting a minimal invasive percutaneous technique that was effective. Further studies, preferably randomized clinical trials, are needed to confirm its effectiveness, as it may improve pain and activity levels in patients with this condition.
Keywords
Tennis leg, Chronic, Platelet-rich-plasma
#32 USING A COMBINATION OF THREE CLINICAL TESTS FOR DETECTING MENISCAL TEARS INCREASES THE ACCURACY OF THE CLINICAL EXAMINATION
Alan Mahnik, Silvija Mahnik, Ana Aljinović
Conference topic: Sports medicine rehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
USING A COMBINATION OF THREE CLINICAL TESTS FOR DETECTING MENISCAL TEARS INCREASES THE ACCURACY OF THE CLINICAL EXAMINATION
Background and Aims
Recent studies indicate that using combination of two or more clinical tests for detecting meniscal tear gets a higher sensitivity and specificity than any clinical test performed individually. The aim was to investigate the validity of combination of three clinical tests for detection of meniscal tear (Thessaly Test, joint line tenderness, McMurray Test) and compare it with the results of another combination of three clinical tests (Ege Test, Steinmann I Test, atrophy of the thigh muscles) as well as with all six clinical tests performed individually.
Methods
The study involved 84 participants who were divided into two groups: the “OP group” consisting of participants diagnosed with a meniscal tear and who consequently underwent arthroscopic meniscectomy, and the “CN group” comprising of healthy participants with no history of knee injury. Two independent observers recorded the results of six clinical tests: Thessaly Test, joint line tenderness, McMurray Test, Ege Test, Steinmann I Test, and atrophy of the thigh muscles. The tests were grouped into two combinations of three tests each. The first combination included Thessaly Test, joint line tenderness and McMurray Test, while the second combination comprised of remaining three tests. Cochran’s Q Test was used to calculate interobserver variability for both combinations of tests and for each test performed individually.
Results
First combination of three clinical tests when considering the combination positive if two tests are positive had high sensitivity of 95%, specificity of 90.9%, and an overall accuracy of 92.9%. Furthermore, when compared to clinical tests performed individually, the combination demonstrated superior results.
Conclusion
This study shows that using a combination of three clinical tests for detection of meniscal tear (Thessaly Test, joint line tenderness, McMurray Test), when considering the combination positive if two tests are positive, has greater accuracy than six tests performed individually. There were no statistically significant differences between observers.
Keywords
Meniscus; Exercise; Athletes.
#35 POST STROKE FATIGUE: ANALYSIS OF SUBTYPES AND ASSOCIATED FACTORS
Mohammad Etoom
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
POST STROKE FATIGUE: ANALYSIS OF SUBTYPES AND ASSOCIATED FACTORS
Background and Aims
Post stroke fatigue (PSF) is a disabling complaint endorses stroke recovery. PSF is highly varied among stroke survivors. Most of previous studies considered PSF as one entity, pooling its physical and cognitive subtypes. The current study aimed to investigate the prevalence and associated factors of PSF with consideration of fatigue subtypes among stroke survivors
Methods
A cross-sectional study was conducted. Demographics, medical history, stroke characteristics, depression and anxiety, sleep quality, and stroke recovery were evaluated. The Modified Fatigue Impact Scale (MFIS) has been adopted to assess PSF and its subtypes (physical and cognitive). Descriptive statistics, MFIS subscales comparisons, and regression analyses were performed.
Results
A total of 92 participants were included, with a PSF prevalence rate of 71.7%. The MFIS physical subscale demonstrated a significantly higher prevalence and severity than cognitive subscale. Diabetes mellitus, hypercholesterolemia, and left stroke were associated with the MFIS cognitive subscale, while recurrent stroke was related to the MFIS physical subscales. Stroke recovery, depression and anxiety, and sleep quality were related with the MFIS total score as well as its two subscales. Depression and left stroke were significant predictors for MFIS total score and cognitive subscale. Sleep quality and being male were also significant predictors for MFIS cognitive fatigue
Conclusion
PSF is highly prevalent. PSF subtypes were markedly varied in prevalence, severity and associated factors. Future research and clinical protocols should consider different PSF subtypes rather than conceptualizing PSF as one entity.
Keywords
Fatigue, disorder, Cognitive, Exhaustion
#36 DECIDING ON AMPUTATION: THE CHALLENGES OF PATIENT COUNSELING IN CHRONIC OSTEOMYELITIS – A CASE REPORT
Filipe Moás, Mário Ferreira Vaz, Ana Miguel Afonso, José F Couto, Maria Inês Bonito
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
DECIDING ON AMPUTATION: THE CHALLENGES OF PATIENT COUNSELING IN CHRONIC OSTEOMYELITIS – A CASE REPORT
Background
Chronic osteomyelitis is a persistent and debilitating condition that often requires aggressive treatment, which include amputation in severe cases. However, patient reluctance to this last resort in managing this condition, due to understandable psychological, functional, and social concerns can delay necessary interventions, leading to worse outcomes.
Case report
The present case report discusses a 63-year-old male with a 45-year long standing chronic osteomyelitis of the left tibial shaft, initially managed conservatively, and requiring more invasive procedures in mid to late stages. Despite progressive bone infection, multiple surgical debridements, and significant functional impairment, the patient was disinclined to consider amputation.
Conclusion
We thought over the challenges of patient counseling, the risk of delaying surgical intervention, and the importance of a multidisciplinary approach in guiding the decision-making process. After much consideration and weighing the pros and cons of the 45-year long standing chronic osteomyelitis, the patient understood the complications of the disease progression and agreed to undergo below-knee amputation of the left lower limb.
Keywords
Chronic Osteomyelitis, amputation, counseling, decision-making
#37 THE PREVALENCE OF STRESS AND ITS ASSOCIATION WITH BALANCE AND GAIT SPEED IN PEOPLE WITH MULTIPLE SCLEROSIS IN JORDAN
Mohammad Al-Wardat
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
THE PREVALENCE OF STRESS AND ITS ASSOCIATION WITH BALANCE AND GAIT SPEED IN PEOPLE WITH MULTIPLE SCLEROSIS IN JORDAN
Background and Aims
Multiple sclerosis (MS) is an autoimmune disorder causing demyelination and axonal degeneration, affecting physical, psychological, and cognitive functions. In Jordan, stress prevalence in MS and its impact on balance and gait remain unexplored. This study aimed to explore the prevalence of stress in patients with MS (PwMS) and investigate the relationship between stress, balance and gait speed
Methods
This observation cross-sectional study design included 125 individuals diagnosed with MS according to the 2017- McDonald criteria. The outcome measures included a social-demographic questionnaire to collect demographic information, the Patient Determined Disease Step (PDDS) to examine patient’s disability level, Perceived Stress Scale (PSS) to measure perceived stress levels, Modified Fatigue Impact Scale (MFIS) to measure fatigue levels, Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT) to assess cognitive function, Berg Balance Scale (BBS) to assess balance and 10-meter Walking test (10-MWT) to evaluate gait speed. Correlation analysis was used to investigate the relationship between perceived stress scores and clinical outcome measures.
Results
A total of 125 participants completed the questionnaires and assessments that met the inclusion criteria. The mean age was 36 years± 11.08, and 75.2% were females. The prevalence of stress was found to be 88%. A significant negative correlation was found to be between stress and balance (r= -0.373, p= 0.0001), meanwhile a positive correlation was witnessed between stress and time taken to complete the 10-MWT (r= 0.216, p= 0.01). However, after controlling for confounders (age, BMI, PDDS, disease duration, onset of disease), these correlations were no longer significant.
Conclusion
This study found a high prevalence of stress which affects balance and gait speed in PwMS. These findings suggest that stress management is essential and could play an important role in improving balance and mobility in people with MS.
Keywords
MS, stress, gaite, balance
#39 DOES OSTEOPOROSIS IMPACT THE FUNCTIONAL STATUS OF PATIENTS WITH OSTEOARTHRITIS?
beguiret abdelatif
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
DOES OSTEOPOROSIS IMPACT THE FUNCTIONAL STATUS OF PATIENTS WITH OSTEOARTHRITIS?
Background and Aims
Osteoarthritis and osteoporosis are two common pathologies, which often coexist in the elderly and especially in women during the postmenopausal period. Data from the literature have shown the frequent association of these two conditions, the relationship of which has been studied in several works with sometimes-contradictory results. Our objective is to study the influence of osteoporosis on function in patients with severe osteoarthritis of the knee or hip who are candidates for total prosthesis.
Methods
Descriptive study (transverse, analytical) in patients suffering from severe primary knee or hip osteoarthritis who were candidates for arthroplasty. All patients underwent a careful interview with assessment of function using the Western Ontario and McMaster Universities Osteoarthritis Pain Domain Index (WOMAC function) questionnaire. The patients also benefited from a clinical and paraclinical examination including the assessment of bone status by performing bone mineral densitometry (BMD) at the spine and femoral neck.
Results
Over a period of 2 years, 300 patients were recruited with a sex ratio = 0.45, average age 67.97 ± 6.78 years and an average BMI of 30.81 ± 5.37 kg/m2. 26.7% of patients were osteoporotic, 43.7% were osteopenic. The mean WOMAC function score was 48.08±12.00 in osteoporotic patients and 46.36±13.35 in non-osteoporotic patients. There was no relationship between bone status and function (P=0.312).
Conclusion
Osteoarthritis and osteoporosis are multifactorial diseases. The absence of a link between osteoporosis and functional status revealed by our study demonstrates the complexity of the mechanisms of the relationship between these two conditions.
Keywords
Osteoarthritis, Osteoporosis, BMD, function, WOMAC
#40 RELATIONSHIP BETWEEN VITAMIN D STATUS AND FUNCTION IN PATIENTS WITH OSTEOARTHRITIS
beguiret abdelatif
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
RELATIONSHIP BETWEEN VITAMIN D STATUS AND FUNCTION IN PATIENTS WITH OSTEOARTHRITIS
Background and Aims
Vitamin D plays a major role in bone mineralization, remodeling, and metabolism. Consequently, its deficiency can be a significant factor in the pathogenesis and progression of osteoarthritis. Objective The aim of this study was to examine the relationship between vitamin D status and functional capacity in patients with severe osteoarthritis who are candidates for total knee arthroplasty (TKA) or total hip arthroplasty (THA).
Methods
We conducted a descriptive, analytical, and comparative study in a sunny Mediterranean country (Algeria), including 300 patients with severe knee or hip osteoarthritis at a stage requiring total joint replacement. The patients underwent a clinical and functional assessment of osteoarthritis using the function domain of the WOMAC questionnaire. Serum levels of 25-hydroxyvitamin D (vitamin D) were measured using an electrochemiluminescent immunoassay on blood serum samples collected during patient consultations.
Results
The mean serum vitamin D level was 23.32 ± 13.21 ng/mL, with the majority of patients having low vitamin D status. The average WOMAC function score was 48.08 ± 12.00. There was no relationship between vitamin D status and function as assessed by the WOMAC function score.
Conclusion
In our study, vitamin D status appears to be an independent factor of functional capacity in patients with severe knee or hip osteoarthritis requiring total joint replacement. This could be attributed to the presence of several other elements contributing to the functional severity of osteoarthritis.
Keywords
Osteoarthritis, vitamin D, function
#41 ELSBERG SYNDROME BY HERPES SIMPLEX 1 REACTIVATION: CASE REPORT
Beatriz Afonso, Ines Bernardo, Joao Diniz, Ana Ursula Martins
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
ELSBERG SYNDROME BY HERPES SIMPLEX 1 REACTIVATION: CASE REPORT
Background
Elsberg Syndrome (ES) is a rare condition, described as an acute or subacute lumbosacral radiculitis, often associated with viral infections such as HSV-2, accounting for 5-10% of cases of cauda equina syndrome.
Case report
This case describes a 54-year-old woman with acute low back pain, progressive weakness of the right lower limb, sensory alteration and urinary complaints, preceded by labial herpetic vesicles. Neurological examination revealed motor deficit, hypostasis, abolished reflexes and signs suggestive of radicular involvement. CT of the spine was normal, but lumbar puncture showed pleocytosis and CSF PCR confirmed HSV-1 infection. MRI showed enhancement of the lumbar nerve roots and EMG revealed sensitivomotor polyradiculopathy of L3-S1 on the right. The patient was treated with intravenous acyclovir for 21 days, with early rehabilitation. At the MFR follow-up appointment, 17 days after discharge, she had improved strength, symmetrical sensitivity, normal bladder function and no incontinence. She continued with outpatient rehabilitation and returned to work, despite residual motor deficits.
Conclusion
This case highlights the importance of early diagnosis of ES, even in the absence of active skin lesions or a clear viral history. Detection of HSV-1 in the CSF confirmed the etiology, although treatment can be started empirically. The prognosis depends on the initial severity and therapeutic response, and early initiation of antiviral treatment and rehabilitation is essential. Delayed diagnosis can lead to prolonged bladder dysfunction and persistent neurological deficits.
Keywords
Síndrome de Elsberg, Herpes Simples
#42 ELBOW STIFFNESS: VALUE OF LOCORÉGIONAL ANESTHÉSIA TECHNIQUES USING PERINEURAL CATHETERS IN EARLY REHABILITATION OF ELBOW ARTHROLYSIS
Dalila Chaid
Conference topic: Pain treatment and rehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
ELBOW STIFFNESS: VALUE OF LOCORÉGIONAL ANESTHÉSIA TECHNIQUES USING PERINEURAL CATHETERS IN EARLY REHABILITATION OF ELBOW ARTHROLYSIS
Background and Aims
surgery for elbow stiffness is extremely delicate and painful, depending on the degree of stiffness, so to guarantee success and maximum functional capacity for the patient, an early rehabilitation program must be implemented. pain during rehabilitation often hinders the effectiveness of this program. the aim of this observational work is to control pain using highly effective means such as perineural catheters, thus offering optimal elbow release.
Methods
14 patients operated on for elbow arthrolysis received an infraclavicular perineural catheter with continuous injection via an easy pump and were monitored throughout the period of passive and active physiotherapy, with pump adjustment based on VAS (visual analog scale). Judgement criteria were improvement in flexion-extension and pronation-supination amplitude with pain reduction (stopping injection of local anaesthetics and pain assessment: VAS) and patient satisfaction.
Results
after surgery. It was of the order of 70 to 90% of the initial deficit in 13 patients. one patient had an early postoperative hematoma, which delayed his rehabilitation to 03 months, with a result identical to the others.
Conclusion
The results of these techniques are very encouraging, with patient satisfaction and improved function in over 90% of cases.
Keywords
elbow, arthrolysis, pain, early physiotherapy.
#43 EVALUATING PHYSICAL THERAPY EFFICACY IN MANAGING PREGNANCY-RELATED LOW BACK PAIN
Arpine Muradyan
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EVALUATING PHYSICAL THERAPY EFFICACY IN MANAGING PREGNANCY-RELATED LOW BACK PAIN
Background and Aims
Pregnancy-related lower back pain (LBP) is a prevalent condition affecting functional mobility and quality of life. Effective management strategies are essential to mitigate pain and improve overall well-being. This study aimed to evaluate the impact of a structured physical therapy program, "Prenatal-Mix," on functional limitations and pain intensity in pregnant women with LBP.
Methods
A total of 42 pregnant women (mean age: 28.7 ± 4.3 years) in their second trimester with LBP participated in the study. Participants underwent the “Prenatal-Mix” physical therapy program, which combined core strengthening exercises, pelvic floor muscle training, gentle stretching routines (including Pilates and Yoga), and Prenatal aqua therapy. The Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were used to assess functional disability and pain intensity before and after the intervention. Statistical analysis was conducted using SPSS version 19.0, employing Student's t-test and chi-square (X²) analysis to determine significance.
Results
Pre-intervention, the mean ODI score was 23.95 ± 8.7, which significantly reduced to 8.95 ± 5.7 post-intervention (t=9.4, p<0.001). Pain intensity showed a gradual reduction over time, with 9.5% of participants reporting decreased pain after two weeks, 31% after one month, 55% after three months, and 4.5% after five months. Irregular attendance correlated with delayed pain relief. Initially, 45.2% of participants exhibited minimal disability (ODI 0–20), increasing to 95.2% post-intervention (p<0.001). Chi-square analysis indicated a statistically significant association between training and reduced disability (X²=28.17, p=0.0001) as well as pain intensity (X²=48.9, p=0.0001).
Conclusion
A structured physical therapy program significantly reduces functional limitations and pain intensity in pregnant women with LBP. Regular participation enhances outcomes, underscoring the importance of integrating targeted physical therapy into prenatal care to improve maternal health and quality of life.
Keywords
back pain, pregnancy, physical therapy
#44 ATYPICAL FEMUR FRACTURE REHABILITATION-CASE REPORT
Aida Čengić, Sumeja Selimbegović, Neira Serhatlija
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
ATYPICAL FEMUR FRACTURE REHABILITATION-CASE REPORT
Background
Postmenopausal osteoporosis is a metabolic disease characterized by mineral density loss and bone architecture alteration with the consequent possibility of vertebral and non-vertebral fractures. Commonly used medications are bifosfonates, which suppress osteoclastic activity. The prolonged use of bisfosphonates (> 5 years) is associated with an increased incidence of atypical femoral fractures, possibly due to excessive suppression of bone remodeling. Surgical treatments include open and closed reposition, and internal fixation. The rehabilitation goals include pain reduction, complications prevention, mobility and strength improvements, and functional recovery
Case report
Patient A.N., born in 1973, from Sarajevo, with a negative personal and family medical history, was diagnosed with menopause at the age of 35 with consequent osteoporosis treated with bisphosphonates, not taken for several months. Hospitalized at Orthopedics Department on 13.09.2023, due to a left femoral condylar fracture sustained after fall, and admitted to rehabilitation treatment on 02.02.2024, at the orthopedist recommendation. Radiological verification showed an atypical subtrochanteric low-energy fracture - iceberg type. Operated on 14.10.2023 (Op. Ostesynthesis partis proximalis femoris l. sin. cum femoral nail), after which undergoes outpatient physical treatment based on kinesitherapy and magnetotherapy, enabling walking with one crutch with a full support on the left leg. Left leg muscular hypothrophy remains. Control RTG shows inadequate fracture healing. In the follow-up examination (04.06.2024), the patient complains of left hip and inguinal region soreness. Radiological verification shows left femor osteosynthetic material fracture, after which a surgery is performed on 06.06.2024 (Op: Extractio alenthesis femoris l. sin. Osteosynthesis cum IM nail). Following physical therapy, 90 degrees flexation is achieved in the left hip. Knee and ankle joint movements are re within normal physiological ranges. Densitometry measurements on 21.08.2024, show: T-score (vert): -2.0 T-score (fem): -1.7
Conclusion
After rehabilitation, the patient regained the ability to walk independently, with acceptable motion range and functional movement in the hip.
Keywords
fracture, osteoporosis, bisphosphonates
#45 WILLIAMS-BEUREN SYNDROME SHROUDED IN NEURODEVELOPMENTAL DELAY, SEVERE SCOLIOSIS, AND „COCKTAIL PARTY PERSONALITY“
Jelena Marunica Karšaj1, Kristina Žgela Talan2, Valentina Matijević1
2 Istarski domovi zdravlja, Croatia/Hrvatska
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
WILLIAMS-BEUREN SYNDROME SHROUDED IN NEURODEVELOPMENTAL DELAY, SEVERE SCOLIOSIS, AND „COCKTAIL PARTY PERSONALITY“
Background
Williams-Beuren syndrome (WBS) is a rare congenital multisystem condition caused by a spontaneous heterozygous microdeletion at 7q11.23. It occurs in 1:7.500-20.000 live births. The syndrome manifests through characteristic dysmorphic facial features, described as an elfin visage, alongside cardiovascular anomalies, cognitive impairments, as well as endocrine, ophthalmologic, and orthopedic abnormalities. The course of treatment is contingent upon the particular abnormality; however, the paramount objective universally remains the alleviation of symptoms and the prevention of potential complications.
Case report
Our patient is the first child of nonconsanguineous healthy parents born at 36 weeks gestational age via spontaneous vaginal delivery from an orderly course pregnancy. He underwent phototherapy to alleviate neonatal jaundice. Ultrasound brain findings verified subependimal intracranial bleeding with multiple cystic formations. Phenotypic characteristics revealed craniofacial dysmorphism, including epicanthal folds, large ears, an upturned nose, a wide mouth, a small jaw, and small teeth. His cardiac anomaly in terms of bicuspid aortal valve has been regularly under cardiac surveillance. He has been under pediatric physiatrist follow-up since the time he was two months old until six years due to neurodevelopmental delay, trunkal hypotonia and increased muscle tone on extremities, and severe dextroconvex thoracolumbal scoliosis with punctum maximum at L4 and pectus excavatum. He has been toe walking since he was 15 months old. He has a very outgoing personality and empathy, has difficulty identifying strangers and therefore fits the description „cocktail party personality“. As gross and fine motor skills and cognitive functions were affected, comprehensive inpatient and outpatient multidisciplinary habilitation is pursued encompassing Bobath concept and Vojta principle. The clinical exome sequencing has unveiled a microdeletion at locus 7q11.23.
Conclusion
We present this case to underscore the benefits derived from the timely referral to pediatric physiatrist, aimed at optimally promoting gross motor development and facilitating the resolution of scoliosis in a child afflicted with WBS.
Keywords
Williams-Beuren syndrome, child, scoliosis, neurodevelopmental
#46 OPTIMISING ADMISSION CRITERIA FOR INPATIENT REHABILITATION: POPULATION-BASED INSIGHTS FROM MALTA
Christa Vella
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
OPTIMISING ADMISSION CRITERIA FOR INPATIENT REHABILITATION: POPULATION-BASED INSIGHTS FROM MALTA
Background and Aims
This population study aims to analyse referral patterns and admission decisions at Karin Grech Hospital, Malta’s sole inpatient rehabilitation facility, while also comparing the findings to corresponding local data from 2018 to identify emerging trends. To identify key shifts in acceptance rates and patient profiles, and thereby provide evidence to enhance in-patient rehabilitation selection frameworks and guide international rehabilitation strategies.
Methods
A retrospective, population-based analysis was conducted on all in-patient rehabilitation referrals in Malta between July 1, 2022, and December 31, 2023. Referral outcomes, acceptance rates, and primary admission diagnoses were examined. Referrals from the acute care hospital, Mater Dei, to Karen Grech Rehabilitation Hospital for in-patient rehabilitation were analysed. Patients who were admitted to Mater Dei Hospital for acute care and referred to in-patient rehabilitation during July 1, 2022, and December 31, 2023, were included.
Results
407 referrals were placed. 64% (n=261) were accepted—a notable rise from 47% in 2018. Non-acceptance was recorded in 96 cases, while 50 patients were discharged or deceased before review. The average length of stay at Karen Grech Rehabilitation Hospital increased to 69.74 days from 59.1 days in 2018. Cerebrovascular accidents were the leading cause of referral (22.36%), while post-oncological rehabilitation referrals were the least common (1.22%).
Conclusion
As a population-based analysis of national in-patient rehabilitation data, this study provides insights into optimising admission criteria to enhance efficiency and outcomes. These findings may serve as a framework for rehabilitation policies worldwide. Future research should investigate barriers influencing discharge and long-term rehabilitation success.
Keywords
Rehabilitation, Length of Stay, Hospital
#47 SHOULDER TENDINOPATHY INDUCED BY STATINS: SYSTEMATIC REVIEW AND CASE REPORT
Nicola Manocchio1, Nicola Manocchio1, Carmelo Pirri2, Andrea Sorbino1, Laura Giordani1, Giulia Vita1, Concetta Ljoka1, Calogero Foti1
2 Padua University, Italy
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SHOULDER TENDINOPATHY INDUCED BY STATINS: SYSTEMATIC REVIEW AND CASE REPORT
Background and Aims
Statins are widely used to manage cholesterol levels, but their use can lead to musculoskeletal side effects, including tendinopathy of the shoulder. Among these, Rotator Cuff Disease (RCD) is one of the most prevalent forms of shoulder tendinopathy. Here we present a clinical case of statin-induced RCD and a systematic review on the association between statins and shoulder tendinopathy.
Methods
A systematic review was conducted following PRISMA guidelines, utilizing databases such as PubMed, Web of Science, and SCOPUS. Additionally, the case of a 49-year-old male patient with statin-induced RCD is reported. The patient was treated with a individual rehabilitation project (IRP) that included steroid and hyaluronic acid (HA) injections, mesotherapy, and therapeutic exercises.
Results
From an initial pool of 217 articles, three cohort studies met the inclusion criteria for the systematic review. The findings revealed conflicting evidence regarding the relationship between statins and shoulder tendinopathy. In the case report, symptoms improved after reducing the statin dose and implementing a multimodal personalized IRP.
Conclusion
Statins may contribute to tendon injuries by disrupting extracellular matrix composition and cell membrane integrity. Although the association between statins and tendinopathy remains debated, clinicians should monitor patients for signs of tendinopathy and consider alternative treatments if symptoms develop. This case report demonstrated that a multimodal personalized IRP can effectively manage statin-induced RCD. Further research is required to elucidate the relationship between statins and shoulder tendinopathy. Early diagnosis and individualized treatment strategies are critical for optimizing patient outcomes.
Keywords
Statins, Tendinopathy, intra-articular-injections, mesotherapy, therapeutic-exercise
#48 BENEFITS OF EARLY PROACTIVE PRM EVALUATION IN ACUTE CARE SETTINGS FOR PATIENTS WITH MULTI-TRAUMA INJURY
Michael Glukhoded, Vera Knaizer, Tamara Kimelman, Alon Friedman, Iuly Treger
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BENEFITS OF EARLY PROACTIVE PRM EVALUATION IN ACUTE CARE SETTINGS FOR PATIENTS WITH MULTI-TRAUMA INJURY
Background and Aims
Victims of terrorism and combat injuries usually present with a multifaceted injury pattern, including orthopedic injury, mild traumatic brain injuries, and acute stress response. These patients show a significant functional decline requiring an intensive and prolonged rehabilitation process to return to optimal functioning levels. PRM assessments are typically conducted upon request by the acute care team, which may lead to underdiagnosis and delay in diagnosis of impairments. Starting from October 9, 2023, the rehabilitation department at Soroka University Medical Centre began proactively identifying patients needing rehabilitation intervention following a multi trauma injury due to military operations or terrorism. Since then, daily monitoring by a rehabilitation physician has been conducted for all hospitalized patients with multi-trauma injuries. Our aim was to assess whether proactive assessment and monitoring by a rehabilitation physician for all war-related multi-trauma patients from the first day of hospitalization contribute to referring more patients to a multidisciplinary intensive rehabilitation framework.
Methods
A retrospective study compared two groups of patients: Those injured on October 7 and 8, 2023, and the intervention group of multi-trauma patients hospitalized in the following year. Demographic data of the patients, aspects of hospitalization, and the type of rehabilitation required, were examined and compared between the two groups.
Results
The demographic and injury data of the two groups were similar. Among the 302 patients in the control group, 68 were discharged and 28 were sent to rehabilitation. Among the 625 patients receiving an early proactive assessment and intervention, 318 were discharged and 67 were sent to rehabilitation. (X2 (1, N=628) = 4.2, p = 0.04).
Conclusion
Proactive and early intervention by a rehabilitation physician leads to more effective identification of patients needing multidisciplinary intensive rehabilitation, and therefore, such measures should be considered for populations at risk of severe functional decline due to multi-trauma or similar situations.
Keywords
multi-trauma, acute rehabilitation
#53 FOCUSED SHOCKWAVE THERAPY ON PATELLAR ENTHESOPATHY IN SPONDYLOARTHROPATHY: A CASE REPORT
Yi-Hong Wu
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
FOCUSED SHOCKWAVE THERAPY ON PATELLAR ENTHESOPATHY IN SPONDYLOARTHROPATHY: A CASE REPORT
Background
Anterior knee pain is a common manifestation in spondyloarthropathy (SpA), frequently attributed to enthesopathy and Hoffa’s fat pad inflammation. While conventional treatment includes anti-inflammatory medications and rehabilitation, some cases remain refractory. Focused shockwave has been widely used for calcific lesions and tendinopathy, but reports of its application in spondyloarthropathy is limited. This report presents a novel use of focused shockwave therapy in managing SpA-related knee pain, highlighting its potential role in pain relief and tissue recovery.
Case report
A 27-year-old male with seronegative peripheral SpA presented with persistent right anterior knee pain for six months, unresponsive to oral hydroxychloroquine, NSAIDs and physical therapy. The pain was activity-related, with morning stiffness and localized tenderness at the distal patella and Hoffa’s fat pad. Focused shockwave was administered under ultrasound guidance to the proximal patellar tendon and Hoffa’s fat pad three times per week (2500 pulses/session, energy flux density: 0.142–0.341 mJ/mm²). Following two sessions, the patient's visual analog scale (VAS) score improved from 8 to 0. The Knee injury and Osteoarthritis Outcome Score (KOOS) also improved significantly, increasing from 59% to 90%, with the greatest improvements observed in the pain and sports subscales, which increased by 113% and 78%, respectively. The Victorian Institute of Sport Assessment Questionnaire for Patellar Tendon (VISA-P) improved from 32 to 79. Follow-up ultrasonography at one month, comparing both the affected and asymptomatic sides, as well as pre- and post-treatment images, revealed reduced tendon thickness, improved fibrillar pattern, and resolution of fat pad inflammation.
Conclusion
The patient experienced complete resolution of pain and sonographic signs of enthesopathy without adverse effects. Focused shockwave may enhance recovery of soft tissue structures in SpA-associated knee pathology, and appears to be a promising adjunct for refractory patellar enthesopathy in SpA. Its non-invasive nature and favorable safety profile warrant further evaluation in larger studies and controlled trials.
Keywords
focused shockwave, patellar enthesopathy, spondyloarthropathy
#54 MACHINE BASED TRUNK MUSCLE STRENGTHENING IN THE PREVENTION OF LOW BACK PAIN IN ACTIVE NURSES AGED 45+: RESULTS OF A FEASIBILITY RANDOMIZED CONTROLLED STUDY.
Gerold Ebenbichler, Nicolett Kainz, Peter Merschdorf, Mariama Mauri, Galateja Jordakieva, Franz König, Jasminca Godnic-Cvar
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
MACHINE BASED TRUNK MUSCLE STRENGTHENING IN THE PREVENTION OF LOW BACK PAIN IN ACTIVE NURSES AGED 45+: RESULTS OF A FEASIBILITY RANDOMIZED CONTROLLED STUDY.
Background and Aims
Active nurses aged 45+ are at very high risk for low back pain (LBP). As evidence-based recommendations of regular trunk muscle training to prevent LBP in nurses remains unclear, this pilot study sought 1) to ascertain the feasibility of machine-based trunk muscle strengthening at the workplace to prevent LBP and disability and 2) to identify suitable and sensitive health and functional measures to be included in a confirmatory RCT.
Methods
Thirty-three active nurses older than 45yrs who reported LBP on at least six of 30 monitored days (intensity ≥3 on 11pts RSA) participated in this randomized, controlled cross-over trial. The intervention engaged participants to train back extensor and trunk flexor muscles for five months (2x/week) using machines. Controls remained without intervention. After six months, groups were switched. Evaluations were performed at baseline, five, and 11 months later. The primary outcome measures included daily pain and disability ratings, the Roland Morris Disability Questionnaire (RMDQ), the Multidimensional Pain Inventory (WHYMPI), and the Work Productivity and Ability Index (WPAI). Secondary outcomes were trunk strength, endurance and activity measures, and satisfaction with the intervention.
Results
82% of the participants completed the training sessions, 81% of whom expressed satisfaction with the intervention and indicated a willingness to repeat it. No significant changes were observed for the RMDQ or the WPAI at the conclusion of the intervention. The MPID exhibited a clinically relevant improvement among participants when allocated to the intervention. No correlation was found between secondary outcome and primary outcome measures.
Conclusion
A confirmatory study with active 45+ nurses who experience LBP that does not require medical attention would likely demonstrate that regular trunk muscle training would positively effect on psychosocial life aspects as measured with the WHYMPI. However, the efficacy of this intervention in enhancing back-related health (RMDI), or workability (WPAI), in these individuals appears improbable.
Keywords
Low, back, pain, prevention, training
#55 IMPACT OF BOTULINUM TOXIN TYPE A IN THE TREATMENT OF PISA SYNDROME IN PATIENTS WITH PARKINSON’S DISEASE.
labiba fadel, abdelghani miliani, naima benzamouche, mohamed medaouar
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
IMPACT OF BOTULINUM TOXIN TYPE A IN THE TREATMENT OF PISA SYNDROME IN PATIENTS WITH PARKINSON’S DISEASE.
Background
Introduction: Dystonia is not a rare complication in patients with Parkinson’s disease and can involve the trunk and cause abnormalities of body posture such as the Pisa syndrome and annoying pain affecting gait and quality of life or even social isolation. Aim: The interest of using botulinum toxin type A in the correction of postural disorders in Parkinson's disease.
Case report
Material and Methods: This is a study of a case of PD at Hoehn and Yahr stage II, who presents axial pain associated with postural disorders such as Pisa syndrome. A clinical assessment of pain and postural disorders and their impact on gait using generic scales (VAS, TUG, 10-meter test) and specific MSD-UPDRS with an assessment of quality of life (PDQ-39) and videos are made before and after treatment. We performed an intramuscular motor block of the lateral muscles of the trunk supplemented by the injection of botulinum toxin A, followed by a rehabilitation protocol Result: The results are marked by an almost complete resolution of the abnormal posture and an improvement in the parameters studied and in the quality of life, which translates into great satisfaction on the part of our patient.
Conclusion
The injection of botulinum toxin A into the hyperactive muscles of the trunk associated with rehabilitation has proven to allow an almost complete resolution of the Pisa syndrome. Keywords: Parkinson's disease (PD); dystonia; rehabilitation; Pisa syndrome; posture; intramuscular motor block; botulinum toxin type A.
Keywords
Parkinson's disease, Pisa syndrome, botulinum
#57 PLANTAR FASCIITIS AS AN INITIAL DIAGNOSIS OF TARSAL TUNNEL SYNDROME: CASE REPORT
David Eliécer Rodríguez Rodríguez1, Julio Ernesto Giraldo2, Julian David Valero3, Rafael Alejandro Rozo3, Alejandro Meneses Gurdorj3
2 Electrodiagnóstico Giraldo, Colombia
3 Colombia, Colombia
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Postgraduates students
Type of abstract: Case report
Abstract
Title
PLANTAR FASCIITIS AS AN INITIAL DIAGNOSIS OF TARSAL TUNNEL SYNDROME: CASE REPORT
Background
Tarsal Tunnel Syndrome (TTS) is a rare kind of neuropathy caused by entrapment of posterior tibial nerve deep to the flexor retinaculum on the medial side of the ankle. It can cause chronic pain, paresthesia, and muscle weakness.
Case report
A female patient aged 62 years presented stabbing pain in the soles of her feet. The pain sometimes radiated to the ankle and was worse while walking. She was first diagnosed with plantar fasciitis and was treated with physiotherapy, analgesics, and shockwave therapy without any benefit. When she saw a physical medicine and rehabilitation specialist, she stated that she had tingling in the soles as a new symptom. The physical examination showed atrophic intrinsic plantar muscles and hypoesthesia in medial and lateral plantar nerves territories in the right foot. Ultrasound revealed thickening of the tibial nerve. Electrodiagnostic tests exhibited reduced amplitude of the tibial nerve compound motor action potential (CMAP) and there was no response on the sensory nerve conduction study of the plantar nerves. Electromyography showed denervation in the abductor hallucis muscle. Based on these findings, a diagnosis of TTS was made. The patient was sent to orthopedic surgery and had surgical decompression. After surgery, her pain and neurologic symptoms improved singnificantly.
Conclusion
Foot pain can be derived from multiple causes. Therefore, appropriate neuromusculoskeletal and neurologic evaluation is key to diagnosis. Proper approach highlights the importance of physical medicine and rehabilitation specialist, as this specialty brings together knowledge in anatomy, ultrasonography, and neurophysiology. This case also highlights the need for a re-evaluation of the diagnosis in patients not responding to conventional treatment.
Keywords
Tarsal tunnel syndrome, Electrodiagnosis, Ultrasound.
#59 ENHANCING POSTURAL CONTROL BY MULTICOMPONENT BALANCE EXERCISES AND FUNCTIONAL SOMATOSENSORY FOOT MOBILIZATION IN PATIENTS AFTER BRAIN TUMOR SURGERY
Maruša Brcar, Marko Brcar, NIKA ČERNEC, Nataša Kos
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
ENHANCING POSTURAL CONTROL BY MULTICOMPONENT BALANCE EXERCISES AND FUNCTIONAL SOMATOSENSORY FOOT MOBILIZATION IN PATIENTS AFTER BRAIN TUMOR SURGERY
Background and Aims
: Patients who have undergone brain tumor surgery often experience postural instability. Our pilot study investigated the effects of multicomponent balance exercises (MBE) and sensorimotor mobilization with foot muscle strengthening (SMFE) on postural control in these patients. We assessed their postural stability using the Balance Error Scoring System (BESS), which consists of 20-second tasks performed with closed eyes and hands on hips on both hard and soft surfaces.
Methods
Twenty postoperative patients participated in a randomized clinical study, divided into two groups: the MBE group (6 women and four men, average age 30.2) and the SMFE group (6 women and four men, average age 34.5). All patients who underwent WHO grade 1 parasagittal meningioma surgery followed the postoperative instructions. They scored at least 25 on the Mini-Mental State Exam (MMSE) and a minimum of 30 on the Berg Balance Scale (BBS). Balance was evaluated using the Balance Error Scoring System (BESS) on the third postoperative day and before discharge. The average length of hospitalization was 10 days.
Results
Both patient groups showed significant improvements (p < 0.05) in maintaining an upright posture after the BESS test. In the MBE group, 80% of patients achieved a clinically significant change of 10 points in postural stability, while 100% of patients in the SMFE group did so. Additionally, the SMFE group demonstrated even more significant improvements (p < 0.01) in balance tasks performed on both hard and soft surfaces. These tasks included maintaining an upright posture with feet together, standing on one leg, and tandem standing.
Conclusion
Patients improved static balance after the BESS test at discharge. The SMFE group showed enhanced functional balance and confidence through sensorimotor mobilization and foot arch strengthening. We recommend this approach for early rehabilitation, though more research is needed.
Keywords
Surgery, Posture, MBE, SMFE, BESS
#60 CAN VESTIBULAR REHABILITATION THERAPY BE A VITAL SUPPORT FOR PATIENTS TRANSITIONING HOME AFTER UNDERGOING ACOUSTIC NEUROMA SURGERY?
NATAŠA KOS, NIKA ČERNEC, MARKO BRCAR, MARUŠA BRCAR
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CAN VESTIBULAR REHABILITATION THERAPY BE A VITAL SUPPORT FOR PATIENTS TRANSITIONING HOME AFTER UNDERGOING ACOUSTIC NEUROMA SURGERY?
Background and Aims
The surgical removal of an acoustic neuroma impacts the patient's balance system, leading to symptoms such as dizziness, nausea, visual disturbances, and instability during daily activities. Vestibular exercises are an evidence-based approach for managing vertigo and are effective for various balance disorders. This study aimed to evaluate the effects of Vestibular Rehabilitation Training (VRT) on enhancing patients' walking performance, as measured using the Functional Gait Assessment (FGA) scale.
Methods
: In a pilot study approved by the Medical Ethics Commission on September 19, 2017 (No. 0120–472/2017/5), a total of 22 male and 28 female participants were enrolled, with a mean age of 47.3 years (± 7.8). All patients underwent unilateral surgical resection of an acoustic neuroma. Each patient scored at least 25 out of 30 on the Mini-Mental State Examination (MMSE) and a minimum of 30 out of 56 on the Berg Balance Scale (BBS). During the 14-day recovery period in the hospital, patients participated in vestibular exercises to enhance their eye, head, and body movements while seated, standing, or walking. After being discharged to their home environment, patients continued to perform vestibular vestibular VRT exercises. The functionality of their walking was assessed using the FGA scale both before discharge and three months after surgery.
Results
To determine a clinically significant change between two FGA measurements, we used an external criterion of 5 points, as established in the literature. Our analysis revealed that 75% of patients surpassed this minimum clinically significant change of 5 points, indicating improved dynamic adaptation during functional walking.
Conclusion
VRT enhanced walking performance and balance in our patients, resulting in improved daily functioning and greater self-confidence in their home environments. Further research with a larger patient group and ongoing monitoring of their rehabilitation progress is needed.
Keywords
Surgery, Vestibular, Disorders, VRT, FGA
#63 INCIDENCE AND RISK FACTORS OF URINARY INCONTINENCE AMONG POSTPARTUM WOMEN
labiba fadel, abdelghani miliani, naima benzamouche, mohamed medaouar
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
INCIDENCE AND RISK FACTORS OF URINARY INCONTINENCE AMONG POSTPARTUM WOMEN
Background and Aims
Introduction: Urinary incontinence is defined as the involuntary loss of urine, occurring during efforts (such as coughing, laughing, or lifting), forcing women to use protective measures constantly. Common during the postpartum period, it can significantly impact quality of life. This study aims to assess the link between childbirth and the onset of urinary incontinence.
Methods
Materials and Methods: This is a prospective study involving 125 postpartum women. A questionnaire consisting of 11 items was administered during the first newborn check-up. No paraclinical examinations were performed, and no treatment promise was made.
Results
Out of 125 women surveyed, 15 (12%) reported urinary incontinence after delivery. All were continent before giving birth. The main associated factors were age > 30, obesity, multiparity, and obstetric trauma.
Conclusion
Postpartum trauma appears to be a major contributing factor to urinary incontinence. This study aimed to quantify the impact of childbirth on this condition. A second phase is planned to expand the sample size and investigate prevention and treatment strategies.
Keywords
postpartum, Urinary Incontinence
#64 COULD THE PRESENCE OF CARDIAC ARRHYTHMIA HINDER PROPER HABILITATION?
Jelena Marunica Karšaj, Ana Giljanović, Valentina Matijević
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
COULD THE PRESENCE OF CARDIAC ARRHYTHMIA HINDER PROPER HABILITATION?
Background
Cardiac fibromas, despite being benign, may produce severe symptoms including cardiac arrhythmias, chest pain, and occasionally a sudden death. They are the second most common primary cardiac tumor among children. Genetic assays are often conducted to rule out genetic conditions like tuberous sclerosis, which are usually linked to pediatric cardiac tumors.
Case report
An eight-month-old male patient was referred to a pediatric physiatrist for a neuromotor development evaluation following complications after birth caused by a tumor (most likely fibroma) located on the interventricular septum of the heart. The tumor was detected in the 28th gestational week with fetal echocardiography. After an induced delivery in the 39th week, a comprehensive cardiological workup also discovered supraventricular tachycardia (up to 289 bpm) on a 24-hour electrocardiogram. On day 7, a decrease in blood oxygen saturation was caused by arrhythmia, which was ultimately converted to a sinus rhythm with the administration of adenosine, an antiarrhythmic medication. The initial pediatric physiatrist examination disclosed that the age-appropriate milestones were met albeit to a suboptimal level, except for the quadrupled position coupled with truncal hypotonia. After obtaining cardiological consent, the patient was enrolled in the neurodevelopmental habilitation with the components of the esteemed Bobath concept once a week in the outpatient settings and at home repeatedly. No complications were encountered during the habilitation. Due to the patient's regular cardiac surveillance and prescribed antiarrhythmic medications (sotalol and digoxin), no pathological tachycardias were recorded. Following an extensive habilitation, the latest pediatric physiatrist examination confirmed the 2-year-old boy has attained all age-appropriate developmental milestones.
Conclusion
It is necessary to obtain cardiologist consent before starting habilitation with heart disease. The objective of habilitation is to pursue motor skills development to the utmost potential. Physiatrists must be aware of potential limitations of these patients before performing any physical therapy to ensure proper and safe habilitation.
Keywords
arrhythmia, cardiac fibroma, neurodevelopmental habilitation
#65 HETEROTOPIC OSSIFICATION AFTER CRYPTOCOCCAL MENINGITIS IN A DIALYSIS-DEPENDENT PATIENT: A CASE OF ELBOW CONTRACTURE
Nadica Laktašić Žerjavić1, Nataša Kalebota2, Vanja Dekleva2, Kristina Kovač Durmiš1, Iva Žagar1, Helena Kolar Mitrović2, Duje Birkić2, Porin Perić1, Nadica Laktašić Žerjavić1
2 Department of Rheumatology and Rehabilitation, University Hospital Centre Zagreb, Croatia/Hrvatska
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
HETEROTOPIC OSSIFICATION AFTER CRYPTOCOCCAL MENINGITIS IN A DIALYSIS-DEPENDENT PATIENT: A CASE OF ELBOW CONTRACTURE
Background
Heterotopic ossification (HO) is bone formation in soft tissues where it does not normally occur, such as subcutaneous fat, tendons, or around nerves. The most common form is myositis ossificans (MO), involving calcification in muscle. HO typically follows trauma or orthopedic surgery, while neurological and genetic causes are rarer but often more severe. Symptoms include pain, swelling, and reduced range of motion. Treatment includes medication, physical therapy, surgery, or radiation.
Case report
A 39-year-old male with a history of mesangioproliferative glomerulonephritis underwent a cadaveric kidney transplant in 2021. In August 2024, he developed cryptococcal meningitis with impaired consciousness and hypertensive hydrocephalus, requiring placement of a ventriculoperitoneal shunt. During treatment, graft function deteriorated, requiring resumption of hemodialysis. Given CNS cryptococcosis and the risk associated with continued immunosuppression, graft nephrectomy was performed in December 2024. The patient was immobile, without motor lateralization, with generalized edema, bilateral foot drop, flexion contractures of the feet, and a contracture of the left elbow. An A-V fistula was created in his right elbow During rehabilitation, he regained the ability to sit with assistance and stand with a walker and therapist support but remained non-ambulatory. Despite early elbow mobilization, range of motion remained limited: there was a 40° extension deficit, and flexion was possible up to 90°. Due to persistent contracture, heterotopic ossification was suspected and radiological evaluation was performed. X-ray revealed joint space narrowing and irregular ossifications in periarticular soft tissues. CT confirmed massive heterotopic ossification near the medial epicondyle, olecranon, and radial head. Differential diagnosis included myositis ossificans versus dialysis-related calcifications.
Conclusion
This case highlights the importance of considering heterotopic ossification as a potential cause of elbow contracture in non-traumatic contexts. Timely recognition and interdisciplinary rehabilitation are crucial to preserving function and quality of life.
Keywords
heterotopic, ossification, elbow, contracture, cryptococcal
#66 EPIDEMIOLOGICAL SURVEY ON THE MAIN MUSCULOSKELETAL DISORDERS RELATED TO THE USE OF CHORD INSTRUMENTS IN PROFESSIONAL MUSICIANS
Marko Zecevic1, Calogero Foti2, Concetta Ljoka2, Nicola Manocchio2, Laura Giordani2
2 University of Tor Vergata, Italy
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
EPIDEMIOLOGICAL SURVEY ON THE MAIN MUSCULOSKELETAL DISORDERS RELATED TO THE USE OF CHORD INSTRUMENTS IN PROFESSIONAL MUSICIANS
Background and Aims
Performing music require considerable physical effort and, being a prolonged activity, exposes musicians to the possible development of musculoskeletal disorders (MSKDs) that can influence their health and career. The aim of the study is to collect concrete data on the prevalence of MSKDs related to the use of chord instruments in professional musicians in order to outline a complete epidemiological picture. This could lead to targeted intervention and optimized preventive strategies.
Methods
A questionnaire composed of 14 multiple choice questions was delivered to chord instrument professional musicians being, part of international orchestras. The questionnaire was divided into 4 sections: demographic information, type of chord instrument used, individual musical experience and possible presence of MSKDs suffered during musical activity.
Results
51 professional musicians were enrolled. Among them 41.2% suffered from one or more impairments related to the use of the musical instrument. The most common found were: tendinitis (36.4%), localized inflammatory states (bursitis and joint inflammation, 22.7%), muscle tension and widespread pain (18.2%), nerve impairment (De Quervain's syndrome and ulnar nerve entrapment, 13.6%) and vertebral protrusions (9.1%). Over 47% of participants reported persistent or recurrent symptoms, which significantly affected their musical practice.
Conclusion
MSKDs are a significant problem among professional musicians. Despite preventive measures such as regular breaks and stretching, a portion of the population examined continues to suffer from chronic symptoms. Just a few musicians regularly consult a physiatrist to prevent MSKDs, thus clearly highlighting the need for proper prevention through regular medical consultations and management of their MSKDs. It would be appropriate therefore to introduce specific education and prevention programs for musicians, focused on ergonomic techniques for musical practice and on the management of MSKDs.
Keywords
Musicians, injuries, physical therapy
#67 PULMONARY REHABILITATION FOR CHRONIC RESPIRATORY DISEASES：A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Deying Kang1, Jia Song2, Chongyang Zhao2, Qin Wang2, Lei Wang3
2 Department of Evidence-based Medicine and Clinical Epidemiology, Frontiers Science Center for Disease-relatedMolecular Network, China
3 Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, China
Conference topic: Cardiopulmonary rehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
PULMONARY REHABILITATION FOR CHRONIC RESPIRATORY DISEASES：A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Background and Aims
The efficacy across distinct pulmonary rehabilitation (PR) modalities as well as its optimal duration has seldom been investigated due to lack of available studies on chronic respiratory diseases. As more RCTs of PR in patients with chronic respiratory diseases being published since 2013, a new systematic review was conducted accordingly.
Methods
We systematically searched major electronic databases (PubMed, Cochrane Library, and Web of Science) for relevant literature published after 2013, with weekly automated updates continuing until March 2025. The methodological quality of each study was independently assessed by using the revised Cochrane Collaboration Risk of Bias tool RoB1.0. The use of Egger analysis and funnel plots was to assess whether the intervention exhibits small sample effects or an existence of publication bias. For closed-loop studies with both direct evidence and indirect evidence, the node-splitting model was used to test the consistency of closed-loop studies.
Results
33 studies(n=2538) were included in this review and of those, 27 studies(n=2106) were used for meta-analysis. Most of the studies (n=20; 60.6%) were high quality. Compared with usual care，PR patients have significant improvement on 6-minute walking distance as well as dyspnea (both P<0.01). Among the evaluated modalities, outpatient rehabilitation exhibited superior efficacy, followed by community/home-based rehabilitation. Compared with usual care, the efficacy in terms of 6-minute walking distance of treatment modalities for chronic respiratory disease patients were downgraded as follows: outpatient rehabilitation (MD=65.45, 95%Cl 45.06-85.84), community/home-based rehabilitation (MD=61.92, 95%Cl 31.58-92.26), telerehabilitation (MD=36.07, 95%Cl 8.80-63.34), inpatient rehabilitation (MD=8.67, 95%Cl -30.54 - 47.89). The cumulative ranking probability curves and forest plot analyses revealed a hierarchical efficacy profile among rehabilitation modalities for chronic respiratory disease, with outpatient rehabilitation (MD=-0.82, 95%Cl -1.45 - -0.19) demonstrating superiority.
Conclusion
The findings demonstrate that PR significantly improves exercise capacity, reduces dyspnea severity in patients with chronic respiratory diseases, with outpatient-based rehabilitation demonstrating the greatest efficacy.
Keywords
Pulmonary, Rehabilitation；Chronic, Respiratory, Diseases；network, meta-analysis；telerehabilitation；outpatient-rehabilitation
#68 CASE REPORT OF A CHILD WITH POIRIER-BIENVENU NEURODEVELOPMENTAL SYNDROME
Valentina Matijević, Abdelkarim Al-Jabiri, Marija Markota, Jelena Marunica Karšaj
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CASE REPORT OF A CHILD WITH POIRIER-BIENVENU NEURODEVELOPMENTAL SYNDROME
Background
Neurological syndrome known as Poirier-Bienvenu neurodevelopmental syndrome (POBINDS) is characterized by early onset of epileptic seizures and delayed psychomotor development. It is a rare disease associated with mutations in the CSNK2B gene. This gene encodes the beta subunit of casein kinase CK2, which is involved in numerous processes and regulates metabolic pathways, signal transduction, transcription, translation and replication.
Case report
A firstborn boy from a first pregnancy that proceeded normally. Delivery at 41 weeks, vaginal, birth weight 4050 g, birth length 50 cm, Apgar score 10/10. At the age of 6 months, he manifested four generalized epileptic seizures. Hospitalized at the Children's Hospital Zagreb, where diagnostic workup was performed: neuroimaging methods CT and MRI of the brain were normal, laboratory and metabolic workup showed no abnormalities, lumbar puncture findings were normal. Genetic testing (Blueprint panel epilepsy) identified a pathogenic mutation in the CSNK2B gene (c.139C>T, p.(Arg47*)), with an autosomal dominant inheritance pattern. The clinical picture varies; some individuals have frequent and severe epileptic seizures, severe motor deficits and difficulties in language and speech development, others may have seizures that respond to treatment and have normal psychomotor development. Some children have symptoms from the autism spectrum, dysmorphic facial features (triangular face, hypertelorism, sparse eyebrows). Sporadic cases have vascular abnormalities and growth hormone deficiency. In most, this is a de novo mutation.
Conclusion
Treatment is symptomatic, based on epilepsy management and stimulation of psychomotor development. Given the significant phenotypic variability, the approach to POBINDS patients must be individualized. Multidisciplinary care involves neuropediatricians, geneticists, child physiatrists, speech therapists, and psychologists and is essential for optimal outcomes. Early recognition and timely treatment improve developmental outcomes.
Keywords
Poirier-Bienvenu, neurodevelopmental, syndrome;, child;, multidisciplinary
#70 EFFECT OF VARIOUS PHOTOBIOMODULATION REGIMENS ON BREAST CANCER‑RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW AND META‑ANALYSIS
Shao Tang Chiu
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EFFECT OF VARIOUS PHOTOBIOMODULATION REGIMENS ON BREAST CANCER‑RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW AND META‑ANALYSIS
Background and Aims
Breast cancer-related lymphedema (BCRL) is common among patients who have completed their cancer treatment. Lymphedema affects not only limb movement but also psychological status. Although Low-level laser therapy (LLLT) has been explored as a treatment option for BCRL, we could not find a regimen that is more effective than others. This meta-analysis aimed to organize existing research and determine the optimal combination of LLLT parameters for BCRL treatment.
Methods
Studies were collected from online databases: Embase, Ovid Medline, Cochrane, and CINAHL. The study type was defined as a randomized controlled trial (RCT) comparing LLLT with sham laser or conventional therapies. We focused on the aspects of the treatment area, treatment regimen, and total treatment sessions across the included studies. The effectiveness of the treatment was evaluated based on four aspects in each classification: reduction in swelling, grip strength, pain, and QOL. These assessments were conducted at two time points: post-treatment and 1–3 months post-treatment. The comparisons between LLLT and non-LLLT were performed through a meta-analysis.
Results
All analyzed studies were RCTs published between 2003 and 2021, with seven included in the meta-analysis. Post-treatment QOL was significantly better in the axillary group (P=0.04). The group treated "three times/week with a laser density of 1.5–2 J/cm2" had significantly better outcomes in terms of swelling reduction, both immediately post-treatment (P=0.04) and at 1–3 months (P=0.03) follow-ups. The group with > 15 treatment sessions had significantly better post-treatment outcomes regarding reduced swelling (P<0.000001) and improved grip strength (P=0.0005).
Conclusion
LLLT has been explored as a treatment option for BCRL. Further exploration in this study found a treatment approach targeting the axilla, combined with an increased treatment frequency, appropriate laser density, and extended treatment course, yielded better outcomes. However, further large-scale, long-term follow-up studies, are needed to substantiate this regimen.
Keywords
Low-level laser, Breast cancer, lymphedema
#74 EFFECTS OF INTRA-ARTICULAR BOTULINUM TOXIN INJECTION FOR THE MANAGEMENT OF OSTEOARTHRITIC KNEE PAIN – A LITERATURE REVIEW AND STATE OF THE ART
Inês Morais, Ana Borges, Andreia Morgado, Sara Martins, Maria João Sousa, Sofia Moreira, André Ribeiro, João Constantino
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EFFECTS OF INTRA-ARTICULAR BOTULINUM TOXIN INJECTION FOR THE MANAGEMENT OF OSTEOARTHRITIC KNEE PAIN – A LITERATURE REVIEW AND STATE OF THE ART
Background and Aims
Knee osteoarthritis (KOA) is a progressive degenerative joint disease affecting over 30% of individuals above 65 years. It commonly presents with increasing pain, reduced knee mobility, and impaired quality of life. Although the mechanisms behind KOA pain are not fully understood, both peripheral and central sensitization are thought to play significant roles5. Persistent peripheral nociceptive input may maintain central sensitization, supporting the use of intra-articular (IA) injections to modulate this input. Since long-term non-steroidal anti-inflammatory drugs (NSAID) use is not advised8, alternative therapies are needed. This literature review aims to evaluate the efficacy and safety of intra-articular botulinum toxin injections in managing knee osteoarthritis pain.
Methods
A search of PubMed and Cochrane databases was performed using keywords and corresponding MeSH terms including “botulinum toxin”, “injections”, “intra-articular”, “osteoarthritis”, “knee”, and “pain.” The search focused on systematic reviews, meta-analyses, and randomized clinical trials from the past 20 years specifically addressing botulinum toxin for KOA-related pain.
Results
Seven studies were included: 3 randomized controlled trials and 4 systematic reviews with meta-analyses. Intra-articular botulinum toxin type A (single dose of 100–200 UI) appears to reduce pain in KOA, particularly in patients with central sensitization. Its mechanism may involve inhibition of the release of inflammatory mediators and neuropeptides from nociceptors, thus reducing neurogenic inflammation associated with osteoarthritis. However, current evidence does not show a clear advantage over other intra-articular treatments. While its high cost is a limitation, it is safe, causing no cartilage degeneration, metabolic disturbance, or bone ischemia, and can be used in joints with metallic implants.
Conclusion
Intra-articular botulinum toxin appears to be an effective and safe treatment option for nociceptive pain management in knee osteoarthritis. However further and stronger studies should be undertaken to determine the optimal dose and frequency of botulinum toxin administration.
Keywords
Botulinum Toxin, Intra-articular, Knee, Osteoarthritis
#75 CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY WITH ATYPICAL PRESENTATION – A PARANEOPLASTIC SYNDROME?
Inês Morais, Ana Borges, Andreia Morgado, Sara Martins, Carolina Paiva, José Eduardo Sousa, Maria João Sousa, Nuno Madureira, Sofia Moreira, João Constantino
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY WITH ATYPICAL PRESENTATION – A PARANEOPLASTIC SYNDROME?
Background
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an acquired immune-mediated neuropathy, usually presenting with symmetrical, insidious sensorimotor deficits, responsive to immunomodulatory therapy. However, atypical presentations, such as acute onset or severe motor impairment, may resemble other neuropathies and hinder diagnosis. In such cases, paraneoplastic syndromes should be considered. Although rare, the association between CIDP and malignancy is documented and justifies further investigation when clinical presentation or imaging findings raise suspicion.
Case report
We present the case of a 73-year-old man, previously independent, with a history of poorly controlled type 2 diabetes mellitus, dyslipidemia and atrial flutter. He developed acute-onset tetraplegia, initially suspected to be Guillain-Barré syndrome, for which he received intravenous immunoglobulin without clinical improvement. During hospitalization, motor worsening occurred, with associated dysphagia and facial paresis. Lumbar puncture revealed marked hyperproteinorrachia, and electromyography demonstrated an acquired demyelinating sensory-motor polyneuropathy with signs of secondary axonal damage, consistent with CIDP. He was treated with plasma exchange and high-dose corticosteroids, resulting in partial improvement of upper limb strength, while severe lower limb motor deficits persisted, in correlation with follow-up EMG findings. A PET-FDG scan revealed a suspicious pulmonary lesion, raising the possibility of a paraneoplastic syndrome and prompting lung biopsy. Histological analysis showed resolving atelectasis without evidence of malignancy, and follow-up with a chest CT was recommended in two months. The patient was admitted to an intensive rehabilitation unit, where he remains, showing functional improvement and having started gait training with third-party assistance.
Conclusion
This case highlights an atypical presentation of CIDP, initially difficult to distinguish from an acute polyradiculoneuropathy, followed by targeted investigation for a possible paraneoplastic syndrome. Despite the absence of confirmed malignancy, this case reinforces the importance of considering paraneoplastic causes in patients with unusual clinical or imaging features. A multidisciplinary approach and broad diagnostic work-up were essential for proper diagnosis and therapeutic management.
Keywords
CIDP, Paraneoplastic, Electrodiagnosis, Neurorehabilitation
#76 NEUROPLASTICITY AND MOTOR RELEARNING IN REHABILITATION FOLLOWING NERVE TRANSFER SURGERY: A CLINICAL CASE REPORT
Claudia Sofia Correia, Afonso Schönenberger Braz, João Filipe Tocha, Xavier Melo, Frederico Moeda, Humberto Lemos, Pedro Xavier Faria, Nuno Tomás, Miguel Rovisco Andrade
Conference topic: Neurorehabilitation
Occupation: Postgraduates students
Type of abstract: Case report
Abstract
Title
NEUROPLASTICITY AND MOTOR RELEARNING IN REHABILITATION FOLLOWING NERVE TRANSFER SURGERY: A CLINICAL CASE REPORT
Background
Peripheral nerve injuries (PNIs) involving critical motor nerves often lead to severe functional impairments, especially when direct repair is not feasible. Nerve transfer surgery has become a valuable alternative, relying heavily on neuroplasticity for functional recovery. Postoperative rehabilitation strategies, including Constraint-Induced Movement Therapy (CIMT), electrical stimulation, and task-specific training, play a crucial role in motor relearning by promoting cortical reorganization.
Case report
We present the case of a 27-year-old male with traumatic right peroneal nerve injury resulting in foot drop. In February 2024, he underwent nerve transfer surgery, redirecting a finger flexor nerve to the anterior tibialis to restore dorsiflexion. A comprehensive rehabilitation program was implemented, focusing on neuroplasticity through electrical stimulation, task-specific training, motor imagery, and CIMT. One year post-surgery, the patient demonstrated active dorsiflexion with inversion, preserved tibiotarsal joint amplitudes, and functional gait with an orthosis. Without it, slight steppage and inversion were observed.
Conclusion
This case underscores the essential role of tailored, neuroplasticity-oriented rehabilitation following nerve transfer surgery. Combining CIMT, task-specific training, and electrical stimulation contributed to substantial motor recovery. Nevertheless, residual deficits indicate the need for prolonged and individualized therapeutic strategies. Continued research is necessary to refine these protocols and optimize patient outcomes.
Keywords
Neuroplasticity, Nerve, Rehabilitation, Motor, Relearning
#77 IS HIGH-INTENSITY INTERVAL TRAINING FEASIBLE WITH ROBOT ASSISTED GAIT THERAPY?: A RANDOMIZED CONTROLLED TRIAL
Jiae Kim
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
IS HIGH-INTENSITY INTERVAL TRAINING FEASIBLE WITH ROBOT ASSISTED GAIT THERAPY?: A RANDOMIZED CONTROLLED TRIAL
Background and Aims
This study investigates the feasibility and effectiveness of combining High-Intensity Interval Training (HIIT) with Robot-Assisted Gait Therapy (RAGT) to enhance gait, balance, and lower limb function in chronic stroke patients.
Methods
A randomized controlled trial was conducted with 48 chronic stroke patients, of whom 44 completed the study. Participants were randomly assigned to a control group, receiving treadmill-based gait therapy, or an intervention group, undergoing RAGT with HIIT using an end-effector robot. Both groups trained for 30 minutes, three times weekly, over eight weeks. HIIT alternated between moderate and high intensities. Outcomes included the 10-Meter Walk Test (10MWT), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), Fugl-Meyer Assessment – Lower Extremity (FMA-LE), VO₂max, Modified Barthel Index (MBI), and Lean Body Mass.
Results
The intervention group showed significant improvements in 10MWT (p < 0.001, d = 1.2), FAC, BBS, and FMA-LE scores compared to the control group. Additionally, the intervention group demonstrated enhanced 2MWT and VO₂max, while MBI and lean body mass changes were minor in both groups. The superior gains in the intervention group highlight the synergistic benefits of combining HIIT with RAGT, utilizing intensive, repetitive, and task-specific training.
Conclusion
HIIT integrated with RAGT is a feasible and effective approach for improving gait and functional outcomes in chronic stroke patients. This novel combination shows promise for enhancing rehabilitation strategies, with potential implications for optimizing functional recovery and quality of life.
Keywords
Robot, gait, therapy,
#78 CLINICAL AND ULTRASONOGRAPHIC EVALUATION OF HIGH-POWER PAIN THRESHOLD ULTRASOUND AND LOW-LEVEL LASER THERAPY IN MYOFASCIAL PAIN SYNDROME
Ozlem Erol Durgun1, Zeliha Unlu2, Sebnem Orguc3, Fatih Duzgun3
2 Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
3 Department of Radiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CLINICAL AND ULTRASONOGRAPHIC EVALUATION OF HIGH-POWER PAIN THRESHOLD ULTRASOUND AND LOW-LEVEL LASER THERAPY IN MYOFASCIAL PAIN SYNDROME
Background and Aims
Myofascial Pain Syndrome (MPS) is a musculoskeletal condition characterized by myofascial trigger points(MTrPs), causing localized and referred pain. Various treatment options exist, but their efficacy lacks objective validation. High-power pain threshold ultrasound(HPPT-US) and low-level laser therapy(LLLT) are promising non-invasive modalities. Aims To assess the efficacy of HPPT-US and LLLT in treating active MTrPs, through clinical and ultrasonographic evaluations.
Methods
Patients with chronic neck pain and active MTrPs in the upper trapezius were randomly assigned to five groups: HPPT-US, LLLT, sham HPPT-US, sham LLLT, and combined HPPT-US + LLLT. Evaluations were conducted at baseline, the first month, and the third month after treatment. Clinical assessments included pain intensity(VAS), cervical lateral flexion(goniometer), physical function(SF-36), anxiety(Profile of Mood States), and the Neck Disability Index. Ultrasonographic assessments measured treatment effects: trigger point size(B-mode imaging), vascularity -Blood Flow Waveform Score(BFS), tissue elasticity(elastography) and Tissue Imaging Score(TIS). These imaging techniques quantified microstructural and hemodynamic changes.
Results
HPPT-US improved clinical and ultrasonographic parameters compared to placebo. LLLT showed no clinical improvement but enhanced radiological parameters at the third month. Combined HPPT-US + LLLT improved outcomes at all time points, superior to LLLT alone, though not over HPPT-US except for pain relief in the first month. Significant improvements in tissue elasticity and vascularity were observed, with elasticity values gradually decreasing, resulting in softer and more flexible tissue, particularly in the ultrasound group, and enhanced vascularization with reduced vascular bed resistance, supporting tissue healing (Figure 1,Figure 2). A strong correlation was found between clinical improvements and elasticity/Doppler findings, particularly at 3 months post-treatment.
Conclusion
HPPT-US significantly improved clinical and ultrasonographic parameters, supporting its role in MPS treatment. While combined therapy provided additional benefits, it was not superior to HPPT-US alone. Considering cost-effectiveness, HPPT-US may serve as a viable standalone treatment, with micro-level tissue changes playing a key role in therapeutic success.
Keywords
MPS, Elastography, ultrasound, laser
#79 OLECRANON STRESS FRACTURES: EPIDEMIOLOGY, CLASSIFICATION, AND CURRENT MANAGEMENT
Ana Catarina Borges1, Inês Morais1, Andreia Morgado1, Sara Martins1, Carolina Paiva1, Maria João Sousa1, José Eduardo Sousa1, Álvaro Vicente Brandão2, Filipe Carvalho1
2 Unidade Local de Saúde de Viseu Dão Lafões, Portugal
Conference topic: Sports medicine rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
OLECRANON STRESS FRACTURES: EPIDEMIOLOGY, CLASSIFICATION, AND CURRENT MANAGEMENT
Background and Aims
Stress fractures are rare injuries, accounting for 0.8% of fractures in adolescent sports activity. The prevalence of olecranon fractures in throwing athletes seems to be on the rise, accounting for 58% of stress fractures among baseball players. The mechanism of injury in throwing athletes has been attributed to forces similar to overload extension in valgus. These injuries represent a challenge from the standpoint of prevention, treatment, and rehabilitation.
Methods
A search in the PubMed and Cochrane databases was conducted using keywords and their respective MeSH terms, including “Stress fractures,” “Elbow fractures,” and “Sports.” The search focused on systematic reviews, meta-analyses, and randomized clinical trials from the past 20 years. Eight articles were included: 3 narrative review articles, 1 systematic review, and 4 case reports.
Results
Elbow stress fractures predominantly occur in the olecranon and mainly affect young athletes. Baseball is the sport most frequently associated with these injuries, although they have also been reported in javelin throwers, football players, and softball players. Furushima et al. classify these fractures into five types based on the fracture line: physeal, classic, transitional, sclerotic, and distal. The diagnosis is difficult, with magnetic resonance imaging being the most effective test. Simple radiographs may not initially show fractures but can identify indirect signs, such as the formation of osteophytes in the posteromedial olecranon fossa. Treatment can be conservative or surgical, with most cases treated surgically, usually after failure of conservative treatment. Non-surgical treatment involves rest and progressive rehabilitation, while the most common surgical treatment is internal fixation with screws. Both approaches have high return-to-sport rates.
Conclusion
Olecranon stress fractures are uncommon but important injuries in throwing athletes, with a rising prevalence in baseball. Early diagnosis, aided by MRI, is crucial for prompt treatment and rehabilitation. Both treatment modalities have good return-to-sport rates, despite potential surgical complications.
Keywords
Olecranon, stress fracture, sports
#80 FROM SKIN TO NERVES: A REVIEW OF SUDOSCAN IN POLYNEUROPATHY DETECTION
Ana Catarina Borges, Inês Morais, Andreia Morgado, Sara Martins, Carolina Paiva, Maria João Sousa, Nuno Madureira, André Ribeiro, Filipe Carvalho
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
FROM SKIN TO NERVES: A REVIEW OF SUDOSCAN IN POLYNEUROPATHY DETECTION
Background and Aims
Polyneuropathies are conditions characterized by peripheral nerve damage, leading to distal sensory alterations, pain, and muscle weakness. Some also involve autonomic fiber impairment, affecting sudomotor function. Sudomotor dysfunction (SMD) results from damage to small-diameter nerve fibers, such as unmyelinated C fibers of the autonomic nervous system, leading to abnormal sweat production. Reduced sweat production can compromise skin hydration and increase the risk of lesions, particularly in diabetic patients. Early detection of peripheral nervous system (PNS) alterations is crucial to preventing severe complications. This review examines the literature on electrochemical skin conductance (ESC) and Sudoscan test in evaluating sudomotor dysfunction across clinical contexts.
Methods
A literature review was conducted in the PubMed and Cochrane databases using keywords and their corresponding MeSH terms, including “Sudoscan,” “Autonomic Nervous System Diseases,” and "Electrodiagnosis”. The search focused on systematic reviews, meta-analyses and randomized clinical trials from the past 10 years that addressed the sensitivity, specificity and clinical utility of these techniques for autonomic neuropathy detection. Studies evaluating ESC measurements against established peripheral neuropathy diagnostic criteria were included.
Results
ESC has been introduced as a non-invasive method for assessing sudomotor function by measuring the skin galvanic response to a low-intensity electric current. Sudoscan test provides a sensitive and specific evaluation of sympathetic innervation in sweat glands, making it a valuable tool for early SMD detection. Its use can offer an accessible and efficient alternative for diagnosing autonomic neuropathy. Studies suggest that ESC, when combined with other diagnostic tools, enhances early detection and management of peripheral neuropathies, allowing for more effective interventions.
Conclusion
A thorough analysis of existing studies highlights the potential of these techniques in clinical practice, their limitations and future directions for improving the diagnosis and management of autonomic neuropathies.
Keywords
Autonomic dysfunction, Polyneuropathy, Sudoscan
#81 ASSESSMENT OF THE EFFICACY OF MESOTHERAPY IN THE MANAGEMENT OF COMMON CHRONIC LOW BACK PAIN: A CASE SERIES OF 20 PATIENTS
Yassine BENGHALI, Ahmed Amine El Oumri
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSESSMENT OF THE EFFICACY OF MESOTHERAPY IN THE MANAGEMENT OF COMMON CHRONIC LOW BACK PAIN: A CASE SERIES OF 20 PATIENTS
Background and Aims
Common chronic low back pain (CCLBP) is one of the leading reasons for consultation in physical medicine and rehabilitation. Mesotherapy, a technique involving intradermal microinjections of low doses of medication, has emerged as a complementary treatment option. It aims to provide targeted local pain relief while minimizing systemic side effects
Methods
This was a descriptive cross-sectional study conducted on 20 patients with common chronic low back pain who were treated with mesotherapy in our department. Each patient underwent three weekly sessions involving a combination of lidocaine, ketoprofen, and a muscle relaxant. A mixed technique—both point-by-point and meso-linear (“nappage”)—was applied to the painful lumbar regions. Pain intensity was assessed using the Visual Analog Scale (VAS) before and after treatment. Functional outcomes were measured using the Oswestry Disability Index (ODI). Treatment tolerance was also evaluated.
Results
A total of 20 patients were included, comprising 13 women (65%) and 7 men (35%), with a mean age of 53.8 ± 13.33 years. The mean Visual Analog Scale (VAS) score decreased significantly from 7.8 before treatment to 3.05 after the third session. All patients showed functional improvement, as evidenced by a marked reduction in the mean Oswestry Disability Index (ODI) score from 53.35 to 27.40. No adverse effects were reported during the three treatment sessions.
Conclusion
The results of this case series confirm the potential of mesotherapy in the management of CCLBP. The reduction in pain and functional improvement observed are comparable or even superior to those reported in the literature. The absence of side effects reinforces its excellent safety profile. These findings support the integration of mesotherapy into a multimodal rehabilitation strategy. Larger controlled studies are warranted to confirm these results.
Keywords
Mesotherapy, Low Back Pain Rehabilitation
#82 EMPOWERING INDIVIDUALS THROUGH PERSONAL GOAL SETTING IN LONG-TERM BRAIN INJURY REHABILITATION: A TAXONOMIC ANALYSIS AND ITS IMPACT ON QUALITY OF LIFE
Jasna Vešligaj Damiš
Conference topic: Neurorehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
EMPOWERING INDIVIDUALS THROUGH PERSONAL GOAL SETTING IN LONG-TERM BRAIN INJURY REHABILITATION: A TAXONOMIC ANALYSIS AND ITS IMPACT ON QUALITY OF LIFE
Background and Aims
Long-term rehabilitation following an acquired brain injury (ABI) requires an individualized, person-centered approach that respects the needs, autonomy, and life aspirations of individuals. At Center Naprej, we implement a structured goal-setting model based on a two-level taxonomy, enabling the formulation of goals across ten key life domains, including Health, Knowledge/Work, Emotions, and Social Life. This approach fosters active user participation in the rehabilitation process, supports the creation of personalized goals, and facilitates long-term progress monitoring, thereby adjusting rehabilitation to their individual needs.
Methods
This study was conducted in two phases (2019–2024) and included 62 individuals with ABI from two units of Center Naprej. Firstly, we examined general and specific goals set by users. An internal assessment tool – the Wheel of Life - was used.
Results
Participants defined 253 general goals across ten life domains. The majority of these goals were related to the domains of Knowledge/Work (36%), Health (28%), and Emotions (8%). The users formulated 1,122 specific goals based on these goals across six rehabilitation areas. Again, the largest percentage was directed toward Health and Knowledge/Work (35% and 46%, respectively). A five-year analysis revealed that users maintain consistent goals over time, indicating long-term commitment. Furthermore, increases in their evaluations over the research period suggest measurable progress in goal attainment. In the second phase, involving 47 users, we explored the relationship between goal achievement and quality of life using the QOLIBRI questionnaire. A positive trend was found: higher levels of goal achievement were associated with higher quality of life scores (η² = 0.083), although the results were not statistically significant (p = 0.058).
Conclusion
The findings highlight the importance of long-term commitment to personal goals and the role of structured taxonomies in identifying key life domains. This contributes significantly to improved rehabilitation outcomes and enhanced quality of life for individuals after ABI.
Keywords
Rehabilitation, Goals, QoL, Taxonomy, Empowerment
#83 EFFECTS OF TRAINING USING A TILT TABLE ROBOT IN MOTOR INCOMPLETE SPINAL CORD INJURY PATIENTS
Onyoo Kim, Duk Youn Cho, Jung-Eun Lim
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EFFECTS OF TRAINING USING A TILT TABLE ROBOT IN MOTOR INCOMPLETE SPINAL CORD INJURY PATIENTS
Background and Aims
Approximately 53% of spinal cord injury (SCI) cases are classified as incomplete injuries, which are associated with greater potential for neuroplastic changes compared to complete injuries. Lower extremity robotic training offers advantages by providing repetitive and efficient interventions, such as sit-to-stand exercises and gait. The Erigo®Pro (Hocoma, Volketswil, Switzerland) is a tilt table robotic system that enables lower limb exercise while supporting the patient in an upright position up to 90 degrees.
