Zeitschriftenartikel zum Thema „Proprioceptive joint care“

Introduction: Proprioception is the body’s ability to perceive its position and movement in space, crucial for maintaining balance and coordination, especially in older adults. As individuals age, both peripheral and central mechanisms of proprioception decline. Peripheral contributions include sensory mechanisms in muscle spindles and cutaneous mechanoreceptors, vital for joint position sense. This decline can lead to balance disturbances and increased fall risk. Central contributions involve neuroanatomical changes, neurochemical alterations, and cognitive factors such as decreased memory, obstructing effective proprioceptive integration. Methods: The search utilised key databases such as PubMed, PubMed Central (PMC) BioMed Central (BMC) along with various grey literature sources, to gather a comprehensive range of information. Clinical implications: Impaired proprioception can decrease postural control and balance, increasing fall risk and associated chronic pain conditions. Interventions: Evidence highlights the effectiveness of technological advancements, personalised physical activity programmes, and proprioceptive training strategies. Collaborative efforts among healthcare professionals are vital for creating comprehensive care plans. Conclusion: Age-related proprioceptive decline significantly impacts balance and functional independence in older adults. Effective interventions to preserve proprioceptive function and reduce fall risk are crucial. A multifaceted approach that includes targeted training and interdisciplinary collaboration can enhance outcomes and support a more active life for older individuals. Future research should address literature gaps through longitudinal studies and randomised controlled trials to evaluate intervention effectiveness and advancements in technologies like virtual reality. A holistic approach involving interdisciplinary collaboration among healthcare professionals is essential. Keywords: Proprioception, ageing, balance, risk of falls, proprioception interventions

Background/AimAnkle sprains are frequent musculoskeletal injuries that can lead to sensorimotor deficits provoking long-term instability at the ankle joint. A broad variety of clinical tests currently exist to assess sensorimotor processing, and are commonly clinically referred to as proprioceptive tests. However, there is a discrepancy in the use of the term proprioception when looking at the main outcome of these tests. As identifying specific deficits is important for motor recovery, it is critical for clinicians to select the most appropriate tests.MethodsA systematic review of four databases was performed to provide an up-to-date review of the psychometric properties of available tests referred to as proprioceptive tests. Seventy-nine articles on eight ankle proprioceptive tests were included and critically appraised. Data on validity, reliability and responsiveness were extracted from the included articles and synthesised. The tests reviewed were then divided into two categories based on their main outcome: motor control or somatosensation.ResultsStrong evidence showed that the Star Excursion Balance Test, a motor control test, is capable of differentiating between stable and unstable ankles. Moderate evidence suggests that somatosensation tests, such as Joint Position Sense, are also valid and reliable, but their responsiveness has yet to be evaluated.ConclusionsTogether, these findings indicate that the Star Excursion Balance Test can be used in the clinic to assess motor control based on its excellent psychometric properties. However, as ankle stability control involves complex sensorimotor interactions, care has to be taken regarding the use of this test as a specific tool for proprioception assessment.

Background Diabetic polyneuropathy (DPN) is a notable microvascular complication of DM, affecting 16%-66% globally. DPN often leads to proprioceptive deficits in the lower limbs (LL), leading to impaired functional performance. However, evidence supporting proprioceptive rehabilitation programs (PRP) for DPN remains scarce. Aims This pilot study aims to evaluate the effectiveness of a novel 12-week PRP on LL static and dynamic proprioception and shed light on the potential benefits of PRP for DPN population. Methods Randomized Controlled Trail was conducted among 30 DPN patients (age 53.25±7.72 years, BMI 24.01±1.41 and DM duration 9.48±6.45 years), randomly allocated to intervention (n = 15) or control (n = 15) groups. The intervention group received PRP 3 times/week for 12 weeks. The control group received no exercise. Both groups received regular diabetic care. Static and dynamic proprioception of both LL were assessed at baseline, 6 weeks and 12 weeks. Position-reposition test was used to assess ankle joint position sense by obtaining difference between target and reproduced angles. Error in detecting knee angle and speed were obtained by performing Lower Limb Matching and Sense of Movement tests respectively to assess dynamic proprioception. Results Two-way ANOVA and paired comparisons revealed, no significant improvement in proprioceptive deficits at 6 weeks (p>0.05), but significant improvement was achieved at 12-weeks (p<0.05) in the intervention group. Mean errors in Pposition re-position(R:p<0.001, L;p<0.001) and Lower limb matching (R:p<0.001, L;p<0.001) tests reduced by 5° and 10° respectively, indicating a70% improvement in the intervention group. Error of detecting speed reduced only on right side by 0.041ms-1 accounting for a 42% improvement. No improvements were observed in the control group. Conclusions Novel 12-week PRP may yield a significant reduction in LL proprioceptive deficits among DPN patients. Future RCTs with larger samples should compare the effectiveness of this PRP compared with conventional rehabilitation programs.

Introduction. Adolescent idiopathic scoliosis (AIS), described as a complex three-dimensional spinal deformity, is thought to affect neurophysiological processes that result in a loss of proprioceptive input. The main purpose of this case study is to investigate the effect of Proprioceptive Neuromuscular Facilitation (PNF) on spine joint reposition (JR) sense in a 20-year-old with AIS. Methods/ Case Description. The subject was a 20-year-old college student with moderate dextrothoracic and levolumbar scoliosis. She has structural scoliosis-related impaired posture, as evidenced by findings of impaired JR sensation in all directions, postural deviations, and patient-reported deformity perception using the Walter Reed Visual Assessment Scale. She was seen 4 times a week for 3 weeks. Results: The most recent radiographs analyzed by a radiologist revealed that the curvature of the thoracic spine had decreased from 38° to 32° and the curvature of the lumbar spine had decreased from 26° to 24°. There were also improvements noted in JR sensation, postural deviation, and deformity perception. Discussion: Incorporation of PNF in the patient’s plan of care may have positively contributed to improvement in JR sense of the spine, postural symmetry, and deformity perception. Future studies should examine the other components of proprioception, the effect of PNF in subjects with greater or more severe curvature, and information on joint position perception in healthy subjects.

Parkinson's disease (PD) is a progressive neurological disease characterized by muscle stiffness, tremor, slowness of movement, and difficulties with posture and walking. Muscle and joint pain are frequent non-motor symptoms of PD. Pain associated with PD is mainly caused by a combination of truncal dystonia, stooped posture, and muscle rigidity. However, PD deformities were rarely discussed in the literature. A 68-year-old Asian female with PD treated with Levodopa for six years complained of progressive neck pain, contractures, and subluxation of both hands in the last two years. A positron emission tomography (PET) scan revealed decreased rostrocaudal gradient uptake in both posterior putamen. After 9 months of multimodal chiropractic rehabilitation, the patient had significant improvement in symptoms, including pain resolution as per the numeric rating scale and physical and mental improvement as per the PD questionnaire. Radiographic measurement showed significantly improved postural alignment and stability. Measurement of joint motion and angles showed an improvement in hand deformity. Although PD is a neurodegenerative disease that is not curable, multimodal rehabilitation may improve neurological and musculoskeletal functions by inducing proprioceptive balance, motor strength, and joint movement. The current study may illustrate multimodal rehabilitation addressing orthopedic deformity associated with symptoms in a PD patient.

Introduction. In psoriasis, plaque psoriasis is the most common kind. Patients may experience mild to severe symptoms, and while the sickness is not lethal, it is difficult to cure. Aim. The purpose of this study is to evaluate the efficacy of bee venom phonophoresis in treating mild to moderate plaque psoriasis of the knee. Materials and methods. Group A received bee venom phonophoresis in conjunction with conservative care, group B received bee venom topical application in conjunction with conservative care, and group C served as a control in a double-blind randomized controlled experiment including 96 patients with plaque psoriasis. Over the course of three months, every patient underwent a thorough evaluation that included blood tests to measure systemic inflammation (Neutrophil to lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate), as well as PASI (Psoriasis Area and Severity Index) and Isokinetic knee proprioceptive. Results and disscusion. No statistically significant difference was found between the three groups at baseline measurement; however, a treatment effect was observed after 12 weeks of treatment (p = 0.001 and f-value = 50.718). In addition, both groups (A and B) showed a statistically significant interaction between pre- and post-treatment treatment and time; however, this interaction was much more pronounced and noticeable in group A. Conclusion. Phonophoresis with bee venom improves proprioception in the knee joint and decreases N/L ratio, CRP, ESR, and PASI. Registration: Clinicaltrials.gov identifier No. NCT06106230; registered 20.10.2023.

IntroductionPatients with generalised joint hypermobility, including knee hypermobility (GJHk), often experience knee pain and are typically managed with low-intensity strength training and/or proprioceptive training as part of standard care. However, not all patients experience satisfactory outcomes. High-load strength training may offer additional benefits, such as increased muscle cross-sectional area, neural drive and tendon stiffness, which may reduce pain and improve active knee joint stability during movement tasks and daily activities. So far, no randomised controlled trials (RCTs) have compared high-load strength training with traditional treatment strategies (standard care) for this patient group.Methods and analysisIn this RCT, we aim to recruit patients with GJHk and knee pain from primary care physiotherapy clinics in the Region of Southern Denmark and via social media. Patients with competing injuries or experience with high-load strength training will be excluded. Patients will be randomised (1:1 ratio) to either 2 weekly sessions of high-load strength training or standard care for 12 weeks. The primary outcome is self-reported knee pain during an activity nominated by the patient as the most aggravating for their present knee pain measured using the Visual Analogue Scale for Nominated Activity (VASNA, 0–100; 0=no pain and 100=worst imaginable pain). This will be collected at baseline, 6 weeks, 12 weeks and 12 months. Secondary outcomes include self-reported knee function and adverse events (collected at baseline, 12 weeks and 12 months), objective measurements including a 5-repetition maximum single-leg press, proprioception and single-leg-hop for distance (collected at baseline and 12 weeks), and a range of other outcome measures such as fear of movement, tendon stiffness and global perceived effect. We aim to recruit 90 patients in total to detect a 10 mm group difference in the primary outcome with 80% power.Ethics and disseminationThis study was funded by Independent Research Fund Denmark (grant number 2034-00088B) on 14 June 2022; the Regional Committees on Health Research Ethics for Southern Denmark approved it (S-20230050) on 30 August 2023. The first recruitment site opened on 15 February 2024, and the final results will be submitted to a peer-reviewed journal to inform rehabilitation strategies for symptomatic GJHk.Protocol version 1, dated 4 July 2024.Trial registration numberNCT06277401.

Background Sensorimotor and specifically proprioception sense has been used in rehabilitation to treat neurological and joint injuries. These feedback loops are not well understood or implemented in wrist treatment. We observed a temporary sensorimotor loss, following distal radius fractures (DRF) that should be addressed postsurgery. Purpose The purpose of this prospective therapeutic study was to compare the outcomes of patients following surgery for DRF treated using a sensorimotor treatment protocol with those patients treated according to the postoperative standard of care. Patients and Methods Patients following surgery for DRF sent for hand therapy were eligible for the study. Both the evaluation and treatment protocols included a comprehensive sensorimotor panel. Patients were randomized into standard and standard plus sensorimotor postoperative therapy and were evaluated a few days following surgery, at 6 weeks, and 3 months postsurgery. Results Sixty patients following surgery were randomized into the two treatment regimens. The initial evaluation was similar for both groups and both demonstrated significant sensorimotor deficits, following surgery for DRF. There was documented sensorimotor and functional improvement in both groups with treatment. The clinical results were better in the group treated with the sensorimotor-proprioception protocol mostly in the wrist; however, not all of the differences were significant. Conclusion Patients after surgery for DRF demonstrate significant sensorimotor deficits which may improve faster when utilizing a comprehensive sensorimotor treatment protocol. However, we did not demonstrate efficacy of the protocol in treating proprioceptive deficits. Further study should include refinement of functional outcome evaluation, studying of the treatment protocol, and establishment of sensorimotor therapeutic guidelines for other conditions. Level of Evidence This is a level II, therapeutic study.

Abstract Thumb carpometacarpal joint osteoarthritis (CMC OA) is a common condition characterized by chronic progressive degeneration of the joint cartilage. Patients present with complaints of pain at the base of the thumb, morning stiffness, and muscle weakness, all of which impair hand function and thus interfere with activities and social participation. Grip and lateral pinch movements are most affected and have a direct impact on independence, self-care, and leisure activities. This review’s objective is to find physical therapy techniques for patients with thumb CMC OA’ and their effect on pain, function, grip strength, and quality of life. Databases searched were Google Scholar, PubMed, and ScienceDirect with keywords CMC arthritis, OA, function, and physiotherapy. Articles published in the last 5 years, in the English language, randomized controlled trials, controlled trials, prospective studies, or systemic reviews were included. Duplicate and nonrelevant articles, case reports, and noncontrolled trials were excluded. Thirteen articles were found of which five articles were included. Prefabricated CMC-metacarpophalangeal immobilization splint, proprioceptive exercises, and ischemic compression over myofascial trigger points in the first dorsal interossei, first dorsal interossei strengthening, and a self-management program called OA thumb-based therapy trial has shown an effect on pain, pinch strength, grip strength, and quality of life. Additional treatments can be used along with conservative treatment for better results in reducing pain, improving grip strength, function, and quality of life in patients with CMC joint arthritis. Utilizing these methods can enhance clinical practice interventions in the management of thumb CMC joint arthritis.

The brain damage caused by a stroke can lead to severe and long-lasting physical and mental health problems, which can have a significant impact on human quality of life. Although restoring gait parameters in stroke patients is one of the most important rehabilitation goals, currently around 80% of stroke survivors have some degree of upper limb motor impairment. Several authors have shown that restoration of upper limb function is often more difficult to achieve and requires a longer rehabilitation period. Proprioceptive neuromuscular facilitation (PNF) is thought to be one of the most common neurophysiological techniques used by physiotherapists in post-stroke rehabilitation. The aim is to evaluate the effectiveness of proprioceptive neuromuscular facilitation (PNF) in improving upper limb function in patients after stroke through a systematic literature review. The research inquiry was performed by searching through various online databases until February 2023. Following the PRISMA 2020 guidelines, studies were selected using the PICO model and its elements, and based on the inclusion and exclusion criteria. The quality of the selected studies was assessed using the PEDro scale. The review examined five studies on PNF effects in 210 stroke patients, all scoring six or more on the high-quality PEDro scale. Patients were, on average, 52 to 63 years old. Four of the five studies, using the Arm Motor Ability Test and Fugl-Meyer assessment, showed statistically significant improvements in upper limb motor ability and function post-PNF intervention. One study assessing self-care functional ability revealed significant improvements in the Barthel index for both experimental and control groups. Spasticity assessment with the Ashford scale in one study indicated a statistically significant reduction in upper limb spasticity in both groups. Yeole et al. found significant improvements in active range of motion using a manual goniometer in shoulder and elbow joints and wrist joint flexion, extension, and radial deviation for PNF-applied participants.

Introduction: Chronic ankle instability (CAI) is described as the patient’s sense of an abnormal ankle, which is characterized by a combination of symptoms such as recurrent sprains, discomfort, edema, or activity avoidance. Talocrural thrust manipulation (TCTM) is a manual treatment technique that includes applying a manual push to a specific motion segment, often in the form of a joint glide. The study aimed to find out the dosimetry and effect of TCTM on the range of motion (ROM) and quality of life (QoL) in subjects with CAI. Materials and Methods: Forty subjects fulfilling the selection criteria were included in the study, with single group repeated measures design. A talocrural thrust is given to the ankle and outcomes were assessed during 1st week, 2nd week, and 3rd week after the intervention, and the scores were recorded. Results: The group was ranging from 13 to 22, with a mean and standard deviation (SD) of 16.15 ± 2.28. After 1 week, showed an increase in the range of 17–29, with a mean and SD of 22.40 ± 2.75. Similarly, for 2 weeks, the range increased to 24–32 with a mean and SD of 29.53 ± 1.71 after 2 weeks. However, the range was found to have increased to 31–34, with a mean and SD of 32.35 ± 0.70, and found to be statistically significant (P < 0.001). Conclusion: TCTM is effective in improving ROM and QoL in people who have persistent ankle instability. Talocrural thrust manipulation technique stimulates the proprioceptive awareness which is often impaired in chronic instability subjects targeting the joints with specific thrust to treat pain and dysfunction and the consistency of the movement underlying the tissues which is more crucial in identifying the restrictions of the joint. The following core competencies are addressed in this article: Medical knowledge, Patient care, Systems-based practice

Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: −21.91; 95% confidence interval [CI]: −36.59, −7.24; p = 0.003) and wrist disability (MD: −8.1, 95% CI: −4.6, −11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: −0.76; 95% CI: −1.30, −0.21; p = 0.007) and short-term (SMD: −0.93; 95% CI: −1.86, −0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: −0.94; 95% CI: −1.68, −0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.

Recent advances in wearable sensors and computing have made possible the development of novel sensory augmentation technologies that promise to enhance human motor performance and quality of life in a wide range of applications. We compared the objective utility and subjective user experience for two biologically inspired ways to encode movement-related information into supplemental feedback for the real-time control of goal-directed reaching in healthy, neurologically intact adults. One encoding scheme mimicked visual feedback encoding by converting real-time hand position in a Cartesian frame of reference into supplemental kinesthetic feedback provided by a vibrotactile display attached to the non-moving arm and hand. The other approach mimicked proprioceptive encoding by providing real-time arm joint angle information via the vibrotactile display. We found that both encoding schemes had objective utility in that after a brief training period, both forms of supplemental feedback promoted improved reach accuracy in the absence of concurrent visual feedback over performance levels achieved using proprioception alone. Cartesian encoding promoted greater reductions in target capture errors in the absence of visual feedback (Cartesian: 59% improvement; Joint Angle: 21% improvement). Accuracy gains promoted by both encoding schemes came at a cost in terms of temporal efficiency; target capture times were considerably longer (1.5 s longer) when reaching with supplemental kinesthetic feedback than without. Furthermore, neither encoding scheme yielded movements that were particularly smooth, although movements made with joint angle encoding were smoother than movements with Cartesian encoding. Participant responses on user experience surveys indicate that both encoding schemes were motivating and that both yielded passable user satisfaction scores. However, only Cartesian endpoint encoding was found to have passable usability; participants felt more competent using Cartesian encoding than joint angle encoding. These results are expected to inform future efforts to develop wearable technology to enhance the accuracy and efficiency of goal-directed actions using continuous supplemental kinesthetic feedback.

(1) Background: The anterior cruciate ligament (ACL) is a crucial ligament in the knee joint. This study compares the differences in knee range of motion (ROM), knee proprioception error, balance, function, and quality of life (QOL) among participants with and without meniscus repair or partial meniscectomy nine months post ACL reconstruction. (2) Methods: In this cross-sectional study, 57 male participants were selected through convenience sampling from a tertiary care hospital. Knee flexion and extension ROM were assessed using a digital goniometer; a digital inclinometer was used to assess knee proprioception error; the Y balance test was used to evaluate balance; the lower extremity functional scale (LEFS) was used to assess activity; and QOL was assessed using the ACLQOL questionnaire. (3) Results: There were no significant differences in outcomes except balance. The YB composite score had a moderate negative correlation with knee proprioception error with an R-value of −0.372 **. (4) Conclusions: Nine to 12 months post ACL reconstruction, the isolated ACL reconstruction participants had better lower-quarter single-leg balance than those who underwent ACL reconstruction and meniscal repair or partial meniscectomy. The remaining parameters, like knee ROM, knee proprioception error, LEFS score, and ACLQOL scores, were similar between these two groups.

Background: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including pain, episodes of giving way, compromised proprioception and neuromuscular control, and re-injury leading to chronic ankle instability. The aim of this study was to see the effect of chronic ankle sprain on pain, range of motion, proprioception, and, static and dynamic balance among athletes. Methods: A total of 80 athletes, aged 18 to 25 years, involved in track-and-field sports were invited to participate in this study. They were divided in two groups. Athletes with history of grade 1 or 2 ankle sprain on either side requiring medical care who reported at least three episodes of ankle giving way in past 12 months were included in group A. An equal number of healthy athletes without any history of ankle sprain or injury in the lower limbs in the past one year matched by sex, age, height, weight, and limb dominance, were included in group B (control). Outcome measures: Participant’s pain, range of motion, proprioception and balance (static and dynamic) was measured using visual analog scale, half circle goniometer, degree of foot position sense, single leg stance time and Y-balance test respectively. Results: Although there were no differences in the active ankle joint range of motion (p > 0.05) in comparison to the control group, athletes with chronic ankle sprain reported mild pain and statistically significant (p < 0.05) deficits in foot proprioception, static and dynamic balance. Conclusions: Deficits in foot proprioception, static and dynamic balance even one year after the ankle sprain could be the reason for limitations in the dynamic defense system of the joint that predisposes to recurrent injury and instability. It is essential to understand the normal clinical course and risk factors for athletes who sustain sprain before devising a long term comprehensive rehabilitation program that focuses on mechanical and functional insufficiencies in order to improve their functional performance and prevent the risk of recurrent sprain.

Coordinated landing requires anticipating the timing and magnitude of impact, which in turn requires sensory input. To better understand how cane toads, well known for coordinated landing, prioritize visual versus vestibular feedback during hopping, we recorded forelimb joint angle patterns and electromyographic data from five animals hopping under two conditions that were designed to force animals to land with one forelimb well before the other. In one condition, landing asymmetry was due to mid-air rolling, created by an unstable takeoff surface. In this condition, visual, vestibular and proprioceptive information could be used to predict asymmetric landing. In the other, animals took off normally, but landed asymmetrically because of a sloped landing surface. In this condition, sensory feedback provided conflicting information, and only visual feedback could appropriately predict the asymmetrical landing. During the roll treatment, when all sensory feedback could be used to predict an asymmetrical landing, pre-landing forelimb muscle activity and movement began earlier in the limb that landed first. However, no such asymmetries in forelimb preparation were apparent during hops onto sloped landings when only visual information could be used to predict landing asymmetry. These data suggest that toads prioritize vestibular or proprioceptive information over visual feedback to coordinate landing.

Neuroarthropathy (neuropathic osteoarthropathy), also known as Charcot joint, is a condition characterized by a progressive articular surface destruction in the setting of impaired nociceptive and proprioceptive innervation of the involved joint. It is seen most commonly in the foot and ankle secondary to peripheral neuropathy associated with diabetes mellitus. Cases of hip (Charcot) neuroarthropathy are rare and almost exclusively reported in patients with neurosyphilis (tabes dorsalis). We report a case of a 36-year-old man who presented to the emergency department complaining of right hip pain. On physical examination, pain and thermal sensory deficits were noted in the upper torso with a cape-like distribution, as well as signs of an upper motor neuron lesion in the left upper and lower extremities. A magnetic resonance imaging study (MRI) of the right hip showed evidence of early articular surface destruction and periarticular edema consistent with hip Charcot arthropathy. An MRI of the spine revealed an Arnold-Chiari type I malformation with extensive syringohydromyelia of the cervical and thoracic spine.

Sports injuries are a problem that often occurs in the sports environment, and its rehabilitation research is mostly theoretical or empirical research on a certain therapy, and lacks systematic research. In this study, the literature method and logical analysis method are used to search relevant literature in various databases, and summarize the rehabilitation therapies for sports injuries, the principles, contents and treatment sequence of rehabilitation plans, in order to conduct a systematic analysis of rehabilitation research on sports injuries. It finds that the rehabilitation for sports injuries took physical and mental rehabilitation, including physical rehabilitation and psychological rehabilitation. Rehabilitation programs should be based on principles of avoidance of injury deterioration, timing of treatment, adherence, individualization, specificity assessment, intensity of recovery plans, and overall health; cover muscle strength and endurance, range of motion and flexibility of joints, proprioceptive and neurological function, cardiorespiratory endurance rehabilitation content; follow the sequence of diagnosis, identify treatment goals, primary care, intermediate care, functional rehabilitation, and circulation assessment and maintenance therapy.

Summary. The article presents rehabilitation program for the patients after anterior cruciate ligament reconstruction. The program is used at the Feofaniya Hospital’s Center of Orthopedics, Traumatology and Sports Medicine and at the Department of Sports and Ballet Injuries of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. The rehabilitation course is divided on five periods: 1) preoperative period; 2) early postoperative period (acute) (0–2 weeks); 3) function restoring period (up to 9 week); 4) period of preparing and gradual returning to recreation and sports activity (from 9 week); 5) period of returning to full sports activity (after 6–9 months, depending on the type of sport). Principles of postoperative care and rehabilitation in our clinics are as follows: 1) decreasing pain, swelling, and inflammation; 2) full load of the operated on limb with or without crutches; 3) immediate exercises to restore range of motion from 0° to 60–90°, with gradually increase to 120° and full flexion after 6–9 weeks postoperatively (using continuous passive motion; passive, active assisted, and active exercises); 4) exercises for training quadriceps muscle, shin flexor muscles and all lower limb and pelvis muscles, with increasing resistance in close and open kinetic chains; 5) exercises for training proprioception and coordination (from early postoperative period); 6) return to work after 3–6 weeks, health-improvement and sports activity after 4, 6, and 9 months; 7) close cooperation between a surgeon, a rehabilitologist, and a patient during rehabilitation. We focus on achieving the fastest full extension of the knee joint, muscle control and restoration of proprioception. Exercises are performed in closed and open kinetic chains, with muscles tension in the back of the thigh and shin, in the way to avoid too much stress on transplantate. In cases of athletes and recreational active patients, elements of sports specific exercises were included to the rehabilitation program (from early postoperative period). That helped to restore proper patterns of movements and to overcome physical barrier in returning to full sports activity. Return to sport was allowed patients when achieved full range of motion, normal proprioception and balance of muscles; functional tests results were about 90% of the norm and there was no pain or swelling during exercise loads.

Aim of the study This report aimed to assess the nonpainfull and currative effect of the electropuncture technique complemented by massage and active proprioceptive postural kinetotherapy of causal occlusion-posture imbalances accompanied by acute or chronic pain. This research provide an insight into the report of evidence available for the analgesic, uses of TENS in pathologies of the stomatognathic apparatus that induce postural defects. Malocclusion correction correlated with postural rehabilitation with non-invasive and non-drug methods, without adverse effects, including electropuncture (TENS) applied in conjunction with proprioceptive kinetotherapy techniques, massage and psychotherapy is the path to the success of occlusion-postural rehabilitation with significant results both on painful suffering and on the correction of malocclusions and global postural imbalances. Material and methods The forty-for patients ranged in age from 20 to 50 years, came to the rehabilitation center accusing important pain and functional impotence at various levels: temporo-mandibular, occlusal, postural, sole etc. Patients received clinical consultation, occlusal, postural and plantar evaluation, occluzal, postural and plantar analysis with the posturograph device receiving diagnostics of malocclusion overlapped with postural imbalances like kyphosis, scoliosis, genu varum, genu valgum, flat foot or claw foot and even psychotherapy. Group P1 received only orthodontic dental treatment to correct the occlusion. Group P2 received in addition to orthodontic treatment to correct the occlusion the complete non-invasive postural rehabilitation treatment including transcutaneous electrical neurostimulation (TENS), massage, proprioceptive kinetoterapy and psychotherapy. Results La finalul tratamentului aplicat complet, holistic si tenace, am constat rezultate notabile relevate la Group P2 (who benefited from electroneurostimulation therapy and psychotherapy in addition to kinetotherapy and massage) fata de Group P1 (who only benefit from the stomatologically approach) prin atenuarea semnificativa si chiar eradicarea durerii resimtite la nivelul articulatiei temporo-mandibulare, a zonei cervicale, toracale si lombare, reducerea dezechilibrelor de curbura si posturale ale coloanei vertebrale, corectarea dezechilibrelor de arcurire la nivelul talpilor, dupa caz. In plus, we obtained physiological mobility angles of the temporomandibular joint, muscle relaxation on paravertebral and abdominal hypertonic areas, muscle toning on hypotonic areas, efficient, operational muscle strength, so that the muscles are able to support physiologically correct posture, physiological posture at the umeral, pelvis, knee level as well as plantar flatfoot rehabilitation, patients finally approaching a plantar arch at the limit of physiological values. Conclusions The multidisciplinary collaboration regarding both diagnosis and treatment has an effect and proves its effectiveness in the context of the existence of occlusal and global postural imbalances. The increased incidence and prevalence of global postural imbalances induced by daily static professional, family, recreational activities requires opting for holistic and multidisciplinary integrative treatments.

Background: A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. There are three types of stroke ischemic stroke hemiplegic stroke and transient ischemic stroke. Objective: To determine the association of lower extremity somatosensory deficit in balance and gait in sub-acute stroke patients. Methods: Cross sectional survey was used in this study. The age group of participants was 40 to 75 years. Sample size was 204 calculated from Rao software and non-probability convenient sampling technique was used. Data was collected from Lahore General Hospital. Data was obtained from patient by applying distal proprioception test to assess the joint position sense. For the assessment of two point discrimination bolay gauge was used. The cutaneous vibration sensation was assessed through tuning fork. Soft goat hair brush was used to check the light touch pressure. For balance assessment berg balance scale and time up and go test was used. Gait was observed through Wisconsin gait index. Results: Mean value and standard deviation of age of participants were 62.99and 6.592 respectively. There was association of berg balance scale with two point discrimination test, light touch pressure and distal proprioception. There was no association between berg balance scale and vibration sense. Mean value and standard deviation of Wisconsin gait index was 23 and 4.986 respectively. Association between TUG and two point discrimination was found. There was no association of TUG with vibration sense, distal proprioception test and light touch pressure. Conclusion: This study concluded that balance was affected in sub-acute stroke patients due to the somatosensory deficit. Fall risk increased in the sub-acute stroke patient as the patients performance measured in time up and go test and berg balance scale. It was also inferred that while patients performing Wisconsin gait index scale, gait was affected in sub-acute stroke patients. Keywords: Balance, Gait, Sub-acute Stroke, fall risk, Somatosensory, Lower extremity

Abstract Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.

Background: Proper posture is considered to be a state of musculoskeletal balance that involves a minimal amount of stress or strain to the body. When the head is held forward in relation to the trunk, the alignment is said to be poor and is referred as, ‘forward head posture’ (FHP). If abnormal posture persists for a long time, it compromises balance because of muscular imbalance which can cause loss of proprioception sense in joint and decreased balance, and trunk endurance is significantly reduced in FHP and may lead to poor muscular control of the spine. Purpose: To find the correlation between the core muscle endurance and balance among college student with forward head posture. Methodology: A cross-sectional observational study was conducted in a tertiary care hospital. 25 healthy college student individuals within the age group of 18-30 years having forward head posture were taken. FHP was assessed by craniovertebral angle. Trunk endurance was measured by McGill core endurance test and static balance was assessed by standing stork test. Results: Karl Pearson’s correlation coefficient test was used to find the correlation between Trunk muscle endurance and static balance. Strong positive correlation was found which was statistically significant between trunk flexor endurance, trunk extensor endurance, right lateral endurance, left lateral endurance, and static balance. Conclusion: Among college students with FHP decreased core endurance can affect the static balance. Keywords: forward head posture, core endurance, static balance.