Methods
This prospective, randomized controlled trial included 52 patients with motor incomplete SCI (American Spinal Injury Association Impairment Scale [AIS] C-D) within 24 months post-injury who were admitted to the National Rehabilitation Center between 2019 and 2023. Participants in the IG received Erigo®Pro training, while those in the CG underwent conventional physiotherapy. Both groups received interventions three times per week for five weeks (15 sessions in total). Outcome measures included the total motor score index, Trunk Impairment Scale (TIS), and Functional Ambulation Category (FAC), assessed before and after the intervention.
Results
In the IG (n=26), significant improvements were observed in all bilateral lower limb muscle and total sum scores. The CG (n=23) also demonstrated significant improvements in all bilateral lower limb muscle groups and total sum scores, except for the left long toe extensor. In the TIS assessment, the IG showed significant improvements in dynamic balance, coordination, and total scores, while the CG demonstrated significant improvements in static balance, coordination, and total scores. In the FAC assessment, significant improvement was observed only in the CG.
Conclusion
Both tilt table robotic training and conventional physiotherapy were effective in improving lower limb strength and trunk balance in motor incomplete SCI. However, gait function was improved only with conventional physiotherapy. These findings suggest that tilt table robotic training may be considered as a preparatory phase before initiating gait training for patients with incomplete SCI.
Keywords
tilt table robotic training
#84 EFFICACY OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) IN KNEE OSTEOARTHRITIS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Andreea-Daniela Pălăștea
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
EFFICACY OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) IN KNEE OSTEOARTHRITIS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Background and Aims
Knee osteoarthritis (OA) is a progressive, degenerative condition marked by joint pain, stiffness, and limited function, heavily impacting quality of life. Its prevalence is increasing due to aging populations, obesity, and sedentary habits, with projections indicating it may become the leading global cause of disability by 2030. TENS (Transcutaneous Electrical Nerve Stimulation) has been proposed as a non-invasive method for pain management in OA, though current guidelines (e.g., ACR 2019) no longer recommend its use due to inconclusive efficacy data.
Methods
This meta-analysis included six randomized controlled trials (2008–2021) assessing TENS efficacy in knee OA, with diverse patient populations and variable methodological quality. Studies analyzed pain relief and joint function outcomes using tools such as WOMAC, VAS, and functional performance tests. Statistical heterogeneity was measured (I² = 81%), and analyses included funnel and forest plots to assess study bias and effect size consistency
Results
Results were mixed. TENS showed modest short-term benefits in early-stage OA (Kellgren-Lawrence grade 0–1), particularly in functional performance tasks like the 6-minute walk test and stair climb test. However, in patients with radiographic OA (grade ≥2), TENS was not superior to placebo for pain relief or functional improvement. Some studies noted placebo effects, and others highlighted benefits only when TENS was combined with acupuncture. No significant adverse effects were reported.
Conclusion
TENS may provide limited benefit in early-stage OA but lacks therapeutic advantage in moderate-to-severe cases. Findings support current guidelines advising against routine TENS use in knee OA. Further high-quality, double-blind trials are needed to clarify TENS's role, particularly in early intervention contexts
Keywords
osteoarthritis, knee, pain, metaanalysis, TENS
#85 FENICE PROTOCOL IN BREAST CANCER REHABILITATION: A CASE SERIES
GIULIA VITA1, Concetta Ljoka1, Calogero Foti2
2 Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
Conference topic: Cancer rehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
FENICE PROTOCOL IN BREAST CANCER REHABILITATION: A CASE SERIES
Background and Aims
Background: Breast cancer (BC) is among the most common cancers in women, and its treatment often leads to long-term physical and psychological sequelae. Rehabilitation strategies play a key role in managing these effects, improving quality of life (QoL), and supporting functional recovery. The Fenice Protocol introduces fencing as an innovative form of Adapted Physical Activity (APA) for non-metastatic breast cancer women (BCWS), aiming at psychophysical reconditioning and social reintegration. Aims: To describe the implementation and effects of the Adapted Training Exercise by Fenice Project (ATEF) through two illustrative cases of post-surgical BC rehabilitation.
Methods
Methods: Two BCWS underwent personalized rehabilitation pathways, including Motor Re-educational Programs (MRP) and ATEF. Functional assessments were performed at one month from surgery (T0), after the first 4 weeks (T1), and after 4 months (T2), using validated clinical scales (VAS, DASH, CONSTANT, NDI, Barthel, SF-36) and upper limb circumference measurements to monitor recovery and detect lymphedema.
Results
Results: Both cases showed improvements in pain, joint mobility, upper limb functionality, and QoL, without signs of lymphedema. Fencing proved to be effective not only for physical recovery but also for enhancing self-esteem, emotional well-being, and patient engagement in the rehabilitation process.
Conclusion
Conclusion: The Fenice Protocol, combining MRP and fencing-based APA, appears to be a safe and valuable rehabilitation strategy for BCWS. It fosters holistic recovery by addressing both physical and psychological needs, and may represent an innovative model in multidisciplinary cancer rehabilitation.
Keywords
Breast, Cancer, Rehabilitation, Holistic, Approach
#86 PERIPHERAL FACIAL PALSY AND BOTULINUM TOXIN: FIVE YEARS OF CLINICAL EXPERIENCE IN A HOSPITAL-BASED REHABILITATION SETTING
Ana Isabel Romeiro, Joana Ramalho, Ana Sofia Azevedo, Manuel Coutinho Fernandes, Filipe Mendes, Diana Rocha Oliveira, David Moura, Maria Inês Táboas, Pedro Cubelo Pereira, Catarina Aguiar Branco
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PERIPHERAL FACIAL PALSY AND BOTULINUM TOXIN: FIVE YEARS OF CLINICAL EXPERIENCE IN A HOSPITAL-BASED REHABILITATION SETTING
Background and Aims
Peripheral facial palsy (PFP) can cause functional and psychosocial impairment due to facial asymmetry, involuntary movements and synkinesis. A considerable number of patients develop persistent sequelae requiring targeted rehabilitation. Botulinum toxin (BTX) injection is a valuable therapeutic option to manage synkinesis and muscular hyperactivity in chronic PFP, improving facial symmetry and quality of life. We aim to characterize the clinical profiles of patients with PFP treated with BTX at a hospital-based rehabilitation service over a 5-year period (2020–2025) and describe treatment patterns (target muscles, dosages, adverse events).
Methods
We conducted an observational, retrospective study, analysed dose evolution over successive sessions using a mixed-effects model, and explored the relationship between initial and final doses via Pearson correlation.
Results
Fifteen patients (66.7% female, mean age 58.3 years) with PFP were included. All underwent initial rehabilitation with physiotherapy and a home exercise program. Due to refractory synkinesis and/or asymmetry, they were referred a median of 15 months after the initial diagnosis for BTX treatment, receiving a mean of 4.5 sessions. Treatment objectives included improving symmetry (100%), reducing synkinesis of the orbicularis oculi (86.7%) and/or platysma (13.3%), and minimizing oral mucosa trauma (20%), pain (13.3%), and tearing (13.3%). The most frequently injected muscle was the orbicularis oculi (100%), followed by the inferior tarsal (93.3%) and frontalis (66.7%), which received the highest total doses. Least frequently injected muscles included the procerus, nasal, depressor anguli oris and levator alaeque nasi (all 6.7%). A mixed-effects model suggested a 0.053-unit dose increase per session. Pearson correlation indicated a moderate positive correlation between initial and final doses. 26.7% of patients reported minor adverse events. Satisfaction was commonly reported after two treatment sessions.
Conclusion
BTX injections are safe and effective for managing late complications of PFP. Our findings suggest a gradual dose increase over time, with higher initial doses predicting higher final doses.
Keywords
Peripheral facial palsy, botulinum toxin
#87 INTRODUCING A NOVEL APPROACH: ULTRASOUND-GUIDED HYDRODISSECTION OF FLEXOR TENDON ADHESIONS COMBINED WITH INDIVIDUAL KINESIOTHERAPY TO PROMOTE POST-OPERATIVE AND POST-INJURY REHABILITATION
Rudolf Ditmar
Conference topic: Innovation/imaging in PRM
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
INTRODUCING A NOVEL APPROACH: ULTRASOUND-GUIDED HYDRODISSECTION OF FLEXOR TENDON ADHESIONS COMBINED WITH INDIVIDUAL KINESIOTHERAPY TO PROMOTE POST-OPERATIVE AND POST-INJURY REHABILITATION
Background
Flexor tendon adhesions, a formidable challenge following injuries or surgeries involving the fingers, particularly in tendon repair, necessitate a new treatment approach. The formation of adhesions, often a result of an over-stimulated inflammatory response, can lead to restriction in the gliding function of the tendons, progressing to decreased range of motion and impaired functionality, thus limiting the use of the fingers in activities of daily living (ADL). Post-operative rehabilitation outcomes are significantly impacted by the formation of adhesions, often leading to prolonged therapy without satisfactory results.
Case report
Our approach has yielded promising results. We present a series of cases of 15 patients treated in our department after finger and hand injuries and/or operations, who later developed flexor tendon adhesions with severe limitation in the range of motion of the finger/s. Surgical adhesiolysis was not indicated, predominantly due to an abundance of scar formation, worsening prognosis of consequent adhesion formation after repeated surgical incisions. Ultrasound was used as a diagnostic tool for the localization of adhesions and kinematic evaluation of the tendon. Most cases were treated in the region of proximal phalanges (zone 2). Ultrasound-guided hydrodissection of flexor tendon adhesions in local anesthesia was then used in combination with physiotherapy. In selected patients, a combination of regional anesthesia was used to further promote adhesiolysis by manual redress therapy. Progression in finger movement and hand function was recorded, resulting in satisfactory results for patients and therapists.
Conclusion
Ultrasound-guided hydrodissection of the flexor tendon adhesions is a minimally invasive procedure with the potential to significantly improve post-injury and/or post-surgical rehabilitation after the formation of flexor tendon adhesions. We propose that this method be considered part of the rehabilitation treatment to shorten the recovery and markedly improve the functional results of these patients, offering hope for better outcomes.
Keywords
USG, hydrodissection, adhesions, flexor tendon
#89 THE ROLE OF BOTULINUM TOXIN IN THE TREATMENT OF NOTALGIA PARESTHETICA - CASE REPORT AND LITERATURE REVIEW
Miguel Guimarães, Ana Gonçalves, Tiago Ribeiro, José Luís Carvalho
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
THE ROLE OF BOTULINUM TOXIN IN THE TREATMENT OF NOTALGIA PARESTHETICA - CASE REPORT AND LITERATURE REVIEW
Background
Notalgia Paresthetica (NP) is a sensory neuropathy characterized by chronic pruritus, paresthesias, and pain, often linked to cervical or thoracic spinal nerves dorsal rami dysfunction. Damaged C fibers generate ectopic discharges, with neuroinflammatory mediators amplifying peripheral sensitization. Botulinum Toxin (BT) inhibits neurotransmitter release, modulating neurogenic inflammation and peripheral sensitization, which presents a promising therapeutic option for refractory NP.
Case report
Case 1: An 81-year-old woman presented with chronic pruritus and right dorsal pain, for 14 years, worsening, reaching an intensity 10/10 on the numeric scale. Objectively, a hyperpigmented lesion was observed in the scapular region. Lhermitte, Spurling, and Hoffman tests were negative. MRI revealed left-predominant C6/C7 disc protrusion with possible involvement of C7 nerve root. Gabapentinoids, tricyclic antidepressants, and topical lidocaine, proved ineffective. Consequently, subcutaneous infiltration of 100U Onabotulinum Toxin A was proposed in the delimited region. The procedure occurred without complications, and after one week, the patient reported a 30% improvement – the first relief in 14 years. Case 2: A 69-year-old man presented with pruritus in the left scapular region, for over a year, with a 8/10 intensity on the numeric scale. Initially misdiagnosed as dermatophytosis, he was treated with topical antifungal and antihistamines without resolution. Objectively, a pruritic hyperpigmented area with scratch lesions was observed. MRI documented diffuse posterior disco-osteophytic complex with reduced foraminal permeability bilaterally at the C6/C7 level, possibly compromising the C7 nerve root. A subcutaneous infiltration with 100U Onabotulinum Toxin A was performed in the delimited region, without adverse effects. After one month, the patient reported a 50% improvement, and by four months, he was asymptomatic.
Conclusion
Botulinum toxin demonstrated a safe and effective therapeutic option for refractory Notalgia Paresthetica, leading to symptomatic relief, even in longstanding cases, without adverse effects. Neverthless, further controlled studies are necessary to establish optimal dosing, treatment duration, and patient selection criteria.
Keywords
Botulinum, Toxin, Notalgia, Paresthetica, Pruritus
#90 SUBACUTE COMBINED DEGENERATION: FUNCTIONAL OUTCOMES OF TWO PATIENTS FOLLOWING STRUCTURED, MULTISTAGE REHABILITATION
Ana Isabel Romeiro, Joana Ramalho, Ana Sofia Azevedo, Manuel Coutinho Fernandes, Filipe Mendes, Diana Rocha Oliveira, David Moura, Vitor Costa Pereira, Pedro Cubelo Pereira, Catarina Aguiar Branco
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SUBACUTE COMBINED DEGENERATION: FUNCTIONAL OUTCOMES OF TWO PATIENTS FOLLOWING STRUCTURED, MULTISTAGE REHABILITATION
Background
Subacute Combined Degeneration (SCD) is a rare complication of vitamin B12 deficiency that primarily affects the posterolateral columns of the spinal cord, leading to sensory and motor deficits. Early diagnosis and a structured rehabilitation program (RP) are crucial for improving functional outcomes and quality of life. This case report illustrates the clinical variability of SCD and the impact of timely rehabilitation.
Case report
Two female patients, aged 60 and 49, presented to the emergency department with progressive, symmetrical, ascending paraesthesia in the lower limbs and gait instability. Neurological examination revealed impaired proprioception, positive Romberg sign, wide-based gait, and diminished lower limb strength. Laboratory evaluation revealed megaloblastic anemia, pancytopenia, and vitamin B12 deficiency in the older patient; the younger, with chronic alcohol consumption, had macrocytosis and folate deficiency with normal B12 levels. Both were negative for anti-parietal cell and anti-intrinsic factor antibodies. Neuroimaging showed a normal spinal MRI in one case and a T2 hyperintense lesion from the bulbomedullary junction to T11 in the other. Electromyography in the latter revealed symmetrical, axonal sensory-motor polyneuropathy with marked sensory predominance. SCD was diagnosed and they began a multidisciplinary RP with physiotherapy and occupational therapy, initially in a hospital setting, then in a rehabilitation centre, and later as outpatients. After 10 weeks of inpatient rehabilitation, both showed notable functional gains: motor FIM scores improved from 71 to 84 in one case and from 50 to 60 in the other. Both gained independence in activities of daily living and progressed from wheelchair use to walking-stick assisted ambulation upon discharge. At six months, one no longer required a walking aid and was preparing to return to work; the other continued to use a cane.
Conclusion
These cases highlight the heterogeneity of SCD and the vital role of intensive, multidisciplinary rehabilitation in functional recovery and reintegration in metabolic myelopathies.
Keywords
Subacute Combined Degeneration, Rehabilitation
#91 URODYNAMIC ASSESSMENT OF LOWER URINARY TRACT DYSFUNCTION FOLLOWING SURGERY FOR POSTERIOR URETHRAL VALVES
Nada Kyal, Ryme El Beloui, Hasnaa Boutalja, Doaa El Mahil, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
URODYNAMIC ASSESSMENT OF LOWER URINARY TRACT DYSFUNCTION FOLLOWING SURGERY FOR POSTERIOR URETHRAL VALVES
Background and Aims
Posterior urethral valves (PUV) are one of the main causes of congenital bladder outlet obstruction and can significantly impact long-term renal function. Despite successful surgical treatment of PUV, lower urinary tract dysfunction (LUTD) may persist. The aim of this study is to review the characteristics of lower urinary tract symptoms (LUTS) following PUV surgery and to discuss their management.
Methods
This is a retrospective descriptive study involving 35 boys presenting LUTS after surgery for PUV. All patients were evaluated in a neuro-urology consultation at the department of Physical Medicine and Rehabilitation. Each patient underwent a renal and bladder ultrasound, a voiding diary, and a full urodynamic assessment.
Results
The mean age of the patients was 6.8 years. LUTS was mainly characterized by recurrent urinary tract infections, urinary incontinence, and urinary frequency. Renal and bladder ultrasound consistently revealed urinary tract dilatation, a thickened, trabeculated bladder and a significant post-void residual volume. Urodynamic evaluation showed dysuria in 14 children with significant post-void residual volume on uroflowmetry. Filling cystometry revealed detrusor overactivity in 20 cases, large-capacity bladders in 9 cases, while 6 urodynamic studies were normal. All patients received specific management, including prescription of anticholinergic medications, training in clean intermittent catheterization and pelvic floor physical therapy.
Conclusion
Our study found results consistent with those reported in the literature. Urodynamic evaluation proves to be essential in the assessment of persistent LUTS after PUV repair, allowing for tailored therapeutic management.
Keywords
Posterior urethral valve, urodynamic study
#92 ADDITIONAL EXERCISES IN CARDIAC REHABILITATION IMPROVE GAIT PARAMETERS IN FRAIL PATIENTS AFTER OPEN-HEART SURGERY
Vitalija Stonkuvienė, Raimondas Kubilius, Eglė Lendraitienė
Conference topic: Cardiopulmonary rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
ADDITIONAL EXERCISES IN CARDIAC REHABILITATION IMPROVE GAIT PARAMETERS IN FRAIL PATIENTS AFTER OPEN-HEART SURGERY
Background and Aims
Exercise-based cardiac rehabilitation (CR) is the most commonly used after open-heart surgeries (OHS)(1), these patients are more likely to have frailty syndrome(2) and have walking difficulties(3). There are no universally accepted standards for CR patients. Aim was to evaluate and compare the effects of additional exercises in CR on gait parameters in frail patients after OHS.
Methods
All 105 patients ≥65 years, after OHS and with frailty were invited to the study. Patients were randomly assigned to 3 different groups: control group (CG), intervention group 1 (IG-1), and intervention group 2 (IG-2). All groups received 20-day conventional CR program that included aerobic, stretching, breathing exercises 6 times/week; IG-1 additionally received multicomponent dynamic aerobic, balance and strength training (with unstable balance platforms, resistance bands and weights) 3 times/week; the IG-2, a combined computer-based program (with computer devices for gait, balance, strength training) 3 times/week. Groups were assessed 2 times: on admission and after CR. Frailty level was measured using Edmonton Frail Scale (≥4 score). Gait parameters were measured using Zebris program with force plate. Foot rotation, step and stride length, step width, double stance, step and stride time, cadence and gait speed were recorded.
Results
Within-group comparisons showed that significant differences were observed in all 3 groups in step, stride length, double stance phase and gait speed. Step, Stride time and cadence significantly improved results in CG and IG-2 groups, however, foot rotation significantly changed only in IG-2 group. Results showed that significant change in measuring step and stride time was found between CG and IG-1 as well as between the CG and the IG-2. Double stance significant change was observed only between the IG-1 and IG-2 groups.
Conclusion
All programs improved almost all gait parameters, however, combined computer-based program showed a greater effect on the results of gait parameters compared with other programs.
Keywords
Cardiac, rehabilitation, frailty, exercises, surgery
#94 APPLICATION OF A PULMONARY REHABILITATION EXERCISE PROGRAM BASED ON IMB MODEL IN PATIENTS WITH SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Mingrong Huang
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
APPLICATION OF A PULMONARY REHABILITATION EXERCISE PROGRAM BASED ON IMB MODEL IN PATIENTS WITH SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Background and Aims
This study aims to construct a pulmonary rehabilitation program based on the Information-Motivation-Behavioral Skills (IMB) model to improve lung function and quality of life in patients with severe Chronic Obstructive Pulmonary Disease (COPD).
Methods
Convenience sampling was used to select patients with severe COPD admitted to the Department of Respiratory and Critical Care Medicine of a tertiary hospital in Chongqing from October 2023 to February 2024. Patients were randomly divided into an experimental group (n=32) and a control group (n=31). The experimental group received 6 months of IMB model-based pulmonary rehabilitation in addition to routine care, while the control group received routine care measures. The degree of dyspnea, exercise endurance, quality of life, pulmonary rehabilitation compliance, self-management level, and lung function were compared between the two groups before and after the intervention.
Results
After the intervention, the experimental group showed better results in terms of dyspnea severity, exercise endurance, quality of life, pulmonary rehabilitation compliance, and self-management level compared to the control group, with statistically significant differences (P0.05).
Conclusion
Pulmonary rehabilitation based on the Information-Motivation-Behavioral Skills model can effectively alleviate dyspnea symptoms in patients with moderate to severe COPD, improve their exercise endurance, compliance with pulmonary rehabilitation, self-management ability, and quality of life.
Keywords
pulmonary rehabilitation,IMB,POCD
#95 URODYNAMIC EVALUATION OF BLADDER COMPLIANCE AND DETRUSOR ACTIVITY FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER
Kyal Kyal, Hasnaa Boutalja, Ryme El Beloui, Khaoula Rsaissi, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
URODYNAMIC EVALUATION OF BLADDER COMPLIANCE AND DETRUSOR ACTIVITY FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER
Background and Aims
Local treatment of prostate cancer (PC) involves radical prostatectomy and radiotherapy (RT). Despite significant advancements in RT techniques, these modalities can adversely affect the genitourinary system. Lower urinary tract symptoms (LUTS) are among the most commonly reported side effects of RT, primarily resulting from radiation-induced genitourinary toxicity. This study aimed to evaluate bladder compliance and detrusor activity following radiotherapy for prostatic cancer using urodynamic study (UDS)
Methods
This is a single-center prospective study, including 41 patients who underwent radiotherapy for prostate cancer. All patients had completed radiotherapy at least 12 months before UDS to assess bladder compliance and detrusor activity during filling cystometry. We evaluated LUTS using Urinary Symptom Profile (USP), 3-day frequency-volume charts (FVC) and post-void residual (PVR) measurement.
Results
Medical records of 41 patients were analysed. The mean age was 65.23 years. The evaluation of LUTS was done after an average of 20 months after finishing radiotherapy. 73.2% had radical prostatectomy prior to radiotherapy. 46.34% had hormonotherapy and 36.6% had chemotherapy. About LUTS, 68.3% had urgency urinary incontinence, 63.4% stress urinary incontinence and 61% dysuria. Using USP, stress urinary incontinence subscore was 7/9, overactive bladder subscore 16/21 and dysuria subscore was 6/9. FVC showed increased urinary frequency and an average voided volume of 150 ml. All patients had filling cystometry that revealed a poor bladder compliance in 24.4% and detrusor overactivity (DO) in 19.6%.
Conclusion
Radiotherapy for prostate cancer induces a low bladder compliance and capacity. DO may occur following radiotherapy. The small sample size (41 patients) highlights the need for further prospective studies to clarify and confirm the effects of radiotherapy on bladder and urethral function.
Keywords
Prostate cancer, radiotherapy, urodynamic, compliance
#96 THE EFFECT OF THE TREDMIL PROGRAM ON THE SPATIO-TEMPORAL GAIT PARAMETERS OF PATIENTS AFTER STROKE
Olivera Pilipovic -Spasojevic, Dijana Lastro, Teodora Talic
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist
Type of abstract: Scientific abstract
Abstract
Title
THE EFFECT OF THE TREDMIL PROGRAM ON THE SPATIO-TEMPORAL GAIT PARAMETERS OF PATIENTS AFTER STROKE
Background and Aims
Treadmill training is a part of kinesitherapy treatment aimed at practicing a more correct gait pattern in the rehabilitation of patients with a mild form of hemiparesis. The aim of this study is to objectively measure the spatio-temporal parameters of gait to determine whether mechanically assisted walking improves the parameters of the gait scheme, gait cycle and its temporal determinant.
Methods
The pilot study with a series of subjects included a total of 29 men with an average age of 45-65 years, in the subacute phase of recovery after a stroke, who are able to walk independently. In addition to daily kinesitherapy, occupational therapy and electrotherapy, the subjects had a 30-minute training in mechanically assisted walking. The intensity of exercise was initiated by a subjective sense of the speed that the patient could master and gradually increased. Rehabilitation was carried out 21 days / 5 days a week. Outcome measures were monitored by Barthel index, Trunk Control Test, Motoricity Index, and registration of kinematic changes in gait with Zebris FDM-T HP/Cosmos software.
Results
The Wilcoxon rank test showed a statistically significant increase in all parameters of the functional tests used by p = 0.000 and a significant statistical improvement in the horizontal distance between the two central starting points of the heels of opposite legs (p = 0.031), cadence (p = .015), time to step (p = 0.014) and a very significant improvement (p = 0.00) in speed, The width of the steps of the opposite and the length of the stride of the same leg, as well as the phase of support and the phase of swinging of both legs.
Conclusion
Treadmill gait training in mild forms of hemiparesis is an additional tool for a more correct gait pattern, which enhances functional recovery and reduces rehabilitation costs.
Keywords
Stroke, tredmil training, gait
#97 FROM SPINE TO SOLE: FOOT STRUCTURE CHANGES IN SCOLIOSIS
Nisrine Mounsif, Hamza Imami, Zineb Raffaa, Ryme El Beloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
FROM SPINE TO SOLE: FOOT STRUCTURE CHANGES IN SCOLIOSIS
Background and Aims
Since scoliosis, a three-dimensional spinal deformity, influence posture, weight-bearing distribution, and overall biomechanics. This study aims to understand compensatory changes in foot structure and plantar load in scoliosis patients in order to guide rehabilitation strategies and improve functional outcomes.
Methods
An optical podoscope was used to assess the foot morphology of 27 scoliosis patients, while electronic measurements evaluated plantar pressure distribution in the same cohort. Statistical tests were conducted to assess significant differences in pressure distribution between the right and left feet.
Results
A total of 27 patients (74% female), aged between 14 and 66 years (mean age 22 ± 16.5 years), were included in the study. Of these, 62% exhibited pes cavus and 18% presented pes planus. Furthermore, 6 patients had limb-length discrepancy (ranging from 10 to 20 mm), 6 patients presented hallux valgus, and 4 patients exhibited calcaneal valgus. Additionally, 55% of patients showed increased pressure under both heels, 26% on the left heel, and only one on the right heel. Furthermore, 22% (6 patients) demonstrated elevated pressure in the forefoot. The median maximum pressure was 13.74 N/cm² on the left foot and 11.6 N/cm² on the right foot, with median average pressures of 4.91 N/cm² on the left and 4.81 N/cm² on the right. A statistically significant difference (Wilcoxon test = 231 , p-value < 0.001) was observed in the plantar load distribution between the left and right feet. These findings indicate a disruption in weight-bearing distribution associated with scoliosis, with individual variations in the direction of the imbalance.
Conclusion
A thorough podiatric assessment is essential for scoliosis patients to identify foot deformities and abnormal plantar load distribution. Correcting these imbalances through custom orthotics and targeted rehabilitation can improve foot function, enhance alignment, and contribute to better overall stability, posture, and quality of life.
Keywords
Scoliosis, Foot, Biomechanics, Posture
#98 LHERMITTE'S PHENOMENON TREATMENT, NEW APPROACH
Abdulnaser Aboud
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
LHERMITTE'S PHENOMENON TREATMENT, NEW APPROACH
Background
Lhermitte's Phenomenon is an electrical sensation that occurs down the length of the spine and is exacerbated with neck flexion. Some patients report a Lhermitte sign with fatigue, heat exposure, or during an exacerbation
Case report
this is a 35 years old female has RR-MS for 10 years back . She is on Fingolimod (Gilenya) treatmen, and she is stable and doesn,t have relapses for 2 years back.Patient has fatigue and mild weakness in lower limbs with muscle power range 4-5/5.She has neurogenic bladder that controlled with anticollenergic medication. She is independent in her ADL and ambulating without any assistive devices .she has positive Lhermitte sign that triggered by neck flexion. On examination patient has pain at extreme ROM of cervical spine , muscle spasm in neck muscles and upper trapezius and rhomboid muscles . neck flexion trigger the electric shock-like sensation extending down the spine and the lower limbs. Patient has clear trPs at the upper trapezius and rhomboid muscles that refer pain . Patient was injected Lidocaine 1% for TrPs in 4 sites (bilateral) . after injection there is dramatic improvement in ROM and disappear of the electrical sensation that come with neck flexion . Improvement was continues for 6 month and after that when pain relapsed it was less than before and another injection was done again.
Conclusion
It is important to examine the musculoskeletal structure at the neck and upper back in MS patients who have Lhermitte's Phenomenon as mostly they have myofascial TrPs that can be easily treated by local injetion and make the patient feel relieved from this annoying symptom.
Keywords
No conflict
#99 ULTRASOUND FINDINGS IN THE DIAGNOSIS OF EXERCISE-INDUCED RHABDOMYOLYSIS - A CASE REPORT
Maria Joao Sousa1, Sara Martins1, Diana Serra2, Carolina Paiva1, José Eduardo Sousa1, Nuno Madureira1, Sofia Moreira1, Ines Morais1, André Ribeiro1, João Paulo Castro2
2 ULS São João, Portugal
Conference topic: Sports medicine rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
ULTRASOUND FINDINGS IN THE DIAGNOSIS OF EXERCISE-INDUCED RHABDOMYOLYSIS - A CASE REPORT
Background
Rhabdomyolysis is an acute clinical syndrome characterized by muscle damage, which can lead to systemic complications. Early diagnosis prevents complications, but also improve prognosis. The clinical presentation is characterized by a triad of myalgias, muscle weakness and dark urine. The incidence of exercise-induced rhabdomyolysis(EIR) has been increasing. EIR is observed in high-performance athletes who are subjected to intense, repetitive and prolonged exercise but is also observed in untrained individuals. Temperature/humidity during training, medications and genetic factors are also risk factors.
Case report
The authors present the case of a 54-year-old healthy male with sporadic exercise practices, who went to the PRM consult due to bilateral forearm myalgias associated with decreased strength and edema, after physical exercise two days earlier. Denied trauma, urine change or the use of drugs. At physical examination, had tense edema and tenderness. An ultrasound was made during the assessment, which revealed a decrease in echogenicity, disorganization of the muscular structure and infiltration of adipose tissue. On suspicion of rhabdomyolysis, an analytical study was performed which revealed high level of creatine kinase (CK) without renal function alterations. Treatment included water reinforcement, draining massage, cryotherapy and rest. With a favorable progression, after 2 weeks showed complete recovery.
Conclusion
The classic triad of EIR is very sensitive, but less than 10% of patients report all three symptoms at initial presentation. The case presented is an example of this diagnostic difficulty, as although the patient presented with pain and muscle weakness, the absence of myoglobinuria may lead to think of other diagnoses. Studies have shown typical echographic alterations present in rhabdomyolysis, which increase the level of suspicion, guiding the etiological study. Physical exercise is an increasingly common cause of rhabdomyolysis and the use of ultrasound as a method of evaluating muscle pain helps in the early diagnosis of EIR, especially in sports practice.
Keywords
exercise, rhabdomyolysis, ultrasound, diagnosis
#100 PHYSICAL THERAPY AND REHABILITATION OF A PATIENT WITH HEREDITARY SENSORIMOTOR POLYNEUROPATHY CHARCOT-MARIE-TOOTH TYPE 1A - CASE REPORT
Ana Krsteska, Biljana Kalchovska-Ivanovska, Valentina Koevska, Biljana Mitrevska, Teodora Jugova, Maja Manoleva, Marija Gocevska, Cvetanka Gjerakaroska-Savevska, Daniela Gechevska, Lidija Stojanoska-Matjanoska, Erieta Nikolikj-Dimitrova
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
PHYSICAL THERAPY AND REHABILITATION OF A PATIENT WITH HEREDITARY SENSORIMOTOR POLYNEUROPATHY CHARCOT-MARIE-TOOTH TYPE 1A - CASE REPORT
Background
Charcot-Marie-Tooth disease type 1A (CMT1A) is the most common inherited sensorimotor polyneuropathy, caused by a duplication of the PMP22 gene. It is characterized by slowly progressive distal muscle weakness, sensory loss, and foot deformities. Although there is no cure, physical rehabilitation plays a key role in preserving function and alleviating secondary musculoskeletal symptoms. (1,4,6)
Case report
We present a female patient with a genetically confirmed diagnosis of hereditary sensorimotor polyneuropathy CMT1A, initially diagnosed at the National Academy of Sciences of Macedonia six years ago. She reported chronic pain in the neck and right shoulder radiating to the arm with tingling, as well as right hip and buttock pain radiating to the right leg. The patient also experienced longstanding upper limb weakness. Clinical examination revealed preserved cervical lordosis, reduced lumbar lordosis, and increased thoracic kyphosis. Cervical and lumbar spine movements were globally reduced. Both upper extremities showed generalized muscle hypotrophy, particularly in the interosseous muscles of the hands, along with tremor. The range of motion in the shoulders was preserved but painful on the right. Reflexes were symmetrical, and sensory function remained intact. A tailored rehabilitation program was initiated, including physical therapy (pain management and spinal mobility) and kinesitherapy (postural correction, strengthening, and coordination). Progress was assessed using Manual Muscle Testing (MMT), the Timed Up and Go (TUG) test, the 6-Minute Walk Test (6MWT), and the Visual Analog Scale (VAS) for pain. These showed gradual improvement in strength, mobility, and pain
Conclusion
This case illustrates how individualized rehabilitation can improve function and reduce secondary symptoms in CMT1A. Continued therapy is essential to maintaining independence and quality of life in hereditary neuropathies.(2,3)
Keywords
Charcot-Marie-Tooth Disease Rehabilitation Neuropathy Management
#101 PREDICTORS OF FUNCTIONAL RECOVERY AND MORTALITY AFTER HIP FRACTURE- DO WE RECOGNIZE THEM IN DAILY CLINICAL WORK?
Emilija Dubljanin Raspopović1, Nela Iic1, Una Nedeljkovic1, Ivan Selakovic2, Silvana Stojicic3, Milica Aleksic3
2 School of Medicine, University of Belgrade, Serbia
3 Clinical Center Serbia, Serbia
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PREDICTORS OF FUNCTIONAL RECOVERY AND MORTALITY AFTER HIP FRACTURE- DO WE RECOGNIZE THEM IN DAILY CLINICAL WORK?
Background and Aims
Hip fractures in the elderly are followed by increased mortality, and functional decline. Identification of early postoperative mortality and functional predictors enables the stratification of high-risk patients and can help in the development of strategies aimed at reducing risk and improving outcome after hip fracture. The primary aim of this study was to investigate predictive factors during the early postoperative phase related to mortality and functional outcome after hip fracture.
Methods
We examined 344 elderly patients with hip fracture. Multivariate logistic regression analysis was used to explore independent prognostic factors for 1 year mortality. We further analyzed functional recovery of 191 patients with hip fracture after 6 months.
Results
By the end of 12 months, 87 patients (25.4%) had died. Our results revealed that age, cognitive status, functional status prior to injury, functional status on discharge, and presence of delirium were independent predictor of 1 year mortality. Our investgation further showed that patients with worse general health, weaker handgrip strength and longer time from admission to surgery had worse functional recovery 6 months after hip fracture.
Conclusion
Identifying patients upon admission for mortality and worse functional outcome possibly enables development of targeted prevention and intervention strategies in older patients with hip fracture.
Keywords
hip fracture, mortality, functional outcome
#102 THE BRAIN STORY OF CHRONIC PAIN: AN OPINION ON TISSUE STATE OF HEALTH
Rachid El Khoury
Conference topic: Pain treatment and rehabilitation
Occupation: Health professionals (Physiotherapist
Type of abstract: Scientific abstract
Abstract
Title
THE BRAIN STORY OF CHRONIC PAIN: AN OPINION ON TISSUE STATE OF HEALTH
Background and Aims
Chronic pain is perhaps the most burdensome health issue facing the planet. Our understanding of the pathophysiology of chronic pain has increased substantially over the past 20 years, including but not limited to changes in the brain. However, we still do not know why chronic pain develops in some people and not in others. This presentation will highlight the current misconceptions of chronic pain concepts, and their misperceptions by clinicians. It will also attempt to bridge the considerable gap between what we already know on pain but somehow disregarded, the development in pain science, and clinical practice.
Methods
Literature review and long standing clinical experience.
Results
Although the Biopsychosocial model of pain management was presented decades ago, the Bio-reductionist model remains, unfortunately, at the heart of many practices across professional and geographic boundaries. A large body of evidence shows that nociception is neither sufficient nor necessary for pain. Pain is a conscious experience that can certainly be, and often is, associated with nociception, however, always modulated by countless neurobiological, environmental, and cognitive factors.
Conclusion
Majority of clinicians are still managing chronic pain the may they manage acute pain, hoping this advocacy presentation will push clinicians to attain more trainings on chronic pain management.
Keywords
Chronic Pain, Biopsychosocial, Neuroplasticity
#103 SPINAL CORD INJURY AND AUTONOMIC DYSREFLEXIA IN A PATIENT WITH CONGENITAL PAIN INSENSITIVITY (RARE CONDITION): A CASE REPORT
Ahmed Omer Ali Ahmed
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SPINAL CORD INJURY AND AUTONOMIC DYSREFLEXIA IN A PATIENT WITH CONGENITAL PAIN INSENSITIVITY (RARE CONDITION): A CASE REPORT
Background
Congenital insensitivity to pain (CPI) is a rare genetic disorder characterized by the inability to perceive pain, often leading to delayed diagnosis of serious injuries. In patients with CPI and spinal cord injury (SCI), management of complications such as autonomic dysreflexia (AD) poses unique challenges.
Case report
We present the case of an 18-year-old male with CPI admitted to the Port-Sudan Rehabilitation Hospital following sudden onset of paraplegia and urinary incontinence. The patient reported a history of clicking sensations in his back for one year following a fall during a psychotic episode induced by marijuana use. Despite progressive symptoms, absence of pain delayed medical attention. On examination, he exhibited bilateral lower limb weakness, right-sided foot drop, anosmia, and signs of chronic spinal cord compression without sensory pain response. MRI imaging revealed L2-L3 disc space narrowing, chronic inflammatory changes, disc protrusion with compression of the anterior thecal sac, and moderate canal stenosis. Surgical decompression and stabilization were performed. Rehabilitation focused on mobility training, bladder and bowel management, psychological support, and prevention of secondary complications. This case highlights the diagnostic difficulties and rehabilitation complexities in patients with CPI and spinal cord injury. The lack of pain perception may contribute to delayed diagnosis and atypical presentation. Multidisciplinary neurorehabilitation and a holistic approach are essential to optimize functional outcomes.
Conclusion
Early suspicion, imaging, and intervention are crucial in CPI patients presenting with neurological symptoms. Tailored rehabilitation programs addressing physical, psychological, and social domains are key to improving recovery and quality of life.
Keywords
Congenital Pain Insensitivity, Autonomic Dysreflexia
#104 COMPREHENSIVE TREATMENT APPROACH OF NEUROPATHIC PAIN IN PATIENT WITH FEMORAL NERVE NEUROTMESIS
Nino Zahirović1, Viviana Avancini-Dobrović2, Vlasta Orlić Karbić3, Tea Schnurrer Luke-Vrbanić2
2 Clinical medical center Rijeka, Croatia/Hrvatska
3 Clinical medical ceter Rijeka, Croatia/Hrvatska
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
COMPREHENSIVE TREATMENT APPROACH OF NEUROPATHIC PAIN IN PATIENT WITH FEMORAL NERVE NEUROTMESIS
Background
Neuropathic pain is a common clinical problem that is under-recognized, inadequately treated, and significantly impairs quality of life.
Case report
A 72-year-old female patient came to the physical and rehabilitation medicine (PRM) specialist due to chronic pain along the entire length of her left leg. Patient had increasing difficulty moving and is limited in her activities of daily living. She describes the pain as shooting and burning. Pain intensity was 8/10 according to visual analog scale (VAS). She was taking extended-release tramadol up to 100 mg per day with minimal effect on pain reduction. She underwent magnetic resonance imaging (MRI) of the lumbar spine which revealed degenerative changes. In 1990 patient underwent surgery for an ovarian cyst and the procedure was complicated by neurotemesis of the left femoral nerve. The nerve was subsequently repaired with a transplant of the left sural nerve. She now has a neuroma with extreme allodynia at the site of the sural nerve extirpation. A year before she was treated with pregabalin but due to side effects treatment was discontinued. We additionally recommended duloxetine in a dose of 60mg. At the follow-up examination, the pain reduction was minimal. The patient was admitted to the hospital for rehabilitation treatment. Treatment consisted of individual kinesiotherapy that improved spinal stability, proprioception and balance. Additionally, electroanalgesic procedures and desensitization techniques in the area of the neuroma were applied. Psychological support was also provided. Duloxetine was excluded from therapy. At an interdisciplinary meeting between anesthesiology and PRM specialist, it was decided to start with the third line of treatment, amitriptyline. The dose of amitriptyline was gradually increased to 20 mg, which achieved a 30% reduction in pain and significant improved in the patient's quality of life.
Conclusion
Individual and interdisciplinary approach to rehabilitation treatment successfully reduced pain and improved the patient's quality of life.
Keywords
neurotmesis, pain, rehabilitation
#105 INTERDISCIPLINARY TREATMENT OF CHRONIC LOW BACK PAIN DUE TO LUMBAR DISC EXTRUSION WITH RADIOFREQUENCY ABLATION OF THE L5/S1 DISC
Nino Zahirović1, Ivan Radoš2, Vlasta Orlić Karbić3, Mia Prebeg4, Viviana Avancini-Dobrović4, Tea Schnurrer Luke-Vrbanić4
2 Clinical medical center Osijek, Croatia/Hrvatska
3 Clinical medical ceter Rijeka, Croatia/Hrvatska
4 Clinical medical center Rijeka, Croatia/Hrvatska
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
INTERDISCIPLINARY TREATMENT OF CHRONIC LOW BACK PAIN DUE TO LUMBAR DISC EXTRUSION WITH RADIOFREQUENCY ABLATION OF THE L5/S1 DISC
Background
Chronic low back pain is one of the leading causes of disability. Radiofrequency ablation and neuromodulation are modern treatment techniques that have increasing role in the treatment of chronic pain.
Case report
A 48 year-old female patient came to the physical and rehabilitation medicine specialist due to chronic low back pain irradiating alongside right leg. On the visual analogue scale (VAS) she rates the pain intensity at 8/10, describes cramping pain in the lower leg that wakes her up from sleep with no neurological deficit. Multimodal analgesia principle was recomanded with naproxen and combination of tramadol/paracetamol. She was provided with lumbosacral orthosis. Since the analgesic effect was mild, methylprednisolone was introduced according to a 10 days de-escalation protocol. X-ray imaging of the lumbar spine showed degenerative changes. Magnetic resonance imaging was performed and revealed extrusion of the L5/S1 disc with 15mm caudal migration and compression of the S1 root. Since the neurosurgeon recommended surgical treatment and the patient was unwilling to it, it was decided to try conservative treatment. Two cycles of physical rehabilitation were performed that consisted of moderate medical exercises in the form of core muscle strengthening and manual techniques in form of the Maitland principle. Physical therapy procedures were applied; interferential current, low-level laser therapy and therapeutic ultrasound. After therapy pain was significantly reduced; VAS 4/10. Patient was examined by anesthesiologist and minimally invasive treatment procedure was recommended in form of radiofrequency ablation (RF) of the disc. After the procedure pain was minimal. After a month, an additional cycle of rehabilitation treatment was performed. Three months after the procedure patient does not feel pain and has returned to moderate sports activities.
Conclusion
Through interdisciplinary rehabilitation treatment with a minimally invasive RF disc ablation, patient's quality of life was restored and she returned to moderate sports activities without pain.
Keywords
chronic, pain, radiofrequency, rehabilitation
#106 WHOLE BODY CRYOSTIMULATION IN REHABILITATION. WHAT IS THE EVIDENCE ?
Paolo Capodaglio
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
WHOLE BODY CRYOSTIMULATION IN REHABILITATION. WHAT IS THE EVIDENCE ?
Background and Aims
Whole-body cryostimulation (WBC) is mostly used in sports for muscle recovery but it is emerging as a promising non-pharmacological intervention for a wide range of conditions (Multiple Sclerosis, Parkinson, chronic inflammatory or neuropathic pain, fibromyalgia, long Covid, spasticity). Repeated cold exposures have been shown to improve inflammation and autonomic imbalance and reduce symptoms like pain and fatigue. The treatment is safe after medical screening for recently revised contraindications. This presentation aims to provide up-to-date evidence on the benefits of WBC in various conditions of rehabilitation interest.
Methods
We will provide a narrative synthesis of the existing evidence at molecular, clinical and functional level on the use of WBC in a range of rehabilitation conditions.
Results
A synthesis of the reviews, RCTs, observational and case reports available in the literature will be provided.
Conclusion
The current state of the art suggests that WBC holds significant promise as an adjunctive therapy for several musculoskeletal, neurological and metabolic conditions of rehabilitation interest. Adverse events are rare and minor but proper medical screening and supervision is mandatory.
Keywords
whole-body, cryostimulation, rehabilitation, pain, fatigue
#107 THE ROLE OF PROPRIOCEPTIVE TRAINING IN REDUCING LUMBAR SPINE PROBLEMS AMONG ELITE FIGURE SKATERS
Marcela Romić, Iva Sesar Cirković, Damir Mišura, Sanda Dubravčić-Šimunjak
Conference topic: Sports medicine rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE ROLE OF PROPRIOCEPTIVE TRAINING IN REDUCING LUMBAR SPINE PROBLEMS AMONG ELITE FIGURE SKATERS
Background and Aims
Figure skating is a physically demanding Olympic sport that requires a unique combination of artistic expression and athletic performance. The sport's growing technical complexity places increasing stress on the musculoskeletal system, particularly the lumbar spine, posing a concern for rehabilitation specialists and sports medicine professionals. This study aimed to investigate the prevalence of lower back pain among elite figure skaters and explore contributing factors related to training type, gender, discipline, and performance of specific skating elements.
Methods
A cross-sectional study was conducted with 194 competitive figure skaters: 35 male singles, 45 female singles, 56 pair skaters, and 58 ice dancers. Data were collected through structured questionnaires assessing the presence of lumbar pain in relation to on-ice and off-ice training routines and technical element execution.
Results
Lower back pain was reported by 33.8% of singles skaters, 41.1% of pair skaters, and 25.9% of ice dancers. A statistically significant difference (p<0.05) was observed among disciplines in relation to off-ice training and performance of physically demanding lifts and spins. No significant difference was found regarding spirals and step sequences.
Conclusion
The findings underscore a notable prevalence of lumbar spine pain in figure skaters, particularly in disciplines requiring greater physical load through lifts and spins. These results highlight the need for multidisciplinary approaches in injury prevention and athlete management, including tailored rehabilitation protocols, biomechanical assessments, and modifications to training intensity. Early intervention strategies and collaboration between coaches, physical medicine specialists, and physiotherapists are essential to preserve spinal health and athletic longevity.
Keywords
figure skating, injury prevention, rehabilitation
#108 MEDICAL COMPLICATIONS DURING ACUTE INPATIENT TRAUMATIC BRAIN INJURY REHABILITATION - CROATIAN EXAMPLE
Valentina Blažinčić, Ivica Ščurić, Ivana Klepo, Ivan Dubroja, Duško Cerovec
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
MEDICAL COMPLICATIONS DURING ACUTE INPATIENT TRAUMATIC BRAIN INJURY REHABILITATION - CROATIAN EXAMPLE
Background and Aims
Traumatic Brain Injury (TBI) is a chronic disease according to WHO. It has complex consequences on every level of society and impact that is not yet sufficiently quantified. This disease has a high incidence of medical complication (MC). They affect the course of acute treatment, the course of acute rehabilitation, the outcome of rehabilitation and some of complication lead to an increase risk of mortality. Aim of the study is to demonstrate the type and frequency of MC in patients with TBI during acute inpatient rehabilitation (IR).
Methods
On a randomly selected day we analyzed all patients with TBI admitted to the acute IR. Inclusion criteria were age over 18 years, TBI (with possibility of included spinal cord injury and bone fractures). Exclusion criteria were other reason for inpatient acute rehabilitation and chronic TBI. The investigated complications were: posttraumatic epilepsy paroxysmal sympathetic hyperactivity, hydrocephalus, venous thromboembolism, hyponatremia, spasm, contractures, dysphagia, malnutrition, urinary retention, tracheal cannula, infections, colonization with multidrug-resistant bacteria (MDRB) and presence of pressure ulcers.
Results
We analyzed data for 22 patients, average age of 45 year ( 85% were men). Average initial GCS 9, average admission FIM 44, average time of data collection 99 days. The following complications were recorded: contractures (68%), spasm (59%), dysphagia (59%), colonization with MDRB (55%), malnutrition (50%), presence of tracheal canula (50%), posttraumatic epilepsy (50%), infections (18%), hyponatremia(14%), pressure ulcers (9%) patients. On the day of screening we did not register hydrocephalus, paroxysmal sympathetic hyperactivity and venous thromboembolism. Patient with disorders of consciousness had higher incidence of the recorded MC.
Conclusion
Patients with TBI have high frequency of MC. Some of MC that occur during acute IR can be prevented by appropriate treatment during the acute care of patients with TBI. Timely diagnosis and treatment MC during IR can reduce mortality and improve outcome of patients.
Keywords
TBI, inpatient rehabilitation, medical complications
#109 A CASE OF MISDIAGNOSED ACUTE GLUTEUS MEDIUS AND MINIMUS TEARS WITH SUBSEQUENT COMPLICATIONS
Jasmina Milovanović-Arsić1, Slađana Marković1, Vedrana Milić-Rašić2
2 Faculty of Medicine, University of Belgrade, Serbia
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
A CASE OF MISDIAGNOSED ACUTE GLUTEUS MEDIUS AND MINIMUS TEARS WITH SUBSEQUENT COMPLICATIONS
Background
Background: Greater trochanteric pain syndrome (GTPS), including gluteal tendon tears, in the elderly is frequently misattributed to spinal pathology due to overlapping symptoms and age-related changes. Unrecognized gluteal tendon tears can lead to serious functional impairment and secondary issues.
Case report
A 76-year-old woman presented with chronic left lateral hip pain, tenderness over the greater trochanter, and limited hip abduction. Following a fall on a flat surface, symptoms worsened, including progressive limp and thigh/lumbar pain. Initial diagnostics - lumbar spine MRI (polydiscarthrosis, mainly L5-S1) and hip ultrasound (normal finding) led to a misdiagnosis of lumbar radiculopathy. Conservative treatment with physical therapy yielded no improvement. Over time, the patient developed progressive gait disturbance, gluteal muscle hypotrophy, and a positive Trendelenburg sign. Eight months later, pelvic MRI revealed chronic full-thickness tears of the gluteus medius and minimus with severe atrophy and fatty degeneration, alongside L4-L5 disc extrusion. Delayed recognition led to irreversible gait impairment requiring permanent cane use. This in turn caused worsening lumbar pain and compressive ulnar neuropathy due to cane overuse, manifesting as hand weakness. The patient also suffered emotional distress due to reduced mobility and chronic pain.
Conclusion
This case illustrates the clinical importance of considering gluteal tendon injuries in elderly patients with GTPS, particularly following trauma. These injuries are frequently underdiagnosed, and early MRI evaluation is critical for accurate diagnosis. Early diagnosis and timely management (physical or surgical) can significantly reduce the risk of long-term disability and secondary complications
Keywords
Greater trochanteric pain syndrome
#110 CONSTRUCTION AND VALIDATION OF EARLY EXERCISE STRATIFIED MANAGEMENT SCHEME FOR CARDIOVASCULAR SEVERE PATIENTS BASED ON CROSS THEORETICAL MODEL
Mei Qin
Conference topic: Cardiopulmonary rehabilitation
Occupation: Nurses
Type of abstract: Scientific abstract
Abstract
Title
CONSTRUCTION AND VALIDATION OF EARLY EXERCISE STRATIFIED MANAGEMENT SCHEME FOR CARDIOVASCULAR SEVERE PATIENTS BASED ON CROSS THEORETICAL MODEL
Background and Aims
To integrate the behavior change stages and critical rehabilitation characteristics of the Cross Theory Model , construct an early exercise stratified management plan for cardiovascular critical patients, and verify its clinical applicability.
Methods
Convenience sampling was used to select 102 critically ill cardiovascular patients admitted to a tertiary hospital from June 2024 to December 2024 as the study subjects. They were randomly divided into a control group (conventional nursing) and an observation group (early exercise stratified management plan for critically ill cardiovascular patients based on a cross theoretical model), with 51 cases in each group, using a random number table method. Compare the hospitalization time, left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), 6-minute walk test (6MWT), Brief Mood Scale (BPOMS), and incidence of adverse events between two groups.
Results
After nursing, the hospitalization time, LVESD, LVEDD, BPOMS score levels, and incidence of adverse events in the observation group were lower than those in the control group, while LVEF and 6MWT levels were significantly higher than those in the control group (P<0.05).
Conclusion
This plan integrates behavior change theory into severe exercise rehabilitation, which can improve patients' cardiac function, enhance their psychological state, reduce the incidence of adverse events, and promote their recovery.
Keywords
Cardiovascular critical illness, Early exercise
#111 BLOOD FLOW RESTRICTION (BFR) EXERCISE FOR SARCOPENIA: A CASE SERIES
Joon Shik Yoon, Seok Kang, Ji Ae Kim, Si Hyeon Oh, Geum Ju Yoon, Eun Ae Koh
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BLOOD FLOW RESTRICTION (BFR) EXERCISE FOR SARCOPENIA: A CASE SERIES
Background and Aims
Sarcopenia, characterized by progressive loss of muscle mass and strength, is a significant health concern in older adults. Blood flow restriction (BFR) exercise has emerged as a promising intervention, enabling muscle adaptation at lower loads, which may be safer and more feasible for frail individuals.
Methods
We present a case series of three older adults (ages 58–81 years) diagnosed with sarcopenia based on reduced muscle mass and strength. The participants included two females and one male with body mass index (BMI) ranging from 19.5 to 23.9 kg/m². All patients participated in a supervised BFR exercise program, consisting of three sessions per week for four weeks. The BFR pressure was set at 40% of arterial occlusion pressure (AOP), and exercise intensity was maintained at 30% of one-repetition maximum (1RM). Each session included a combination of lower limb resistance exercises performed under BFR conditions.
Results
All patients completed the intervention without adverse events. Hand grip strength (HGS) showed varying degrees of improvement across cases, ranging from 0.8% to 46.5% (from 14.2 kg to 23.0 kg post-intervention). Thigh muscle thickness increased by 37.9% to 44.7%, with final measurements up to 28.8 mm. In terms of physical performance, short physical performance battery (SPPB) scores improved from 8–9 at baseline to 11 at follow-up, and 6-minute walk test (6MWT) distances increased by 37 to 74 meters. However, no consistent changes were observed in appendicular muscle mass index (AMI).
Conclusion
This case series suggests that low-load blood flow restriction (BFR) exercise may be a feasible and well-tolerated approach for enhancing muscle strength, muscle mass, and physical function in older adults with sarcopenia. While these observations are encouraging, further research with larger samples is needed to confirm the potential benefits of BFR training in this population.
Keywords
Sarcopenia, BFR
#112 POINT-OF-CARE ULTRASOUND SCREENING FOR HEMOPHILIC JOINTS IN AN OUTREACH CAMP AT ALAPUZHYA, KERALA: A PILOT STUDY
Nittu Panjikaran
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
POINT-OF-CARE ULTRASOUND SCREENING FOR HEMOPHILIC JOINTS IN AN OUTREACH CAMP AT ALAPUZHYA, KERALA: A PILOT STUDY
Background and Aims
Hemophilia, characterized by impaired blood clotting, often leads to spontaneous or post traumatic bleeding episodes, increasing morbidity. Globally, hemophilia affects about 1 in 10,000 births , with India home to approximately 80,000 cases and the southern state of Kerala accounting for 1750 cases. The objective of the research was to assess the musculoskeletal status using point-of-care ultrasound for symptomatic hemophilia patients in the rural areas of Alappuzha district , Kerala.
Methods
A cross-sectional survey was carried out among the symptomatic hemophilia patients attending an outreach camp in Alapuzhya District . Convenience based non -probability sampling was done. A semi structured questionnaire was used to collect socio-demographic data, Joint assessment and Functional assessment were done using the Hemophilia Joint Health Score ( HJHS) and Functional Independence Score in Hemophilia(FISH) respectively. The Mindray point -of care ultrasound machine was used to assess the joint status.
Results
From the 31 patients who attended the camp, a total of 31 patients had hemophilia. The mean age was 24.13+- 12.49 years and most of them were male. Using the point-of-care ultrasound, joint bleeds were diagnosed in 17 patients ( ankle 5, knee 8, elbow 4) and psoas bleed and compartment syndrome in one patient each. The Universally Simplified Ultrasound Screening (US US) protocol was applied to 13 patients to efficiently detect joint changes in a short time span . The mean scores for HJHS and FISH were 6.7+- 10.8 and 30.2+/- 5.1 respectively, indicating greater joint damage and lower independent functional ability.
Conclusion
As it excludes axial images and used predetermined views in US-US protocol allowed joint scans in a short time frame. The use of point-of-care ultrasound in outreach camp setting helped to facilitate quick and efficient screening of patients , thereby diagnosing joint and muscle bleeds.
Keywords
hemophilia, point-of-care, ultrasound, outreach
#113 REHABILITATION IN A PATIENT AFTER KNEE ARTHROSCOPY DUE TO PATELLAR INSTABILITY - CASE REPORT
Teodora Jugova, Ana Krsteska, Daniela Gechevska, Maja Manoleva, Marija Gocevska, Lidija Stojanoska- Matjanoska, Cvetanka Gjerakaroska Savevska, Valentina Koevska, Biljana Kalchovska, Biljana Mitrevska, Erieta Nikolikj- Dimitrova
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
REHABILITATION IN A PATIENT AFTER KNEE ARTHROSCOPY DUE TO PATELLAR INSTABILITY - CASE REPORT
Background
Patellar dislocations are traumatic injuries that occur most often in individuals under the age of twenty and are related to sports and physical activity. Currently, there are no published reports describing the rehabilitation of younger males after arthroscopy and open reconstruction of the medial patellofemoral ligament (MPFL) using a tibialis anterior allograft
Case report
Patient A.K. , 26 years old age, with patellar instability of the right knee, which occurred as a result of sports overloads. The patient was treated surgically with arthroscopy, retinaculum lateral capsulotomy, osteotomy and reconstruction. For the assessment of the patient, the following were applied: clinical examination, measurement of the circumference of the right leg and the range of motion in all joints of the right leg. Examinations were performed at the beginning of treatment and at the end of treatment. The rehabilitation was carried out over a period of 4 weeks. The following procedures were applied in the rehabilitation: kinesitherapy with gradual introduction of exercises according to the rehabilitation protocol and gradual increase of the load, hydro kinesiotherapy in the pool with exercises for the right leg, physical agents (cryotherapy, therapeutic ultrasound, low-intensity laser therapy, interference currents)
Conclusion
Our results suggested that active physical therapy and kinesiotherapy might benefit the early recovery of knee joint function and reduction of muscle atrophy in patients with recurrent patellar dislocation after MPFL reconstruction.
Keywords
rehabilitation, knee arthroscopy, patellar instability
#114 ROBOTIC REHABILITATION FOR UPPER LIMB NEURORECOVERY IN INDIVIDUALS WITH SUBACUTE STROKE: PROTOCOL OF A MULTICENTER INTERNATIONAL RANDOMIZED CONTROLLED TRIAL
Sanaz Pournajaf1, Sanaz Pournajaf2
2 IRCCS San Raffaele Rome, Italy
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
ROBOTIC REHABILITATION FOR UPPER LIMB NEURORECOVERY IN INDIVIDUALS WITH SUBACUTE STROKE: PROTOCOL OF A MULTICENTER INTERNATIONAL RANDOMIZED CONTROLLED TRIAL
Background and Aims
Stroke is a leading cause of long-term disability, with upper limb and particularly hand impairments severely limiting autonomy and quality of life. Recovery of hand function is often the most complex and crucial aspect for regaining independence. Robotic rehabilitation has emerged as a promising intervention to enhance neuromotor recovery through intensive, repetitive, and personalized training. However, current evidence is limited by small sample sizes and methodological variability. This international, multicenter randomized controlled trial (RCT) primarily aims to evaluate the effectiveness of robot-assisted upper limb rehabilitation, with a particular focus on hand function, compared to conventional therapy in individuals with subacute stroke.
Methods
This assessor-masked RCT (approved 31/01/2025-Ethics Committee) will involve 130 subacute stroke survivors (<90 days post-onset) recruited from 19 international centers. Participants will be randomized to: Experimental group: robot-assisted therapy with R-Touch Pro® plus conventional therapy. Control group: conventional therapy only. The protocol includes a 6-week treatment phase (18+/-3 sessions). Primary outcomes include the Fugl-Meyer Assessment Upper Extremity motor part (0–66). Secondary outcomes include muscle strength, range of motion, manual dexterity (Box and Block Test, Nine Hole Peg Test), daily living autonomy (ABILHAND, modified Barthel Index), and social participation (Stroke Impact Scale). Assessments will occur at baseline (T0), post-treatment (T1), and at 3-month follow-up (T2).
Results
We hypothesize that robot-assisted therapy will yield greater improvements in upper limb motor function than conventional therapy, surpassing the Minimally Clinically Important Difference (MCID) on the Fugl-Meyer Assessment. Expected improvements include manual dexterity and quality of life. Data will be analyzed to identify prognostic factors and evaluate the feasibility of integrating robotic therapy into standard care.
Conclusion
This multicenter RCT will provide robust evidence on the effectiveness of robot-assisted upper limb rehabilitation with a particular focus on hand function in individuals with subacute stroke, supporting its integration into clinical practice, contributing to future post-stroke rehabilitation guidelines.
Keywords
StrokeRehabilitation, RobotAssistedTherapy, UpperLimbNeurorecovery, HandFunction, Sub-acuteStroke
#115 EARLY EXOSKELETON-ASSISTED THERAPY SIGNIFICANTLY ENHANCES UPPER LIMB NEURORECOVERY IN SUBACUTE STROKE: A MULTICENTER RANDOMIZED CONTROLLED TRIAL
Sanaz Pournajaf
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
EARLY EXOSKELETON-ASSISTED THERAPY SIGNIFICANTLY ENHANCES UPPER LIMB NEURORECOVERY IN SUBACUTE STROKE: A MULTICENTER RANDOMIZED CONTROLLED TRIAL
Background and Aims
Upper limb motor deficits are common and disabling after stroke, especially in the subacute phase. Exoskeleton-based Robot-Assisted Therapy (RAT) offers a promising intervention by delivering intensive, task-specific, and feedback-driven training. While its potential is recognized, evidence of its superiority over conventional therapy in real-world settings remains limited. This multicenter randomized controlled trial (RCT) aimed to assess the effectiveness of exoskeleton-based RAT as an adjunct to standard rehabilitation in individuals with subacute stroke.
Methods
In this randomized, single-blind, controlled trial, patients with moderate-to-severe upper extremity (UE) motor impairment due to subacute stroke (<3 months’ onset) were randomly assigned (1:1) to receive 25 sessions (5 times/week for 5 weeks) of exoskeleton-RAT training or conventional upper limb therapy. The primary outcome was the change in the Fugl-Meyer Assessment for Upper Extremity from baseline to end of treatment. A 3-month telephonic follow-up was conducted. The odds ratio of subjects achieving the minimal clinically important difference (MCID) on the primary outcome was also calculated. The trial was ethically approved and registered at ClinicalTrial.gov (NCT04697368).
Results
A total of 94 individuals (35% women; mean age 62.5 ± 13.5 years; mean time from stroke onset 34 ± 28 days) were randomized, with 82 completing the intervention (12% dropout rate). The Robotic Group (RG) showed significantly greater improvement on the Fugl-Meyer Upper Limb Assessment compared to the Control Group (CG), with a median between-group difference of 22 points (p<0.001). Clinically meaningful improvements (MCID ≥10 points) were achieved by 68.4% of RG versus 31.8% of CG (OR = 4.64, 95% CI: 1.83–11.8; p<0.001). Secondary outcomes favored RG, though spasticity and dexterity did not differ significantly.
Conclusion
This trial provides strong evidence supporting exoskeleton-based RAT in early post-stroke rehabilitation, with significantly higher MCID achievement than conventional therapy. Findings highlight its potential for integration into routine care and encourage further exploration of long-term benefits.
Keywords
StrokeRehabilitation, 3-D Exoskeleton, Robot-AssistedTherapy, UpperLimbNeurorecovery
#116 WEARABLE POWERED OVERGROUND EXOSKELETON REDUCES DOSE-DEPENDENTLY THE SPASTICITY IN INDIVIDUALS WITH SPINAL CORD INJURY.
Sanaz Pournajaf
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
WEARABLE POWERED OVERGROUND EXOSKELETON REDUCES DOSE-DEPENDENTLY THE SPASTICITY IN INDIVIDUALS WITH SPINAL CORD INJURY.
Background and Aims
Spasticity is a common and debilitating consequence of spinal cord injury (SCI), negatively affecting mobility, independence, and overall quality of life. In recent years, wearable powered overground exoskeletons have emerged as a promising tool in neurorehabilitation, with the potential to reduce spasticity and enhance functional outcomes through repeated, task-specific gait training. This study investigated the dose-dependent effects of overground exoskeleton-assisted gait training on spasticity and functional independence in individuals with SCI.
Methods
A multicenter retrospective pre-post cohort study was conducted across four rehabilitation centers in Italy. Seventy-four individuals with SCI participated in at least five gait training sessions using the Ekso™ overground exoskeleton. The primary outcomes included changes in spasticity, assessed through the aggregated Modified Ashworth Scale (MAS), and functional independence, measured by the Spinal Cord Independence Measure (SCIM). Secondary analyses examined the influence of the number of sessions on outcomes.
Results
The analysis revealed statistically significant reductions in spasticity across proximal, intermediate, and distal muscle groups following the intervention (p < 0.0001). Similarly, SCIM scores improved significantly (p < 0.0001), reflecting enhanced functional independence. Participants who underwent 15 or more sessions demonstrated significantly greater improvements in both MAS and SCIM scores compared to those with fewer sessions (p < 0.05), suggesting a dose-response relationship.
Conclusion
Overground exoskeleton-assisted gait training appears to be an effective intervention for reducing spasticity and improving functional outcomes in individuals with SCI. The observed dose-dependent effects underscore the importance of session frequency in maximizing therapeutic benefits. These findings support the incorporation of wearable powered exoskeletons into standard rehabilitation protocols, providing clinicians with an evidence-based option to improve recovery trajectories in SCI rehabilitation.
Keywords
SpinalCordInjury, OvergroundExoskeleton-AssistedGaitTraining, Spasticity, Rehabilitation
#118 EVALUATION OF POSTURAL BALANCE IN PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING THE TIMED UP AND GO TEST (TUG)
El Beloui Ryme, Kyal Nada, Boutalja Hasnaa, Lmidmani Fatima, El Fatimi Abdellatif
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EVALUATION OF POSTURAL BALANCE IN PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING THE TIMED UP AND GO TEST (TUG)
Background and Aims
Total hip arthroplasty (THA) is a surgical intervention aimed at alleviating pain and restoring functional mobility. Assessing postural balance is a key aspect of patient management following THA, as it influences stability and mobility outcomes. This study aims to assess changes in postural stability in patients before and after undergoing THA.
Methods
A prospective and descriptive study of 52 patients who underwent unilateral THA were recruited to evaluate postural balance before surgery, as well as at 3 and 6 months postoperatively. Assessments were conducted using the Timed Up and Go (TUG) test and the single-leg stance duration. Patients with bilateral THA, neurological conditions, or any disorder likely to interfere with balance control were excluded. Postoperatively, all patients followed a standardized rehabilitation program that included muscle strengthening and proprioception exercises
Results
The mean age was 59.6 years, with a predominance of male participants. Significant improvements were noted in both the TUG test and single-leg stance duration across the different assessment periods. • Pre-surgery: The average TUG test duration was 45 seconds, with 81.3% of patients relying on assistive devices. Single-leg stance was impossible for 37.2% of patients, while 62.8% could not exceed 5 seconds. • Three months post-surgery: The average TUG test time improved to 21 seconds, with 48.3% still requiring assistive devices. Single-leg stance lasted on average 9 seconds. • Six months post-surgery: The TUG test further improved to 17 seconds, and only 12.7% of patients still needed assistive devices. The single-leg stance duration increased to 12 seconds on average.
Conclusion
Our findings indicate that THA has an impact on postural stability, emphasizing the need for structured rehabilitation programs. Balance assessment plays a crucial role in monitoring patients' recovery and progression toward functional independence. The TUG test is a practical clinical tool for evaluating mobility, balance, and functional capacity.
Keywords
Postural, balance, hip, arthroplasty,
#119 ISOKINETIC EVALUATION OF SHOULDER MUSCLE DEFICITS IN REPETITIVE STRAIN INJURY AND ITS IMPACT ON QUALITY OF LIFE AND FUNCTIONAL PERFORMANCE
El Beloui Ryme, Kyal Nada, Boutalja Hasnaa, Lmidmani Fatima, El Fatimi Abdellatif
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ISOKINETIC EVALUATION OF SHOULDER MUSCLE DEFICITS IN REPETITIVE STRAIN INJURY AND ITS IMPACT ON QUALITY OF LIFE AND FUNCTIONAL PERFORMANCE
Background and Aims
Isokinetic testing is a gold standard method for assessing muscle strength. It allows for a functional diagnosis by quantifying objectively the level of impairment in shoulders affected by repetitive strain injury (RSI). This study aims to determine the isokinetic profile of shoulders with RSI compared to a healthy population and to evaluate its impact on functional performance and quality of life( QoL).
Methods
A prospective, descriptive, and analytical study was conducted on 55 patients diagnosed with rotator cuff tendinopathy due to RSI, alongside a control group of 30 healthy individuals. Participants were recruited from the Department of Physical Medicine and Rehabilitation at CHU Ibn Rochd in Casablanca. All subjects underwent clinical, paraclinical, and isokinetic assessments. Qol was evaluated using the SF-36 as for the functional performance the DASH score was used
Results
The average age of participants was 36 ± 3.7 years, with a female predominance (68%). Isokinetic testing revealed a significant (p<0,05) reduction in muscle strength of the medial and lateral rotators in the RSI group compared to the healthy controls. Additionally, muscle strength asymmetry between the left and right shoulders was observed in patients with RSI. 65,45% of the patients had a high DASH score as well as 70,90% who had a low SF-36 score indicating a negative impact on their functional performance and quality of life.
Conclusion
A deficit in shoulder muscle strength is a key factor in the development of rotator cuff tendinopathy, leading to a significant decline in quality of life. Targeted strengthening and stretching exercises are essential components of rehabilitation programs for RSI-related shoulder dysfunction with a special focus on excentric strengthening.
Keywords
isokinetic, shoulder, quality of life
#120 ASSESSMENT OF POSTERIOR TIBIAL NERVE STIMULATION EFFECTIVENESS IN PEDIATRIC OVERACTIVE BLADDER: A MOROCCAN STUDY
El Beloui Ryme, Kyal Nada, Boutalja Hasnaa, Lmidmani Fatima, El Fatimi Abdellatif
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSESSMENT OF POSTERIOR TIBIAL NERVE STIMULATION EFFECTIVENESS IN PEDIATRIC OVERACTIVE BLADDER: A MOROCCAN STUDY
Background and Aims
Transcutaneous tibial nerve stimulation (TTNS) has shown efficacy in treating overactive bladder syndrome (OAB). This study evaluates its effectiveness in improving OAB parameters in a pediatric population.
Methods
A prospective study included 46 children with refractory (non-responsive to the medical and rehabilitation treatments) non-neurogenic OAB treated with daily 20-minute TTNS sessions (5/week, 10 Hz, 2000 ms). Voiding diary and uroflowmetry data were assessed at 1 and 6 months.
Results
46 children were included (27 girls, 19 boys), with a mean age of 12.7 ± 1.9 years. All patients had OAB syndrome and underwent renal bladder ultrasound and urodynamic evaluation, which showed no detrusor overactivity on cystomanometry. A 3-day voiding diary was completed. The average TTNS duration was 7 months, with 6 children lost to follow-up. At 1 month, improvements were observed in voiding diary and uroflowmetry parameters. At 6 months, OAB had resolved in 28 children, while 39.14% still had urinary frequency and urgency without incontinence.
Conclusion
TTNS is a promising therapeutic option for managing OAB syndrome in non-neurogenic bladder due to its non-invasive nature and ease of use. Further studies are needed in this area.
Keywords
urodynamic, tibial nerve stimulation
#121 EFFICACY OF ANKLE-FOOT ORTHOSES ON GAIT IN CHILDREN WITH CEREBRAL PALSY
El Beloui Ryme, Boutalja Hasnaa, Kyal Nada, Lmidmani Fatima, El Fatimi Abdellatif
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EFFICACY OF ANKLE-FOOT ORTHOSES ON GAIT IN CHILDREN WITH CEREBRAL PALSY
Background and Aims
Ankle-foot orthoses (AFOs) are used in children with cerebral palsy (CP) to improve gait and stability. Their effectiveness varies depending on the severity of CP. This study aims to evaluate the effectiveness of AFOs in improving gait patterns in children with CP by analyzing gait parameters.
Methods
This prospective analytical study included children with CP recruited from a physical medicine and rehabilitation department. Patients were prescribed AFOs, and gait parameters (step count, step length, cadence, and walking speed) were assessed with and without AFOs.
Results
A total of 68 patients were included, with a mean age of 9.2 years. Among them, 43.9% had spastic tetraparesis. Gait analysis showed improvements in step count for 100 meters, step length, cadence, and walking speed when using AFOs compared to barefoot walking.
Conclusion
Some studies report significant gait parameter improvements with AFOs, while others show no notable changes. AFOs should be integrated into a comprehensive treatment plan, including motor rehabilitation, occupational therapy, and other therapeutic interventions. They are valuable tools for improving gait in children with CP. They provide support, enhance stability, and reduce the risk of falls.
Keywords
Cerebral palsy, orthoses, Gait
#122 SEXUAL DYSFUNCTION IN MULTIPLE SCLEROSIS: A SILENT STRUGGLE FOR MOROCCAN PATIENTS
El Beloui Ryme, Kyal Nada, Boutalja Hasnaa, Lmidmani Fatima, El Fatimi Abdellatif
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SEXUAL DYSFUNCTION IN MULTIPLE SCLEROSIS: A SILENT STRUGGLE FOR MOROCCAN PATIENTS
Background and Aims
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, leading to various deficits, including sexual dysfunction. This study aims to assess the prevalence of sexual dysfunction in Moroccan MS patients and highlight the challenges they face in discussing this issue.
Methods
A prospective, descriptive, and analytical study was conducted on MS patients followed at the Physical Medicine and Rehabilitation Department of CHU Ibn Rochd, Casablanca. Sexual dysfunction was evaluated using the International Index of Erectile Function (IIEF-5) for men and the Female Sexual Function Index (FSFI-6) for women as well as a tailored questionnaire.
Results
A total of 120 patients were included, with a mean age of 34.4 ± 8.5 years and a female predominance. The average disease duration was 9.1 ± 4 years. MS forms were relapsing-remitting (68.3%), progressive-relapsing (18.3%), and progressive (13,3%). The prevalence of sexual dysfunction was 100% in sexually active men (IIEF-5) and 57.9% in women (FSFI-6). Married patients were more willing to discuss sexual dysfunction than single patients. 76,6% admitted a loss of self-confidence , 95% never spoke about their issue to a health professional and 100% consider it a taboo in the Moroccan society.
Conclusion
Sexual dysfunction is highly prevalent among sexually active MS patients in Morocco, with men being more affected than women. The topic remains difficult to address, underscoring the need for better awareness and patient support.
Keywords
multiple sclerosis, sexual dysfunction
#123 CLINICAL CODING: HOW TO BUILD A CODABLE CLINICAL RECORD IN PMR
Pedro Gameiro1, Madalena Rangel2, Gema Mira1
2 ULSAC, EPE, Portugal
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CLINICAL CODING: HOW TO BUILD A CODABLE CLINICAL RECORD IN PMR
Background and Aims
Clinical coding and auditing activities are carried out in the Sistema de Informação para a Morbilidade Hospitalar (SIMH), exclusively by doctors with specific training in Portugal. Clinical coding is carried out in exclusive compliance with the coding rules of the International Classification of Diseases (ICD), in the version that is in guidelines issued by the Central Administration of the Health System, IP (ACSS). The aim of this paper is to describe an example of a model to be used for drawing up clinical records, in a detailed way, in order to promote an improvement in the process of clinical coding of PMR files, in order to get better quality of the data extracted.