Knee ligament injuries are common in sports players, military training, and high-demand professionals. In young, active patients, anterior cruciate ligament (ACL) restoration is usually recommended for regaining anterior-posterior and rotatory knee stability [1]. Due to the high incidence of ACL injury, it is important to design a rehabilitation program that targets a return to high-impact activities. The rehabilitation differs as per the graft used as well as the guidelines given by the arthroscopic surgeon; the functional demands of the patient should be considered while designing the rehabilitation program [2]. Rehabilitation holds an integral component of a complete recovery after ACL reconstruction (ACLR). Research shows that a standard prehabilitation following isolated ACL rupture holds importance in gaining the post-operative quadriceps and hamstring strength thereby, improving knee function as compared to those who do not receive prehabilitation [3]. Prehabilitation not only includes physiotherapy but also a multidisciplinary approach consisting of patient counseling by a psychologist and a nutritional advice [4]. The timing of surgical intervention of ACL also significantly affects the potential outcomes which substantially improve functional outcomes [5]. It is important to note the changing trend in rehabilitation based on criteria rather than duration which helps incorporate recent advancements [6]. To design a suitable treatment plan, the rehabilitation specialist must use their clinical assessment skills to plan evidence-based therapeutic approach. This rehabilitation protocol spans over a 6-month period and is divided into 7 timelines. Each timeline has goals and exercise suggestions for several domains: Range of motion (ROM) and flexibility, strength and endurance, proprioception, gait, and cardiovascular fitness. For healthy, active patients, full recovery from ligament surgeries typically takes 6–9 months. ACL rehabilitation may not require daily or weekly monitoring, but participation in physical therapy for education, evaluation, function monitoring, and treatment plan and its progression is essential to a successful and safe rehabilitation program. Through a five-phase rehabilitation program, the knee and lower extremities gradually experience an increase in the joint stress [7]. A long-term rehabilitation provides good joint stability and a return to pre-injury activity levels. Rehabilitation focuses on return to activities of daily living and sporting activity. When an athlete is cleared following physical therapy and returns to sports specific training despite of injury related deficits, the gap appears in rehabilitation. Thus, returning back to unrestricted play should be a gradual transition focusing on functional impairments. The prime focus of strength training should be proper movement patterns, strength endurance and postural stability [8]. The focus of the rehabilitation protocol mentioned below is from “acute care” to “return to sports.” Phase I: Acute Phase (0–2 Weeks) Goals The goals of rehabilitation in the acute phase are as follows: Patient education about the importance of long-term rehabilitation ACLR Graft protection to prevent graft rupture Prevent post-operative complications such as deep vein thrombosis, iatrogenic nerve injury, and septic arthritis [9] Minimize pain and swelling Prevent extension lag at the knee and tightness of lower extremity muscles Improve knee ROM: 0–90° Prevent arthrogenic muscle inhibition and stimulate adequate quadriceps contraction Protective weight-bearing with a long knee brace and a walking aid. Exercises The following therapeutic exercises are recommended in the acute phase: Ankle pumps, elevation, and compression for swelling reduction Patellofemoral mobilization and tibiofemoral mobilization Static quadriceps sets for muscle activation Passive knee ROM (0–90°) Core stabilization and strengthening exercises with a primary focus on transversus abdominis activation and its progression Supine heel slides, wall slides, and hip mobility exercises like straight leg raises (SLR) in all planes Vastus medialis obliqus (VMO) activation to maintain terminal knee extension (fig 1) Supine gastrocnemius and soleus stretch to maintain muscle flexibility, iliopsoas stretch using unoperated leg knee flexion (Thomas position) – (fig 2) Prone hangs, if extension lag is present to promote end-range extension Soft tissue mobilization to quadriceps, hamstrings, and calf Hip strengthening: static gluteal sets to activate hip extensors, short hip flexor (iliopsoas) activation Upper extremity strengthening using weight cuffs, dumbbells, or therabands Sit-to-stand transfer training to start the protected weight-bearing activity. Rehabilitative devices Cryotherapy for 15–20 min for swelling and pain reduction Neuromuscular electrical stimulation for adequate muscle contraction (fig 3) Continuous passive movement for the knee joint (0–70°). Criteria for progression Minimal pain and swelling Absence of extension lag at the knee Knee ROM ≥90° Absence of antalgic gait SLR without extension lag. Phase II: Sub-Acute Phase (3–6 Weeks) Goals The goals of rehabilitation in the sub-acute phase are as follows: 1. Continue graft protection 2. Improve neuromuscular control of the knee joint 3. Maintain knee ROM (0–110°) and improve muscle flexibility 4. Improve quadriceps and hamstring strength 5. Improve joint stability and knee proprioception 6. Bracing of the knee using a hinged knee brace 7. Initiate closed-chain and open-chain exercises to increase gradual joint loading 8. Progress with full weight-bearing gait training with or without walking aid; encourage heel-to-toe gait. Exercises The following therapeutic exercises are recommended in the sub-acute phase: 1. Continue acute-stage exercises 2. Active-assisted prone hamstring curls and standing hamstring curls after 4 weeks of rehabilitation to activate the knee flexors 3. Initiate gentle hamstring stretch to maintain its flexibility, posterior capsule stretch, and prone quadriceps stretch, Thomas stretch for iliopsoas, and iliotibial (IT) band stretch 4. Active VMO activation 5. Muscle energy technique to increase ROM 6. Retrograde-walking to strengthen hip and knee extensors 7. Static cycling without resistance for improving muscle endurance 8. Initiate step-up, step-down, and lateral step-up exercises (2–4 inch step) to increase joint stress 9. Supine bridging to stabilize and strengthen core and hip extensor muscles 10. Hip clamshell exercise to activate gluteus medius and minimus (fig 4) 11. Hip abductor strengthening 12. Progression of transversus abdominis activation and core strengthening exercises 13. Multiple angle isometrics to quadriceps in sitting 14. Mini wall squats (0–45°) to strengthen quadriceps (fig 5) 15. Heel raises with support for gastrocnemius and soleus strengthening 16. Toes raises with support for ankle and foot dorsiflexor muscle strengthening 17. Balance training with a bilateral stance on an even surface. Rehabilitative devices 1. Biofeedback/electrical stimulation to stimulate functional muscle activity 2. Aquatic therapy uses buoyancy of water to strengthen the muscles and aid in recovery [10] 3. Dry needling can be used to relieve myofascial pain syndrome post-surgery to reduce pain and muscle spasms [11] 4. Cupping therapy helps to relax the muscles by decreasing muscle tension [12] 5. Matrix rhythm therapy produces oscillations that help to regain normal cellular frequency. Criteria for progression 1. No pain and swelling at the knee joint; no signs of active inflammation 2. Knee ROM ≥110° 3. Quadriceps strength >50% of the uninvolved side 4. Normal gait pattern 5. Presence of normal patella mobility 6. Full weight-bearing without a walking aid. Phase III: Chronic Phase (6–9 Weeks) Goals The goals of rehabilitation in the chronic phase are as follows: 1. Maintain and improve muscle flexibility 2. Improve motor control and knee joint stability 3. Maintain knee ROM (0–125°) 4. Improve core and lower limb muscle strength 5. Improve proprioception and balance 6. Full weight-bearing without walking aid (may or may not use hinged knee brace). Exercises The following therapeutic exercises are recommended in the chronic phase: 1. Continue phase 1 and phase 2 exercises 2. Initiate forward and lateral lunges for core stability and lower limb strengthening 3. Standing quadriceps stretch, IT band stretch/foam roller (fig 6) 4. Supine unilateral bridging 5. Wall squats (0–90o) to strengthen knee extensors. Maintain knee stability during wall squats to avoid unwanted joint loading 6. Step-up exercises (up to 8 inch)- (fig 7) 7. Obstacle walking for gait training 8. Static cycling with resistance for strength endurance training 9. Muscle energy technique to increase ROM 10. Seated leg extension (90°–45°) with weights or therabands for quadriceps strength (fig 8) 11. Leg presses focusing on knee extensor strengthening (45°–0) 12. Recumbent bicycling with mild resistance for knee extensors 13. Core strengthening 14. Balance training on an unstable surface; progress to single-leg balance training and balance with perturbations. Rehabilitative devices 1. Blood flow restriction (BFR) training for muscle strengthening and hypertrophy 2. Aquatic therapy to accelerate the recovery process. Criteria for progression 1. Absence of pain 2. Knee ROM: 120–130° 3. Quadriceps and Hamstring strength >70% of the uninvolved side 4. Able to jog or run 5. No compensation during a squat 6. Hop test >80% as compared to the uninvolved side 7. Unilateral stance for 20–30 s without support 8. Ascent and descent of stairs without pain and compensation. Phase IV: Return to Activities of Daily Living (9–12 Weeks) Goals The goals of rehabilitation in this phase are as follows: 1. Maintain knee proprioception and neuromuscular control 2. Maintain knee ROM (0–135°) 3. Improve lower limb muscle strength and endurance 4. Improve balance and coordination 5. Improve aerobic fitness 6. Initiate skill-specific training 7. Full weight-bearing (with or without neoprene sleeve). Exercises The following therapeutic exercises are recommended in this phase: 1. Warm up with 10 min of cycling to improve aerobic fitness and muscle endurance 2. Balance and proprioception training on an unstable surface (fig 9) 3. Step-ups and lateral step-ups (up to 12 inches) 4. Plyometric training for improving physical performance using variations in speed and forces with changing movements 5. Retrograde walking on a treadmill for balance and hip extensor training 6. Leg press (90°–0) with resistance for strengthening of lower limb muscles 7. Body weight squats for improving mobility and strengthening of lower limb 8. Single leg squat for balance training and strengthening 9. Closed chain core strengthening exercises 10. Agility drills for skill-specific training to improve functional activities 11. Warm up with 10–20 min of cycling or running 12. Single-leg balance on an unstable surface 13. Step-ups and lateral step-ups (up to 18–20 inches) with weight cuffs 14. Sports-specific cardiovascular training for aerobic fitness 15. Body weight squats 16. Deadlifts for hip mobility, front squats, and overhead squats for lower limb strengthening with upper limb stability. Rehabilitative devices 1. BFR training can be used to increase muscle girth and cause hypertrophy. Criteria for progression 1. No pain 2. Full ROM at the knee 3. Hop test >90% as compared to the uninvolved side 4. Quadriceps strength ≥90% of the uninvolved side 5. Able to run comfortably. Phase V: Return to Sports (12 Weeks–6 Months) Goals The goals of rehabilitation in this phase are as follows: 1. Maintain full ROM at the knee joint 2. Increase aerobic fitness 3. Achieve maximum muscle strength and endurance 4. Improve sports-specific explosive strength and power 5. Improve multidirectional balance and proprioception 6. Sports-specific and skill training 7. Achieve sports-specific fatigue to improve strength and endurance 8. Maintain full ROM at the knee joint 9. Increase aerobic fitness 10. Achieve maximum muscle strength and endurance 11. Improve sports-specific explosive strength and power 12. Improve multidirectional balance and proprioception 13. Sports-specific and skill training 14. Achieve sports-specific fatigue to improve strength and endurance 15. Sports psychology and nutritional counseling for multidisciplinary approach 16. Sports-specific strengthening of entire body. Exercises The following therapeutic exercises are recommended in this phase: 1. Warm up with 10–20 min of cycling or running 2. Single-leg balance on an unstable surface 3. Plyometric training for performance enhancement 4. Step-ups and lateral step-ups (up to 18–20 inches). Progress with weights and stepping exercises 5. Sports-specific cardiovascular training for maintaining optimal oxygen uptake 6. Reduce ground contact time and improve force production required for particular sports 7. Box jumps with a progressive increase in box heights, bounding, sprinting, hopping, and jumping with a soft landing 8. Agility drills for skill-specific training to enhance functional activities and increase lower limb endurance 9. Sports-specific strengthening. Conclusion: It is important to note that rehabilitation may vary depending on the surgeon’s advice, the graft used for reconstruction, prehabilitation status, and patient compliance. All these factors should be considered while designing a tailored protocol for an individual. The overall rehabilitation outcome is gaining functional independence without any deficits in the knee joint. A collaborative approach is necessary to bridge the gap between different disciplines of the health profession. Clinical Message: In order to ensure the patients long term knee health and functional recovery, a properly planned rehabilitation program after ACL reconstruction is essential. The emphasis should be on a collaborative approach wherein the arthroscopic surgeon and the physiotherapist can showcase teamwork to ensure holistic care.

In support of NASA’s plan to establish human settlements on the Moon and Mars in the near future and the emergence of cutting-edge artificial intelligence as a tool for better health care, we look for ways to help astronauts stay physically and mentally healthy during a long and stressful trip. After reviewing existing aerobic and strength exercise methods available to astronauts, we propose that traditional Tai Chi Chuan (TCC) or Taijiquan can serve as a non-invasive intervention to help astronauts maintain physical and physiological integrity and cope with the impact of microgravity during and after spaceflights. Biomechanical aspects of TCC in terms of neuromuscular and musculoskeletal conditions are presented based on a review of evidence from the scientific literature that defines physiological responses associated specifically with the practice of TCC as relevant to space mission-related effects of microgravity on human physiology. This article provides a comprehensive review and description of the TCC biomechanics and their health influences in microgravity. The mysterious Chi (or Qi) of TCC is scientifically defined as kinesthetic sensations of position, movement, and force of muscles, tendons, and joints throughout body segments in kinetic chain motions. These sensations can be used to judge the correctness of TCC trainings as a countermeasure against microgravity to improve proprioception, kinesthesia, and mind-body coordination for astronauts. This study has far-reaching implications for the integration of TCC practices in complement with the effectiveness of existing countermeasure approaches, and provides direction for future research that might bridge the knowledge gap in improving exercise countermeasures for human spaceflight.

BackgroundTotal knee arthroplasty (TKA) is used to treat patients with end-stage osteoarthritis who experience pain and struggle to perform activities of daily living owing to having degenerative knee joints. Although TKA can improve the quality of life of patients, some may experience a decrease in their proprioception and the ability to balance after surgery (1). Decreased balance ability makes it difficult to undertake daily life activities in patients after TKA, impairs walking capacity and increases the risk of falling (2). Almost all studies which investigate the risk of falling conclude that physical activity(PA) are effective methods in order to maintain an intact balance control and prevent falls(4). Today, however, measures aimed at controlling COVID-19 include quarantines that lead to PA restrictions (5). In these days when PA cannot be increased due to quarantines, the most effective way to prevent falls in TKA patients may be to apply balance exercises (3). The “gold standard” in clinical trials are randomized controlled trials(RCTs) in which healthcare professionals make decisions about the safety and efficacy of treatments. However, poorly designed and reported RCTs can give misleading results. Methodological quality (MQ) assessment of clinical trials is important because it can prevent erroneous results in clinical practice and improve the quality of medical care. (6) Although RCTs provide the highest quality clinical evidence selection of balance exercises(BE) to be applied, there is no study in the literature investigating the MQ of RCTs of BE in TKA patients.ObjectivesThe aim was to investigate assess the reporting MQ of RCTs of BE in patients with TKA.MethodsWe analyzed 17 published full-text reports of RCTs using BE in patients who underwent TKA. RCTs were sourced from PubMed, the Cochrane Reviews and PEDro Database. The PEDro scale and the 9-item CONSORT (7) were used to evaluate the MQ of the studies.ResultsThe mean PEDro score was 6,64 ± 1,57. Classification of RCTs according to total PEDro score revealed that 1 study was classified as excellent, 13 studies as good, and 3 as fair. The least fulfilled criteria in the PEDro scale were: Blinding of all therapists who administered the therapy (1[5.88%]), allocation was concealed (5[29.4%]) and blinding of all subjects (7[41.17%]). The adherence of the reports to CONSORT items ranged from 41.17 % to 100%. The most underreported CONSORT items were: funding sources (7[41.17%]), statistical adjustment for multiple primary outcomes (8[47.05%]), and number of primary outcomes (8[47.05%]).ConclusionOur findings show that the quality of reporting for RCTs of BE in TKA patients is not high quality. Since it is not possible to improve balance with PA today, when there are quarantine due to COVID-19, patients should be encouraged to participate in BE programs with telerehabilitation, home-based or web-based exercises, and high quality RCTs should be planned in these programs.References[1]Lee, H. G., et al International journal of environmental research and public health, 2021;18(5), 2513.[2]Matsumoto H, et al. Arch Orthop Trauma Surg. 2012;132(4):555–63.[3]Doma K, et al. Sports Med. 2018 Oct;48(10):2367-2385.[4]Thomas, E., et al. Medicine, 2019;98(27), e16218.[5]Füzéki, E., et al. Journal of occupational medicine and toxicology (London, England), 2020;15, 25.[6]McCormick F, et al. J Shoulder Elbow Surg. 2013 Sep;22(9):1180-5[7]Gonzalez GZ, et al. Arch Phys Med Rehabil. 2018 Jan;99(1):129-136.Disclosure of InterestsNone declared

The purpose of the study was to evaluate the effectiveness of the developed physical therapy program based on the dynamics of indicators characterizing the psychosomatic status of women with an endoprosthetic hip joint who underwent cesarean section. The control group consisted of 19 women without endoprostheses of the joints of the lower limbs. The main group consisted of 9 women 1 month after childbirth, which took place by caesarean section. The developed program of physical therapy lasted 1 month. Therapeutic exercises were applied; functional training, proprioceptive neuromuscular facilitation; massage of lower limbs, back. Movement limitations associated with an incompletely formed scar after cesarean section and the presence of an endoprosthesis were taken into account; accordingly, safe strategies for movements related to child care were created. Indicators of physical (hand and standing dynamometry, PWC170) and psychoemotional (Edinburgh Postnatal Depression Scale) status were determined. During the initial examination, deterioration of the psychosomatic status was found in women with an endoprosthetic hip joint – muscle weakness (according to dynamometry), low physical capacity (according to PWC170), psycho-emotional depression (according to the Edinburgh Postnatal Depression Scale). During re-examination, the condition of women characterized the dynamics of physiological recovery after abdominal delivery and the effectiveness of the physical therapy program in women of the main group. The improvement in static dynamometry and static strength index in the control group was 14.7% and 9.9%, respectively, in the main group – 27.2% and 21.7%. According to the results of PWC170, the physical performance of women in the control group improved by 13.4 %, and in the main group by 41.5%. In the control group, the improvement of psychoemotional status according to the Edinburgh Postnatal Depression Scale in the control group was 32.9 %, in the main group – 38.8 %. Based on the results of the study, it was concluded that it is advisable to prescribe physical therapy in the complex recovery of women with an endoprosthetic hip joint who underwent cesarean section, to reduce muscle weakness, increase work capacity, and improve psycho-emotional status. Keywords: rehabilitation, abdominal delivery, lower extremity joint endoprosthesis.

Introduction: Ehlers–Danlos Syndrome (EDS) is a hereditary and heterogeneous syndrome that affects conjunctive tissue, due to collagen production compromise. Hypermobile EDS (hEDS) is the most common subtype of this syndrome and can cause shoulder joint instability, which can lead to chronic pain and significant functional impairment. Methods: A case report of a patient with hEDS followed in our local health unit was made. The authors describe their clinical insight regarding the case, as well as the rehabilitation program the patient was submitted to. Results: Female patient, 32 years old. Functionally autonomous in every daily living activity. Clinically diagnosed with hEDS in 2013, after reporting bilateral shoulder instability. The patient presented herself in a Physical and Rehabilitation Medicine consultation, 6 months after being submitted to the third surgical intervention of the right shoulder. She presented an overall limited range of motion, decreased muscle strength and positive apprehension and drawer tests. An extensive rehabilitation program was prescribed, focusing on joint mobilization, dynamic stabilizers strengthening and proprioceptive training. After 12 weeks, the patient presented reduced shoulder pain and a better functional status. Conclusion: hEDS compromises the integrity of the static and dynamic stabilizers of the shoulder. Clinical management of these cases involves a multidisciplinary approach with early and adequate rehabilitation care treatments.

The purpose of the study was to evaluate the effectiveness of the developed physical therapy program based on the dynamics of indicators characterizing the limitation of life activities due to lumbopelvic pain in women with an endoprosthetic hip joint who underwent cesarean section. 9 women aged (28,5±1,6) years were examined 1 month after childbirth, which took place by caesarean section. The developed program of physical therapy lasted 1 month. Therapeutic exercises were applied; functional training, proprioceptive neuromuscular facilitation; massage of lower limbs, back. Movement limitations associated with an incompletely formed scar after cesarean section and the presence of an endoprosthesis were taken into account; safe strategies of movements related to child care were created. Determined The degree of restriction of vital activity according to the Oswestry Disability Index, Pelvic Girdle Questionnaire, Pregnancy Mobility Index was determined. During the initial examination, women were found to have a deterioration in their daily life activities and activities according to all the investigated indicators. During the re-examination, the improvement of vital activity in women according to the Oswestry Disability Index was 54.8 % compared to the initial result, according to the Pelvic Girdle Questionnaire – 58.6 % (р<0.05). The dynamics of the Pregnancy Mobility Index results showed a statistically significant improvement in the condition of the examined women relative to the initial result in the subscales of daily home mobility (by 54.1 %), household activity (by 60.9%), and non-household activity (by 54.6 %). Based on the results of the study, it was concluded that physical therapy should be prescribed in the complex recovery of women with an endoprosthetic hip joint who underwent cesarean section to reduce the limitation of the degree of vital activity due to lumbopelvic pain. Keywords: rehabilitation, postpartum period, abdominal delivery, lower extremity joint endoprosthesis.

The purpose of the study: to analyze the results of studies devoted to the study of the effectiveness of the use of mobilization techniques in patients with adhesive capsulitis of the shoulder joint. Materials and methods. This work is the result of an analysis of studies devoted to the study of the effect of mobilization techniques as monotherapy and as part of a complex physical therapy on the range of motion in the shoulder joint, pain on the visual analog scale, and the shoulder pain and disability index. Results. Stretching exercises, pendulum exercises, various manual therapies, proprioceptive neuromuscular facilitation techniques, and muscle energy techniques are used in physical therapy for adhesive capsulitis. Analysis of the literature confirmed that mobilization is widely used in the therapy of patients with adhesive capsulitis of the shoulder joint. At the same time, the number of mobilization techniques, which are used in the form of monotherapy or part of complex treatment, is significant. There are quite a few types of mobilization techniques for adhesive capsulitis of the shoulder joint: angular mobilization; progressive mobilization; mobilization of the spine in combination with scapular stretching, angular and translational mobilization; high-intensity techniques based on the pain threshold; the Cyriax approach; Mulligan technique; Maitland technique. There are research results that indicate an immediate effect of intensive mobilization on the amplitude of passive abduction. A number of studies have established the advantages of end-range and intensive mobilization compared to mid-range mobilization. At the same time, studies were found that did not establish the advantages of mobilization over therapeutic exercises, and also established the advantages of therapeutic exercises without pain compared to a complex intervention that included exercises and mobilization with exceeding the pain threshold. Thus, the question of the intensity of mobilization, the level of pain during mobilization remains relevant. Results of literature reviews noted that the Kaltenborn technique shows better results after 2-6 weeks of therapy in reducing pain, improving range of motion and functional activity; that there is moderate evidence of effectiveness of mobilization methods in the short and long term; that the Maitland technique and combined mobilization are recommended for use. In the aspect of mobilization with adhesive capsulitis, there is a question of its direction (anterior or posterior) to improve the amplitude of external rotation. At the same time, the conclusions of the last systematic review of the effectiveness of conservative methods of treatment of adhesive capsulitis indicate that there is no reliable evidence that would convincingly testify to the superiority of one method of treatment of adhesive capsulitis over another. Conclusions. The results of scientific studies indicate different conclusions regarding the effectiveness of mobilization techniques. There are works that indicate both the advantages of mobilization in adhesive capsulitis of the shoulder joint and their absence. Undisputed strong evidence in favor of one of the mobilization techniques is also lacking. Mobilization techniques can be used in physical therapy for patients with adhesive capsulitis, but more research is needed to determine the most effective intervention.

Abstract. Purpose: to determine the parameters of the quality of life of women with an endoprosthetic hip joint in the postpartum period as a criterion for the effectiveness of the physical therapy program. Methods. In the course of the study, 9 women aged 28.5±1.6 years were examined 1 month after childbirth, which took place by caesarean section. The developed program of physical therapy lasted 1 month (from the end of the first month after childbirth). In her process, therapeutic exercises for the trunk, upper and lower limbs were used; functional training to improve movements related to child care, Proprioceptive Neuromuscular Facilitation of lower limbs, back, trunk; massage of lower limbs, back. We took into account movement restrictions associated with an incompletely formed scar after cesarean section and with the presence of an endoprosthesis (excessive bending, rotation of the hip joint); accordingly, they created safe movement strategies related to child care (lifting, carrying) and transporting a baby carriage. Individual determination of short- and long-term goals of rehabilitation contributed to the improvement of psycho-emotional mood and increased compliance of women. The effectiveness of the tested program was evaluated using the standard SF-36 quality of life questionnaire («Medical outcomes study short form»). Results. During the initial examination, all women with hip arthroplasty in the postpartum period were found to have a deterioration in the quality of life according to the SF-36. Overloading of elements of the musculoskeletal system during pregnancy and changes in the biomechanics of a woman's body, which causes certain physical discomfort, is justified by hormonal and physical processes.During repeated testing, the effectiveness of the physical therapy program was confirmed by its positive impact on both scales - physical and mental functioning. The difference between the results of Physical health at the initial and repeated examination according to the Physical Functioning scale in the examined women was 41.9%, Role-Physical – 39.4%, Bodily Pain – 26.0%, General Health – 42.2%. Accordingly, for all subscales of Physical health, a statistically significant improvement in the condition of women was obtained compared to the initial parameters (р<0.05). The improvement of Mental health in comparison with the primary result on the Vitality scale in the examined women was 26.9%, Social Functioning - 60.3%, Role-Emotional - 32.5%; Mental Health - 49.9%. Therefore, a statistically significant improvement in the condition of women compared to the initial parameters was obtained for all subscales of Mental health (р<0.05). Conclusions. In women with an endoprosthetic hip joint in the postpartum period (abdominal delivery), a significant decrease in the physical and mental components of quality of life, determined by the SF-36 questionnaire, was found. The use of physical therapy (therapeutic exercises, functional training, massage taking into account the limitations of the abdominal wall scar and the functionality of the endoprosthesis) caused a statistically significant (p<0.05) improvement in the condition of the examined women in all subscales of SF-36 - physical and role functioning, pain intensity , general state of health, vitality, social functioning, influence of emotional state on role functioning; self-assessment of mental health.

IntroductionPosition sense, which belongs to the sensory stream called proprioception, is pivotal for proper movement execution. Its comprehensive understanding is needed to fill existing knowledge gaps in human physiology, motor control, neurorehabilitation, and prosthetics. Although numerous studies have focused on different aspects of proprioception in humans, what has not been fully investigated so far are the neural correlates of proprioceptive acuity at the joints.MethodsHere, we implemented a robot-based position sense test to elucidate the correlation between patterns of neural activity and the degree of accuracy and precision exhibited by the subjects. Eighteen healthy participants performed the test, and their electroencephalographic (EEG) activity was analyzed in its μ band (8–12 Hz), as the frequency band related to voluntary movement and somatosensory stimulation.ResultsWe observed a significant positive correlation between the matching error, representing proprioceptive acuity, and the strength of the activation in contralateral hand motor and sensorimotor areas (left central and central-parietal areas). In absence of visual feedback, these same regions of interest (ROIs) presented a higher activation level compared to the association and visual areas. Remarkably, central and central-parietal activation was still observed when visual feedback was added, although a consistent activation in association and visual areas came up.ConclusionSumming up, this study supports the existence of a specific link between the magnitude of activation of motor and sensorimotor areas related to upper limb proprioceptive processing and the proprioceptive acuity at the joints.

Background: Anterior cruciate ligament (ACL) ruptures occur frequently, with ACL reconstruction among the most commonly performed orthopaedic sports surgeries. The remnant ACL is typically debrided for visualization. However, further evidence has suggested that this remnant tissue contains a wealth of proprioceptive nerve fibers and a vascular blood supply. Theoretically, preserving the ACL remnant may improve joint proprioception and graft synovialization. Therefore, ACL hybrid remnant preservation reconstruction (HRPR) was developed to preserve and tension the native remnant in combination with an ACL reconstruction. Indications: Patients with proximal tears or femoral-sided avulsions, Sherman type 1 or 2, may be indicated for ACL-HRPR. Technique Description: In this technique, we use a bone–patellar tendon–bone (BTB) autograft, which can be harvested based on the surgeon's preference. After performing a diagnostic arthroscopy, the notch of the knee is debrided, with care to preserve the tibial ACL remnant. The tibial remnant is then undermined with electrocautery. Nonabsorbable suture is passed through the remnant tissue. A tibial guide is placed, and a pin is drilled just posterior to the tibial insertion. Next, the appropriately sized tibial tunnel is drilled just posterior to the tibial remnant insertion. Using an anteromedial-portal technique with the knee maximally flexed, an over-the-top guide with appropriate offset is used to insert the guide pin, and the femoral tunnel is drilled. The proximal graft bone block and the remnant sutures are then passed through the femoral tunnel. Metal screws are then inserted to fix the BTB graft bone blocks on the femoral side, followed by the tibial side. Backup fixation is also used by placing a biocomposite anchor 1 cm distal to the tibial tunnel. Results: A myriad of techniques exist for preserving the ACL remnant. For the present surgical technique, a retrospective cohort revealed that patients undergoing ACL-HRPR achieved full range of motion without extension loss and equivalent patient-reported outcomes, without increased complication rates. Discussion/Conclusions: For patients with femoral-sided ACL tears or avulsion, ACL-HRPR is a viable option that may augment traditional ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

This case report highlights the role of occupational therapy (OT) in addressing developmental delays within primary care, particularly in rural areas where access to specialists is limited. Madison, a three-month-old infant, presented with motor delays but faced long wait times for specialist appointments. OT intervention, involving joint compressions to enhance proprioception and motor function, was introduced early through a family connection, resulting in significant improvement. This case underscores the potential of OT to bridge gaps in care, reduce delays, and provide cost-effective, timely interventions, advocating for OT integration in primary care settings to enhance pediatric healthcare outcomes.

Abstract Objective To investigate the effect of Sensorimotor Training (SMT) on gait, ankle joint proprioception, and quality of life in Diabetic Peripheral Neuropathy (DPN) patients. Design A prospective, single-blind, randomized controlled experiment was performed. Forty patients with DPN aged 50 to 65 yrs were distributed randomly into two groups, the SMT group (n = 20) and the control group (n = 20). Both groups attended awareness sessions about diabetes and foot care for 30 minutes, every two weeks. Moreover, the SMT group received 6wk (3 days/week) of SMT. Spatiotemporal gait parameters, proprioception accuracy of the ankle joint, and quality of life were measured before and after 6 weeks of intervention. Results Regarding baseline data, no significant differences were identified among groups (p > 0.05). After 6wk intervention, the SMT group exhibited significant improvements in all outcome variables (p < 0.001), while the control group showed significant changes in quality of life only (p = 0.03). Comparing groups after intervention reveals statistically significant differences in all measured variables in favor of the SMT group (p < 0.001). Conclusions Sensorimotor training may improve spatiotemporal gait parameters, ankle joint proprioception, and quality of life of patients with DPN.

Background Ankle position sense may be reduced before the appearance of the clinical manifestation of diabetic peripheral neuropathy. This is known to impair gait and cause falls and foot ulcers. Early detection of impaired ankle proprioception is important because it allows physicians to prescribe an exercise program to patients to prevent foot complications. Methods Forty-six patients diagnosed as having type 2 diabetes mellitus and 22 control patients were included in the study. Presence of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Level of foot care awareness was determined using the Nottingham Assessment of Functional Footcare (NAFF). Joint position sense was measured using a dynamometer. Results Mean absolute angular error (MAAE) values were significantly higher in the neuropathy group compared with the control group (P &lt; .05). Right plantarflexion MAAE values were significantly lower in the group without neuropathy compared with the group with neuropathy (P &lt; .05). No correlation was found between MAAE values (indicating joint position sense) and age, educational level, disease duration, glycemic control, NAFF score, and MNSI history and examination scores in the groups with and without neuropathy (P &gt; .05). Educational level and disease duration were found to be correlated with NAFF scores. Conclusions Increased MNSI history scores and increased deficits in ankle proprioception demonstrate that diabetic foot complications associated with reduced joint position sense may be seen at an increased rate in symptomatic patients.