Methods
A research has been made in the search engine like Pubmed, Web of Science and Scopus. The indexed terms "clinical coding" and " physical medicine and rehabilitation" were operated with the terms OR, AND. To this search data from the SIMH was added.
Results
A detailed "guideline" to build the clinical record of inpatient was obtained from the literature and from the clinical expertise of the authors contributing to this work, based on the daily work as PMR specialists and also clinical coders.
Conclusion
The standardization of clinical records allows the Clinical Coding Office to improve the performance of coding of both primary and secondary diagnoses, as well as procedures carried out during a patient's hospitalization. The immediate result of using a risk-adjustment tool is a systematized characterization of the population in terms of various variables, providing information for planning and monitoring. These variables, provide information for the planning and monitoring of health services as well as a measure of the casemix of each healthcare provider. Guidelines to normalize the PMR clinical records are needed to allow us to a more realistic risk stratification.
Keywords
clincal, coding, PMR
#124 DIFFERENTIATING SPASTICITY-RELATED PAIN - A CASE REPORT OF HEREDITARY SPASTIC PARAPLEGIA
Manuel Fernandes1, Filipe Mendes2, Sofia Martins Azevedo2, Ana Isabel Romeiro2, Carlos Gama2, Cláudia Dionísio Silva2, José da Cunha Marques2, Maria Inês Táboas2, Catarina Aguiar Branco2
2 ULS Entre Douro e Vouga, Portugal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
DIFFERENTIATING SPASTICITY-RELATED PAIN - A CASE REPORT OF HEREDITARY SPASTIC PARAPLEGIA
Background
Hereditary Spastic Paraplegia (HSP) refers to a rare group of highly heterogeneous neurodegenerative diseases whose hallmark is progressive spasticity and weakness of the lower limbs. When evaluating patients with HSP, clinicians should also account for non-motor symptoms such as bladder disturbances, depression, fatigue and pain. In the presence of other comorbid conditions, such as respiratory infections, it can be hard to distinguish whether pain is spasticity-related or due to other conditions, requiring an appropriate evaluation together with good clinical awareness of HSP’s symptoms.
Case report
A 32-year-old man with diagnosed HSP type 7, who had lost medical following in Neurology and Physical and Rehabilitation Medicine (PRM), was hospitalized with complicated pneumonia with posterior, left-sided pleural effusion (PE) confirmed by CT scan. Despite appropriate treatment, the patient complained of left-sided pain, attributed to pleuritic inflammation. At the PRM internal consultation, marked spasticity of the lower limbs and lower back muscles was noted. The patient also presented coughing bouts that aggravated the pain in the left back, preventing effective coughing, which raised suspicion for other causes of pain. The patient started a rehabilitation program during hospital stay, together with baclofen progressive titration to optimal dosing, with resolution of the pain complaints. Furthermore, the patient was referred to the PRM consultation for lower limbs spasticity focal treatment with botulinum to avoid side effects of high doses of baclofen and appropriate follow-up.
Conclusion
A lot of medical conditions present with pain. In this case, a patient with pneumonia with PE presented with pain, most likely of pleuritic cause. However, when dealing with patients with HSP, spasticity-related pain should also be considered. This case highlights the importance of recognizing pain patterns associated with spasticity, which in turn leads to more effective symptomatic management, especially when pain persists after treatment of the presumed alternative cause.
Keywords
Hereditary Spastic Paraplegia; Spasticity; Pain
#125 BOTULINUM TOXIN INJECTION IN CROCODILE TEARS SYNDROME: WHAT DO WE DO AND WHAT WE KNOW?
Manuel Coutinho Fernandes, Filipe Mendes, Sofia Martins Azevedo, Ana Isabel Romeiro, Carlos Gama, Cláudia Dionísio Silva, José da Cunha Marques, Maria Inês Táboas, Catarina Aguiar Branco
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BOTULINUM TOXIN INJECTION IN CROCODILE TEARS SYNDROME: WHAT DO WE DO AND WHAT WE KNOW?
Background and Aims
Crocodile tears syndrome (CTS) is a rare sequela of peripheral facial palsy (PFP) causing excessive lacrimation during mastication, deglutition or salivation. CTS occurs from the misdirection of regenerating salivary nerve fibers and innervation of the lacrimal gland post-PFP, affecting the patient’s quality of life. Transconjunctival injection of botulinum toxin (TIBT) type A has been growing as an option, although still rarely implemented and with no standardized protocols available. We aim to review the current literature on TIBT on CTS in adults, using 2 clinical cases, reviewing clinical evaluation, therapeutical goals establishment, injection protocols and possible complications.
Methods
Case 1: right PFP sequelae following temporal bone trauma. Case 2: left PFP sequelae post-Ramsay-Hunt syndrome. Both with facial asymmetry and CTS worsened by mastication. Goals for TIBT: facial symmetry; reduce lacrimation. We conducted a literature review on Pubmed using the keywords “crocodile tears syndrome”; “toxin injection”; “facial palsy”; articles released in the last 10 years and including studies describing CTS, TIBT protocols in adults, its effect and possible complications.
Results
We identified 4 articles. All recommended anamnesis and systematic clinical evaluation, including pre- and post-procedure Schirmer test and establishing therapeutical goals. The authors used onabutulinumtoxinA or incobotulinumtoxinA, with doses ranging from 1 to 10U (maximum of 20U), most commonly 4 or 5U, with epiphora resolution within a week. Some authors recommended starting with a lower dose and if necessary, reinjecting in 2 to 3 weeks to avoid overdosing. Reinjection intervals ranged between 3 to 6 months. Despite relatively painless and safe, potential but temporary side effects included palpebral ptosis, hematoma, xerostomia, diplopy, among others.
Conclusion
TIBT has been shown to be effective and safe, however with possible complications, therefore careful clinical assessment, establishing clear treatment goals and using an adequate protocol (based on the best clinical practice) is essential for therapeutical success and patients’ well-being.
Keywords
Crocodile, tears, syndrome;, Botulinum, toxin
#126 TERAPEUTICAL BENEFIT OF HIGH-INTENSITY LASER IN PATIENTS WITH KNEE OSTEOARTHRITIS - A RANDOMIZED COMPARATIVE SINGLE-BLIND STUDY
Valentina Koevska, Biljana Mitrevska, Biljana Kalcovska, Erieta Nicolic-Dimitrova, Cvetanka Gjerakaroska-Savevska, Marija Gocevska Gocevska, Maja Manoleva, Daniela Gecevska, Ana Krstevska, Teodora Jugova
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
TERAPEUTICAL BENEFIT OF HIGH-INTENSITY LASER IN PATIENTS WITH KNEE OSTEOARTHRITIS - A RANDOMIZED COMPARATIVE SINGLE-BLIND STUDY
Background and Aims
Knee osteoarthritis is a musculoskeletal disease characterized by degeneration and deterioration of articular cartilage. In addition to pharmacological therapy, physical modalities including low-intensity laser therapy (LILT) and high-intensity laser therapy (HILT), and kinesitherapy are used to treat knee osteoarthritis (КОА). To date, no research has been conducted in the Republic of North Macedonia that could be compared to existing research about the effects of HILT and LILT on functional ability in patients with КОА. The aim of this study was to compare the treatment effects of HILT and LILT in patients with KOA.
Methods
This was a randomized comparative single-blind study involving 72 patients divided into two groups. The first group was treated with 10 sessions of HILT, and the second group with 10 sessions of LILT. Patients of both groups performed exercises for 1 month. Functional outcome was evaluated after the end of the laser therapy and after 1 month using the Western Ontario and McMaster Universities Osteoarthritic Index (WOMAC). Statistical significance was defined as p<0.05.
Results
At the end of the laser therapy and 1 month later, a statistically significant difference was found between the two groups, measured by the WOMAC index (p<0.001). Additionally, the WOMAC index was compared within the groups.
Conclusion
Patients with KOA who were treated with HILT had significantly better functional recovery than patients treated with LILT.
Keywords
high-intensity, laser, low-intensity, laser, knee
#127 USEFULNESS OF THE SINS SCORE IN THE PHYSICAL THERAPY MANAGEMENT OF AN ONCOLOGY PATIENT: A CLINICAL CASE REPORT.
Valerio Massimo Magro, Andrea Sorbino, Nicola Manocchio, Concetta Ljoka, Calogero Foti
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
USEFULNESS OF THE SINS SCORE IN THE PHYSICAL THERAPY MANAGEMENT OF AN ONCOLOGY PATIENT: A CLINICAL CASE REPORT.
Background
The rehabilitation of an oncologic patient is a difficult task from which the physiatrist does not shy away. The spine is afflicted from neoplastic diseases which can lead to instability, that it can cause deformity, pain, and spinal cord compression and is an indication for surgery/radiotherapy. The spinal instability neoplastic score (SINS) helps to assess tumor-related instability of the vertebral column. It has been shown to be useful in guiding the mobilization or operative management of patients with neoplastic spinal disease and correlates with patient-reported outcomes.
Case report
An elderly oncologic patient is hospitalized and at the level of the vertebral bodies of L2, L3, L4 and L5, we found areas of subtle osteolysis, in the presence of degenerative phenomena and one area of sub-centimetric osteolysis, , respectively at the level of the distal third of the sternal body, of D7 and D8, of the left hemi-sacrum. We used the Spine Instability Neoplastic Scale (SINS) and obtained a score of 8, which characterized a potential vertebral instability with a significant risk of vertebral fracture caused by lytic lesions of a neoplastic nature. So we e prescribed a trunk orthosis; we started the therapy for the primary neoplasm first in hospital and subsequently establishing new outpatient checks after having activated a home physiotherapy service and managing to discharge the patient to her home.
Conclusion
The concept of spinal instability remains important in the clinical decision-making process for patients with spine neoplasms. SINS is a score that it has the potential to be a valuable guide to the management of patients with spinal metastases. In this case report the skills of the geriatrician and those of the physiatrist and the oncologist are called upon to collaborate closely to take charge of a complex patient using this score in clinical practice.
Keywords
elderly patient
#128 MULTIMODAL REHABILITATION TREATMENTS FOR THE MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS IN HEAD AND NECK CANCER PATIENTS: A SYSTEMATIC REVIEW
Marco Monticone1, Marco Monticone1, Matteo Pellegrini2, Anita Groppi2, Andrea Pibiri1, Barbara Rocca3, Federico Solla3, Andrea Scribante2
2 University of Pavia, Italy
3 Lenval University Children's Hospital, Nice, France
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
MULTIMODAL REHABILITATION TREATMENTS FOR THE MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS IN HEAD AND NECK CANCER PATIENTS: A SYSTEMATIC REVIEW
Background and Aims
Temporomandibular disorders (TMD) in patients with head and neck cancer (HNC) are understudied, particularly regarding multimodal rehabilitation (MR) treatments aimed at functional recovery, pain reduction, and quality of life (QoL) improvement. This systematic review (SR) evaluates the role of MR interventions in addressing these outcomes.
Methods
Eligible studies included randomized controlled trials (RCTs) and observational studies involving HNC patients with TMD, undergoing MR treatments. Outcomes considered were mandibular mobility (Maximum Interincisal Opening, MIO), pain intensity (0-100 Visual Analogue Scale, VAS), and QoL (0-100 University of Washington Quality of Life, UW-QOL; 0-148 Functional Assessment of Cancer Therapy – Head and Neck, FACT-HN). Exclusion criteria were non-English articles, duplicates, studies unrelated to the review’s aim, non-motor interventions, ex vivo or animal studies, absence of Ethics Committee approval, and non-original studies. A systematic search was conducted across PubMed, Scopus, and Web of Science (1990–2024). Evidence quality was assessed using the National Heart, Lung, and Blood Institute tools, and risk of bias (RoB) with the RoB in the Non-Randomized Studies of Interventions Version 2 tool for observational studies, and the Cochrane RoB tool for RCTs. Data extraction covered study design, patient characteristics, interventions, and outcomes.
Results
Of 257 articles, 7 met the criteria (3 observational studies, 4 RCTs; 340 patients). Studies showed a RoB ranging from low to high and evidence quality from fair to good. MIO improved by an average of 10 mm, pain intensity decreased by 15–20%, and QoL improved significantly (UW-QOL by 25–30 points; FACT-HN by 20–25 points).
Conclusion
Despite study heterogeneity and short-term follow-up, MR appears effective in improving mandibular function, reducing pain, and enhancing QoL in HNC patients with TMD. Funding: none. Registration: PROSPERO Registration n° CRD42024618345.
Keywords
Exercise, Rehabilitation, Neoplasm
#129 BRIDGING DISCIPLINES TO RESTORE LIVES: A CASE OF INTERDISCIPLINARY NEURO-REHABILITATION IN HYPOXIC BRAIN INJURY
ASMAA MAHMOUD MOUSTAFA
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
BRIDGING DISCIPLINES TO RESTORE LIVES: A CASE OF INTERDISCIPLINARY NEURO-REHABILITATION IN HYPOXIC BRAIN INJURY
Background
Hypoxic brain injury (HBI) is a devastating condition caused by oxygen deprivation, often leading to profound cognitive and motor disabilities. Recovery depends on early intervention and sustained, specialized long-term rehabilitation. We present the journey of a 36-year-old woman (EE), who after cardiac arrest in September 2022, underwent a complex interdisciplinary rehabilitation from a minimally conscious state to functional reintegration.
Case report
Initially admitted with a Glasgow Coma Scale (GCS) of 4, EE required ICU care. After stabilization, rehabilitation began at Santo-Stefano Rehabilitation, Villa Fastiggi, Italy. Initial Phase (Oct 2022–May 2023): In a minimally conscious state with severe diffuse spasticity and requiring enteral feeding, she received passive mobilization, cognitive stimulation, and reintroduction of oral feeding. Mid Phase (Sept 2023–July 2024): Orthopedic surgeries addressed contractures and joint issues, including tendon lengthening and total hip replacement. Rehabilitation emphasized mobility recovery, weight-bearing, and continued cognitive, speech, and swallowing therapy. Final Phase (July–Aug 2024): EE gained partial independence in activities of daily living (ADLs), independent wheelchair use, and ambulation with two crutches. Functional scores showed remarkable gains: FIM score increased from 18 to 103; CRS-R cognitive score improved from 9 to 24; mobility rose from 10% to 75%.
Conclusion
Physiatrists, neurologists, internists, ward physicians, orthopedic surgeon, physical therapists, psychologists, speech therapists, social workers, nurses and health-care assisitants collaborated daily, each in his/her vital role in clinical monitoring, skin care, emotional support, and fostering early mobility. This case is a testament to the power of true interdisciplinary collaboration. At Santo-Stefano Rehabilitation-Villa Fastiggi, each professional’s contribution built a pathway to recovery, proving that even in severe brain injuries, structured teamwork can reawaken potential, save brains and restore lives.
Keywords
Neuroplasticity, Neuro-Motor Recovery, Interdisciplinary Team
#130 LOWER LIMB AMPUTATION AND LOW BACK PAIN: A 2024 RETROSPECTIVE ANALYSIS AT CENTRO DE MEDICINA DE REABILITAÇÃO DE ALCOITÃO
Carolina Pereira e Carvalho1, Tiago Cunha2, Natália Ramos2, Luís Jorge Jacinto2
2 Centro de Medicina de Reabilitação de Alcoitão, Portugal
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
LOWER LIMB AMPUTATION AND LOW BACK PAIN: A 2024 RETROSPECTIVE ANALYSIS AT CENTRO DE MEDICINA DE REABILITAÇÃO DE ALCOITÃO
Background and Aims
Despite advances in the treatment of peripheral arterial disease, lower limb amputation remains necessary for a significant number of patients. Low back pain (LBP) is one of the most common pain complaints following amputation, occurring in over half of unilateral lower limb amputees. Several mechanical factors contribute to LBP in amputees, including movement asymmetry, altered joint forces, limb length discrepancy, prosthesis type, muscle atrophy, and weakness.
Methods
A retrospective observational study was conducted, including all patients assessed in the amputee rehabilitation consultation from January to December 2024. Data collected included demographics, amputation type and level, prosthetic use, functional classification (K levels), presence of LBP, stump and phantom limb pain, and prescription of assistive devices.
Results
A total of 261 amputees were included, predominantly male (73.56%), with a mean age of 57.47 years. Lower limb amputations accounted for 90.01%, mainly unilateral transtibial amputations (39.46%). Vascular causes were responsible for 45% of cases. At evaluation, 73.56% used prostheses, with most classified as K1 (35.63 %). LBP was reported by 25% of patients, although 18% of records lacked this information. Most patients with LBP were transfemoral amputees (75.58%). Stump pain was reported by 13% and phantom limb pain by 32% of patients.
Conclusion
Although LBP is prevalent among amputees, the observed prevalence may have been underestimated due to sample size limitations and incomplete data. Even though it was not analyzed in our study, it would be important to investigate the most common causes of low back pain in our amputee patients and to determine which patient groups are more frequently affected. This is important to prevent or treat this condition, which adds further disability to the amputee and worsens their quality of life. Larger studies are needed to clarify LBP aethiology and prevalence in this population.
Keywords
Low back pain; amputation
#131 FROM SENSORY DISTURBANCE TO DIAGNOSIS: A CASE OF DEJERINE-ROUSSY SYNDROME AFTER THALAMIC STROKE
Catarina Afonso, Inês Camarinha, Marta Lopes, Ana Rita Pessoa, Fábio Pinho, Diogo Ribeiro Martins
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
FROM SENSORY DISTURBANCE TO DIAGNOSIS: A CASE OF DEJERINE-ROUSSY SYNDROME AFTER THALAMIC STROKE
Background
Dejerine-Roussy syndrome, or poststroke thalamic pain, is a form of central pain that occurs after ischemic or hemorrhagic strokes involving the thalamus. It is characterized by chronic neuropathic pain, often presenting as allodynia, hyperalgesia, and dysesthesias. In addition to pain, patients may experience sensory deficits, including loss of touch and proprioception. The prevalence of thalamic pain varies, ranging from 3% to 25% among stroke patients. Diagnosis is primarily clinical, based on the patient's stroke history and characteristic symptoms. Treatment is challenging and typically involves a multimodal approach, including medications like antidepressants, anticonvulsants, and occasionally opioids, though responses are often variable.
Case report
A 65-year-old man, with a history of hypertension and chronic alcohol use, was admitted to an Internal Medicine unit after a left thalamo-capsular ischemic stroke. He presented with mild right-sided hemiparesis, hypoesthesia, and impaired sensation, predominantly in the distal upper limb. He underwent physiotherapy during his hospital stay. Despite favorable functional recovery, he continued to experience persistent sensory disturbances, including constant paresthesias, numbness, and paroxysmal dysesthesias. Initially, he was treated with pregabalin (25 mg + 100 mg), with only mild improvement. Following discharge, he was referred to a Physical and Rehabilitation Medicine outpatient consultation, where Dejerine-Roussy Syndrome was diagnosed. His treatment was adjusted with increased pregabalin (75 mg twice daily) and the introduction of amitriptyline (25 mg). A month later, he reported clear improvement, with less frequent and milder episodes of dysesthesias. He remains under follow-up in Rehabilitation Medicine, resuming therapy as an outpatient.
Conclusion
Dejerine-Roussy Syndrome significantly impacts quality of life, especially after a thalamic stroke. This case highlights the challenges of diagnosis and treatment, with the progression of sensory symptoms and partial response to initial treatment with pregabalin and a tricyclic antidepressant. A multidisciplinary approach is essential for optimizing rehabilitation and improving patient outcomes.
Keywords
Dejerine-Roussy, Thalamic pain, Stroke, Neuropathy
#134 LOW BACK PAIN PREVALENCE AMONG DISTANCE LEARNING STUDENTS
Mohannad Hawamdeh1, Ziad Hawamdeh2, Calogero Foti3
2 The University of Jordan, Jordan
3 Tor Vergata University, Italy
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
LOW BACK PAIN PREVALENCE AMONG DISTANCE LEARNING STUDENTS
Background and Aims
Background: Low back pain as a symptom affects many individuals around the globe regardless of their economic status or sociodemographic characteristics. During the 2019 COVID-19 pandemic, students found themselves obligated to sit down for long periods of time. The aim of this current study is to investigate the impact of these prolonged periods of sitting down in front of computers on developing a new episode of low back pain.
Methods
This research adopted an observational cross-section study design. Students who are currently enrolled or have experienced distance learning classes in the last 6 months were eligible to participate. An online-based questionnaire was developed by the investigators through reviewing the literature with relevant objectives. McNemar’s test was used to compare certain variables between two periods before and during online distance learning. We used paired t-tests to compare pain intensity before, during, and after online learning, while a chi-square test was used to investigate correlations between factors influencing low back pain.
Results
A total of 84 students participated in the study 46 (54.8%) females and 38 (45.2%) males. Before online distance learning, only 42.9% of participants reported low back pain, while only 20% had a back injury. The mean pain scores before, during, and after online distance learning were (2.85 ± 2.16, 4.79 ± 2.6, and 4.76 ± 2.7), respectively. The pain scores before online learning were significantly lower than pain scores during and after online distance learning (p < 0.05), respectively.
Conclusion
The study findings suggested that low back pain prevalence increased among students during the COVID-19 pandemic. Future research should study participants’ behavior during online learning and assess the long-run impact of distance learning among high-school and undergraduate students.
Keywords
COVID-19, low, back pain, online.
#135 REDUCING PAIN AND IMPROVING FUNCTIONAL ABILITY AND QUALITY OF LIFE WITH APPLICATION OF RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY IN PATIENTS WITH KNEE OSTEOARTHRITIS
Biljana Kalchovska, Marija Gocevska, Maja Manoleva, Valentina Koevska, Biljana Mitrevska, Cvetanka Gerakaroska-Savevska, Daniela Gechevska, Ana Krsteska, Erieta Nikolikj-Dimitrova, Teodora Jugova
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
REDUCING PAIN AND IMPROVING FUNCTIONAL ABILITY AND QUALITY OF LIFE WITH APPLICATION OF RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY IN PATIENTS WITH KNEE OSTEOARTHRITIS
Background and Aims
Background: Knee osteoarthritis is a musculoskeletal disorder that leads to reduced functional ability and quality of life of the patients. Radial extracorporeal shockwave therapy (RECTUB) has been proposed as a safe, non-invasive, alternative conservative treatment for knee osteoarthritis. Aims: to prove the effect of RECTUB in improving the quality of life in patients with knee osteoarthritis
Methods
Methods: The study represents prospective, monocentric, interventional, non-randomized clinical study of 40 RECTUB treated patients (totalling 5 weekly sessions with 5-minute application of 2000 impulses, 2 Bar intensity, 10 Hz frequency at painful knee points) and kinesitherapy. The patients’ progress was monitored on the Numeric scale of pain, the WOMAC Index and Short Form 36 Health Survey Questionnaire. The clinical findings were evaluated before the treatment started; immediately after its completion and 3 and 6 months afterwards.
Results
Results: Regarding the NSP scored a mean of 7, 4, 2, and 2, respectively, before treatment and at the three follow-up examinations after treatment. It was found that patients had reduced pain intensity was maintained even for 6 months after the applied physical treatment. Statistically significant differences were found of the total WOMAC index and its three subscales at the end of the first, second and third control. The three subscale WOMAC index median was 9, 4, 2, and 2 respectively for subscale 1; 3 and 0 for subscale 2; 34.5, 12.5, 7.5 and 8 at baseline and the three follow-up examinations and subscale 3 respectively, at the beginning and the three follow-up examinations. Regarding the SF-36 Questionnaire, it was shown that the patients had significantly better values for the quality of life in terms of physical functioning, and their general health rated as good.
Conclusion
The study proved that treatment with RECTUB led to improved functional ability and quality of life in patients with knee osteoarthritis.
Keywords
osteoarthritis, shock, wave, therapy,
#136 "PECTUS EXCAVATUM AND OTHER THORACIC DEFORMATIES: WHAT TO DO?"
Fábio Fernandes Pinho, Marta Jacinta Lopes, Rita Cardoso Francisco, Ana Rita Pessoa, Catarina Afonso, Ines Camarinha, Pedro Soares Branco
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
"PECTUS EXCAVATUM AND OTHER THORACIC DEFORMATIES: WHAT TO DO?"
Background and Aims
Chest wall deformities such as pectus excavatum, pectus carinatum, and pectus arcuatum can have both functional and aesthetic implications. Multidisciplinary evaluation is essential for individualized therapeutic guidance. This study aimed to identify clinical patterns regarding symptoms, deformity type, aesthetic concerns, and therapeutic orientation among patients referred to a Multidisciplinary Chest Wall Deformity Clinic involving Thoracic Surgery and Physical and Rehabilitation Medicine of a central hospital in Lisbon.
Methods
We retrospectively analyzed first consultations conducted at the multidisciplinary clinic. Data collected included type of chest wall deformity, reported symptoms (e.g., chest pain, palpitations, dyspnea, fatigue), aesthetic perception, and therapeutic recommendations. Management options included vacuum bell therapy, dynamic compression orthoses, surgical correction (Nuss or Ravitch), or discharge without intervention.
Results
Among patients with pectus excavatum, 43% were advised to use a vacuum bell device. In the pectus carinatum subgroup, 73% were recommended a dynamic compression brace. Overall, 25% of patients with chest wall deformities were either placed on a surgical waiting list or were under follow-up after bar placement. Only 12% (19 out of 163 patients with deformity) were awaiting initial surgical intervention. Aesthetic concern was noted in approximately 55% of patients with a deformity. This concern was highest among those with pectus excavatum, with 73% expressing aesthetic discomfort.
Conclusion
This multidisciplinary approach enabled comprehensive evaluation and tailored treatment strategies. Vacuum bell therapy and dynamic compression orthoses were the most commonly recommended non-surgical treatments. While aesthetic concerns were frequent, particularly in pectus excavatum, most patients were managed conservatively. These findings help establish patterns that may inform clinical decision-making and resource allocation in chest wall deformity management.
Keywords
Pectus; Vaccum beel; Thoracic deformities
#138 RELATIONSHIP BETWEEN PEAK COUGH FLOW AND IMMEDIATE EFFECT OF ONE-WAY SPEAKING VALVE PLACEMENT ON DYSPHAGIA
jong hwa lee, seong uk hwang
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
RELATIONSHIP BETWEEN PEAK COUGH FLOW AND IMMEDIATE EFFECT OF ONE-WAY SPEAKING VALVE PLACEMENT ON DYSPHAGIA
Background and Aims
With the application of a one-way valve to the cannula, air flows into the lungs through the tracheostomy cannula, bypassing the pharynx. We tried to find out the difference in dysphagia improvement when one-way valve is applied according to the peak cough flow (PCF) value, which is one of the expiratory flow indicators.
Methods
Video fluoroscopic swallowing study was consisted of a total two sessions. All patients underwent a first session before one-way valve application. After initial session, patients cleared residue and penetration & aspiration materials, and then applied one-way valve on tracheostomy tube (T tube). After applying one-way valve on T tube, we measured PCF. After measuring PCF, we examined second session. And then, radiologic review was performed. Before and after one-way valve apply, PCF, penetration-aspiration scale (PAS, 1~8) and functional dysphagia scale (FDS) were measured.
Results
Total thirteen patients were recruited. Seven patients improved with aspiration after one-way valve apply, and six patients had no change before and after one-way valve apply. When compared between two groups, there were no difference at age, tracheostomy duration and FDS. However, the improvement group showed a statistically significantly higher PCF value than the no improvement group.
Conclusion
In patients with high PCF, one-way valves can be actively applied to improve swallowing function. Further studies should be needed to find the applicable PCF cut-off value.
Keywords
peak cough flow, one-way valve
#139 EARLY VFSS IN ACUTE STROKE PATIENTS WITH DYSPHAGIA
jong hwa lee, seong uk hwang
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EARLY VFSS IN ACUTE STROKE PATIENTS WITH DYSPHAGIA
Background and Aims
We hypothesized that intensive videofluoroscopic swallowing study (VFSS) helps to choose a proper feeding. This study was to investigate a usefulness after early VFSS in stroke patients with dysphagia.
Methods
VFSS was performed within 7 days after stroke onset. We enrolled the patients who dieted the food via nasogastric tube. Patients were divided into 3 groups according to their brain lesion, cortical lesion (CL), subcortical lesion (SCL) and brainstem/cerebellar lesion (BCL). On the result of VFSS, we checked tendency of changing dietary method and discrepancy of predicting the aspiration risk between the DST and the VFSS.
Results
One hundred sixty three patients met our inclusion criteria; 61 patients were enrolled to the CL group, 54 to the SCL, and 48 to the BSL group. Patients who had aspiration risk, which penetration aspiration scale (PAS) scores were 6 to 8, were noted in three groups on the VFSS (47.5% in CL, 59.3% in SCL, and 47.9% in BCL). 79.2 % of patients were needed to change their feeding methods after VFSS and patients who could have a normal regular diet (NRD) was only 20.8%. 64.4 % of patients were needed to change their feeding methods after VFSS. Among them, 37.4% of patients should restrict the control of their feeding methods due to aspiration risk. Aspiration pneumonia was observed in 12 patients (7.4%) after VFSS during 3 weeks.
Conclusion
Early VFSS for acute stroke patients provides a more proper feeding method and helps to manage dysphagia effectively
Keywords
early VFSS, acute stroke, dysphagia
#140 EFFECT OF EXTRACORPOREAL SHOCK WAVE THERAPY ON DIFFERENT SITES ON PLANTAR FASCIITIS
jong hwa lee, seong uk hwang
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EFFECT OF EXTRACORPOREAL SHOCK WAVE THERAPY ON DIFFERENT SITES ON PLANTAR FASCIITIS
Background and Aims
We tried to compare the effect of applying Extracorporeal Shock Wave Therapy (ESWT) alone to the tendon insertion area on calcaneal tuberosity and together to the tender point along aponeurosis including tendon insertion site on plantar fasciitis (PF).
Methods
Plantar fascia thickness over 4 mm in calcaneal insertion area by ultrasound was diagnosed as PF. ESWT applied for 3 weeks, 1 session per week, total 2,000 shots, frequency 10, and energy level of 0.025mJ/mm2. In study group, ESWT was applied 1,000 shots for calcaneal tendon insertion area and tender points along plantar fascia each. In control group, 2,000 shots for tendon insertion site only. Before and after the 3 sessions, VAS of pain at rest, at night, at pressure, at weight bearing, at first step at morning, and American Orthopedic Foot and Ankle society (AOFAS) scale were measured.
Results
Total 24 patients were recruited in the study. VAS of pain in weight bearing showed significant improvement only in study group. When compared the changes of measurement between the groups, VAS of pain in weight bearing and first step in the morning showed better outcome in study group.
Conclusion
Applying ESWT both on tender point and tendon insertion area on calcaneal tuberosity could be more useful for PF patients than applying ESWT on calcaneal tuberosity only.
Keywords
ESWT, plantar fasciitis, different sites
#141 PREVALENCE ESTIMATIONS OF THE COMORBIDITY OF ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (ADHD) AND DEVELOPMENTAL CO-ORDINATION DISORDER (DCD), IN CHILDREN AGED 8 TO 9.
Pamela M.T Dawson
Conference topic: Children rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
PREVALENCE ESTIMATIONS OF THE COMORBIDITY OF ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (ADHD) AND DEVELOPMENTAL CO-ORDINATION DISORDER (DCD), IN CHILDREN AGED 8 TO 9.
Background and Aims
Children diagnosed with ADHD often encounter motor co-ordination difficulties. Little is known about the extent of these and thus motor difficulties are often left untreated. The deficit in management of these is what gave this study impetus. Aims: The purpose of the study was to establish the prevalence and demographics of comorbid ADHD and DCD, in children aged 8 to 9. By demonstrating the extent of the comorbidity, a more holistic approach to management could be investigated and subsequently provided.
Methods
Clinical experience indicated that children often had symptoms of ADHD and DCD, in comorbidity. A cross-sectional, observational study was undertaken on 151 children, aged 8 to 9 years, in South Africa. Children were clinically diagnosed with ADHD, by educational psychologists/physicians/psychiatrists. The diagnosis of ADHD was confirmed with a teacher-rated Conners' score (Inattention/Impulsivity/Hyperactivity). The DCD diagnosis was made clinically then confirmed with a parent-rated DCD Questionnaire (DCDQ) and a therapist-administered Movement assessment Battery for Children (MABC) version 2. The prevalence percentage of comorbidity was calculated and the demographics of the comorbid population were presented.
Results
A 74% prevalence of comorbidity was identified, with a male to female ratio of 2:1. The combined type of ADHD was most commonly associated with comorbid DCD.
Conclusion
The relatively high prevalence figure, shows that there is association between ADHD and DCD. Thus, children with ADHD should always be assessed for motor skill deficiencies and offered the appropriate intervention/s. Clinical significance of this study: This will pioneer a more holistic approach to assessment and management of ADHD and DCD, in comorbidity.
Keywords
ADHD;, DCD;, Comorbidity.
#142 RECOGNIZING EARLY SIGNS OF FIBRODYSPLASIA OSSIFICANS PROGRESSIVA IN INFANCY: A CASE REPORT
Sofia Martins Azevedo, Ana Isabel Romeiro, Diana Oliveira, David Moura, Manuel Coutinho Fernandes, Filipe Mendes, Catarina Aguiar Branco
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
RECOGNIZING EARLY SIGNS OF FIBRODYSPLASIA OSSIFICANS PROGRESSIVA IN INFANCY: A CASE REPORT
Background
Fibrodysplasia ossificans progressiva (FOP) is an ultrarare, autosomal dominant disease characterized by congenital malformations of the great toes and progressive heterotopic ossification of the connective tissues. It has a prevalence of approximately 1 in 2 million individuals. As the disease progresses, patients experience increasing limitations in mobility, which in turn compromises thoracic cavity expansion, affecting both pulmonary and cardiac function. To date, around 800 cases have been reported worldwide, however, nearly 90% of patients are initially misdiagnosed. Clinical examination, radiological imaging, and genetic testing for mutations in the ACVR1 gene are critical for early and accurate diagnosis.
Case report
We present a case of a one-month-old infact referred to a Physical and Rehabilitation Medicine consultation due to congenital bilateral hallux valgus associated with microdactyly and bilateral thumb adduction. Clinical examination revealed bilateral symmetrical bilateral hallux valgus with microdactyly of the great toes, adducted thumbs and clinodactyly of both fifth fingers. Foot radiographs demonstrated malformation of the first metatarsal bilaterally. Physical rehabilitation was initiated with the goals of functional improvement and correction of hand deformities. At four-months-old, the appearance of multiple hard bony swellings over the cranial vault raised suspicion of FOP, which was subsequently confirmed by genetic testing revealing a mutation of the ACVR1 gene.
Conclusion
FOP is a rare and highly disabling musculoskeletal condition for which no curative or progression-halting treatment currently exists. Misdiagnosis can lead to unnecessary and potentially harmful interventions. The presence of congenital hallux valgus with microdactyly and malformation of great toe in a child, particularly when associated with other skeletal anomalies, should prompt early consideration of FOP, even before the developmental of soft tissue lesions. Prevention of injury by all means, medical management of acute painful flare-ups and rehabilitation efforts should be the goal in the care strategy of individuals with FOP.
Keywords
Fibrodysplasia Ossificans Progressiva, Rehabilitation, Children
#143 SPASMUS NUTANS AND TORTICOLLIS: THE ROLE OF MULTIDISCIPLINARY EVALUATION IN EARLY CHILDHOOD DIAGNOSIS AND MANAGEMENT
Sofia Martins Azevedo, Ana Isabel Romeiro, Diana Oliveira, David Moura, Manuel Coutinho Fernandes, Filipe Mendes, Catarina Aguiar Branco
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SPASMUS NUTANS AND TORTICOLLIS: THE ROLE OF MULTIDISCIPLINARY EVALUATION IN EARLY CHILDHOOD DIAGNOSIS AND MANAGEMENT
Background
Congenital muscular torticollis is the most common form of congenital torticollis, but acquired causes must be considered, especially after 6-month-old. Spasmus Nutans (SN) is an acquired nystagmus affecting children under two years old, characterized by asymmetric, pendular nystagmus, head nodding, and torticollis. Its cause remains unknown, but it is usually not associated to neurological disorders.
Case report
A 4-month-old child with no relevant medical history was referred to the Physical and Rehabilitation Medicine (PRM) department for right equinovarus foot evaluation. Examination revealed a right flexible, reducible equinovarus foot and bilateral convergent strabismus. Cervical examination was normal, and developmental milestones were appropriate for age. Transfontanellar ultrasound showed no abnormalities. Ophthalmology confirmed congenital strabismus and initiated daily alternating eye patching for six hours. Ultrasound revealed no abnormalities. At 7-months-old parents noticed a new right-sided cervical tilt, sometimes with neck flexion and extension movements. Examination showed convergent strabismus, nystagmus, right cervical tilt, and intermittent head nodding. Cranial, cervical, and neck MRI were normal. A multidisciplinary discussion involving PMR, Neonatology and Ophthalmology was conducted, and the diagnosis of SN and strabismus was made. Child was treated with ocular botulinum toxin. At 22-months-old, examination showed right eye unchanged, left eye with slightly limited adduction, no nystagmus or right cervical tilt. Follow up was scheduled in two months.
Conclusion
SN is an idiopathic disorder in which head nodding suppresses nystagmus through the vestibular-ocular reflex and aids vision. Diagnosis relies on excluding neurological and ophthalmological diseases and treatment is mainly supportive including strabismus, amblyopia and refractive errors correction. It is usually a limited condition with good prognosis. PMR is key in child developmental evaluation, with each appointment addressing both the primary condition and overall neurodevelopment. This case highlights significance of comprehensive assessment, early diagnosis, and the importance of a multidisciplinary team in promoting motor recovery and quality of life.
Keywords
Spasmus Nutens, Torticollis, Rehabilitation, Children
#144 CRICOPHARYNGEAL DYSFUNCTION AND UPPER ESOPHAGEAL SPHINCTER HYPERTONIA: CHALLENGES IN REHABILITATION AFTER TRAUMATIC BRAIN INJURY
Sofia Martins Azevedo, Ana Isabel Romeiro, Diana Oliveira, David Moura, Manuel Coutinho Fernandes, Filipe Mendes, Catarina Aguiar Branco
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CRICOPHARYNGEAL DYSFUNCTION AND UPPER ESOPHAGEAL SPHINCTER HYPERTONIA: CHALLENGES IN REHABILITATION AFTER TRAUMATIC BRAIN INJURY
Background
The cricopharyngeal muscle, part of the upper esophageal sphincter (UES), relaxes during swallowing and contracts to prevent reflux. Cricopharyngeal dysfunction (CPD) disrupts this, causing food entering the laryngeal vestibule. Symptoms include dysphagia, globus sensation, and vocal changes. CPD can result from traumatic brain injury (TBI). Treatment options include speech therapy (ST), UES surgery, botulinum toxin injections, or alternative feeding if needed.
Case report
62-year-old man with history of TBI and percutaneous endoscopic gastrostomy (PEG) due to severe dysphagia, was referred to a PMR/Dysphagia appointment. Still PEG-fed, he was trialing pureed solids and honey-thickened liquids, reporting coughing, vocal changes, and choking during meals. Examination showed midline tongue protrusion, preserved oromotor function, reduced tongue strength, and symmetrical soft palate elevation with normal gag and palatal reflexes. Hyolaryngeal elevation and sustainment were reduced. Videofluoroscopic Swallow Study (VFSS) showed significant oral residue (cavity, tongue base and valleculae), with poor clearance in the oral phase; incomplete epiglottic movement, severely reduced hyolaryngeal elevation and pharyngeal residue noted throughout. Clearance was ineffective despite compensatory maneuvers, with absent UES relaxation; only minimal residual food entered the esophagus. Full PEG feeding and continued ST were recommended. Six months later, he independently discontinued PEG and transitioned to oral feeding with moistened solids and thin liquids (TL). Tongue strength improved; hyolaryngeal elevation was preserved, although sustainment remained reduced. Second VFSS showed improved epiglottic movement, hyolaryngeal elevation, and UES relaxation. Textures below IDDSI Level 3 and clearance maneuvers were recommended. He continues ST and oral feeding, requiring volume/texture adjustments and maneuvers, without complications.
Conclusion
CPD from UES hypertonia can be life-threatening. Hyolaryngeal distraction and tongue base propulsion aid compensation, but when compromised, UES opening is impaired. PMR and ST improved UES relaxation, allowing safer oral feeding. The patient awaits otorhinolaryngology intervention with botulinum toxin, as ~50% of ingested volume remains above the UES.
Keywords
Cricopharyngeal dysfunction, Rehabilitation
#145 APPLICATION RESEARCH OF MICROWAVE THERAPY FOR SUDDEN DEAFNESS PATIENTS BASED ON 5A NURSING MODE
Chunmei Song
Conference topic: Other topic
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
APPLICATION RESEARCH OF MICROWAVE THERAPY FOR SUDDEN DEAFNESS PATIENTS BASED ON 5A NURSING MODE
Background and Aims
To explore the application effect of ear microwave therapy based on the 5A nursing model (evaluation Assess, suggestion Advice, consensus Agree, assist Assist, follow-up Range) in patients with sudden deafness.
Methods
A randomized controlled design was used to select 120 SSNHL patients admitted from January 2024 to December 2024, who were randomly divided into an intervention group (n=60) and a control group (n=60). Both groups received ear microwave therapy, with the intervention group receiving personalized intervention based on the 5A nursing model, and the control group receiving routine care. Compare the hearing recovery effect (pure tone hearing threshold measurement), treatment compliance, anxiety and depression score (HADS score), and quality of life (SF-36) between two groups of patients.
Results
The improvement of pure tone hearing threshold in the intervention group was significantly better than that in the control group after treatment (P<0.05), and the total effective rate of treatment (88.3%) was higher than that in the control group (71.7%) (P<0.05). The treatment compliance score of the intervention group was significantly higher than that of the control group (P<0.05), and the HADS score and SF-36 score were significantly improved compared to the control group (P<0.05).
Conclusion
Ear microwave therapy based on 5A nursing mode can effectively promote hearing recovery, improve treatment compliance, alleviate negative emotions, and improve quality of life in patients with sudden deafness.
Keywords
Sudden deafness, 5A nursing mode.
#146 THE IMPORTANCE OF POSTOPERATIVE REHABILITATION IN FUNCTIONAL RECOVERY IN TOTAL ELBOW ARTHROPLASTY DUE TO SUPRAINTERCONDYLAR FRACTURE OF THE HUMERUS
Carlos Gama, Cláudia Silva, José Marques, Filipe Mendes, Manuel Fernandes, Ana Romeiro, Ana Azevedo, Jorge Moreira, Catarina Branco
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
THE IMPORTANCE OF POSTOPERATIVE REHABILITATION IN FUNCTIONAL RECOVERY IN TOTAL ELBOW ARTHROPLASTY DUE TO SUPRAINTERCONDYLAR FRACTURE OF THE HUMERUS
Background
Supraintercondylar fractures of the humerus are common in children but rare in adults, accounting for approximately 2% of all adult fractures and about one-third of distal humeral fractures. When there is significant articular involvement, total elbow arthroplasty may be indicated. In young adults, these fractures are typically caused by high-energy direct trauma to the olecranon, whereas in the elderly, they usually result from indirect hyperextension mechanisms
Case report
We present a 74-year-old female who sustained a supraintercondylar fracture of the left humerus following a fall from standing height. Clinical findings included pain, swelling, and deformity of the left elbow, with no neurovascular deficits and preserved distal mobility. The patient underwent a cemented total elbow arthroplasty (LIMA prosthesis). At one-month post-surgery, the patient had 100º of elbow flexion with a 20º extension deficit. After participating in an intensive rehabilitation program three times per week, her range of motion improved significantly. After five months, she achieved 138º of flexion and full extension (0º). Grip strength measured by dynamometer was 18 kg in the left hand and 23 kg in the right. Quick DASH score improved greatly from 93.25 to 4.5 after the rehabilitation program.
Conclusion
This case highlights the importance of a structured and intensive postoperative rehabilitation program in the functional recovery of elderly patients undergoing total elbow arthroplasty for distal humerus fractures with joint involvement. The rehabilitation regimen played a crucial role in restoring range of motion and grip strength, ultimately contributing to the functional reestablishment of the affected limb. The combination of appropriate surgical management and physiatric prescription of an appropriate rehabilitation program proved essential for achieving a favorable outcome
Keywords
total, elbow, arthroplasty, postoperative, rehabilitation
#147 DOES RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY REDUCES POST STROKE HAND SPASTICITY?
Cvetanka Gjerakaroska Savevska, Erieta Nikolikj Dimitrova, Valentina Koevska, Biljana Mitrevska, Marija Gocevska, Biljana Kalcovska, Maja Manoleva, Daniela Gecevska
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
DOES RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY REDUCES POST STROKE HAND SPASTICITY?
Background and Aims
Hand spasticity after a stroke decreases residual hand functions and independence of every day activities. It is associated with pain, contractures and high level of disability. Radial extracorporeal shock wave therapy (RESWT) is an enticing treatment option for focal spasticity. The main goal of this clinical study was to evaluate the effects of RESWT on the hand spasticity after stroke. Afterwards to assessed the efficiency of RESWT in motor and functional recovery of a spastic hand poststroke.
Methods
This controlled clinical trial included 90 patients with spastic hand post stroke, assigned in to examined group (EG) and control group (CG). The EG received RESWT and standard rehabilitation treatment and the CG received only a standard rehabilitation treatment. For evaluation of treatment efficacy were used: Modified Ashworth Scale (MAS), Disability Assessment Scale (DAS) and the subscore for motor recovery of the Fugl–Meyer assessment for upper extremity. The clinical findings were evaluated at the same time points for both groups: before the start of the rehabilitation, immediately after the end of the 2nd, 6th and 14th week from the start of the rehabilitation.
Results
In the EG the results indicated a significantly lower MAS score for more than one average score (<0.05). Analysis of the results in the EG for DAS domains showed a significant disability reduction in maintaining hand hygiene, dressing, limb position abnormality and pain due to spasticity in all control measurements. The RESWT resulted in significantly better hand motor control in all three control measurements in the EG.
Conclusion
Study results showed that RESWT reduced hand spasticity after stroke. This treatment resulted in reduced disability leading to better quality of life in this patients. Given that no side effects were observed it remains that RESWT is a safe, non-invasive treatment for spastic hand after a stroke.
Keywords
spasticity, radial, extracorporeal, shock, wave
#148 THE DESIGN AND CONSENSUS OF A MOTOR INTERVENTION FOR USE IN MANAGEMENT OF COMORBID ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (ADHD) AND DEVELOPMENTAL CO-ORDINATION DISORDER (DCD).
Pamela M.T Dawson
Conference topic: Children rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
THE DESIGN AND CONSENSUS OF A MOTOR INTERVENTION FOR USE IN MANAGEMENT OF COMORBID ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (ADHD) AND DEVELOPMENTAL CO-ORDINATION DISORDER (DCD).
Background and Aims
ADHD is a common neurobehavioral disorder. Studies have revealed that children with ADHD, frequently experience motor co-ordination difficulties. ADHD is conventionally treated with neuro-pharmacological medication and psychotherapy. The influence of this management on the motor symptoms, has not yet been established. Several studies have investigated the management of comorbid ADHD and DCD, using a combination of various neuro-motor treatments with the conventional treatment of ADHD. However, a gold standard treatment for the management of comorbid ADHD and DCD , does not exist at present. Physical exercises have significant somatic, cognitive, educational and behavioural benefits. Facts presented above have been the motivation to design the exercise intervention, discussed in this study. Aim of study: To design and obtain consensus on a motor intervention that addresses both motor and cognitive symptoms of comorbid ADHD and DCD.
Methods
A motor intervention was designed, based on 5 conceptual frameworks, the literature and clinical experience. This was validated by a 3-phase, modified Delphi process (Using Likert scales and polar questions), by several experts in the neuro-paediatric field.
Results
Consensus on structure and content of the motor intervention was achieved. A well-designed, well-illustrated (content, structure, frequency, duration, repetitions and equipment needed) motor intervention was the result.
Conclusion
A motor intervention is presented, which is innovative, in the management of symptoms of comorbid ADHD and DCD.
Keywords
ADHD; DCD; Comorbidity; Motor Intervention.
#149 HAMSTRING FLEXIBILITY AND ITS ROLE IN STRENGTH GENERATION AND POSTURAL ALIGNMENT
Ramzi Alajam
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Health professionals (Physiotherapist
Type of abstract: Scientific abstract
Abstract
Title
HAMSTRING FLEXIBILITY AND ITS ROLE IN STRENGTH GENERATION AND POSTURAL ALIGNMENT
Background and Aims
Hamstring muscle inflexibility might negatively impact the concentric strength of the hamstring and quadriceps muscles. Additionally, it may contribute to posterior pelvic tilt, which can affect spinal alignment and potentially exacerbate forward head posture. Therefore, this study aimed to evaluate the relationship of hamstring muscle flexibility with the strength of hamstring and quadriceps muscles and forward head posture.
Methods
A cross-sectional study was conducted at the Faculty of Nursing and Health Sciences, Jazan University, involving 64 healthy male students. Hamstring flexibility of the dominant and non-dominant legs was assessed using the Active Knee Extension Test (AKET). The concentric strength of the hamstring and quadriceps muscles in the dominant leg was evaluated using an isokinetic dynamometer. Forward head posture (FHP) was measured by assessing the craniovertebral angle with a goniometer.
Results
The hamstring flexibility of the dominant leg, as determined by the AKET, was significantly correlated with the concentric strength of the hamstring (r = -0.398, p = 0.001) and quadriceps muscles (r = -0.416, p < 0.001). A significant correlation was also found between FHD and the AKET of the dominant leg (r = -0.523, p < 0.001) and between FHD and the AKET of the non-dominant leg (r = -0.576, p < 0.001).
Conclusion
The findings of this study underscore the significance of hamstring flexibility in generating leg muscle strength and maintaining proper head postural alignment. Future research should prioritize the development of interventions to enhance hamstring flexibility and evaluate their impact on overall musculoskeletal health.
Keywords
flexibility, Hamstring, quadriceps, head, posture
#150 REHABILITATION OF ACHILLIS TENDON AFTER SURGICAL MANAGEMENT WITH ALLOGRAFT DONOR TENDON TRANSFER – CASE REPORT
Maja Manoleva, Elena Spasevski
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
REHABILITATION OF ACHILLIS TENDON AFTER SURGICAL MANAGEMENT WITH ALLOGRAFT DONOR TENDON TRANSFER – CASE REPORT
Background
Background and aim Chronic Achilles tendon rupture is defined as a rupture diagnosed or treated more than six weeks post-injury. Tendon grafting and transfer techniques are often required in such cases to restore function. This case report presents the rehabilitation outcomes of a patient with a chronic Achilles tendon rupture treated with allograft donor tendon transfer, marking the first such procedure performed in North Macedonia.
Case report
Methods: A female patient with persistent posterior ankle pain, swelling, and functional limitation had unsuccessful conservative treatment with NSAIDs. Imaging and clinical evaluation confirmed a chronic rupture of the left Achillis tendon. Surgical reconstruction was performed using a donor tendon graft. Rehabilitation program for restoring mobility and enhancing muscle strength was provided with two separate inpatient stays. Rehabilitation protocol included electrotherapy with diadynamic currents, ultrasound therapy, magnetic therapy, exercise therapy including walking on parallel bars and also occupational therapy. Results: Over a two rehabilitation treatments the patient demonstrated improvement in ankle dorsal and plantar flexion, gain of thigh muscle mass, and reduced pain in the affected leg. By the end of therapy the patient achieved independent walking and functional recovery of the affected limb.
Conclusion
Conclusion: Rehabilitation of Achillis tendon after allograft donor tendon transfer is crucial for restoring function and achieving optimal outcomes in tendon injuries.
Keywords
tendon rupture, alograft, rehabilitation
#151 EFFECTS OF A MULTIMODAL THERAPY PROGRAM (MTP) INCLUDING RADONTHERMAL THERAPY (RTT) ON BASDAI SCORES AND PAIN IN INPATIENTS WITH ANKYLOSING SPONDYLITIS (AS)
Carla Coric1, Patrick Ebeling1, Bibiane Steinecker-Frohnwieser2, Anna Günther3, Aleksandra Gvozdenovic-Opacic1, Martin Offenbächer1, Renata Cop1
2 Ludwig Boltzmann Institut, Saalfelden, Austria
3 Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EFFECTS OF A MULTIMODAL THERAPY PROGRAM (MTP) INCLUDING RADONTHERMAL THERAPY (RTT) ON BASDAI SCORES AND PAIN IN INPATIENTS WITH ANKYLOSING SPONDYLITIS (AS)
Background and Aims
AS is a chronic inflammatory disease of insidious onset, mostly affecting the axial skeleton. It leads to varying degrees of restricted spinal mobility, pain and loss of functional capacity. Although there is a wide range of medications, including biologics, rehabilitation plays an important role in the treatment. Various MTPs are available for the management of individuals with AS. These programs can also include balneotherapy. In the Gastein valley RTT in the Gastein healing gallery (GHG) and radon baths (RBs) are administered, because of known positive analgesic and anti-inflammatory effects of RTT.
Methods
The aim of this study was to evaluate the effectiveness of a specific MTP: 3 weeks physical therapy (active und passive) combined with 5 RBs (0.3-3 kBq/l; 25 minutes bathing time) and 10 sessions in the GHG (radon content 30-160 kBq/m3; 1 hour). We recorded the BASDAI index and VAS scores for pain at the beginning (T0) and at the end of the program (T1).
Results
70 inpatients (mean age 54.8; 58% males) with AS treated in Klinikum Bad Gastein between January and April 2025 were assessed. 65.7% of the patients took NSAIDs and 51.4% biologics. The mean BASDAI scores were at T0 4.49 and at T1 2.56, respectively. Mean VAS pain scores were at T0 6.41 and at T1 2.87. The reduction in both BASDAI and VAS pain scores were significant (p<0.05). We also found a reduction in other symptoms and a clinical improvement in general.
Conclusion
This study demonstrated significant and clinical relevant reductions in disease activity and in pain in inpatients with AS, who underwent a MTP including RBs and sessions in the GHG. From our point of view a MTP with RTT is an important part in the management of AS in addition to medical treatment.
Keywords
Ankylosing Spondylitis, BASDAI, Rehabilitation, Radon
#152 NON-OPERATIVE TREATMENT AS AN OPTION IN CASE OF COMPLETE RUPTURE OF THE RADIAL COLLATERAL LIGAMENT OF THE THUMB
Damir Mišura, Marcela Romić, Iva Sesar-Cirković, Sanda Dubravčić-Šimunjak
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
NON-OPERATIVE TREATMENT AS AN OPTION IN CASE OF COMPLETE RUPTURE OF THE RADIAL COLLATERAL LIGAMENT OF THE THUMB
Background
We are presenting a case of a twenty-eight-year-old patient, a surgeon by profession, with trauma of the thumb and rupture of the radial collateral ligament of the I MCP joint.
Case report
While performing physical activity (football), our patient received a moderately strong blow to the thumb of the right hand but couldn't recall the exact mechanism of injury. Shortly after, pain, haematoma and mild joint swelling had started to develop. He was examined by a surgeon, and standard imaging was done - RTG, which showed no abnormality, and the diagnostic ultrasound, which was inconclusive. Rest, ice, NSAIDs and an immobilisation splint were prescribed. At this point the working diagnosis was an injury of the ulnar collateral ligament (skier’s thumb). Since the pain persisted, MR imaging was ordered which showed a complete rupture of the proximal attachment of the radial collateral ligament with retraction, as well as a minor partial rupture of the abductor pollicis brevis muscle. A hand surgeon specialist examined our patient and, taking into consideration the MR finding, concluded that since there were clinically no signs of instability of the MCP joint, conservative treatment is preferred. The patient was enrolled in a physical therapy program focusing on the mobility and strength exercises, but also passive procedures were included (such as HILT).
Conclusion
We would like to emphasise two important notes with this case. Firstly, although the pathology of the radial collateral ligament is rare and much less common than the UCL, we need to take it into consideration with injuries of the thumb. Also, for the correct diagnosis we often need targeted MR images. Secondly, while the available literature states that a complete rupture requires surgical treatment, in some cases conservative treatment is possible.
Keywords
Thumb, injury, RCL, UCL, ligament
#153 THE EFFECT OF CONVENTIONAL PHYSICAL THERAPY IN REDUCING PAIN IN PATIENTS WITH CALCIFIC ROTATOR CUFF TENDINITIS OF THE SHOULDER
Maja Manoleva1, Erieta Nikolic Dimitrova1, Biljana Mitrevska1, Valentina Koevska1, Marija Gocevska1, Cvetanka Gjerakaroska Savevska1, Biljana Kalcovska1, Daniela Gechevska1, Liljana Malinovska Nikolovska2
2 Acibadem Sistina Clinical Hospital, Dept. of Pediatric Cardiac Surgery, Skopje, North Macedonia, Macedonia
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE EFFECT OF CONVENTIONAL PHYSICAL THERAPY IN REDUCING PAIN IN PATIENTS WITH CALCIFIC ROTATOR CUFF TENDINITIS OF THE SHOULDER
Background and Aims
Calcific tendinitis of the shoulder rotator cuff is a common disorder of commonly treated with physical treatment modalities. The objective of thе clinical study is to evaluate the effect of conventional physical therapy in reducing the pain in patients with calcific tendinitis of the shoulder rotator cuff.
Methods
The research was a prospective, monocentric clinical study that included 40 patients who received conventional physical treatment, ultrasound therapy with an intensity of 0.5 W on an area of 1 cm², for 5 min, and diadynamic currents, for a duration of 3 weeks, every working day, namely 15 treatments of therapeutic ultrasound and 10 treatments of diadynamic currents and shoulder exercises. The efficacy of the treatment was evaluated using the Visual Analogue Scale (VAS) and Constant Murley Score. The patients were evaluated at the same time in four time points: before starting physical therapy, immediately after the end of the therapy, after the third and the sixth month after starting physical therapy.
Results
All patients after the treatment had statistically significantly better results in the pain score and Constant Murley score, which were maintained even 6 months after the end of conventional physical therapy.
Conclusion
Conventional physical therapy is a safe and noninvasive treatment in patients with calcific tendinitis of the shoulder rotator cuff that reduces the pain and improves quality of life.
Keywords
Calcific tendinitis, shoulder, physical therapy
#155 INTERVAL TRAINING IN PATIENTS WITH PARKINSONS DISEASE
Teodora Talić, Olivera Pilipović Spasojević
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
INTERVAL TRAINING IN PATIENTS WITH PARKINSONS DISEASE
Background and Aims
Walking difficulties, characteristic of Parkinson's disease, gave us the goal to apply interval training on a treadmill as an additional exercise program and to compare it with the previous general exercise program, using appropriate standardized functional tests.
Methods
A prospective, experimental, double-blind study was conducted on a sample of 46 patients with an average age of 63.3±9.8 years. The participants were randomly selected and divided into two groups: an experimental group (EG) and a control group (CG). Over a 21-day rehabilitation period, both groups followed the same general kinesitherapy and occupational therapy program lasting a total of 80 minutes. The experimental group additionally participated in a treadmill program consisting of interval training, with 4 minutes of walking at maximum speed followed by 3 minutes of rest, repeated four times. At the beginning and end of the rehabilitation, standardized tests were used for assessment: the UPDRS, Tinetti Balance Scale, Timed Up&Go test, and the 10-meter walk test. The data were statistically analyzed using the chi-square and t-tests.
Results
A significant increase in velocity was observed in the experimental group (D velocity EG = 0.10 ± 0.19 and D velocity KG = 0.04 ± 0.11). UPDRS II, UPDRS III before and after treatment were significantly higher in the control group, but changes were almost identical in both groups, without significance (DUPDRS II p = 1.0 and DUPDRS III p = 0.65). Tinetti and 10m test were significantly higher in the experimental group before and after treatment, but no significance was observed between groups in terms of change (DTINETTI = 0.31 and D10m_test = 0.643). No significant differences were observed between the groups regarding UP&GO (DUP&GO = 0.439).
Conclusion
For a more valid results , it is necessary to include a more homogeneous and numerous sample and objective measurements of gait with a software program
Keywords
interval, training, treadmill, rehabilitation
#156 CLINICAL EFFECTS OF AN INTEGRATIVE CHINESE-WESTERN MEDICINE APPROACH BASED ON THE “LUNG-KIDNEY CO-TREATMENT” PRINCIPLE ON INFLAMMATORY STATUS AND PULMONARY FUNCTION RECOVERY IN PATIENTS WITH AECOPD
Zhensheng Xie
Conference topic: Cardiopulmonary rehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
CLINICAL EFFECTS OF AN INTEGRATIVE CHINESE-WESTERN MEDICINE APPROACH BASED ON THE “LUNG-KIDNEY CO-TREATMENT” PRINCIPLE ON INFLAMMATORY STATUS AND PULMONARY FUNCTION RECOVERY IN PATIENTS WITH AECOPD
Background and Aims
This study aimed to evaluate the clinical effectiveness of an integrative Chinese-Western medicine approach based on the “Lung-Kidney Co-Treatment” principle in improving inflammatory markers and pulmonary function in patients with AECOPD.
Methods
A retrospective cohort study was conducted involving patients with AECOPD admitted to the Affiliated Traditional Chinese Medicine Hospital of Chongqing Three Gorges Medical College between January 2023 and December 2024. Patients who received standard Western medical therapy were assigned to the control group(n=54), while those who received an additional Chinese herbal formula based on the “Lung-Kidney Co-Treatment” principle were included in the intervention group(n=66).
Results
Baseline characteristics between the two groups were comparable (P>0.05). At 7-14 days post-treatment, the intervention group showed significantly better outcomes than the control group in the following parameters: WBC(7.2 ± 1.6×109/L vs 8.4 ± 2.1×109/L), NEU%(62.1 ± 8.5% vs 68.3 ± 9.3%), CRP(6.5 ± 2.8 mg/L vs 9.8 ± 3.4 mg/L), PCT(0.10 ± 0.05 ng/mL vs 0.15 ± 0.07 ng/mL), IL-6(10.2 ± 3.9 pg/mL vs 15.1 ± 5.2 pg/mL), TNF-α(10.6 ± 3.6 pg/mL vs 14.2 ± 4.8 pg/mL), FEV1/FVC(53.5 ± 8.3 vs 48.6 ± 7.5), and FEV1% pred (64.5 ± 10.2% vs 46.7 ± 8.4%) (all P<0.05). The 6-month hospital readmission rate was also significantly lower in the intervention group [9.1%(6/66) vs 24.1%(13/54), P<0.05]. Multivariate logistic regression identified the integrative treatment as an independent protective factor against readmission within 6 months[OR=0.32(95%CI,0.12-0.86), P =0.03].
Conclusion
The integrative Chinese-Western medicine approach based on the “Lung-Kidney Co-Treatment” principle was effective and feasible for AECOPD and reduced the 6-month readmission risk.
Keywords
AECOPD, lung-kidney co-treatment, risk factors.
#157 A COMPARATIVE ISOKINETIC EVALUATION POST HIIT TRAINING: STEMI PATIENTS VS. HEALTHY COUNTERPARTS
Vedrana Mužić Radović, Sandra Rusac-Kukić, Smiljana Šupak, Vedrana Mužić Radović, Barbara Ravnić Marušić, Matija Brentin, Kristina Skroče, Viktor Peršić, Dijana Travica Samsa
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
A COMPARATIVE ISOKINETIC EVALUATION POST HIIT TRAINING: STEMI PATIENTS VS. HEALTHY COUNTERPARTS
Background and Aims
High-intensity interval training (HIIT) is recognized for improving cardiorespiratory fitness. However, its effects on muscular strength, in-STEMI patients are less understood. This study investigated the impact of a 12-week HIIT program on aerobic capacity and isokinetic muscle strength in post-STEMI patients and healthy controls, respectively.
Methods
A total of 32 participants (16 post-STEMI patients, 16 age-matched healthy controls) completed a supervised 12-week HIIT protocol (3 sessions including 4x4 min at 85-95% of HRmax/week). Pre- and post-intervention assessments included a cardiopulmonary exercise test (CPET) to determine VO₂max and isokinetic dynamometry to evaluate peak torque of the quadriceps and hamstrings at 60°/s and 240°/s angular velocities. No resistance training was included in the intervention. Paired t-tests and Wilcoxon signed-rank test valuated pre- to post-intervention changes, while independent t-tests as well as Wilcoxon rank-sum test assessed group differences. P < 0.05 was set for statistical significance.
Results
CPET testing showed significant improvements for both groups from baseline (+32%, p<0.001 and +34%, p<0.001 for MI and CTRL, respectively). Significant improvements were found in extension peak torque at 60°/s (PRE: 86.36±28.1 Nm; POST: 89.82±29.3 Nm; p = 0.035) and extension torque relative to body weight (p = 0.050). Flexion torques and deficits did not change significantly. Group comparison revealed no statistically significant differences between MI and CTRL groups for other parameters. Deficit trends remained stable post-intervention.
Conclusion
Both STEMI patients and healthy individuals showed significant improvements in VO₂max following the HIIT intervention. Notably, both groups also demonstrated marked increases in peak torque at both isokinetic velocities, despite the absence of dedicated strength training. These findings suggest that HIIT may confer neuromuscular adaptations contributing to increased dynamic strength, highlighting its potential as a dual-benefit modality for improving both cardiovascular and muscular function in clinical and healthy populations.
Keywords
HIIT, STEMI, isokinetic dynamometry, exercise
#158 NON-INVASIVE MODALITIES FOR CHRONIC LOW BACK PAIN: HILT VS. ULTRASOUND THERAPY OUTCOMES
Marija Gocevska, Biljana Kalchovska, Maja Manoleva, Cvetanka Gjerakaroska Savevska, Valentina Koevska, Biljana Mitrevska, Daniela Gechevska, Erieta Nikolikj Dimitrova
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
NON-INVASIVE MODALITIES FOR CHRONIC LOW BACK PAIN: HILT VS. ULTRASOUND THERAPY OUTCOMES
Background and Aims
Chronic low back pain (CLBP), persisting for more than 12 weeks, is a prevalent condition associated with pain, muscle weakness, restricted lumbar mobility, functional limitations, and psychosocial distress. Among the non-invasive physical modalities, high-intensity laser therapy (HILT) has recently emerged as a promising intervention due to its deep tissue penetration and analgesic properties. Ultrasound therapy remains a commonly utilized standard modality.The aim of this study was to examine the effectiveness of HILT in patients with chronic low back pain. The principal aim was to compare the effects of both physical modalities, therapy with high-intensity laser versus ultrasound therapy, and to point out the eventual differences in the analgesic effect and the range of lumbar spine motion.
Methods
This prospective, monocentric, controlled clinical study aimed to evaluate and compare the therapeutic efficacy of HILT versus ultrasound therapy in patients with CLBP. A total of 140 patients were randomized into two groups: the experimental group (HILT with therapeutic exercises) and the control group (ultrasound therapy with exercises). Outcome measures included the Numeric Pain Rating Scale, Oswestry Disability Index, Schober’s test, and the Beck Depression Inventory, assessed at baseline, post-treatment, and at 3- and 6-month follow-ups.
Results
The results demonstrated a statistically significant reduction in pain intensity, improvement in lumbar spine mobility, and decreased disability in the HILT group compared to the control group across all time points. Moreover, the HILT group showed greater improvement in psychological well-being, as reflected in significantly lower BDI scores at follow-ups.
Conclusion
HILT combined with therapeutic exercise appears to be a safe, effective, and sustainable treatment option for CLBP. It provides superior clinical outcomes in terms of pain relief, functional recovery, and reduction of depressive symptoms when compared to conventional ultrasound therapy.
Keywords
low, back, pain, physical, therapy
#159 A QUASI-EXPERIMENTAL STUDY TESTING THE EFFICACY OF A MOTOR INTERVENTION, ON MANAGEMENT OF COMORBID ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (ADHD) AND DEVELOPMENTAL CO-ORDINATION DISORDER (DCD).
Pamela M.T Dawson
Conference topic: Children rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
A QUASI-EXPERIMENTAL STUDY TESTING THE EFFICACY OF A MOTOR INTERVENTION, ON MANAGEMENT OF COMORBID ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (ADHD) AND DEVELOPMENTAL CO-ORDINATION DISORDER (DCD).
Background and Aims
Children diagnosed with ADHD commonly encounter motor difficulties. Conventional management is with neuro-pharmacological medication plus psychotherapy. The effect of this management, on motor symptoms, has not yet been established. Physical exercises have significant somatic and cognitive benefits. Aim: The purpose of this study was to test the efficacy of a motor intervention, on the management of of comorbid ADHD and DCD, with a view to providing more holistic management.
Methods
Children, aged 8 to 9 years, recruited in South Africa, diagnosed with ADHD; were allocated to one of four intervention groups: A: Neuro-pharmacological medication. B: Motor intervention. C: Medication plus Motor intervention. D: Control. A teacher-generated Conners' ADHD score, a parent-rated DCD Questionnaire (DCDQ)and a therapist-administered Movement Assessment Battery for Children (MABC) version 2, were completed pre and post-intervention. The motor intervention, which consisted of motor co-ordination, balance, posture, motor planning and executive function exercises; was administered to participants, weekly, for eight weeks. Pre and post intervention scores, were analysed using the Wilcoxon Signed Ranked Test.
Results
The group receiving Medication plus Motor intervention, showed the greatest improvement, followed by the Motor intervention group. The Medication only and Control groups showed little or no improvement.
Conclusion
Medication plus Motor intervention is most effective in reducing symptoms of of co-morbid ADHD and DCD. Motor intervention should thus be included as an integral part of a holistic management of comorbid ADHD and DCD. this is an innovative study, bringing a complementary form of management of comorbid ADHD and DCD. The motor intervention can also be used effectively where medication cannot be tolerated by the child due to serious side effects.
Keywords
ADHD;, DCD;, Comorbidity;, Motor, Intervention.
#160 PAIN AND DISABILITY IN UNIVERSITY STUDENTS WITH NON-SPECIFIC LOW BACK PAIN PARTICIPANTS IN A COMPREHENSIVE PHYSICAL THERAPY PROGRAM
Carolina Ramírez Ramírez, Maria Cristina Rodríguez
Conference topic: Pain treatment and rehabilitation
Occupation: Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
PAIN AND DISABILITY IN UNIVERSITY STUDENTS WITH NON-SPECIFIC LOW BACK PAIN PARTICIPANTS IN A COMPREHENSIVE PHYSICAL THERAPY PROGRAM
Background and Aims
Non-specific low back pain (NSLBP) is the most common musculoskeletal disorder among adults worldwide. Physical modalities, conventional exercise, lumbopelvic stabilization exercises, and education have individually shown benefits in treating this population. The aim of this work was to analyze the effect on pain and disability of a comprehensive physical therapy program for university students with NSLBP
Methods
Quasi-experimental study with university students referred to Physiotherapy due to NSLBP at the Industrial University of Santander (Colombia). Sociodemographic information, pain intensity (VAS) and disability (ODI) were recorded at the beginning and end of treatment, which consisted of: a) Physical modalities; b) Active range of motion exercises for spine and hip; c) Lumbopelvic stabilization exercises in three phases, 3 sets of 10 repetitions, or 3 sets of 30 seconds, depending on the exercise. d) Thoracolumbar and hip stretches for 10 minutes. e)Education on pain neuroscience and postural recommendations; f) Home exercise plan. Treatment was performed 2-3 times/week, for 6-8 weeks. All procedures were performed according to the Declaration of Helsinki and participants signed an informed consent. The data were analyzed using STATISTICA 13.3 software. Data normality was determined using Shapiro-Wilk, the paired t-Student test was applied, a p value <0.05 was established, the effect size was analyzed using Cohen's d.
Results
Twenty-four students, with 21.1±2.2 years old, 50% women and BMI<25, were included who performed 10±3 sessions. Pain intensity was significantly reduced (p<0.05), with an effect size of 1.9. Also, disability was significantly reduced (p < 0.05), with an effect size of 1.1 (Cohen's d).
Conclusion
Comprehensive physical therapy program for university students with NSLBP had a beneficial effect on pain intensity, and that was large enough to be clinically meaningful; as well as a significant reduction in disability, with a large effect size, were observed when performing 10±3 sessions, in a period of 6-8 weeks.
Keywords
pain, rehablitation, students
#162 FACTORS ASSOCIATED WITH FUNCTIONAL OUTCOME, LENGTH OF STAY, AND DISCHARGE DESTINATION IN PATIENTS WITH LOWER LIMB LOSS
Manoa KOUASSI, Doriane PELZER, Jean-François KAUX
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
FACTORS ASSOCIATED WITH FUNCTIONAL OUTCOME, LENGTH OF STAY, AND DISCHARGE DESTINATION IN PATIENTS WITH LOWER LIMB LOSS
Background and Aims
The aim of this study was to explore the associations between baseline patient characteristics (age, BMI, gender, etiology, amputation level, and time from amputation to rehabilitation entry) and three key rehabilitation outcomes in individuals with major lower limb amputation (LLA): functional level at discharge, length of stay (LOS), and discharge destination.
Methods
Medical records of 132 patients admitted to a rehabilitation center between January 2015 and December 2018 were retrospectively reviewed and analyzed.
Results
The median age at amputation was 66.0 years (IQR 57.8–73.0). Median BMI was 23.3 kg/m² (IQR 20.1–27.8), and 73.5% of patients were male. Dysvascular etiologies accounted for 76.7% of LLAs, with 40.2% related to diabetic vascular disease. Non-vascular causes represented 23.3% of cases, including traumatic (12.1%) and other etiologies (11.4%). Unilateral transtibial amputations were most common (49.2%), followed by unilateral transfemoral (41.7%), bilateral transtibial (7.6%), and mixed bilateral amputations (1.5%). The median time between amputation and rehabilitation admission was 17 days (IQR 12–31).
Conclusion
Significant associations were identified between baseline characteristics and rehabilitation outcomes. Younger age was associated with higher functional levels at discharge. Etiology was also significantly related to functional outcomes: patients with traumatic LLAs were more frequently classified into higher functional categories, whereas dysvascular LLAs were more represented in lower functional categories. Regarding discharge destination, younger patients were significantly more likely to return home, and etiology significantly influenced orientation at discharge. As for LOS, older patients and those with dysvascular LLAs, compared with non-vascular LLAs, had significantly longer rehabilitation stays. Finally, a longer interval between amputation and rehabilitation admission was significantly associated with a shorter length of stay. These findings provide insights into optimizing rehabilitation after major LLA, but larger-scale studies are needed to confirm these associations and guide individualized care.
Keywords
Rehabilitation, Amputation, Outcome assessment
#164 INFLUENCE OF OCCUPATIONAL GYMNASTICS ON MUSCULOSKELETAL SYMPTOMS AND QUALITY OF LIFE IN WORKERS AT A FOAM COMPANY
Cristina Mesquita1, Ana Costa2, Paula Santos1, Sofia Lopes1
2 Grupo Copo | Flexipol, Portugal
Conference topic: Other topic
Occupation: Health professionals (Physiotherapist
Type of abstract: Scientific abstract
Abstract
Title
INFLUENCE OF OCCUPATIONAL GYMNASTICS ON MUSCULOSKELETAL SYMPTOMS AND QUALITY OF LIFE IN WORKERS AT A FOAM COMPANY
Background and Aims
Workers are subject to high demands that can cause musculoskeletal symptoms and reduce their quality of life. Workplace Gymnastics (WG) emerges as a health promotion tool with benefits for physical, mental, economic, and social well-being. Aim: Evaluate the influence of workplace gymnastics on musculoskeletal symptoms and the quality of life of blue-collar and white-collar workers in a foam company, as well as quantify the pressure pain threshold.
Methods
Pre-experimental study with a sample of 92 workers, including blue-collar (n=68) and white-collar (n=24). A WG program was implemented, (strengthening, stretching, and coordination for 10 minutes exercises). Initially (M0) and after 13 months (M1), the NMQ, the SF-36, and the Algometry test were applied. Was used descriptive and inferential statistics, with a significance level of 0.05. For data analyze used the SPSS version 29.0.
Results
After 13 months of intervention, blue-collar (M0:33.8%; M1:20.6%) and white-collar (M0:37.5%; M1:12.5%) workers showed significant improvements in neck symptoms over the last 7 days (p=0.050 and p=0.034). Blue-collar workers showed significant improvements in wrist/hands (reduced pain, p=0.049), hips/thighs (less activity limitation, p=0.021 and pain, p=0.041), knees (fewer symptoms in 7 days, p=0.033), and ankles/feet (fewer symptoms in 12 months, p=0.029 and 7 days, p=0.018; less activity limitation, p=0.034 and pain, p=0.017). After the intervention, the pain pressure threshold showed positive and significant results (p<0.05) for almost all muscles evaluated in both worker groups. Regarding quality of life, the both groups showed good levels in all dimensions with slight improvements, in blue-collars (M0: 64.0-87.2; M1: 63.9-90.4) in white-collars workers (M0: 54.2-88.5; M1: 59.1-90.4) only in the "emotional dimension" in white-collar workers showed to be significant (p=0.030).
Conclusion
After 13 months of the WG program, musculoskeletal symptoms decreased, pressure pain threshold increased, and perceived quality of life improved among both blue- and white-collar workers.
Keywords
Exercise, Nordic, Musculoskeletal, Questionnaire, algometry
#165 FEMORAL NEUROPATHY SECONDARY TO ILIOPSOAS HAEMATOMA: A CASE SERIES AND REHABILITATION OUTCOMES
Sofia Moreira1, Sara Cabete Martins2, Inês Morais2, Maria João Sousa2, André Ribeiro2, Joana Machado Santos3, Teresa Rodrigues3
2 Unidade Local de Saúde de Coimbra - Centro de Medicina de Reabilitação da Região Centro Rovisco Pais, Portugal
3 Unidade Local de Saúde da Póvoa e Vila do Conde, Portugal
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
FEMORAL NEUROPATHY SECONDARY TO ILIOPSOAS HAEMATOMA: A CASE SERIES AND REHABILITATION OUTCOMES
Background
Spontaneous iliopsoas haematoma is a recognized complication of anticoagulant therapy, though less frequently associated with traumatic injuries. Femoral neuropathy is an uncommon but serious consequence, often resulting from compression by masses within the iliopsoas muscle. There is no established consensus regarding the best treatment approach, with both conservative and surgical options considered viable. We report three cases of femoral neuropathy secondary to iliacus and psoas muscle haematomas.
Case report
Case 1: An 81-year-old previously autonomous female, anticoagulated with a NOAC for atrial fibrillation, developed generalized weakness, asthenia, and gait impairment following a seizure. Imaging revealed a left iliacus and psoas haematoma compressing the femoral nerve. Electromyography (EMG) showed severe neurogenic compromise. Despite conservative management and rehabilitation, significant deficits persisted, impacting gait. Case 2: An 82-year-old autonomous male suffered a cervical fracture in a car accident and was treated conservatively with a neck brace. He initially had no neurological deficits but developed bilateral lower limb weakness after initiating anticoagulation for immobilization. Imaging identified extensive bilateral iliopsoas haematomas and retroperitoneal collection. EMG revealed severe axonal damage of the left femoral nerve. Despite a reduction of the haematoma after blood transfusion and anticoagulation reversion the deficit persisted and gait remains impaired. Case 3: An 82-year-old male with atrial fibrillation on warfarin, hospitalized for pneumonia and respiratory failure, experienced abdominal and left inguinal pain, knee extension deficit, and sudden haemoglobin drop. Imaging revealed a right iliopsoas haematoma with signs of active bleeding. Anticoagulation was reversed, and bleeding stopped spontaneously. After stabilization, rehabilitation was initiated, and anticoagulation therapy was optimized by switching to a NOAC.
Conclusion
Iliopsoas haematomas can result in significant neurological impairment, particularly femoral neuropathy, severely impacting patient mobility and independence. Early recognition, prompt imaging, multidisciplinary management, and individualized rehabilitation are crucial to optimize outcomes.
Keywords
Iliopsoas Haematoma; Femoral Neuropathy; Rehabilitation
#166 A TANGLED WEB: AXILLARY WEB SYNDROME AND EXTENSOR POLLICIS LONGUS TENDON INJURY —A RARE DUAL COMPLICATION CHALLENGING RECOVERY
Carolina Dias da Silva, João Carvalho, Sofia Amorim, Renato Nunes
Conference topic: Cancer rehabilitation
Occupation: Postgraduates students
Type of abstract: Case report
Abstract
Title
A TANGLED WEB: AXILLARY WEB SYNDROME AND EXTENSOR POLLICIS LONGUS TENDON INJURY —A RARE DUAL COMPLICATION CHALLENGING RECOVERY
Background
Extensor pollicis longus (EPL) tendon rupture, a rare complication of distal radius fractures, often occurs at Lister’s tubercle due to poor vascularization. It results from mechanical attrition, ischemia, or compartment pressure. Conservatively managed fractures can lead to EPL rupture, presenting as thumb extension loss and wrist tenderness. Treatment typically involves extensor indicis proprius (EIP) tendon transfer. Axillary Web Syndrome (AWS), a post-surgical breast cancer complication, causes painful axillary cords that restrict shoulder mobility. It usually resolves within three months, with physiotherapy as the main treatment. Lymphatic dissection, and chemotherapy are risk factors.
Case report
A 70-year-old woman with left breast cancer underwent neoadjuvant chemotherapy. On the day of her axillary lymph node dissection, she sustained a fall, resulting in left radius and ulna fractures, managed conservatively with a plaster splint. She later developed a complete active extension deficit of the left thumb interphalangeal joint, leading to a diagnosis of extensor pollicis longus (EPL) tendon rupture, requiring tendon transfer using the extensor indicis proprius (EIP). The patient continued oncological treatment with radiotherapy and hormone therapy. Post-surgery, she regained thumb extension and index finger flexion but had difficulty with thumb opposition, tip-to-tip pinch, and developed allodynia in the index finger scar. Left axillary web syndrome (AWS) was also noted, limiting shoulder mobility (active ROM: 80º, passive ROM: 110º). Rehabilitation included passive mobilization, strengthening exercises, thumb motor training, scar release massage, and sensory re-education. She also received Neurobion, Pregabalin, and Lidocaine plasters. Passive shoulder ROM improved to 140º and active ROM to 120º. She regained the ability to perform a tip-to-tip pinch with the 5th finger, showing functional improvement despite residual limitations.
Conclusion
This case highlights the rare coexistence of EPL rupture and AWS, complicating recovery. Early tendon transfer and physiotherapy were crucial, emphasizing the need for a multidisciplinary approach in complex post-fracture and post-surgical rehabilitation.
Keywords
DistalRadiusFracture, ExtensorPollicisRupture, AxillaryWebSyndrome
#167 MULTIDISCIPLINARY REHABILITATION APPROACH FOLLOWING PALMAR THIRD-DEGREE BURN WITH SYNDACTYLY: A CASE REPORT
Carolina Dias da Silva, João Carvalho, Renato Nunes
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
MULTIDISCIPLINARY REHABILITATION APPROACH FOLLOWING PALMAR THIRD-DEGREE BURN WITH SYNDACTYLY: A CASE REPORT
Background
Although hand burns cover less than 5% of body surface area, they can cause profound functional limitations. Factors like edema, infection, poor positioning, and delayed skin coverage often lead to deformities such as syndactyly. Early, multidisciplinary rehabilitation — including surgery, therapeutic exercises, and scar care — is crucial for recovery. This case report shows how a tailored rehab approach enhances hand function and quality of life after a third-degree palmar burn with syndactyly.
Case report
A 56-year-old woman suffered a third-degree contact burn on the palmar surface of her dominant right hand and fingers, involving 1% of her total body surface area, which led to syndactyly affecting digits three to five and significant joint stiffness. She underwent multiple Plastic and Reconstructive Surgery procedures, including contracture release in the 2nd-4th interdigital spaces, application of a dermal regeneration template, and later split-thickness skin grafting. Hand dressings were consistently applied in a functional position, and passive mobilization of the upper limb began on day one, performed three times daily. Physical and rehabilitation medicine was initiated in the second week. The initial evaluation revealed restricted passive wrist and finger motion, especially absent flexion in the interphalangeal joints, accompanied by neuropathic pain in the 3rd finger, for which gabapentin was prescribed. A structured rehabilitation plan, including frequent passive and gradual active mobilization exercises, was maintained throughout hospitalization. By discharge, the patient demonstrated moderate improvement in wrist and metacarpophalangeal joint range of motion but persistent stiffness in the distal interphalangeal joints and limited thumb opposition, underlining the complexity of functional recovery following severe hand burns and the essential role of multidisciplinary rehabilitation in improving hand function and quality of life.
Conclusion
This case highlights the importance of early multidisciplinary rehabilitation in managing post-burn syndactyly, emphasizing how structured therapy and surgical intervention can enhance hand function and quality of life.
Keywords
BurnRehabilitation, HandBurn, Syndactyly, HandFunctionRecovery
#168 ACUTE CALCIFIC TENDINITIS OF THE SHOULDER: WHEN CALCIUM DECIDES TO MIMIC SEPTIC ARTHRITIS
Diogo Marques, Pedro Rocha, Francisco Moreira, João Pedro Matos, Daniano Caires, Fabiana Rodrigues, Pedro Diogo Silva, Joana Macedo
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
ACUTE CALCIFIC TENDINITIS OF THE SHOULDER: WHEN CALCIUM DECIDES TO MIMIC SEPTIC ARTHRITIS
Background
Calcific tendinitis of the shoulder is a self-limiting disorder, it is the calcification and tendon degeneration caused by deposition of calcium hydroxyapatite crystals. Typically affects patients between 30 and 60 years, with a predilection for women. The supraspinatus tendon is most often involved. The supraspinatus tendon is most often involved. In some patients, acute and severe shoulder pain is the first symptom. This acute presentation is traditionally associated with the resorptive phase of the disorder. Symptoms generally resolve in a few weeks of onset. We present a case of acute calcific tendinitis of the shoulder associated with a systemic inflammatory response that mimicked septic arthritis. To our knowledge, only four similar cases have been reported in scientific literature.
Case report
A 75-year old woman with known history of rotator cuff syndrome was admitted to the emergency department with acute and disabling left shoulder pain persisting for over a week along with fever that began the day before. Laboratory tests showed leukocytosis, elevated C-reactive protein (138.33 mg/L; normal <5.00). An ultrasound-guided needle drainage revealed purulent material. A CT-Scan was performed and revealed a 22 mm calcification localized in Subscapularis tendon along with inflammatory changes of the surrounding tissues. Given the concern for septic arthritis the patient was started on Vancomycin and Ceftriaxone. However, cultures of the aspirated material revealed no bacterial growth. After five days the inflammatory markers normalized, and the patient was discharged.
Conclusion
The resorptive phase of calcific tendinitis is the most symptomatic and may resemble septic arthritis. Usually, the absence of systemic signs and mild elevation of inflammatory markers help differentiate them. However, in a subset of patients, resorption of calcific deposits produces systemic response which may confound the diagnostic process, mislead the treating physician. Awareness may help clinicians to correctly diagnose the patient and avoid unnecessary treatments and procedures.
Keywords
Calcific Tendinitis, Suprastinatus, Septic Arthritis
#169 REHABILITATION OF FUNCTIONAL MOTOR DISORDERS: A LITERATURE REVIEW
Diogo Marques, Pedro Rocha, Francisco Moreira, João Pedro Matos, Daniano Caires, Fabiana Rodrigues, Pedro Diogo Silva, Joana Macedo
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
REHABILITATION OF FUNCTIONAL MOTOR DISORDERS: A LITERATURE REVIEW
Background and Aims
Functional motor disorders represent a "gray area" in neurology. They are not caused by structural damage to the nervous system, but rather by a disruption in the brain's ability to receive and send signals. Symptoms include muscle weakness, paralysis, tremor, dystonia, gait disturbances, among others. The aim of this study is to define the importance of rehabilitation in the treatment of this spectrum of disorders
Methods
Articles were searched on PubMed (MEDLINE) using the MeSH terms “functional motor disorders” and “rehabilitation,” and the most relevant articles were selected.
Results
Rehabilitation in its various forms is an understudied topic that lacks robust randomized clinical trials. The literature review found retrospective studies, one prospective study, and case reports. The symptoms were heterogeneous, and rehabilitation programs were not standardized. Despite these limitations, the studies showed that rehabilitation is an important treatment approach, with improvement seen in up to 70% of patients. One randomized trial showed promising results in hospitalized patients with gait disturbances in a 3-week program. The most commonly used approach combined motor relearning with a behavioral component.
Conclusion
Functional motor disorders are complex, have multifactorial etiology, and are challenging to diagnose. Rehabilitation aims at functional and movement recovery, and although not yet supported by strong scientific evidence, it has shown beneficial effects for patients when integrated into a multimodal treatment plan.
Keywords
Functional Motor Disorder; Rehabilitation
#170 "INPATIENT REHABILITATION OF TRAUMATIC BRAIN INJURY PATIENTS IN CROATIA-IS TIME RELEVANT?
Valentina Blažinčić, Ivica Ščurić, Ivana Klepo, Marija Jeršek, Ivan Dubroja, Duško Cerovec
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
"INPATIENT REHABILITATION OF TRAUMATIC BRAIN INJURY PATIENTS IN CROATIA-IS TIME RELEVANT?
Background and Aims
Traumatic brain injury (TBI) is acquired brain injury caused by an external mechanical force that lead to temporary or permanent damage of neurological system. Although TBI is preventable it remains a leading cause of death and disability. Better outcome is often associated with earlier transfer to rehabilitation departments. Aim of this study was to investigate influence of admission time to rehabilitation department for TBI patients in Croatia.
Methods
Single center, retrospective study for 5 year period. Inclusive criteria were: age over 18 years, acute inpatient TBI rehabilitation. Exclusion criteria were: other reason for inpatient acute rehabilitation, chronic TBI and patients who died during rehabilitation.
Results
Study included 207 patients average age of 45 years. There was significantly more male patients (172). Average median initial GCS was 7 (interquartile range from 4.0 to 10.0). Average median time from TBI incident to admission was 62 days (interquartile range from 47 .0 to 86.0 days). Average median admission FIM was 38.5 (interquartile range from 21.0 to 95.0) and average median dismission FIM was 93.0 ( interquartile range from 38.0 to 112.0). Improvement significantly negatively correlates with period from TBI to admission to rehabilitation (p <0,001).
Conclusion
It is important to enable transfer to rehabilitation department as early as possible for severe and medium severe TBI patients because than they have possibility to achieve better functional outcome. But do we have enough rehabilitation capacity in our country? This field of healthcare needs to be considered carefully.
Keywords
TBI, inpatient rehabilitation, admission, outcome
#171 REHABILITATION OF A PATIENT WITH FEMORAL NERVE PALSY AFTER BILATERAL TOTAL HIP ARTHROPLASTY VIA DIRECT ANTERIOR APPROACH: A CASE REPORT
Katarina Marija Kobeščak1, Domagoj Andrić1, Marin Miljak2, Darija Granec1
2 Clinical Hospital Dubrava, Croatia/Hrvatska
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
REHABILITATION OF A PATIENT WITH FEMORAL NERVE PALSY AFTER BILATERAL TOTAL HIP ARTHROPLASTY VIA DIRECT ANTERIOR APPROACH: A CASE REPORT
Background
Bilateral total hip arthroplasty (THA) has proven to be an effective treatment modality for patients with bilateral hip osteoarthritis, allowing for faster recovery. This case highlights the importance of rehabilitation following THA and the challenges associated with potential complications such as femoral nerve palsy (FNP).
Case report
A 44-year-old female patient with bilateral secondary hip osteoarthritis due to developmental hip dysplasia underwent bilateral THA in a single operative session under general anesthesia, using a direct anterior surgical approach. The patient was mobilized 24 hours after surgery and rehabilitation was initiated. Clinically, active extension of the left knee was absent. On the seventh postoperative day, the patient was transferred to a rehabilitation facility where the initial evaluation recorded passive flexion of 70° in both hips, minimal activity of the left quadriceps muscle (manual muscle test, MMT 1/5), and preserved strength of the distal musculature of the left leg. The right leg showed an expected postoperative status. Clinical suspicion of an acute left FNP was confirmed by electromyoneurography, and ultrasound excluded nerve discontinuity or compression in the left groin. The rehabilitation program included kinesiotherapy, gait training, cryocompression and muscle electrostimulation. After six weeks of inpatient rehabilitation, functional hip range of motion was achieved bilaterally, with persistent weakness in the left knee extensors (MMT 1/5). Outpatient rehabilitation was continued, and after six months, complete recovery of motor deficit was observed. Electromyoneurography also confirmed recovery of the left FNP.
Conclusion
FNP during THA is a relatively rare complication (incidence 0.21%). Studies report recovery periods ranging from six months to two years, with rehabilitation—particularly early muscle electrostimulation of the denervated muscles—remaining the gold standard of treatment. Compared to rehabilitation after unilateral THA, this case required greater focus on achieving symmetrical recovery of hip function and the prevention of complications.
Keywords
femoral nerve palsy, hip arthroplasty
#172 6-MONTHS MORTALITY PREDICTORS EASILY RECOGNIZABLE UPON INPATIENT GERIATRIC REHABILITATION ADMISSION
Dan Justo1, Amitai Avnon Sawicki2, Itamar Feldman1
2 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
6-MONTHS MORTALITY PREDICTORS EASILY RECOGNIZABLE UPON INPATIENT GERIATRIC REHABILITATION ADMISSION
Background and Aims
To study 6-months mortality predictors upon inpatient geriatric rehabilitation admission.
Methods
A single-center retrospective study of all patients admitted for inpatient geriatric rehabilitation during 2018-2020. Logistic regression analysis and Chi-squared automatic interaction detection (CHAID) decision tree were used to study which variables were independently associated with 6-months mortality upon rehabilitation admission including: age, gender, chronic co-morbidities, prior functional status, and rehabilitation indication.
Results
The final cohort included 993 patients: 588 (59.2%) females, median age 82.0 years (IQR 75.0-87.0 years). Overall, 101 (10.2%) patients died within six months of rehabilitation admission. Logistic regression analysis showed that mortality was independently associated with male gender (OR 1.9, 95%CI 1.2-3.1), symptomatic severe aortic stenosis (OR 3.6, 95%CI 1.4-9.6), chronic kidney disease (OR 2.0, 95%CI 1.3-3.3), active cancer (OR 3.3, 95%CI 1.8-6.1), prior mild dependency (OR 5.3, 95%CI 2.3-12.4), prior severe dependency (OR 5.8, 95%CI 2.4-14.0), and deconditioning indicating rehabilitation (OR 2.2, 95%CI 1.2-3.9). CHAID decision tree showed that chronic kidney disease was the first splitting variable (p<0.001) followed by male gender (p81 years (p=0.027).
Conclusion
Symptomatic severe aortic stenosis and chronic kidney disease are presented herein, for the first time, as 6-months mortality predictors upon geriatric rehabilitation admission.
Keywords
Aortic stenosis, Kidney disease, Mortality
#173 COMBINING REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION AND AUGMENTED REALITY THERAPY FOR REHABILITATION OF CHRONIC STROKE PATIENTS
Ying-Chi Hunag, Chien-Hung Lai
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
COMBINING REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION AND AUGMENTED REALITY THERAPY FOR REHABILITATION OF CHRONIC STROKE PATIENTS
Background and Aims
Stroke affects 15 million people globally each year, with 55–75% experiencing long-term motor and balance deficits that lower quality of life. Ischemic brain damage results in persistent functional impairments. Studies show combining varied rehabilitation strategies supports motor recovery. Virtual Reality (VR) and Augmented Reality (AR) are emerging tools for improving motor function in stroke patients. VR enhances upper limb dexterity, gait, and balance—key for independence. AR also improves limb function and engagement but needs more validation. Low-frequency repetitive transcranial magnetic stimulation (rTMS) and AR with dynamic motion capture are modern rehab approaches. This study examines the combined effects of rTMS and AR on balance and walking in chronic stroke, an area with limited research.
Methods
Patients aged 55–79 years with a first-ever chronic stroke (≥6 months post-stroke) and hemiplegia, with MMSE >21, were recruited. The study excluded those over 80 or with contraindications to rTMS. Participants were randomly assigned to three groups: rTMS plus AR training, sham rTMS plus AR training, and conventional rehabilitation. The intervention lasted four weeks, focusing on balance and walking improvement. Data were analyzed using SPSS 27. A total of 18 patients (11 males, 7 females; mean age 60.1±13.0 years) participated.
Results
The rTMS + AR group showed the greatest improvements in balance and walking, outperforming other groups in post-test measures. The AR-only group also demonstrated better trends than conventional rehabilitation. No significant post-test differences in MEP amplitude were found among groups.
Conclusion
The group receiving rTMS and AR showed notable balance improvements over other groups, suggesting this combination as an effective rehabilitation option for chronic stroke patients with unstable balance. No significant interhemispheric differences in MEP amplitude were observed in any group post-test. More MEP data is needed to clarify the effects of rTMS on corticospinal excitability.
Keywords
AR, rTMS
#174 THE ANALGESIC EFFECT OF ELECTROTHERAPY IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY
Ana Spasovska1, Valentina Koevska2, Besarta Jonuzi Ibraimi3
2 PHO University Clinic for Physical Medicine and Rehabilitation, Skopje, Macedonia
3 PHO General Hospital Gostivar, Macedonia
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE ANALGESIC EFFECT OF ELECTROTHERAPY IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY
Background and Aims
Diabetic peripheral neuropathy (DPN) is a common complication of improperly regulated glycemia, affecting approximately 50% of diabetic patients, with half of them experiencing painful symptoms. Patients complain of pain, numbness, and tingling in the extremities. Both pharmacological and physical therapy methods are used in the treatment of painful diabetic peripheral neuropathy. The aim of this study is to demonstrate the analgesic effect of transcutaneous electrical nerve stimulation (TENS) and galvanic currents in patients with painful diabetic peripheral neuropathy.
Methods
The study included 18 patients diagnosed with diabetic peripheral neuropathy of the lower limbs, treated at the HO Polyclinic of the University “St. Cyril and Methodius” in Skopje, aged between 18 and 80 years. The patients were divided into two groups: 9 in the experimental group and 9 in the control group. The experimental group received 15 sessions of electrotherapy (TENS and galvanic currents), while the control group maintained regular foot hygiene and used orthopedic shoes. Pain levels in both groups were assessed using the Visual Analogue Scale (VAS) and the DN4 questionnaire for neuropathic symptoms, administered before and one month after the physical therapy intervention.
Results
The experimental group showed a significant reduction in pain compared to the control group. Neuropathic symptoms such as burning, tingling, and cold sensations in the lower limbs and feet were reduced in the experimental group, whereas these symptoms remained persistent in the control group.
Conclusion
Galvanic currents and TENS significantly reduced pain and neuropathic symptoms in patients with diabetic peripheral neuropathy.
Keywords
diabetic neuropathy, TENS, galvanic current
#175 IMPROVING BALANCE IN DIABETIC PERIPHERAL NEUROPATHY THROUGH STABILOMETRIC PLATFORM REHABILITATION – A CASE REPORT
Diana Maria Stanciu, Oana Georgiana Cernea, Cosmina Diaconu, Mihaela Stanciu, Florina Ligia Popa
Conference topic: Neurorehabilitation
Occupation: Postgraduates students
Type of abstract: Case report
Abstract
Title
IMPROVING BALANCE IN DIABETIC PERIPHERAL NEUROPATHY THROUGH STABILOMETRIC PLATFORM REHABILITATION – A CASE REPORT
Background
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus, presenting significant challenges for rehabilitation management. This condition is caused by peripheral nerve damage, particularly in the lower limbs, resulting from prolonged hyperglycemia and is characterized by a variety of sensory, motor, and autonomic dysfunctions. The main cause of disability in these patients is balance disorders that increase substantially the risk of falls, consequent injuries, and a diminished quality of life. The integration of somatosensory, visual, and vestibular inputs is paramount for maintaining postural control and equilibrium.
Case report
We present the case of a 65-year-old male patient admitted in our rehabilitation department for numbness and burning sensations, muscle cramps and weakness, balance and gait disorders. He is known with a 20-year history of type 2 diabetes mellitus, diagnosed with stage II symmetrical distal peripheral neuropathy. The rehabilitation program, conducted over a 2-week period, included static and dynamic balance training using a stabilometric platform that includes virtual reality and visual feedback. Assessment was performed using the Michigan Neuropathy Screening Instrument (MNSI), Berg Balance Scale (BBS), Tinetti Balance and Gait Assessment, Timed Up and Go Test (TUG) and the platform evaluations, all of these being carried out before and after the rehabilitation treatment. At the end of the program, a significant improvement was noted, with the BBS score increasing from 49 to 52 points, Tinetti total score 18 to 26, indicating improved postural stability and functional mobility. Also demonstrated notable improvements in the most relevant stabilometric variables, with a marked reduction in sway path length and sway area, alongside a significant enhancement of the stability index.
Conclusion
The use of the stabilometric platform as a standalone rehabilitation tool resulted in meaningful improvements in balance disorders, underscoring its efficacy in managing diabetic peripheral neuropathy.
Keywords
diabetic, peripheral, neuropathy, stabilometric, platform
#177 THE FUNCTIONAL EVALUATION OF THE LOWER LIMBS IN OBESE SUBJECTS: STUDY EXPERIMENTAL FOR THE PREVENTION OF TRAUMA
MAria Chiara Parisi
Conference topic: Pain treatment and rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
THE FUNCTIONAL EVALUATION OF THE LOWER LIMBS IN OBESE SUBJECTS: STUDY EXPERIMENTAL FOR THE PREVENTION OF TRAUMA
Background and Aims
Obesity represents a major public health concern. It is defined as a condition involving excessive accumulation of adipose tissue, which may lead to significant health complications. The musculoskeletal system is significantly involved in the quality of life of individuals with obesity. The excessive accumulation of adipose tissue in the musculoskeletal and locomotor systems, particularly in the visceral region, places strain on the spine, leading the individual to adopt incorrect postures. This results in a shift of the body’s center of gravity and a misalignment of the spine, which is no longer properly aligned. The increased body weight restricts the range of motion in daily activities, reducing overall quality of life. The aim of the study is to assess the functional overload affecting the musculoskeletal and osteoarticular systems in individuals with obesity, and to demonstrate how an effective adapted physical activity protocol can serve as a valuable tool for the prevention and management of the identified impairments.
Methods
For the study, 63 participants aged between 50 and 65 years were recruited, including 30 males and 33 females. The experimental group participated in an adapted training program. The parameters assessed included joint pain levels (hip, back, and knee) and joint range of motion (ROM). These parameters were measured at three time points: baseline (T0), after 6 months (T1), and after 12 months of training (T2).
Results
Our results indicate that the implemented exercise program may be a valid option for improving postural balance, reducing pain symptoms and functional limitations in individuals with obesity, while also enhancing their overall quality of life
Conclusion
The present study demonstrated that the adapted physical activity protocol, tailored to the individual’s needs and identified postural deviations, led to significant improvements in quality of life, physical performance, and a reduction in perceived pain levels.
Keywords
obesity, trauma, rehab, exercise
#178 CASE PRESENTATION: IATROGENIC AXONAL INJURY OF THE SURAL NERVE
Ioannis - Alexandros Tzanos, Gerasimos Katopodis, Aikaterini Kotroni
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CASE PRESENTATION: IATROGENIC AXONAL INJURY OF THE SURAL NERVE
Background
The sural nerve is a purely sensory nerve formed by branches of the common peroneal and tibial nerves. It provides cutaneous innervation to the lateral surface of the ankle and the foot extending to the base of the fifth toe. Isolated injuries to this nerve represent a rare clinical entity. Symptoms typically include paresthesia or pain along the lateral ankle and foot, which worsen with foot inversion and plantarflexion. Known causes include acute trauma (such as fractures of the base of the fifth metatarsal, talus, calcaneus, or the cuboid bone), traction injuries leading to secondary fibrosis of the nerve, tendinopathies of the Achilles or peroneal tendons, space-occupying lesions (e.g., ganglia), and gastrocnemius muscle injuries. This report presents a case of iatrogenic sural nerve injury with corresponding electromyographic findings.
Case report
A 22-year-old woman presented to the Electromyography Laboratory of the Department of Physical Medicine and Rehabilitation at GNA KAT, complaining of pain and paresthesia in the distribution of the sural nerve, ongoing for four months. According to her medical history, symptom onset followed a dermatological skin cleansing procedure near the lateral malleolus of the right ankle. Clinical examination revealed hypoesthesia in the sural nerve distribution below the right lateral malleolus, while muscle strength and tendon reflexes were normal. Sensory evoked potentials of the sural nerve were recorded bilaterally, with the recording electrode placed below and anterior to the usual recording site to examine the region distal to the injury. The results showed a significantly prolonged latency and reduced amplitude of the sensory nerve action potential on the right compared to the left. These findings are consistent with axonal damage to the right sural nerve.
Conclusion
This case highlights a rare cause of sural nerve injury and emphasizes the importance of clinical vigilance when performing medical procedures in the affected area.
Keywords
iatrogenic, sural nerve, axonal, injury
#179 EARLY TREATMENT WITH BOTULINUM TOXIN TYPE A IN PATIENTS WITH POST-STROKE SEQUELAE: OUR EXPERIENCE AT THE NEUROREHABILITATION CLINIC, IRCCS OSPEDALE POLICLINICO SAN MARTINO, GENOA
Anna De Giovanni1, Giovanna Canu1, Andrea Cervia1, Laura Mori2, Carlo Trompetto1, Stefania Canneva3
2 Università degli Studi di Genova, Cambodia
3 IRCCS Ospedale Policlinico San Martino, Italy
Conference topic: Neurorehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
EARLY TREATMENT WITH BOTULINUM TOXIN TYPE A IN PATIENTS WITH POST-STROKE SEQUELAE: OUR EXPERIENCE AT THE NEUROREHABILITATION CLINIC, IRCCS OSPEDALE POLICLINICO SAN MARTINO, GENOA
Background and Aims
Spasticity occurs in 4–27% of stroke survivors within six weeks and in 17–38% at 12 months post-event. Spastic hypertonia impairs motor function, hinders caregiving, and causes significant pain. Spastic dystonia, a severe form of spasticity, leads to pathological postures and intrinsic muscle changes, resulting in profound disability. Botulinum toxin type A (BoNT-A) is the gold standard for focal spasticity management in the chronic phase. However, specific guidelines on the timing and efficacy of early intervention are lacking. This pilot study aims to evaluate whether early BoNT-A administration during the subacute phase can prevent chronic spastic dystonia and promote motor recovery through neuroplasticity.
Methods
Patients with subacute ischemic or hemorrhagic stroke and early emerging spasticity were recruited. Inclusion criteria included Mini-Mental State Examination >24 and informed consent capacity. Assessments included the Modified Ashworth Scale (MAS), Visual Analogue Scale (VAS) for pain, and the FAST-UL for upper limb motor function. Patients with MAS >1+ received BoNT-A injections under ultrasound guidance (T0). Reassessments were conducted at 1 month (T1), 3 months (T2), 6 months (T3), and 12 months (T4). Booster doses were administered if hypertonia persisted at T1.
Results
Thirteen patients (9 males, 4 females; mean age 64 years) were enrolled. BoNT-A was administered in the upper limb in 10 patients and both limbs in 3 patients. Treatment was well-tolerated with no systemic adverse effects or impairment of functional recovery. Four patients required a booster dose at T1. Pain significantly decreased at T1 and T2 in all subjects. Spasticity recurred in T3 and T4 evaluations, requiring further BoNT-A administration, but no cases of disabling spastic dystonia developed.
Conclusion
Preliminary findings suggest early BoNT-A treatment is safe, reduces pain, and may prevent severe spastic dystonia without hindering recovery. Ongoing study and increased sample size are necessary to validate these results.
Keywords
spasticity, botulinumtoxin, stroke, neurorehabilitation
#180 EFFECTS OF A SPECIFIC PROPRIOCEPTIVE TRAINING ON INJURY PREVENTION IN BASKETBALL PLAYERS
MAria Chiara Parisi
Conference topic: Sports medicine rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
EFFECTS OF A SPECIFIC PROPRIOCEPTIVE TRAINING ON INJURY PREVENTION IN BASKETBALL PLAYERS
Background and Aims
Basketball carries a high risk of both chronic and acute musculoskeletal injuries, affecting various parts of the body. This study aimed to investigate the impact of a specific proprioceptive training protocol on professional basketball players.
Methods
Thirty male basketball players (M = 21.93, SD = 3.75 years) were divided into two groups: an experimental group (n = 15) and a control group (n = 15). The experimental group completed an adapted proprioceptive training program designed to enhance position-specific skills, following their regular team training. The parameters assessed included longitudinal body axis alignment, spinal range of motion, and total plantar load distribution. These were measured at three time points: baseline (T 0 ), after 4 weeks of training (T 1 ), and after 8 weeks of training (T 2 ).
Results
Data analysis showed a significant improvement of the assessed parameters in the experimental group, compared to the control group.
Conclusion
In conclusion, the findings highlight the effectiveness of specific and detailed training programs in injury prevention, offering valuable insights for coaches and sports psychologists.
Keywords
Basket; injury; prevention; performance; trauma;
#181 CASE PRESENTATION: NEUROPHYSIOLOGICAL CONFIRMATION OF INJURY TO THE PALMAR BRANCHES OF THE ULNAR NERVE CAUSED BY PERIPHERAL VENOUS CATHETER PLACEMENT
Ioannis - Alexandros Tzanos, Ioulia - Eleni Panagiotopoulou, Gerasimos Katopodis, Aikaterini Kotroni
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CASE PRESENTATION: NEUROPHYSIOLOGICAL CONFIRMATION OF INJURY TO THE PALMAR BRANCHES OF THE ULNAR NERVE CAUSED BY PERIPHERAL VENOUS CATHETER PLACEMENT
Background
A common site for peripheral venous cannulation is the dorsal surface of the hand. Although generally considered safe, a few cases of complications involving peripheral nerve injury have been reported in the literature.
Case report
A 70-year-old man was referred for electromyography due to reported numbness of the little finger on one side. The patient's history revealed that symptoms had started six months earlier, specifically after the removal of a peripheral venous catheter that had been placed for three days on the dorsal surface of the corresponding hand. Clinical examination showed mild atrophy of the first dorsal interosseous muscle and hypoesthesia of the little finger on the affected side. The SNAP of the ulnar nerve from the little finger on the affected side showed low amplitude and prolonged latency, with normal values on the contralateral side. The CMAP of the ulnar nerve recorded from the abductor digiti minimi muscle was normal bilaterally, without significant differences in conduction velocity between the wrist–below elbow and below elbow–above elbow segments. However, the CMAP recorded from the first dorsal interosseous muscle showed an amplitude of 6.2 mV on the affected side and 9.8 mV on the contralateral side, without significant differences in latency. Electromyographic examination of the first dorsal interosseous muscle revealed no spontaneous activity, but only mildly reduced recruitment of motor units on the affected side.
Conclusion
The combination of clinical and electrophysiological findings supports the diagnosis of axonal injury to the sensory branch of the ulnar nerve and, to a lesser extent, to the motor branch, sparing the branch to the abductor digiti minimi. The most likely causes are either direct injury during catheter removal or hematoma formation leading to compression of the affected branches.
Keywords
palmar branches, ulnar, catheter, electromyographic
#182 VULPIAN-BERNHARDT SYNDROME IDENTIFICATION THROUGH ELECTROMYOGRAPHIC STUDY: CASE REPORT
Ioannis - Alexandros Tzanos, Maria Nianiarou, Nikolaos Pappas, Aikaterini Kotroni
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
VULPIAN-BERNHARDT SYNDROME IDENTIFICATION THROUGH ELECTROMYOGRAPHIC STUDY: CASE REPORT
Background
Vulpian-Bernhardt syndrome is a rare variation of amyotrophic lateral sclerosis (ALS) with a more prominent attack of the lower motor neuron. It presents with bilateral weakness and atrophy mostly proximally in the upper limbs, resulting in bilateral flail arms. Compared to classic ALS it progresses slower and swallowing difficulty and diaphragmatic weakness present later in the progression of the disease.
Case report
A 71 year old male presented to the NCS department with reported upper limb weakness that started 5 months prior. He reported previous chemotherapy treatments due to prostate cancer. He presented with bilateral arm weakness more prominent proximally (mostly torso and shoulder region), and very mild weakness in the lower limbs (ambulatory). Fasciculations were seen in the triceps muscles billatery. The deep tendon reflexes were absent in the upper limbs and no sensory deficits were found. The electoneurographic testing regarding the nerves: median, ulnar, peroneal and tibial was normal bilaterally. The electromyographic testing was conducted with a needle electrode and resulted in positive sharp waves, fibrilations and fasciculations at rest and reduced reqruitment in the supraspinatus, deltoid, triceps, bracoradilis, extensor capri radialis longus, abductor pollicis brevis, abductor digiti minimi, quadriceps, tibialis anterior, extensor digitorum brevis and gastrocnemius muscles bilaterally. More impacted were the upper limbs, and proximal muscles compared to distal in all four limbs.
Conclusion
It is necessary for a Physical and Rehabilitation Medicine physician to be aware of this rare variation of ALS, as its symmetrical presentation prominently affecting the upper limbs can pose a significant difficulty in the differential diagnosis.
Keywords
Vulpian-Bernhardt syndrome, electromyographic, fasciculations
#183 DIAGNOSTIC APPROACH AND MANAGEMENT OF A PATIENT WITH NILATERAL PERONEAL NERVE MONONEUROPATHY ON THE BACKGROUND OF GIANT CELL ARTERITIS
Ioannis - Alexandros Tzanos1, Maria Nianiarou1, Konstantinos Navalis1, Nefeli - Anna Papageorgiou1, Dimitrios Artemis2, Aikaterini Kotroni1
2 Laiko General Hospital Of Athens, Greece
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
DIAGNOSTIC APPROACH AND MANAGEMENT OF A PATIENT WITH NILATERAL PERONEAL NERVE MONONEUROPATHY ON THE BACKGROUND OF GIANT CELL ARTERITIS
Background
Giant cell arteritis is a chronic inflammatory vasculitis affecting medium and large sized blood vessels, mostly in the cranial arteries emerging from the aortic arch and affects mostly people around 50 years of age. It can be accompanied by rare peripheral nerve damage caused by damage to the vasa nervorum causing low blood supply to the nerves. Our aim is to present a case of bilateral mononeuropathy of the peroneal nerve attributed to giant cell arteritis.
Case report
A 78 year old male presented to the outpatient clinic of our PRM department describing a 3 month history of unilateral lower limb weakness, which started affecting both lower limbs in the last two months. Five months prior a diagnosis of giant cell arteritis had been made which was being treated with high dose prednisone. During clinical examination bilateral drop foot and impaired sensation in the area innervated by the peroneal nerve was observed. Recently performed nerve conduction studies demonstrated spontaneous activity in the tibialis anterior and extensor digitorum brevis muscles bilaterally while there were not signs of polyneuropathy. The patient was prescribed active assisted physical therapy of the lower limbs, range of motion exercises at the ankles and neuromuscular electrical stimulation. The use of plastic ankle-foot orthoses was suggested to be used during ambulation as well as the use of a cane for medium and long distances.
Conclusion
In the case of this patient the bilateral paralysis of the peroneal nerve should be attributed to the preexisting condition of giant cell arteritis, a rarely reported case. Therefore, a paralysis of the peroneal nerve as well as other signs and symptoms regarding the peripheral nerve system should be regarded as a manifestation of giant cell arteritis on older persons with increased erythrocyte sedimentation rate and c reactive protein.
Keywords
Giant cell arteritis, peroneal
#184 SEVERE PROXIMAL AXONAL INJURY OF THE MEDIAN NERVE FOLLOWING TRAUMATIC SHOULDER DISLOCATION: ELECTROMYOGRAPHIC INVESTIGATION
Ioannis - Alexandros Tzanos, Maria Nianiarou, Nikolaos Pappas, Aikaterini Kotroni
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SEVERE PROXIMAL AXONAL INJURY OF THE MEDIAN NERVE FOLLOWING TRAUMATIC SHOULDER DISLOCATION: ELECTROMYOGRAPHIC INVESTIGATION
Background
Acute traumatic shoulder dislocation is correlated with damage to th proximal peripheral nerves. Most common is damage to the brachial plexus, the axillary and musculocutaneous nerve. Less common is the damage the proximal parts of the median, ulnar and radial nerves.
Case report
A 72 year old woman was referred to electrodiagnostic studies department 3 months after surgical treatment for right humeral fracture with shoulder dislocation. She reported three month long severe weakness and reduced sensation in the right upper limb. Upon clinical examination the characteristic Benediction hand was observed with reduced sensation confined to the median nerve distribution. The sensory nerve action potential(SNAP) and the compound muscle action potential(CMAP) of the right ulnar nerve were normal, but the SNAP and CMAP of the right median nerve could not be recoded. Fibrilations and positive sharp waves were recorded in the flexor capri radialis, extensor pollicis longus and abductor pollicis brevis muscles, while the electromyographic testing was normal in the right deltoid, biceps, triceps, brachioradialis, extensor capri radialis longus, extensor digitorum comminis and abductor digiti minimi muscles. Taking into consideration that the median nerve derives from the branches of the median and lateral cords of the brachial plexus and in this case only muscles innervated by this nerve were denervated, the diagnosis of an isolated median nerve damage is the most likely.
Conclusion
Although the initial diagnostic approach focused on a diffuse brachial plexus injury due to the severity of weakness and the anatomical location of the injury, the detailed combination of clinical and electrophysiological findings supports the diagnosis of an acute traumatic injury to the median nerve above the elbow.
Keywords
median nerve, proximal, shoulder dislocation
#185 FUNCTIONAL EVALUATION IN A PATIENT WITH SMA TYPE 2, CASE REPORT
Biljana Mitrevska1, Valentina Koevska1, Cvetanka Gerakaroska Savevska1, Marija Gocevska1, Biljana Kalcovska2, Maja Manoleva2, Daniela Gecevska2, Teodora Stevanoska2, Emilija Sajcevska3, Angela Martinoska2, Erieta Nikolik Dimitrova2
2 university Clinic for Physical medicine and rehabilitation, Macedonia
3 General Hospital Ohrid, Macedonia
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
FUNCTIONAL EVALUATION IN A PATIENT WITH SMA TYPE 2, CASE REPORT
Background
Spinal muscular atrophy (SMA) is a common, inherited neuromuscular disease that causes hypotonia and progressive muscle weakness and wasting (atrophy). The acquisition and maintenance of motor function is one of the key treatment goals in SMA; therefore, the assessment of motor function plays an important role in regular clinical practice and in clinical studies. Validated and reliable scales are crucial for assessing the effect of treatment on motor function in people with SMA.
Case report
Case report: Male patient. Born 24.05.1993. First functionally tested in 2021 (28 years old) Type: SMA 3B at MANU 2020 with 3 copies of the SMN 2 gene. On therapy with Evrysdi since 2021. Age range up to 12 years. Current age 32 years, receiving a disability pension, graduated from an economic school. Evaluation of the effects of therapy and kinesitherapy with functional tests: MFM-32, RULM, SMAIS as well as measuring the range of motion in the upper and lower extremities. The patient conducts kinesitherapy at home and regularly stands up with over-the-knee devices and assistance from other people. Results: MFM-32: 53.12%; 56.25%; 53.25%; 56.25%. RULM: D32 L 24 entry 4; D 32 L 24 entry 4; D 33 L 24 entry 5; D 33 L27 entry 5. SMAIS 55/58; 56/58.
Conclusion
Conclusion: Kinesitherapy as a key link in rehabilitation has an important role in the progression of the disease and improvement of motor function, in addition to drug therapy. Functional tests are an important tool in monitoring the progression of the disease and the only way to monitor the effects of therapy in patients with SMA.
Keywords
Spinal muscular atrophy, rehabilitation,kinesiotherapy
#186 CLUBFOOT - DEFORMITY DEGREE AND FUNCTIONAL OUTCOMES AFTER THE TREATMENT
Filip Milanovic1, Sinisa Ducic1, Milena Jankovic2, Bojan Bukva1, Dejan Nikolic1
2 University Clinical Center of Serbia, Serbia
Conference topic: Children rehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
CLUBFOOT - DEFORMITY DEGREE AND FUNCTIONAL OUTCOMES AFTER THE TREATMENT
Background and Aims
Occuring in 1-2 per 1.000 newborns, clubfoot is one of the most common anomalies of the locomotor system. With its multifactorial etiopathogenesis, including both genetic and environmental factors, 80% of clubfeet are idiopathic while 20% are syndromic, present with associated malformations. The aim of this study was to show correlation between deformity degree and functional outcomes after the treatment.
Methods
In our cross-sectional study, we evaluated 50 randomly selected, eligible clubfoot patients that were treated at the University Children’s Hospital, Belgrade, Serbia between November 2006 and November 2022. The treatment has consisted of using Ponseti method while surgical treatment was used for those patients resistent to previous conservative method accroding to Ponseti, as well as for syndromic or neglected clubfoot cases. Deformity degree was categorized as I, II, III or IV, according to Dimeglio classification while functional status of patients after the treatment was assessed by using Clubfoot Assessment Protocol (version 1.0). Correlation between deformity degree and different functional scores was tested by Spearman’s test.
Results
Results of our study have shown statistically significant (p<0,001), negative correlation between clubfoot deformity degree and all evaluated functional scores, including: passive mobility, muscle function (strenght), morphology and motion quality of the foot after the treatment. Surprisingly, more patients (around 70%) were treated both conservatively and surgically, despite Ponseti method being seen as a "gold standard". Possible explanation could be higher number of syndromic or neglected clubfoot cases, resistent to previous conservative treatment.
Conclusion
This study has shown an important impact of initial clubfoot deformity degree on its functional outcomes after the treatment, suggesting that severe clubfeet are associated with the worst functional scores after conservative and/or surgical treatment that should be started during first weeks of life.
Keywords
clubfoot, Dimeglio classification, Ponseti method
#187 EFFICIENCY OF THE ROBOTIC SYSTEM WITH DYNAMIC BODY WEIGHT SUPPORT IN THE REHABILITATION OF A COMPLICATED BIMALLEOLAR ANKLE FRACTURE - CASE REPORT
Oana Georgiana Cernea, Diana Maria Stanciu, Cosmina Diaconu, Mihaela Stanciu, Florina Ligia Popa
Conference topic: Postoperative rehabilitation
Occupation: Postgraduates students
Type of abstract: Case report
Abstract
Title
EFFICIENCY OF THE ROBOTIC SYSTEM WITH DYNAMIC BODY WEIGHT SUPPORT IN THE REHABILITATION OF A COMPLICATED BIMALLEOLAR ANKLE FRACTURE - CASE REPORT
Background
Recent statistics have shown that at European level, bimalleolar fractures represent 20-25% of all ankle fractures. After these fractures, a series of complications can occur including complex regional pain syndrome, deep vein thrombosis, intolerance to osteosynthesis material, vicious callus, but the most common is pseudarthrosis.
Case report
We present the case of a 43-year-old patient who suffered a fall trauma from the same level one year ago, resulting in a bimalleolar fracture of the right ankle. The patient was admitted to the orthopedics department of the hospital where osteosynthesis with a titanium plate and 9 screws was performed at the distal part of the right tibia. Despite two successive medical rehabilitation programs, the evolution was unfavorable, as the pain persisted during walking. Following other imaging investigations, computed tomography revealed a pseudarthrosis of the right distal tibia and a vicious consolidation of the fibula. As a result, in February 2025, surgical intervention was performed again to cure the pseudarthrosis. After the surgery, the patient followed a complex rehabilitation program in our department, which consisted of high-frequency pulse therapy, conventional physiotherapy and robotic rehabilitation. The use of the robotic system with dynamic body weight support favored the resumption of walking with progressive loading and significantly improved the patient's rehabilitation process. Specific walking parameters were measured before the start of treatment but also at the end of it and the results obtained were significantly improved.
Conclusion
In this case, the pseudarthrosis led to an increase in the patient's disability and made the patient's rehabilitation process more difficult. Surgical reintervention, followed by a personalized rehabilitation program which included the use of a robotic body weight support system for gait training, were essential elements in the patient's management and favorable outcome.
Keywords
Robotic, rehabilitation, fracture, bimalleolar, pseudarthrosis
#188 REHABILITATION OUTCOMES OF POST-STROKE FACIAL PALSY IN FIFTEEN PATIENTS : A PROSPECTIVE STUDY
Abdelhakim KABIL
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
REHABILITATION OUTCOMES OF POST-STROKE FACIAL PALSY IN FIFTEEN PATIENTS : A PROSPECTIVE STUDY
Background and Aims
Post-stroke facial palsy significantly impairs motor function and quality of life. While rehabilitation is widely recommended, evidence on optimal protocols remains limited. This study evaluates the efficacy of a multimodal rehabilitation program in 15 patients with facial palsy following ischemic or haemorrhagic stroke. The aim of the study is to demonstrate the importance of early and appropriate rehabilitation of facial palsy following a stroke to improve function and quality of life.
Methods
A prospective study was conducted on 15 consecutive patients (mean age 62 ± 8 years; 9 males, 6 females) with unilateral central facial palsy secondary to stroke. All participants underwent a 12-week standardized rehabilitation program combining : - Neuromuscular re-education (mirror therapy, proprioceptive neuromuscular facilitation), - Electrostimulation (at 20–50 Hz), - Functional training (speech, mastication, and eyelid closure exercises). Outcomes were assessed at baseline, 6 weeks, and 12 weeks using the House-Brackmann Grading System (HBGS), Sunnybrook Facial Grading System (SFGS), and the Facial Disability Index (FDI).
Results
- Functional Improvement : 12/15 patients (80%) achieved ≥1-grade improvement on HBGS (p < 0.01). - Symmetry : SFGS scores improved by 42% ± 12% (p < 0.001), with marked gains in voluntary movement (e.g., smile amplitude increased by 58%). - Quality of Life : FDI social/well-being subscores rose from 45 ± 10 to 72 ± 8 (p < 0.05). Two patients developed mild synkinesis.
Conclusion
A structured 12-week multimodal rehabilitation program significantly improves facial symmetry, motor function, and psychosocial outcomes in post-stroke facial palsy. Early intervention and individualized adjustments (e.g., electrostimulation parameters) are critical for minimizing complications. These findings support integrating such protocols into standard post-stroke care.
Keywords
Facial, palsy, stroke, rehabilitation, functional
#189 REHABILITATION OUTCOMES OF POST-STROKE FACIAL PALSY IN FIFTEEN PATIENTS : A PROSPECTIVE STUDY
Abdelhakim KABIL, Rime DADES, Mouad YAZIDI, Jihad EL ACHKOURA, Ryme EL BELOUI, Hasnaa BOUTALJA, Nada KYAL, Fatima LMIDMANI, Abdellatif EL FATIMI
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
REHABILITATION OUTCOMES OF POST-STROKE FACIAL PALSY IN FIFTEEN PATIENTS : A PROSPECTIVE STUDY
Background and Aims
Post-stroke facial palsy significantly impairs motor function and quality of life. While rehabilitation is widely recommended, evidence on optimal protocols remains limited. This study evaluates the efficacy of a multimodal rehabilitation program in 15 patients with facial palsy following ischemic or haemorrhagic stroke. The aim of the study is to demonstrate the importance of early and appropriate rehabilitation of facial palsy following a stroke to improve function and quality of life.
Methods
A prospective study was conducted on 15 consecutive patients (mean age 62 ± 8 years; 9 males, 6 females) with unilateral central facial palsy secondary to stroke. All participants underwent a 12-week standardized rehabilitation program combining : - Neuromuscular re-education (mirror therapy, proprioceptive neuromuscular facilitation), - Electrostimulation (at 20–50 Hz), - Functional training (speech, mastication, and eyelid closure exercises). Outcomes were assessed at baseline, 6 weeks, and 12 weeks using the House-Brackmann Grading System (HBGS), Sunnybrook Facial Grading System (SFGS), and the Facial Disability Index (FDI).
Results
- Functional Improvement : 12/15 patients (80%) achieved ≥1-grade improvement on HBGS (p < 0.01). - Symmetry : SFGS scores improved by 42% ± 12% (p < 0.001), with marked gains in voluntary movement (e.g., smile amplitude increased by 58%). - Quality of Life : FDI social/well-being subscores rose from 45 ± 10 to 72 ± 8 (p < 0.05). Two patients developed mild synkinesis.
Conclusion
A structured 12-week multimodal rehabilitation program significantly improves facial symmetry, motor function, and psychosocial outcomes in post-stroke facial palsy. Early intervention and individualized adjustments (e.g., electrostimulation parameters) are critical for minimizing complications. These findings support integrating such protocols into standard post-stroke care.
Keywords
Facial, palsy, stroke, rehabilitation, functional
#191 TARLOV'S CYST, CAUSE OF VESICO-SPHINCTER DISORDERS : INTEREST OF URODYNAMIC EXPLORATION : ABOUT TWO CASES
Abdelhakim KABIL, Rime DADES, Mouad YAZIDI, Radia SELLAMI, Ryme EL BELOUI, Hasnaa BOUTALJA, Nada KYAL, Fatima LMIDMANI, Abdellatif EL FATIMI
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
TARLOV'S CYST, CAUSE OF VESICO-SPHINCTER DISORDERS : INTEREST OF URODYNAMIC EXPLORATION : ABOUT TWO CASES
Background
Tarlov’s cyst (TC) is a local dilatation of the subarachnoid space in contact with a nerve root, often affecting the sacral roots. Only 1% of Tarlov’s become symptomatic. The aim of this study is to demonstrate the value of urodynamic exploration in patients with bladder and bowel problems caused by Tarlov cysts.
Case report
Clinical case n°1 : Mrs S.D. aged 53, operated in 2018 for TC, presented at the age of 45 with vesico-sphincter symptoms consisting of an overactive bladder syndrome and dysuria. Urodynamic investigation revealed dysuria with significant post-void residual (PVR) on debimetry, a hyposensitive bladder without uninhibited detrusor overactivity or leakage on cystomanometry, and normal sphincter tone on profilometry. Clinical case n°2 : This is a 3-year-old child, I.B., who underwent a sacral CT scan at the age of 6 months, which revealed a sacral TC at S2. Clinically, the child presented with recurrent urinary tract infections. A urodynamic investigation, indicated by the TC with vesico-ureteral reflux (VUR), revealed a large-capacity bladder without uninhibited detrusor overactivity. The child was referred to paediatric surgeons for suprapubic catheterisation.
Conclusion
Vesico-sphincter disorders are common in Tarlov’s cyst, with signs of a peripheral bladder requiring urodynamic investigation. Appropriate treatment can improve quality of life.
Keywords
Tarlov, cyst, vesico-sphincter, urodynamic
#192 REHABILITATION TREATMENT OF FLACCID PARALYTIC FOOT DROP FOLLOWING A SEVERE KNEE SPRAIN : ABOUT ONE CASE
Abdelhakim KABIL, Mouad YAZIDI, Rime DADES, Oumaima BOULENOUAR, Ryme EL BELOUI, Hasnaa BOUTALJA, Nada KYAL, Fatima LMIDMANI, Abdellatif EL FATIMI
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
REHABILITATION TREATMENT OF FLACCID PARALYTIC FOOT DROP FOLLOWING A SEVERE KNEE SPRAIN : ABOUT ONE CASE
Background
Paralytic foot drop is a frequent complication of peripheral nervous system disorders. Trauma of the lower limb can cause injury to the external popliteal sciatic nerve, resulting in a flaccid paralytic foot that impairs walking.
Case report
We report the case of a young man aged 22, with no particular pathological history, who suffered a closed trauma to the left knee during a football match, resulting in total functional impotence of the left lower limb, and who underwent orthopaedic treatment using an orthosis with appropriate medical treatment. As the impotence persisted, the patient was seen again 21 days later and underwent MRI of the knee, which revealed damage to the anterior cruciate ligament (ACL) and external lateral ligament, tendinitis of the quadricipital tendon and suspected damage to the popliteal external sciatic (PES). An electroneuromyography (ENMG) of the lower limb showed severe truncal damage (neurotmesis) of the PES with signs of active denervation. Functionally, the patient had a stepping gait with a paralytic foot drop and voluntary control of the left foot at 0 in dorsal flexion. For daily walking, the patient used a walking stick on the healthy side. The patient underwent 30 sessions of functional rehabilitation of the left lower limb with work on the gait pattern and prescription of a levator splint. Progress was marked by an improvement in voluntary control of the foot drop, with voluntary control in dorsal flexion increased to 2 with weaning of the English cane, while retaining the levator splint for walking.
Conclusion
Post-traumatic paralytic foot drop due to damage to the external popliteal sciatic nerve is a frequent functional disorder, the management of which can range from functional re-education and orthopaedic devices to surgical intervention via tenotomies, tendon transfers or arthrodesis, depending on the indications.
Keywords
flaccid, paralytic, foot, knee, sprain
#193 ASSISTIVE TECHNOLOGY AND PERCEIVED SAFETY AND AUTONOMY IN PEDIATRIC NEUROLOGICAL REHABILITATION: A DESCRIPTIVE STUDY
PINELOPI VLOTINOU1, FILOMENI ARMAKOLA2, ELENI POTAMITI2, GEORGIOS FELEKIS3, ZOI DALIVIGKA2, ELENI MANTHA2, FOTEINI PAPAGEORGIOU4, ANNA TSIAKIRI5, GEORGIA TSAKNI4, YIANNIS KOUMPOUROS4, PINELOPI VLOTINOU4
2 Early Intervention & Rehabilitation Unit, P. & A. Kyriakou Children's Hospital, Greece
3 University of Medicine and Pharmacy “Grigore T. Popa”, Romania
4 University of West Attica, Greece
5 Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
Conference topic: Children rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
ASSISTIVE TECHNOLOGY AND PERCEIVED SAFETY AND AUTONOMY IN PEDIATRIC NEUROLOGICAL REHABILITATION: A DESCRIPTIVE STUDY
Background and Aims
Background Assistive technology (AT) plays a vital role in the rehabilitation of children with neurological conditions, aiming to enhance functionality, independence, and quality of life. However, its effect on the perception of safety and autonomy remains underexplored. Aim To investigate the impact of assistive technology on the perceived sense of safety and autonomy in children with neurological disorders.
Methods
Methods An epidemiological study was conducted using data collected in 2024 from the Early Intervention and Rehabilitation Department of the “P. & A. Kyriakou” Children’s General Hospital. Descriptive statistics and frequency analysis were applied. Demographic characteristics of participants were recorded, and the “Pythia” scale was used to assess the type and frequency of AT usage.
Results
Results The study included 27 children aged 5–14 years (19 boys, 8 girls) diagnosed with cerebral palsy or posterior fossa tumors. AT devices used included: 11 wheelchairs, 22 ankle-foot orthoses, 1 spinal brace, 5 bicycles, 8 hand orthoses, 7 crutches, 8 walkers, and 4 standing frames. Both the walker and bicycle achieved 100% perceived safety and autonomy according to the children. However, caregiver responses showed some variation: 64% for wheelchairs, 86% for crutches, 75% for walkers, and 78% for ankle-foot orthoses. Among children using upper limb orthoses, only 1 out of 2 reported a sense of autonomy.
Conclusion
Conclusion Assistive technology significantly supports children's perceived sense of safety and autonomy during rehabilitation. Despite variations in self-image, AT is widely adopted and well-accepted in pediatric neurorehabilitation. The supportive role of the family environment enhances comfort and satisfaction with AT. Overall, AT contributes positively to promoting independence in children with neurological impairments.
Keywords
Assistive Technology,children, Neurological Rehabilitation
#194 SPA-BASED REHABILITATION FOR LONG COVID SYNDROME: A PROSPECTIVE STUDY ON FUNCTIONAL AND PSYCHOSOCIAL OUTCOMES IN PREVIOUSLY HOSPITALIZED AND NON-HOSPITALIZED PATIENTS
Maria Chiara Maccarone, Stefano Masiero, Gianluca Regazzo, Paola Contessa, Anna Scanu
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SPA-BASED REHABILITATION FOR LONG COVID SYNDROME: A PROSPECTIVE STUDY ON FUNCTIONAL AND PSYCHOSOCIAL OUTCOMES IN PREVIOUSLY HOSPITALIZED AND NON-HOSPITALIZED PATIENTS
Background and Aims
Long Covid is associated with persistent symptoms such as fatigue, dyspnea, cognitive impairment, and psychological distress, often resulting in a marked decline in patients’ quality of life and autonomy. Conventional rehabilitation may not sufficiently address the multisystemic nature of the condition. Spa settings, integrating traditional treatments with land-based and aquatic rehabilitation, may represent an innovative therapeutic option. This study aimed to evaluate the effects of a 5-week spa-based rehabilitation program on physical, psychological, and cognitive outcomes in Long Covid patients, and to compare recovery patterns based on prior hospitalization status during the acute phase.
Methods
A prospective study was conducted involving Long Covid patients participating in a structured 5-week program at a certified spa center. The intervention included thermal aerosol therapy, individualized physiotherapy (land and aquatic), and cognitive training. Patients were divided into two subgroups based on whether they had been hospitalized during the acute infection. Assessments were performed at baseline (T0), post-treatment (T1), and at 3-month (T2) and 6-month (T3) follow-up. Outcome measures included fatigue (Fatigue Assessment Scale - FAS), dyspnea (Modified Medical Research Council scale - mMRC), pain (Visual Analog Scale - VAS), motor function (6-Minute Walking Test - 6MWT), psychological well-being (Beck’s Anxiety Index - BAI and Beck Depression Index - BDI), and quality of life (12-item Short Form Survey - SF12).
Results
Significant improvements were observed in FAS, mMRC, VAS, 6MWT, BAI and BDI at T1, with sustained benefits at T2 and T3 (p < 0.05). Previously hospitalized patients had initially lower scores in SF12 but showed progressive improvement, reaching similar outcomes to non-hospitalized patients by T3.
Conclusion
Spa-based rehabilitation appears to be a promising approach for Long Covid recovery, offering tailored interventions that address the complex needs of both hospitalized and non-hospitalized patients. These findings support the inclusion of spa facilities in future rehabilitation models for chronic conditions.
Keywords
Long Covid; balneology; aquatic therapy.
#195 ARTIFICIAL INTELLIGENCE FOR EARLY RISK STRATIFICATION AND TREATMENT OPTIMIZATION IN ADOLESCENT IDIOPATHIC SCOLIOSIS: PRELIMINARY RESULTS FROM A CLINICAL IMPLEMENTATION
Maria Chiara Maccarone, Elena Barzizza, Paola Contessa, Gianluca Regazzo, Riccardo Ceccato, Luigi Salmaso, Stefano Masiero
Conference topic: Innovation/imaging in PRM
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ARTIFICIAL INTELLIGENCE FOR EARLY RISK STRATIFICATION AND TREATMENT OPTIMIZATION IN ADOLESCENT IDIOPATHIC SCOLIOSIS: PRELIMINARY RESULTS FROM A CLINICAL IMPLEMENTATION
Background and Aims
Adolescent Idiopathic Scoliosis (AIS) is a multifactorial condition characterized by curve progression. Early identification of high-risk patients is important for timely and effective interventions, including bracing and specific rehabilitation programs. Traditional decision-making relies on single clinical parameters, which may not capture the complexity of risk profiles for each patient. Recent advancements in Artificial Intelligence (AI) that can process and analyze large amounts of data offer new possibilities for precision medicine in AIS care. This study aimed to evaluate the real-world applicability of an AI-based predictive model for early risk stratification in AIS and its role in supporting clinicians in personalized therapeutic decision-making.
Methods
A supervised Machine Learning (ML) algorithm was developed and internally validated using clinical and radiographic data from a retrospective cohort of 600 AIS patients. The model integrated demographic, skeletal maturity, and postural parameters to estimate the risk of curve worsening over 12 months. The outcome variable was defined as either an increase in the Cobb angle or, when follow-up radiographs were unavailable, a clinically assessed increase in rib hump during follow-up.
Results
In the ML model, the most influential predictors of AIS worsening were: lower hump at baseline, lower Risser stage, smaller initial Cobb angle, younger age at the time of brace prescription, and brace prescription for 18–24 hours per day.
Conclusion
The integration of AI in the early management of AIS may enhance clinical decision-making by providing individualized risk profiles and suggesting targeted interventions. Our ML model identifies individualized risk profiles and reveals that patients with milder clinical presentations, such as lower Cobb angles and subtle humps, may paradoxically carry a higher risk of curve progression, thus requiring careful therapeutic consideration to avoid undertreatment.
Keywords
artificial intelligence; scoliosis; machine learning.
#196 IMPROVEMENTS IN GAIT BIOMECHANICS AFTER AN AQUATIC EXERCISE PROGRAM IN A HEALTH RESORT SETTING: A CASE STUDY OF KNEE OSTEOARTHRITIS
Maria Chiara Maccarone, Paola Contessa, Gianluca Regazzo, Stefano Masiero
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
IMPROVEMENTS IN GAIT BIOMECHANICS AFTER AN AQUATIC EXERCISE PROGRAM IN A HEALTH RESORT SETTING: A CASE STUDY OF KNEE OSTEOARTHRITIS
Background
Knee osteoarthritis (OA) is one of the most common degenerative joint diseases causing progressive loss of cartilage that leads to joint stiffness, pain, and difficulty walking and performing activities of daily living. Among non-pharmacological interventions, aquatic exercise programs conducted in health resort settings, combining the benefits of therapeutic exercise with the physical and chemical properties of mineral-rich thermal water, have emerged as a promising approach.
Case report
This case study reports results on the improvements in gait biomechanics in a patient with knee OA (female, age 74 y.o., weight 85 kg, height 163 cm, OA grade II-III on the Kellgren and Lawrence scale) after 2-weeks of rehabilitation treatment, delivered in a health resort setting. Treatment included: 12 sessions of mud therapy and thermal baths and 6 sessions of hydrokinesis. Before and after treatment gait biomechanics was measured using a stereophotogrammetric system (Vicon Motion System Ldt, UK) synchronized with force plates (Bertec Corporation, USA). Results showed that mobility and walking pattern improved, as indicated and increase in walking speed (+6% on average), a decrease in double support time (-44% on average), an increase in knee joint angle range of motion during the gait cycle (+3% on average), and an increase in ankle joint power at toe off (+24% on average). These changes were associated with improvements in the patient’s condition, measured with the Western Ontario and McMaster Universities Arthritis Index improved (decrease from 39 to 19).
Conclusion
Instrumental assessments indicated improvements in mobility and gait, which were associated with clinically measured improvements in function. These preliminary findings suggest that the health resort setting can offer promising therapeutic benefits for knee OA patients, enhancing functional outcomes.
Keywords
Knee, osteoarthritis, balneotherapy, thermal, rehabilitation.
#197 SPASTICITY PREDICTIVE FACTORS OF INPATIENTS WITH STROKE DIAGNOSIS DURING THEIR HOSPITALIZATION IN A REHABILITATION CLINIC
Angeliki Paraschou, Avgoustinos Kampas, Raisa Stylidi, Christina Ziagka, Dimitris Pikridas, Athanasios Tsivgoulis, Konstantina Petropoulou
Conference topic: Neurorehabilitation
Occupation: Nurses
Type of abstract: Scientific abstract
Abstract
Title
SPASTICITY PREDICTIVE FACTORS OF INPATIENTS WITH STROKE DIAGNOSIS DURING THEIR HOSPITALIZATION IN A REHABILITATION CLINIC
Background and Aims
To study and analyze the incidence and onset time of regional spasticity of stroke patients suffering from their first stroke that are inpatients in a rehabilitation clinic. To analyze the predicting factors of early spasticity
Methods
342 stroke patients that were treated as inpatients immediately after their stroke in our rehabilitation clinic were assessed during the period of July 2023 and July 202 . 89/342 patients demonstrated spasticity and from them 71/89 patients were selected fulfilling the criteria of onset of rehabilitation hospitalization 7-90 days (Mean Value 17,8 days) after their stroke onset.
Results
89/342 presented signs of spasticity ( 34.2%) inclusive of patients with mAshworth scale of 1 and Brunnstrom recovery scale of 2. 41/71 of patients were men (57,7%) and 30/71 women (42.25).Ischaemic 57/71(80,28%) and 14 hemorrhaging (7.10%). Left hemiplegia 34 /71(47.8% and right hemiplegia 37/71 (52.11%). Age span 22.85% >80 y.o , 30.5% (71-80) , 25.71% (61-70), 11.45% (51-60) and 4,41% (41-50).24.28% of patients had comorbidities and 55.7 % were smokers and13.0% obese. Admission Barthel Index ranged 2-24/100 with mean value of 9/100 38/71 (53,52%) of patients received im Botulinum Toxin treatment and 26/71(36.6%) were treated only with per os antispastic drugs.
Conclusion
( 34.2%) of patients with diagnosis of first Stroke had spasticity onset at the acute and subacute phase. Sex , hemiplegia side and age are not relevant to the appearance of hypertonia. Patients with lower Barthel Index and ischaemic type of stroke with lifestyle characteristics as obesity and smoking tend to manifest spasticity after stroke. Therefore it is important during the admission of stroke patients in a rehabilitation clinic to systematically assess on a weekly basis the muscle tone to detect signs of early onset spasticity. The training of the nursing and therapeutic staff to detect hypertonia signs is crucial to diagnose and treat early spasticity.
Keywords
Spasticity, Stroke, Botulinum, Toxin
#198 THE INFLUENCE OF THE INTENSITY OF SENSORY INTEGRATION THERAPY ON THE OUTCOME MEASURED BY THE GAS SCALE
Tatjana Šimunić, Jasmina Kurjak, Tatjana Vrga, Marija Ćuk
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE INFLUENCE OF THE INTENSITY OF SENSORY INTEGRATION THERAPY ON THE OUTCOME MEASURED BY THE GAS SCALE
Background and Aims
Sensory integration therapy (SIT) is an important therapeutic concept in the treatment of children with sensory integration difficulties. In the modern world there is a high prevalence of SI integration difficulties. 5% to 20% of children without diagnosed developmental disabilities have SI difficulties. SIT has a clinically positive effect on the treatment of these disorders but without clearly defined guidelines about the intensity of its implementation. The aim of this randomized controlled trial is to assess whether the intensity of sensory integration therapy has an impact on the achievement of therapeutic goals measured through an individualized outcome measure the Goal Attainment Scale (GAS).
Methods
This randomized controlled trial included 20 children aged 2-9 years with sensory integration difficulties. The children were randomly selected into two groups of 10 children each. First group attended sensory integration therapy (SIT) periodically once a week for 45 minutes over 10 visits, while the second attended SIT in a cycle of 10 therapy sessions of 45 minutes daily. Each child was assigned 3 therapeutic goals. Each goal was assigned a baseline value (- 1) and a final value using the GAS scale ranging from -2 to +2. Then a GAS score, called a T-score and level of change were calculated for each participant.
Results
The study outcomes were achieved T score and level of change. The T score outcome was statistically significantly better in the daily treatment group and the change level outcome recorded an even larger difference, which was highly significant. The group that received treatment daily had statistically significantly better results than the group that received treatment once a week.
Conclusion
More extensive studies are needed for definitive recommendations on the intensity of the implementation of SIT but the preliminary results of our study move in the direction that it should be implemented in daily cycles.
Keywords
Sensory difficuties; SIT; GAS scale
#199 MANAGEMENT OF LOWER URINARY TRACT (LUT) OF STROKE PATIENTS IN THE ACUTE AND SUBACUTE PHASE.
Avgoustinos Kampas, Angeliki Paraschou, Raisa Stylidi, Christina Ziagka, Pagonntini Chatzidimitriou, Athanasios Tsivgoulis, Konstantina Petropoulou
Conference topic: Neurorehabilitation
Occupation: Nurses
Type of abstract: Scientific abstract
Abstract
Title
MANAGEMENT OF LOWER URINARY TRACT (LUT) OF STROKE PATIENTS IN THE ACUTE AND SUBACUTE PHASE.
Background and Aims
Stroke patients often present urinary dysfunction and symptoms of incomplete bladder voiding, urgency and incontinence. Inappropriate management of the lower urinary tract can lead to several complications. Purpose: The study aims to demonstrate the importance of early LUT management and the removal of indwelling catheter towards a normalized function of the sphincter-bladder unit and a positive rehabilitation program outcome.
Methods
We studied 47 stroke patients, 17 female and 30 male, that were hospitalized in our rehabilitation clinic for the interval of 60 days (September 2024-October2024). Before removing the indwelling catheter, a thorough assessment of the LUT and cognitive function, of the perineal reflexes and sensibility was performed, taking also into account the prostate function of male patients as well as urinary tract ultrasound, urine analysis and urine culture. Antimuscarinic and a-blockers drugs were administered and the indwelling catheter was safely removed according to our clinic protocol.
Results
25 out of 47 patients had their catheter removed 7-15 days after admission for rehabilitation under a-blockers medication and antimuscarinic drugs that were ceased when voluntary micturition with low post micturition urine volume was achieved. Unsuccessful catheter removal was analyzed per patient case.
Conclusion
The early removal of the indwelling catheter of stroke patients can lead to a normalized LUT function and at the same time allows an unburdened rehabilitation program including hydrotherapy , having positive effect on the cerebral function assuring continence.
Keywords
Lower, urinary, tract, Cerebral, stroke
#200 LOWER URINARY TRACT MANAGEMENT PROTOCOLL OF PATIENTS WITH SPINAL CORD INJURY . THE CONTRIBUTION OF THE NURSING STAFF
Angeliki Paraschou, Avgoustinos Kampas, Raisa Stylidi, Christina Ziagka, Asimina Griva, Vasiliki Mani, Athanasios Tsivgoulis, Konstantina Petropoulou
Conference topic: Neurorehabilitation
Occupation: Nurses
Type of abstract: Scientific abstract
Abstract
Title
LOWER URINARY TRACT MANAGEMENT PROTOCOLL OF PATIENTS WITH SPINAL CORD INJURY . THE CONTRIBUTION OF THE NURSING STAFF
Background and Aims
Purpose: To demonstrate the contribution of rehabilitation nurses to the management of lower urinary tract dysfunction (LUTD) of spinal cord injury (SCI) patients
Methods
A micturition dysfunction protocol was implemented to our SCI patients with neurogenic bladder dysfunction that were admitted to our rehabilitation clinic, in order to prevent complications , to reassure a without residual volume or incontinence bladder emptying , with low bladder detrusor pressure. We analyzed the bladder-sphincter mechanism of the LUT. The study includes patients with cervical, thoracis and lumbar spinal cord injury as well as patients with cauda equina syndrome. All patients during admission to the rehabilitation clinic had indwelling catheter. To all patients with suprasacral lesion anticholinergic drug was administered to prevent risk of detrusor hyperactivity. The patients were assessed my medical rehabilitation specialist team, urinary tract ultrasound and urine analysis and urine culture were performed. To all male patients with suprasacral lesion an a-blocker was added to their medication before removing the indwelling catheter
Results
Patients with incomplete SCI were set under a protocol of intermittent catheterization in order to supervise their neurogenic bladder and alter the prescribed medication according to their needs. Patients with complete suprasacral SCI were treated with antimuscarinic drugs and were educated in intermittent catheterization technique so as to assure a regular bladder voiding under low intradetrusor pressure. Patients with sacral spine lesions present significant difficulty in the management of their neurogenic bladder.
Conclusion
The training of the rehabilitation clinics nursing staff and their involvement in the management of SCI patients neurogenic bladder is crucial to the success of the process, the lower urinary tract safety , a successful rehabilitation program and the social integration of the patient
Keywords
LOWER URINARY, SPINAL CORD INJURY
#202 SEVERE NEUROLOGICAL COMPLICATIONS OF CHRONIC NITROUS OXIDE ABUSE: A CASE SERIES
Gonçalo Martins e Pereira, David Oliveira Cordeiro, João Ventura Luís, Sandra Palma, João Morgadinho, Marta Nascimento, Alyne Cordeiro, Margarida Mota Freitas, Inês Mendes Ribeiro, Pedro Pereira
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SEVERE NEUROLOGICAL COMPLICATIONS OF CHRONIC NITROUS OXIDE ABUSE: A CASE SERIES
Background and Aims
Nitrous oxide (N₂O) is widely used for its anesthetic and analgesic properties, but its increasing recreational use poses serious neurological risks. N₂O toxicity is linked to vitamin B12 deficiency and demyelination, affecting both the central and peripheral nervous systems. This study presents a case series of severe NI-NDs, focusing on pathophysiology, clinical presentation, and treatment. It also highlights the role of PRM in patient recovery.
Methods
A retrospective case series was conducted, analyzing NI-ND patients treated at a Portuguese tertiary hospital from January 2021 to December 2024. Data were extracted from hospital records, assessing demographics, neurological and systemic manifestations, laboratory, imaging and electrophysiological findings, therapeutic strategies, functional outcomes, and PRM departments' collaboration.
Results
Eight NI-ND cases required hospital care. Patients were mostly women (75%), aged 17–28 years. Half worked in the food and beverage industry, 25% were unemployed, and the rest were students. All had chronic N₂O use (2.88±1.79 years). All patients presented sensory deficits and gait disturbances, with symptoms progressing for 26.25±40.63 weeks before seeking hospital care. All patients had Vitamin B12 deficiency and homocysteine levels indeterminable. All MRI showed T2 hypersignal in the posterior cervical cords. Electromyography identified axonal sensorimotor polyneuropathy in 71.4%, and all somatosensory evoked potentials showed central deep sensory pathway dysfunction. Transcranial magnetic stimulation in four patients revealed pyramidal tract dysfunction in 75%. All received vitamin B12 supplementation. All hospitalized patients were evaluated by the PMR team, and 75% continued treatment in PRM department, with one requiring rehabilitation centre admission. Functional status was assessed using the FIM, improving from 114±18.42 to 124.38±3.86 over six months.