INTRODUCTION: Hemiarthroplasty for hip fracture is a common surgical procedure and is the treatment of choice for displaced intracapsular neck of femur fracture. Numerous approaches are used to access the hip joint. The standard posterior approach is used by many surgeons to preserve the abductor complex but is associated with higher dislocation rate. In this study we assess functional outcomes of piriformis sparing posterolateral approach for hemiarthroplasty of hip. MATERIAL AND METHODOLOGY: We retrospectively reviewed 96 patients who underwent bipolar hemiarthroplasty of hip performed by chief surgeon between May 2018 to September 2020. All the database was retrieved from institutional database of tertiary care hospital. Functional outcome was measured by modied HARRIS HIP SCORE. RESULTS: Till minimum 1 year follow up we noticed that there was no single case of hip dislocation. Joint proprioception was preserved. In the nal follow up average Harris hip score was 92.2. No infection, nerve injury, implant migration occurred in our study. DISCUSSION: The main aim of the arthroplasty procedure is to decrease pain, to achieve mobility and restore anatomy. The piriformis sparing approach not only preserves abductor complex but also piriformis muscle. The muscle works like cradle, at the posterosuperior part of the joint, an area with a high risk of dislocation. The only disadvantage was noted in this approach was increased exposure difculty in obese patients CONCLUSION: From this study we conclude that Piriformis sparing posterolateral approach is safe, demands some technical aspects and should be used by surgeons using posterolateral approach.

ABSTRACT Introduction The focus of attention in high-performance athlete injuries tends to be on physical recovery, neglecting psychological factors and their practical social impacts on the rehabilitation of the injured athlete. In this phase, giving attention to the importance of athletes’ thoughts, emotions, and motivation can speed up the biopsychosocial rehabilitation process. Objective To analyze the characteristics involved in the major sports injuries of high-level athletes to provide a reference for athletes and coaches during recovery. Methods This article analyzes through bibliographic research the characteristics of the major sports injuries in high-level athletes, including physiological, psychological, and social factors. Results The physical impact of injuries requires patience and persistence for recovery, including additional muscle strengthening to compensate for the loss of residual joint proprioception, ensuring performance recovery. Mental factors such as insecurity when returning from games, reduced self-confidence, and fear of hurting the team must be worked through in parallel in multi-professional care and during long recovery periods. Conclusion Sports injuries can occur in athletes of all levels. For elite athletes, the impact of injuries, especially severe ones that need to interrupt training or even surgery, will lead to forced suspension of training or competition, preventing the improvement of sports performance, decreasing the quality of the sports career, and may even lead to physical or psychological disability in severe cases. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Cranial sutures and periodontal ligaments (PDL) are fibrous connective tissue articulations found between intramembranous bones and teeth of the vertebrate cranium. Growth and remodeling of these tissues is believed to be partially regulated by biomechanical loading patterns that include stresses relating to chewing. Masticatory advances in the structure and function of the cranium that enabled mammalian‐style chewing is commonly tied to the origins and evolution of this group. Such oral processing is an advantageous feeding behavior that often involves an individual handling a food item in the mouth while it is probed, tested, and reduced. To what degree masticatory overuse or underuse shapes the complexity and ossification around these articulations can be predicted based on prior experimental and comparative work. Here I report on a mouse model system that has been used to experimentally manipulate dietary material properties, label bone formation, and investigate central nervous system proprioceptive tissues of the cranial fibrous joints. All animal use has been conducted in conformance with the FASEB Statement of Principles for the use of animals in research and education. Treatment groups were fed diets of contrasting material properties, such as dry and powderized (with and without pumice added), gelatin, and enhanced pelleted rodent chow. Animals were raised from weaning to adulthood and calvarial suture morphology as well as sites of bone formation within the PDL were compared between groups. Predicted intergroup variation is observed in body mass, masticatory muscle mass, and mandibular corpus size suggesting that masticatory overuse is associated with muscle and bone growth. Cranial suture complexity is not as obviously impacted in this experiment because the masticatory underuse category also had more complex sutures. Regions of bone formation around the molar PDL in the mandibular corpus did not show any clear pattern of contrast between groups. The counterintuitive results from the cranial sutures indicate a confounding factor in this study. One such factor likely includes masticatory stress that results from other types of non‐dietary strains, like chewing on cage surroundings (e.g., metal wires). Nevertheless, treatment groups were different in many morphological aspects and this probably results from the contrasting patterns (either magnitudes, frequency, or both) of chewing behavior that occurs during diets with diverse and enriching material properties. To what degree the mammalian central nervous system receives sensory input from these ligaments that help to coordinate chewing kinematics is unknown. A possible method for answering this question is presented.

Abstract Introduction Patients with intra-articular hip pathology see an average of three clinicians prior to diagnosis. A 2015 study by Rankin et al. suggested femoroacetabular impingement (FAI) syndrome was described in 40% of hip joint pathology. FAI syndrome occurs when irregularities in femoral and acetabular anatomy create abnormal contact forces across the joint, leading to labral and chondral damage. These anatomical irregularities are categorised into three morphologies: cam (an aspherical femur head resulting in superior acetabulum impingement), pincer (over-coverage of the femoral head by the acetabulum) and mixed. This case highlights this tricky diagnosis in a young and active patient. Case description A 28-year-old fit and active man presented with a three-year history of gradually worsening atraumatic right hip pain. He described a constant ache in the anterior aspect of the right hip, occasionally referring to the groin and right knee. He experienced significant morning stiffness of the right hip, lasting approximately 30 minutes. His symptoms were aggravated by prolonged walking and running. He denied lower limb paraesthesia, numbness, incontinence, rashes and was otherwise systemically well. He reported no past medical history, family history and was on no regular medications. He practises yoga a few times a week but has had to stop his recreational running due to his pain. Examination revealed no deformity of the lumbar or sacral spine. There was no swelling, redness, or tenderness on palpation. Range of motion of the right hip was significantly limited, with flexion to 90 degrees, abduction to 30 degrees, external rotation to 25 degrees and internal rotation to 0 degrees (in flexion). Trendelenburg's test was negative. Functional assessment revealed poor pelvic control on right side during single-leg squat and lunge. The modified Thomas test showed tense hip flexors bilaterally, worse on right. FADIR test was strongly positive on the right but all other special tests for the hip, including Laslett’s cluster of sacroiliac provocation tests, were negative. After significant discussion regarding radiation exposure, he was referred for an X-ray pelvis and right hip. This revealed significant widening of both femoral heads and necks, with joint space narrowing with articular sclerosis. This was worse on the right side with femoral osteophyte formation. Appearances were in keeping with bilateral cam morphology, with associated changes in the right hip joint indicative of femoral acetabular impingement. He has since been referred to physiotherapy and orthopaedics to explore management options, whilst encouraged to continue his yoga practise. Discussion A 2014 cross-sectional study by Clohisy et al. reported the average age of FAI syndrome to be 28 years and the Frank et al. 2015 systematic review revealed cam morphology was more prevalent in men and three times more likely in athletes than the general population. This patient exemplifies these demographics. His history and examination contained features typical of FAI syndrome: his description of pain on movement, positive FADIR test, restricted internal rotation restriction, and poor single leg balance. However, classical symptoms of clicking, catching, and locking were not reported. This corroborates with the 2016 Warwick Consensus statement that FAI syndrome diagnosis does not rely on a single symptom or clinical sign. The statement confirms that X-Ray is the initial imaging modality of choice, which includes AP, lateral and Dunn views as was requested in this case. Treatment options to allow our patient to return to running include conservative management with patient education, anti-inflammatory agents, and physiotherapy. The Hoit et al. 2019 systematic review showed that physiotherapy, targeting core stability, proprioception, and correction of hip destabilising imbalances, provided significant improvements in functional outcomes compared to controls without. This supports a trial of physiotherapy before further interventions and commends the patient’s participation in yoga. Evidence for intra-articular injections of corticosteroids, hyaluronic acid or platelet-rich plasma is currently limited and are unlikely to be considered for this patient. Surgery aims to arthroscopically correct anatomical abnormalities. Two RCTs, UK FASHIoN and FAIT, compared surgery and physiotherapy interventions in FAI syndrome patients and showed statistically significant improvement in symptoms and functional outcomes with surgery, particularly in those with cam morphology like our patient. Orthopaedics may offer this option to our patient due to his lack of negative prognostic indicators related to surgery with the exception of his extended duration of symptoms. Key learning points Hip and pelvic pain with morning stiffness in a young adult male is not always inflammatory in nature, and femoroacetabular impingement (FAI) syndrome should be considered in these patients. FAI is associated with pain on movement, positive FADIR test, restricted internal rotation, and poor single leg balance, but clicking/locking is not always described. In primary care where access to MR imaging may be limited, AP, lateral and Dunn view X-rays of the pelvis and femoral neck can help clinch the diagnosis if there is uncertainty Cam morphology of the hip, revealed by X-ray, is more prevalent in men and athletes and has better treatment outcomes with surgery compared to physiotherapy. Referral to a specialist musculoskeletal service is recommended to discuss management options of physiotherapy, intra-articular injections and surgery alongside patient education and anti-inflammatory medication. Discussing the clinical experience of peers evaluating, diagnosing, treating, and monitoring long-term outcomes of similar patients will contribute to the understanding of the rapidly evolving evidence base.

Lumbar epidural spinal cord stimulation (SCS) was used to improve motor function in a 50-yr old patient who suffered hemiparesis due to a basal ganglia haemorrhagic stroke. Spinal cord stimulation targeted at the dorsal root afferent fibres at the conus improved the tonic control of the muscles at the knee and ankle joints. This allowed the patient better left knee and foot motor control. The improvement was documented initially during ambulation on a treadmill using decreasing body weight support and subsequently when using walking aids. Our observation is consistent with previous human data suggesting that in humans with brain lesions, the stimulation of preserved neural circuitry can increase spontaneous muscle tone in affected muscles and improve locomotion. Article Details How to Cite CHUA, Nicholas HL; JOHN, Thomas; BUCHSER, Eric. Epidural Stimulation of the Lumbosacral Spinal Cord After Basal Ganglia Haemorrhage: A Case Study. Medical Research Archives, [S.l.], v. 11, n. 3, mar. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3689>. Date accessed: 03 apr. 2023. doi: https://doi.org/10.18103/mra.v11i3.3689. ABNT APA BibTeX CBE EndNote - EndNote format (Macintosh & Windows) MLA ProCite - RIS format (Macintosh & Windows) RefWorks Reference Manager - RIS format (Windows only) Turabian Issue Vol 11 No 3 (2023): March issue, Volume 11, Issue 3 Section Research Articles The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives. References References: 1 Rathor, M. Y. et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage by clinicalcomputed tomographic correlations. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences 17, 1056-1062 (2012). 2 Sutherland, G. R. & Auer, R. N. Primary intracerebral hemorrhage. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 13, 511-517, doi:10.1016/j.jocn.2004.12.012 (2006). 3 Garibi, J., Bilbao, G., Pomposo, I. & Hostalot, C. Prognostic factors in a series of 185 consecutive spontaneous supratentorial intracerebral haematomas. British journal of neurosurgery 16, 355-361, doi:10.1080/0268869021000007579 (2002). 4 Stroke epidemiological data of nine Asian countries. Asian Acute Stroke Advisory Panel (AASAP). Journal of the Medical Association of Thailand = Chotmaihet thangphaet 83, 1-7 (2000). 5 Broderick, J. et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38, 2001-2023, doi:10.1161/STROKEAHA.107.183689 (2007). 6 Urban, P. P. et al. Occurence and clinical predictors of spasticity after ischemic stroke. Stroke 41, 2016-2020, doi:10.1161/STROKEAHA.110.581991 (2010). 7 Sharififar, S., Shuster, J. J. & Bishop, M. D. Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis. Annals of physical and rehabilitation medicine 61, 339-344, doi:10.1016/j.rehab.2018.06.005 (2018). 8 Chen, S. C. et al. Effects of surface electrical stimulation on the muscle-tendon junction of spastic gastrocnemius in stroke patients. Disability and rehabilitation 27, 105-110, doi:10.1080/09638280400009022 (2005). 9 Buonomano, D. V. & Merzenich, M. M. Cortical plasticity: from synapses to maps. Annual review of neuroscience 21, 149-186, doi:10.1146/annurev.neuro.21.1.149 (1998). 10 Cioni, B., Meglio, M. & Zamponi, A. Effect of spinal cord stimulation on motor performances in hemiplegics. Stereotactic and functional neurosurgery 52, 42-52, doi:10.1159/000099485 (1989). 11 Visocchi, M., Cioni, B., Pentimalli, L. & Meglio, M. Increase of cerebral blood flow and improvement of brain motor control following spinal cord stimulation in ischemic spastic hemiparesis. Stereotactic and functional neurosurgery 62, 103-107, doi:10.1159/000098604 (1994). 12 Quinn, T. J., McArthur, K., Dawson, J., Walters, M. R. & Lees, K. R. Reliability of structured modified rankin scale assessment. Stroke 41, e602; author reply e603, doi:10.1161/STROKEAHA.110.590547 (2010). 13 Rizkallah, M., El Abiad, R., Badr, E. & Ghanem, I. Positional disappearance of motor evoked potentials is much more likely to occur in non-idiopathic scoliosis. Journal of children's orthopaedics 13, 206-212, doi:10.1302/1863- 2548.13.180102 (2019). 14 Formento, E. et al. Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury. Nature neuroscience 21, 1728-1741, doi:10.1038/s41593-018- 0262-6 (2018). 15 Wagner, F. B. et al. Targeted neurotechnology restores walking in humans with spinal cord injury. Nature 563, 65-71, doi:10.1038/s41586-018- 0649-2 (2018). 16 Proske, U. & Gandevia, S. C. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiological reviews 92, 1651-1697, doi:10.1152/physrev.00048.2011 (2012). 17 Sanes, J. N., Mauritz, K. H., Dalakas, M. C. & Evarts, E. V. Motor control in humans with large-fiber sensory neuropathy. Human neurobiology 4, 101-114 (1985). 18 Asanuma, H. & Mackel, R. Direct and indirect sensory input pathways to the motor cortex; its structure and function in relation to learning of motor skills. The Japanese journal of physiology 39, 1-19, doi:10.2170/jjphysiol.39.1 (1989). Epidural Stimulation Post-Basal Ganglia Bleed Medical Research Archives |https://esmed.org/MRA/index.php/mra/article/view/3689 7 19 Tanei, T. et al. Predictive Factors Associated with Pain Relief of Spinal Cord Stimulation for Central Post-stroke Pain. Neurologia medico-chirurgica 59, 213-221, doi:10.2176/nmc.oa.2018- 0292 (2019). 20 Park, S. W., Wolf, S. L., Blanton, S., Winstein, C. & Nichols-Larsen, D. S. The EXCITE Trial: Predicting a clinically meaningful motor activity log outcome. Neurorehabilitation and neural repair 22, 486-493, doi:10.1177/1545968308316906Lumbar epidural spinal cord stimulation (SCS) was used to improve motor function in a 50-yr old patient who suffered hemiparesis due to a basal ganglia haemorrhagic stroke. Spinal cord stimulation targeted at the dorsal root afferent fibres at the conus improved the tonic control of the muscles at the knee and ankle joints. This allowed the patient better left knee and foot motor control. The improvement was documented initially during ambulation on a treadmill using decreasing body weight support and subsequently when using walking aids. Our observation is consistent with previous human data suggesting that in humans with brain lesions, the stimulation of preserved neural circuitry can increase spontaneous muscle tone in affected muscles and improve locomotion. (2008).