Conclusion
Chronic N₂O abuse leads to severe neurological consequences. Early recognition and multidisciplinary care, including PRM, are crucial for recovery. Despite functional improvement, some symptoms persist. Increased awareness, early screening, and patient education are essential to reduce long-term disability and improve patient outcomes.
Keywords
Nitrous-Oxide, Substance-Abuse, Neuropathy, Multidisciplinarity
#203 LATE-ONSET LIMB ISCHEMIA AFTER TOTAL HIP REPLACEMENT: RECOGNIZING A RARE VASCULAR COMPLICATION
Raquel Sofia Santos, Diogo Araújo, José Pedro Pimenta, Joana Silva, Ana Carolina Nunes, Luís Silva, José Vilaça-Costa, Rui Vaz
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
LATE-ONSET LIMB ISCHEMIA AFTER TOTAL HIP REPLACEMENT: RECOGNIZING A RARE VASCULAR COMPLICATION
Background
Total hip arthroplasty (THA) is a widely performed procedure with high rates of patient satisfaction. Despite its safety profile, complications, including vascular events, can occur. Vascular complications following THA are uncommon, with an estimated prevalence of 0.2-0.3%, being more frequent in revision procedures. Although rare, such complications can have devastating consequences.
Case report
We present the case of a 63-year-old male with a history of adult-onset Still's disease and hypertension, who underwent THA due to avascular necrosis of the femoral head. Approximately three years later, he underwent revision surgery for acetabular component loosening. Ten months post-revision, he reported right hip pain. A CT scan revealed an extensive collection containing metallic fragments, suggestive of metallosis, along with significant thinning of acetabular wall, leading to being proposed for revision surgery. However, within two months, he developed acute ischemia of the right lower limb. Imaging showed a thrombus in the external iliac artery at the site of contact with the area of metallosis, causing significant stenosis. The patient underwent prosthetic explantation and stent placement in the affected artery. Due to progressive ischemia, a transtibial amputation was required. The rehabilitation process was complex, requiring an individualized program focused on strengthening the periarticular hip musculature, the contralateral lower limb, and the upper limbs, as well as gait training using assistive devices and stump conditioning for prosthetic fitting. Subsequently, the patient underwent hip reconstruction with a custom-made acetabular component. Currently, the patient demonstrates modified independence in daily activities, ambulates with two crutches, exhibiting preserved hip and knee function, with potential for limited community ambulation (Medicare Funcional Classification - K2 level), awaiting prosthetic fitting.
Conclusion
This case highlights the rare but severe risk of late vascular complications following THA revision and underscores the critical role of coordinated multidisciplinary rehabilitation in restoring function and autonomy after limb loss.
Keywords
Hip_arthroplasty; Limb_ischemia; Transtibial_amputation; Multidisciplinary_Rehabilitation
#204 FROM PAIN TO PERFORMANCE: SHOCKWAVE THERAPY RESOLVING REFRACTORY SESAMOIDITIS IN A PROFESSIONAL DANCER
Inês Camarinha1, Catarina Afonso2, Adriana Correia2, Jorge Rodrigues2, Diogo Martins2, Daniano Caires3
2 ULS São José, Portugal
3 Hospital Central da Madeira, Portugal
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
FROM PAIN TO PERFORMANCE: SHOCKWAVE THERAPY RESOLVING REFRACTORY SESAMOIDITIS IN A PROFESSIONAL DANCER
Background
Metatarsalgia related to sesamoid bone dysfunction is a frequent clinical challenge in Physical and Rehabilitation Medicine (PRM), particularly among active individuals. Sesamoiditis is often associated with mechanical overload, repetitive microtrauma, and anatomical variants such as bipartite sesamoids. Conservative management is the first-line treatment, though some cases prove refractory. Extracorporeal Shockwave Therapy (ESWT) has emerged as a promising non-invasive option for resistant cases.
Case report
We report the case of a 28-year-old woman, a professional ballroom dancer and habitual wearer of high-heeled shoes, who developed mechanical pain localized at the plantar aspect of the right first metatarsal head. The pain worsened with weight-bearing, like walking and dancing, leading to significant limitations in her daily and professional activities.Initial treatment with NSAIDs and analgesics provided no relief. US and MRI revealed a bipartite sesamoid and suggested sesamoiditis. Orthotic insoles and multiple sessions of physiotherapy were prescribed but failed to improve symptoms. Given the refractory nature of her condition, ESWT was initiated. The treatment protocol consisted of one session per week for four weeks, with 2000 pulses per session, a frequency of 7 Hz, and a medium energy level of 0.3 mJ/mm². Progressive pain relief was noted during therapy. By the end of the treatment cycle, she reported only mild residual discomfort, no limitations in walking, and gradual return to dancing activities. No further pharmacological or surgical interventions were necessary.
Conclusion
This case underscores the critical role of PRM in the comprehensive management of metatarsalgia, particularly in refractory cases. ESWT proved to be an effective and safe non-invasive rehabilitation strategy, providing significant pain relief and functional recovery, enabling return to professional activity without restrictions. The inclusion of ESWT in rehabilitation protocols may offer a valuable alternative for accelerating recovery and avoiding invasive treatments in sesamoiditis.
Keywords
Sesamoiditis, Rehabilitation, Shockwave, Therapy, Metatarsalgia
#205 QUALITATIVE ANALYSIS OF EXPECTATIONS AND USER EXPERIENCE WITH A BRAIN-MACHINE INTERFACE IN HEALTHY PARTICIPANTS: A PILOT STUDY FOR UPPER LIMB MOTOR REHABILITATION AFTER STROKE
Marta Torres1, João Oliveira2, João Freitas3, Miguel Pais-Vieira4
2 Universidade Nova Lisboa, Portugal
3 Unidade Local de Saúde de Coimbra, Portugal
4 Universidade de Aveiro, Portugal
Conference topic: Innovation/imaging in PRM
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
QUALITATIVE ANALYSIS OF EXPECTATIONS AND USER EXPERIENCE WITH A BRAIN-MACHINE INTERFACE IN HEALTHY PARTICIPANTS: A PILOT STUDY FOR UPPER LIMB MOTOR REHABILITATION AFTER STROKE
Background and Aims
As an emerging rehabilitation approach, brain-machine interfaces (BMI) have garnered significant attention, particularly for their potential to enhance patient compliance and rehabilitation outcomes. Optimizing their configuration requires consideration not only of technical performance but also of non-technical aspects of user experience. This study aimed to understand how healthy subjects perceive the use of a BMI, considering expectations, ethical concerns and user experience, to adapt the device for later use in the rehabilitation of post-stroke patients.
Methods
Qualitative analysis of semi-structured interviews using WebQDA software. Interviews were conducted at two distinct junctures: before and after the experience with the BMI. The BMI used electroencephalogram to detect brain activity. Subjects used motor imagery of extending their wrist and fingers on a visual cue while immersed in a hyperrealist virtual reality (VR) setting and receiving electrical stimulation of wrist and fingers.
Results
Seven subjects were recruited, 4 women and 3 men aged between 40 and 76. Prior to the task, all except one expected difficulty in activating the BMI using motor imagery. After the experience, 6 subjects were satisfied and felt their expectations had been met or surpassed. Four felt the VR environment contributed most to feeling connected to the device, while 3 credited electrical stimulation. Only one felt in control, the others felt controlled by the system. Three reported tiredness by the end of the experiment and 6 reported slight discomfort, either from the VR goggles, the electrical stimulation or the prolonged sitting position. None had ethical concerns about this BMI.
Conclusion
Subjects demonstrated overall tolerance for the BMI and satisfaction with its performance. Emphasizing motivating elements and enhancing users' sense of agency and connection is crucial, as is minimizing factors that cause discomfort, boredom or disengagement. We expect this study will improve BMI user experience and rehabilitation success in post-stroke patients.
Keywords
"Brain-machine interface", "stroke", "rehabilitation"
#206 REHABILITATION OF A PATIENT WITH PARAPLEGIA AFTER SPINAL CORD INJURY-CASE REPORT
Daniela Gechevska, Cvetanka Gjerakaroska Savevska, Biljana Mitrevska, Valentina Koevska, Erieta Nikolikj Dimitrova, Maja Manoleva, Marija Gocevska, Biljana Kalchovska, Teodora Jugova, Lidija Stojanoska Matjanoska, Ana Krsteska
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
REHABILITATION OF A PATIENT WITH PARAPLEGIA AFTER SPINAL CORD INJURY-CASE REPORT
Background
Spinal cord injury (SCI) is a critical medical condition that causes numerous impairments leading to accompanying disabilities. The rehabilitation of paraplegic patients following SCI is influenced by various factors like level of injury, timing of rehabilitation and available therapeutic interventions. Robotic-assisted gait training (RAGT) offers many advantages, including the capability to increase intensity and total duration of training while maintaining a physiological gait pattern.
Case report
A 20-year-old patient with a fracture of the Th10 and Th11 vertebrae following a car accident, with compression on the spinal cord at those levels, underwent surgery а month before first rehabilitation. He was presented with bilateral lower limb weakness, spasticity, absence of bowel and bladder control, unable to stand and walk. Incomplete SCI classified as B on the American Spinal Injury Association (ASIA) Impairment Scale, Berg Balance scale (BBS) score 0 out of 56 reflecting complete inability to walk. Barthel index (BI) for activities of daily living (ADL) was 13 - total dependency. The patient was treated with a combined approach of conventional physiotherapy and RAGT on the Lokomat Pro. Conventional rehabilitation consisted of manual massage, magnetotherapy, stretching exercises, positioning, bed mobility and trunk stability exercises, static and dynamic balance exercises, walking with orthosis and crutches, occupational therapy. RAGT was carried out in three sessions,15 treatments each with individually customized parameters.
Conclusion
Results:The combined approach led to a significant improvement in functional motor skills, including walking without orthosis, balance and lower limb muscle strength. After three sessions he was classified D on ASIA scale, 54 score on BBS-independent, BI was 100-full independence. This case study's findings show the importance of early onset of physiotherapy and RAGT in enabling patients to carry out ADL and prevention of serious secondary problems. A combined approach could be promising in alleviating the burden of disability caused by SCI.
Keywords
SCI injuries, Lokomat , combined approach
#207 MEDIAL COLLATERAL LIGAMENT BURSITIS: A RARE BUT TREATABLE CAUSE OF KNEE PAIN UNMASKED BY ULTRASOUND
Inês Camarinha1, Catarina Afonso2, Ana Rita Pessoa2, Fábio Pinho2, Diogo Martins2, Jorge Rodrigues2
2 ULS São José, Portugal
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
MEDIAL COLLATERAL LIGAMENT BURSITIS: A RARE BUT TREATABLE CAUSE OF KNEE PAIN UNMASKED BY ULTRASOUND
Background
Persistent medial knee pain in older adults is frequently attributed to osteoarthritis (OA), often overlooking less common yet treatable periarticular conditions. Medial collateral ligament (MCL) bursitis is an underdiagnosed source of knee pain that can mimic or coexist with OA. The use of musculoskeletal ultrasound (MSK-US) at the point of care not only refines diagnosis but also enables targeted interventions, potentially altering patient outcomes. This case highlights the successful management of MCL bursitis using ultrasound guidance, with both symptomatic relief and imaging-confirmed structural resolution.
Case report
A 73-year-old woman presented with chronic medial knee pain of mixed mechanical and inflammatory pattern, worsened by weight-bearing. Radiographs showed moderate medial compartment gonarthrosis. Despite conservative management, including physiotherapy, NSAIDs, and analgesics, her pain remained localized to the medial aspect of the knee with significant functional limitation. During a Physical and Rehabilitation Medicine (PRM) consultation, bedside MSK-US identified an exuberant bursitis adjacent to the MCL, precisely matching the site of maximal pain (US images will be presented). An ultrasound-guided injection was performed into the MCL bursa using 1% lidocaine and 14 mg of betamethasone, with no complications. The patient experienced progressive pain relief, and at 3-month follow-up, reported substantial clinical improvement. Repeat ultrasound confirmed resolution of the bursitis, with notable approximation of the deep and superficial layers of the MCL, indicating structural recovery.
Conclusion
This case illustrates the diagnostic and therapeutic value of ultrasound in identifying MCL bursitis, a rare but significant cause of persistent medial knee pain that must be considered for the differential diagnosis. Ultrasound-guided corticosteroid injection resulted in both clinical and imaging-confirmed resolution, demonstrating that targeted periarticular interventions can offer effective pain relief and structural normalization. Incorporating routine MSK-US in the evaluation of refractory knee pain can refine diagnoses and personalize treatment strategies, avoiding unnecessary escalation of OA management.
Keywords
Medial, collateral, ligament, bursitis, ultrasound
#208 PAIN AND THE PEDIATRIC POPULATION, A NEW HOPE IN SICKLE CELL DISEASE.
Ana Rita Pessoa, Fabio Pinho, Inês Camarinha, Catarina Afonso, Tiago Rei Miranda, Marta Lopes, Diogo Cardadeiro, Diogo Ribeiro Martins
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
PAIN AND THE PEDIATRIC POPULATION, A NEW HOPE IN SICKLE CELL DISEASE.
Background
Sickle cell disease (SCD) is a hereditary and chronic hematological disease with no cure to date. It has a complex pathophysiology and multisystemic repercussions that can limit participation in daily life activities and significantly reduce QoL. Vaso-occlusive crises (VOC), the main clinical hallmark of this condition, occur due to changes in blood rheology, adhesion of dense aggregates of sickled erythrocytes, activated leukocytes and platelets to the vascular endothelium, release of inflammatory mediators, downstream obstruction of blood flow with local hypoxemia, tissue damage and pain. The intense pain characteristic of VOC is the main reason for ER visits and hospital admissions. In the chronic setting, the cumulative damage induced by VOC affects multiple systems including the musculoskeletal system. Recurrent bone infarctions, increased susceptibility to infections, and the accelerated bone resorption, culminate in phenomena such as osteonecrosis, arthritis, decreased bone mineral density, osteoporosis, and pathological fractures.
Case report
This case concerns a 17-year-old adolescent with severe, chronic, and disabling gonalgia that led to multiple hospital admissions for pain control and therapeutic adjustment. She underwent an intra-articular corticosteroid injection, with no clinical benefit. At discharge, she still experienced mixed-pattern pain, with an intensity of 3/10 on the baseline NRS and 8/10 at peak, despite ongoing treatment. A diagnostic ultrasound-guided block of the genicular nerves and the infrapatellar branch of the saphenous nerve was performed, which yielded a positive response, leading to the decision to proceed with cooled radiofrequency (c-RF) ablation. The procedure was uneventful, and at the eight-week follow-up, she continued to experience a significant reduction in pain intensity and had no new VOC, acute chest syndrome or other acute complications of SCD.
Conclusion
To our knowledge, this is the first reported case of c-RF performed in a pediatric population, and it opens the door to improved QoL for children and adolescents with SCD.
Keywords
SCD, Pain, cooled-RF
#209 RECURRENT ANKLE SPRAINS IN THE VISUALLY IMPAIRED: HIDDEN IMPACT ON POSTURAL CONTROL
Jihad El Achkoura1, Khaoula Rsaissi1, Papa Lo Ndiouga2, Ryme El Beloui1, Hasnaa Boutalja2, Nada Kyal2, Fatima Lmidmani2, Abdellatif El Fatimi2
2 Physical and Rehabilitation Medicine Department,Ibn Rochd University Hospital, Casablanca, Morocco
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
RECURRENT ANKLE SPRAINS IN THE VISUALLY IMPAIRED: HIDDEN IMPACT ON POSTURAL CONTROL
Background and Aims
Visually impaired individuals are at increased risk of balance disorders and falls due to reduced visual input. Recurrent ankle sprains are a common complication in this population and may result from impaired proprioception and postural instability. Despite the frequency of these injuries, few studies have objectively evaluated the balance and joint stability in visually impaired patients with chronic ankle instability. To assess postural control and ankle proprioception in visually impaired patients with a history of recurrent ankle sprains, using validated clinical scales and static posturography.
Methods
We conducted a cross-sectional study involving 30 adult patients with low vision (visual acuity <3/10 in the better-seeing eye) and at least two ankle sprains in the past 12 months. The following assessments were performed: Static posturography on a force platform (firm and foam surfaces, natural visual condition), Cumberland Ankle Instability Tool (CAIT) for functional ankle instability, Berg Balance Scale (BBS) for static and dynamic balance, Timed Up and Go (TUG) test to evaluate fall risk, Ankle joint position sense test to assess proprioceptive accuracy.
Results
The mean age was 42.3 ± 11.2 years; 70% had bilateral ankle instability. The mean CAIT score was 15.2 ± 3.4 (cutoff <24 indicating instability). The mean center of pressure sway area increased significantly on foam (410 mm² vs. 275 mm² on firm surface, p 13.5 seconds. The mean ankle repositioning error was 4.1° (normal <2°).
Conclusion
Visually impaired individuals with recurrent ankle sprains demonstrate significant postural and proprioceptive deficits. These findings highlight the need for tailored rehabilitation programs including balance training and proprioceptive re-education to reduce recurrence and fall risk in this vulnerable population.
Keywords
Visual impairment, Ankle
#210 A RARE CASE OF BOTULISM AFTER HOMEMADE SAUSAGE INGESTION: INITIAL MISDIAGNOSIS AND ITS LONG-TERM FUNCTIONAL OUTCOME
Catarina Vasconcelos Fonseca1, Sara Lima2, Marta Gil2, Mariana Soutinho2, Michel Mendes2, Maria João Cotter2
2 ULSTMAD, Portugal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
A RARE CASE OF BOTULISM AFTER HOMEMADE SAUSAGE INGESTION: INITIAL MISDIAGNOSIS AND ITS LONG-TERM FUNCTIONAL OUTCOME
Background
Botulism is a rare neuroparalytic disease caused by botulinum toxin from Clostridium species. It presents with cranial nerve paralysis with descending progression and is often linked to consuming contaminated food. Diagnosis is confirmed through toxin detection. Treatment involves supportive care and antitoxin, with PMR essential for recovery.
Case report
A 45-year-old male with a history of dyslipidemia, obesity, and hyperuricemia, who was previously independent in ADL, presented to the Emergency Department (ED) with holocranial headache, nausea, photophobia, dizziness, and right upper limb paresthesia. A CT scan showed no significant findings, and he was discharged after symptomatic treatment. Two days later, he returned with worsening symptoms, including dysphagia and progressive global motor deficits. He reported consuming homemade sausages prior to symptom onset. Physical examination revealed peripheral facial paralysis, dysphagia, flaccid dysarthria, and symmetric tetraparesis (MRC G3), without sensory deficits. A lumbar puncture showed slight albuminocytological dissociation. Suspecting Guillain-Barré Syndrome, the patient was transferred to the ICU for respiratory failure risk, completing 5 days of immunoglobulin therapy. On day 8, he started physiotherapy, including speech and physical therapy. After 2 weeks, the diagnosis was confirmed with a positive C. botulinum neurotoxin test. Due to favorable clinical progression, the patient was discharged with outpatient rehabilitation. At 6 months follow-up, there was significant improvement in neuromotor function, particularly in orofacial motor skills and dysphagia. Muscle strength was grade 4+ globally, except for proximal thigh strength (grade 4). He regained independence in ADLs, needing minimal assistance for transitions, and was able to walk independently with slight postural imbalance. (video)
Conclusion
Although the antitoxin was not administered due to the delayed definitive diagnosis of botulism, the patient had a favorable clinical outcome. The physiatric treatment, tailored to improve orofacial motility, voice and swallowing training, along with global muscle strengthening and gait training, was essential in the patient’s rehabilitation.
Keywords
Botulism; Misdiagnosis; rehabilitation;
#211 EPIDEMIOLOGY AND MANAGEMENT OF FUNCTIONAL URINARY DISORDERS IN CHILDREN
Nada Kyal, Hasnaa Boutalja, Ryme El Beloui, Taha Zineddine, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EPIDEMIOLOGY AND MANAGEMENT OF FUNCTIONAL URINARY DISORDERS IN CHILDREN
Background and Aims
Urinary disorders in children are very common. If left untreated, they can affect quality of life as well as nephrological prognosis. The objective of our study is to evaluate these functional urinary disorders in children to propose an appropriate therapeutic approach.
Methods
This is a retrospective descriptive study involving 125 children referred to the department of Physical Medicine and Rehabilitation for the management of functional urinary disorders. The parameters analyzed include: Sociodemographic characteristics of patients, Urinary symptoms, Urodynamic data and therapeutic management implemented.
Results
The average age was 8 ± 0.5 years, with a female predominance. The most common urinary symptoms were: Primary nocturnal enuresis (68%), Urgency (58.4%), Urge incontinence (52%), Pollakiuria (44%). Urinary tract infection was found in 48% of patients, while 41.6% had constipation and 26.4% presented with anal incontinence. A family history of urinary disorders was reported in 32% of cases. Neurological examination revealed no abnormalities, and vesicorenal ultrasound showed no upper urinary tract anomalies. However, a significant post-void residual volume was noted in 23.2% of patients. Urodynamic exploration, performed in 82 patients, revealed: a reduced bladder capacity (62.4%) and detrusor overactivity (53.6%). Therapeutic management combined multiple approaches: Therapeutic educational measures and treatment of irritative factors in all patients, pharmacological treatment with prescription of anticholinergic drugs in 61.6% of patients, administration of an ADH analogue in 6 patients, intermittent catheterization in 20% and perineal rehabilitation in 78 children.
Conclusion
The management of urinary disorders in children requires a systematic and thorough analysis of multiple parameters to propose a comprehensive and tailored therapeutic approach.
Keywords
Functional urinary disorders, Children, urodynamic
#212 CAREGIVER BURDEN AND PSYCHOLOGICAL IMPACT OF NOCTURNAL ENURESIS
Nada Kyal, Ryme El Beloui, Hasnaa Boutalja, Sara Hadir, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CAREGIVER BURDEN AND PSYCHOLOGICAL IMPACT OF NOCTURNAL ENURESIS
Background and Aims
Nocturnal enuresis (NE), commonly known as bedwetting, is characterized by involuntary urination during sleep at least twice a week in children over five years of age, persisting for a minimum of 3 months. This study aimed to assess the burden experienced by caregivers of children with NE and its effect on their psychological well-being.
Methods
It’s a prospective study including 85 patients over five years old undergoing treatment for primary NE. The impact on caregivers was assessed using the french version of Zarit Burden Interview (ZBI) and the Hamilton Depression Scale (HAM-D), while children's enuresis patterns were evaluated through a voiding diary. Caregivers of children with additional lower urinary tract symptoms or other comorbidities, and caregivers with pre-existing psychological health conditions, were excluded.
Results
The average age of children was 8.7 years [6 -15 years], with 80% coming from low-income families and 35.3% having a family history of enuresis. The mean duration of enuresis was 4.3 years, and all children were receiving simple behavioral interventions, such as reward-based strategies and scheduled nighttime awakenings for urination. According to voiding diary records, 69.4% of children experienced nocturnal enuresis daily. The mean age of caregivers was 34.6 years, with 94.1% of mothers. The average score on the ZBI was 63.2, with 68.2% of caregivers reporting a lack of personal time due to their caregiving responsibilities. Additionally, 96.2% of mothers felt that their social life was negatively impacted. According to the HAM-D, 35.3% of caregivers experienced mild depression, yet only 7% sought professional help.
Conclusion
Healthcare professionals often focus primarily on the patient’s quality of life, while overlooking caregiver burden. Further research on anxiety and depression management in caregivers of children with NE is needed. Implementing support strategies for caregivers could improve their well-being and contribute to better adherence to treatment plans for affected children.
Keywords
nocturnal enuresis, children, caregiver burden
#213 EVALUATION OF THE SATISFACTION OF OLDER ADULTS WITH A KNEE ARTHROPLASTY AFTER A GROUP EXERCISE PROGRAMME
Alexandre Silva, Catarina Branco
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Health professionals (Physiotherapist
Type of abstract: Scientific abstract
Abstract
Title
EVALUATION OF THE SATISFACTION OF OLDER ADULTS WITH A KNEE ARTHROPLASTY AFTER A GROUP EXERCISE PROGRAMME
Background and Aims
Knee arthroplasty is the most frequently performed lower limb surgery in older adults. Adherence to physical exercise programme has been shown to contribute significantly to improved functionality, quality of life and perception of safety, factors that are closely associated with high levels of satisfaction among individuals undergoing this type of surgery. Aims: To analyse the satisfaction of older adults with knee arthroplasty with a group exercise programme.
Methods
A descriptive observational study involving 36 older adults who took part in a group exercise programme supervised by a physiotherapist. The programme lasted a total of 15 sessions, held three times a week, with sessions lasting 30 minutes each. Individuals who took part in the programme in an aquatic environment were excluded from the study. For data collection, a characterisation questionnaire was applied, including specific questions about the participants' satisfaction with the programme.
Results
The sample showed a homogeneous gender distribution, with an average age of 70.3 years (SD = 5.3). Most of the participants were retired (94%; n=34) and 33% (n=12) perceived their state of health as good. The participants attributed benefits to the exercise programme in terms of functionality and safety in activities of daily living. The majority (97.2%) perceived an improvement in quality of life. However, only 25% considered the duration of the sessions to be adequate. It is important to note that all respondents reported being satisfied with the programme.
Conclusion
The programme shows satisfaction among older adults in terms of functionality, safety and quality of life. However, its duration doesn't seem to show satisfaction. These data reinforce the importance of the user experience as an indicator of quality in healthcare.
Keywords
Exercise, Physiotherapy, Functionality, Safety
#214 GERIATRIC REHABILITATION AGAINST FRAILTY AND SARCOPENIA
Marija Markovski1, Marija Markovski2, Vesna Lazarovska3, Biljana Shishkova4, Irina Popdimitrova Mitrevska5, Bozidar Blazevski2, Nerhim Tufekcioski2
2 CGH "8th September" - Skopje, Macedonia
3 Public Health Institution- Rehabilitation Center for pathology of verbal communication"- Skopje, Macedonia
4 PHI Kardiomedika- Srbinovski- Skopje, Macedonia
5 CH Acibadem Sistina - Skopje, Macedonia
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
GERIATRIC REHABILITATION AGAINST FRAILTY AND SARCOPENIA
Background
The goal of geriatric rehabilitation is to improve functional ability, autonomy, and quality of life in older adults after illness, injury, or surgery. It aims to restore independence, prevent further decline, support mental health, facilitate community reintegration, and coordinate multidisciplinary care. The aim of this paper is to highlight the role of physical activity through various exercises in improving strength and power at the level of individual muscle fibers, as well as enhancing overall functionality. Before starting different exercise programs, methods for pre-exercise assessment will be presented, along with contraindications for participation in the exercise program.
Case report
Various low-intensity exercises will be presented, including gradually progressive resistance training, respiratory and aerobic exercises. These types of training improve muscle mass, strength, and function, promote neurological adaptation and coordination, and increase bone density. The program will be designed with an individualized approach and will include walking exercises, as well as balance exercises, which are particularly effective in preventing falls in individuals with a history of falling. Methods for assessing muscle mass, muscle strength, and physical performance will also be presented. Physical performance is defined as the objectively measured function of the whole body related to locomotion, for objective evaluation, the gait speed test is used, which is safe and highly reliable for diagnosing frailty, while the SPPB (Short Physical Performance Battery) is applicable in clinical practice.
Conclusion
In the recommendations of EWGSOP2 and the FACS algorithms, the first step in the rehabilitation of sarcopenia and frailty together with nutritional support, which are the two most important interventions is best implemented together.
Keywords
Geriatric, Rehabilitation, kinesiotherapy, Progressive Resistance
#215 URINARY AND ANO-RECTAL SPHINCTER DYSFUNCTION IN CHRONIC PELVIC PAIN SYNDROME: A CROSS-SECTIONAL STUDY IN A PHYSICAL MEDICINE AND REHABILITATION CENTER
Jihad El Achkoura1, Doaa El Mahil1, Khaoula Rsaissi2, Ryme El Beloui1, Hasnaa Boutalja2, Nada Kyal2, Fatima Lmidmani2, Abdellatif El Fatimi2
2 Physical and Rehabilitation Medicine Department,Ibn Rochd University Hospital, Casablanca, Morocco
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
URINARY AND ANO-RECTAL SPHINCTER DYSFUNCTION IN CHRONIC PELVIC PAIN SYNDROME: A CROSS-SECTIONAL STUDY IN A PHYSICAL MEDICINE AND REHABILITATION CENTER
Background and Aims
Chronic pelvic pain syndrome (CPPS) is a multifactorial condition that significantly impairs quality of life. Urinary and ano‐rectal sphincter disturbances often coexist, exacerbating functional morbidity. This cross‐sectional study aimed to assess the prevalence and characteristics of sphincteric disorders in patients with CPPS managed in a Physical Medicine and Rehabilitation (PM&R) setting.
Methods
Between January and December 2024, 130 consecutive patients (83 women, 47 men; mean age 44.3 ± 11.7 years) with CPPS duration > 6 months were enrolled. Assessments included clinical history; pelvic pain intensity via Visual Analog Scale (VAS) and neuropathic pain screening (DN4); urinary sphincter evaluation using the Urinary Sphincter Profile (USP) score; ano‐rectal function via the Cleveland Clinic Constipation and Incontinence scores; and health‐related quality of life using the SF-12 questionnaire. Complementary investigations (urodynamic studies, imaging) were performed when indicated.
Results
Mean CPPS duration was 3.2 ± 1.5 years. Etiologies comprised endometriosis (23.1 %), pelvic myofascial pain (20 %), traumatic childbirth sequelae (13.1 %), prostatodynia (11.5 %), post‐surgical changes (10.8 %), interstitial cystitis (9.2 %), and idiopathic cases (12.3 %). Urinary symptoms were reported by 64.6 % (urgency 40.8 %, dysuria 29.2 %, incontinence 21.5 %), while 38.5 % exhibited ano‐rectal disturbances (constipation 26.2 %, fecal incontinence 12.3 %). Dual sphincter involvement occurred in 23.1 %. Neuropathic pain (DN4 > 4) was present in 41.5 %. Average VAS was 6.8 ± 1.3, mean USP score 14.0 ± 3.9, and 68.5 % had impaired physical SF-12 scores (< 35).
Conclusion
Sphincteric dysfunction, especially urinary, is highly prevalent in CPPS and substantially undermines physical quality of life. Central sensitization features in over 40 % of patients, and one‐quarter experience combined urinary and ano‐rectal involvement. A comprehensive, multidisciplinary PM&R approach incorporating targeted sphincter evaluation is essential for optimal management.
Keywords
Chronic, pelvic, pain-Sphincter, dysfunction-Urinary, symptoms-Ano-rectal
#216 ASSESSING DRIVING COMPETENCE IN SPINAL CORD INJURY PATIENTS: A RETROSPECTIVE STUDY
Catarina Vasconcelos Fonseca1, Joana Ramalho2, Ana Isabel Romeiro3, Margarida Rodrigues4, Maria Cunha4, Maria João Cotter5
2 ULSEDV, Portugal
3 ULSDEV, Portugal
4 CRN, Portugal
5 ULSTMAD, Portugal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSESSING DRIVING COMPETENCE IN SPINAL CORD INJURY PATIENTS: A RETROSPECTIVE STUDY
Background and Aims
Spinal cord injury (SCI) is a damage to the spinal cord that has significant repercussions on functionality and participation in basic activities of daily living (ADLs) and instrumental activities (IADLs), and can even compromise the ability to drive a car. This study characterises a sample of patients who underwent a driving fitness assessment after a SCI, identifying the most common adaptations to vehicles and the restrictions imposed.
Methods
This is an observational, analytical and retrospective study carried out in a rehabilitation centre that has a specific consultation for assessing driving ability. The medical records of patients diagnosed with SCI who were assessed in this context over the past two years were reviewed. The variables age, gender, referral, etiology, level of SCI, classification according to the American Spinal Injury Association (AIS) and motor scores were included. The Statistical Package for the Social Sciences (SPSS) software, version 29.0.0.0 (IBM Corp., Armonk, NY), was used for statistical analysis.
Results
A total of 66 patients were included, mostly male (77.3%), with a median age of 59 years, and referred from outpatient clinics (68.2%). The most representative SCI was of non-traumatic etiology (50%) and with an AIS D classification (71.2%). The majority of patients were deemed fit to drive (98.48%), with the most frequent adaptations being automatic gear selection (56.1%) and the handbrake (34.8%). A lower motor score in the lower limbs and total motor score were associated with a greater number of adaptations (p<0.001), as were complete injuries (AIS A) (p=0.003).
Conclusion
The level of SCI directly affects autonomy and therefore driving ability. A careful assessment by a doctor, following a pathology or trauma that could compromise this ability, is essential to restore the patients autonomy and enable them to resume driving in a safe and adapted manner.
Keywords
Spinal cord injury; rehabilitation; driving
#217 LONG-TERM CAREGIVER SUPPORT NEEDS AFTER TBI: ASSOCIATION WITH FIM SCORES AT DISCHARGE
José Nuno Teles da Silva Madureira1, Matilde Rodrigues2, André Ribeiro2, Sara Cabete Martins2, Maria João Sousa2, Inês Campos2
2 Centro de Medicina de Reabilitação da Região Centro - Hospital Rovisco Pais, Portugal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
LONG-TERM CAREGIVER SUPPORT NEEDS AFTER TBI: ASSOCIATION WITH FIM SCORES AT DISCHARGE
Background and Aims
TBI often results in long-term functional impairments, necessitating varying levels of caregiver support to perform daily activities. Assessing functional outcomes at discharge, such as the FIM scores, may help predict the long-term need for caregiver support.
Methods
This is a observational, cross-sectional, and analytical study including adults with moderate to severe TBI who completed intensive inpatient rehabilitation and had available follow-up data two years post-discharge. Patients with other systemic conditions with significant functional impact were excluded. Data were collected retrospectively from anonymized medical records and included age, gender, injury severity, FIM scores at discharge, and daily hours of caregiver support two years post-injury. Statistical analysis was performed using IBM®SPSS®Statisticsv29. Means and standard deviations were reported for continuous variables. The Shapiro-Wilk test assessed normality. Associations between FIM scores and caregiver support needs were evaluated using Spearman’s rank correlation (p<0.05).
Results
Twelve individuals were enrolled in the study. The mean age was 40.9 years (SD 14.5), and 83.3% participants were male . At discharge, the mean total FIM score was 73.3 (SD 35.9). The average motor and cognitive FIM gains during rehabilitation were 19.2 (SD 18.8) and 6.0 (SD 7.4), respectively. Two years post-injury, participants required an average of 10.3 hours of caregiver support per day (SD 9.6), ranging from 0 to 24 hours. A significant negative correlation was observed between total FIM score at discharge and the number of weekly hours of caregiver support (Spearman’s ρ=-0.72, p=0.009). Motor FIM gain also showed significant inverse correlation with caregiver support needs (ρ=-0.65, p=0.021), while cognitive gain was moderately correlated, though not significantly (ρ=-0.54, p=0.068).
Conclusion
There is a significant association between functional status at discharge and long-term caregiver support needs after TBI. While no standardized predictive models currently exist in Europe, establishing objective criteria grounded in functional assessment tools could have meaningful clinical and legal implications.
Keywords
TraumaticBrainInjury; FunctionalIndependenceMeasure; CaregiverSupport; RehabilitationOutcomes;
#218 PERSONALIZATION OF CARE IN PHYSICAL AND REHABILITATION MEDICINE DURING THE POSTPARTUM PERIOD AFTER STROKE IN YOUNG ADULTS: A CASE REPORT
Diogo Rodrigues, Catarina Afonso, Adriana Correia, Inês Camarinha, António Monteney, Marta Silva
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
PERSONALIZATION OF CARE IN PHYSICAL AND REHABILITATION MEDICINE DURING THE POSTPARTUM PERIOD AFTER STROKE IN YOUNG ADULTS: A CASE REPORT
Background
Postpartum period is a delicate and physically and emotionally demanding phase in a woman’s life. When complicated by a severe event such as a stroke, this phase presents unique challenges due to motor, cognitive, and emotional impairments, which impact both rehabilitation and maternal caregiving.
Case report
A 36-year-old postpartum woman, mother of a 2-month-old baby, with medical history of hepatitis B virus infection and non-ischemic dilated cardiomyopathy with an implanted cardioverter-defibrillator, presented to the emergency department with global aphasia, a preferential gaze deviation to the left crossing the midline, minor right central facial paresis, right hemiparesis with muscle strength grade 2 in the upper limbs and grade 3 in the lower limbs, ipsilateral painful hemihypoesthesia, with a NIHSS score 17. Initial brain imaging revealed a carotid top occlusion (ASPECTS 5) followed by thrombectomy with partial reperfusion (TICI2b), complicated by distal occlusion and internal carotid artery dissection. After monitoring in the Stroke Unit she was transferred to the PRM Service (PRMS) for an intensive, multidisciplinary rehabilitation program including physical, occupational, and speech therapy. At admission to PRMS, she followed simple and some complex commands, displayed pseudobulbar affect and severe global aphasia, and had right hemiparesis (muscle strength grade 3), impaired fine motor function, and sensory deficits. She also struggled with ADLs/IADLs, especially those related to infant care. Personalized rehabilitation included not only motor and language recovery but also training in baby care tasks, compensatory communication strategies, and safe feeding and handling techniques. Visits with her baby were encouraged to promote bonding, and family education sessions supported the transition home. At discharge, the patient could safely and independently perform essential baby care, including hygiene, bottle feeding, and holding her infant.
Conclusion
This case highlights the importance of personalized, multidisciplinary rehabilitation approaches that address both functional recovery and postpartum caregiving adaptation in young stroke survivors.
Keywords
Stroke, Postpartum, Rehabilitation, Personalized care
#219 ASSOCIATION BETWEEN CIGARETTE SMOKING AND FRAGILE HIP FRACTURE IN BOSNIAN POSTMENOPAUSAL WOMEN
Amila Kapetanovic1, Gordan Bajic2
2 Pan-European University Apeiron, Banja Luka, Bosnia and Herzegovina
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSOCIATION BETWEEN CIGARETTE SMOKING AND FRAGILE HIP FRACTURE IN BOSNIAN POSTMENOPAUSAL WOMEN
Background and Aims
Cigarette smoking is a well-established risk factor for osteoporosis; however, limited evidence exists regarding its association with skeletal fragility in specific population groups. The aim of this study was to examine the association between cigarette smoking and the occurrence of fragile hip fractures among Bosnian postmenopausal women.
Methods
A study was conducted involving 100 Bosnian postmenopausal women, divided into two groups: those with fragile hip fractures (n=50) and those without (n=50). Bone mineral density (BMD) was measured at the lumbar spine and proximal femur using Dual-Energy X-ray Absorptiometry (DXA). Smoking status was self-reported. To compare differences between groups, χ2 test and Student’s t-test were used.
Results
No significant difference in age was observed between groups. A significantly higher proportion of women in the fracture group were smokers (54%; n=27) compared to the control group (16%; n=8) (p=0.0001). Additionally, average femoral neck BMD was significantly lower in women with hip fractures (-2.74 ± 0.73 SD) than in those without fractures (-1.48 ± 0.99 SD) (p=0.0001).
Conclusion
Cigarette smoking is significantly associated with an increased risk of fragile hip fracture in Bosnian postmenopausal women. Lower BMD is also confirmed as a major contributing factor to fracture risk in this population.
Keywords
Bosnian postmenopausal women, fracture, smoking
#220 STRACHAN-SCOTT SYNDROME IN A MODERN CONTEXT: A CASE REPORT AND REHABILITATION PERSPECTIVE
Kaung Zaw Hein1, Mohankumar Mariappan2, Moe Myint1, Gayathri Ruwanpura3
2 Royal Wolverahampton NHS Trust, United Kingdom
3 Royal Wolverahmpton NHS Trust, United Kingdom
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
STRACHAN-SCOTT SYNDROME IN A MODERN CONTEXT: A CASE REPORT AND REHABILITATION PERSPECTIVE
Background
Strachan-Scott Syndrome, also known as Tropical Ataxic Neuropathy (TAN) or Jamaican Neuropathy, was first described in 1887 by Dr Henry Strachan among plantation workers in Jamaica. It is characterized by a triad of optic neuropathy, painful symmetrical sensory polyneuropathy and less commonly, auditory symptoms. Other features may include ataxia, mucocutaneous lesions and nutritional deficiencies—particularly riboflavin (B2) and B12. Though historically linked to undernutrition and cassava consumption, it remains under-recognised especially in individuals of Afro-Caribbean descent.
Case report
We present a 35-year-old Afro-Caribbean woman, born in United Kingdom, with morbid obesity, mental health comorbidities and alcohol excess, who became bedbound following progressive neuropathic symptoms. Initial symptoms began over two years ago and worsened during a visit to Jamaica and after bereavement. She reported visual disturbances, symmetrical limb paraesthesia, weakness and incontinence without hearing loss or significant ataxia. Examination revealed reduced lower limb power, areflexia, sensory loss up to the knees, and finger-nose ataxia. MRI spine showed dorsal column signal changes without compressive myelopathy. NCS confirmed severe sensory axonal polyneuropathy. Investigations revealed vitamin B12 deficiency and elevated acylcarnitine levels. Despite extensive workup, an underlying metabolic disorder was not confirmed. Given clinical features and background, a diagnosis of Strachan-Scott Syndrome was made. Rehabilitation challenges Management involved riboflavin and B-vitamin supplementation, pain control, bladder/bowel retraining, neuropsychological support and tailored mobility rehabilitation. Her significant obesity posed challenges in mobilisation and assessment including failed lumbar puncture. She improved with physiotherapy and was discharged to step-down rehabilitation.
Conclusion
Strachan-Scott Syndrome is a neglected yet potentially reversible neuropathy. Awareness among rehabilitation physicians is crucial particularly in at-risk populations to facilitate timely diagnosis, nutritional support and functional recovery.
Keywords
Strachan-Scott Syndrome, Tropical_Ataxic_Neuropathy, Neuro_rehaiblitation
#222 SPINAL CORD INJURY : TARGETED REHABILITATION ALIGNED WITH MOROCCAN PATIENTS' FUNCTIONAL GOALS
Radia Sellami, Kawtar Mansag, Nisrine Mounsif, El Beloui Ryme, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SPINAL CORD INJURY : TARGETED REHABILITATION ALIGNED WITH MOROCCAN PATIENTS' FUNCTIONAL GOALS
Background and Aims
Spinal cord injury (SCI) is a mojor cause of disability that severely impacts quality of life (QoL). Rehabilitation programs must address patients’ most critical functional deficits. However, current guidelines rely heavily on Western data, which may not reflect Moroccan patients' socio-cultural context. Our study identifies the functional priorities of Moroccan SCI patients to elaborate culturally adapted rehabilitation.
Methods
SCI patients hospitalized or following up in the physical and rehabilitation medicine department at Ibn Rochd University Hospital, were asked to ranked five functional areas from 1 (most important) to 5 (least important): hand and arm function, walking, bladder and bowel function, sexual function and pain relief. Additional demographic and clinical data were collected medical personnel: age, gender, educational level, cause of SCI, time since onset, level of injury and ASIA score.
Results
59 patients were included in the study, of which 37,3% women and 62,7% men. Their mean age was 38,9 ± 16,4 years. The mean duration since onset was 6,8 ± 9,5 years, and 81,3 % of patients had onset since ≥ 3 years. Only 35 % had a high level of education. 39% were tetraplegic and 61% were paraplegic. 32,2% had a complete injury. Walking (n= 22) as well as hand and arm function (n=18) were most selected as first priority, followed by bladder and bowel function (n=14). Sexual function was ranked least important by 33.9% (n=20). Tetraplegic patients strongly prioritized hand/arm function, while no other demographic factors significantly influenced rankings.
Conclusion
Understanding functional priorities of SCI patients in Morocco enables healthcare providers to deliver targeted, patient-centered care. Larger studies are needed to gather enough data in order to develop rehabilitation programs that are tailored to our socio-cultural context, which can lead to better results regarding QoL and overall wellbeing.
Keywords
Spinal Cord Injury, Functionnal Recovery
#224 IS LIMB-SPARING SURGERY MORE EFFECTIVE THAN AMPUTATION IN ENHANCING PATIENTS' QUALITY OF LIFE AND FUNCTIONAL CAPACITY?
Hasnaa BOUTALJA, Ryme ELBELOUI, Nada KYAL, Fatima LMIDMANI, Abdellatif ELFATIMI
Conference topic: Cancer rehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
IS LIMB-SPARING SURGERY MORE EFFECTIVE THAN AMPUTATION IN ENHANCING PATIENTS' QUALITY OF LIFE AND FUNCTIONAL CAPACITY?
Background and Aims
For patients with aggressive musculoskeletal tumors in the lower extremities, treatment options may include above-knee amputation or limb-salvage surgery. However, the comparative subjective and objective advantages of limb-salvage surgery over amputation remain uncertain. This study aims to compare functional status and quality of life for patients treated with above-knee amputation versus limb-salvage surgery.
Methods
As part of a retrospective cohort study, we analyzed 39 out of 68 patients aged 17 years and older who underwent either above-knee amputation or limb-salvage surgery for aggressive musculoskeletal tumors around the knee between 2014 and 2022. During the final follow-up, we collected data using the Physiological Cost Index, the Reintegration to Normal Living Index, SF-36, and the Toronto Extremity Salvage Score questionnaires. The minimum follow-up duration was 14 months, with a median of 60 months
Results
Patients who underwent limb-salvage surgery demonstrated higher Physiological Cost Index scores and greater reintegration into normal living than those who had above-knee amputation. However, the Toronto Extremity Salvage Scores and SF-36 outcomes were comparable between the groups.
Conclusion
These findings indicate that limb-salvage surgery provides superior gait efficiency and facilitates reintegration into daily life compared to above-knee amputation. However, it does not enhance the patient's perceived quality of life
Keywords
Limb, sparing, surgery, amputation, functional
#225 BEYOND BASIC MOBILITY: COMPREHENSIVE ASSESSMENT OF WHEELCHAIR DRIVING SKILLS IN CHILDREN
Katja Groleger Sršen1, Simona Korelc2, Laura Kostanjšek2, Jana Brodnik2, Anita Pesek2
2 URI Soča, Slovenia
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BEYOND BASIC MOBILITY: COMPREHENSIVE ASSESSMENT OF WHEELCHAIR DRIVING SKILLS IN CHILDREN
Background and Aims
Children using wheelchairs require efficient driving skills to enhance their functioning and participation in daily activities, including engagement in traffic. Currently available assessment tools lack sufficient focus on these specific skills. Therefore, we developed a new comprehensive test to evaluate wheelchair driving abilities in pediatric populations.
Methods
We designed a test comprising four subscales with 32 items for active wheelchair (AW) users—managing wheelchair, basic and advanced driving skills, skilful driving, and traffic—with an additional subscale for electric-powered wheelchair (EPW) users. Each item was evaluated on a 4-point scale. For pilot testing, we recruited children referred to our pediatric department between July 2019 and September 2024. Following assessment, selected participants underwent a 10-day specific training program targeting identified skill deficits.
Results
The study included 100 children (68 boys), with a mean age of 8.3 years; 55 used AW and 45 used EPW. Vast majority of children were with cerebral palsy (90 %), others with neuromuscular diseases. None were excluded from the study. Children using EPW scored significantly lower than those using AW across all four subscales (p<0.001). On average, children demonstrated greatest difficulty in wheelchair management and advanced driving skills, achieving only 43.5% and 46.2% of the maximum possible score for AW users (15.2% and 45.7% for EPW users, respectively). Twenty children participated in the targeted training program, resulting in mean total improvements of 2.5 points for the AW group (n=8) and 3.2 points for the EPW group (n=12).
Conclusion
The developed assessment tool effectively identifies specific wheelchair driving skills requiring improvement and clearly differentiates between AW and EPW users' abilities. The test demonstrated adequate sensitivity to detect modest improvements following a focused training intervention. Future research will focus on establishing the psychometric properties of this assessment tool to validate its use in clinical practice.
Keywords
child, wheelchair, skills,test
#226 ELBOW ARTHROLYSIS OUTCOMES: PAIN, MOTION, FUNCTION, AND SOCIO-OCCUPATIONAL RECOVERY
Hamza IMAMI1, Nisrine MOUNSIF1, Ryme EL BELOUI1, Hasnaa BOUTALJA1, Nada KYAL1, Fatima LMIDMANI1, Abdellatif EL FATIMI2
2 Abdellatif, Morocco
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
ELBOW ARTHROLYSIS OUTCOMES: PAIN, MOTION, FUNCTION, AND SOCIO-OCCUPATIONAL RECOVERY
Background and Aims
Background Elbow stiffness, whether post-traumatic or secondary to neurogenic paraosteoarthropathy (PAON), can severely impair upper limb function. Beyond pain and reduced mobility, it may limit autonomy and restrict return to daily activities or work. While arthrolysis improves joint mechanics, long-term outcomes and reintegration remain variable. Aim To evaluate functional outcomes after elbow arthrolysis and assess the impact of residual disability on autonomy and return to work.
Methods
This retrospective study included 18 patients hospitalized in our Physical Medicine and Rehabilitation department at CHU Ibn Rochd, who underwent elbow arthrolysis followed by standardized inpatient rehabilitation. Mean follow-up was 18 months (range: 12–24 months). Assessments included: • Pain (VAS), • Joint mobility (flexion, extension, ROM), • Functional scores (QuickDASH, Mayo Elbow Performance Score), • Autonomy (Functional Independence Measure – FIM), • Quality of life (SF-12 physical and mental scores), • Occupational status at follow-up.
Results
The mean age was 30.9 ± 9.3 years (range: 18–45), with 9 men and 9 women. Stiffness was post-traumatic in 13 cases and PAON-related in 5. Pain decreased (VAS: 6.2 → 1.6). Flexion improved from 75.8° to 108.3°, extension from −29.7° to −7.2°, and ROM from 105.6° to 115.6°. QuickDASH improved from 71.5 to 34.8, MEPS from 38.3 to 84.4 (83% rated “good” or “excellent”), and FIM from 83.9 to 114.3. SF-12 physical scores rose from 32.5 to 46.6, and mental from 29.6 to 53.1. Despite improvements, 5 patients (27%) could not return to their previous jobs due to persistent functional limitations.
Conclusion
Elbow arthrolysis leads to meaningful improvements in pain, mobility, and overall function. However, its true impact extends beyond physical recovery, as residual limitations may affect independence, mental well-being, and return to work. A multidisciplinary approach—integrating rehabilitation, psychological support, and vocational planning—is essential to ensure full and sustainable reintegration how many word
Keywords
Elbowarthrolysis, Functionalrecovery, Returntowork, Rehabilitation
#227 FOUR-YEAR FOLLOW-UP ON POST-STROKE FATIGUE AND WORKFORCE REINTEGRATION
Hasnaa BOUTALJA, Nada KYAL, Ryme ELBELOUI, Fatima LMIDMANI, Abdellatif ELFATIMI
Conference topic: Neurorehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
FOUR-YEAR FOLLOW-UP ON POST-STROKE FATIGUE AND WORKFORCE REINTEGRATION
Background and Aims
Although post-stroke fatigue can hinder returning to work, there is a lack of quantitative research on this topic. Therefore, we performed a long-term cohort study to determine if fatigue is independently linked to the likelihood of returning to paid employment.
Methods
Our study included 95 first-time stroke patients under 65 years old who were employed full-time at baseline. They were recruited from the neurology department of IBN ROCHD University Hospital between 2018 and 2020 and followed for four years. Fatigue levels were measured using the Multidimensional Fatigue Inventory, with pathological fatigue defined as a General Fatigue dimension score of ≥12. Return to paid employment was characterized as working at least 10 hours per week. Data analysis was conducted using multivariable logistic regression.
Results
After four years, 60% of patients had resumed paid employment. The adjusted Odds Ratio (OR) for returning to work was 0.37 (95% confidence interval [CI] 0.15-1.05) for those who had a baseline General Fatigue score of ≥12. Persistent pathological fatigue after four years of follow-up was linked to a reduced likelihood of returning to paid work [Adjusted OR 0.31, 95% CI 0.12-0.78]. Additionally, higher General Fatigue scores at follow-up showed a negative association with work resumption, with each point increase in fatigue corresponding to an adjusted OR of 0.86 (95% CI 0.79-0.93).
Conclusion
Post-stroke fatigue seems to be an independent factor contributing to the inability to return to paid employment after a stroke.
Keywords
Post stroke, fatigue, work-reintegration
#228 OSTEONECROSIS OF THE KNEE AFTER PARENTERAL CORTICOSTEROID APPLICATION AND INTRA-ARTICULAR HYALURONIC ACID INJECTION
Diana Balen1, Marija Cetinić2, Tomislav Nemčić1
2 Special Hospital for Medical Rehabilitation Kalos, Croatia/Hrvatska
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
OSTEONECROSIS OF THE KNEE AFTER PARENTERAL CORTICOSTEROID APPLICATION AND INTRA-ARTICULAR HYALURONIC ACID INJECTION
Background
Osteonecrosis is the death of bone tissue due to interruption of blood supply. The development is associated with systemic and intra-articular use of corticosteroids. The earliest symptom is pain. We present the case of an 65-year-old female that developed osteonecrosis of the right knee after parenteral corticosteroid application and intra-articular hyaluronic acid injection.
Case report
Patient was presented in our practice in October 2024 with the pain in the right knee. Degenerative changes of the knee were visible on MRI in July 2024 and were treated with intra-articular corticosteroid injection with good effect on pain. Because of spinal stenosis symptomatology, she received an epidural corticosteroid injection (ESI). Two days prior the ESI, intra-articular hyaluronic acid injection (HAI) was applied because of the degenerative changes of the knee. Two weeks after the HAI, at the beginning of August 2024, the knee pain got worse which led to further corticosteroid intra-articular applications. Two months after the pain intensified, at the beginning of 10/24, the diagnosis of osteonecrosis of medial femoral condyle was confirmed with a MR scan. The patient started walking with two crutches and 50 days of continuous physical therapy were performed. On MR scan control edema was reducing. The load on the right leg was gradually increased. During the last check-up in March 2025., due to clinical deterioration and deterioration of edema on MR findings, knee arthroplasty was recommended.
Conclusion
If left untreated, osteonecrosis can lead to the destruction of joint. Except one study, we haven`t found any cases in literature connecting the onset of osteonecrosis with hyaluronic acid intra-articular application. The goal of our case report is to draw attention to the cumulative dose of corticosteroids that can lead to the development of osteonecrosis as well as after the combination of corticosteroids and intra-articular hyaluronic acid injection.
Keywords
osteonecrosis, intra-articular, corticosteroid, hyaluronic acid
#229 THE SPINAL CORD INJURED PATIENT: WHAT CHANGES IN BODY PERCEPTION ? AND WHAT IMPACT ON MENTAL HEALTH?
Oumaima Boulenouar, Abir Lemkadem, Radia Sellami, Ryme Elbeloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif ELfatimi
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE SPINAL CORD INJURED PATIENT: WHAT CHANGES IN BODY PERCEPTION ? AND WHAT IMPACT ON MENTAL HEALTH?
Background and Aims
Spinal cord injury (SCI) leads to profound sensorimotor deficits, significantly altering body perception. Understanding these changes is crucial for rehabilitation and improving quality of life. The Body Perception Questionnaire for Spinal Cord Injury (BOFI-SCI) assesses how SCI patients perceive their body post-injury. The Aims of this study is to : Investigate changes in body perception in SCI patients using the BOFI-SC, to identify correlations between injury level, completeness, and body perception alterations and to explore psychological and functional implications of these changes.
Methods
This study includes adults who have experienced either traumatic or non-traumatic spinal cord injuries at least six months ago. People will be excluded if they have severe cognitive issues or other neurological conditions that aren’t related to their SCI. 50 patients was included. The research is a cross-sectional study using the BOFI-SCI, a trusted tool that measures feelings of body ownership, agency, and disconnection. We also gathered information like age, gender, injury details (using the ASIA Impairment Scale), and psychological health with the HADS questionnaire
Results
As regards how individuals feel their bodies, there are relatively obvious differences, especially in the case of tetraplegia patients. They feel less like they own their bodies. Also, the more serious the damage is, the more they feel less in control of their movements. Interestingly, about 30% of people with complete spinal cord injury experience phantom sensations. Psychologically, the feeling of being disconnected from your body seems to be linked with higher depression.
Conclusion
SCI drastically impairs body perception, with tetraplegia and complete injuries demonstrating the most significant alterations. BOFI-SCI is a sensitive index of these alterations, arguing in favor of the need for specific interventions (mirror therapy, cognitive-body integration strategies) for improving body schema and mental health. Long-term changes following rehabilitation need to be explored in future work.
Keywords
spinal , injury, body, perception , mental
#230 ELECTROMYOGRAPHIC ASSESSMENT OF PROFESSIONAL GOALKEEPERS EXPERIENCING SHOULDER PAIN DURING A FUNCTIONAL ACTIVITY
Hasnaa BOUTALJA, Ryme ELBELOUI, Nada KYAL, Fatima LMIDMANI, Abdellatif ELFATIMI
Conference topic: Sports medicine rehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
ELECTROMYOGRAPHIC ASSESSMENT OF PROFESSIONAL GOALKEEPERS EXPERIENCING SHOULDER PAIN DURING A FUNCTIONAL ACTIVITY
Background and Aims
This study aimed to assess and compare the electromyographic activity of specific shoulder girdle muscles in professional goalkeepers, both with and without shoulder pain.
Methods
Ten professional goalkeepers participated in the study, five experiencing shoulder pain (mean age: 19.60 ± 3.20 years, body mass: 74.50 ± 2.85 kg, height: 17.80 ± 5.39 cm) and five without pain (mean age: 19.11 ± 1.65 years, body weight: 73.50 ± 6.10 kg, height: 178.50 ± 5.10 cm). Surface electromyography signals were recorded from seven upper limb muscles while participants performed a task, marking points with a pen in a counterclockwise motion within three circles. The normalized root-mean-square value was used to assess muscular activation.
Results
Goalkeepers experiencing shoulder pain exhibited increased activation in the upper trapezius (pain group mean: 27.90 ± 10.50, control group mean: 13.30 ± 6.10; p = 0.002, η²p = 0.450), serratus anterior (pain group mean: 30.50 ± 19.80, control group mean: 13.20 ± 5.60; p = 0.025, η²p = 0.280), and latissimus dorsi (pain group mean: 26.90 ± 17.80, control group mean: 4.85 ± 3.95; p = 0.002, η²p = 0.448) muscles. However, no significant differences (p > 0.05) were observed in the activation of the middle and lower trapezius, middle deltoid, and sternocleidomastoid
Conclusion
Modified muscle activation patterns may play a role in shoulder pain among professional goalkeepers and should be taken into account in rehabilitation strategies.
Keywords
EMG; goalkeepers; shoulder pain
#231 FUNCTIONAL REHABILITATION AFTER TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH RHEUMATOID ARTHRITIS: SPECIFIC CHALLENGES AND PERSONALIZED STRATEGIES
Douae EL OUAZZANI, Asmaa Hsissi, Radia Sellami, Ryme El Beloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
FUNCTIONAL REHABILITATION AFTER TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH RHEUMATOID ARTHRITIS: SPECIFIC CHALLENGES AND PERSONALIZED STRATEGIES
Background and Aims
Total knee arthroplasty (TKA) aims to improve function in rheumatoid arthritis (RA) patients; however, diverse epidemiological, clinical, radiological, biological profiles, and ongoing medical treatments influence rehabilitation outcomes. This study therefore investigated the impact of personalized rehabilitation, tailored to these parameters, on functional recovery post-TKA in these patients.
Methods
A prospective cohort study enrolled 60 rheumatoid arthritis (RA) patients undergoing primary total knee arthroplasty (TKA) at the Physical Medicine and Rehabilitation Department of Ibn Rochd University Hospital Center in Casablanca. Baseline data collected included age, body mass index (BMI), Charlson Comorbidity Index, pain intensity (Numeric Pain Rating Scale - NPRS), functional status (Health Assessment Questionnaire - HAQ), Kellgren-Lawrence grade, inflammatory biological markers (C-reactive protein - CRP, erythrocyte sedimentation rate - ESR), and current medical treatment (corticosteroids, conventional synthetic /biologicDMARDs.. ). Personalized rehabilitation programs were designed based on these individual patient profiles. Functional outcomes were evaluated at 12 weeks postoperatively using the Timed Up and Go (TUG) test and the Knee Injury and Osteoarthritis Outcome Score (KOOS).
Results
At 12 weeks, personalized rehabilitation significantly improved functional outcomes, with mean Timed Up and Go (TUG) decreasing from 22.1 ± 4.5 s to 14.5 ± 2.8 s (p<0.001) and mean Knee Injury and Osteoarthritis Outcome Score for Activities of Daily Living (KOOS-ADL) increasing from 45.8 ± 7.6 to 72.3 ± 9.1 (p<0.001). Subgroup analysis indicated that patients with fewer comorbidities, negative inflammatory markers, and those receiving biologic DMARD therapy achieved significantly better TUG (13.5 ± 2.3 s, 13.2 ± 2.0 s, 13.0 ± 2.1 s respectively) and KOOS-ADL (75.0 ± 8.0, 77.0 ± 7.0, 78.5 ± 7.5 respectively) compared to their respective counterparts (p<0.05).
Conclusion
Personalized rehabilitation enhances functional recovery after TKA in RA patients. Fewer comorbidities, lower inflammation, and biologic DMARD use correlate with greater improvements, highlighting the importance of individual patient characteristics in rehabilitation strategies.
Keywords
knee arthroplasty, rheumatoid arthritis, rehabilitation
#232 IS THERE AN IMPACT OF RESISTANCE TRAINING ON THE PHYSICAL CONDITION OF INDIVIDUALS WITH MULTIPLE SCLEROSIS ?
Hasnaa BOUTALJA, Nada KYAL, Ryme ELBELOUI, Fatima LMIDMANI, Abdellatif ELFATIMI
Conference topic: Neurorehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
IS THERE AN IMPACT OF RESISTANCE TRAINING ON THE PHYSICAL CONDITION OF INDIVIDUALS WITH MULTIPLE SCLEROSIS ?
Background and Aims
The progression of physical disability due to multiple sclerosis (MS) leads to various consequences, including greater mobility loss and diminished quality of life. This study investigated the impact of resistance training on the functional capacity of individuals with MS.
Methods
Participants were intentionally grouped based on the Expanded Disability Status Scale (EDSS). The experimental group (EG) consisted of eight individuals, with 10.8% scoring 0-3.0, 83.1% scoring 3.5-5.5, and 6.1% scoring 6.0-7.5 on the EDSS. The control group (CG) also included eight participants, with 22.4% having a score of 0-3.0, 65.8% scoring 3.5-5.5, and 11.8% scoring 6.0-7.5. The EG completed a 12-week resistance training program, while the CG did not receive intervention. The Timed "Up & Go" test was used to evaluate lower limb function, while the Timed 7.62 Meters Walk test and the Sit-to-Stand test assessed lower limb strength. Balance and fall risk were measured using the Berg Balance Test.
Results
At baseline, lower limb function was comparable between the experimental group (EG) and the control group (CG). However, following 12 weeks of resistance training, significant differences emerged between the two groups in the Timed "Up and Go" test (P=0.022), Timed 7.62 Meters Walk (P=0.028), Sit-to-Stand test (P=0.018), and Balance test (P=0.038).
Conclusion
The findings of this study suggest that this form of training enhances muscle strength and functional capacity in individuals with multiple sclerosis.
Keywords
Multiple sclerosis, Exercise, Resistance training
#234 ASSOCIATIONS BETWEEN PARENTAL PHYSICAL ACTIVITY AND CHILDREN’S MOTOR DEVELOPMENT
Daiva Šatkutė, Lina Budrienė, Tomas Aukštikalnis
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSOCIATIONS BETWEEN PARENTAL PHYSICAL ACTIVITY AND CHILDREN’S MOTOR DEVELOPMENT
Background and Aims
Research has shown the importance of physical activity for all people, regardless of gender, age or health condition, aims were to assess parental physical activity (FA) and children's motor development, and to identify associations between them.
Methods
The assessment was carried out before or after the physiotherapy. The Peabody Developmental Motor Skills Test was used to assess the children's motor development (reflexes, positioning, movement and object manipulation). The International Physical Activity Questionnaire was used to assess parental FA, consisting of questions on vigorous, moderate-intensity physical activity, walking and sitting. A questionnaire about the child. For data analysis, physical activity was translated into MET, according to IPAQ Scientific Committee guidelines.
Results
The average mean of parents physical activity was high. 44% had a high level, 53% a medium level, and 3% had a low level. The mean value of the motor development quotient for all the subjects was moderate. 53% of the children scored at the average level and 47% scored above the average level. Children of parents with moderate and high levels of physical activity had average and above-average motor development.
Conclusion
The the average mean of physical activity score for all subjects was high. 44% of adults achieved a high level of FA, with the highest proportion of 53% in the medium range and 3% in the low range. The assessment of motor development resulted in an average motor development coefficient of all subjects reaching the average level of motor development. The results of the assessment of the four domains of large motor development showed that reflex development determines the development of position-holding and movement skills. Children of parents with moderate and high levels of physical activity had moderate and above-average motor development coefficient, but no association was found between parental physical activity and children's motor development (p>0.05).
Keywords
children's motor development, physical activity
#235 KNEE MUSCLES POWER AND FUNCTIONAL PERFORMANCE IN PATIENTS WITH KNEE ARTHROPLASTY
Ileana Monica Borda, Rodica Ana Ungur
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
KNEE MUSCLES POWER AND FUNCTIONAL PERFORMANCE IN PATIENTS WITH KNEE ARTHROPLASTY
Background and Aims
Lower limb muscular power has a strong influence on the quality of gait and on other activities in patients with total knee arthroplasty (TKA). However, directly and objectively assessing muscle power is not always evident in clinical practice, as expensive equipment is required. Thus, there is a need for identifying accessible and easily applicable tests, strongly correlated with muscle power, to be included in the clinical evaluation of these patients. In this regard, functional performance tests could be very helpful. The aim of this study was to assess the relationship between functional performance and knee muscles power in patients with TKA.
Methods
33 patients (17 men and 16 women) were included in a cross-sectional study at six months after TKA. The power of the knee extensor and flexor muscles was assessed by the isokinetic method at the velocities of 60o/s, 90o/s and 120o/s, using a Gymnex Iso 1 Dynamometer. Functional performance was evaluated using the timed up-and-go (TUG), stair climbing test (SCT) and 6-minute walk (6MW) tests. Based on these data, the relationship between functional performance and muscle power parameters was analysed.
Results
Quadriceps and hamstrings power significantly correlated (p<0.05) with all three functional performance tests. The highest level of correlation was found between knee extensor power and TUG test. The correlation was significant (p<0.05) for all the three angular velocities used.
Conclusion
Functional performance tests were highly correlated with knee extensor and flexor power, thus representing valuable tools for completing the clinical examination. On the other hand, as muscle power essentially contributes to improving functional performance, the rehabilitation programs after TKA should address also this parameter, for preventing disabilities and for enhancing long term autonomy.
Keywords
knee, arthroplasty, quadriceps, power, function
#236 HAND MYXOFIBROSSARCOMA AND THE IMPORTANCE OF THUMB OPPOSITION
Maria Joao Sousa1, Mário Vaz2, Sara Martins1, Carolina Paiva1, José Eduardo Sousa1, Nuno Madureira1, Ines Morais1, Pedro Cantista2
2 ULS Santo António, Portugal
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
HAND MYXOFIBROSSARCOMA AND THE IMPORTANCE OF THUMB OPPOSITION
Background
Myxofibrosarcoma (MFS) is a rare malignant soft tissue sarcoma, originates in the body's connective tissue, most commonly affecting elderly individuals.Usually occurs in extremities (75%), mostly the hand.Given the complexity of the hand's anatomy and function, treatment planning must be carefully managed, including surgical intervention and rehabilitation program.Preserving hand function, particularly thumb opposition, is crucial for grasp, manual dexterity and object manipulation.Losing this ability impacts hand functionality and quality of life.
Case report
A 68-year-old male patient, right-handed, presented with a painless swelling in the 3rd interdigital space of his right hand with no history of trauma.Over 6 months, the swelling grew progressively and reduced movement and grip strength.Suspecting malignancy, an excisional biopsy was performed.Histopathological analysis confirmed MFS.The subsequent MRI demonstrated persistence of disease.The patient underwent amputation of the 3rd-5th fingers.Post-surgery, the patient was discharged to rehabilitation.During a 6-month rehabilitation program, the focus was on wound care, joint mobility of the remaining limb and adaptation to the new condition.At follow-up, the patient showed effective pinch capacity with 1st-2nd fingers, with similar strength comparable to the unaffected hand.Progressively started his activities of daily life in an adapted way, referring be autonomous in his self-care, eating and meal preparation, having restarted his gardening hobby.After discussion with the medical team, a passive silicone cosmetic prosthesis was prescribed.One year after the amputation, the patient remained free disease but maintained some residual functional limitations.
Conclusion
MFS is often asymptomatic, leading to delayed diagnosis and significant functional loss.Timely diagnosis and clear surgical margins are essential for prognosis, but radical excision with amputation can severely affect functional outcomes.The challenge is preserving thumb function, especially opposition.This case highlights the critical role of thumb opposition in hand function and show the need for a multidisciplinary approach to ensure both oncological safety and functional preservation.
Keywords
Myxofibrossarcoma, tumb-opposition, rehabilitation, amputation, functional.
#237 PELVIC FLOOR REHABILITATION IN URINARY INCONTINENCE - ANALYSIS OF THE FIRST YEAR OF TREATMENTS IN A HOSPITAL IN THE NORTH OF PORTUGAL
Mariana Xavier, Sofia Gaião Silva, Carolina Pereira e Carvalho, André Pereira, Josiana Carvalhosa, Inês Santos Jorge
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PELVIC FLOOR REHABILITATION IN URINARY INCONTINENCE - ANALYSIS OF THE FIRST YEAR OF TREATMENTS IN A HOSPITAL IN THE NORTH OF PORTUGAL
Background and Aims
Urinary incontinence (UI) is one of the main conditions addressed in pelvic floor rehabilitation (PFR) consultations. The most common types are stress, urge and mixed UI. It mostly affects women. The risk factors identified include multiparity and menopause in women; prostate surgery in men; and neurological disease, obesity, and advanced age in both sexes. Treatment may be conservative or surgical. PFR can be considered a first-line treatment for various types of UI, having been shown to reduce symptoms and improve patients’ quality of life. Aims of this work: 1) to characterize the patients treated for UI during the first year of functioning of the Pelvic Floor Unit (PFU) of the Physical and Rehabilitation Medicine Department (PRMD) of a hospital in the North of Portugal; 2) to evaluate the clinical outcomes achieved through the implemented PFR programs.
Methods
Retrospective study conducted between October 2023 and October 2024. Instruments used: anal elevator test (Modified Oxford Scale), ICIQ-SF, UDI-6, OABSS. Patients’ perceived improvement with treatment was also assessed.
Results
In total, 18 patients were treated, the majority women (94.4%). The types of UI treated were mixed and stress UI (55.6% and 44.4%, respectively). The main reported triggering factor for UI was childbirth (44.4%). As for the treatments implemented, all patients received instruction on home-based exercises and counseling on lifestyle modifications, with the majority (88.9%) reporting regular adherence to the exercise plan. All rehabilitation programs included pelvic floor kinesiotherapy and BFB. Endocavitary electrotherapy was used in 66.7% of patients, and transcutaneous tibial nerve stimulation in 61.1%. Overall improvement was observed across all evaluated parameters.
Conclusion
The PFR programs used at the PFU showed positive clinical outcomes in most cases of UI, during the first year of activity. The acquisition of additional therapeutic modalities by the Department may provide further benefit to patients with UI and other conditions.
Keywords
Incontinence, Rehabilitation
#238 OPTIMIZING UPPER LIMB FUNCTION IN CEREBRAL PALSY: A REVIEW OF EVIDENCE ON CONSTRAINT-INDUCED MOVEMENT THERAPY
Inês Bernardo
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
OPTIMIZING UPPER LIMB FUNCTION IN CEREBRAL PALSY: A REVIEW OF EVIDENCE ON CONSTRAINT-INDUCED MOVEMENT THERAPY
Background and Aims
erebral palsy (CP) is a leading cause of motor disability in childhood, frequently affecting upper limb function, particularly in unilateral presentations. Constraint-Induced Movement Therapy (CIMT), which involves constraining the unaffected limb to encourage use of the affected one, has emerged as a promising intervention. This review aims to summarize current evidence on the effectiveness, optimal dosage, and comparative benefits of CIMT in children with CP.
Methods
A literature review was conducted based on recent systematic reviews and meta-analyses identified through PubMed and academic databases. The included studies evaluated CIMT in children with hemiplegic CP, focusing on functional outcomes, dosage, age-related effects, and comparisons with alternative interventions such as bimanual therapy.
Results
Evidence consistently supports CIMT as an effective strategy to improve upper limb function and participation in children with unilateral CP. Meta-analyses demonstrate moderate effect sizes, particularly when therapy is delivered in natural settings or with caregiver involvement. CIMT was shown to be as effective as bimanual intensive therapy, although neither intervention demonstrated clear superiority. Optimal dosage appears to be between 30–60 hours, with no significant association found between treatment duration or age and effectiveness. Modified versions of CIMT (mCIMT) also showed benefit, and early implementation (infants and toddlers) is feasible when paired with structured, engaging environments.
Conclusion
CIMT is an evidence-based intervention for improving upper limb activity and functional use in children with unilateral cerebral palsy. While it is not clearly superior to other high-intensity therapies, it offers comparable outcomes and may be particularly effective when integrated into the child’s everyday environment. Further high-quality studies are needed to refine treatment protocols, determine long-term outcomes, and explore patient-specific predictors of response.
Keywords
Pediatric Rehabilitation, Neuroplasticity, CIMT
#239 PREHABILITATION IN CANCER PATIENTS: CURRENT EVIDENCE ON FUNCTIONAL AND PSYCHOLOGICAL OUTCOMES
Ines Bernardo
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PREHABILITATION IN CANCER PATIENTS: CURRENT EVIDENCE ON FUNCTIONAL AND PSYCHOLOGICAL OUTCOMES
Background and Aims
Prehabilitation, defined as the implementation of physical, nutritional, and psychological interventions prior to cancer treatment, has gained growing interest for its potential to optimize functional reserve and improve outcomes. This review aims to summarize the most recent evidence regarding the effectiveness of prehabilitation in enhancing physical performance, reducing psychological distress, and improving postoperative recovery in cancer patients.
Methods
A narrative synthesis was conducted using findings from recent systematic reviews and meta-analyses published between 2023 and 2024. The studies included evaluated the impact of multimodal and exercise-based prehabilitation programs on outcomes such as anxiety, depression, endurance (6-minute walk test and VO₂ peak), and postoperative complications in patients undergoing oncological treatment, primarily surgical resections.
Results
Recent meta-analyses confirm that prehabilitation significantly improves physical endurance, with one study showing a mean increase of 38.5 meters in the 6-minute walk test and moderate improvements in VO₂ peak. Mental health also benefits: prehabilitation was associated with significant reductions in anxiety and depression (HADS scores improved by -0.49 and -0.71, respectively). In surgical patients, prehabilitation led to reduced postoperative complications, including pulmonary events, and shorter hospital stays. Despite promising results, evidence quality was rated as low to moderate in several reviews due to methodological heterogeneity and variability in program designs.
Conclusion
Prehabilitation is a promising approach to improve functional capacity and mental well-being in cancer patients prior to treatment. It may reduce postoperative complications and enhance recovery, particularly in surgical candidates. However, variability in protocols and limited high-certainty evidence highlight the need for standardized, large-scale trials to confirm these benefits and inform clinical guidelines.
Keywords
Cancer; Prehabilitation
#240 THE UNTAPPED POTENTIAL: ADAPTED PHYSICAL ACTIVITY AND FUNCTIONAL IMPROVEMENT IN ADOLESCENT IDIOPATHIC SCOLIOSIS
Douae EL OUAZZANI, Oumaima Boulenouar, Abir Lemkadem, Ryme El Beloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Sports medicine rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE UNTAPPED POTENTIAL: ADAPTED PHYSICAL ACTIVITY AND FUNCTIONAL IMPROVEMENT IN ADOLESCENT IDIOPATHIC SCOLIOSIS
Background and Aims
While standard care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, the specific benefits of tailored exercise warrant further investigation. This prospective study evaluated the impact of a 6-month Adapted Physical Activity (APA) intervention on functional capacity and postural alignment in adolescents with AIS. We hypothesized that APA would lead to measurable gains in these key clinical outcomes.