Scientific Program Oral Presentations Authors Title Abstract CONSTANTIN MUNTEANU, Mihail HOTETEU, Diana MUNTEANU, Gabriela DOGARU - 12 minutes PERSPECTIVES OF BALNEOLOGY - INTERNATIONAL DATA INPUTS, NATIONAL OUTPUTS Link L1 UMBERTO SOLIMENE - 14 minutes CLIMATE AND HEALTH: A NEW CHALLENGE FOR AN OLD SCIENCE Link L2 Zeki KARAGÜLLE - 14 minutes BALNEOLOGICAL TREATMENTS WITH NATURAL HYDROGEN SULFIDE (H2S) Waters Link L3 Constantin Florin Dragan, Liliana Padure, Gelu Onose - 12 minutes SPECIFIC ADVANCED QUANTIFICATIONS ON THE RELATIONSHIP BETWEEN THE ANGULATION OF THE MAIN SCOLIOTIC CURVE AND LEG SWING IN THE GAIT PHASES, IN CHILDREN AND ADOLESCENTS WITH AND WITHOUT POSTURAL TREATMENT Link L4 Irina ALBADI, Camelia CIOBOTARU, Andreea-Alexandra LUPU, Ionela BALASA, Claudiu FATU, Enghin SACHIR, Gelu ONOSE - 12 minutes A MULTIMODAL APPROACHES TO MANAGE REHABILITATION THERAPY OF DISFUNCTIONALS ASPECTS TO A PACIENT WITH GOUT, MIELLITUS DIABETES, ATRIAL FIBRILATION AND MIDDLE CEREBRAL ARTERY STROKE Link L5 ELENA RAEVSCHI - 12 minutes PREVENTION CONSIDERATIONS IN Cardiovascular Diseases regarding the premature mortality reduction Link L6 ANIȘOARA CIMIL - 12 minutes THE EFFECTIVENESS OF THE REHABILITATION PROGRAMME ACCORDING TO THE ETIOPATHOGENESIS OF PROSTHETIC JOINT PATHOLOGY Link L7 TRAIAN -VIRGILIU SURDU, Monica SURDU, Olga SURDU - 10 minutes FOURTH INDUSTRIAL REVOLUTION (INDUSTRY 4.0) AND MODERN THERMAL MEDICINE (THERME 4.0) IN XXIST CENTURY Link L8 Gabriela DOGARU, Akos MOLNAR, Marieta MOTRICALA - 10 minutes EFFECTS OF CARBONATED MINERAL WATER AND MOFETTE IN BĂILE TUŞNAD IN EXPERIMENTALLY INDUCED ISCHEMIC HEART DISEASE Link L9 Q & A – 12 minutes Authors Title Abstract Aurelian Anghelescu, Valentin Deaconu, Catalina Axente,Elena Constantin, Gelu Onose - 12 minutes THERAPEUTIC DIFFICULTIES IN A YOUNG PATIENT WITH MULTIDRUG RESISTANT EPILEPSY (NEEDING VAGAL NERVE ELECTROSTIMULATION), SEQUELAE AFTER CONGENITAL VASCULAR CEREBRAL MALFORMATION, WITH CHRONIC GAIT IMPAIRMENTS AND RECENT TRAUMATIC BRAIN COMPLICATION Link L10 Luminița NIRLU, Alexandru G. STAVRICĂ, Laura Georgiana Popescu, Ana Carmen Albeșteanu, Ali-Osman Saglam, Gelu Onose - 12 minutes DIAGNOSTIC PARTICULARITIES AND MULTIMODAL THERAPEUTIC AND REHABILITATION APPROACHES TO A COMPLEX CASE OF POST ISCHEMIC STROKE WITH DYSPHAGIA AND DYSPHONIA, ASSOCIATING MILLARD-GUBLER AND WALLENBERG SYNDROMES - CASE REPORT Link L11 Cristina Octaviana DAIA, Croitoru Stefana, Mariana Axente, Gelu ONOSE - 14 minutes IONTOPHORESIS AND LASER APPLICATIONS IN FACIAL NERVE PALSY Link L12 Doina Maria MOLDOVAN, Gabriela DOGARU - 12 minutes SPLINTING VERSUS SURGICAL TREATMENT IN MALLET FINGER Link L13 Doina Maria MOLDOVAN, Gabriela DOGARU - 12 minutes EARLY REHABILITATION IN PATIENT AFTER TREATMENT FOR DISTAL RADIUS FRACTURE Link L14 Liliana PADURE, Raluca PETCU, Anca Irina GRIGORIU - 12 minutes THE IMPACT OF MULTIFACTORIAL GAIT ANALYSIS ON THE DIAGNOSIS AND REHABILITATION OF CHILDREN WITH WALKING DISORDERS Link L15 Valerica Creanga-Zarnescu, Ana-Maria Fatu, Mihaela Lungu, Violeta Sapira, Anamaria Ciubara - 12 minutes REHABILITATION POSSIBILITIES OF APHASIC PATIENT Link L16 Cristina DAIA, Simona SCHEK, Stefana CROITORU, Alina GHERGHICEANU, Gelu ONOSE - 12 minutes FAVORABLE REHABILITATION RESULTS ON A PATIENT WITH SEVERE LEFT HEMIPLEGIA AFTER AN INTRAPARENCHYMAL HEMATOMA Link L17 Elena VIZITIU, Mihai CONSTANTINESCU, Sînziana Călina SILIȘTEANU - 12 minutes THE ROLE OF THERAPEUTIC SWIMMING IN THE PROPHYLAXIS OF SCOLIOSIS IN THE "C" LEFT IN CHILDREN DURING THE PREPUBERTAL PERIOD Link L18 Q & A – 12 minutes Authors Title Abstract Alexandru G. STAVRICĂ, Luminiţa Nirlu, Laura Georgiana Popescu, Ana Carmen Albeşteanu, Gelu ONOSE - 12 minutes DIAGNOSTIC AND THERAPEUTIC APPROACHES IN REHABILITATION CORRELATED TO A CASE OF TETRAPARESIS (WITH PREDOMINANCE OF PARAPARESIS) AFTER SEVERE CCT - BIFRONTO - BASAL AND BITEMPORAL CONTUSION. Link L19 Ana Maria Bumbea, Otilia Rogoveanu, Carmen,Albu Rodica Traistaru, Catalin,Bostina, Bogdan Stefan Bumbea, Roxana Dumitrascu, Borcan Madalina MANAGEMENT OF SPASTICITY IN NEUROLOGICAL PATIENTS Link L20 Laura Georgiana Popescu, Luminița Nirlu, Ana Carmen Albeșteanu, Ali Osman Saglam, Gelu Onose - 12 minutes PARTICULARITIES OF COMPLEX THERAPEUTICALLY-REHABILITATIVE MANAGEMENT, STEPWISE, IN A PATIENT WITH POST-CCT PSYCHO-COGNITIVE IMPAIRMENT IN A LARGE POLYTRAMATIC CONTEXT - CASE REPORT Link L21 Adrian MELNIC, Oleg PASCAL - 12 minutes DEVELOPING STRATEGIES TO ADDRESS COMORBIDITY IN STROKE REHABILITATION. Link L22 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes MONOGENIC DISEASES WITH MUSCULO ARTICULAR LAXITY. DIAGNOSTIC CRITERIA AND PRINCIPLES OF RECOVERY THERAPY Link L23 Catalin Ionite, Dragos Arotaritei, Mihai Ilea, Mariana Rotariu - 12 minutes THE USE OF ELASTIC BANDS IN THE RECOVERY OF ANKLE SPRAINS Link L24 Mariana Rotariu, Marius Turnea, Calin Corciova, Catalin Ionite - 12 minutes THE EFFECTS OF CUBE THERAPY IN THE RECOVERY OF THE ARTHROSIS HAND IN GERIATRICS Link L25 Cristian Ştefan LIUŞNEA - 12 minutes FITNESS AND WELLNESS. CONCEPTUAL DELIMITATIONS Link L26 Adriana LUPU - 12 minutes NSAID THERAPY OF MUSCULOSKELETAL PAINS AND ITS PARTICULARITIES IN THE PATIENTS SUFFERING FROM CARDIOVASCULAR DISORDERS Link L27 Q & A – 12 minutes Authors Title Abstract Mihaela MANDU, Cristinel Dumitru BADIU, Raluca PETCU, Cosmin OPREA, Gelu ONOSE - 12 minutes CLINICAL-EVOLUTIVE PARTICULARITIES AND A MULTIMODAL THERAPEUTIC-REHABILITATIVE, AS WELL AS THROUGH CONNECTED CARES, APPROACH, IN A CASE OF HEMIPLEGIA AFTER ISCHEMIC CARDIO-EMBOLIC STROKE WITHIN A POLYPATHOLOGICAL CONTEXT Link L28 Ana Carmen Albesteanu, Laura Georgiana Popescu, Luminița Nirlu, Ali Osman Saglam, Gelu Onose - 12 minutes MULTIMODAL - REHABILITATIVE THERAPEUTICAL APPROACHES IN A COMPLEX OF PATHOLOGY INCLUDING POSSIBLY EVOLVING DISCARIOTIC TYPE - CASE REPORT Link L29 Liliana PADURE, Cristian Adam, Laura Fierbinteanu - 12 minutes ATTACHMENT - PROGNOSTIC FACTOR IN MEDICAL RECOVERY Link L30 Prof. Alexandru Vlad Ciurea - 20 minutes MOTILITY OR MORBIDITY IN NEUROSURGERY Link L31 Valerica CREANGA-ZARNESCU, Ana-Maria FATU, Anamaria CIUBARA, Violeta SAPIRA,Aurelia ROMILA, Mihaela LUNGU - 12 minutes EXERCISES PROGRAM AND REHABILITATION IN PARKINSON’S DISEASE Link L32 Irina VERINCEANU,Alice MUNTEANU, Andreea STOICA, Stefan ISPAS - 12 minutes THE CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Link L33 Marius Turnea, Catalin Ionite, Mihai Ilea, Dragos Arotaritei - 12 minutes STATISTICAL ANALYSIS OF PHYSIOTHERAPEUTIC MEANS USED IN THE RECOVERY OF MUSCLE INJURIES IN ATHLETES Link L34 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF IL1β IN CARTILAGINOUS DISTRUCTION IN RHEUMATOID ARTHRITIS Link L35 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF THE INFLAMMASOMS IN THE PATHOGENESIS OF INFLAMMATORY REACTION Link L36 Q & A – 8 minutes Authors Title Abstract Prof. Dr. Gelu Onose, (Keynote Speaker) Vlad Ciobanu, Corina Sporea - 20 minutes A TOPICAL SYSTEMATIC LITERATURE REVIEW AND REAPPRAISAL ON ESSAYS TOWARDS SYSTEMATIZING CLINICAL ASSESSMENT INSTRUMENTS USED TO EVALUATE NEURO-functional deficits after spinal cord injuries, mainly in adults, including through the ICF(-DH) conceptual framework Link L37 Diana-Elena SERBAN, Aurelian ANGHELESCU, Elena CONSTANTIN, Gelu ONOSE - 12 minutes THE ACQUISITION OF SELF-DEFENSE TECHNIQUES AND PROCEDURES AGAINST THE ACT OF AGGRESSION IN THE PACIENT WITH PARAPLEGIA, WHEEL-CHAIR INDEPENDENT Link L38 Aurelian Anghelescu, Elena Constantin, Anca Sanda Mihaescu, Gelu Onose - 12 minutes “PREVENTION IS CURE, EDUCATION IS ESSENTIAL” - RESPONSIBLE IMPLICATION OF YOUNG PEOPLE IN EDUCATIONAL AND PROPHYLACTIC ACTIONS AGAINST ACCIDENTAL CERVICAL SPINAL CORD INJURY AND SEVERE DISABILITIES BY DIVING IN UNVERIFIED WATERS. Link L39 Alexandra SPORICI, Irina ANGHEL, Lapadat MAGDALENA, Gelu ONOSE - 12 minutes RECOVERABLE RESULTS AT A PATIENT WITH AIS/FRANKEL D INCOMPLETE TETRAPLEGIA / POST SPINAL CORD INJURY BY FALLING FROM A HEIGHT, ON AN ANKYLOSING SPONDYLITIS BACKGROUND Link L40 Ioana ANDONE, Carmen CHIPĂRUȘ, Andreea FRUNZA, Aura SPÎNU, Simona STOICA, Liliana ONOSE, George PATRASCU, Gelu ONOSE -12 minutes CLINICAL, PARACLINICAL ASPECTS AND COMPLEX THERAPEUTICAL APPROACHES IN A PATIENT WITH INCOMPLETE PARAPLEGIA, POST THORACIC MENIGIOMA SURGICALLY TREATED, IN NEUROFIBROMATOSIS CONTEXT Link L41 Cristina Octaviana DAIA, Alina-Elena Gherghiceanu, Helene Ivan, Gelu ONOSE - 12 minutes RESEARCH ON NEUROREHABILITATION RESULTS IN VERTEBRO-MEDULLARY POST-TRAUMATIC CONDITIONS ASSOCIATING FRACTURES, IN A POLITRAMATIC CONTEXT Link L42 Ali-Osman Saglam, Alexandru G. Stavrica, Ana Carmen Albeşteanu, Laura Georgiana Popescu, Luminita Nirlu, Gelu Onose - 12 minutes MEDICAL-REHABILITATION ENDEAVORS, CARE INTERVENTIONS AND CONNOTATIONS OF A MEDICO-SOCIAL TYPE, IN A COMPLEX POLYPATHOLOGICAL CASE: PARAPLEGIA, SPONDYLODISCITIS, KIDNEY FAILURE IN THE HAEMODIALYSIS STAGE AND BILATERAL NEPHROSTOMIES AFTER SURGICALY TREATTED BLADDER NEOPLASM. Link L43 Sorina Petrușan-Dunca, Liviu Lazăr, Tiberiu-Dorin Corha - 12 minutes INDICATIONS AND LIMITIS OF REHABILITATION TREATMENT FOR LUMBAR DISCOPATHY IN PREGNACY Link L44 Q & A – 8 minutes Authors Title Abstract Elena Silvia SHELBY, Mihaela AXENTE, Liliana PĂDURE - 12 minutes CHARCOT MARIE TOOTH DISEASE. CASE PRESENTATION. GENETIC DISEASES WHICH REQUIRE physical rehabilitation Link L45 Link L46 Simona Carniciu - 12 minutes Influence of nutrition and exercise on the use of different energy substrates in the prevention of metabolic diseases Link L81 Simona-Isabelle STOICA, Carmen Elena CHIPĂRUȘ, Magdalena Vasilica LAPADAT, George PĂTRAȘCU, Gelu ONOSE - 12 minutes CLINICAL-THERAPEUTIC AND RECUPERATORY FEATURES IN A PATIENT WITH PLURIPATOLOGY: ISCHEMIC STROKE, ISCHEMIC HEART DISEASE (SECHELAR MYOCARDIAL INFARCTION), CHRONIC KIDNEY DISEASE AND MONSTROUS GOUT- CASE PRESENTATION Link L47 Eugen BITERE, Mihaiela CHICU - 12 minutes PATHOPHYSIOLOGY OF ATHEROGENESIS AND CARDIOVASCULAR RISK IN CHRONIC INFLAMMATORY DISEASES Link L48 Victoria CHIHAI, Alisa TĂBÎRȚĂ, Anastasia ROTĂREANU, Vladlena MIHAILOV, Mihail CÎRÎM - 12 minutes THE IMPACT OF ACTIVE KINETIC PROGRAMS ON CLINICAL AND FUNCTIONAL STATUS ADRESSED TO PEOPLE WITH DIABETIC ANGIOPATHY Link L49 Ana-Maria Fătu, Ana Maria Pâslaru, Valerica Creangă-Zărnescu, Alexandru