Methods
Twenty-five adolescents (mean age 14.2 ± 1.8 years, mean Cobb angle 22.5° ± 8.1°) with AIS (Cobb angle 10°-40°) participated in a 6-month individualized APA program. This program, delivered twice weekly (60-minute sessions), focused on active self-correction, core stabilization, and targeted strengthening. Assessments at baseline and 6 months included Cobb angle (radiography), functional capacity (Timed Up and Go, Single Leg Stance), and postural alignment (trunk imbalance, shoulder asymmetry). Adherence was recorded.
Results
Following the 6-month APA program, significant improvements were observed. Mean Timed Up and Go time decreased from 10.8 ± 2.1 s to 8.9 ± 1.5 s (p<0.001), and Single Leg Stance time increased from 8.2 ± 3.5 s to 11.5 ± 4.0 s (p<0.001). Trunk imbalance significantly reduced from 2.1 ± 1.5 cm to 1.2 ± 0.9 cm (p<0.001), and shoulder asymmetry significantly improved (p=0.01). Cobb angle showed a non-significant change (22.5° ± 8.1° to 21.0° ± 7.5°, p=0.15), with 78% demonstrating stabilization or improvement. Adherence was high (85.2% ± 10.5%).
Conclusion
Adapted Physical Activity significantly improves function and posture in adolescent idiopathic scoliosis, suggesting its value alongside standard care. Future research should explore long-term effects, compare APA to other interventions, and identify optimal exercise parameters for diverse scoliosis types. Larger studies are needed to optimize APA integration into comprehensive management strategies.
Keywords
Adapted Physical Activity ,idiopathic scoliosis
#241 APPROACH TO MEDIAL COMPARTMENT KNEE PAIN - A CASE SERIES AND RETROSPECTIVE STUDY
Adriana Correia, Fábio Pinho, Ines Camarinha, Ana Rita Pessoa, Diogo Rodrigues
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
APPROACH TO MEDIAL COMPARTMENT KNEE PAIN - A CASE SERIES AND RETROSPECTIVE STUDY
Background and Aims
In managing knee osteoarthritis, it is crucial to identify whether pain stems from intra-articular inflammation or extra/peri-articular structures. In some patients, especially women, medial compartment overload can cause meniscocapsular and ligamentous pathology, with pain localized to the medial joint line. These peri-articular issues may be more significant and reported as the primary source of discomfort. Therefore, treatment should target the most clinically relevant complaints. Ultrasound, combined with physical examination, is a valuable tool for both diagnosis and ultrasound-guided injections. This retrospective analysis aims to evaluate the effectiveness of ultrasound-guided corticosteroid injections around the medial collateral ligament (MCL) and medial meniscus in controlling pain and the duration of its effect in patients with pain localized to the medial knee compartment.
Methods
A retrospective analysis was conducted of the clinical records of patients seen in the Ultrasound-Guided Procedures clinic between January 2024 and March 2025. Patients with knee osteoarthritis presenting with primary pain in the medial compartment who underwent peri-MCL and meniscal injection were selected.
Results
During the established time period, 25 patients were treated. Of this sample, 100% were female, with ages ranging from 52 to 95 years. Twenty percent of these patients underwent a repeat procedure. No adverse reactions were reported.
Conclusion
85% of patients experienced a favorable outcome, defined as a pain improvement of more than 30% on the numerical pain scale lasting longer than 3 months. The average duration of the effect was 5 months, with a median of 4 months. Patients reported satisfaction with this approach and noted a considerable improvement in their quality of life. This approach demonstrated short to medium-term efficacy in pain control, with associated functional improvement and a good safety profile, and should be considered a therapeutic option for the treatment of this patient population.
Keywords
Ultrasound-guide Injection, Medial Knee Osteoarthritis
#242 HEREDITARY SPASTIC PARAPARESIS (HSP) - CASE REPORT
Tamara Vukić
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
HEREDITARY SPASTIC PARAPARESIS (HSP) - CASE REPORT
Background
Hereditary spastic paraparesis (HSP) is a group of rare neurodegenerative diseases with genetic and clinical heterogeneity characterized by progressive symptoms of spasticity and weakness of the lower limbs. It is considered a rare condition with the disease prevalence estimated at 1-9 cases per 100,000 people.
Case report
A 45-year-old female patient presented to the outpatient clinic with complaints of gait disturbances, and stumbling while walking. She denied any other symptoms. In her family history she stated that her father had similar difficulties with walking but at a later age than the patient. A physical examination found her upper limbs were normal with full power. The lower limbs had intense spasticity, she had spastic ataxic gait and used crutches to help her walking. Her lower limb reflexes were uniformly increased, and she had bilateral up-going plantar responses. She had normal sensation for light touch, pain, and proprioception on both upper and lower limbs, bladder and bowel sphincters were normal. A nerve conduction study of both upper and lower limbs was performed and it was normal. Magnetic resonance imaging (MRI) of her brain was normal and of her cervical spine showed mild C6C7 disc protrusion. Her serum vitamin B12 level, folic acid and homocysteine levels were normal, and anti Hu, Yo, Ri antibodies were negative. She was also tested for PMP22 which was negative. Molecular genetic analysis confirmed the diagnosis of hereditary spastic paraparesis (confirmed by clinical exome analysis - mutation in the SPAST gene - reading frame shift). After the confirmation of the HSP diagnosis patient now regularly goes to physical therapy.
Conclusion
Hereditary spastic paraparesis is a rare condition and should be taken in consideration when having a patient with progressive symptoms of spasticity and lower limbs weakness. A final diagnosis is confirmed combining clinical evaluation, genetic testing and exclusion of alternative diagnoses.
Keywords
hereditary paraparesis, spasticity, genetic testing
#243 "WHEN THE BODY SAYS 'STOP!': ISCHIOPUBIC RAMUS STRESS FRACTURE IN A RUNNER"
Adriana Correia, Ines Camarinha, Catarina Afonso, Ana Rita Pessoa, Fábio Pinho, Diogo Rodrigues
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
"WHEN THE BODY SAYS 'STOP!': ISCHIOPUBIC RAMUS STRESS FRACTURE IN A RUNNER"
Background
Stress fractures occur when bone is subjected to repeated mechanical stress that results in microscopic fractures. It can be classified as fatigue reaction stress fracture, result from repetitive and excessive strain placed on structurally normal bone, or insufficiency reaction stress fractures, when normal stress and straining are applied to a bone where bone formation is impaired, as seen in ostheoporosis. Pelvic stress fractures are a rare cause of pain in the inguinal/gluteal region, leading to the underdiagnosis of this condition. In athletes, stress fractures account for 2% of reported injuries, with a higher incidence observed in long-distance runners and triathletes.
Case report
A 42-year-old healthy female with no relevant medical history, who is a regular long-distance runner, presented with pain in the left gluteal region during an athletic competition, with no associated trauma. Initially, the pain was mild but progressively worsened. The episode coincided with her return to sports after a period of inactivity. Initial imaging with hip radiography showed no abnormalities. After a series of unsuccessful physical therapy sessions, she underwent MRI, which revealed a fracture of the left ischiopubic ramus.
Conclusion
This case highlights risk factors for stress fractures, including female sex and rapid return to sports after inactivity. Diagnosis was delayed, as these fractures may not be detected in the acute phase with simple radiographs, with 60-70% yielding negative results. Early imaging signs include bone marrow edema on MRI and increased activity on bone scintigraphy. The absence of radiographic evidence in the acute phase can lead to underdiagnosis. Bone scintigraphy, CT, or MRI may aid early diagnosis. Treatment involves rest (6-10 weeks), with a risk of re-fracture if not adhered to. Progression and return to play should depend on patient symptoms.
Keywords
Stress fracture; ischiopubic ramus fracture;
#245 COLOSTOMY IN SPINAL CORD INJURY PATIENTS: A CASE SERIES ON POSTOPERATIVE SATISFACTION
José Nuno Teles da Silva Madureira, José Eduardo Sousa, Ana Carolina Paiva, Sara Cabete Martins, André Ribeiro, Inês Campos
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
COLOSTOMY IN SPINAL CORD INJURY PATIENTS: A CASE SERIES ON POSTOPERATIVE SATISFACTION
Background and Aims
Neurogenic bowel dysfunction is a common complication in patients with SCI, often leading to constipation, fecal incontinence, and reduced quality of life. Despite its low utilization, colostomy has shown promise as a viable option when conservative strategies fail.
Methods
This is an observational, cross-sectional case series. All adult patients, SCI who completed an inpatient intensive rehabilitation program between 2015 and the present and subsequently underwent a colostomy were eligible. Patients with other conditions causing significant gastrointestinal dysfunction were excluded. Collected variables included age, sex, education, employment status, neurological level of injury, AIS grade, type of colostomy, time since SCI, discharge bowel management program, compliance, and autonomy in daily bowel care, assessed via the FIM item H. The main outcome measure was an adapted version of the “Questionnaire concerning bowel management pre- and post-colostomy”.
Results
Four individuals were enrolled in the study. The sample included two men and two women, with a mean age of 57.5 years (28-56). Three participants presented with complete paraplegia at neurological levels T3, T11, and T12, and one with complete tetraplegia at neurological level C5. All had undergone colostomy between one and eight years after SCI. All paraplegic patients improved from a FIM score of 1 to 6 on item H. All four participants reported that bowel management was no longer considered problem and that had become significantly more efficient, with time reduced to 0–15 minutes. All participants stated they would not choose colostomy reversal and would have preferred to undergo the procedure earlier. All four participants noted positive changes in their social participation and daily life, including reduced emergency department visits and financial relief.
Conclusion
Colostomy should be considered in individuals with SCI across all motor impairment levels, as it may significantly improve quality of life and reduce bowel care burden, even in patients with limited functional gains.
Keywords
SpinalCordInjuries; Colostomy; NeurogenicBowel; PatientSatisfaction;
#246 EFFECTS OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION ON MULTIPLE SCLEROSIS FATIGUE, SENSORY DISTURBANCES, AND OPTIC NEURITIS: A CASE REPORT
hana khalidi1, Ziad hawamdeh2
2 University of Jordna, Jordan
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
EFFECTS OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION ON MULTIPLE SCLEROSIS FATIGUE, SENSORY DISTURBANCES, AND OPTIC NEURITIS: A CASE REPORT
Background
Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system, leading to demyelination and neurodegeneration, which cause motor, sensory, and visual impairments among others. While disease-modifying therapies aim to slow progression, symptom management remains crucial. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has shown promise in alleviating MS-related fatigue, spasticity, and cognitive impairment. However, its effects on sensory disturbances and optic neuritis remain underexplored. This case report investigates the potential of rTMS in treating these symptoms, contributing to growing evidence supporting its role as a versatile intervention for MS-related impairments.
Case report
A 27-year-old male bank accountant was diagnosed with relapsing-remitting multiple sclerosis (RRMS) after experiencing progressive symptoms, including left upper and lower limb hypoesthesia, fatigue, and right eye vision loss. MRI confirmed multiple demyelinating lesions. Initial treatment with high-dose glucocorticoids provided partial relief. Due to concerns about long-term medication effects, he opted for repetitive transcranial magnetic stimulation (rTMS). A 5 Hz protocol was administered over two weeks, resulting in significant improvements in fatigue, sensation, and vision. His Fatigue Severity Scale dropped from 6.2 to 2.7, and his EDSS score improved from 3.5 to 1.5. Follow-ups confirmed sustained benefits with no relapses. The patient regained functional independence, returning to full-time work with restored mobility and vision.
Conclusion
Our findings support the utility of 5 Hz rTMS over the motor cortex in improving sensory symptoms, vision, and fatigue in MS patients, reinforcing prior reports on the benefits of high-frequency stimulation on fatigue and suggesting that it could be beneficial in improving sensory symptoms and vision in Multiple sclerosis patients.
Keywords
NIBS, rTMS, neuroplasticity, MS,neuromodulation
#247 SLIPPING RIB SYNDROME – CASE REPORT
Diana Balen1, Ružica Brešić Paunović2, Štefanija Opalin1, Tomislav Nemčić1
2 General Hospital Nova Gradiška, Croatia/Hrvatska
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SLIPPING RIB SYNDROME – CASE REPORT
Background
Slipping rib syndrome (SRS) is an underdiagnosed condition caused by hypermobility of costal cartilages of false ribs, allowing the 8th to 10th ribs to slip under the rib above causing impingement of the intercostal nerve. It was first described by Cyriax in 1919, as an anterior rib subluxation causing intermittent pain in the lower rib arch (LRA) radiating to the side and the upper abdomen. SRS is likely related to overuse and sudden core movements, but it also could be a congenital or related to trauma. SRS is most often unilateral, left sided and affects females.
Case report
The case report presents a 29-year-old woman who came to physiatrist clinic because of the pain in the left LRA, which started in the second trimester of pregnancy and continuously lasted two months after delivery. The pain appeared as stabbing, increased with inhalation, severe intensity, mixed character, predominantly neuropathic, spreading mainly along the anterior part of the 10th rib. A "hooking" maneuver was performed, which confirmed the diagnosis of SRS. Patient performed 3 cycles of 10 times of physical therapy (breathing exercises and specific core stabilization exercises with passive procedures), also infiltration of dexamethasone (3x) and triamcinolone acetonide (3x) with 0.2% bupivacaine (6x) in the trigger points along the lower edge of the 10th rib. After 4 months of therapy, there was significant improvement.
Conclusion
SRS is a rare cause of pain in the chest area. It limits persons' ability in performing daily living activities and has a strong psychological impact. Differential diagnosis includes osteochondritis, intercostal neuralgia, chest trauma or Tietze syndrome. Initial treatment is conservative which includes symptomatic therapy, intercostal nerve block or botulinum toxin injection. Definitive treatment is surgical resection of the affected rib. Failure to recognize this syndrome can expose patient to unnecessary diagnostic procedures and lead to significant delays in treatment.
Keywords
chest pain, costal cartilage, rib
#248 EVALUATING NEURACI: ACCURACY OF A NEUROREHABILITATION COMPLEXITY AND RESOURCE ALLOCATION INDEX
Maria Julieta Russo, Hernán Pavón, Darío Toledo, Jorge Cancino, Gonzalo Quiero, Carlos Gonzalez Malla, Mauro Bosso, María de la Paz Sampayo
Conference topic: Neurorehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
EVALUATING NEURACI: ACCURACY OF A NEUROREHABILITATION COMPLEXITY AND RESOURCE ALLOCATION INDEX
Background and Aims
Efficient resource allocation at hospital admission is essential in neurological rehabilitation due to the clinical heterogeneity of patients, which complicates expenditure assessment. This study aimed to evaluate the accuracy of NeuRACI (Neurorehabilitation Resource Allocation and Complexity Index) in categorizing patients by clinical complexity and to compare its performance with individual clinical variables.
Methods
We included 243 patients referred to neurological rehabilitation. NeuRACI is a composite index that allocates resources by combining four clinical factors: clinical complexity, acute length of stay (LOS), age, and presence of an artificial airway. Each factor is assigned an adjustable weight. Patients were classified into two groups based on the absence (Group A) or presence (Group B) of an artificial airway. ROC curve analysis was used to assess the accuracy of NeuRACI and other clinical variables in distinguishing between these groups.
Results
The mean NeuRACI score for Group A was 943.19, while Group B had a significantly higher mean score of 5251.41, reflecting greater resource allocation priority for more complex patients with artificial airways or prolonged LOS (t = -23.427; p < .001). Group B also exhibited multiple comorbidities indicative of a more complex clinical state compared to Group A (t = -14.103; p < .001). No significant differences were found between groups in age or acute LOS. NeuRACI demonstrated excellent discriminative ability with an AUC of 0.98 (95% CI: 0.96–0.99; p < .001).
Conclusion
NeuRACI effectively integrates multiple clinical factors to categorize patients by complexity and airway status in neurorehabilitation setting. This index facilitates objective decision-making and supports tailored care planning aligned with individual patient needs.
Keywords
rehabilitation, needs, care, patients, resources
#249 CLINICAL IDENTIFICATION OF PATIENTS WITH COVERT AWARENESS.
Maria Julieta Russo, María de la Paz Sampayo, Yanina Gambero, Mariano Maiarú, Hernán Pavón
Conference topic: Neurorehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
CLINICAL IDENTIFICATION OF PATIENTS WITH COVERT AWARENESS.
Background and Aims
Covert consciousness is a state of residual consciousness after a severe brain injury or neurological disorder that represents a diagnostic challenge in routine clinical practice and research. It is mandatory to improve the clinical ability to identify those patients with suspected covert cognition and those who would benefit from complementary functional studies for diagnostic and prognostic purposes. Objective: To investigate the relationship between the number of subtle neurological signs indicative of covert cognition as measured by the Motor Behavior Tool - revised (MBT-r) scale with the severity of the disorder of consciousness as measured by the traditional score and with the additional index of the Simplified Evaluation of Consciousness Disorders (SECONDs) scale.
Methods
Twenty-nine subjects with chronic disorders of consciousness secondary to brain injury acquired in the context of inpatient rehabilitation were included. Multivariate linear regression analysis was performed to evaluate the association of the MBT-r score (independent) with the traditional score and the additional SECONDs index (dependent), correcting for age.
Results
The regression equation was statistically significant F(1,20)=16.994,p<.001. The R2 value was .46, indicating that 46% of the change in MBT-r score can be explained by the regression model including the additional SECONDs index. The regression equation was -0.35 + .13* (Additional Index), where the MBT-r score increases .13 for each point of the additional SECONDs index.
Conclusion
Our findings show that the MBT-r designed to capture clinically relevant aspects related to clinical suspicion of masked awareness correlates with the SECONDs Additional Index which was designed to document subtle clinical changes even in the same diagnostic category.
Keywords
consciousness, injury, assessment, scale, SECONDs
#250 PROTOCOL OF PHYSIOTHERAPEUTIC PROCEDURES USED IN THE MEDICAL MAGNUS HOSPITAL AFTER HIP REPLACEMENT
MAREK KILJAŃSKI, KAMIL KLUPIŃSKI, MAREK KROCHMALSKI, PIOTR SZAFRANIEC, MAREK KILJAŃSKI
Conference topic: Postoperative rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
PROTOCOL OF PHYSIOTHERAPEUTIC PROCEDURES USED IN THE MEDICAL MAGNUS HOSPITAL AFTER HIP REPLACEMENT
Background and Aims
Osteoarthritis (OA) is one of the most common conditions diagnosed in healthcare. It most often accompanies changes in the knee joints, hip joints, lumbar spine, the soft tissue surrounding the joint. It is the main cause of disability among the elderly. The development of the disease clearly increases after the age of 50. Risk factors can be divided into personal (age, sex, genetics, obesity, diet, bone metabolism) and joint (physical activity, injuries, nature of work, skeletal system, muscle imbalance). Symptoms of OA include pain, stiffness, limited mobility and crackling in the joint. Hip replacment (THA) is an effective method of treating advanced hip OA. The aim of the study is to manage the postoperative procedure after THA, educate patient and minimize the risk of complications due to OA.
Methods
Medical Magnus is a leading hospital in Poland and has been helping people with hip OA for 20 years performing about 400 THA procedures a year and having extensive experience in patient rehabilitation.
Results
Basing on our many years experience, standardization of the procedure after THA was created, which is used by other medical centers in Poland. The standards of conduct are divided into the inpatient and outpatient stages.
Conclusion
Implementation of uniform protocols of conduct based on EBM.
Keywords
rehabilitation, coxarthrosis, THA, postoperative care
#251 LOWER LIMB AMPUTATIONS IN A NORTHERN PORTUGUESE HEALTH UNIT: A RETROSPECTIVE STUDY
João Diniz1, Ana Aguiar2, Maria Pires3, Mário Vaz4, Pedro Cantista4
2 Hospital do Divino Espírito Santo, Portugal
3 Centro de Medicina e Reabilitação do Sul, Portugal
4 Unidade Local de Saúde do Santo António, Portugal
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
LOWER LIMB AMPUTATIONS IN A NORTHERN PORTUGUESE HEALTH UNIT: A RETROSPECTIVE STUDY
Background and Aims
Lower limb amputations are complex, last-resort surgeries with significant impact on patient functionality and quality of life. Although exact prevalence data is scarce, it is estimated that around 150,000 amputations are performed annually in the United States. The most common causes are Diabetes Mellitus, Peripheral Arterial Disease, and trauma, though congenital, neoplastic, and infectious pathologies are also reported. This study aims to describe and characterize patients who underwent major (hip disarticulation, transfemoral, transtibial) and minor (distal to tibiotalar level) lower limb amputations at the Santo António Local Health Unit in northern Portugal.
Methods
A retrospective analysis was conducted using clinical records from 2015 to 2024 of patients followed in the Physical and Rehabilitation Medicine Department. Data collected included age, sex, amputation level and side, cause, cardiovascular risk factors, prosthetic use and mortality. Statistical analysis was performed using IBM SPSS Statistics 29.0.2.0.
Results
A total of 744 patients were included (71.8% male), with a mean age of 67.3 years. Transtibial amputation was the most common (39.2%). Other major amputations included transfemoral (35.2%) and hip disarticulation (0.8%) and minor amputations accounted for 7.5%. Vascular causes were most prevalent (50.9%), followed by trauma (15.3%), neoplasia (5.6%), and infection (3.9%). Cardiovascular risk factors were frequent: 53.1% of patients had diabetes, 67.6% hypertension, 66.2% dyslipidemia, 50.4% peripheral arterial disease, and 33.7% were smokers. Prosthetic fitting was achieved in 76.9% of cases. During follow-up, 27.8% of patients died, with a mean age at death of 70.9 years.
Conclusion
Vascular etiology was the leading cause of lower limb amputation in this cohort. The high prosthetic fitting rate may reflect quality rehabilitation services. Further studies are essential to improve care strategies for this patient population.
Keywords
"Lower limb"; "Amputation"; "Portugal".
#252 EFFICACY OF LOW-FREQUENCY WHOLE-BODY ELECTROMYOSTIMULATION IN NONSPECIFIC CHRONIC BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS
Karl Lorenz Konrad1, Patrick Sadoghi2, Jana Konrad3, Erik Cattrysse1, Jean-Pierre Baeyens1, Bernd Wegener4
2 Medical University Graz, Austria
3 Institut Ascend (TRIA) Röfingen, Germany
4 Ludwig-Maximilians- University Munich (LMU), Germany
Conference topic: Pain treatment and rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
EFFICACY OF LOW-FREQUENCY WHOLE-BODY ELECTROMYOSTIMULATION IN NONSPECIFIC CHRONIC BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS
Background and Aims
Nonspecific chronic back pain (NSCBP) is a prevalent global condition, significantly contributing to disability and impacting quality of life worldwide. Its management is often limited by conventional exercise barriers, such as time constraints and comorbidities. Whole-body electromyostimulation (WB-EMS) offers a promising alternative, being a time-efficient and joint-friendly intervention. This systematic review evaluates the effectiveness of low-frequency WB-EMS in alleviating pain and enhancing function in NSCBP patients.
Methods
Following PRISMA guidelines, PubMed and PEDro databases were systematically searched for clinical trials involving adults with NSCBP, focusing on RCTs or CCTs with WB-EMS interventions. Two independent reviewers extracted data and assessed quality using the PEDro Scale. A narrative synthesis and meta-analysis pooled standardized mean differences (SMD) with 95% confidence intervals, evaluating heterogeneity via I².
Results
Six studies (n = 677; WB-EMS: 278, controls: 329), including four RCTs, one CCT, and one meta-analysis (2017–2023), were analyzed. LF WB-EMS (20-minute weekly sessions, 8–16 weeks, 50–85 Hz) significantly reduced pain (-0.60 to -1.58 NRS/VAS) and improved function (+7.19 kg trunk strength to -15.8 ODI). Meta-analysis revealed a pooled pain reduction of -0.87 (95% CI [-1.02, -0.72], I² = 70%) and functional SMD of 0.84 (95% CI [0.68, 0.99], I² = 76%). Compared to passive controls (n = 15/group), effect sizes were 0.75 for pain and 0.85 for function; against active controls, pooled effects were 0.33 (pain, I² = 96%) and 0.28 (function, I² = 92%).
Conclusion
LF WB-EMS effectively mitigates NSCBP symptoms, showing strong within-group effects and competitive outcomes against controls, suggesting potential superiority over some therapies. Its efficiency and safety make it also suitable for patients with joint problems. However, small passive control sample sizes and high active control heterogeneity necessitate larger, standardized trials. Further research on medium-frequency WB-EMS and comparisons with LF-EMS is needed to optimize protocols and long-term outcomes.
Keywords
Whole-Body-Electromyostimulation, Stimulation, Back-Pain, Rehabilitation
#253 THE ROLE OF NUTRITION AND DIETARY SUPPLEMENTS IN THE PREVENTION AND TREATMENT OF MALNUTITION IN PATIENTIS WITH COPD
Sanja Vujević, Drinka Stevandić
Conference topic: Cardiopulmonary rehabilitation
Occupation: Other medical specialties
Type of abstract: Case report
Abstract
Title
THE ROLE OF NUTRITION AND DIETARY SUPPLEMENTS IN THE PREVENTION AND TREATMENT OF MALNUTITION IN PATIENTIS WITH COPD
Background
Malnutrition is a significant comorbidity in chronic obstructive pulmonary disease (COPD), contributing to disease progression and reduced quality of life. This paper examines the role of medical nutrition therapy in the prevention and treatment of malnutrition in patients with COPD, emphasizing an evidence-based approach and its clinical implifications. Patients with COPD face increased metabolic demands, systemic inflammation, and reduced food intake, resulting in sarcopenia, osteopenia and cachexia. Recent studies have highlighted the efficacy of targeted nutritional strategies, including supplementation with essential amino acids, omega-3 fatty acids, vitamin D and antioxidants to improve respiratory function, muscle strength ang quality of life in patiens. Comprehensive nutritional assessments and personalized interventions are increasingly recognized as critical components of the care of patients with chronic obstructive pulmonary disease. Medical nutrition therapy plays a key role in the treatment of malnutrition and improving clinical outcomes in COPD.
Case report
The aim of the research is to determine the effect of pulmonary rehabilitation and individual medical nutritional therapy on muscle mass measured by the bioimpedance method before and after the implementation of physio-rehabilitation treatment.
Conclusion
Individually prescribed medical nutritional therapy, adequate and adapted physical activity with the participation of balneofactors, led to changes in body composition with the desired outcome of increasing muscle mass in patients with COPD.
Keywords
nutritional therapy, pulmonary rehabilitation, sarcopenia
#254 PREVALENCE OF UNDIAGNOSED OSA IN PATIENTS STARTING THE CARDIAC RHB PROGRAM
Marta Supervia Pola, Leticia Salcines Rueda
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PREVALENCE OF UNDIAGNOSED OSA IN PATIENTS STARTING THE CARDIAC RHB PROGRAM
Background and Aims
Determine the prevalence of undiagnosed obstructive sleep apnea syndrome (OSAS) in patients starting a cardiac rehabilitation program.
Methods
The risk of OSA was assessed using the STOP-BANG questionnaire in patients who began the cardiac rehabilitation program between October 2023 and October2024. Data collected included sex, age, CVRF, neck circumference, BMI, and smoking status.
Results
460 patients were seen in the cardiac RHB between October 2023 and October 2024. Of these, 11.52% (n=53) had ≥3 positive findings on the STOP-BANG questionnaire, which implies a high risk of OSAS. Of these 53 patients, 16.98% (n=9) were women with a mean age of 63.42 (SD 6.64) years, and 83.01% (n=44) were men with a mean age of 57.59 (SD 11.06) years. 64.15% (n=34) had a BMI >30, and 24.52% (n=13) had a BMI of 25-29.9. Regarding neck circumference, 73.58% (n=39) had a circumference >40 cm. A total of 35.71% (n=20) of patients had a previous diagnosis of OSAS, and 62.26% (n=33) had not been evaluated and were therefore referred to the pulmonology department. A total of 69.7% of referred patients were diagnosed with OSAS, 9.09% (n=3) had the diagnosis excluded, and 24.2% (n=8) are awaiting overnight polysomnography. The analysis found a statistically significant relationship (p40 cm and a high risk of OSAS. No statistically significant relationships were found between being overweight (p=0.261) or obese (p=0.45) and an increased risk of OSAS.
Conclusion
A high percentage of patients enrolled in cardiac rehabilitation programs are at high risk for OSA, and most of them are undiagnosed and untreated. A screening method should be included in cardiac rehabilitation consultations. Neck circumference is a simple measure and has been shown to be an important predictor of OSA risk. Diagnosis and treatment of OSA has been shown to reduce the risk of further cardiovascular events.
Keywords
OSAS, Cardiacrehabilitation
#255 ASSESSING AWARENESS AND MANAGEMENT OF PATIENTS WITH OBESITY AMONG PHYSICAL MEDICINE AND REHABILITATION PHYSICIANS IN SPAIN: A PIONEER SURVEY STUDY
Marta Supervia Pola, Leticia Salcines Rueda
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSESSING AWARENESS AND MANAGEMENT OF PATIENTS WITH OBESITY AMONG PHYSICAL MEDICINE AND REHABILITATION PHYSICIANS IN SPAIN: A PIONEER SURVEY STUDY
Background and Aims
Obesity is a chronic and multifactorial disease that significantly impacts the adult population, contributing to disability and leading to economic consequences. People with obesity have significantly lower number of disability free years, what leads to an increase demand of rehabilitation. AIM The aim of our survey is to analyze the current situation in Spain in relation to awareness and management of patients with obesity in the Physical Medicine and Rehabilitation (PMR) services, as it has never been studied before in our county.
Methods
In this cross-sectional study, an online survey was sent out from the Spanish Society of Rehabilitation (SERMEF) to their PRM members from May 1st to July 31st 2023. It was developed by the obesity working group and it included 22 questions. Data was collected in REDcap.
Results
205 (10.07%) PRM physicians participated, half of them (n=102, 49.8%) worked with obese patients and 99% (n=201) considered obesity a disease. 52.2% (n=107) recognized that obesity influences functional prognosis of patients that receive rehabilitation treatment. However, 83.3% (n=184) considered that the facilities at their working areas were not adapted to the needs of obese patients, and only 9.8% (n=20) felt they had received enough training to asses properly this kind of patients. Only 21%(n=43) had an interdisciplinary unit to manage morbid obesity, and in those only half of the units had a PRM doctor who worked 2 ±1.61 hours/week.
Conclusion
This study shows that despite PRM physicians are aware of the implications of obesity in functional outcomes, improvements in the management in hospitals of these patients including PRM departments are required. Multidisciplinary units for addressing obesity should be developed including PRM physicians to get better functional outcomes .
Keywords
obesity, Survey, facilities, exercise
#256 AID2GAIT - REAL-TIME BIOFEEDBACK FOR MONITORING ROBOTIC ASSISTED GAIT TRAINING IN CHILDREN WITH CEREBRAL PALSY: A PRELIMINARY STUDY
Alice Cichelli1, Teresa Paolucci1, Francesco Romano2, Giovanni Morone3, David Perpetuini2, Irene Ciancarelli3, Marta Di Nicola1, Francesca Gimigliano4, Arcangelo Merla2, Emanuele Francesco Russo5, Maria Teresa Gatta5, Antimo Moretti4, Daniela Cardone2
2 Department of Engineering and Geology, "G. d'Annunzio" University of Chieti-Pescara, Italy
3 Department of MESVA, University of L'Aquila, Italy
4 Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Italy
5 Padre Pio Rehabilitation Centers Foundation, Italy
Conference topic: Neurorehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
AID2GAIT - REAL-TIME BIOFEEDBACK FOR MONITORING ROBOTIC ASSISTED GAIT TRAINING IN CHILDREN WITH CEREBRAL PALSY: A PRELIMINARY STUDY
Background and Aims
Cerebral Palsy (CP) is a non-progressive neurological disorder affecting movement and posture. Robotic Assisted Gait Training (RAGT), using exoskeletons, has shown promising results in promoting motor control and neuroplasticity. Patient engagement, influenced by motivational and psychophysical factors, is crucial for therapy effectiveness. This case study, part of the PRIN 2022 PNRR "AID2GAIT" project, evaluates motivation, neuroplasticity, and physiological parameters in a paediatric patient undergoing RAGT.
Methods
Conducted at the Padre Pio Rehabilitation Centers Foundation (FG), the study involved a paediatric CP patient over 12 RAGT sessions with the pediatric Lokomat® system over 30 days (3 sessions/week). Physiological and kinematic data were collected during sessions T0, T1, and T2. Clinical scales WeeFIM and GMFM-88 were evaluated at T0 and T2. Heart rate variability (HRV) was monitored via Garmin Vivosmart 5® smartwatch, facial temperature via FLIR A400® thermal imager, and brain activity via fNIRS (functional near-infrared spectroscopy), measured by Cortivision® PhotonCap. Wavelet analysis of hip/knee movements estimated active participation.
Results
WeeFIM showed mobility and locomotion improvements; GMFM-88 reported an 11.6% total increase. HRV rose by 7.5%, indicating higher engagement. Facial temperature decreased from T0 to T2 (e.g., nose -2.4%, nostrils -31.2%), except for the perioral area, suggesting reduced fatigue and increased well-being. Wavelet power from exoskeleton data increased by 22.1%, reflecting greater active contribution. fNIRS results indicated increased cortical activity.
Conclusion
RAGT improved both physical condition and engagement in the patient, supporting its potential in paediatric neurorehabilitation. These results highlight the importance of integrating multimodal monitoring tools to personalize therapy in real-time. Further studies will validate this approach in larger populations and explore predictive models for long-term outcomes. This work was supported by the European Union – Next Generation EU, Mission 4, Component 1, CUP D53D23021770001, Project Name: AID2GAIT.
Keywords
robotic, gait, neuroplasticity, cerebral palsy
#257 FLOATING SHOULDER WITH BRACHIAL PLEXUS INJURY: A COMPLEX CASE OF NEURO-MUSCULOSKELETAL IMPAIRMENT
João Diniz, Rui Sousa, Gonçalo Pires, Inês Cunha
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
FLOATING SHOULDER WITH BRACHIAL PLEXUS INJURY: A COMPLEX CASE OF NEURO-MUSCULOSKELETAL IMPAIRMENT
Background
Floating shoulder is a complex injury typically resulting from high-energy trauma to the shoulder region, characterized by a fracture of the scapular neck and concurrent disruption of the coracoclavicular and coracoacromial ligaments. This traumatic pathology is potentially unstable and is frequently associated with neurovascular complications.
Case report
A 24-year-old male presented to the Emergency Department after a motor vehicle accident. Imaging revealed a comminuted fracture of the left scapula involving the neck, base of the spine, supraspinous and infraspinous fossae, and a grade IV acromioclavicular dislocation—consistent with a floating shoulder. Due to neurological deficits in the affected limb, brachial plexus and cervical spine MRI was performed, showing no structural abnormalities. The patient underwent orthopedic surgery without complications. Postoperatively, physiatric evaluation revealed scapular girdle atrophy, glenohumeral subluxation, absence of active shoulder muscle contraction and significant elbow movement limitation. A multidisciplinary rehabilitation program was initiated, including muscular electrical stimulation, passive mobilization, isometric strengthening, scapular kinematics retraining, and proprioceptive exercises. Six weeks post-trauma, electromyography identified injury to multiple branches of the left brachial plexus: suprascapular, musculocutaneous, axillary, and radial nerves. At six months, the patient showed mild improvement in muscle trophism and shoulder stability, with partial recovery of shoulder and elbow function.
Conclusion
This case illustrates the potential severity of floating shoulder injuries, particularly when compounded by brachial plexus involvement. A multidisciplinary approach—including early diagnosis, surgical stabilization, and targeted rehabilitation—is essential for optimizing functional outcomes and improving quality of life.
Keywords
Floating, Shoulder, Brachial, Plexus, Rehabilitation
#258 SAFETY AND EFFICACY OF ULTRASOUND AND FLUOROSCOPY-GUIDED RADIOFREQUENCY THERMAL ABLATION IN OSTEOARTHRITIS HIP PAIN
Miguel Guimarães, Ana Gonçalves, Tiago Ribeiro, Bruno Cancela, Ana Esteves, Luís Oliveira, José Luís Carvalho
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SAFETY AND EFFICACY OF ULTRASOUND AND FLUOROSCOPY-GUIDED RADIOFREQUENCY THERMAL ABLATION IN OSTEOARTHRITIS HIP PAIN
Background and Aims
Osteoarthritis hip pain significantly impacts quality of life. When conservative treatments fail and surgery is not viable, less aggressive strategies are needed. Thermal radiofrequency ablation has emerged as a minimally invasive alternative for pain control. Ultrasound and fluoroscopy have refined the precision targeting neural structures. The aim of the study is to evaluate the safety and efficacy of associating ultrasound and fluoroscopy to guide hip joint denervation for the treatment of osteoarthritis hip pain.
Methods
An analysis of clinical records and patient interviews were conducted from January 2022 to January 2025. Patients with hip osteoarthritis experiencing severe pain and undergoing ultrasound and fluoroscopy-guided thermal radiofrequency ablation of the articular branches of the femoral, obturator, and accessory obturator nerves were included. Pain and functional outcomes were assessed with Numeric Pain Scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Additionally, adverse effects and analgesics use were documented.
Results
A total of 32 patients were included, 60% male, with a mean age of 64.09±13.98 years. Symptoms persisted for 40.91±38.98 months. Radiographic Tönnis classifications were distributed between grade II (53%) and III (47%). Additionally, 56% of patients presented associated pathologies, mainly femoroacetabular impingement (83%). Pre-intervention pain scores averaged 8.39±1.47, reducing 4.78±2.35 (p<0.001). The initial mean WOMAC score was 72.91±12.41, decreasing 38.39±18.09 (p<0.001). The mean time from procedure to reassessment was 7.17±3.89 months. Regarding obesity, no statistically significant relationship was found with pain reduction efficacy (p=0.8684) or functional improvement (p=0.8303). Concerning analgesics consumption, 19 patients discontinued pain medication entirely. Regarding procedural safety, no adverse effects were reported.
Conclusion
Ultrasound and fluoroscopy-guided radiofrequency nerve ablation represented an effective strategy, significantly reducing osteoarthritis hip pain, with notable improvements in functional scores. However, larger prospective studies with well-defined follow-up periods are necessary to better understand the duration of the therapeutic effect and the factors associated with a better prognosis.
Keywords
Hip; Osteoarthritis; Pain; Radiofrequency; Denervation;
#260 THE ASSOCIATION OF BRAIN-DERIVED NEUROTROPIC FACTOR VAL66MET POLYMORPHISM WITH STROKE OUTCOMES: A CROSS-SECTIONAL STUDY
Eduard Tiozzo1, Kerstin Yu2, Gary Farkas2, Joslyn Gober2, Tatjana Rundek2, Sebastian Koch2
2 University of Miami Miller School of Medicine, United States
Conference topic: Neurorehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
THE ASSOCIATION OF BRAIN-DERIVED NEUROTROPIC FACTOR VAL66MET POLYMORPHISM WITH STROKE OUTCOMES: A CROSS-SECTIONAL STUDY
Background and Aims
Stroke is the leading cause of long-term disability in the United States. Post-stroke recovery can be highly variable, suggesting the need to elucidate responsible mechanisms, such as brain-derived neurotropic factor (BDNF) Val66Met polymorphism. The aim of this study was to investigate the effect of BDNF Val66Met polymorphism on post-stroke outcomes including quality of life, physical fitness, cognitive function, quality of life, overall disability, and depression.
Methods
We included stroke participants enrolled in a Randomized Trial of Combined Aerobic, Resistance, and Cognitive Training who underwent a three-month exercise and cognitive training program. Of 131 participants enrolled in the trial, 89 participants (68%) had data available on BDNF Val66Met polymorphism and stroke outcomes (mean age, 57±10 years; 58% male; 54% White, and 49% Hispanic). The difference between Met-carriers and non-Met carriers were analyzed for 89 participants and in pair-matched analysis, using age (±5), sex, time since stroke (3 months, 3-6 months, and 6 months after a stroke), and race (White, Black, or other/unknown race). Both main and ancillary studies were approved by the Institutional Review Board at the University of Miami.
Results
Twelve participants (13%) had one copy of the BDNF Val66Met (Val/Met heterozygotes) and none had two copies (Met/Met homozygotes). Comparing Met (n=12) and non-Met carriers (n=77) demonstrated no statistically significant differences in demographics or clinical characteristics, including motor or cognitive outcomes. In pair-matched analysis, the significant difference was observed for Center of Epidemiological Studies Depression (CES-D) scale, where Met carriers had significantly greater CES-D scores than non-Met carriers (24±16 vs 9±9, p=0.011). Regardless of the chosen CES-D cut-off scores (≥16 vs ≥20) more cases of depressive symptomatology were observed among those with the BDNF Val66Met polymorphism than those without it (p values = ≤0.05).
Conclusion
The BDNF Val66Met polymorphism is associated with depression but not physical and cognitive outcomes post-stroke.
Keywords
stroke, recovery, polymorphism, BDNF, depression
#261 STUDY ON FIRST AID AND CARDIOPULMONARY RESUSCITATION (CPR) KNOWLEDGE AMONG THERAPISTS IN THE REHABILITATION GYM
Marta Supervía Pola, Arià Camps Royo, María Olga Arroyo-Riaño, David Guerrero Falsay
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
STUDY ON FIRST AID AND CARDIOPULMONARY RESUSCITATION (CPR) KNOWLEDGE AMONG THERAPISTS IN THE REHABILITATION GYM
Background and Aims
Therapy areas within Physical and Rehabilitation Medicine (PRM) departments involve patients with significant comorbidities, increasing the risk of medical emergencies. Adequate training in cardiopulmonary resuscitation (CPR) and first aid is essential to ensure prompt and effective responses by healthcare professionals. This study aimed to assess the theoretical knowledge and perceived preparedness for emergency situations among rehabilitation staff, including physiotherapists, occupational therapists, speech therapists, and support staff.
Methods
A cross-sectional descriptive study was conducted through a structured survey administered to PRM staff working in the rehabilitation gyms of Hospital General Universitario Gregorio Marañón. The survey collected sociodemographic data, professional experience, training background in CPR and first aid, theoretical knowledge through clinical scenarios, and self-perceived readiness to handle emergencies. Descriptive and comparative analyses were performed using non-parametric statistical tests.
Results
Out of 86 invited professionals, 57 completed the survey (response rate: 66.3%). While 87.5% had received CPR training, only 47.3% had completed a first aid course. Merely 14.5% considered their training sufficient. Those who completed both CPR and first aid courses scored significantly higher in the knowledge test (mean 7.05/10) compared to those without training (5.05/10; p = 0.03). Physiotherapists outperformed other professional groups (p = 0.001). Self-perceived preparedness was reported by only 27.3%, but this group had significantly higher knowledge scores (p = 0.011). Almost all participants demanded regular training, with a recommended update frequency of approximately 2.3 years.
Conclusion
Combined training in CPR and first aid is associated with higher theoretical knowledge and greater self-confidence in emergency management. Despite extensive clinical experience, most professionals felt inadequately trained. The findings highlight the need for structured, accredited, and regularly updated training programs tailored to the rehabilitation setting, as well as specific emergency protocols to enhance patient safety and professional response capacity.
Keywords
Cardiopulmonary, Resuscitation, First, Aid, Emergency
#263 BEHAVIORAL AND COGNITIVE DISTURBANCES IN CHILDREN WITH POSTERIOR FOSSA TUMORS POST-SURGERY: A DESCRIPTIVE LONGITUDINAL ANALYSIS
FILOMENI ARMAKOLA1, ELENI POTAMITI2, GIORGOS FELEKIS3, ZOI DALIVIGKA2, EIRINI SIDERA2, DIMITRIS KALIARAS2, kostantinos SIOUMPOURAS4, ANNA TSIAKIRI5, MARIANTHI PAPANDRIKOU2, PINELOPI VLOTINOU4
2 Early Intervention & Rehabilitation Unit, P. & A. Kyriakou Children's Hospital, Greece
3 University of Medicine and Pharmacy “Grigore T. Popa”, Romania
4 University of West Attica, Greece
5 Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BEHAVIORAL AND COGNITIVE DISTURBANCES IN CHILDREN WITH POSTERIOR FOSSA TUMORS POST-SURGERY: A DESCRIPTIVE LONGITUDINAL ANALYSIS
Background and Aims
Background: Posterior fossa tumors (PFTs) in children are associated with motor, cognitive, and behavioral challenges that may hinder social reintegration and quality of life post-surgery. Aim: This study investigates the incidence and characteristics of behavioral disturbances in children following surgical treatment for PFTs, focusing on psychosocial and cognitive impacts.
Methods
Methods: Epidemiological analysis was conducted using data (2013–2024) from the Early Intervention and Rehabilitation Unit at “P. & A. Kyriakou” Children's Hospital. Children with histologically confirmed PFTs were included. Data collected covered demographics, anxiety, behavioral and sleep disorders, suicidal ideation, and cognitive deficits.
Results
Results: Among 183 patients (mean diagnosis age: 5.8 years; male-to-female ratio: 1.5:1), attention and memory deficits were reported in 84%, persisting in 61% despite cognitive improvements. Children ≤6 years showed high rates of parental attachment (64%) and behavioral control needs (73%). In older children, 77% had limited socialization, and ≥9-year-olds reported anxiety (84%) and fear of relapse (91%). Sleep disorders were prominent early (91%), decreasing to 12% after one year. Psychological support was regular in 68% of cases.
Conclusion
Conclusion: Early identification and intervention for behavioral and cognitive issues in children with PFTs are critical to promoting recovery, autonomy, and successful community reintegration.
Keywords
brain tumour, children, cognition, behaviour
#266 REHABILITATION MANAGEMENT OF PERIPHERAL NERVE INJURY FOLLOWING PEDIATRIC SURGERY: A CASE REPORT
Ana Rita Pessoa, Inês Camarinha, Catarina Afonso, Fábio Pinho
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
REHABILITATION MANAGEMENT OF PERIPHERAL NERVE INJURY FOLLOWING PEDIATRIC SURGERY: A CASE REPORT
Background
Every year, there are approximately 400 to 600 cases of pediatric heart transplantation worldwide. The most common indication for heart transplantation in children over the age of 10 are Cardiomyopathies. Following surgery, a small percentage of patients will suffer a peripheral nerve injury, mostly due to compression, traction or nerve ischemia.
Case report
A 12-year-old boy with no significant prior medical history was diagnosed with dilated cardiomyopathy of unknown etiology after experiencing asthenia, progressive fatigue, orthopnea, and persistent abdominal pain and vomiting over a five-month period. He was admitted to the hospital on February 2nd, 2024, and approximately one month later underwent orthotopic heart transplantation. On the first postoperative day, the patient reported numbness, tingling, and a sensation of heaviness in the right upper limb, accompanied by marked weakness in active wrist and finger extension (graded 1/5), suggestive of radial nerve injury. Ultrasound examination revealed no structural abnormalities along the course of the nerve. Electromyography findings were consistent with radial nerve dysfunction. During hospitalization, the patient engaged in daily physiotherapy sessions that included both cardiac and neuromotor rehabilitation. The neuromotor component focused on neural mobilization techniques, postural re-education, proprioceptive training, strengthening exercises, and electrotherapy. Additionally, a custom orthosis was fabricated to ensure proper limb positioning at rest.
Conclusion
After discharge, the patient continued a telerehabilitation program while attending online school. Four months post-transplant, he had achieved near-complete functional recovery.
Keywords
pediatric heart transplantation, peripheral nerve
#267 INFLUENCE OF AGE AND TYPE OF OPERATION ON OUTCOMES AND EXPECTATIONS AFTER ORTHOPEDIC SURGERIES
Dejan Miscevic1, Dinko Kolarić2, Ana Kolarić2, Dajana Lukić Demeter2, Ana Marija Čurlić3, Luka Slivar2, Domagoj Sirovec2, Ana Marija Šepl Plentaj2, Marta Čivljak4
2 Specijalna bolnica "Daruvarske toplice", Croatia/Hrvatska
3 Specijalna bolnica "Stubičke toplice", Croatia/Hrvatska
4 Catholic University of Croatia, Croatia/Hrvatska
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
INFLUENCE OF AGE AND TYPE OF OPERATION ON OUTCOMES AND EXPECTATIONS AFTER ORTHOPEDIC SURGERIES
Background and Aims
The impact of age on the outcomes of specific orthopedic procedures remains contradictory (1,2,3). This study aimed to compare two types of procedures (anterior cruciate ligament (ACL) reconstruction and total hip arthroplasty (THA) and their outcomes and patient expectations after surgery.
Methods
In this retrospective study, 200 patients participated: 100 after THA (53% women, average age 67 years) and 100 after ACL reconstruction (33% women, average age 26 years). All participants completed a validated questionnaire with questions related to outcomes (rehabilitation process, post-operative pain, acceptance of assistive devices) and expectations (belief and desire for recovery, fear of lasting consequences) after surgery, rated from 1 to 5 (Likert scale (4)). For statistical analysis, we used percentage calculation, the asymptotic general independence test, and the Cochran–Armitage test of association for a contingency table. All results were set at significance level p < 0.05.
Results
Older patients after THA felt more relaxed during rehabilitation (64% THA; 35% ACL) and accepted assistive devices more easily after surgery (65% THA; 35% ACL). They had similar pain tolerance (Z=1.93; p=0.053), confidence in themselves and their recovery (Z=0.56; p=0.57), desire for recovery (Z=1.82; p=0.068), as well as fear of not being able to walk normally in the future (Z=-1.81; p=0.07). The younger group after ACL surgery is more confident that they will become independent in the future (Z=2.6, p < 0.01).
Conclusion
Although younger patients after ACL surgeries do not feel relaxed during rehabilitation and have more difficulty accepting assistive devices than older patients after THA, they have greater confidence that they will become independent over time, which may be explained by a higher level of optimism in younger generations.
Keywords
Operation outcome, ACL, TEP
#268 DIFFERENCE IN OPINIONS ON THE NEED FOR THE MEDITERRANEAN DIET AMONG PHYSIOTHERAPY STUDENTS BASED ON THEIR PLACE OF RESIDENCE
Dejan Miscevic1, Dinko Kolarić2, Ana Kolarić2, Luka Slivar2, Domagoj Sirovec2, Ana Marija Čurlić3, Dajana Lukić Demeter2, Karolina Ružička2, Tanja Kovač4
2 Specijalna bolnica "Daruvarske toplice", Croatia/Hrvatska
3 Specijalna bolnica "Stubičke toplice", Croatia/Hrvatska
4 Fakultet za dentalnu medicinu i zdravstvo Osijek, Croatia/Hrvatska
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
DIFFERENCE IN OPINIONS ON THE NEED FOR THE MEDITERRANEAN DIET AMONG PHYSIOTHERAPY STUDENTS BASED ON THEIR PLACE OF RESIDENCE
Background and Aims
The Mediterranean diet (MD) is a dietary pattern characterized by the consumption of large amounts of whole grains, fruits, vegetables, legumes, seeds, nuts, and fish. It is associated with reduced disability in multiple sclerosis, reduction of symptoms in cognitive impairments, and neurovegetative diseases (3), which can indirectly lead to stronger muscles and improved mobility. The aim of this study is to examine the knowledge of physiotherapy students (PS) regarding their awareness of the MD concept, based on their place of residence, and their opinions on the usefulness of the MD in the prevention of poor posture and its impact on learning.
Methods
In this prospective longitudinal study, 79 physiotherapy students participated, of whom 48 were from the city and 31 from rural areas. All participants completed a validated questionnaire about their awareness of the MD concept, the frequency of MD consumption, and their opinions on whether MD could influence posture improvement and, consequently, facilitate learning. Depending on the normality of the distribution of the results, statistical analysis was performed using the chi-square test and the Shapiro-Wilk test. All results were set at a significance level of p<0.05.
Results
A total of 79% of the physiotherapy students were familiar with the MD concept, with no differences based on their place of residence (p=0.11). 85% consume MD at least once a week, with significantly higher consumption (p=0.04) and frequency (p<0.01) in the city. 66% of the participants believe that MD can influence body posture, and consequently, improve learning (89%), with no significant differences based on place of residence (posture p=0.48; learning p=0.58).
Conclusion
Although a relatively large number of physiotherapy students are familiar with the MD concept and believe that it can positively affect posture and thus facilitate learning, 15% still consume it less than once a week, with significantly lower consumption in rural areas.
Keywords
MEDITERRANEAN DIET, PHYSIOTHERAPY STUDENTS, POSTURE
#269 GENDER DIFFERENCES IN PHYSICAL ACTIVITY HABITS AMONG PHYSIOTHERAPY STUDENTS
Dinko Kolarić1, Ana Kolarić1, Luka Slivar1, Domagoj Sirovec1, Dajana Lukić Demeter1, Dejan Miscevic2, Ana Marija Čurlić3, Tea Medak1, Tanja Kovač4
2 Poliklinika "Faktor zdravlja", Croatia/Hrvatska
3 Specijalna bolnica "Stubičke toplice", Croatia/Hrvatska
4 Fakultet za dentalnu medicinu i zdravstvo Osijek, Croatia/Hrvatska
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
GENDER DIFFERENCES IN PHYSICAL ACTIVITY HABITS AMONG PHYSIOTHERAPY STUDENTS
Background and Aims
Kinesiotherapy is the most important form of physical therapy¹, and it is essential for physiotherapists to understand the significance of physical activity (PA) in both the prevention and treatment of musculoskeletal disorders. The aim of this study was to investigate the physical activity habits of physiotherapy students and compare them based on gender.
Methods
This longitudinal, prospective study included 38 physiotherapy students with an average age of 22.4 years, representing both genders (57.9% women). All participants completed a validated questionnaire that asked about general demographics (gender, age) as well as frequency ( a) less than once a week; b) 1-2 times a week; c) 3-4 times a week; d) 5 or more times a week), and type of physical activity (a) aerobic activity; b) strength exercises; c) group exercises; d) other). The number of participants was sufficient for valid statistical analysis. Significance in terms of exercise type and frequency was tested using the chi-square test, with a significance level set at p<0.05.
Results
Men were represented in all categories of physical activity intensity, whereas no women participated in the “5 or more times a week” category. Although more women (18.4%) than men (5.3%) exercised 1-2 times a week, the chi-square test suggested that gender was not a significant factor influencing PA frequency (p=0.24). Women more frequently engaged in various types of exercises (they were represented in all categories), while men significantly preferred strength exercises (31.6%). There was a statistically significant relationship between the gender of physiotherapy students and the type of PA they preferred (p<0.01).
Conclusion
Previous research indicates that the proportion of regular exercisers within the physiotherapy population is low², though the difference in our study was statistically insignificant. Ultimately, there is no gender difference in the frequency of exercise among physiotherapy students, although male students tend to prefer strength exercises.
Keywords
PHYSIOTHERAPY STUDENTS, PHYSICAL ACTIVITY
#272 THE EFFECTS OF TECAR THERAPY ON PAIN, DISEASE ACTIVITY, RANGE OF MOTION AND FUNCTION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS
Simeon Grazio1, Ana Giljanović1, Hana Skala Kavanagh1, Frane Grubišić1, Sonja Muraja2, Branko Markulinčić2, Ines Doko Vajdić1, Simeon Grazio1
2 Special Hospital for Medical Rehabilitation Stubičke Toplice, Croatia/Hrvatska
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE EFFECTS OF TECAR THERAPY ON PAIN, DISEASE ACTIVITY, RANGE OF MOTION AND FUNCTION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS
Background and Aims
The Transfer of Energy Capacitive and Resistive (TECAR) therapy is PRM modality that predominantly increases tissue temperature, promotes blood flow and improves oxygen and nutrient delivery while reducing swelling and pain. TECAR therapy is used for numerous indications, including low back pain, knee osteoarthritis, painful shoulder, myofascial pain syndrome and many others. The aim of this study was to evaluate the effect of TECAR, on pain intensity (VAS), disease activity (VAS-GDA and Bath Ankylosing Spondylitis Disease Activity Index – BASDAI), function (Bath Ankylosing Spondylitis Functional Index - BASFI), and the range of motion (Bath Ankylosing Spondylitis Metrology Index - BASMI), in individuals with axial spondyloarthritis (axSpA), immediately after stopping the therapy (T1) and one month thereafter (T2).
Methods
TECAR was applied in 6 sessions during 2 or 3 weeks, alongside exercise for patients with axSpA.
Results
The study included 33 individuals of both sexes, aged between 18 and 65 years. In comparison with baseline values in T1 visit there was an improvement in VAS-pain (median baseline 6 vs 3; the average decrease of 44.82%), VAS-GDA (the median 5 vs 3; the average decrease of 26.88%). Also, BASDAI decreased by an average of 34.58%, BASMI by 28.27%, and BASFI by 27.47%. When comparing the results of 20 patients between T0 and T2 the positive effects faded away for BASDAI (-5.47%), but partially persisted for VAS-GDA (28.6%), BASFI (16.78%) and VAS-pain (17.2%).
Conclusion
In our study of patients with axSpA, TECAR therapy has proven to be successful in alleviating pain, decreasing inflammation, and improving range of motion and function. Also, data showed that the effect for the majority of observed outcomes might not be long-lasting. Future research is needed to determine the extent to which TECAR therapy can reduce analgesic use and to compare its effect with some other treatment modalities.
Keywords
Ankylosing, spondylitis, Axial, spondyloarthritis, Efficacy
#273 BALNEOTHERAPY COMPARED TO ADDITIONAL THERMOTHERAPY IN THE TREATMENT OF CHRONIC NONSPECIFIC LOW BACK PAIN
Dinko Kolarić1, Ana Kolarić1, Dejan Miscevic2, Ana Marija Čurlić3, Dajana Lukić Demeter1, Luka Slivar1, Domagoj Sirovec1
2 Poliklinika "Faktor zdravlja", Croatia/Hrvatska
3 Specijalna bolnica "Stubičke toplice", Croatia/Hrvatska
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BALNEOTHERAPY COMPARED TO ADDITIONAL THERMOTHERAPY IN THE TREATMENT OF CHRONIC NONSPECIFIC LOW BACK PAIN
Background and Aims
Balneotherapy is a commonly used conservative method for treating chronic nonspecific low back pain (NSLBP), often combined with medical gymnastics (MG) and thermotherapy. The objective of this study was to compare the effectiveness of hydrogymnastics (HG) with MG and mineral-rich mud therapy (MB), versus the same kinesitherapy paired with paraffin thermotherapy.
Methods
This prospective, randomized study included 61 patients over a three-week period. Thirty patients received daily MG and HG with paraffin, while 31 received MB three times per week instead of HG. Pre- and post-treatment assessments included finger-to-floor distance (Thomayer test), sagittal lumbar mobility (Schober test), bilateral lateral flexion, and patient- reported outcomes: the Roland-Morris Disability Questionnaire (RMDQ), ClinFit, DASS-21, EQ- 5D-5L, and a visual analogue scale (VAS) for pain. Depending on data distribution, paired t- tests or Wilcoxon tests were used. Delta values were analyzed with ANOVA to assess the effects of treatment type, age, and sex. Significance was set at p < 0.05.
Results
All outcome measures, except Schober’s test, showed significant post-treatment improvement. Schober’s measure was significantly associated with treatment type, with greater improvement observed in the MT group, and with age, showing better results in older patients. No other outcome was significantly associated with treatment type. Age was significantly related to RMDQ, EQ-5D pain and anxiety dimensions, DASS-21, and VAS, with younger patients showing greater improvements. Initially, age was also linked to EQ-5D activity, but this lost significance when adjusting for sex and treatment. DASS-21 results were significantly influenced by both age and sex, with women showing greater benefit. In univariate analysis, sex was associated with EQ-5D care, though this did not hold in multivariate analysis.
Conclusion
MB therapy showed superior outcomes only in spinal mobility, while age had the greatest influence on treatment response. Both approaches are recommended, with the choice guided by comorbidities and patient preference.
Keywords
Balneotherapy, Thermotherapy, Nonspecific, Low, Back
#275 THE EFFECT OF THE MEDITERRANEAN DIET ON DIASEASE ACTIVITY, FUNCTION AND FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Hana Skala Kavanagh1, Kristina Žgela Talan2, Abdelkarim Al-Jabiri1, Frane Grubišić1, Simeon Grazio1, Vedrana Škoro Rendulić3, Iris Tadić3, Hana Skala Kavanagh1
2 Istrian Health Center, Croatia/Hrvatska
3 Department of Nutrition and Dietetics, Sestre milosrdnice University Hospital Center, Croatia/Hrvatska
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE EFFECT OF THE MEDITERRANEAN DIET ON DIASEASE ACTIVITY, FUNCTION AND FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Background and Aims
In order to maintain remission or low disease activity and prevent disease progression in rheumatoid arthritis (RA), a multimodal approach is preferred one, including pharmacological and non – pharmacological treatment. The aim of our study was to evaluate effect of the Mediterranean diet on RA activity.
Methods
A total of 26 patients (19 female and 7 male) mean age 61 years from the Sestre milosrdnice University Hospital Center were observed in longitudinal analyses from February 2025 to April 2025, at baseline (T0), after 6 week period (T1). All the patients underwent nutritional consultation and following data were analyzed: demographic, clinical and laboratory data, as well as composite indices and questionnaires assessing disease activity (DAS 28), function (HAQ-DI) and fatigue (FACIT-F). No pharmacological therapy was changed in the time frame of interest.
Results
The mean DAS28 score significantly decreased from 4.13 ± 1.20 at T0 to 3.45 ± 1.39 at T1, with a mean change of −0.68 ± 0.76 (p< 0.001). Mean HAQ-DI scores demonstrated modest improvement from 1.04 (SD=0.83) at T0 to 0.96 (SD=0.68) at T1 (mean change -0.08, 95% CI -0.32 to 0.16). While 54% of patients showed reduced disability scores (median improvement -0.5 points), the overall difference did not reach statistical significance (p=0.483). Mean FACIT-F scores improved significantly from 29.6±11.2 (T0) to 33.5±10.8 (T1), with a mean increase of +3.9 points (95% CI: 1.5-6.3). Effect size was moderate-large.
Conclusion
In our cohort of patients with established RA, Mediterranean diet showed positive effects on significantly improving disease activity and fatigue, with moderate improvement in function. Dietary guidelines for RA patients should be made in order to improve outcomes in these patients.
Keywords
Rheumatoid, arthritis; Mediterranean, diet; fatigue
#276 COMPRESSIVE MONONEUROPATHY OF ULNAR NERVE IN THE CUBITAL CANAL CAUSED BY OSSIFICATION – A CASE REPORT
Gordana Cesarec1, Valentina Blažinčić1, Ivana Kern2
2 Special hospital for Children with Neurodevelopmental and Motor Disorders, Croatia/Hrvatska
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
COMPRESSIVE MONONEUROPATHY OF ULNAR NERVE IN THE CUBITAL CANAL CAUSED BY OSSIFICATION – A CASE REPORT
Background
Cubital tunnel syndrome is the second most common canalicular syndrome of the upper extremity. It occurs when the ulnar nerve is compressed in the cubital tunnel of the elbow. The etiology of this syndrome is multifactorial. The most common symptoms of syndrome are pain, paresthesias of the little finger and ring finger, hypoesthesia and hypotrophy of the hypothenar and small muscles of the hand. Neurography is considered relevant if the conduction velocity through the ulnar nerve in the elbow region is less than 50 m/s and ultrasound finding is relevant if ulnar nerve cross-sectional area is greater than 10 mm2.
Case report
We present a a 24-year-old patient with spastic tetraplegia after a severe traumatic brain injury. The compressive neuropathy of the ulnar nerve in the area of the cubital tunnel was diagnosed by neurography. X-ray revealed extensive ossification of the elbow and ultrasound showed a thickened ulnar nerve. A cross-sectional area of ulnar nerve was 13.4 mm2 along the medial condyle and in the area between the head of the ulnar flexor muscle, the nerve was still thickened and edematous, and measured 18.7 and 18.2 mm. Initially, a perineural blockade was performed for symptom relief, followed by operative decompression. Three months after the operation a control ultrasound of the nerve was performed. In the area of the medial condyle the cross-sectional area of ulnar nerve was 15.8 mm2, while other measurements at typical locations were <10 mm2.
Conclusion
The control ultrasound finding still indicated possible compression of the nerve in the area of the medyal epycondil. According to the literature the ulnaris nerve can be compressed in 5 different places in the elbow area. It is important to considering the possibility of compression ulnar nerve in different places as well as possibility of multiple causes of compression present at the same.
Keywords
compressive mononeuropathy, ulnar nerve, ultrasound
#277 UNMASKING RESPIRATORY MUSCLE WEAKNESS DURING EFFORT IN MYOTONIC DYSTROPHY TYPE 1
Jan Aksentijević, Josip Ljoka, Katarina Doko Šarić, Matea Stiperski Matoc, Dubravka Bobek
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
UNMASKING RESPIRATORY MUSCLE WEAKNESS DURING EFFORT IN MYOTONIC DYSTROPHY TYPE 1
Background
Myotonic dystrophy type 1 (MD1), also known as Steinert’s disease, is the most common monogenic autosomal dominant disorder affecting both skeletal and smooth muscles. Since treatment is symptomatic, early recognition of complications and timely, goal-oriented rehabilitation are essential.
Case report
A 50-year-old male with a confirmed diagnosis of MD1, under the care of a multidisciplinary team, was referred to a physical and rehabilitation medicine specialist for assessment of functional status and rehabilitation needs. At initial evaluation, hand muscle stiffness and weakness were observed. Following occupational therapy, the patient was referred for assessment of cardiorespiratory capacity based on a recommendation for respiratory rehabilitation. Isolated hypercapnia was identified despite otherwise normal pulmonary function tests, with the cause determined to be extrapulmonary—specifically, weakness of the respiratory muscles. The patient reported no signs of cardiorespiratory deconditioning. A 6-minute walk test showed normal performance (655 meters, minimum SpO₂ 94%, expected blood pressure response to 140/90 mmHg). Maximal inspiratory pressure at rest (Pimax = 65 mbar) was within normal limits. Cardiopulmonary exercise testing, conducted using a RAMP protocol, revealed a VO₂max of 34.1 mL/kg/min (92% predicted), an oxygen pulse at 101% predicted, and a breathing reserve of 50.2%, all indicating preserved aerobic and ventilatory capacity. However, the VE/VCO₂ slope was elevated at 35.6, and VE/VCO₂ at the first ventilatory threshold was 27.9—both above normal, indicating reduced ventilatory efficiency. This finding, together with desaturation to 88% at peak exertion, confirmed exertional respiratory dysfunction since cardiopulmonary causes were excluded earlier. The patient was referred for targeted respiratory rehabilitation focusing on aerobic conditioning and strengthening of respiratory muscle function.
Conclusion
The aim of this case report is to highlight the importance of assessing cardiorespiratory capacity both at rest and during exertion to guide effective and personalized rehabilitation planning.
Keywords
myotonic, dystrophy, respiratory, muscles, weakness
#278 INCIDENCE AND RISK FACTORS OF PRESSURE ULCERS IN PATIENTS WITH SPINAL CORD INJURY IN SUBACUTE REHABILITATION
Natalija Lebedeva, Jekaterina Krasovska, Emilija Reimane, Dace Stirane
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
INCIDENCE AND RISK FACTORS OF PRESSURE ULCERS IN PATIENTS WITH SPINAL CORD INJURY IN SUBACUTE REHABILITATION
Background and Aims
Pressure ulcers are among the most common complications within the first year following a spinal cord injury (SCI), significantly impeding the rehabilitation process. The aim of this study was to determine the incidence of pressure ulcers among SCI patients during first two rehabilitation courses, to analyze the associated risk factors.
Methods
A retrospective analysis of 135 SCI patients admitted to the National Rehabilitation Centre “Vaivari” 2018 - 2021 was conducted. Data were collected from medical records during first two specialized subacute inpatient rehabilitation courses, included ASIA, SCIM, Braden assessments.
Results
A total of 135 medical records of patients with SCI were analyzed, males 68.15%. Based on the Braden Scale, high or very high risk of developing pressure ulcers was identified in 41.48% of patients during the first rehabilitation course, in 13.33% during the second. Pressure ulcers were observed in 15.56% of cases during the first rehabilitation course, with 38.10% of these classified as deep (Stage III–IV). During the second course, pressure ulcers occurred in 11.11% of cases, with 33.33% considered deep. Pressure ulcers were present in 28% of patients in high risk and in 9.68% in very high risk during the first rehabilitation course. In the second, ulcers were present in 57.14% of high-risk and 18.18% of very high-risk patients. Pressure ulcers were more frequent in male patients (P = 0.02). However, patients with complete spinal cord injury had a higher incidence of pressure ulcers (P = 3.83 × 10⁻⁵). Reduced mobility and limited self-care ability, were associated with an increased risk of developing pressure ulcers (P = 8.18 × 10⁻⁴ and P = 5.14 × 10⁻⁶).
Conclusion
The risk of pressure ulcers is highest during the early subacute phase following spinal cord injury. Key risk factors include the completeness of the lesion, as well as impaired mobility and self-care abilities.
Keywords
spinal cord injury, pressure ulcers
#279 CHANGES IN SUPRASPINATUS TENDON PATHOLOGY AND SHOULDER PAIN AFTER TRAUMATIC SPINAL CORD INJURY
Elizabeth Felix1, Diana Cardenas1, Robert Irwin1, Rachel Cowan2, Nathan McKenty3
2 University of Alabama Birmingham, United States
3 Henry Ford Health, United States
Conference topic: Pain treatment and rehabilitation
Occupation: Other medical specialties
Type of abstract: Scientific abstract
Abstract
Title
CHANGES IN SUPRASPINATUS TENDON PATHOLOGY AND SHOULDER PAIN AFTER TRAUMATIC SPINAL CORD INJURY
Background and Aims
Shoulder pain affects between 30-78% of individuals with spinal cord injury (SCI). Over time, repetitive use of the upper extremities, for wheelchair propulsion and transfers, can contribute to increases in pain in persons with SCI. The Aim of this study was to evaluate the change in shoulder pain and supraspinatus (SS) tendon pathology from inpatient discharge to one-year post-discharge.
Methods
This was an observational, prospective study. Individuals at least 20 years old who had a traumatic SCI and who were completing inpatient rehabilitation at the study hospital were recruited. Participants were evaluated regarding SS tendon health (Ultrasound Shoulder Pathology Ratings Scale and quantitative ultrasound (QUS) metrics) and shoulder pain and function (Disabilities of the Arm, Shoulder, and Hand; Wheelchair Users Shoulder Pain Index; and 0-10 ratings of shoulder pain). All measures were repeated 12 months later, and differences across the two time points were evaluated.
Results
The SS tendon in the non-dominant shoulder showed significant changes for QUS metrics of width, contrast, and homogeneity across the first year after traumatic SCI, but the dominant SS tendon exhibited no significant changes during this time period. Clinical measures of shoulder pain and function did not significantly change between baseline and 12-month follow-up. No significant correlations were found between changes in SS QUS measures and changes in shoulder pain across time for either shoulder.
Conclusion
Changes in non-dominant SS tendon width during the first year after SCI were detected in this study, but were not found for the dominant shoulder and were not significantly related to patient-reported shoulder pain. These results suggest that non-invasive and inexpensive ultrasound methods may be useful for monitoring pre-clinical signs of rotator cuff tendinopathy in individuals with SCI, and that special attention should be paid to the health of the non-dominant SS tendon during the first year after injury.
Keywords
ultrasonography, supraspinatus, spinal cord injury
#280 ULTRASOUND-GUIDED MULTIMODAL TREATMENT FOR PATELLAR TENDINOPATHY: A PERSONALIZED THREE-STEP INTERVENTIONAL APPROACH
Arianna Pesaresi1, Danilo Gallo2, Vincenzo Ricci2
2 Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, Italy
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
ULTRASOUND-GUIDED MULTIMODAL TREATMENT FOR PATELLAR TENDINOPATHY: A PERSONALIZED THREE-STEP INTERVENTIONAL APPROACH
Background
Patellar tendinopathy, commonly known as “Jumper’s Knee”, is a chronic overuse condition frequently observed in athletes engaged in repetitive knee-loading activities. In some cases, it may be associated with partial tendon rupture and Hoffa fat pad impingement, contributing to persistent anterior knee pain and functional limitations. Recent studies have emphasized the importance of targeting not only the tendinous tissue but also the peritendinous structures, including the interface with Hoffa fat pad, to optimize clinical rehabilitation outcomes.
Case report
A 49-year-old non-competitive kickboxing athlete presented with chronic bilateral knee pain localized at the lower pole of the patella, significantly limiting sports participation and daily activities. He was referred to a PRM specialist after undergoing an MRI scan, which revealed bilateral patellar tendinopathy with partial tendon ruptures (6mm on the left, 10mm on the right), reactive bone edema, and Hoffa fat pad inflammation. Following clinical examination and ultrasound evaluation, the patient underwent a three-session ultrasound-guided interventional protocol, with one-week intervals. Each session included: (1) hydrodissection of the Hoffa–patellar tendon interface using saline and lidocaine, to disrupt adhesions and debride bridging neovessels and neonerves; (2) micro-fenestration of the damaged tendon tissue (dry needling) to stimulate blood flow and growth factors release; (3) injection of tendon-specific hyaluronic acid (e.g., Hyalotend MD) to improve tendon gliding and promote intra-tendinous structural remodeling. A tailored physiotherapy program followed, focusing on isometric and eccentric strengthening. Pain and function were assessed using the VISA-P and NRS scales, which improved from 31/100 and 9/10 pre-treatment to 84/100 and 1/10 at follow-up, respectively.
Conclusion
This case highlights how a personalized, ultrasound-guided approach targeting both intra- and peritendinous structures can lead to substantial clinical improvement in complex patellar tendinopathy. The combination of hydrodissection, dry needling, and hyaluronic acid injections under ultrasound guidance may provide synergistic benefits in pain relief and functional recovery.
Keywords
Patellar-Tendinopathy, Hoffa-Pad-Syndrome, HyaluronicAcid, Ultrasound
#281 IDIOPATIC TOE WALKING IN CHILDREN – GUIDED SELF-REHABILITATION AS A NEW THERAPEUTIC APPROACH, CASE STUDY
Nicole Musilová
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
IDIOPATIC TOE WALKING IN CHILDREN – GUIDED SELF-REHABILITATION AS A NEW THERAPEUTIC APPROACH, CASE STUDY
Background
Toe walking is a suboptimal locomotion pattern in which children walk on the tiptoes without the hindfoot touching the floor. The majority of causes remains idiopathic (habitual) toe walking (ITW). Several causes of ITW have been suggested, such as delayed development of the cortico-spinal tract, vestibular dysfunction, psychogenic causes or congenital shortening of the Achilles tendon. In some children, functional disruption or general deconditioning may develop. Treatment is usually based on age, underlying cause, the development and severity of tendon contracture. There is good evidence for casting and surgery in the treatment of idiopathic toe walking, but also the intramuscular injection of botulotoxin into calf muscles in combination with an exercise program can improve the walking pattern.
Case report
8 years old boy, who suffered from IWT, was sent to our department by an orthopedist for consultation. In case history, there was neurologically suspicion of Asperger´s syndrome. ITW occurred when the patient was 2 years old. He underwent repeated sessions of guided physiotherapy, including Vojta reflex locomotion and Bobath concept, as well as orthotic management (splinting and shoe insoles), all with minimal therapeutic effect. Patient was examined according to professor Gracies´ concept. Range of motion (ROM) was restricted bilaterally. No signs of spasticity were observed. The patient was unwilling to undergo injection treatment, so we chose kinesiotherapy. He and his mother were briefed in self-rehabilitation based on a combination of stretching the triceps surae muscle and strengthening the antagonistic muscle groups. The follow-up examination after four weeks showed significant improvement in both active and passive ROM, with complete elimination of toe walking.
Conclusion
Guided self-rehabilitation based on the concept of prof. Gracies, commonly used in patients with focal spastic paresis, can be effectively used in therapy of IWT. Parenteral and child compliance is crucial and it is a key factor in treatment effectiveness.
Keywords
toe walking, children, self-rehabilitation
#282 CHALLENGES IN THE REHABILITATION OF SPINAL SERONEGATIVE RHEUMATOID ARTHRITIS IN NON SPINAL SPECIALIST UNIT: A MULTIDISCIPLINARY APPROACH
ali AL-FADHLY
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CHALLENGES IN THE REHABILITATION OF SPINAL SERONEGATIVE RHEUMATOID ARTHRITIS IN NON SPINAL SPECIALIST UNIT: A MULTIDISCIPLINARY APPROACH
Background
Seronegative arthritis describes a group of conditions that present with inflammatory arthritis but without a positive rheumatoid factor.Seronegative Rheumatoid arthritis(RA)represents a significant disease burden,for which prompt therapeutic intervention continues to be hampered by diagnostic challenges.
Case report
We report a 68 year old lady with a diagnosis of seronegative Rheumatoid Arthritis (RA).She had multilevel disc prolapse with severe spinal stenosis at L4/5 due to disc prolapse in combination with facet joint hypertrophy.Had lumbar spinal decompression.She developed severe cauda equina secondary to spondylolisthesis at L4/5 and has had two decompressions.She then had CT guided aspiration of left facet joint.Scans confirmed a right psoas abscess L4/L5 that has increased in size.She was managed conservatively. She received extended doses of intravenous antibiotics and followed by 3 months of oral antibiotics.During the course of illness she developed weakness in her left foot (3/5) and severe pain in her legs more so in the left limb. She developed a grade 2 pressure sore on her sacrum.She was managed on complete bed rest with frequent turns.She started to develop contractures in both lower limbs.Once the skin had healed she started a protocol of gradual sitting up.Her severe pain improved and was weaned off opiates. Soft tissue contractures were prevented and reversed by passive stretching daily.Her bladder function has been maintained by using a flip/flow regime.Her bowel sensation started to recover but not fully.Her care was provided in one unit (non-spinal) with a wide range of expertise to cover aspects of her rehabilitation.ASIA score has improved from C to D.
Conclusion
There is insufficient evidence to support a bespoke treatment strategy for seronegative RA subset.Complications can be devastating.A multidisciplinary Team approach is essential due to the complexity in such cases.Sound knowledge and proactive approach in preventing complications is crucial.Patient education of spinal injuries is vital to their rehabilitation.
Keywords
Seronegative arthritis, Spinal injury, complications
#283 HYDRODISSECTION OF THE MEDIAN NERVE AFTER COMMINUTED TRAUMA OF THE HAND USING PRP – A CASE STUDY
Rudolf Ditmar, Veronika Dobrá
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
HYDRODISSECTION OF THE MEDIAN NERVE AFTER COMMINUTED TRAUMA OF THE HAND USING PRP – A CASE STUDY
Background
Post-traumatic carpal tunnel syndrome (CTS) is a notable concern following an injury to the wrist. Early identification and intervention are crucial to prevent long-term neurological deficits, which may lead to chronic pain, paresthesias, and muscle weakness, disrupting the function of the hand. Ultrasound-guided hydrodissection of the median nerve involves separating the median nerve from surrounding fibrous tissues, thereby promoting neural mobility. The application of platelet-rich plasma (PRP) in conjunction with hydrodissection has shown potential in augmenting tissue regeneration and reducing inflammation.
Case report
We present a clinical case of posttraumatic CTS after osteosynthesis of a comminuted dislocated fracture of the second metacarpal at the carpometacarpal (CMC) joint, later converted to arthrodesis of the second and third CMC joints, significantly disrupting the function of the affected hand. Due to the severity of the injury, the wrist mobility and analytic exercises were prioritized in the early rehabilitation. CTS then gradually developed because of fibrosis of the wrist caused by bony fragments. The rehabilitation was compromised due to pain and paresthesias in the median nerve distribution, and the development of paresis of the innervated muscles. The grip function was disrupted by progressive ulnar deviation of the wrist, accompanied by progressive resting adduction of the thumb. Therefore, the USG examination of the wrist was performed. After the diagnosis of CTS, the patient underwent USG-guided hydrodissection of the median nerve using PRP. The gradual regression of the paresthesia and pain was recorded after intervention, peaking at 6 weeks. The patient continues rehabilitation with significant progression of the grip strength, function, and fine motor skills.
Conclusion
The use of USG-guided hydrodissection with PRP presents a novel therapeutic approach for patients with posttraumatic CTS. The dual approach seems suitable for rehabilitation progression and has the potential to improve patient outcomes significantly. It should be considered individually to optimize treatment strategy.
Keywords
Hydrodissection, post-traumatic, CTS, PRP
#285 CLINICAL MANIFESTATIONS OF RHEUMATIC POLYMIALGIA
Vanesa Muharemović Medenčević1, Antonija Gračanin2, Ivan Antun Mašić2, Ana Gudelj Gračanin3
2 School of medicine, University of Zagreb, Croatia/Hrvatska
3 Klinička bolnica Sveti Duh, Croatia/Hrvatska
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CLINICAL MANIFESTATIONS OF RHEUMATIC POLYMIALGIA
Background
Polymyalgia rheumatica (PMR) is a chronic inflammatory disease that affects people older than 50 years. It causes joint and muscle pain and stiffness, mainly in the shoulder and hips. The diagnosis of PMR relies mainly on symptoms and signs combined with laboratory markers of inflammation.
Case report
The aim of this study was to present the clinical manifestations of patients who were treated for PMR at the Department of Clinical Immunology, Rheumatology and Pulmology of the Sveti Duh university Hospital in the period from 2021 to 2025. Patients diagnosed with PMR according to the EULAR/ACR classification criteria from 2012 were included in the study. A retrospective study was conducted based on the data collected by reviewing the available medical documentation. Descriptive statistics methods were used in the analysis of the results. A total of 7 patients with PMR were analyzed. The average age is 76 years, where the female gender predominates (71.43%). The most common manifestation of PMR was joint pain 87.71%, stiffness 57.14%, myalgia 28.57% and fever 28.57%. Three patients (42, 28%) were diagnosed with temporal arteritis (TA), everyone manifested with headache and visual disturbances. No malignant diseases were found in these patients. All patients were treated with glucocorticoids, followed by a rapid clinical response. Relapse occurred in 2 patients (28.57%).
Conclusion
PMR is a disease that appears in older age and is characterized by a good and rapid therapeutic response to glucocorticoid treatment. Polymyalgia rheumatica (PMR) and temporal arteritis (TA) are closely related rheumatic diseases and often occur in the same patient. The most common manifestations of PMR in our patients were joint pain, stiffness, myalgia and fever. By timely recognition of the most common clinical manifestations of PMR and considering the characteristic of a quick response to the use of glucocorticoids, we prevent complications of these disease.
Keywords
rheumatic polymialgia, temporal arteritis
#286 INCREASE IN EXERCISE ADHERENCE FOLLOWING WHIPLASH INJURY USING MOBILE APP INTERVENTION: WHO CAN BENEFIT MOST?
Blaž Barun1, Jure Aljinović1, Zdravko Divić1, Ante Katić1, Benjamin Benzon2, Ana Poljičanin1
2 Departments of Anatomy, Histology and Embryology, School of Medicine, University of Split, Croatia/Hrvatska
Conference topic: Innovation/imaging in PRM
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
INCREASE IN EXERCISE ADHERENCE FOLLOWING WHIPLASH INJURY USING MOBILE APP INTERVENTION: WHO CAN BENEFIT MOST?
Background and Aims
Adherence to exercise is a well-known problem. Despite considerable efforts, there is still no efficient solution available. Whiplash injury often causes chronic disability, and long-term exercise is a tool to reduce it. Mobile apps are widespread, easy to use, and have demonstrated the ability to increase adherence to exercise following whiplash injury. The aim of this study was to find out who can benefit from a mobile app intervention.
Methods
A randomized controlled trial was conducted. Participants with whiplash injury were divided into an intervention and a control group. All participants completed the physical therapy program and were advised to continue exercising at home. The intervention group received daily push notifications via mobile app as a reminder to exercise. Outcomes were exercise adherence assessed six months after the injury by a 4-point Likert scale (no sessions, occasional, 2-4 sessions/week, or ≥5 sessions/week), initial physical functioning (NDI), initial psychological functioning (PCS), and pain intensity (VAS).
Results
Fifty-nine participants were analyzed. Participants were divided into three groups: mild disability (n=8 vs. n=10), moderate disability (n=15 vs. n=13), and severe disability (n=5 vs. n=7). The intervention increased adherence most in participants with moderate disability (3 [2-4] vs. 2 [2-2];p=0.004, median [IQR]) followed by mild disability (3 [3-4] vs. 2 [2-3];p=0.037), and had no impact on participants with severe disability (2 [2-3] vs. 3 [2-3];p=0.483). Additionally, improvement in exercise adherence was not associated with pain catastrophizing (p=0.884), pain intensity (p=0.890), sex, or age.
Conclusion
Mobile app intervention can increase exercise adherence in participants with mild and moderate disability following whiplash injury of the neck, regardless of their sex and age. This easy-to-use intervention could be applied to stimulate exercise adherence in other pain conditions, such as chronic neck pain or low back pain, where long-term exercise is crucial in achieving better outcomes.
Keywords
mobile-app, intervention, exercise, adherence, disability
#287 THE USE OF THERAPEUTIC ULTRASOUND FOR LIQUIFYING PAINFUL MUSCOLOSKELETAL CYST BEFORE ULTRASOUND-GUIDED INTERVENTION: A CASE STUDY
Miroslav Haltmar1, Rudolf Ditmar2
2 University Hospital Olomouc, Rehabilitation Department, Czech Republic
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Postgraduates students
Type of abstract: Case report
Abstract
Title
THE USE OF THERAPEUTIC ULTRASOUND FOR LIQUIFYING PAINFUL MUSCOLOSKELETAL CYST BEFORE ULTRASOUND-GUIDED INTERVENTION: A CASE STUDY
Background
Therapeutic ultrasound is a widely used therapeutic modality in many rehabilitation protocols. One of its effects is the liquefaction of solid swelling or gelled fillings of cysts or joints. This case study aims to highlight the potential use of therapeutic ultrasound in cysts with gelled fillings.
Case report
This case study concerns a man (born in 1946) with degenerative shoulder joint disease and a painful acromioclavicular joint cyst formation, which was palpably very stiff and immobile. It has been punctured repeatedly by an orthopaedic surgeon in the past, often complicated by post-puncture secretion. It has never been able to be fully aspirated due to the very stiff and gel-like filling, nor has the pain been alleviated. For this reason, a series of therapeutic ultrasounds was resorted to. The scheme was as follows: week 1 + 2 – three times per week – Mon/Wed/Fri; week 3 – four times per week – Mon-Thu, a total of 10 times. Ultrasound parameters were 1.0-1.6 W/cm2, duty factor 50-100 %, alternation of 1 MHz and 3 MHz, application time 6-10 minutes. After each application, the cyst was palpably significantly less stiff and painful. After the series of therapeutic ultrasound described above, the cyst was re-punctured under ultrasound guidance using a subcutaneous tunnel technique to prevent post-puncture secretion, and all the fluid was successfully aspirated. With a specific time interval (2 weeks), the acromioclavicular joint area is significantly less painful, with no signs of further filling production.
Conclusion
This case study demonstrates the significant effectiveness of therapeutic ultrasound in liquefying gelled cyst fillings within the musculoskeletal system, providing a valuable therapeutic tool for ultrasound-guided interventions procedural planning.
Keywords
therapeutic ultrasound, cysts, gelled fillings
#288 SPINAL MUSCULAR ATROPHY TYPE 4: A CASE REPORT
Mladenka Parlov1, Dora Dujmović1, Diana Vučina1, Adela Arapović1, Viktor Čulić1, Nikola Parlov2
2 University of Zagreb, School of Medicine, Croatia/Hrvatska
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SPINAL MUSCULAR ATROPHY TYPE 4: A CASE REPORT
Background
Spinal muscular atrophies (SMA) are a group of inherited neuromuscular disorders caused by degeneration of alpha motor neurons in the spinal cord, resulting in progressive muscle weakness and atrophy. Most forms of SMA are autosomal recessive and associated with biallelic deletions or mutations in the SMN1 gene on chromosome 5q13. Clinically, SMA is classified based on age at onset and maximal motor function: type 1 (non-sitters), type 2 (sitters), type 3 (walkers with childhood onset), and type 4 (adult onset). All types present with symmetrical proximal muscle weakness, more pronounced in the lower limbs, and reduced or absent deep tendon reflexes. Diagnosis relies on clinical evaluation, EMG/EMNG findings, and confirmatory genetic testing.
Case report
We report a case of a 67-year-old woman evaluated in June 2016 by a physiatrist after surgical treatment of a left femur fracture. She had a previous forearm fracture in March 2016. Rehabilitation was slow, with persistent gait impairment and frequent falls. Clinical examination revealed proximal lower limb weakness and impaired ambulation using forearm crutches. EMNG findings showed generalized lower motor neuron involvement. Genetic testing confirmed SMA type 4. Risdiplam therapy (0.75 mg/mL once daily) was initiated in December 2023. Following an influenza infection in January 2024, the patient required mechanical ventilation. Post-recovery, she experienced worsening gait difficulties, painful knee recurvatum, and transitioned to a walker. In February 2024, motor assessments showed: MMT, RHS 32/69, RULM 43/43. Barthel Index was 68; 6-minute walk test was not feasible due to knee pain. She was prescribed KAFO orthoses and enrolled in a personalized rehabilitation program focusing on individual kinesitherapy.
Conclusion
This case underscores the importance of recognizing adult-onset SMA, which may present subtly and be misdiagnosed. Timely diagnosis, initiation of disease-modifying treatment, and ongoing rehabilitation are crucial for maintaining function, reducing disability, and improving quality of life in adult SMA patients.
Keywords
SMA, weakness, neurorehabilitation
#289 PHYSIOTHERAPY EFFECT ON THE FUNCTIONAL STATUS OF CHILDREN WITH CEREBRAL PALSY AFTER SELECTIVE DORSAL RHIZOTOMY SURGERY
Daiva Šatkutė1, Lina Budrienė1, Tomas Aukštikalnis1, Vilma Dudonienė2
2 Lithuanian Sports University, Lithuania
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PHYSIOTHERAPY EFFECT ON THE FUNCTIONAL STATUS OF CHILDREN WITH CEREBRAL PALSY AFTER SELECTIVE DORSAL RHIZOTOMY SURGERY
Background and Aims
The study has shown the importance of selecting patients according to functional status for surgical treatment and the importance of assessing functional status indicators when planning a rehabilitation program for children after selective dorsal rhizotomy, the aims were to evaluate the effect of physiotherapy on the functional status of children with cerebral palsy after selective dorsal rhizotomy surgery.
Methods
VAS scale for pain level assessment, goniometry, Ashworth scale for muscle tone assessment, manual muscle strength testing according to the Lovett scale, Tinetti test for balance and gait assessment, modified FIM scale for mobility assessment.
Results
A statistically significant change in the following functional status indicators was found after physiotherapy: pain level, range of motion, lower limb muscle tone, balance and gait, and mobility (p<0.05). Mobility showed the most significant change. When comparing the differences in indicators between the GMFCS classification system levels, muscle tone before physiotherapy differed statistically significantly, while mobility and balance differed statistically significantly after physiotherapy. It was found that the results of Level II patients improved the most after physiotherapy, and those of Level IV patients improved the least.
Conclusion
Statistically significant (p<0.05) improvements were observed in the following functional status indicators in children with cerebral palsy after selective dorsal rhizotomy surgery: pain level, range of motion, muscle tone, balance and gait, and mobility. Muscle strength increased statistically significantly only in separate muscle groups. When assessing and comparing the differences in functional status indicators before and after physiotherapy, a statistically significant difference was found in mobility function between Level II and Level III, and between Level II and Level IV, and in balance function between Level II and Level IV (p<0.05). The greatest statistically significant improvement in indicators after physiotherapy was found in Level II according to the GMFCS classification system, and the smallest improvement was found in Level IV.
Keywords
Cerebral palsy, selective dorsal rhizotomy
#290 PERCUTANEOUS ULTRASOUND-GUIDED NEEDLE TENOTOMY OF THE LATERAL EPICONDYLITIS WITH HUMERORADIAL JOINT INFILTRATION OF PLATELET-RICH PLASMA
Rudolf Ditmar, Naděžda Calábová
Conference topic: Sports medicine rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
PERCUTANEOUS ULTRASOUND-GUIDED NEEDLE TENOTOMY OF THE LATERAL EPICONDYLITIS WITH HUMERORADIAL JOINT INFILTRATION OF PLATELET-RICH PLASMA
Background
The concurrent diagnoses of humeroradial plica syndrome and chronic lateral epicondylitis present unique challenges for treatment. Both conditions can result in similar lateral elbow pain, making accurate diagnosis arduous. It is crucial to evaluate the possible presence of a synovial plica in individuals with chronic lateral epicondylitis, as this may complicate clinical presentations. In this complex clinical scenario, ultrasound emerges as a crucial and reliable tool in both diagnosis and management.
Case report
A case series of 5 patients with chronic lateral epicondylitis who did not experience symptom alleviation with conservative management for 3 months was referred to our department for ultrasound examination. The clinical presentation suggested the possible presence of simultaneous humeroradial plica syndrome and chronic lateral epicondylitis. Ultrasound confirmed both diagnoses, and patients agreed to undergo percutaneous ultrasound-guided tenotomy of the common extensor tendon with PRP application. PRP was applied to the sites of the tenotomy to promote healing. Simultaneous humeroradial joint infiltration with PRP was also performed. Individual kinesiotherapy was then initiated 2 weeks post-procedure, focusing mainly on the elbow range of motion with progressive mechanical loading of the common extensor tendon. The USG reevaluation was performed 2 and 6 weeks after the procedure. Significant improvement in pain, elbow range of motion, grip strength, and overall satisfaction with elbow and wrist function was recorded after 6 weeks post-procedurally without symptom recurrence.
Conclusion
The interplay between humeroradial plica syndrome and chronic lateral epicondylitis necessitates a comprehensive approach to diagnosis and management. This novel dual-target treatment, which involves the use of PUNT and humeroradial joint infiltration with PRP, is showing significant promise in the management of chronic lateral elbow pain. We propose considering this therapeutic modality as a bridge therapy before referring patients to elbow arthroscopy, offering a new ray of hope in the treatment of these conditions.
Keywords
Humeroradial plica, lateral elbow pain
#291 THE USE OF POINT-OF-CARE KINEMATIC ANALYSIS IN THE TREATMENT OF FOCAL SPASTICITY
Rudolf Ditmar1, Nicole Musilová1, Marika Kolářová2
2 Palacky University Olomouc, Faculty of Medicine, Czech Republic
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
THE USE OF POINT-OF-CARE KINEMATIC ANALYSIS IN THE TREATMENT OF FOCAL SPASTICITY
Background
Kinematic assessment in the treatment of focal spastic paresis offers valuable insights into the factors influencing gait and overall movement in patients, thereby guiding treatment interventions, such as botulinum toxin injections and physical therapy. The kinematic evaluation of candidates for botulinum toxin therapy could refine treatment targeting. In clinical practice, the availability of a kinesiological laboratory presents an obstacle for most ambulatory specialists. Nonetheless, it is essential to distinguish between the various contributors to movement impairments, including muscle weakness and reduced motor control, as these factors significantly affect rehabilitation approaches for individuals with spastic paresis.
Case report
We present a case series of patients with focal spastic paresis of the lower limb after ischemic stroke, where point-of-care gait kinematic evaluation, using high-speed video recorder with kinematic software, that was used for determining candidate muscles for botulinum toxin treatment. The evaluations were performed as a part of gait testing commonly used with prof. Gracies’ therapeutic concept of focal spastic paresis. Gait speed, stride length, and joint goniometry were measured and evaluated. After analysis, the muscle map was established, and ultrasound-guided application of the botulinum toxin with electrophysiological verification of the contractibility of the selected muscles was performed. After 1 month, patients were reevaluated and the measurements compared with prior data. The muscle compensation strategies, spastic co-contractions and synkinesis were evaluated to appraise selected spastic muscles. The kinematic feedback leads to increased motivation for self-rehabilitation among patients and also inspires them as they experience measurable progress in their movement abilities.
Conclusion
The integration of personalized goals and innovative treatment methodologies, coupled with continuous evaluation of movement through kinematic analysis, ultimately contributes to more effective rehabilitation. This approach not only facilitates the alignment of kinematic assessments with patients’ specific rehabilitation goals, but also optimizes the management of spastic paresis and enhances patient engagement in the treatment.
Keywords
Kinematic analysis, focal spasticity, botulinumtoxin
#292 KINESIOPHOBIA IS ASSOCIATED WITH DISABILITY, QUALITY OF LIFE, PSYCHOLOGICAL MORBIDITY, AND SURGERY SATISFACTION IN PATIENTS WITH LUMBAR MICRODISCECTOMY: A CROSS-SECTIONAL CONTROLLED STUDY
nihal tezel1, aslı can2
2 Yildirim Beyazit Faculty of Medicine, Turkey
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
KINESIOPHOBIA IS ASSOCIATED WITH DISABILITY, QUALITY OF LIFE, PSYCHOLOGICAL MORBIDITY, AND SURGERY SATISFACTION IN PATIENTS WITH LUMBAR MICRODISCECTOMY: A CROSS-SECTIONAL CONTROLLED STUDY
Background and Aims
Our study aimed to investigate the presence of kinesiophobia in patients who have undergone lumbar microdiscectomy and to reveal its relationship with pain intensity, disability, quality of life, depression anxiety, and surgery satisfaction.
Methods
Tampa Scale for Kinesiophobia (TSK), Roland-Morris Disability Index (RMDI), Hospital Anxiety and Depression Scale-(HADS-A and HADS-D), and Short Form-36 health survey (SF-36) were applied to both groups.
Results
The scores of TSK, RMDI, HADS-A, and HADS-D were significantly higher in patients with microdiscectomy than in control subjects (p<0.001). The scores of SF-36 were significantly lower in patients with microdiscectomy than control subjects. The rate of kinesiophobia was 70.8% in patients with microdiscectomy and 18.7% in normal subjects. In the microdiscectomy group, the scores of RMDI, HADS-A, and HADS-D were significantly higher in kinesiophobic patients than in non-kinesiophobic patients (p<0.05). The scores of SF-36 and surgery satisfaction VAS were significantly lower in kinesiophobic patients than in non-kinesiophobic patients (p<0.05). We found a significant correlation between TSK scores and RMDI, HADS-A, HADS-D, SF-36 scores, and surgery satisfaction (p<0.05).
Conclusion
Kinesiophobia is related to an increased disability, psychiatric morbidity, decreased quality of life, and patient dissatisfaction in patients with lumbar microdiscectomy.
Keywords
kinesiophobia, microdiscectomy, disability, quality, of
#293 THE IMPORTANCE OF A MULTIDISCIPLINARY APPROACH IN MANAGING COMPLEX REGIONAL PAIN SYNDROME (CRPS) – CASE REPORT
Josip Ljoka, Jan Aksentijević, Matea Stiperski Matoc, Katarina Doko Šarić, Dubravka Bobek
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
THE IMPORTANCE OF A MULTIDISCIPLINARY APPROACH IN MANAGING COMPLEX REGIONAL PAIN SYNDROME (CRPS) – CASE REPORT
Background
Complex regional pain syndrome (CRPS) is a chronic pain condition marked by sensory, motor, autonomic, and trophic disturbances, typically following injury or surgery. Diagnosis is clinical, as no definitive test exists. The Budapest Criteria is the most widely accepted tool, requiring ongoing pain disproportionate to the inciting event, at least one symptom in all four categories (sensory, vasomotor, sudomotor/edema, motor/trophic), and at least one clinical sign in two or more categories. Other potential diagnoses must be excluded. A multidisciplinary approach is essential for effective CRPS management. The rehabilitation medicine specialist typically leads the care team, prescribes medication, and monitors progress. Physiotherapists play a key role by employing range of motion exercises to restore joint mobility, lymph drainage to reduce edema, and desensitization techniques to address hypersensitivity. Occupational therapy focuses on improving hand function and enhancing independence in daily tasks. Educational rehabilitation includes sensory stimulation and hand-strengthening exercises using various therapeutic tools. Nurses support the process by encouraging treatment adherence, monitoring symptoms, and providing emotional support.
Case report
A 48-year-old nurse developed CRPS type I after sustaining a fourth metacarpal fracture from a fall at home. Following immobilization, she experienced worsening pain, swelling, and arm discoloration. Her wrist was diffusely edematous with a bluish hue, and she reported severe pain (VAS 9), weakness, and forearm paresthesia. Joint stiffness and restricted movement in the wrist and fingers prevented her from forming a fist, with a 7 cm gap from the palm. She fulfilled the full Budapest Criteria for CRPS. Her individualized, multidisciplinary treatment included analgesics, corticosteroid injections, vitamin supplementation, physiotherapy (lymph drainage, myofascial release), occupational therapy, and educational rehabilitation.
Conclusion
After several weeks, she showed significant improvement in pain, strength, and mobility. Her recovery highlights the importance of early diagnosis and a coordinated, patient-centered approach in CRPS management.
Keywords
Rehabilitation, Pain, CRPS, Fractures, Analgesics
#294 SEGMENTAL ZOSTER PARESIS PRESENTING WITH FOOT DROP: A RARE COMPLICATION OF HERPES ZOSTER
Ayşegül Garip Honamlıoğlu, Zahide Nur Tunca Yavuz, Serpil Savaş
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SEGMENTAL ZOSTER PARESIS PRESENTING WITH FOOT DROP: A RARE COMPLICATION OF HERPES ZOSTER
Background
Herpes zoster is a viral infection caused by the reactivation of the varicella-zoster virus latent in the dorsal root ganglia, typically presenting with dermatomal vesicular rashes and neuropathic pain. Its incidence increases with aging and immunosuppression. A rare but clinically significant complication is segmental zoster paresis (SZP), which involves motor nerve impairment leading to weakness in the affected limb. Motor deficits usually develop within 1–8 weeks after the appearance of skin lesions. Although the prognosis is generally favorable with timely diagnosis and intervention, delayed recognition may result in long-term functional impairments.
Case report
A 63-year-old male presented with right foot drop and difficulty walking. Two months earlier, he had developed vesicular lesions on the anteromedial side of his right leg, accompanied by pain on the lateral aspect. He was diagnosed with herpes zoster and treated with oral valacyclovir. One week after the rash appeared, he noticed weakness in his right foot. There was no history of trauma, systemic illness, lower back pain, or prior surgery. Electromyography (EMG) revealed severe partial axonal involvement of the right deep peroneal nerve proximal to its innervation of the tibialis anterior; there was no evidence of radiculopathy on EMG. Laboratory findings were unremarkable. On physical examination, the strength of dorsiflexion, eversion, and inversion in the right foot was graded 0/5, and hypoesthesia was noted in the first web space. An ankle-foot orthosis was prescribed, and the patient was enrolled in a rehabilitation program. At 3-month follow-up, eversion and inversion improved to 2/5, but no further motor or sensory recovery was observed.
Conclusion
Segmental zoster paresis is a rare but disabling complication of herpes zoster that can significantly impact daily activities. Early diagnosis, treatment and initiation of rehabilitation are crucial for better outcomes. Delayed diagnosis and management may lead to poor prognosis and persistent neurological deficits.
Keywords
Foot Drop, Segmental Zoster Paresis
#295 PELVIC FLOOR REHABILITATION IN FEMALE STRESS URINARY INCONTINENCE: RESULTS OF A PROTOCOL COMBINING BIOFEEDBACK AND ELECTROSTIMULATION
Mouad Yazidi, Rime Dades, Abdelhakim Kabil, Ryme El beloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El fatimi
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
PELVIC FLOOR REHABILITATION IN FEMALE STRESS URINARY INCONTINENCE: RESULTS OF A PROTOCOL COMBINING BIOFEEDBACK AND ELECTROSTIMULATION
Background and Aims
Stress urinary incontinence is the involuntary loss of urine during physical effort, sneezing or coughing. The aim of our work was to study the effect of pelvic floor rehabilitation on stress urinary incontinence in women.
Methods
We conducted a prospective study of 52 patients followed in our department for monosymptomatic stress urinary incontinence. A protocol of 30 sessions of perineal rehabilitation was carried out for each patient: the first 10 with biofeedback and 20 others with electrostimulation via an intra-vaginal probe. We assessed the severity and impact of stress urinary incontinence using the Michigan Incontinence Symptom Index before (T0) and at the end of the sessions (T1).We excluded patients with other urinary symptoms and those with cognitive disorders
Results
The mean age was 51.4 years. 59.6% of the patients had given birth vaginally in at least one of their deliveries and 23.07% had undergone labor dystocia. Our patients did not perform any perineal exercises during pregnancy. Assessment of pelvic floor muscle contraction by digital palpation revealed a score of less than 3 on the modified Oxford scale (MOS) in 67.3% of cases. 13.4% had 2nd degree urogenital prolapse and 7.6% 3rd degree. The mean stress urinary incontinence sub score according to the Michigan Incontinence Symptom Index was 8.4 at T0 and 7.1 at T1, and the sanitary pad use sub score was greater than 2 at T0 in 86.5% of patients and less than 2 in 21.15% at T1. The mean boredom score was 6.7 at T0 and 5.7 at T1.
Conclusion
Our results confirm that pelvic floor retraining improves the symptoms and quality of life of women suffering from stress urinary incontinence. Our study is limited because we evaluated our patients in the short term, and further studies on the long-term efficacy of pelvic floor retraining are needed.
Keywords
stress, incontinence, pelvic, rehabilitation
#297 HOW TO INDIVIDUALIZE AEROBIC TRAINING IN STROKE PATIENTS?
Matea Stiperski Matoc1, Josip Ljoka2, Katarina Doko Šarić2, Jan Aksentijević2, Dubravka Bobek2
2 Klinička bolnica Dubrava, Croatia/Hrvatska
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
HOW TO INDIVIDUALIZE AEROBIC TRAINING IN STROKE PATIENTS?
Background and Aims
Stroke is one of the leading causes of disability and mortality worldwide. Patients after stroke often have reduced cardiorespiratory fitness and physical activity levels, which is associated with an increased risk of cardiovascular diseases. Cardiopulmonary exercise testing (CPET) can be used to determine cardiovascular disease risk and indicate aerobic exercise in stroke patients. The aim of this study was to demonstrate the role of CPET in the stroke rehabilitation.
Methods
Review of recent studies on CPET after stroke.
Results
Early aerobic training has a positive effect on aerobic capacity, walking speed and endurance in the stroke recovery. CPET should be performed as soon after stroke as patients are medically stable. Prior to CPET, patients shouldn't have contraindications such as unstable angina or uncontrolled hypertension. Blood pressure, heart rate, ECG, oxygen saturation and clinical symptoms are closely monitored during the test. The exercise mode (cycle ergometer or treadmill) is determined based on the patient's motor deficits. Cycle ergometry is safer for patients with balance or gait disorders. CPET evaluates parameters such as peak oxygen consumption (VO₂peak), ventilatory threshold and respiratory exchange ratio, which help to determine aerobic capacity and training zones. The VO₂peak is a predictor of functional independence and long-term survival in stroke patients. CPET is terminated when the patient becomes symptomatic or when maximal effort is reached. Aerobic exercise in subacute and chronic stroke patients should be performed three to five days per week for at least eight weeks. The intensity must be moderate (training zone assessed by CPET). Patients should start with 20 minutes per exercise and gradually increase duration.
Conclusion
Aerobic exercise improves cardiorespiratory fitness and physical activity levels in stroke patients and helps reduce the risk of a second stroke. CPET is critical for assessing aerobic fitness and exercise intensity and for monitoring long-term recovery in stroke patients.
Keywords
CPET, stroke, aerobic capacity
#298 BALANCE EXERCISE FOR PATIENTS WITH PARKINSON'S DISEASE
Matea Stiperski Matoc1, Katarina Doko Šarić2, Josip Ljoka2, Jan Aksentijević2, Dubravka Bobek2
2 Klinička bolnica Dubrava, Croatia/Hrvatska
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BALANCE EXERCISE FOR PATIENTS WITH PARKINSON'S DISEASE
Background and Aims
Parkinson's disease is the second most common neurodegenerative disease and occurs in 2-3% of the population over the age of 65. Postural instability occurs early in the course of Parkinson's disease. Specific balance disorders include postural swaying, gait instability, slow turning, decreased trunk rotation, decreased ability to maintain balance in a tilted position, impaired anticipatory postural adjustment and decreased reactive postural responses. Reduced speed and amplitude of postural adaptation contribute to reduced stability during gait initiation and transition from sitting to standing, while impaired reactive postural responses contribute to an increased risk of falling. The aim of the study was to evaluate the effect of balance exercises in patients with Parkinson's disease.
Methods
Balance was assessed in nineteen patients (N = 19) with Parkinson's disease using the Berg Balance Scale (BBS) on the first and last day of rehabilitation. Rehabilitation included balance and proprioception exercises on the ground and training on a computerized balance platform. Physical therapy was performed five days per week for four weeks.
Results
The BBS score improved significantly after the balance exercises. The median BBS score before training was 50 (IQR 6) and after training 52 (IQR 6). The median difference was 3 (IQR 4). A paired t-test showed a statistically significant difference between the BBS scores before and after training: t(18) = 2.28, p < 0.035.
Conclusion
Rehabilitation based on balance exercises in patients with Parkinson's disease had a significant positive effect on balance. These results support the effectiveness of balance exercises in improving postural stability.
Keywords
Parkinson, postural instability, balance exercise
#300 HUBER PROPRIOCEPTIVE TRAINING AND ALPHA- LIPOIC ACID: A NEW APPROACH IN OPTIMIZING NERVE FUNCTION IN PATIENTS WITH CHRONIC LOW BACK PAIN
Aldijana Kadric1, Edina Tanovic1, Damir Celik2, Dzevad Vrabac2, Ena Gogic1
2 Clinic for Physical Medicine and Rehabilitation, Clinical Center of University of Sarajevo,, Bosnia and Herzegovina
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
HUBER PROPRIOCEPTIVE TRAINING AND ALPHA- LIPOIC ACID: A NEW APPROACH IN OPTIMIZING NERVE FUNCTION IN PATIENTS WITH CHRONIC LOW BACK PAIN
Background and Aims
While there is evidence supporting the potential of Alpha-lipoic acid (ALA) to improve nerve conduction parameters in certain neurological conditions, its specific effects on nerve conduction in chronic low back pain (CLBP) patients have not been directly addressed in the current context. There is a connection between proprioceptive system deficits and movement control dysfunction in patients with CLBP, but the exact mechanism of this link is unknown. To analyze the effectiveness of the proprioceptive rehabilitation method using the Huber system of exercises and to describe the nerve conduction study findings in a patient with CLBP treated with ALA.
Methods
A quasi-experimental, pre-test post-test repeated measures design was used to include 15 patients at the Clinic for Physical Medicine and Rehabilitation, Clinical Center of the University of Sarajevo, in a three-week follow-up period. The patients were treated with 600 mg of ALA supplementation per day and participated in Huber proprioception training five days per week. Patients were followed for the next three weeks, with two study visits: one at baseline and one at the end of the study. The study visits included Electromyography and Nerve Conduction Studies.
Results
Out of the total patients (n = 15), 11 (73.3%) were male. The most commonly affected levels were L4/L5 (87%), followed by L3/L4 (6.5%) and L5/S1 (6.5%). There was a statistically significant median increase after three weeks in both proximal (z = -3.298, p < .001) and distal peroneal M wave amplitude (z = -3.415, p < .001). A statistically significant median increase was also observed in proximal (z = -3.408, p < .001) and distal tibial M wave amplitude (z = -3.409, p < .001).
Conclusion
Future research should be carried out with a larger sample size to examine the long term effects of the proprioceptive training and ALA supplementation on treatment of CLBP.
Keywords
Electromyoneurographic, activity, proprioceptive, training, Alpha-lipoic
#301 THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OSTEOARTHRITIS REHABILITATION: EMPHASIS ON BODY MASS REDUCTION
Katarina Doko Šarić, Jan Aksentijević, Matea Stiperski Matoc, Josip Ljoka, Dubravka Bobek
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OSTEOARTHRITIS REHABILITATION: EMPHASIS ON BODY MASS REDUCTION
Background and Aims
Osteoarthritis (OA) is a leading cause of disability worldwide, often aggravated by excess body weight, which increases biomechanical stress on joints and accelerates disease progression. Effective weight management, particularly through structured physical activity, is a key component of OA rehabilitation. However, exercise prescription must be individualized to ensure safety, efficacy and adherence, especially in patients with compromised joint function. The aim is to evaluate the role of cardiopulmonary exercise testing (CPET) in the development of personalized rehabilitation programs for patients with OA, with a specific emphasis on interventions aimed at body mass reduction.
Methods
CPET provides an objective, comprehensive assessment of cardiovascular, pulmonary and musculoskeletal function during graded exercise. Parameters such as peak oxygen uptake, ventilatory thresholds, heart rate kinetics and respiratory parameters offer critical insights into functional capacity and exercise limitations. These data support the formulation of individualized aerobic training zones and guide selection of appropriate exercise modalities.
Results
In overweight or obese individuals with OA, CPET- guided rehabilitation enables the safe implementation of low-impact, aerobic exercise modalities that optimize caloric expenditure while minimizing joint load. Strategically planned training improves metabolic efficiency, supports sustainable weight loss and enhances overall physical function. Furthermore, the use of CPET improves patient stratification, monitoring and outcome prediction, ultimately enhancing long-term adherence and therapeutic outcomes.
Conclusion
CPET is a valuable tool in the management of OA, particularly when body mass reduction is a therapeutic goal. Patients with osteoarthritis have high prevalence of comorbidities which requires individualized, risk-adapted exercise prescriptions. By enabling precise exercise prescription, it contributes to improved functional outcomes, reduced symptom burden and better quality of life for patients with OA. Incorporating CPET into rehabilitation protocols represents a step toward more personalized, evidence-based care for patients with osteoarthritis.
Keywords
cardiopulmonary exercise testing, osteoarthritis, rehabilitation
#302 COMPARISON OF THE EFFECTIVENESS OF CONVENTIONAL AND COOLED RADIOFREQUENCY ABLATION IN ADVANCED KNEE OSTEOARTHRITIS: A PILOT STUDY
AYSE NAZ KALEM OZGEN1, Fatma Özcan2, Rabia Layık2, Serdar Kesikburun2
2 Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Turkey
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
COMPARISON OF THE EFFECTIVENESS OF CONVENTIONAL AND COOLED RADIOFREQUENCY ABLATION IN ADVANCED KNEE OSTEOARTHRITIS: A PILOT STUDY
Background and Aims
To investigate the effectiveness of cooled radiofrequency ablation (RFA) and conventional RFA applied to the genicular nerves for chronic severe knee pain and disability in patients with advanced knee osteoarthritis unresponsive to conventional therapies.
Methods
20 patients with knee osteoarthritis were included in the study. The patients were randomly divided into 2 groups: cooled RFA group (n = 12) and conventional RFA group (n = 8). In the first group, cooled RFA was applied to the superomedial, superolateral, and inferomedial branches of the genicular nerve at 80° for 120 second under ultrasound guidance. In the second group, conventional RFA was applied to the superomedial, superolateral, and inferomedial branches of the genicular nerve at 90° for 135 second under fluoroscopy guidance. Patients were assessed before treatment, 4th week after treatment and 12th week after treatment a total of 3 times. Visual Analog Scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC), frequency of analgesic use and Global Assesment of Treatment Response were used as outcome measures in the study.
Results
As a result, both cooled and conventional RFA therapies in patients with chronic knee osteoarthritis was found to be beneficial in knee pain and disability, in addition, this recovery lasted at least 12 weeks (p<0.05). It was determined that cooled and conventional RFA applications were not statistically significantly superior to each other in terms of knee pain, disability, and patient satisfaction (p<0.05).
Conclusion
It has been determined that cooled and conventional RFA, two different types of RFA method applied to genicular nerve branches, are not superior to each other in terms of knee pain and disability in patients with chronic knee osteoarthritis.
Keywords
Osteoarthritis, Radifrequency Ablation, Cooled, Conventional
#303 EFFECTIVENESS OF THE SELF-DIRECTED AI-BASED NECK EXERCISE PROGRAM COMPARED TO CONVENTIONAL METHODS FOR ENHANCING NECK STABILITY AND REDUCING PAIN AMONG RESIDENTS IN THAILAND
YADANUCH BOONYARATANA, Nacha Chondamrongkul, Vitsarut Butragat, Derk Möller
Conference topic: Innovation/imaging in PRM
Occupation: Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
EFFECTIVENESS OF THE SELF-DIRECTED AI-BASED NECK EXERCISE PROGRAM COMPARED TO CONVENTIONAL METHODS FOR ENHANCING NECK STABILITY AND REDUCING PAIN AMONG RESIDENTS IN THAILAND
Background and Aims
Exercise programs provided through mobile applications are effective in reducing pain and improving neck muscle function. However, research on these applications among the older population is still limited. Existing studies that support the utilisation of exercise applications have also identified several significant challenges, including high costs and the requirement for technical expertise. This study evaluated the effects of a self-directed neck muscle exercise program delivered through an AI-based application. Specifically, it compares the program's effectiveness in enhancing neck stability and reducing neck pain with conventional neck muscle exercises among residents older in Chiang Rai Province, Thailand.
Methods
This study conduted a randomized controlled trial (RCT) design to compare the effects of two exercise interventions among older adults residing in a community setting in Thailand. The researchers initially screened 100 older adults enrolled in a community school in Chiang Rai, Thailand. Eligible participants, aged 60 years and above were randomly divided into two groups: the Self-Directed AI-Based Neck Exercise Program (n = 16) with a conventional exercise program (n = 16). Outcome measures included Visual Analogue Scale (VAS) for pain intensity and the Thai version of the Neck Disability Index (Thai-NDI) for functional impairment. Assessments were conducted at baseline and following a 4-week intervention period, resulting in two time points for measurement. A p-value of < 0.05 was considered indicative of statistical significance.
Results
A total of 32 participants aged between 60 and 80 years were selected based on predefined criteria. The outcome measures illustrated that statistically significant improvements, with reductions in pain intensity measured by VAS (p < 0.007) compared control group including improvements neck disability measured by the Thai-NDI (p < 0.045) compared between control group.
Conclusion
The self-directed AI-based neck exercise program has illustrated potential to improve neck stability, reduce pain, and promote better adherence, engagement, and appreciation among older adults.
Keywords
AI-program, Exercise., NDI, Pain., Older
#304 SKIN DEPIGMENTATION AND SOFT TISSUE ATROPHY AFTER TRIAMCINOLONE ACETONIDE INJECTION
Marta Vukorepa, Dragica Vrabec-Matković
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SKIN DEPIGMENTATION AND SOFT TISSUE ATROPHY AFTER TRIAMCINOLONE ACETONIDE INJECTION
Background
Steroids are commonly used in physical therapy/orthopedics practice for various indications with excellent results and a seemingly known safety profile. There are literature reports of triamcinolone acetonide localized skin and fat tissue atrophy in some patients.
Case report
We represent a 29-year-old female patient with skin depigmentation and soft tissue atrophy after triamcinolone acetonide (Kenalog) injection into a ganglion cyst over the radiocarpal joint. The patient came to physical therapy two weeks after a whiplash injury and complained of neck and right arm pain with paresthesia. MR of cervical spine revealed C3-C4 disk protrusion without nerve affection and EMNG revealed right C5 mild radiculopathy. Four months after injury, the patient underwent a Kenalog injection in the ganglion cyst over the left radiocarpal joint. Two months after the injection she noticed skin depigmentation and subcutaneous tissue atrophy on the injection site with paresthesia. Six months after injection all symptoms persisted including neck and right arm pain so repeated MRI revealed C5-C6 disk protrusion without nerve compression and EMG revealed C5 bilateral chronic radiculopathy. Algodystrophy was suspected and the patient underwent intensive physical therapy. Brain MRI did not reveal pathology and MR of both forearms did not reveal muscle atrophy. 16 months after injection, she had only mild forearm atrophy with no skin discoloration or pain.
Conclusion
Soft tissue atrophy and local skin depigmentation are known adverse effects of local corticosteroid injections with reported incidences from 1.5-40% and 1.3-4%, respectively. The average latency period for development of both lesions is 4-8 weeks for some authors and 1- 4 months for skin depigmentation according to others. In most cases, these events are self-limited and resolve in 6-24months. Based on some authors the administration of extra-articular corticosteroid injections seems to be a 'relatively safe' intervention, but patients should be informed about local adverse events before drug administration.
Keywords
depigmentation, skin, atrophy, corticosteroid, injection
#305 EFFICACY AND SAFETY OF A FIXED-DOSE COMBINATION OF TRAMADOL/PARACETAMOL 75 MG/650 MG IN REDUCING PAIN INTENSITY IN PATIENTS WITH LOW BACK PAIN: A REAL-WORLD STUDY
Dalila Scaturro1, Pietro Terrana2, Salvatore Peri2, Nastasja Palombi3, Roberto Piazza3, Mario Mangrella3, Giulia Letizia Mauro1
2 Functional Recovery and Rehabilitation, Hospital “St. Cimino” of Termini Imerese, Italy
3 Italfarmaco, Italy
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
EFFICACY AND SAFETY OF A FIXED-DOSE COMBINATION OF TRAMADOL/PARACETAMOL 75 MG/650 MG IN REDUCING PAIN INTENSITY IN PATIENTS WITH LOW BACK PAIN: A REAL-WORLD STUDY
Background and Aims
Low back pain (LBP) is a prevalent musculoskeletal condition associated with significant healthcare costs and reduced quality of life. Tramadol/paracetamol combinations have been used in clinical practice to manage various pain conditions, enabling the use of lower dosages of each active ingredient and consequently increasing tolerability and safety. However, data on its efficacy and safety are limited. This study aimed to assess the effectiveness and safety of a fixed-dose tramadol/paracetamol combination (75 mg/650 mg) for LBP management.
Methods
In this real-world retrospective study, 100 adults with moderate-to-severe LBP (numerical rating scale ≥6) were treated with tramadol/paracetamol over 15 days. Pain intensity, disability level, and patient satisfaction, alongside the frequency and types of adverse events and dropout rate, were assessed.
Results
Patients showed a significant reduction in pain intensity on the numerical rating scale as early as day 7 (mean score: 2.66) compared with baseline (6.76; p≤0.05), which was maintained over 15 days (2.35; p≤0.05). Disability scores, assessed through the Oswestry Disability Index, improved from 37.5 at baseline to 4.06 by day 15 (p≤0.05). Patient satisfaction on day 15 was moderate, with a score of 1.96 on a 4-point Likert scale. Adverse events, primarily nausea and constipation, were reported by 5% of patients. The dropout rate was also 5%, and in all cases, it was due to adverse events and not treatment inefficacy.
Conclusion
Tramadol/paracetamol (75 mg/650 mg) effectively reduced LBP intensity and led to improvements in functional disability with manageable adverse events. Although further studies are needed to confirm these findings in larger populations, the results indicate the potential of this combination to improve the quality of life of patients while reducing productivity loss and healthcare costs.
Keywords
Low back pain; Tramadol; Paracetamol
#306 NAILFOLD CAPILLAROSCOPY IN COMPLEX REGIONAL PAIN SYNDROME: THE ROLE OF THE PHYSICAL AND REHABILITATION MEDICINE SPECIALIST IN MICROCIRCULATORY MORPHOLOGICAL EVALUATION
Sime Mijic, Ivan Novak
Conference topic: Innovation/imaging in PRM
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
NAILFOLD CAPILLAROSCOPY IN COMPLEX REGIONAL PAIN SYNDROME: THE ROLE OF THE PHYSICAL AND REHABILITATION MEDICINE SPECIALIST IN MICROCIRCULATORY MORPHOLOGICAL EVALUATION
Background and Aims
Complex regional pain syndrome (CRPS) is characterized by chronic pain, autonomic dysfunction, and microcirculatory abnormalities. Vasomotor instability and trophic changes are common features, yet standardized non-invasive tools to assess microvascular changes are limited. Nailfold capillaroscopy, although traditionally used in rheumatology, may offer diagnostic value in CRPS. The aim of this study was to examine whether distinct morphological alterations can be identified in nailfold capillaries of CRPS patients, and to highlight the role of the physical and rehabilitation medicine (PRM) specialist in early evaluation and differential diagnosis.
Methods
A total of 22 patients diagnosed with CRPS type I, according to the Budapest criteria, underwent standardized nailfold capillaroscopy of all fingers on both hands. Parameters analyzed included capillary density, presence of megacapillaries, avascular zones, microhemorrhages, and capillary disorganization. Results were compared to those of 22 healthy age- and sex-matched controls.
Results
Pathological findings were observed in 17 out of 22 patients (77%), including enlarged and tortuous capillary loops, avascular areas, and microhemorrhages, predominantly on the clinically affected hand. In 6 patients, alterations were also detected contralaterally. None of these findings were present in the control group (p < 0.01).
Conclusion
Capillaroscopy reveals significant morphological abnormalities in CRPS patients and may serve as a useful tool in the differential diagnosis of pain and trophic disorders. Given their expertise in musculoskeletal and autonomic dysfunction, physical and rehabilitation medicine specialists are well positioned to apply capillaroscopy as a non-invasive, accessible diagnostic method in the early assessment of CRPS.
Keywords
CRPS,Capillaroscopy
#307 NUTRITIONAL POLYNEUROPATHY FOLLOWING BARIATRIC SURGERY: A COMPLICATION THAT CAN BE PREVENTED
Ali AL-FADHLY
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
NUTRITIONAL POLYNEUROPATHY FOLLOWING BARIATRIC SURGERY: A COMPLICATION THAT CAN BE PREVENTED
Background
Bariatric surgery is considered to be the most effective treatment of morbid obesity and improvement of obesity-related comorbidities, such as type II diabetes. However, both peripheral and central neurological complications can occur after bariatric surgery. Such complications tend to occur more frequently after bypass surgery than after sleeve gastrectomy
Case report
We report a 38 years old lady who had restrictive bariatric surgery in the form of sleeve gastrectomy. She presented couple of months later with sever nausea and vomiting. A month later she developed progressive lower limb weakness and paraesthesia in upper and lower limb with urinary incontinence( flaccid tetra-paresis) . Initially treated as Guillain-Barré syndrome with intravenous immunoglobulins. Further investigations showed low folate with raised homocysteine which raised the possibility of nutritional polyneuropathy. Her Nerve Conduction Studies showed axonal sensory more than motor peripheral polyneuropathy. She was treated with high dose of Vitamin B12 and Folate with good effect but not fully recovered. In addition she received Thiamine replacement. She had paraesthesia in upper and lower limbs associated with neuropathic pain in both feet. Her lower limbs were weaker as compared to her upper limbs. She had impaired proprioception in both feet. In addition she presented with impaired short term memory. Her brain scans were normal. It is not clear if her short term memory impairment is directly related to her nutritional polyneuropathy.
Conclusion
Peripheral neuropathy is a one of the common complications following any type of bariatric surgery affecting 5–16% of patients. It is a collection of disorders arising from damage in the somatosensory system. It usually presents years later and progress insidiously but may be seen early in the course. Vomiting following sleeve gastrectomy can exacerbate nutritional deficiencies and lead to poly or mononeuropathy.
Keywords
Bariatric surgery, polyneuropathy
#308 MODULATION OF MOTOR AND CEREBELLAR FUNCTION USING TMS AND TSMS IN SPINOCEREBELLAR ATAXIA TYPE 3: A CASE-BASED INSIGHT
Ana Margarida Fernandes1, Ana Rita Aguiar2, Clemente Almeida2, Raquel Branco2, João Sampaio2
2 Hospital do divino espirito santo, Portugal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
MODULATION OF MOTOR AND CEREBELLAR FUNCTION USING TMS AND TSMS IN SPINOCEREBELLAR ATAXIA TYPE 3: A CASE-BASED INSIGHT
Background
Spinocerebellar ataxia type 3 (SCA3) is the most common autosomal dominant ataxia worldwide, with a known cluster in the Azores islands. It is caused by a CAG repeat expansion in the ATXN3 gene, leading to progressive neurodegeneration involving both cerebellar and extracerebellar regions. This disrupts cerebellar-cerebral and striatal-cortical pathways, ultimately causing motor and functional impairments. Patients develop progressive gait ataxia, dysarthria, and impaired coordination. As the condition advances, individuals increasingly rely on assistance for mobility, experience substantial functional decline, and face reduced life expectancy. Currently, there is no disease-modifying treatment available for SCA3. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has been shown to improve symptoms in patients with neurodegenerative cerebellar ataxias. A recent study suggested that transspinal magnetic stimulation (TsMS) applied to the thoracic region between vertebrae T3–T4 improved gait speed in SCA3 patients.
Case report
A 50-year-old female diagnosed with SCA3, originally from São Miguel Island (Azores), underwent 1 hour and 15 minutes of 10 Hz rTMS (50 pulses × 40 trains applied to the M1 leg area; 50 pulses × 60 trains to the cerebellum) and 5 Hz TsMS theta burst (20 pulses, 20 bursts) for five consecutive days. Between each pulse train, lasting 25 seconds, the patient performed physiotherapy exercises targeting improvements in posture, gait and dysmetria, under a physiatrist-guided rehabilitation plan. The Scale for the Assessment and Rating of Ataxia (SARA), the International Cooperative Ataxia Rating Scale (ICARS), and the Timed Up and Go Test (TUG 3M) were assessed before and after treatment, showing significant clinical improvement.
Conclusion
Our results with high-frequency rTMS and TsMS therapy showed improvement in SARA, ICARS, and TUG 3M scores, suggesting that this therapy could be promising for enhancing posture, gait, and limb kinetic function. However, larger randomized controlled trials are needed to confirm these findings.
Keywords
SCA, 3;, rTMS;, TsMS;, ataxia;
#309 UNMASKING A CHRONIC LOW BACK PAIN: THE HIDDEN ROLE OF COPEMAN’S NODULES AND TARGETED THERAPY
Ana Margarida Fernandes, Ana Rita Aguiar, Clemente Almeida, Raquel Branco, João Sampaio
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
UNMASKING A CHRONIC LOW BACK PAIN: THE HIDDEN ROLE OF COPEMAN’S NODULES AND TARGETED THERAPY
Background
Chronic low back pain (CLBP) is a common complaint with a broad differential diagnosis, often attributed to mechanical, inflammatory, or neuropathic causes. In clinical practice, musculoskeletal mimickers such as Copeman’s nodules—fatty nodular formations typically associated with myofascial or ligamentous pain—are frequently overlooked. Physical and Rehabilitation Medicine (PRM) plays a crucial role in identifying these underdiagnosed entities and implementing targeted interventions.
Case report
We report the case of a 33-year-old female with a two-year history of daily mechanical low back pain, worse in the evening and exacerbated by prolonged sitting or standing, that was being followed up in reumathology appointment. Initial investigations, including CT imaging, were unremarkable except for mild degenerative changes. Despite symptomatic relief with muscle relaxants and analgesics, the pain persisted. Upon PRM evaluation, bilateral Copeman’s nodules at L5 were identified as the likely pain generators. An ultrasound-guided corticosteroid-anesthetic (1mL Methylprednisolone + 1mL Ropivacaine) infiltration was performed in the nodules. At one-month follow-up, the patient reported complete resolution of pain (EVA 8/10 to 0/10).
Conclusion
This case highlights the importance of PRM in the assessment and management of chronic low back pain, particularly in identifying overlooked etiologies such as Copeman’s nodules. A multidisciplinary approach enabled not only accurate diagnosis but also effective, minimally invasive treatment with rapid symptomatic improvement.
Keywords
copeman, nodules;, low, back, pain;
#310 RADIOFREQUENCY ABLATION OF THE INFERIOR CALCANEAL NERVE IN ESWT-REFRACTORY HEEL PAIN: A FOUR-PATIENT CASE SERIES
Hilal Büşra Ayçiçek
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
RADIOFREQUENCY ABLATION OF THE INFERIOR CALCANEAL NERVE IN ESWT-REFRACTORY HEEL PAIN: A FOUR-PATIENT CASE SERIES
Background
Chronic heel pain is a common condition, most frequently associated with plantar fasciitis or calcaneal spurs. Conservative treatments include physical therapy, stretching exercises, orthosis, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and extracorporeal shock wave therapy (ESWT) are usually among the initial steps in standard treatment. Radiofrequency ablation (RFA) of the inferior calcaneal nerve, which targets the sensory innervation of the heel, might help to reduce symptoms for those who are refractory. This case series reports on four patients with heel pain unresponsive to ESWT who were treated with RFA.
Case report
This case series includes four patients (three females and one male, aged 45 to 64 years) presenting with chronic heel pain refractory to extracorporeal shock wave therapy (ESWT). A total of five feet were treated using conventional radiofrequency ablation (RFA) of the inferior calcaneal nerve. Pain intensity was evaluated using the Visual Analog Scale (VAS) at baseline, one week, and three months post-treatment. Ultrasound guidance was utilized to precisely target the nerve and reduce the risk of complication. All patients tolerated the conventional RFA procedure without any complications. All five treated feet exhibited clinically significant reductions in pain following the treatment. Baseline VAS scores ranged from 6 to 9. At one week post-treatment, VAS scores declined in all cases, ranging from 2 to 6. Continued improvement was noted at the three-month follow-up, with VAS scores ranging from 0 to 4.
Conclusion
Ultrasound-guided radiofrequency ablation of the inferior calcaneal nerve appears to be a safe and effective intervention for managing chronic heel pain refractory to extracorporeal shock wave therapy. Further research with larger patient cohorts and extended follow-up is warranted.
Keywords
plantar, fasciitis, radiofrequency, ablation
#311 TRANSCRANIAL MAGNETIC STIMULATION IN FIBROMYALGIA: A CASE REPORT OF PAIN AND FATIGUE MANAGEMENT
Ana Rita Aguiar, Ana Margarida Fernandes, Clemente Almeida, João Sampaio, Raquel Branco
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
TRANSCRANIAL MAGNETIC STIMULATION IN FIBROMYALGIA: A CASE REPORT OF PAIN AND FATIGUE MANAGEMENT
Background
Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, and cognitive disturbances, often associated with mood disorders such as depression and anxiety. Transcranial Magnetic Stimulation (TMS) has emerged as a non-invasive therapeutic approach for pain modulation and symptom relief. This case report describes the clinical evolution of a fibromyalgia patient who underwent five consecutive sessions of TMS.
Case report
A 45-year-old female diagnosed with fibromyalgia for over 5 years presented with chronic widespread pain and fatigue, with no significant depressive symptoms and mild anxiety. Baseline assessments included the Fibromyalgia Impact Questionnaire (FIQ), Widespread Pain Index (WPI), Symptoms Severity Scale (SSS), Pain Body Map, Fatigue Severity Scale (FSS), and the Hospital Anxiety and Depression Scale (HADS). The patient underwent five consecutive sessions of TMS targeting the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (DLPFC). A total of 5000 pulses were applied during each session (2000 to M1 and 3000 to DLPFC), with 50 pulses per train, at 90% of the Evoked Motor Threshold (EMT) in M1 and 120% of EMT in DLPFC. Post-treatment evaluations demonstrated significant improvements in pain distribution (WPI), symptom severity (SSS), and fatigue levels (FSS). There was also an improvement in HADS scores, although not statistically significant. Notably, the Pain Body Map revealed a marked reduction in the areas of reported pain.
Conclusion
This case report suggests that TMS may be an effective therapeutic option for managing chronic pain and fatigue in patients with fibromyalgia. Further studies with larger cohorts are warranted to validate these findings and optimize TMS protocols for fibromyalgia treatment.
Keywords
Fibromyalgia, transcranial, magnetic, stimulation
#312 LET'S TALK ABOUT SEX... OR NOT? - EXPLORING THE (LACK OF) ENGAGEMENT IN SEXUAL HEALTH CONSULTATIONS AFTER SPINAL CORD INJURY
Ana Almeida Vieira1, Mónica Jorge2, Cristina Baptista2, João Capelo2
2 CMRA, Portugal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
LET'S TALK ABOUT SEX... OR NOT? - EXPLORING THE (LACK OF) ENGAGEMENT IN SEXUAL HEALTH CONSULTATIONS AFTER SPINAL CORD INJURY
Background and Aims
Background and Aims Sexual dysfunction is a common yet often overlooked consequence of traumatic Spinal Cord Injury (SCI), significantly affecting quality of life, self-esteem, and intimate relationships. Despite its impact, sexual health remains underrepresented in rehabilitation programs, often due to stigma, personal discomfort, or a lack of perceived need. This study aims to examine the prevalence and characteristics of patient participation in sexual dysfunction consultations among individuals with SCI who were hospitalized in a specialized rehabilitation center between 2015 and 2024. Additionally, it seeks to identify demographic and clinical factors associated with patient engagement.
Methods
Methods A retrospective observational study was conducted using data from 398 patients with traumatic SCI who were admitted to a rehabilitation center between 2015 and 2024. Patient participation in sexual dysfunction consultations was analyzed alongside potential influencing factors such as sex, age, injury level and completeness, time since injury, and marital status.
Results
Results Despite universal access to consultation, participation rates remained low, indicating that many patients declined specialized support. Differences in engagement were observed based on sex, age, marital status, and injury severity, with male patients, those in relationships, and those with complete injuries being more likely to attend. A significant proportion of patients did not engage in structured sexual health counseling, suggesting that stigma, perceived irrelevance, or discomfort discussing sexual health may act as barriers. Additionally, the time since injury before attending a consultation varied widely, highlighting potential psychological and social factors influencing decision-making.
Conclusion
Conclusion These findings underscore the need for proactive strategies to better integrate sexual health into rehabilitation programs. Addressing stigma, enhancing patient education, and fostering open communication between healthcare providers and patients are key to improving engagement. Rehabilitation centers should implement structured approaches that normalize discussions about sexual health, ensuring that patients feel empowered to seek support.
Keywords
Spinal Cord, Injury; Sexual Dysfunction;
#313 LOST BONE, FOUND CHALLENGES:THE REHABILITATION CHALLENGE OF GORHAM-STOUT DISEASE
Ana Almeida Vieira1, Mónica Jorge2, Cristina Baptista2, João Capelo2
2 CMRA, Portugal
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
LOST BONE, FOUND CHALLENGES:THE REHABILITATION CHALLENGE OF GORHAM-STOUT DISEASE
Background
Introduction Gorham-Stout disease (GSD) is a rare, idiopathic disorder characterized by progressive osteolysis due to aberrant lymphangiogenesis, leading to severe skeletal destruction and functional impairment. The exact pathophysiology remains elusive, and treatment guidelines are not well established. The unpredictable course of the disease makes early recognition critical, particularly for rehabilitation specialists, who play a key role in mitigating disability. This case highlights a rare presentation of scapular osteolysis following minor trauma, illustrating the complex interplay between bone resorption, pain, and functional adaptation in a rehabilitation context.
Case report
Case Description A 45-year-old woman presented in 2015 with progressive right shoulder pain and functional limitation following a low-impact trauma. Initial radiographs were unremarkable; however, subsequent imaging demonstrated progressive, idiopathic osteolysis of the scapula. Histopathology confirmed GSD, revealing extensive osteoclastic activity and lymphatic vessel proliferation. Laboratory tests excluded infectious, metabolic, and neoplastic causes. Despite pharmacological treatment with bisphosphonates and interferon alpha-2b, the patient exhibited worsening bone resorption, leading to severe shoulder instability and compromised upper limb function. Rehabilitation was initiated early, incorporating targeted physiotherapy, neuromuscular re-education, pain control strategies, and assistive adaptations. Longitudinal follow-up revealed progressive loss of scapular support, requiring continuous functional reassessment and task-specific motor training. Discussion This case underscores the challenges of managing rare osteolytic disorders, emphasizing the dynamic role of rehabilitation in addressing functional deterioration. The association between minor trauma and osteolysis onset raises important questions about the pathomechanics of GSD. Rehabilitation strategies must be highly individualized, balancing joint protection, compensatory movement patterns, and long-term musculoskeletal adaptation.
Conclusion
GSD requires a multidisciplinary, rehabilitation-centered approach, given its progressive and functionally devastating nature. Early physiatric intervention is crucial to delaying disability and optimizing quality of life. This case highlights the urgent need for standardized rehabilitation protocols for rare osteolytic diseases and prompts further research into the mechanisms driving disease progression.
Keywords
Gorham-Stout Disease; Progressive Osteolysis Rehabilitation
#314 BILATERAL AVASCULAR NECROSIS OF HIP AND SHOULDER JOINTS IN PATIENT AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION - A CASE REPORT
Tamara Vukić
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
BILATERAL AVASCULAR NECROSIS OF HIP AND SHOULDER JOINTS IN PATIENT AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION - A CASE REPORT
Background
Avascular necrosis, also known as osteonecrosis is the death of bone tissue due to interruption of its blood supply which can lead to collapse of the bone structure over time. Avascular necrosis can result from corticosteroid use, trauma, alcoholism, certain diseases (e.g., sickle cell disease, lupus), radiation therapy, chemotherapy etc.
Case report
A 62-year-old male patient was referred to the physiatry outpatient clinic in 2018 complaining of severe pain in both hips and shoulders. The symptoms appeared gradually and worsened considerably in the last year, and they were not provoked by any injury or trauma. In patient's medical history it was significant that he underwent allogeneic hematopoietic stem cell transplantation in 2013, after being diagnosed with myelodysplastic syndrome. After transplantation he received high doses of corticosteroid therapy. In the clinical status there was severely limited and painful range of motion in both hips with most pain being felt in abduction and internal rotation. On his shoulders there was severe palpation tenderness on both shoulders and severely limited and painful range of motion on both sides. Since osteonecrosis of bone was suspected, magnetic resonance imaging (MRI) of both hip and shoulder joints was indicated. MRI findings showed changes typical for osteonecrosis on both femoral and humeral heads. Patient was prescribed with physical therapy, painkillers and walking with crutches for reduced weight bearing. He was also referred to an orthopedic specialist for surgery consultation.
Conclusion
Osteonecrosis simultaneously affecting both hip and both shoulder joints is uncommon and whenever patient presents with any joint pain and if there is a cognition of high dose corticosteroid use in patient's medical history the clinician must include osteonecrosis as a differential . MRI is the most sensitive modality for the detection of osteonecrosis even in the initial stages that are often not visible on X-rays.
Keywords
avascular necrosis, osteonecrosis, corticosteroid therapy
#315 RARE BUT REAL: REHABILITATION CHALLENGES IN VANISHING WHITE MATTER DISEASE
Ana Almeida Vieira1, Mónica Jorge2, Cristina Baptista2, João Capelo2
2 CMRA, Portugal
Conference topic: Children rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
RARE BUT REAL: REHABILITATION CHALLENGES IN VANISHING WHITE MATTER DISEASE
Background
Introduction Vanishing White Matter Disease (VWMD) is a rare autosomal recessive leukodystrophy caused by mutations in the EIF2B genes, leading to progressive neurological deterioration. It primarily affects the white matter, with symptoms worsened by physiological and emotional stressors. This case highlights the rehabilitation challenges in managing a surviving sibling, particularly regarding motor, respiratory, and swallowing function.
Case report
The patients belong to a non-consanguineous family from a developing African country, with no relevant family history. Among three siblings, the eldest and youngest were diagnosed with VWMD, while the middle sibling remains neurologically healthy. Limited healthcare resources delayed diagnosis and access to specialized rehabilitation. The first affected sibling developed developmental regression at 2 years, presenting with ataxia, spasticity, and cognitive decline. Disease progression was rapid, leading to severe neurological impairment and death at 4 years old. The second sibling exhibited similar early symptoms but with a slower progression, allowing for a prolonged rehabilitation approach. However, her condition remains unpredictable, requiring continuous adaptation of strategies. Rehabilitation efforts focus on mobility preservation, spasticity management, and functional independence. As the disease advances, respiratory and swallowing dysfunction emerge as critical concerns, with high risks of aspiration pneumonia and respiratory failure. This necessitates early intervention in dysphagia management and respiratory physiotherapy to balance function preservation with medical stability. Conventional rehabilitation must be adjusted to prevent overexertion and deterioration. Diagnosis was confirmed through brain MRI (diffuse leukodystrophy) and EIF2B genetic testing. Discussion Beyond motor decline, swallowing and respiratory complications demand early, multidisciplinary intervention. Anticipatory guidance, adaptive strategies, and careful therapy calibration are crucial to maximizing quality of life while preventing complications.
Conclusion
This case underscores the complexity of rehabilitation in VWMD, where balancing motor function, respiratory care, and dysphagia management is essential. A highly individualized, multidisciplinary approach is necessary to optimize patient outcomes while minimizing deterioration risks.
Keywords
Vanishing, White Matter, Disease;, Leukodystrophy;
#316 BRIDGING COMMUNICATION GAPS IN REHABILITATION: A SERVICE-LEARNING APPROACH TO PROMOTING PHYSICAL EXERCISE IN MUSCULOSKELETAL HEALTH
Diogo da Silva Araújo1, Marco Francisco Silva1, João Ramos1, Maria João Azevedo1, Sónia Silva2
2 Universidade Católica Portuguesa, Portugal
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
BRIDGING COMMUNICATION GAPS IN REHABILITATION: A SERVICE-LEARNING APPROACH TO PROMOTING PHYSICAL EXERCISE IN MUSCULOSKELETAL HEALTH
Background and Aims
Effective interpersonal communication in clinical settings is both a hallmark of healthcare delivery and a persistent challenge, particularly when addressing lifestyle-related behavioral change. In the context of musculoskeletal disorders, promoting physical activity as both a preventive and therapeutic strategy requires clear and empathetic communication tailored to diverse patient needs and health literacy levels. However, healthcare professionals receive limited training in communication strategies and patients may be resistant to adopting new habits, particularly when the perceived benefits are long-term or not immediately tangible. This service-learning project consisted of a collaboration between students from the Advertising and Marketing course of a Communication Sciences degree and physicians of the Physical and Rehabilitation Medicine (PRM) Department of a Portuguese public hospital. The primary objective was to implement an advertising campaign to raise awareness among patients about the importance of physical activity in the treatment and prevention of musculoskeletal disorders.
Methods
Through the implementation of action-research methodology this project sought to bridge the gap between health communication and clinical practice by involving communication students in the development of targeted strategies. As such, meetings between the students and physicians of the PRM department took place both in faculty and at the hospital.
Results
The process revealed the need for an advertising strategy tailored for two different recipients: one aimed at healthcare professionals and the other directed toward patients. For physicians, the campaign developed short videos and printed materials with tips and tricks focused on enhancing communication skills to better convey the benefits of physical exercise. For patients, the materials were designed to motivate behavioral change, including advice on how to implement physical activity in their weekly routine.
Conclusion
This project demonstrates the value of intersectoral collaboration in addressing public health challenges, highlighting how communication can be strategically leveraged to improve healthcare delivery and patient engagement.
Keywords
Healthcare Communication, Musculoskeletal Rehabilitation
#318 CHRONIC GRAFT-VS-HOST DISEASE (CGVHD) AS A LATE COMPLICATION IN PATIENT AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION- A CASE REPORT
Tamara Vukić
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CHRONIC GRAFT-VS-HOST DISEASE (CGVHD) AS A LATE COMPLICATION IN PATIENT AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION- A CASE REPORT
Background
Chronic graft-vs-host disease (cGVHD) is a major late complication of allogeneic hematopoietic stem cell transplantation, typically occurring within three years post-transplant and affecting approximately 30%-50% of allogeneic transplant survivors.
Case report
A 29-year-old male patient was referred to the physiatry outpatient clinic by a hematologist complaining of tightness and reduced mobility in his shoulders, elbows, and wrists. The symptoms appeared gradually and were not provoked by any injury or trauma. In patient's medical history it was significant that he underwent allogeneic hematopoietic stem cell transplantation three years ago, after being diagnosed with chronic myeloid leukemia. In his clinical status there was moderately limited range of motion in his shoulders, elbows, and wrists with the sensation of severe tightness of the affected joints. Joint and fascial cGVHD was suspected. Patient was also diagnosed with sclerodermal form of skin cGVHD which significantly correlates with the occurrence of joint and fascial cGVHD. To assess the severity of joint and fascia involvement, the NIH 0-3 point joint and fascia scale that scores a composite of tightness, range of motion and activities of daily living was used. The patient was scored as moderate (NIH score- 2) joint and fascial cGVHD. Patient was prescribed with physical therapy and was refered back to hematologist for possible additional treatment.
Conclusion
Chronic GVHD can involve many organ systems, joint and fascial involvement is relatively common and can cause significant functional impairment. Symptoms may manifest as joint tightness , erythema, edema, restricted range of motion, arthralgia, and rarely arthritis or synovitis. Most common sites of involvement include hands/wrists, shoulders, elbows, and ankles. Chronic GVHD involving joints and fascia is extremly rare condition but should be considered if the patient complains of the above mentioned symptoms and if it is known in patient's medical history that patient underwent allogeneic hematopoietic stem cell transplantation.
Keywords
graft-vs-host disease, stem cell transplantation
#319 RISK FACTOR IDENTIFICATION AS A KEY STRATEGY IN LYMPHEDEMA PREVENTION AND TREATMENT IN PATIENTS AFTER CANCER TREATMENT
Ana Poljičanin1, Ivan Vlak2, Ivan Lasić1, Nera Cvitanić Bilandžić1, Marta Pavlović1, Ivana Klarić Kukuz2, Jure Aljinović1, Blaž Barun1, Ana Poljičanin1
2 Universyty Hospital Split, Croatia/Hrvatska
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
RISK FACTOR IDENTIFICATION AS A KEY STRATEGY IN LYMPHEDEMA PREVENTION AND TREATMENT IN PATIENTS AFTER CANCER TREATMENT
Background
Lymphedema is characterized by the accumulation of lymphatic fluid in soft tissues, most commonly affecting the limbs. This condition can lead to serious complications such as infections, skin changes, and joint stiffness, while also contributing to psychological distress and increased healthcare costs due to the need for prolonged management. Although the exact incidence of treatment-related lymphedema among cancer survivors remains unclear, it is widely recognized as a potentially lifelong, chronic condition that significantly diminishes quality of life. Lymphedema can develop following treatment for any malignancy that involves lymph node dissection or radiation targeting lymphatic regions. Early identification of patients at increased risk is critical for effective prevention and timely intervention. Key contributing factors include the site and extent of radiation therapy, the extent of lymph node removal, and the presence of underlying comorbidities. Recognizing these risk factors can play a pivotal role in reducing the burden of lymphedema in cancer survivors.
Case report
We report the case of a 30-year-old woman admitted in October 2024 for evaluation of progressive bilateral leg swelling. The lymphedema likely resulted from thoracic duct damage caused by mediastinal radiotherapy for Hodgkin’s lymphoma, which she underwent in 2017. Edema appeared about one-year post-treatment and was preceded by significant weight gain. The patient’s comorbidities—including spondyloarthritis, vitamin D deficiency, and anemia—likely contributed to the development and progression of her lymphedema.
Conclusion
This case highlights the importance of comprehensive risk factor identification, including metabolic and autoimmune conditions, which may predispose patients to lymphedema. Early recognition and proactive management of these factors are essential for prevention and for improving long-term outcomes in cancer survivors.
Keywords
Lymphedema, Cancer, Survivors, Radiotherapy, Rickactorshoracicuct
#320 MEDITERRANEAN BY LOCATION, NOT BY DIET: POOR ADHERENCE TO THE MEDITERRANEAN DIET AMONG BREAST CANCER SURVIVORS IN A MEDITERRANEAN REGION
Ana Poljičanin1, Marta Valenta2, Ivana Kukuz Klarić3, Marina Mateljak1, Ana Živalj3, Ela Kolak1, Dora Bućan1, Jure Aljinović1, Blaž Barun1, Ana Poljičanin1
2 Medical School of Split, Croatia/Hrvatska
3 University Department of Health Studies University of Split, Croatia/Hrvatska
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
MEDITERRANEAN BY LOCATION, NOT BY DIET: POOR ADHERENCE TO THE MEDITERRANEAN DIET AMONG BREAST CANCER SURVIVORS IN A MEDITERRANEAN REGION
Background and Aims
The Mediterranean diet is recognized for its positive impact on overall health and is considered beneficial in cancer risk reduction and survivorship. Although it originated in the Mediterranean region, where it was historically the dominant dietary pattern, it's unclear how much the local population still adheres to it today. This study aimed to assess adherence to the Mediterranean diet among breast cancer survivors in a Mediterranean region, a population for whom nutrition plays a important role.
Methods
This cross-sectional observational study was conducted over a 6-month period, from December 2023 to April 2024, at the Lymphedema Clinic of the University Hospital Split. The study included female breast cancer survivors aged 18 years and older who had completed treatment for unilateral breast cancer at least six months prior to enrolment and had consented to participate. Exclusion criteria were applied, and 74 participants were enrolled. Adherence to the Mediterranean dietary pattern was assessed using the Mediterranean Diet Serving Score (MDSS), a validated and reliable questionnaire based on the updated Mediterranean Diet Pyramid model.
Results
A total of 74 breast cancer survivors were included in the analysis. Based on the Mediterranean Diet Serving Score (MDSS), only one participant demonstrated adherence to the Mediterranean dietary pattern. The remaining participants showed low or insufficient adherence across most food categories. These findings are particularly concerning given the study’s Mediterranean setting, where such dietary habits would traditionally be expected.
Conclusion
Despite being conducted in a Mediterranean region, this study revealed alarmingly low adherence to the Mediterranean diet among breast cancer survivors. These results raise important questions about the persistence of traditional dietary habits in the Mediterranean population. Given the well-documented benefits of the Mediterranean diet, particularly for cancer survivors, these findings highlight the urgent need for nutritional education and public health strategies aimed at promoting dietary awareness and adherence.