Nechifor, Mădălina Verenca, Mihaela Lungu, Anamaria Ciubară - 12 minutes THE IMPACT OF COGNITIVE DECLINE ON STROKE REHABILITATION Link L50 Alisa TĂBÎRŢĂ, Victoria CHIHAI - 12 minutes THE USE OF TRINITY AMPUTATION AND PROSTHESIS EXPERIENCE SCALES IN THE COMPLEX REHABILITATION OF PERSONS WITH LOWER LIBM AMPUTATION Link L51 Ilie ONU, Mariana ROTARIU, Elvina MIHALAȘ, Călin CORCIOVĂ - 12 minutes STUDY ON EFFICIENCY OF ELECTROTHERAPY AND PHYSIOTHERAPY MANAGEMENT ON HERNIATED LUMBAR DISC Link L52 María G. Souto Figueroa, Antonio Freire Magariños RESEARCH - SURVEY TO 142 THERMALIST WHO HAVE PERFORMED A THERMAL CURE AT THE BATHS OF BAÑOS DE MOLGAS (OURENSE) AND AUGAS SANTAS (LUGO) - GALICIA – SPAIN Link L53 Q & A – 12 minutes Authors Title Abstract Irina Ionica - 12 minutes ACUPUNCTURE IN REHABILITATION - A GENERAL VIEW Link L54 Denisa COAJĂ, Gabriela DOGARU - 12 minutes THE HEALTH BENEFITS OF FINNISH SAUNA BATHING Link L55 Otilia ROGOVEANU, Florin GHERGHINA , Rodica TRAISTARU - 12 minutes SPINA BIFIDA – FUNCTIONAL REHABILITATION METHODS IN CHILDREN Link L56 Mihaela DUTESCU, Raluca OLTEAN, Petru NENADICI - 12 minutes GEOAGIU BAI RESORT - OUR EXPERIENCE OF MEDICAL REHABILITATION TREATMENT Link L57 Dumitru MIHĂILĂ, SILISTEANU Sinziana Calina, ȚICULEANU Mihaela (Ciurlică) - 12 minutes THE METEOROLOGICAL COMPLEX AND THE HUMAN PATHOLOGY. CASE STUDY – SUCEAVA COUNTY Link L58 Mariana VARODI, Gabriela DOGARU - 12 minutes EFFICACY OF NATURAL THERAPEUTIC FACTORS FROM OCNA SIBIULUI SPA RESORT IN GONARTHROSIS Link L59 Boróka-Panna GÁSPÁR, Gabriela DOGARU - 12 minutes BONE HYDRATION AND MINERAL WATERS Link L60 CALIN BOCHIS, LIVIU LAZAR, HORAȚIU URECHESCU, CARMEN NISTOR-CSEPPENTO, FELICIA CIOARA, NICOLETA PASCALAU, ALIN BOCHIS , DIANA IOVANOVICI - 12 minutes CORRELATION OF VAS PAIN SCORE WITH FUNCTION AT THE PACIENTS WITH TEMPOROMANDIBULAR OSTEOARTHRITIS Link L61 Marian Romeo CALIN, Ileana RADULESCU, Mihaela Antonina CALIN, Elena Roxana ALMASAN - 12 minutes RADIOMETRIC ASSESSMENT OF PELOID AND SALT WATER USED FOR THERAPY AND BALNEARY TRATAMENT FROM TECHIRGHIOL LAKE, ROMANIA Link L62 Q & A – 12 minutes Authors Title Abstract Cristina PETRESCU - 12 minutes EFFICACY NATURAL THERAPEUTIC FACTORS FROM BAILE GOVORA IN BRONCHIAL ASTHMA Link L63 PARASCHIVA POSTOLACHE - 12 minutes PULMONARY REHABILITATION SAVES LIVES AND IMPROVES LIFE Link L64 DOINA-CLEMENTINA COJOCARU, PARASCHIVA POSTOLACHE - 12 minutes ASSESSMENT OF DYSPNEA IN PULMONARY REHABILITATION PRACTICE Link L65 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI - 12 minutes HELIOTHERAPY, CLIMATOTHERAPY AND PATIENTS WITH RESPIRATORY DISEASES Link L66 CONSTANTIN MUNTEANU, DIANA MUNTEANU, MIHAIL HOTETEU - 12 minutes BIOLOGICAL INSIGHTS OF SPELEOTHERAPY Link L67 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI, DOINA-CLEMENTINA COJOCARU - 12 minutes AEROSOLS AND BREATHING Link L68 PARASCHIVA POSTOLACHE, MADALINA ZEBEGA - 12 minutes RESPIRATORY MUSCLE TRAINING AND RESPIRATORY REHABILITATION Link L69 CRISTI FRENȚ, GEORGETA MAIORESCU - 12 minutes DEVELOPMENTS AND INVOLUTIONS OF TOURISM IN THE SPA RESORTS IN ROMANIA AND THE CASE STUDY FOR LACUL SĂRAT RESORT Link L70 Dragos Arotaritei, Andrei Gheorghita, Mariana Rotariu, Marius Turnea - 12 minutes MATHEMATICAL MODEL OF SULPHUR ABSORPTION PROCESS, A POSSIBLE APPLICATION IN CURE WITH SULPHUROUS MINERAL WATER Link L71 Q & A – 12 minutes Authors Title Abstract Mihai Ciocanu, Anișoara Cimil - 12 minutes THE EFFICIENCY OF THE REHABILITATION SERVICE IN HOSPITAL CONDITIONS Link L72 Sinziana Calina SILIȘTEANU, Andrei Emanuel SILIȘTEANU - 12 minutes TRIAL ON THE WATER CONSUMPTION BY THE PERSONS IN THE GROUP AGED 19-30 YEARS Link L73 Liviu Lazăr, Florin Marcu, Felicia Cioară, Carmen Nistor Csepentö - 12 minutes MANAGEMENT OF SPECIAL ARTERIAL DISEASES Link L74 Mihaela-Carmen SUCEVEANU, Paul-Nicolae SUCEVEANU - 12 minutes EVOLUTION OF CARDIOVASCULAR RISK FACTORS AFTER MORE THAN 2 PERIODIC HOSPITALIZATIONS IN THE COVASNA HOSPITAL FOR CARDIOVASCULAR REHABILITATION Link L75 Mihaela DUTESCU, Adina TRAILA, Margit SERBAN, Emilia URSU, Dorina MIU, Ioana MALITA, Bianca CIRESAN - 12 minutes THE EFFICIENCY OF MEDICAL REHABILITATION TREATMENT IN PATIENTS WITH HEMOPHILIA AFTER SURGICAL ORTHOPEDIC INTERVENTIONS - THE EXPERIENCE OF "CRISTIAN SERBAN" BUZIAS CENTER Link L76 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes PRECURSORS OF BALENOLOGY EDUCATION IN ROMANIA Link L77 Dr. Eugenia Dumitrescu, Dr. Carmen Enescu - 12 minutes ANTIALLERGIC PROCEDURES MOST COMMONLY USED IN PHYSICAL RECOVERY MEDICINE AND BALNEOLOGY Link L78 Mihail HOTETEU, Constantin MUNTEANU, Diana MUNTEANU, Gabriela DOGARU - 12 minutes PELOIDS - PERSPECTIVES ON RESEARCH AND FUTURE PLANS Link L79 Liliana Stanciu, Daniela Profir, Viorica Marin, Doinița Oprea, Elena Ionescu, Elena Almășan, Carmen Oprea - 12 minutes THE SCIENCE OF AGING WELL Link L80 Q & A – 12 minutes POSTER SESSION Authors Title Abstract Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Proprioceptive Functional Vibration Stimulation as therapeutic tool in spasticity management of jump gait pattern of spastic diplegic children with cerebral palsy Poster 1 Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Modern computerized techniques for gait’s functional evaluation through a specialized wireless inertial sensor – premise for orthopedic corrective shoes wear in children with gait disorders secondary to Cerebral Palsy Poster 2 Ana Maria PÂSLARU, Ana Maria FĂTU, Anamaria CIUBARĂ The role of medical recovery in oncology Poster 3 Maria Veronica MORCOV, Liliana PADURE, Cristian Gabriel MORCOV, Gelu ONOSE Exercises availed by sensor-based computer advanced devices: part of the interactive cognitive recovery – adjuvant of the therapy applied in the Centrul National Clinic de Recuperare Neuropsihomotorie Copii “Dr. N. Robanescu” Poster 4 Avram Mihai, Liliana Padure, Gelu Onose Theoretical fundamentals and conceptual premise for advanced proprioceptive and sensory stimulus apparatus, with sequential evaluation for the treatment of the recuperator in the equilibrium disorder, from Cerebral Palsy (PC) casuistry. Poster 5 Andrada MIREA, Gelu ONOSE, Madalina LEANCA, Florin-Petru GRIGORAS, Mihaela AXENTE, Liliana PADURE, Corina SPOREA Respiratory management in patients with rare progressive neuromuscular diseases Poster 6 Mihaela MANDU, Elena CONSTANTIN, Cristinel Dumitru BADIU, Cosmin Daniel OPREA, Cristina DAIA, Gelu ONOSE Presentation od the Fugl Meyer Assesment scale and related suggesttion in order to enhance its level of implementation in inner neurorehabilitation units Poster 7 ALEXANDRU BOGDAN-CĂTĂLIN, ALINA SIMONA ȘOVREA, ANNE-MARIE CONSTANTIN, ADINA BIANCA BOȘCA, CARMEN GEORGIU, MONICA POPA Complex oral rehabilitation in an elderly patient with periodontal disease who exercises regularly Poster 8 Dorin-Gheorghe TRIFF, Simona POP MORBIDITY BY OSTEO-MUSCULO-ARTICULAR DISEASES IN THE OCCUPATIONAL ENVIRONMENT IN MARAMURES COUNTY. THE IMPORTANCE OF MEDICAL RECOVERY AND RECORDS THROUGH ELECTRONIC DATA MANAGEMENT SYSTEMS Poster 9 Authors Title Abstract Mihaela Antonina CALIN, Marian Romeo CALIN, Constantin Munteanu New evidence on the effects of pelotherapy on local microcirculation Poster 10 Izabela Lazar, Gabriela Dogaru The effectiveness of balnear treatment in the management of psoriasis Poster 11 Dorin-Gheorghe TRIFF, Mușata Dacia BOCOȘ CORRELATIONS OF OSTEOMUSCULO-ARTICULAR DISEASES WITH WORK ABILITY, PERCEIVED SELF EFFICACY AND OCCUPATIONAL STRESSORS AT A REGULAR MEDICAL CHECK-UP IN PRE-UNIVERSITY EDUCATION UNITS Poster 12 Doroteea Teoibas-Serban, Valentin Stan, Dan Blendea PREVENTION OF LUMBAR DISC HERNIATION IN YOUNG ADULT POPULATION: A PRACTICAL APPROACH Poster 13 Călin Corciovă, Cătălina Luca, Robert Fuior, Flavia Corciovă Development a Monitoring Device for Arm Rehabilitation Poster 14 Simona Daniela Zavalichi, Marius Andrei Zavalichi, Sorin Stratulat, Florin Mitu Cardiovascular rehabilitation: challenges in a case of acute myocardial infarction and familial hypercholesterolemia Poster 15 Simona-Isabelle STOICA, Ioana TANASE, Gelu ONOSE Influences and consequences resulting in addictions in general and to chronic alcoholism, especially for patients with spinal cord injury Poster 16 Roxana Dumitrascu, Ana Maria Bumbea, Carmen Albu, Otilia Rogoveanu, Catalin Bostina, Rodica Traistaru, Borcan Madalina BIOMECHANICAL DYSFUNCTIONS OF THE FOOT – MAJOR IMPACT ON THE KINETIC CHAIN Poster 17 Otilia Rogoveanu, Gherghina Florin, Caimac Dan, Trifu Ramona, Cruceru Andra, Beldie C Medical rehabilitation in post-stroke spastic hemiparesis in young patients Poster 18 Ana Maria Bumbea, Otilia Rogoveanu, Roxana Dumitrascu, Bogdan Stefan Bumbea, Catalin Bostina, Albu Carmen, Borcan Madalina PERIPHERAL MAGNETIC STIMULATION - A CHALLENGE IN VERTEBRAL POSTTRAUMATIC RECOVERY Poster 19 Authors Title Abstract Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR KNEE ARTHROPLASTY RECOVERY OF AN CANCER PATIENT Poster 20 Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR THE IMPACT OF OSTEOARTICULAR PATHOLOGY IN POSTSTROKE RECOVERY Poster 21 Borcan Madalina, Bumbea Ana Maria, Bostina Catalin, Radoi Georgeta, Bumbea Bogdan EFFICIENT REHABILITATION TREATMENT IN A CASE WITH MAV-RUPTA MALFORMATION Poster 22 Demirgian Sibel, Nan Simona, Lulea Adela, Lascu Ioana, Marin Viorica Is possible the management of synovial chondromatosis of the hip by arthroscopy or complex balneal treament? Poster 23 Mădălina Codruța Verenca, Sorina Mierlan, Claudiu Elisei Tanase The Efficiency of Medical Treatment of Scoliosis – Paediatrics Poster 24 Florentina NASTASE¹, Alin Laurentiu TATU², Madalina Codruta VERENCA¹ Orthopaedic manifestations of Neurofibromatosis type 1 – case report Poster 25 Simona CARNICIU, Anatolie BACIU, Vasile FEDAS The attenuation of energy metabolic misbalance by means of aerobic, hypoxic, hypothermal adaptation and environment optimization at recreation resort center Poster 26 Irina Anghel, Alexandra Sporici, Magdalena Lapadat, Gelu Onose Complex clinical and therapeutic rehabilitation approach of a patient with Complete AIS/Frankel A quadriplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study Poster 27 Ana-Maria Pelin , Monica Georgescu , Cristina Stefanescu , Costinela Georgescu Molecular treatment strategies in osteoporosis Poster 28