Keywords
Breast, Cancer, Survivor, Diet, Nutrition
#323 BEYOND THE SWELLING: EXPLORING NEUROPATHIC PAIN IN BREAST CANCER SURVIVORS WITH LYMPHEDEMA
Ivana Klarić-Kukuz1, Jure Aljinović2, Blaž Barun2, Marko Roki2, Dinko Pivalica2, Maja Marinović-Guić2, Danijela Budimir Mršić2, Josipa Grančić3, Gabrijela Tenžera3, Ana Poljičanin2
2 University Hospital Split, 21000 Split, Croatia, Croatia/Hrvatska
3 University Department Of Health Studies, Croatia/Hrvatska
Conference topic: Cancer rehabilitation
Occupation: Postgraduates students
Type of abstract: Scientific abstract
Abstract
Title
BEYOND THE SWELLING: EXPLORING NEUROPATHIC PAIN IN BREAST CANCER SURVIVORS WITH LYMPHEDEMA
Background and Aims
Background: Lymphedema is a common and persistent complication among breast cancer survivors, often accompanied by varying types of pain, including nociceptive and neuropathic components. Pain mechanisms associated with lymphedema include tissue stretching due to swelling, inflammatory responses from lymphatic fluid stasis, nerve compression, and musculoskeletal strain resulting from altered biomechanics. Clinically, this pain may present as heaviness, tightness, burning, tingling, or pain related to complications such as cellulitis and fibrosis. Objective: This study aimed to assess the presence and characteristics of neuropathic pain in patients with breast cancer-related lymphedema (BCRL) using validated instruments such as the PainDETECT questionnaire and conventional pain assessment tools.
Methods
Methods: Lymphedema was identified using limb circumference measurements, with a relative volume change (RVC) of ≥5% considered diagnostic. Pain was evaluated through the PainDETECT questionnaire and a direct inquiry regarding pain presence. Additional symptoms including numbness, tingling, and muscle weakness, were analysed to distinguish neuropathic features from general pain intensity. Sociodemographic and disease-related data were collected via structured questionnaires and medical records review.
Results
Results: Among a total of 87 breast cancer survivors with a mean age of approximately 58 years (58.47 ± 8.95) and a mean body mass index (BMI) of 27 (27.74 ± 5.64), 58% self-reported swelling, while 39% reported no swelling. Based on relative volume change (RVC), 40 participants (45.98%) had RVC < 5%, and 47 participants (54.02%) had RVC ≥ 5%. Participants with higher volume changes demonstrated significantly more advanced disease stages according to the International Society of Lymphology (ISL) staging classification (p < 0.001).
Conclusion
Conclusion: Early identification of neuropathic pain in BCRL may support more personalized and effective pain management strategies, contributing to improved long-term outcomes and quality of life for breast cancer survivors.
Keywords
Keywords., Breast, neoplasm, Lymphedema, Neuropathic
#326 COMPARISON OF THE EFFECTIVENESS OF PHENOL BLOCK AND CORTICOSTEROID-LOCAL ANESTHETIC BLOCK APPLIED TO THE GENICULAR NERVE UNDER ULTRASOUND GUIDANCE IN PATIENTS WITH KNEE OSTEOARTHRITIS
Rabia Layık Arslan1, Koray AYDEMİR2, Serdar KESİKBURUN2
2 University of Health Sciences, Gulhane Medical School, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Turkey
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
COMPARISON OF THE EFFECTIVENESS OF PHENOL BLOCK AND CORTICOSTEROID-LOCAL ANESTHETIC BLOCK APPLIED TO THE GENICULAR NERVE UNDER ULTRASOUND GUIDANCE IN PATIENTS WITH KNEE OSTEOARTHRITIS
Background and Aims
We aimed to evaluate the effects of genicular nerve phenol neurolysis on pain and functional status in patients with knee osteoarthritis and compare its efficacy with CS-LA block.
Methods
88 patients with knee osteoarthritis were included in the study. Patients were randomized into two groups: the phenol group and CS-LA group. Patients in the phenol group received 5 mL of a 6% aqueous phenol solution, while those in the CS-LA group received a 5 mL mixture consisting of 2 mL of 2% lidocaine, 1 mL of betamethasone, and 2 mL of saline. The injections were administered under ultrasound guidance into the inferior medial , superior medial and superior lateral genicular nerve in equal volumes, using syringes covered with opaque tape to maintain blinding. Patients were assessed at baseline and at 4 and 12 weeks post-injection. The primary outcome measure was pain intensity, evaluated using the Numeric Rating Scale (NRS). Secondary outcome measures included the Western Ontario and McMaster Universities Arthritis Index (WOMAC) ,the 6-minute walk test (6MWT), and the timed up-and-go test (TUGT). Patients were monitored for adverse effects following the injection and at all follow-up visits.
Results
As a result of the study, statistically significant improvement was observed in NRS scores, WOMAC scores, 6 MWT and TUGT over time compared to baseline (p0.05). The most common adverse effect was local pain at the injection site. Local pain was more frequent and prolonged in the phenol group compared to the CS-LA group, and this difference was statistically significant (p<0.05).
Conclusion
During the 12-week follow-up period, no significant improvement was observed in the group that received phenol injection compared to the group that received CS-LA injection. The findings indicate that genicular nerve phenol neurolysis is not superior to CS-LA blockade.
Keywords
Genicular, Nerve, Phenol, Knee, Osteoarthritis
#327 SEX-BASED DISPARITIES IN POSTOPERATIVE PAIN AND REHABILITATION EFFICIENCY AFTER ELBOW ARTHROLYSIS: INSIGHTS FROM A MOROCCAN RETROSPECTIVE COHORT
Douae EL OUAZZANI, Kawtar Mansag, Radia Sellami, Ryme El Beloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SEX-BASED DISPARITIES IN POSTOPERATIVE PAIN AND REHABILITATION EFFICIENCY AFTER ELBOW ARTHROLYSIS: INSIGHTS FROM A MOROCCAN RETROSPECTIVE COHORT
Background and Aims
Elbow arthrolysis is a standard intervention for post-traumatic stiffness, with pain management critical to functional recovery. While sex-based differences in pain perception are documented, their impact on postoperative outcomes after elbow arthrolysis remains understudied in North African populations. This study evaluated sex disparities in acute pain control, use of different analgesic classes, and rehabilitation metrics following elbow arthrolysis.
Methods
A retrospective cohort study included 120 patients (60 males, 60 females, aged 18–65 years) undergoing elbow arthrolysis between January 2020 and January 2025 at CHU Ibn Rochd’s Physical Medicine Department. Exclusions: chronic pain or preoperative analgesic use. Pain intensity (Visual Analog Scale, VAS), consumption of analgesics (categorized by class, converted to standardized equivalents), rehabilitation duration, and range of motion (ROM) were assessed at 24h, 72h, 1 week, 3, and 6 months.
Results
Mean VAS scores at 24h were 7.2 ± 1.1 in females and 6.5 ± 1.3 in males (*p* = 0.003), decreasing to 5.8 ± 1.0 (females) and 5.1 ± 0.9 (males) at 72h (*p* = 0.02). At 1 week, scores were 3.4 ± 1.2 (females) and 3.1 ± 1.0 (males) (*p* = 0.15). Total analgesic consumption (standardized equivalents) was higher in females (35.2 ± 8.5 vs. 28.4 ± 7.1, *p* < 0.001). Rehabilitation duration averaged 32 ± 6 days in females and 28 ± 5 days in males (*p* = 0.01). ROM at 3 months measured 95° ± 12° (females) and 105° ± 14° (males) (*p* = 0.004), with 6-month values at 125° ± 15° (females) and 128° ± 13° (males) (*p* = 0.18). Residual pain at 6 months was reported by 22% of females and 12% of males (*p* = 0.04).
Conclusion
Sex-based disparities in acute pain, analgesic requirements, and early rehabilitation progress were observed post-elbow arthrolysis. These findings support sex-specific protocols to enhance postoperative care.
Keywords
Elbow arthrolysis, Postoperative pain, Analgesics
#328 STUDY OF THE PREVALENCE AND CHANGES IN COGNITIVE IMPAIRMENTS IN PATIENTS ENROLLED IN A CARDIAC REHABILITATION PROGRAM
Marta Supervía Pola, Carlos Pedreira Martín, Gustavo Arrieta Bartolomé, Olga Arroyo Riaño
Conference topic: Cardiopulmonary rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
STUDY OF THE PREVALENCE AND CHANGES IN COGNITIVE IMPAIRMENTS IN PATIENTS ENROLLED IN A CARDIAC REHABILITATION PROGRAM
Background and Aims
Cognitive deficits are common after cardiovascular events, with mild impairments often harder to detect. While exercise is known to improve brain function, data on cognitive changes during cardiac rehabilitation is limited. This study used the Montreal Cognitive Assessment (MoCA) to assess cognitive function before and after rehabilitation, aiming to understand how structured programs impact cognitive outcomes. It also explores how factors like age, gender, educational level, and cardiac diagnosis influence cognitive performance.
Methods
Patients enrolled in the cardiac rehabilitation program at HGUGM Hospital (April–June 2023) completed the MoCA test at the beginning and end of the program. Data on age, gender, educatuinal level, cardiac conditions, and cardiovascular risk factors were collected. Changes in MoCA scores before and after rehabilitation were analyzed in relation to these variables.
Results
Seventy-five patients (average age 60) participated, with 79% being men. Ischemic heart disease was the most common condition (82%), and 54.7% had mild cognitive impairment (MoCA < 26). The mean MoCA score improvement after rehabilitation was 0.53 ± 0.59 (p = 0.74), with no statistical significance. A correlation coefficient of 0.7 was observed. Educational level was a key factor, with university-educated patients showing significantly higher scores (p 0.05), hypertension (p > 0.05), or obesity (p = 0.94).
Conclusion
Cardiac rehabilitation showed a trend toward cognitive improvement, with a mean MoCA increase of 0.53 ± 0.59 (p = 0.74). A correlation of 0.7 suggests a larger sample size could show significance. Educational level was a key factor, with university-educated patients showing higher scores (p 0.05).
Keywords
Cardiac, rehabilitation, cognitive, impairment, MoCA
#329 IATROGENIC INJURY IN HAEMORRHAGIC STROKE – A RARE COMPLICATION
Inês Morais, Ana Borges, Andreia Morgado, Maria João Sousa, Carolina Paiva, Nuno Madureira, Sofia Moreira, Ana Lourenço, Paula Amorim, Inês Lucas
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
IATROGENIC INJURY IN HAEMORRHAGIC STROKE – A RARE COMPLICATION
Background
The placement of a peripheral arterial line is a common procedure in clinical practice, with peripheral nerve injury being a rare iatrogenic complication. We report a case of peripheral neuropathy following arterial line placement in the brachial artery.
Case report
A 58-year-old woman presented with a neuromotor picture of grade 4 hemiplegia on the MRC (Medical Research Council) scale, left-sided hemihypoaesthesia and dysmetria, and a wide-based gait. She was admitted for an intensive rehabilitation programme following a cerebellar haemorrhagic stroke. In addition to stroke-related symptoms, the patient reported paraesthesia over the median nerve territory, starting at the left antecubital fossa. Examination revealed atrophy of palmar interosseous muscles, hypoaesthesia in the median nerve territory, and inability to flex the second metacarpophalangeal joint of the left hand. Although affecting the plegic limb, these findings were not attributed to the stroke, prompting further investigation. Electromyography revealed partial left median nerve injury, with severe axonal sensory-motor involvement, above the emergence of motor branches to the pronator teres muscle. Ultrasound of the antecubital fossa showed a small lesion suggestive of a neuroma, nerve swelling, and possible resorbing perineural haematoma. Review of the patient’s acute hospitalisation revealed the placement of an arterial line in the left brachial artery due to loss of peripheral venous access. This was temporally associated with the onset of the reported symptoms and clinical signs. Given the absence of significant functional impact, we opted for conservative management with follow-up consultation to assess the potential need for referral to a specialised consultation.
Conclusion
Given the clinical and temporal correlation, we can assume that the median nerve injury occurred at the antecubital fossa during the placement of the arterial line in the left brachial artery. Although this is a frequently performed procedure, it carries risks that must be recognised and addressed promptly.
Keywords
neuropathy, iatrogenesis, electromyography
#330 THE ROLE OF THE NURSE IN CLEAN INTERMITTENT CATHETERIZATION
Anela Bajramović, Nataša Kic
Conference topic: Neurorehabilitation
Occupation: Nurses
Type of abstract: Case report
Abstract
Title
THE ROLE OF THE NURSE IN CLEAN INTERMITTENT CATHETERIZATION
Background
Clean intermittent catheterization (CIC) is a key method used to ensure safe bladder emptying and maintain continence in patients with neurogenic and other urological disorders. Nurses play a central role in the initiation, education, and long-term support of patients undergoing CIC. Their responsibilities include patient assessment, technical execution, training of patients and caregivers, monitoring for complications, and providing psychological support.
Case report
This report presents the case of implementing CIC in a rehabilitation setting, highlighting the nurse’s involvement from initial assessment to ongoing follow-up. The patient required comprehensive education on hygiene, catheter insertion techniques, and recognition of urinary tract infection symptoms. Due to the patient’s limited independence, a family member was also trained to perform the procedure. The nurse coordinated with the interdisciplinary team to ensure individualized care, minimized complications, and reinforced the patient’s psychological adjustment to catheter use.
Conclusion
The nurse’s role in CIC extends beyond technical execution. It encompasses patient education, emotional support, complication prevention, and interprofessional collaboration. With appropriate knowledge and empathy, nurses significantly contribute to patient safety, autonomy, and improved quality of life. Their active involvement ensures that CIC becomes an effective and empowering part of the rehabilitation process.
Keywords
Catheterization, Nursing, Bladder, Patient Education
#331 THE SILENT POISON: CHRONIC MERCURY TOXICITY MASQUERADING AS NEURODEGENERATIVE DISEASE
Ana Vrbanović, Antonela Tomić, Nino Zahirović, Viviana Avancini-Dobrović, Tea Schnurrer-Luke Vrbanić
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
THE SILENT POISON: CHRONIC MERCURY TOXICITY MASQUERADING AS NEURODEGENERATIVE DISEASE
Background
Heavy metal toxicity may lead to permanent dysfunction across multiple organ systems. The central nervous system, peripheral nervous system, renal, cardiovascular, and hematopoietic systems are most commonly affected. Mercury, a well-known environmental contaminant, is particularly neurotoxic. Chronic exposure often results in CNS dysfunction, with intention tremor being its most consistent neurological manifestation. Neurological deficits are typically slow to resolve and may be only partially reversible.
Case report
A 66-year-old male presented with progressive gait instability, hand tremors, gingivitis, and insomnia. Over six months, he experienced worsening balance, impaired coordination, and speech disturbances. Initial workup, based on a suspicion of encephalitis, included brain MRI and laboratory tests, which revealed only mild diffuse cerebral atrophy; routine labs were unremarkable. He was referred for orthodontic, psychiatric and psychological evaluation, and which continued as outpatient care. Six months later, his condition deteriorated, marked by aggravated speech impairment, vertigo, and further gait instability. Extended laboratory testing revealed serum mercury levels three times above the reference range. Cervical spine imaging showed changes consistent with transverse myelitis/myelopathy related to vitamin B12 deficiency. Detailed occupational history revealed chronic exposure to heavy metals at a waste disposal site. A multidisciplinary evaluation was initiated, including neurological, psychiatric and physiatric assessments. The patient was treated with vitamin B&E supplementations, antiparkinsonian and selenium, and referred for neurorehabilitation using the Bobath concept. Mild functional improvement was noted. Following a severe psychosocial stressor after a few months, he experienced a relapse with worsening speech, pronounced gait instability, nocturnal lower limb spasms, and loss of balance. Pharmacologic therapy was adjusted, and he underwent another cycle of physical and occupational therapy focused on adaptation strategies for daily living. Functional improvement in balance, coordination and performance in ADL followed.
Conclusion
This case underscores the value of thorough history-taking and individualized, multidisciplinary management in diagnosing and treating rare toxic exposures.
Keywords
Mercury, Toxicity, Neurological Rehabilitation
#332 THE EFFECT OF TRANSAURICULAR VAGAL NERVE STIMULATION (TAVNS) ON CARDIAC AUTONOMIC FUNCTIONS IN PATIENTS WITH SPINAL CORD INJURY
Ayşenur Şimşek Yağlıoğlu1, Bilge Yılmaz2, Duygu Koçyiğit Burunkaya3
2 University of Health Sciences, Gulhane Medical School,Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Turkey
3 Ankara Bilkent City Hospital Cardiovascular Hospital, Turkey
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE EFFECT OF TRANSAURICULAR VAGAL NERVE STIMULATION (TAVNS) ON CARDIAC AUTONOMIC FUNCTIONS IN PATIENTS WITH SPINAL CORD INJURY
Background and Aims
To investigate the effect of transauricular vagal nerve stimulation (taVNS) on cardiac autonomic functions in patients with spinal cord injury.
Methods
The study included 30 traumatic SCI patients. Patients were divided into groups as group I cervical complete SCI patients in active taVNS group(n:10), group II cervical complete SCI patients in sham taVNS group(n:10) and group III lumbar SCI patients (diagnosed with cauda equina syndrome) in active taVNS group(n:10). Active taVNS application was performed by stimulating a sterile acupuncture needle placed on the left ear cymba choncae with a stimulator. Active taVNS group received for 10days, 30minutes,1mA, 200µs, 25Hz. In the sham group, stimulation was applied to the lobulus auriculae of the left ear using the same current intensity and duration as the active group. Patients were evaluated on the day before stimulation(day 0), the first day(day 1), the final day(day 10), one day after the completion of the stimulation (day 11). Clinical autonomic tests including heart rate and blood pressure changes with tilt test, respiratory heart rate change, valsalva ratio, time-dependent heart rate variability parameters and frequency-dependent HRV parameters from 24-hour holter ECG and short recording holter ECG were used.
Results
Cervical SCI patients who received active taVNS, there was a significant difference in systolic blood pressure response to the tilt test and respiratory heart rate variation(p<0.05). Significant differences were observed in the clinical autonomic tests both before and after the intervention between groups I and II versus group III (p0.05). No side effects other than earache and headache were detected with taVNS application.
Conclusion
taVNS, which is increasingly used in clinical practice, does not significantly affect cardiac autonomic functions or enhance parasympathetic dominance in individuals with traumatic SCI.
Keywords
Spinal cord injury, vagus nerve
#334 SUPERIOR GLUTEAL NERVE INJURY AFTER TOTAL HIP ARTHROPLASTY, A CASE REPORT
Vinicius Oliveira1, Florbela Abreu1, João Pimenta1, João Castelhano1, Inês Cabral2, Bruno Mendes1
2 CMR de Alcoitão, Portugal
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
SUPERIOR GLUTEAL NERVE INJURY AFTER TOTAL HIP ARTHROPLASTY, A CASE REPORT
Background
Total hip arthroplasty (THA) is a common procedure for treating hip osteoarthritis, known for infrequent complications when compared to other arthroplastic procedures and as such often has a lower threshold for surgical treatment. While rare, peripheral nerve injuries remain an issue. The superior gluteal nerve (SGN) is the most frequently affected nerve following anterolateral approach due to its anatomical course through the greater sciatic foramen and proximity to the gluteal muscles, which is a concern given the growing frequency of such an approach.
Case report
We present the case of a 60-year-old female factory worker, with progressive right hip coxalgia secondary to severe coxofemoral osteoarthritis. She underwent an iniatially appearing uncomplicated cementless right THA via a direct lateral approach. Postoperatively, she exhibited persistent Trendelenburg gait, marked gluteal atrophy, and difficulty with unipodal stance on the right lower limb. Electromyography (EMG) confirmed a chronic moderate-grade lesion of the right superior gluteal nerve, consistent with axonotmesis (Sunderland Grade II). No evidence of radiculopathy or sciatic nerve involvement was found. The patient underwent intensive and prolonged rehabilitation including targeted hip abductor strengthening, gait training, and hydrotherapy. Despite partial clinical improvement, she maintained signs of gluteal insufficiency and Trendelenburg gait after one year. Symptoms of greater trochanteric pain syndrome and iliotibial band overload developed secondarily, likely due to biomechanical alterations from persistent abductor weakness.
Conclusion
SGN injury is the most common nerve lesion following the lateral approach to THA, often underdiagnosed in the early postoperative period. Persistent Trendelenburg gait and gluteal atrophy should prompt early clinical suspicion. Functional prognosis depends on injury severity and timely rehabilitation. Awareness of this complication is critical for postoperative follow-up in order to minimize long-term disability and optimize functional outcomes.
Keywords
Hip arthroplasty nerve injury gluteal
#335 EFFECTS OF GROUP-BASED VS HOME-BASED EXERCISE PROGRAMMES IN PATIENTS WITH ANKYLOSING SPONDYLITIS
Sofia Lopes, Paula Santos, Cristina Mesquita
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
EFFECTS OF GROUP-BASED VS HOME-BASED EXERCISE PROGRAMMES IN PATIENTS WITH ANKYLOSING SPONDYLITIS
Background and Aims
Ankylosing spondylitis (AS) is a chronic inflammatory disease that significantly impairs spinal mobility and functionality. Exercise-based physiotherapy is a key non-pharmacological intervention; however, limited evidence compares supervised group-based with unsupervised home-based programes regarding functional and biomarker outcomes. This study aimed to compare the effects of 6-month group-based versus home-based exercise programes on functional capacity and inflammatory biomarkers in individuals with AS.
Methods
Quasi-experimental study with Thirty-one patients diagnosed with AS were recruited and assigned to one of three groups: group-based exercise (n=12), home-based exercise (n=12), or control (n=7). Functional assessments included the Bath Ankylosing Spondylitis Functional Index (BASFI), Disease Activity Index (BASDAI), and Metrology Index (BASMI), as well as the Oswestry (ODI) and Neck Disability Indices (NDI). Inflammatory biomarkers included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Baseline and post-intervention (6 months) evaluations were conducted. Statistical analyses included intra- and intergroup comparisons (α=0.05).
Results
At baseline, no significant differences were found among groups. After 6 months, the group-based exercise group showed significant improvements in BASFI (p=0.048) and BASMI (p=0.001), while the control group exhibited significant declines in both indices (p=0.003 and p=0.025, respectively). The home-based group presented a significant reduction in CRP (p=0.037), although no functional index showed statistical improvement. BASMI intergroup comparison showed significant differences (p=0.028), with post-hoc tests indicating improvement in both exercise groups compared to control. No significant changes in ESR were detected in any group. The control group showed a significant deterioration in BASDAI (p=0.017) and NDI (p=0.020).
Conclusion
A supervised, group-based exercise programe led to significant improvements in functional mobility and status in individuals with AS, whereas the home-based intervention was associated with a reduction in systemic inflammation (CRP). These findings highlight the differential benefits of exercise modalities in managing AS and support the integration of supervised programes into routine care.
Keywords
Disease activity, functionality, biomarkers, physiotherapy
#336 THE IMPACT OF TEMPERATURE SENSITIVITY ON THE STAY OF MULTIPLE SCLEROSIS PATIENTS IN A REHABILITATION INSTITUTION DURING A YEAR
Lana Bobic Lucic, Dunjica Frantal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
THE IMPACT OF TEMPERATURE SENSITIVITY ON THE STAY OF MULTIPLE SCLEROSIS PATIENTS IN A REHABILITATION INSTITUTION DURING A YEAR
Background and Aims
Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease characterized by demyelination of the central nervous system (CNS), which leads to a slowdown or blockage of the transmission of nerve impulses between nerve cells. Its incidence and prevalence are increasing every year, and in Croatia in 2024, 8.518 people with MS were recorded. The distribution of demyelinating lesions among patients is very heterogeneous, and the clinical picture is diverse. Among patients, there is a very high prevalence of thermoregulation and temperature sensitivity disorders, during which signal transmission in neurons in the CNS is affected. This is manifested in a transient worsening of certain previously present symptoms (Uhthoff's phenomenon), or pseudorelapse. In order to stimulate the neuroplasticity of the CNS, a rehabilitation program is initiated. MS patients in Croatia undergo rehabilitation in rehabilitation institutions once a year. Given the temperature sensitivity of patients, certain physical therapy procedures are limited, while some recommendations limit going out when outside temperatures are above 30°C. All of this could affect the period of year during which rehabilitation will be carried out.
Methods
Data processing of MS patients in Special hospital for medical rehabilitation - Toplice Lipik, during the period from 2017 to 2024.
Results
In Toplice Lipik, 350 to 400 MS patients access rehabilitation annually. During the year, an increased number of visits was observed from September to November and in May, i.e. in the period of the year when the average monthly temperatures in the continental part of Croatia are lower compared to the warmest months.
Conclusion
In patients with multiple sclerosis, a variation in visits to the rehabilitation facility is observed throughout the year, which may be related to temperature sensitivity.
Keywords
multiple sclerosis, rehabilitation, temperature sensitivity
#338 IMPACT OF SPINAL CORD STIMULATOR IN NEUROPATHIC PAIN IN AMPUTEES - NORTHERN IRELAND PERSPECTIVE
Hitesh Jiandani
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
IMPACT OF SPINAL CORD STIMULATOR IN NEUROPATHIC PAIN IN AMPUTEES - NORTHERN IRELAND PERSPECTIVE
Background
Neuropathic pain in patients with amputations significantly affects quality of life. This case series explores the impact of spinal cord stimulation (SCS) on reported quality of life and pain medication requirement for three patients.
Case report
Post-implantation, all three patients reported increased prosthetic wearing time and greater functionality in daily activities, including driving. SCS led to a reduction in the use of neuropathic agents and opioids, enhancing overall function, improvements in sleep quality, mood and in turn better quality of life.
Conclusion
While most previous studies have focused on pain scores associated with SCS, this series emphasizes the enhancement of quality of life and functional capability after insertion of an SCS. Future multicentre studies could explore the benefits associated with SCS and resultant cost-effectiveness.
Keywords
None
#339 REHABILITATION MANAGEMENT OF INTENSIVE CARE UNIT-ACQUIRED WEAKNESS
Milkica Glogovac Kosanović1, Tatjana Bućma1, Tanja Stanivuković1, Igor Sladojević2, Nedžama Begović-Špago3
2 Faculty of medicine, University of Banja Luka, Bosnia and Herzegovina
3 Cantonal hospital dr Safet Mujić, Mostar, Bosnia and Herzegovina
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
REHABILITATION MANAGEMENT OF INTENSIVE CARE UNIT-ACQUIRED WEAKNESS
Background and Aims
Intensive Care Unit–Acquired Weakness (ICU-AW) is a clinically detected weakness in critically ill patients who do not have a primary neuromuscular disorder, and it occurs due to the critical illness or its treatment. It encompasses three separate syndromes: critical illness myopathy, critical illness polyneuropathy and critical illness polyneuromyopathy. This complication develops in 25-45% of critically ill patients admitted to intensive care units and can lead to severe and permanent functional impairment. At the moment, there’s no specific treatment to cure ICU-AW, but only preventive and substantiating measures that include aggressive treatment of sepsis, lowering of the dosages and duration of therapy with neuromuscular blockers and corticosteroids, rehabilitation, adequate positioning, nutritional interventions and usage of immunoglobulins. The goal of the research is to determine the importance of rehabilitation in the functional recovery of patients with ICU-AW.
Methods
The research featured 20 patients of both sexes over the age of 18 who were sent to stationary rehabilitation after their treatment at the Intensive Care Clinic at the Clinical Center of Republic of Srpska, where they were connected to mechanical ventilation. As a result, ICU-AW was developed. At the beginning and at the end of the rehabilitation process, they were tested according to the functional mobility test and the Barthel index. Rehabilitation included a specific kinesitherapy program, occupational therapy, electrical stimulation, pulmonary rehabilitation and robotically assisted rehabilitation.
Results
There was a highly statistical and significant increase in functional mobility test values from the moment of admission (M=0,2, SD=0,2) to discharge (M=2,85, SD=1,927, t(19)=-6,239; p=0,000). The same was detected for values of the Barthel index, from the moment of admission (M=26,7, SD=16,013) to discharge (M=66,8, SD=25,354, t(19)=-8,593; p=0,000).
Conclusion
The results showed a significant role of organized rehabilitation in improving the functional status of patients with ICU-AW, which also leads to improving their quality of life.
Keywords
critical illness, myopathy, polyneuropathy, rehabilitation
#340 COMPLEX REHABILITATION AFTER MULTIPLE AMPUTATIONS
Ivana Orbanić Znika, Kristina Samardžić, Miro Dragović
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
COMPLEX REHABILITATION AFTER MULTIPLE AMPUTATIONS
Background
Rehabilitation of patients after limb amputation is a complex process involving medical, physical, and psychological support aimed at restoring functionality and quality of life. In the early rehabilitation phase, the focus is on wound care, prevention of complications, and preservation of mobility. Functional rehabilitation includes exercises, prosthetic preparation, and learning new skills. Psychosocial support is essential for adapting to a new way of life, while long-term follow-up enables timely problem-solving and maintenance of achieved outcomes. The entire process requires a multidisciplinary approach (physiatrist, physiotherapist, nurse, prosthetic engineer) and an individualized recovery plan.
Case report
The patient, a male active-duty soldier, was severely injured on February 23, 2023, sustaining multiple injuries resulting in the amputation of all four limbs. In our Rehabilitation Department, the patient was provided with appropriate prosthetic devices, as indicated by a multidisciplinary team decision. Rehabilitation was carried out through a structured, individualized plan including physiotherapy, desensitization, gait training, patient and family education, and continuous psychosocial support.
Conclusion
Despite the extreme complexity of the case, the patient achieved significant functional progress and demonstrated a high level of adaptation to his new way of life.
Keywords
rehabilitation, amputation, prosthetics
#343 FEMORAL FRACTURE DURING DENOSUMAB THERAPY IN A PATIENT WITH POSTMENOPAUSAL OSTEOPOROSIS AND RHEUMATOID ARTHRITIS: A CASE REPORT
Adelmo Šegota, Davor Štefanac, Emanuela Lacmanović, Tea Schnurrer-Luke-Vrbanić
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
FEMORAL FRACTURE DURING DENOSUMAB THERAPY IN A PATIENT WITH POSTMENOPAUSAL OSTEOPOROSIS AND RHEUMATOID ARTHRITIS: A CASE REPORT
Background
Postmenopausal osteoporosis is a common cause of fractures in the elderly population. Denosumab is a highly effective antiresorptive agent that significantly reduces the risk of osteoporotic fractures. However, spontaneous fractures may still occur during therapy, particularly in complex patients with multiple comorbidities. This report presents a patient with longstanding postmenopausal osteoporosis, who despite being on denosumab therapy, sustained an atypical femoral fracture.
Case report
A 71-year-old female patient diagnosed with postmenopausal osteoporosis has been treated with risedronate (2011-2021) and teriparatide (2021-2023). In February 2024, she began denosumab therapy (60 mg subcutaneously every 6 months), with optimal calcium and vitamin D supplementation. Regular follow-up with a physiatrist was conducted due to stable vertebral fractures at Th11, Th12 and L3. Since 2022, the patient has been receiving methotrexate treatment (15 mg once weekly) for rheumatoid arthritis. In March 2025, due to a fall, the patient sustained fractures of the third to fifth metatarsal bones in her right foot. One month later, while walking on flat ground and without any trauma, she experienced pain in her left thigh. A femoral diaphyseal fracture was diagnosed and internal fixation was performed using a long gamma nail. After acute care at the Traumatology Department, the patient was transferred to the Physical and Rehabilitation Medicine Department for inpatient rehabilitation and further evaluation of the fracture’s etiology.
Conclusion
This case highlights the importance of vigilant monitoring in patients on long-term antiresorptive therapy, especially those with rheumatologic comorbidities. Despite appropriate supplementation and treatment, atypical fractures may still occur in complex patients, requiring comprehensive physiatric and multidisciplinary evaluation.
Keywords
Osteoporosis, Atypical bone fracture, Denosumab
#344 FUNCTIONAL INSTABILITY IN PATIENTS AFFECTED BY COLLAGENOPATHIES WITH ARTICULAR HYPERLAXITY
Daniela Platano1, Giuseppina Mariagrazia Farella2, Luca Sangiorgi3, Lisa Berti1
2 IRCCS RIzzoli, Bologna, Italy
3 IRCCS ISTITUTO ORTOPEDICO RIZZOLI, Italy
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
FUNCTIONAL INSTABILITY IN PATIENTS AFFECTED BY COLLAGENOPATHIES WITH ARTICULAR HYPERLAXITY
Background and Aims
Joint Hypermobility Syndrome (JHS) is an inherited multisystem connective tissue disorder, primarily characterized by excessive joint mobility and widespread musculoskeletal pain, which is the most frequently reported symptom. Neurophysiological impairments are also commonly observed. The combination of joint hypermobility, hypotonia, and reduced proprioceptive acuity renders individuals with JHS more vulnerable to traumatic injuries resulting from joint overuse or mechanical overload. This study aimed to evaluate both static and dynamic postural balance in individuals with JHS by administering postural stability tests.
Methods
Twenty patients from the Rare Diseases Orthopaedic Outpatient Clinic at the Rizzoli Orthopaedic Institute were enrolled in the study. Postural assessments were conducted using the Delos proprioceptive system, analyzing the following parameters: postural instability, Stability Index (SI), and Autonomy Index (AI), under both static and dynamic conditions, with eyes open and closed. The results were compared to those obtained from a control cohort of healthy individuals.
Results
Balance deficits were observed in subjects with Joint Hypermobility Syndrome (JHS), as evidenced by increased postural instability and reduced Stability Index (SI) and Autonomy Index (AI) values when compared to the control group. Subgroup analysis of JHS patients with (i) a history of lower limb pathologies, (ii) a Numerical Rating Scale (NRS) pain score greater than 3, or (iii) localized lower limb pain revealed a statistically significant decrease in SI and AI values under eyes-closed conditions relative to controls. Furthermore, the majority of patients was unable to complete the assessment under dynamic conditions.
Conclusion
Our findings highlight significant balance and proprioceptive deficits in patients with Joint Hypermobility Syndrome (JHS). Specific clinical features were identified as potential indicators of more severe balance impairment, which may serve as discriminative factors to guide targeted rehabilitation strategies to reduce injury risk, improve gait function, and enhance overall quality of life.
Keywords
collagenopathies, hyperlaxity, instability, musculoskeletal disorders
#345 PERSISTENT SHOULDER PAIN IN A RECREATIONAL CLIMBER: A SYMPTOMATIC BUFORD COMPLEX
Diana Serra, Rita Almeida, Mafalda Guimarães, João Castro
Conference topic: Sports medicine rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
PERSISTENT SHOULDER PAIN IN A RECREATIONAL CLIMBER: A SYMPTOMATIC BUFORD COMPLEX
Background
The Buford Complex is a rare congenital anatomical variant of the shoulder, characterized by the absence of the anterosuperior glenoid labrum and a thickened, cord-like middle glenohumeral ligament. Although typically asymptomatic and regarded as a benign normal variant, it may become clinically relevant in individuals exposed to repetitive overhead activities or increased joint loading—particularly athletes and recreational sports practitioners. Failure to correctly identify this variant can result in misdiagnosis, inappropriate surgical intervention, and suboptimal clinical outcomes. Its recognition relies heavily on high-resolution imaging, especially MR arthrography, and careful correlation with clinical findings.
Case report
A 27-year-old right-handed female and recreational indoor climber, presented with a 10-month history of progressive left shoulder pain, exacerbated by overhead movements and traction positions, impairing daily functional activities and climbing performance. Physical examination revealed tenderness over the anterior joint line, a positive O’Brien test, and pain with resisted external rotation in abduction. Initial shoulder ultrasound raised suspicion of a paralabral cyst, but due to persistent symptoms and incongruent findings, a MR arthrography was performed. Imaging demonstrated complete absence of the anterosuperior labrum and a thick, cord-like middle glenohumeral ligament—findings consistent with the Buford Complex—without associated labral tear or rotator cuff pathology. A subacromial corticosteroid injection was ineffective for pain relief. The patient underwent a targeted rehabilitation program emphasizing dynamic scapulohumeral stabilization, rotator cuff strengthening, proprioception, and neuromuscular retraining. Marked symptomatic improvement was observed within six weeks, with full pain-free return to climbing at three months.
Conclusion
Although often underrecognized, the Buford Complex can become symptomatic in active individuals. This case highlights the importance of recognizing this rare variant, and shows that accurate diagnosis through detailed imaging and clinical correlation is essential to prevent overtreatment. In the absence of concomitant structural lesions, conservative rehabilitation programs can yield excellent functional outcomes.
Keywords
Buford, Shoulder, Variant, Pain, Rehabilitation
#346 POSTURAL BALANCE ASSESSMENT BEFORE AND AFTER UNILATERAL TOTAL HIP ARTHROPLASTY
MOUAD YAZIDI1, Abdelhakim Kabil2, Rime Dades2, Ryme El beloui2, Hasnaa Boutalja2, Nada Kyal2, Fatima Lmidmani2, Abdellatif El fatimi2
2 Chu Ibn Rochd, Morocco
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
POSTURAL BALANCE ASSESSMENT BEFORE AND AFTER UNILATERAL TOTAL HIP ARTHROPLASTY
Background and Aims
Total hip arthroplasty (THA) is a surgical procedure with the aim of relieving pain and restoring functionality in patients with hip joint degeneration. Postural balance assessment plays an important role in the management of patients with THA since it impacts patient’s stability. The aim of this study is to evaluate postural stability in patients before and after THA.
Methods
Prospective and descriptive study conducted in the department of Physical Medicine and Rehabilitation of university hospital « CHU Ibn Rochd » in Casablanca, Morocco. 38 Patients who underwent unilateral THA were recruited to assess postural balance before surgery, 3 and 6 months after THA using timed up and go test (TUG test) and time duration of single leg stance.
Results
The mean age was 58.3 years old with a male predominance. All patients had THA after hip osteoarthritis. Significant differences were observed concerning TUG test and time duration of single leg stance before and after surgery. The average TUG test before surgery was 45 seconds with 78.9% using assistive devices. Single leg stance was impossible for 31.5% and lasted only <5sec for 68.4%. 3 months after surgery, the average TUG test was 23 seconds with 42.8 % still using assistive devices. Single leg stance lasted in average 8 sec. 6 months after surgery, the average TUG test was 16 seconds with only 10.5 % still using assistive devices. Single leg stance lasted in average 10 sec.
Conclusion
In our study, TUG test combined with time duration of single leg stance showed that THA can initially affect patient’s ability to maintain postural stability. Thus, patient must undergo a structured rehabilitation program where balance assessment is an important component in order to monitor patient’s progress in restoring stability, and to provide valuable information about patient’s risk of falling and to walk without any assistive devices
Keywords
Hip arthroplasty, balance, TUG test
#347 POSTERIOR ANKLE IMPINGEMENT SYNDROME:EFFECT OF CONSERVATIVE MANAGEMENT
MOUAD YAZIDI, Rime Dades, Abdelhakim Kabil, Ryme Elbeloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El fatimi
Conference topic: Pain treatment and rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
POSTERIOR ANKLE IMPINGEMENT SYNDROME:EFFECT OF CONSERVATIVE MANAGEMENT
Background and Aims
Posterior ankle impingement syndrome (PAIS) is characterized by chronic or recurrent posterior ankle pain during forced or repetitive plantarflexion. PAIS is common in the athletic population. The objective of our study is to show the effect of the management of this syndrome using Nonsurgical treatment such as activity modification and physical therapy.
Methods
It’s a retrospective study including 10 patients suffering from posterior ankle pain and who were recruited during podiatry consultation in the department of Physical Medicine and Rehabilitation in university hospital of Ibn Rochd. All patients had physical examination , foot examination using optical podoscope and foot pressure assessment system, and radiography.
Results
The mean age was 36 +/- 4 years, with a female predominance. None of them were athletes or had any frequent sport activities. However a microtrauma context was identified in 40%. Physical examination revealed pain at passive forced plantar flexion for all patients. X-ray showed a long tail on the talus in 20 % and a trigone bone in 40 %. Podiatric examination found increased foot pressure in metatarsals in 60%. All patients had physical therapy and prescription of foot orthosis. 40% had ultrasound-guided steroid injections. Following this non surgical treatment, pain visual analogue scale went from a mean of 6.2 to 3.6
Conclusion
PAIS can be diagnosed by clinical history and physical examination. Radiography and magnetic resonance imaging show the cause of this syndrome. Symptoms improve with non surgical treatment but surgery may be required following failure of conservative management.
Keywords
Foot, and, ankle, Posterior, impingement
#348 ANALYZING UROFLOWMETRY OUTCOMES FOR PATIENT AFTER RADIATION THERAPY FOR PROSTATE CANCER
Mouad Yazidi, Abdelhakim Kabil, Rime Dades, Ryme El beloui, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El fatimi
Conference topic: Cancer rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ANALYZING UROFLOWMETRY OUTCOMES FOR PATIENT AFTER RADIATION THERAPY FOR PROSTATE CANCER
Background and Aims
Prostate cancer’s (PC) local treatment includes radical prostatectomy and radiotherapy (RT) that has some impact on genito-urinary system despite of the important advances that had been made in techniques of RT. Some patients may have long-term urinary side effects such as increased urinary frequency, urgency, urinary incontinence and dysuria…These symptoms may impact significantly patient’s quality of life
Methods
retrospective study including 33 patients who underwent radiotherapy for prostate cancer. All patients had completed radiotherapy at least 12 months before uroflowmetry evaluation to analyse the effect of late complications related to RT on voiding. We evaluated lower urinary tract symptoms (LUTS) using Urinary Symptom Profile (USP), 3-day frequency-volume charts (FVC), uroflowmetry (UFM) and post-void residual urine volume (PVR) measurement.
Results
The average age was 69.45 years. The evaluation of LUTS was done after an average of 22 months after finishing radiotherapy. 72.7% had radical prostatectomy prior to the radiotherapy. 45.4% had hormonotherapy and 36.3% had chemotherapy. About lower urinary tract symptoms, 63.6% had urgency urinary incontinence, 54.5% stress urinary incontinence and 81.8% dysuria. Using USP, stress urinary incontinence subscore was 7/9, overactive bladder subscore 14/21 and dysuria subscore was 5/9. FVC showed increased urinary frequency (average number of daytime voids >10 and nocturnal voids > 2) and an average voided volume of 139.2 ml
Conclusion
Despite the effectiveness of radiotherapy, it can cause damages associated with urinary complications that have impact on patient’s quality of life and be sometimes life threatening to the patient. Regular follow-up allow to early detect radiation complications. Uroflowmetry is an indispensable test for patients with LUTS. It can provide objective and quantitative information to understand symptoms
Keywords
Prostate cancer, uroflowmetry LUTS
#349 CLINICAL OUTCOMES OF PLATELET-RICH PLASMA IN SACROILIAC JOINT DYSFUNCTION: A CASE SERIES
Sofia Flores, Rui Peres, Ricardo Nunes, Paulo Tomaz, Afonso Couto, Afonso Pereira, Catarina Peixoto, Nuno Silva, Ana Filipa Neves, André Ladeira
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
CLINICAL OUTCOMES OF PLATELET-RICH PLASMA IN SACROILIAC JOINT DYSFUNCTION: A CASE SERIES
Background
Sacroiliac joint (SIJ) dysfunction is a recognized source of low back pain. Recent reviews show longer-lasting relief with Platelet-Rich Plasma (PRP) than corticosteroids, but evidence is limited by protocol and patient variability.
Case report
We describe four cases of SIJ dysfunction treated with leukocyte-rich PRP without external activation, with platelet concentrations ranging from 4.41 to 5.67 times that of peripheral blood. Three patients (female, 46; female, 20; male, 75) underwent unilateral, bilateral, and unilateral SIJ injections, respectively, using a standardized protocol: 2.5 mL of intra-articular PRP confirmed by fluoroscopic contrast, and 4 mL PRP at the posterior sacroiliac ligaments under ultrasound guidance. In case 1, pain decreased from 6/10 to 2/10 after 2 months, with only mild discomfort when seated on hard surfaces. In case 2, right-sided pain dropped from 7/10 to 3/10 with sustained improvement for 4 months; the left side responded poorly. In case 3, pain reduced from 6/10 to 4/10 for 3 months, with limited overall benefit—possibly due to a multifactorial pain etiology in a older patient with other spinal degenerative changes. In case 4 (female, 19), only peri-ligamentous PRP was administered under ultrasound, as intra-articular contrast placement under fluoroscopic guidance was not achievable. Pain decreased from 7/10 to 3/10 after 1 month, with sustained functional improvement.
Conclusion
Discussion: These cases highlight the variable clinical response to PRP in SIJ dysfunction, reflecting literature findings. While randomized controlled trials (RCTs) typically use single injections, case series often apply 2–3 sessions in refractory cases. Outcomes appear influenced by anatomical, technical, and individual factors, including comorbidities. Conclusion: PRP appears to be a safe and potentially effective therapy for long-term relief. Large RCTs with ≥12-month follow-up are needed to establish consensus on platelet concentration, leukocyte content, activation methods, injection volumes and frequency. Detailed protocol standardization is essential to ensure reproducible and comparable outcomes.
Keywords
Sacroiliac Joint Dysfunction; Platelet-Rich Plasma;
#350 PHYSICAL THERAPY INDUCED AUTOIMUNE DISEASE – CAN NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAID) CAUSE EXACERBATION OF ULCERATIVE COLITIS IN A PATIENT IN REMISSION – A CLINICAL CASE
Filipe Leite Pires Mendes, Manuel Fernandes, Isabel Romeiro, Sofia Azevedo, Carlos Gama, Cláudia Silva, Jose Marques, Joana Silva, Catarina Branco
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
PHYSICAL THERAPY INDUCED AUTOIMUNE DISEASE – CAN NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAID) CAUSE EXACERBATION OF ULCERATIVE COLITIS IN A PATIENT IN REMISSION – A CLINICAL CASE
Background
Ulcerative colitis (UC) is an inflammatory bowel disease often triggered by environmental or pharmacologic factors. Although (NSAID) are commonly used in physiotherapy for musculoskeletal pain, their safety in UC remains debated. We present a case of a patient in long-term UC remission who experienced a severe flare following NSAID use during physiotherapy. This case raises important considerations about the potential role of NSAID in triggering autoimmune responses and the need for caution when prescribing them to patients with underlying inflammatory conditions.
Case report
23-year-old man, engineer, with personal history of UC and ankylosing spondylitis in remission for 4 years, medicated with 2g mesalazine/day. He performed frequent muscular resistance training. He had terrible fracture of the left elbow whilst skateboarding (elbow dislocation, radial head and coronoid fracture). After 1 month of conservative treatment (which included iontophoresis with NSAID-Ketoprofen), his past symptoms of ankylosing spondylitis and UC retuned. Colonoscopy revealed pan-ulcerative-colitis. NSAID were stopped and he started treatment with messalazine enema, 40mg prednisolone/day (followed by slow weaning) and azathioprine, which was initially effective. However, symptoms relapsed when prednisolone dose was lowered bellow 20mg/day, and the patient had to start anti-TNF (infliximab), becoming completely asymptomatic. One year after the fracture, with physiotherapy and gradual return to resistance training, there was complete recovery of arm pain, ROM and muscle atrophy/strength.
Conclusion
This case highlights the potential risk of UC exacerbation associated with NSAID use, even in patients in stable remission, and despite NSAID being used in iontophoresis, not orally/systemically. Clinicians should weight the benefits of symptom relief with NSAIDs against the risk of triggering disease flares in individuals with autoimmune diseases. This case also highlights the possibility of achieving excellent results in Terrible Triad of the Elbow with conservative treatment, especially in young physically patients, motivated to comply with a rehabilitation and muscle strengthening plan.
Keywords
Ulcerative Colitis NSAID Terrible Triad
#352 ASSESSMENT OF MENTAL HEALTH PROBLEMS AMONG UKRAINIANS WITH CHRONIC NONSPECIFIC LOW BACK PAIN DURING THE WAR
Mariia Ovdii, Vasyl korshak
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
ASSESSMENT OF MENTAL HEALTH PROBLEMS AMONG UKRAINIANS WITH CHRONIC NONSPECIFIC LOW BACK PAIN DURING THE WAR
Background and Aims
Chronic pain low back pain is the result of the interaction of biological, psychological and social factors that form the biopsychosocial model of this problem. War has been continuing in Ukraine for more than three years, leading to a difficult socio-economic situation, triggering a number of mental health issues, and exacerbating chronic diseases. The aim of our study is to assess mental problems in patients with chronic nonspecific low back pain.
Methods
To assess mental anxiety and depression, we used the Hospital Anxiety and Depression Scale (HADS), to assess stress level - the Perceived Stress Scale (PSS-10), to assess kinesiophobia - the Tampa Scale of Kinesiophobia (TSK-11).
Results
The study involved 100 people, including 62 women and 38 men, with an average age of 34.7±12.3 years. The average pain intensity of the subjects was 47.2±18.6 mm. VAS. According to the TSK-11 questionnaire, it was found that 48% of the subjects had kinesiophobia, with an average score of 30.9±11.7. According to the results (PSS-10), it was found that the subjective stress level of the subjects with chronic lower back pain was 17.06±6.08, which corresponds to the average stress level. Among the subjects, 28% had low stress levels, 68% had average stress levels, and 7% had high stress levels. Among the subjects with chronic low back pain, the majority had a clinical 65% and subclinical anxiety level of 22.5%, as well as a clinical 35% and subclinical depression level of 27.5%.
Conclusion
Most individuals with chronic nonspecific low back pain have mental health issues. To improve the management of chronic low back pain, we need an active approach to identifying mental health issues and multidisciplinary approaches to their correction.
Keywords
pain, stress, depression, anxiety, кinesiophobia
#353 AZERBAIJAN`S NATIONAL MODEL FOR POST-AMPUTATION REHABILITION: THE EXPERIENCE OF BAKU REHABILITION CENTER
Kamala Bozan
Conference topic: Postoperative rehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
AZERBAIJAN`S NATIONAL MODEL FOR POST-AMPUTATION REHABILITION: THE EXPERIENCE OF BAKU REHABILITION CENTER
Background and Aims
Amputation is not only a surgical intervention but a life-altering transition involving medical, psychological, and social challenges. In Azerbaijan, structured post-amputation rehabilitation was historically absent, leading to poor outcomes and misuse of prosthetic devices. The Baku Rehabilitation Center, established in 2024 under the Ministry of Labour and Social Protection, was designed to address these gaps and serve as the nation’s first coordinated model of post-operative amputee care.
Methods
The center provides a three-phase rehabilitation protocol: (1) Pre-prosthetic phase: limb shaping, contracture prevention, education, strength and balance training. (2) Inpatient phase: a 14-day program focusing on prosthesis use, ADLs, gait training, and psychological support. (3) Outpatient follow-up: one month of mobility refinement, prosthesis adjustment, and mental health reinforcement, beginning three months post-discharge. Patients are evaluated using standardized tools such as AMPPro, 6MWT, Tinetti, Berg Balance, and psychological scales (PHQ-9, GAD-7)
Results
Since launch, ~2,000 patients have been served, including ~1,000 lower limb amputees (ages 19–75; ~80% male). Trauma and war injuries dominate among younger patients; vascular diseases and malignancies are prevalent among the elderly. Early referrals (<3 months post-op) show significantly better functional and psychological outcomes. Patients from remote areas often require repeated interventions.
Conclusion
The Baku Rehabilitation Center provides an integrated, ethical, and multidisciplinary model of post-amputation care. Its early success demonstrates the importance of continuity, accessibility, and psychosocial integration in improving amputee outcomes. This center marks a foundational step in establishing nationwide standards for postoperative rehabilitation in Azerbaijan.The Baku Rehabilitation Center provides an integrated, ethical, and multidisciplinary model of post-amputation care. Its early success demonstrates the importance of continuity, accessibility, and psychosocial integration in improving amputee outcomes. This center marks a foundational step in establishing nationwide standards for postoperative rehabilitation in Azerbaijan.
Keywords
Postoperative, rehabilitation, amputation, prosthetic
#354 IMPACT OF NEUROREHABILITATION NURSING COMBINED WITH PHARMACOLOGICAL SEQUENTIAL THERAPY ON PAIN SENSITIZATION STATUS IN PATIENTS WITH NEUROPATHIC PAIN: A RANDOMIZED CONTROLLED TRIAL
Mei Yu
Conference topic: Pain treatment and rehabilitation
Occupation: Nurses
Type of abstract: Scientific abstract
Abstract
Title
IMPACT OF NEUROREHABILITATION NURSING COMBINED WITH PHARMACOLOGICAL SEQUENTIAL THERAPY ON PAIN SENSITIZATION STATUS IN PATIENTS WITH NEUROPATHIC PAIN: A RANDOMIZED CONTROLLED TRIAL
Background and Aims
Neuropathic pain, affecting approximately 7–10% of the global population, is characterized by maladaptive pain sensitization mechanisms that often resist conventional monotherapies. To investigate the impact and efficacy evaluation of neurorehabilitation nursing combined with pharmacological sequential therapy on pain sensitization in patients with neuropathic pain.
Methods
A randomized controlled trial was conducted, enrolling 120 NP patients. Participants were randomly allocated to either the combined treatment group (neurorehabilitation nursing + pharmacological sequential therapy, n=60) or the control group (routine neurological nursing care + conventional pharmacotherapy, n=60). The neurorehabilitation nursing protocol included exercise therapy, sensory training, and psychological interventions. Pharmacological sequential therapy involved guideline-based stepwise medication adjustments (e.g., pregabalin, duloxetine combined with NSAIDs). Pain sensitization status was assessed using the Visual Analog Scale (VAS) and the Douleur Neuropathique 4 questionnaire (DN4) at baseline, 4 weeks, and 8 weeks post-treatment. Clinical efficacy was compared between groups.
Results
At baseline, no significant differences were observed in VAS or DN4 scores between groups (P>0.05). At 4 and 8 weeks post-treatment, the combined treatment group exhibited significantly lower VAS scores (2.3±0.5 VS. 4.1±0.7; 1.2±0.3 VS. 3.5±0.6) and DN4 scores (4.2±1.2 VS. 6.8±1.4; 2.1±0.7 VS 5.7±1.1) compared to the control group (all P<0.05). The total effective rate in the combined treatment group was 95.0%, significantly higher than the 75.0% in the control group (P<0.05).
Conclusion
The integration of neurorehabilitation nursing and pharmacological sequential therapy significantly improves pain sensitization and enhances therapeutic outcomes in neuropathic pain patients, demonstrating clinical value for widespread application.
Keywords
Neuropathic pain, Neurorehabilitation nursing
#355 SOFT CHANNEL MINIMALLY INVASIVE DRAINAGE VERSUS CRANIOTOMY FOR INTRACRANIAL HEMATOMA EVACUATION: A SINGLE-CENTER COMPARATIVE STUDY
Xishuang Su
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
SOFT CHANNEL MINIMALLY INVASIVE DRAINAGE VERSUS CRANIOTOMY FOR INTRACRANIAL HEMATOMA EVACUATION: A SINGLE-CENTER COMPARATIVE STUDY
Background and Aims
Minimally invasive soft channel techniques and conventional craniotomy represent divergent approaches for intracranial hematoma evacuation, yet comparative data on efficacy and outcomes remain limited. This study aimed to explore the complication rates and functional recovery between these two surgical strategies.
Methods
A retrospective analysis was conducted on 197 consecutive patients with hypertensive basal ganglia hemorrhage treated at our hospital between October 2022 and March 2025. Patients were divided into the soft channel drainage group (n=103, mean age 67 years, 67 men and 36 women) and craniotomy group (n=94, mean age 65 years, 56 men and 38 women). The primary endpoints included operation duration, CT-measured hematoma clearance rate, and intraoperative blood loss. Secondary outcomes encompassed Glasgow Coma Scale (GCS) improvement at 72 hours postoperative complications of infection and modified Rankin Scale (mRS) at 90-day follow-up.
Results
There were no significant differences with regard to age and sex between the two groups. The soft channel group demonstrated significantly shorter operative duration (0.38 ± 0.13h vs 1.04 ± 0.32h, P<0.001) and reduced blood loss (205 ± 38 ml vs 398 ± 57 ml, P<0.001). Hematoma clearance rates (77/103 vs 71/94, P=0.90) and GCS improvement (P=0.87) were comparable. Craniotomy patients exhibited higher rates of surgical site infection (2/103 vs 9/94, P=0.02). At 90 days, favorable functional outcomes as defined as mRS < 3 were achieved in 57.28% of soft channel patients versus 42.55% of craniotomy patients (P=0.04).
Conclusion
Soft channel drainage offers distinct advantages in procedural efficiency, reduced blood loss, lower post-operative infection rate and better functiona outcomes than craniotomy.
Keywords
Craniotomy, Functional outcomes, Intracranial hemorrhage
#356 COMPREHENSIVE NURSING OF ECMO ASSISTED FLOW DYNAMICS MONITORING UNDER EVIDENCE-BASED NURSING PRACTICE
Lu Hong
Conference topic: Cardiopulmonary rehabilitation
Occupation: Health professionals (Physiotherapist, Nurses, Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
COMPREHENSIVE NURSING OF ECMO ASSISTED FLOW DYNAMICS MONITORING UNDER EVIDENCE-BASED NURSING PRACTICE
Background and Aims
To explore a comprehensive nursing strategy for hemodynamic monitoring during extracorporeal membrane oxygenation (ECMO) assisted period in evidence-based nursing practice, in order to improve the treatment efficiency of critically ill patients.
Methods
The system searched UpToDate, Cochrane Library, JBI Evidence Based Healthcare Database, and PubMed (2010-2025), used AGREE II tool to evaluate guideline evidence, and combined with the ECMO nursing expert consensus of the Chinese Nursing Association, developed a nursing process that includes three core elements: standardized monitoring techniques, complication warning, and team collaboration. Systematically evaluate the hemodynamic characteristics of ECMO patients and the limitations of monitoring techniques, and construct a multidimensional nursing intervention plan.
Results
Standardized nursing significantly reduced ECMO related hypoperfusion events (by 30%) (p<0.01), improved the accuracy of hemodynamic parameter collection in ECMO patients (p<0.01), and reduced the incidence of catheter-related thrombosis (OR=0.42, 95% CI 0.31-0.57), verifying the synergistic effect of precise hemodynamic monitoring and comprehensive nursing.
Conclusion
The evidence-based ECMO nursing system can optimize hemodynamic management and provide individualized and precise nursing support for critically ill patients. In the future, multi center research needs to be deepened to improve the evidence chain.
Keywords
Evidence based nursing, ECMO
#357 EFFECTS OF ECCENTRIC EXERCISE ACCOMPANY WITH AND WITHOUT DRY NEEDLING IN PATIENTS WITH CHRONIC ROTATOR CUFF TENDINOPATHY
Shiva Pourshafie
Conference topic: Pain treatment and rehabilitation
Occupation: Physical therapist)
Type of abstract: Scientific abstract
Abstract
Title
EFFECTS OF ECCENTRIC EXERCISE ACCOMPANY WITH AND WITHOUT DRY NEEDLING IN PATIENTS WITH CHRONIC ROTATOR CUFF TENDINOPATHY
Background and Aims
The eccentric exercises (EE) can be effective on reducing inflammation. Besides, dry needling (DN) may affect blood circulation. The purpose of this study is effects of combined treatment methods (EE + DN) on chronic rotator cuff tendinopathy.
Methods
Twenty-eight patients with shoulder pain (chronic rotator cuff tendinopathy) were recruited for this study. The patients were randomly divided into two groups including; Intervention (EE + DN) and Control (EE). All patients had eight sessions of treatment including eccentric exercises. The patients in intervention group were under DN application as well. All patients were evaluated four times (before, after third session and after treatment accomplishment, and 72 hours following last treatment session). The patients were evaluated to identify levels of pain and function.
Results
All variables would be improved following treatment in both groups at the time of treatment accomplishment. (P < 0.001). The improvement level would be lasted 72 hours after treatment accomplishment in combined group, while it was not long lasted for most of the outcome measures following only eccentric exercise group. The patients in EE control group showed just improvement level of TFAST scale after 72 hours of treatment accomplishment.
Conclusion
The results showed that EE + DN protocol could be much effective compare to the EE application alone and improve level of pain and better function on the patients following chronic rotator cuff tendinopathy.
Keywords
Tendonitis, eccentric exercise, dry needling
#358 REDUCTION OF PAIN WITH FOCUSED SHOCKWAVE THERAPY IN EARLY-STAGE DUPUYTREN’S CONTRACTURE – A FOUR-PATIENT CASE SERIES
Sofia Meixedo, Inácio Menezes, Yuriy Mazin, Ismael Carneiro
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
REDUCTION OF PAIN WITH FOCUSED SHOCKWAVE THERAPY IN EARLY-STAGE DUPUYTREN’S CONTRACTURE – A FOUR-PATIENT CASE SERIES
Background and Aims
Dupuytren’s disease is characterized by proliferative fibroplasia of the palmar fascia, leading to flexion contractures of the fingers and significant functional limitations. We aimed to demonstrate the effects of focused shockwave therapy (fSWT) in early-stage Dupuytren’s contracture, as described in the literature.
Methods
We included three patients with early-stage Dupuytren’s contracture (Tubiana ≤1), one with bilateral involvement, who underwent fSWT. The treatment protocol comprised three weekly sessions (interval of 7 days), using a Storz Duolith SD1 Modular Shockwave device (1,500 impulses, 4–6 Hz, 0.01–0.35 mJ/mm²). Functional assessment was performed using the Quick-DASH questionnaire and pain intensity was evaluated with the numeric pain rating scale (NPRS) before and after the intervention.
Results
The mean age of patients was 64.5 years. Improvements were observed in Quick-DASH (mean change: -20.5 points) and NPRS (mean change: -3.5 points). However, statistical significance was not reached (Quick-DASH p=0.058; NPRS p=0.110), despite the Quick-DASH result approaching significance. Subjectively, patients reported perceived reduction of contracture thickening and improved range of motion. Objectively, no significant changes were observed in contracture severity. No adverse effects were reported. In our small series, consistent subjective improvements were noted across patients. Interestingly, the patient with the smallest improvements was the one treated with the lowest intensity (0.07–0.1 mJ/mm²), suggesting that energy level may influence clinical outcomes. The main limitation for wider use of this therapy remains equipment availability and the need for specialized training.
Conclusion
fSWT in early-stage Dupuytren’s disease demonstrated promising results in pain reduction and functional improvement. Although statistical significance was not achieved in this small sample, the consistent subjective benefits and the observation that higher intensities might be associated with better outcomes suggest that fSWT can be a valuable, non-invasive tool to delay disease progression. When available, this approach appears cost-effective and preferable to minimally invasive procedures and surgery in early disease stages.
Keywords
none.
#359 A RARE CASE OF PARSONAGE-TURNER SYNDROME INVOLVING ONLY THE RADIAL NERVE
Carolina Pereira e Carvalho1, Mafalda Guimarães2, Goreti Nadais2, André Cruz1, Luís Braz2, Andreia Costa2
2 Unidade Local de Saúde de São João, Portugal
Conference topic: Neurorehabilitation
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
A RARE CASE OF PARSONAGE-TURNER SYNDROME INVOLVING ONLY THE RADIAL NERVE
Background
Parsonage-Turner Syndrome (PTS) is a rare neurological disorder characterized by sudden onset of severe shoulder pain followed by progressive motor and sensory deficits, primarily affecting the upper limbs. Although traditionally considered a proximal brachial plexopathy, involvement of distal or mixed nerves (sensory and motor nerves) is less commonly reported. The syndrome have multifactorial etiologies, including autoimmune mechanisms, infections, trauma, and post-vaccination responses. Diagnosis is predominantly clinical, supported by electrodiagnostic studies, and management typically involves conservative measures, including pain control and rehabilitation. PTS often remains underdiagnosed, and atypical presentations may further complicate timely recognition.
Case report
We present the case of a 61-year-old right-handed male with a history of focal epilepsy of vascular origin, presented with sudden right shoulder pain which gradually decreased in intensity and began to exhibit neuropathic features over the course of seven months. Diagnostic workup included EMG and imaging studies. EMG revealed a partial axonal lesion of the right radial nerve. Imaging studies were unremarkable, and viral and immunological tests were negative. The patient showed distal upper limb weakness (wrist and finger extension G 2/5) with preserved proximal strength and hypoesthesia in the dorsal hand. These findings were consistent with PTS. A rehabilitation program was initiated focusing on proprioceptive re-education and strengthening of the wrist and finger extensors. After two months, there was functional improvement, with the Cochin Hand Functional Scale score improving from 81/90 to 59/90.
Conclusion
This case highlights a rare presentation of Parsonage-Turner Syndrome with exclusive radial nerve involvement. Clinicians should maintain a high índex of suspicion for PTS in patients presenting with distal upper limb weakness and sensory changes preceded by severe pain, even when classical proximal nerve involvement is absent. Early recognition and a multidisciplinary approach, including targeted rehabilitation, are crucial for optimizing functional recovery and minimizing long-term disability.
Keywords
Parsonage-Turner Syndrome; radial nerve; rehabilitation
#361 INTRAOSSEOUS AND INTRA-ARTICULAR INFILTRATION OF PLATELET-RICH PLASMA FOR SEVERE KNEE OSTEOARTHRITIS: CASE REPORT
Paulo Tomaz, André Ladeira, Nuno Silva, Catarina Peixoto, Rui Peres, Ricardo Nunes, Sofia Flores, Afonso Couto, Afonso Pereira
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
INTRAOSSEOUS AND INTRA-ARTICULAR INFILTRATION OF PLATELET-RICH PLASMA FOR SEVERE KNEE OSTEOARTHRITIS: CASE REPORT
Background
The prevalence of osteoarthritis (OA) continues to rise alongside increasing life expectancy. In advanced stages, subchondral bone marrow lesions (BMLs) are commonly observed and are closely associated with pain severity and disease progression. Intraosseous (IO) platelet-rich plasma (PRP) infiltration, as described by Mikel Sánchez, has shown promising outcomes. This case illustrates a targeted regenerative approach involving IO PRP administration to BMLs identified via magnetic resonance imaging (MRI).
Case report
A 68-year-old retired woman presented with longstanding bilateral mechanical knee pain, predominantly affecting the right knee. Symptoms were exacerbated by stair use, inclined walking surfaces, and prolonged sitting (“movie theater” sign). Baseline scores were 9/10 on the Numeric Pain Rating Scale (NPRS) and 49/100 on the Western Ontario and McMaster Universities Arthritis Index (WOMAC), indicating significant functional limitation. Physical examination revealed a positive Clarke’s test. MRI of the right knee demonstrated Grade IV chondromalacia (Outerbridge classification) of the lateral patellar facet and lateral femoral condyle, with BMLs appearing as poorly marginated hyperintensities on fat-suppressed T2-weighted images. PRP was prepared by processing 52 mL of peripheral blood using the Magellan PRP system, yielding 10 mL of leukocyte-rich PRP with a platelet concentration of 745,000/μL, an absolute platelet count of 7,450,000, a 3.5-fold increase over baseline, and a platelet retention rate of 67.5%. Under fluoroscopic guidance with contrast, which confirmed the absence of vascular extravasation, 2 cc of PRP were infiltrated into the patella and 1.5 cc into the lateral femoral condyle. An additional 6 cc were administered intra-articularly under ultrasound guidance. Two weeks post-procedure, the patient reported complete resolution of symptoms, with sustained improvement lasting 10 months. At the 11-month follow-up, mild symptom recurrence was noted (NPRS 2/10; WOMAC 11/100).
Conclusion
This case highlights the concept of precision regenerative therapy in OA management and underscores the critical role of subchondral bone in the disease’s pathophysiology.
Keywords
Severe-Osteoarthritis; Bone-marrow-lesions; Intraosseous-PRP
#362 ORIGINAL REHABILITATION PROGRAMME IS AN INHERENT PART GIVING POSITIVE RESULTS WITHIN PBHSCS CD34+ TREATMENT IN COXARTHROSIS
KROCHMALSKI MAREK1, Krochmalski Jakub2, Szafraniec Piotr2, Klupiński Kamil2, Kiljański Marek2
2 Medical Magnus Clinic, Poland
Conference topic: Other topic
Occupation: Other medical specialties
Type of abstract: Case report
Abstract
Title
ORIGINAL REHABILITATION PROGRAMME IS AN INHERENT PART GIVING POSITIVE RESULTS WITHIN PBHSCS CD34+ TREATMENT IN COXARTHROSIS
Background
The Authors treat OA, in I-IV on the Kellgren-Lawrence scale, with fresh CD34+ cells from a patient's own peripheral blood. In 2020, the Researchers obtained Grant R+D project co-financed by EU No.RPLD.01.02.0210.0125/19 for the novel treatment of OA (finished in December 31, 2023). The aim of the study is to present the developed original rehabilitation program, in the course of cell therapy, and the corresponding achievements.
Case report
Since 2020, the researchers have introduced their own program based on lumbar anesthesia in order to avoid pain, including muscle tension, and the administration of CD34+ cells obtained by apheresis from peripheral blood, into the joint and to the surrounding tissues and, in some cases, to the femoral head. The presented study comprises 95 hip joints.
Conclusion
• Spinal anesthesia allows for significant improvement of ROM through free manipulation with the physiotherapist in the operating room immediately after the administration of stem cells – greater range of motion translated into better treatment results • The combination of stem cell administration with recommended rehabilitation allows for the effect durability considering non-surgical treatment of hip OA • The stem cell administration combined with the rehabilitation inhibits the progression of hip degenerative changes at all K-L levels • The range of motion in K-L 1-2 group improved after 2 years, in K-L 3-4 group it neither ameliorated nor deteriorated. • The Authors' many years of experience in the treatment of coxarthrosis, confirmed by the R&D study results, have allowed many individuals suffering from OA to avoid hip arthroplasty • The study results, clinical picture, and holistic approach to the patient suggest that stem cell administration and manipulation under subarachnoid anesthesia, along with continued rehabilitation, bring the best results for the patient
Keywords
Stem, cells, Hip, osteoarthritis
#363 CHARACTERIZATION OF PAIN IN LOWER LIMB AMPUTEES AT ULSGE: AN OBSERVATIONAL CROSS-SECTIONAL ANALYTICAL STUDY
João Pitrez, Ricardo Pereira
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Scientific abstract
Abstract
Title
CHARACTERIZATION OF PAIN IN LOWER LIMB AMPUTEES AT ULSGE: AN OBSERVATIONAL CROSS-SECTIONAL ANALYTICAL STUDY
Background and Aims
Vascular disease, frequently associated with diabetes mellitus (DM), is the leading cause of lower limb amputation in developed countries. Pain is a common post-amputation complication, including phantom limb pain (PLP), residual limb pain (RLP), and secondary musculoskeletal pain (lumbar, hip, knee), affecting either the ipsilateral or contralateral (CL) side. While PLP has been extensively studied, data on non-phantom pain remains scarce, underscoring the need for further investigation. To clinically characterize non-phantom pain in lower limb amputees followed at the PRM outpatient clinic of ULSGE and to explore potential associations with mental health status.
Methods
A cross-sectional observational study was conducted. Data were collected via direct patient interviews (November 2024), including variables such as amputation type and duration, sex, prosthesis use, pain characteristics, and psychological impact. The sample included 58 patients followed between February 2023 and October 2024; bilateral amputees were excluded. Statistical analysis was performed using Python libraries (pandas, scipy).
Results
Fifty patients (mean age 65; 72% male) were analyzed. Transtibial amputations were most frequent, predominantly of vascular etiology. Pain was reported by 74%: RLP (46%), low back pain (36%), and CL limb pain (36%), with a mean pain intensity of 6 (NRS). Although associations between time since amputation and pain types were observed, statistical significance was not reached. RLP correlated with higher prevalence of anxiety and depression. Female patients exhibited higher rates of anxiety, low back pain, and RLP.
Conclusion
Non-phantom pain was highly prevalent and strongly associated with anxiety and female sex. These findings emphasize the importance of addressing pain and psychological comorbidities in rehabilitation. Further studies with larger, more diverse samples are warranted to support individualized rehabilitation strategies optimizing function and quality of life.
Keywords
Amputation, Pain, depression , Biomechanics, Rehabilitation
#364 MULTIMODAL TREATMENT IN SPASTICITY MANAGEMENT: AN EDUCATIONAL CASE-BASED INTERNATIONAL PERSPECTIVE
João Pitrez, Ricardo Pereira
Conference topic: Rehabilitation of musculoskeletal disorders (eg inflammatory arthritis…)
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
MULTIMODAL TREATMENT IN SPASTICITY MANAGEMENT: AN EDUCATIONAL CASE-BASED INTERNATIONAL PERSPECTIVE
Background
The definition of spasticity has evolved, integrating both hyperkinetic and hypokinetic components stemming from upper motor neuron (UMN) injuries. Spasticity involves complex pathophysiological mechanisms including altered descending pathways, exaggerated spinal reflexes, maladaptive neuroplasticity, and structural muscle changes such as spastic myopathy. Comprehensive understanding of these mechanisms supports the need for individualized, multimodal management strategies.
Case report
We present a 64-year-old man with chronic left-sided hemiparesis due to right basal ganglia hemorrhage. The patient’s goals were to improve gait efficiency and reduce neuropathic pain. Clinical assessment revealed triceps surae spasticity (Modified Ashworth Scale grade 3), equinus foot deformity, gastrocnemius contracture (positive Silverskiöld test), and significant muscle fibrosis (Modified Heckmatt scale grade 3). A multimodal treatment plan was implemented, including ultrasound-guided botulinum toxin type A injections (abobotulinumtoxinA), a custom ankle-foot orthosis (AFO), physical and occupational therapies, home-based self-rehabilitation, and oral baclofen. At 1-month follow-up, the patient demonstrated significant improvements in gait pattern, balance, and energy efficiency, with complete resolution of pain and spasms (VAS 6→0, Penn Spasm Scale 2→0). These functional gains were sustained over a year with repeated botulinum toxin administrations and consistent AFO use, demonstrating the effectiveness of a patient-centered, multimodal approach.
Conclusion
Spasticity is a multidimensional disorder requiring tailored, resource-sensitive, multimodal management addressing both neural and non-neural contributors. This case illustrates how combining pharmacological, interventional, orthotic, and rehabilitative interventions can achieve significant functional improvements even in resource-limited settings. The proposed international framework emphasizes flexibility, patient-centered goal setting, and interdisciplinary collaboration to optimize outcomes in spasticity management worldwide.
Keywords
Spasticity, Rehabilitation,Plasticity,Botulinum
#365 ISOLATED COMPRESSION OF THE DEEP MOTOR BRANCH OF THE ULNAR NERVE IN A GUITAR PLAYER: ELECTRODIAGNOSTIC INSIGHTS
Ioannis - Alexandros Tzanos, Maria Nianiarou, Aikaterini Kotroni
Conference topic: Other topic
Occupation: Medical doctors PRM specialist
Type of abstract: Case report
Abstract
Title
ISOLATED COMPRESSION OF THE DEEP MOTOR BRANCH OF THE ULNAR NERVE IN A GUITAR PLAYER: ELECTRODIAGNOSTIC INSIGHTS
Background
The ulnar nerve, after its insertion to Guyon’s canal divides into the superficial and the deep branch. The latter is a primarily motor nerve that innervates most of the intrinsic muscles of the hand. Injury of the deep branch is rare and it can be caused by overuse of the hand, due to occupation (e.g. musicians). The aim of this case report is to highlight the electrophysiological characteristics associated with this uncommon neuropathy in a professional guitar player.
Case report
A 66-year-old right-handed female professional guitar player was referred to the KAT General Hospital Electromyography Unit (Kifissia, Greece) in July 2024. She had been playing the instrument since she was sixteen years old, three hours a day. She self-reported weakness of her left thumb and index finger during guitar playing, without tingling or numbness. Symptoms had started a year ago. Clinical examination revealed atrophy of her left 1st dorsal interosseous (DI) muscle, positive Froment sign and no sensory disorders. The sensory nerve action potential recorded from the left 5th digit was normal. The compound muscle action potential (CMAP) recorded from the left abductor digiti minimi was normal, without conduction velocity differences between the wrist-below elbow area and below elbow – above elbow area. However, the latency of the CMAP recorded from the 1st DI was 3.33 msec in the left side and 2.87 msec in the right side, while the amplitude was 5.2 mV in the left side and 8.9 mV in the right side. This amplitude difference of 40% was considered as significant. The needle electromyography examination in the left 1st DI revealed reduced recruitment with high amplitude motor units.
Conclusion
This case highlights the importance of thorough electrophysiological evaluation in patients with atypical motor symptoms of the hand. Further investigation is warranted to identify potential etiologies and guide appropriate management.
Keywords
neuropathy, electromyography, musician, ulnar