Introduction Yeo Siew Hua’s 2018 film A Land Imagined encompasses the “experiential and immersive” aspects of land reclamation, construction projects, and related issues pertaining to the treatment of migrant labour, as the director sought to capture “what [he] saw and felt during each visit” to the worksites. The mistreatment of migrant labour workers (MLWs) in Singapore has long been documented by both local and international groups (Chin 536-37). Despite the Singaporean government conducting steps to improve the treatment and living conditions of migrant labour workers, its request for Singaporeans’ tolerance of living near dormitories underscores the spatial divide between the communities and the “social quarantine” of the MLWs despite being “a permanent part of the workforce” (Chin 531). Yeo’s film reflects such harsh conditions and triggers of negative affect in several ways. The desert-like setting, as “a test of character”, gestures at the “unhealthiness of industrialised modernity” on the reclaimed land (Smith 160; 164). The MLWs’ discontent is presented through verbal visuals such as the “ANGER IN PROGRESS” sign (in lieu of “DANGER”; 42:55) on the worksite. A recipient and nominee for multiple local and international awards (Lundberg and Peer 222), A Land Imagined is a cultural artefact that unveils the silenced stories of MLWs, especially after the shattering of the myth of racial harmony in Singapore by the 2013 Little India Riot. This article echoes Yeo’s point that “the people on this imaginary land are at the same time equally imagined” (Voelcker). The shared sense of being imagined and reified is thematised through the depicted lived experiences of MLWs and police officers in Singapore alike. In the film, middle-aged police investigator Lok (Peter Yu), who is nameless in the film, is tasked with finding a missing lorry. To do so, he must locate its driver, MLW Wang Bi Chen (Liu Xiaoyi). The non-linear plot shows an insomniac Wang who is worried about being repatriated after being injured at work. As if imagined by Lok in the film and by Yeo in the real world, Wang represents the latter’s observations of MLWs: “these indentured workers live in [sic] the outskirts of the restless city; existing in the blind spot of larger society; their exploitation remains unseen. They are the invisible and imaginary – they are the sleepless, the dreamless (“A Land Imagined”). Indeed, alienated and sleepless, Wang spends his nights at “a dreamy cybercafé” with 24-hour air-conditioning opposite his dormitory, where he seeks physical and virtual connections with the cybercafé assistant, undocumented Chinese Mindy (Luna Kwok) and online gamers, respectively (“A Land Imagined”). After the disappearance of his dormitory acquaintance, Ajit (Ishtiaque Zico), Wang becomes increasingly paranoid about Ajit’s possible murder by the construction company – a reflection of Yeo’s remark that MLWs “live in precarity” and are “entrapped in their wretched situation” with no way of reporting their mistreatment (“A Land Imagined”). Wang increasingly dissolves into a spectre reminiscent of the MLWs’ “unseen and unheard” existence (Peer 41) before fully disappearing from the construction site. To solve the case at hand, Lok enters the everyday spaces of MLWs and perceives, to use Yeo’s words, in an “experiential and immersive” manner the harsh living and working conditions on the reclaimed sites of Singapore. Addressing the social divide (Tan 1), cultural artefacts such as Yeo’s A Land Imagined undercut the myth of the “fine” city by foregrounding the experiences of those on whose back the country is built (Lundberg and Peer 206). Hence films like A Land Imagined “impact upon the social landscape – bringing awareness of the ethical issues the state and society either buries or uncovers as it constructs its futuristic city” (Lundberg and Peer 222-23). Employing the Deleuzian notion of assemblages the role of shared transsensoria amongst the characters, affordances in the scenes, and the audience in supporting their sense-making process of the case and the film (Sim), this article examines the theme of the alienating realities of MLWs and police officers in A Land Imagined and the impact of the film on the audience by applying the approach of embodied cognition and affect to moments of dark intervals in the film. Dark intervals are strange instances of “stillness, detachment and suspended time” that shape the indeterminacy of noir and its impact on viewers’ “embodied and sensorial experience, underlining the irreducible relational interactions of the human organism within its environment” (Killeen 1; 4). The study of film noir through affect in dark intervals unveils “the restless tumult of [the human’s] own becoming”, which occurs when the intervallic protagonist experiences a “distinctive exposure and attentiveness to this passionate affective state” and undergoes “radical receptivity to the unfolding of [their] own existence and to the potential inherent in that existence” (Killeen 4-5). Their potential, which includes the virtual, is the affective enactment of actions, challenges the “constrictive and hegemonic manifestations of power” (Killeen 6). Such effects are especially potent when the dark intervals disrupt the eurhythmia of capitalist cities such as Singapore. Suspense and violence are indelible triggers of affect in noir. Yeo’s A Land Imagined evokes affect and reflective empathy by employing gripping dark intervals in liminal spaces while realistically reflecting the non-violent local atmosphere. Such dark intervals include the eternal land reclamation that sustains the Singapore Dream using sand from neighbouring countries, the 24-hour air-conditioned cybercafé that offers the possibility of enacting other roles through violent RPGs and online sexual encounters, highways linking worksites to workers’ dwellings in centrifugal space, and the intertidal beach zone that affords pseudo-escapes from the strictly controlled Singapore. The liminal spaces in the film are accessible via the emblematic iconography of highways in film noir that reiterates the dispersal – and denial – of MLWs’ lives in Singapore. Akin to “in-between spaces of modernity”, such non-places (Augé) defy traditional systems of meaning and are associated with outsiders such as “labourers … and the multiethnic” (Breu and Hatmaker 4). The affective enactment of ‘becoming’ in film noir lures viewers to imagine characters’ consciousness, a process that disrupts the audience’s patterned behaviours and elicits shifts in their perceptions of the world (Flory 319). Cavallian characters who are “simultaneously mysterious and convincing” especially trigger such embodied changes in viewers (Flory 78). Viewers who enact Cavallian characters’ consciousness and actions experience “anxious curiosity” while broadening their imagination about possibilities in the world (Flory 9; 78). The main characters of A Land Imagined are Cavallian characters with complex but comprehensible affective responses to the engulfing urban alienation in the city-state, as both figures work as invisible but vital cogs in the backend of the ever-spinning capitalist wheel. Besides increasingly recognising MLWs as fellow humans, viewers learn to acknowledge both differences and similarities between them. Through this process, they can attain “a more developed sense of tolerance as well as the human itself, and the need to take responsibility for [their] actions, even when doing so will cost [them] dearly” (Flory 321). Moreover, spectators’ reflective empathy, which often occurs through “considered thought” post-viewing, alters their perception of themselves and their place in the world (Flory 319). While Flory’s work pertains to black noir films, the same embodied processes and subjective changes occur in viewers of A Land Imagined through their encounters with the Cavallian Wang, Lok, and Mindy in dark intervals. Dreaming about Escapes to Elsewheres on Reclaimed Land One key dark interval depicts Mindy’s conversation with Wang on the intertidal zone of the reclaimed beach. The sequence commences with the two leaving the cybercafé together for the first time and suggests a potential sexual rendezvous should Wang win their swimming contest. Despite the suggestive atmosphere during the van ride and on the beach, the possibility of intimacy fades as strict gender expectations become subverted. Mindy saves the injured Wang from drowning. Acknowledging Mindy’s unexpected dominance, viewers experience new affective responses as “transsensorial and affective valences are carried through cinematic form through moments where impasse occurs” (Sim 48). The affective impact is evoked not by physical intimacy but by the characters’ honest commiseration about their pursuit of freedom from their lives in Singapore. While Mindy is trapped by her undocumented status, Wang’s movements are mired by his employer’s confiscation of his passport, a practice associated with forced labour. This dark interval particularly presents the characters’ affective enactment of prioprioception (i.e., “a sense that provides information about the location of various parts of the body in relation to each other and the surroundings” (Blumer et al.) through the motif of travelling on the intertidal zone constructed by sand imported from neighbouring countries. The sand implies the “flow of territory”, which is “incorporated within cultural global flows and situated within the flexible practices of neoliberal globalisation” (Lundberg and Peer 216). Repose on the liminal intertidal zone thus affords Wang and Mindy the possibility of imagining their escapes to multiple elsewhere. Their perception of the city lights from afar, however, recalls the forever unattainable green light in Fitzgerald’s The Great Gatsby. By embodying the migrants’ situations, spectators see that their notion of freedom diverges from the Singaporean ideal. Mindy’s inertia and slowly verbalised thoughts (“I was thinking…”) pull the audience into her consciousness in the sultry setting. By internalising her dreams of physical and social mobility, they recognise her Cavallian nature: they share the same desires for mobility, although the migrant is incapacitated by local laws. Rather than seeking their place in Singapore, the migrants dream about leaving behind the stringent rules, perpetual debility, and extreme boredom graphically represented by the straight reclaimed southern coast that Mindy draws on the sand. With lighting as a motif, Singapore’s self-inflated worth is also indicated by the red light in the background of the scene (fig. 1). Two right lights are also sighted later on the religious shrine in the construction office, watching Wang as he searches for Ajit’s passport. The significance of “visual motif[s] can often only be gleaned in the context of the wider elements of the diegesis in which it participates” (Killeen 37). Besides triggering a negative affect (Martinez-Conde and Macknik), the red light further evokes former Indonesian President Habibie’s 1998 denigration of Singapore as “that red dot” on the map, an expression that the country has appropriated as a badge of honour. The success of Singapore, however, is attributed to the efforts of locals and expats, while the MLWs’ hard graft is overlooked (Chin 539). The out-of-focus red light in the background of the intertidal zone analogously stresses the misalignment between deep-seated elitism and MLWs’ vital contributions to the country’s rapid development. Fig. 1: Mindy in a scene from A Land Imagined. Lok/Wang: Acknowledging the Self/Other through Play on Reclaimed Land Lok’s affective enactment of Wang and their merged subjectivities are vital to his solving of the case. The detective’s simulation of Wang’s senses on the bed enables him to make sense of the MLW’s thoughts and enactment of the affordances in the dormitory. This dark interval of blended subjectivities also constitutes a suspension of time – as though taunted by the visual and embodied motif of the constant running of sand in construction sites during the workday – through the absence of Wang and the inert experience of insomnia. To use Killeen’s words, Lok “enters – through processes of visceral sensitivity and proprioception – a passive state of ‘utter receptivity’, wherein his current ‘actual’ movement … fuses with the ‘virtual’ movements of memory and anticipation ingrained in the singularity of his existence” (208). Killeen’s description of Rosnow’s experience in Night of the Hunter applies, too, to Lok’s affective enactment of Wang’s nighttime experiences and disruption of his everyday rhythms as an active police investigator (208). Staring at the ceiling, the insomniac Lok not only listens to the audible nighttime chattering from the streets but also notices the cybercafé’s red light, like Wang must have done during his sleepless nights. Their intersubjectivity strengthens the personal connections between Lok and Wang, even when the two have never met in person in the narrative. Concerning the themes of isolation and alienation felt by both MLWs and police officers, Lundberg and Peer rightly observe that Wang is “the spectre that Lok was trying to bring to light”, while Lok increasingly turns into “Wang’s ‘dream-self’” and “ghost-detective” that Wang wishes would care “care about his plight in a Singapore where he goes unseen” (205). As vital parts of reflective empathy evoked by the dark interval, recognition and acknowledgement are required for the inclusion of MLWs. Since its inception, Singapore has always been diasporic, making the land both globalised and glocalised. The potential for reflective empathy for the other is illustrated in the dark interval of Lok’s final visit to the cybercafé. Thus far, Lok’s assumptions about mere business-like transactions at the cybercafé have caused him to overlook the intimacy between Wang and Mindy. Yet, a moment of heightened psychological noir affectivity manifests when he, prompted by the recording of Wang, carefully enacts the MLW’s turning of the head from Station 57 to catch Mindy in his eye line. As though possessed by Wang’s spirit, Lok adopts an intersubjective liaison with the absent MLW to perceive his association with Mindy, which leads to the solving of the case (figs. 2 and 3). Figs. 2 and 3: Lok enacts Wang's turning of the head. Lok’s potential to expand his experiential traces – and thus his understanding of the case and of himself – is facilitated by his engagement with the computer game that Wang has been playing. As noted by Sim, “the game’s auditory mix of gunshots, rapid clicking, and twinkling sound effects can be heard, while a sonorous and eerie background soundtrack creeps in the distance, reconstructing Lok’s body as an assemblage of affective forces” (51). Lok’s deviating identity also manifests through his role-playing and affective enactment of a terrorist – a separation from his real-life role of a detective – as triggered by the lucid game. Moreover, the more Lok learns about Wang, “their subjectivities begin to morph, flicking between Lok’s timeline and his imagination of what happened to Wang” (Lundberg and Peer 205). With the gameplay eliciting viewers’ affective reactions through its “cybernetic ambience of sensory overstimulation” (Sim 51), and then showing Lok a recording of Wang by the computer’s camera, the viewers perform enactment in this entire sequence on several levels: as the terrorist in the game; an RPG player in the cybercafé; as Lok looking at the recording of Wang and his surroundings; as Wang who previously sat at Station 57 during his sleepless nights; and as the camera spying on both Wang and Lok at different times. The extensive affective enactment by the multiple perspectives is also supported by Sim’s own hypothesis that “the audience – unable to see clearly – is urged to move closer to the screen, shifting the cinematic encounter to one that is embodied and beyond the representational eye that can see through the events on screen” (55). Here, the viewers’ affective responses thus include proprioception as they try to make sense of the obfuscating blend of imagined perspectives offered by the sequence. By adopting Wang’s position in the cybercafé, Lok also begins to perceive Mindy beyond her interpellated role of cybercafé assistant and her toughness signalled by her haircut, tattoos, and attitude. By recognising the migrants’ human connection in the lonely city, Lok not only seeks Mindy’s help to find Wang; the quietude between them facilitates his own escape to imaginary neighbouring lands with the migrants. Mindy’s recollection of the first dark interval imposes a moment of pause that is nevertheless blissful as she recalls the positive affect that she shared with Wang. This sense of inertia is then interrupted by a shot that quickly cuts to the final drive on the highway, where Lok watches the sleeping Mindy in his car (fig. 4). With its warm-toned lighting, this first scene of sleep and female vulnerability creates both sultry and comforting affect in A Land Imagined. Recurring in shots of the highways, the quiet worksite at night, and the final scene at the bonfire, the warm lighting as a motif and an external signifier of Lok’s Cavallian nature is evidently contrasted with the cold, blinding dormitory lighting which silently prevents workers from resting. The iconography of Lok with the warm lights hence carries the affect of calm and safety for Mindy in her defenceless state. Fig. 4: The sleeping Mindy in Lok's car. This scene carries both characters and spectators along the highway to the liminal land of imagination. In this dreamlike sequence, the shot of the concrete highway dissolves into the sequence of the Bengali dance at a bonfire. With its slow rhythmic motion and music, the scene enraptures the viewers to join the hidden experience of the reclaimed land. The shots of Lok’s dance parallel Wang’s at the worksite while also eliciting flashbacks of Wang’s dance during Ajit’s description of his dreams. The latter triggers an almost-sexual affect via a continuous shot of Ajit’s slow massage of Wang’s neck. This instance of physical intimacy that leads nowhere signals the objectification of MLWs as homosexual deviants who taint local culture and destabilise the nuclear family. Ajit’s voice-over about identity (“But I am not me, you not you”), coupled with the slowed-down euphoria of the dance, resonates with the theme of the dark intervals of the film: the need for escape to dream of elsewheres and the possibilities of becoming himself without others’ judgement. Perceiving Self and Other: Teaching Viewers to Look Away The final scene uniting Lok and the migrants on the liminal site indicates the processes of becoming that forge a profound connection between Lok’s self and the other. Lok’s authentic involvement in the Bengali dance embodies his newfound role as a participant in glocalised Singapore. Shedding his earlier crouched position of uncertainty, Lok now dances with the migrants with mutual acknowledgement (figs. 5 and 6). In this dark interval, the noir protagonists “are confronted with the radical passivity and passionate becoming that subtends their sense of ‘self’ and indeed their very concept of existence” (Killeen 15). Marked by his anonymous urban identity, Lok is malleable and open to his “redemptive potentiality” (Killeen 208). Embodying Lok’s changes, the viewers, too, perceive their anonymity in the city-state: they, too, undergo their own process of becoming as they affectively enact the dance with Lok and the MLWs at the bonfire. Figs. 5 and 6: The Bengali dance scene. In the final shot of A Land Imagined, Lok spots the solitary Wang looking at the sea and the reclaimed land. Instead of approaching him, Lok turns away. Facing away from each other, Wang and Lok are free to conjure their own dreams in, to use Killeen’s words, the “‘suspension’ in the interval or passage of his own becoming” (209). Juxtaposed with the dazzling lights and unceasing dance movements, Lok’s inertia also draws attention to his active decision to escape from the dreamless local life through the open police case. According to Killeen, the “profound passivity” of the dark interval “perhaps harbours a strange redemptive quality” (33). In A Land Imagined, such redemption manifests in the characters’ letting loose in the liminal side of Singapore. The affect of freedom embodied by Lok’s dance is present in his earlier play with a glass bottle against the background of construction work. First appearing during Wang’s hallucination about his employer’s demise, the beer bottle changes from a haunting signifier of death to one of spirited deviance that unlocks dreams of the potential self and other. While the film captures the “utterly unbearable” discomfort from “the merciless sand blowing incessantly at one’s face and the brutal cacophony of noise generated from the machines” (“A Land Imagined”), my assessment of Lok’s new playful behaviour in this dark interval reveals the potential of challenging the harsh conditions at the worksites. Lok’s change is further instructed by his beige button-up shirt in both this scene and his first visit to the worksite. Scenes of deviance from work crucial to the order of capitalist Singapore illustrate “the strange joy [Lok] finds in this suspension” of time and order (209). As noted in Benjamin’s “The Work of Art”, viewers encounter both film and architecture through touch instead of visual perception (Smith 49). The emphasis on the body in the dark intervals of A Land Imagined also reiterates Benjamin’s encouragement in The Storyteller for adults to engage physically in childlike play and produce stories that resonate with others across space and time (Breu and Hatmaker 185). In addition to presenting deeper insights into the cultural contexts of local settings, they will evoke viewers’ critical empathy for the simultaneously familiar and mysterious Cavallian characters in the stories to modify stereotypical beliefs about marginalised groups. By affectively enacting the lives of MLWs, for instance by experiencing insomnia in Wang’s dormitory bed, Lok re-assesses his self and acknowledges the other in Singapore. Similarly, the spectators imagine the consciousness of the characters – including Lok – to experience reflective empathy for the marginalised other. Both Wang and Lok conclude the film with their backs to the spectators for them to better share their perspectives. This directed perspective suggests what Chan calls the “rupture or the shifting of identification” as where the viewers’ “realisation of the gaze” (Lacan 84-5) is triggered and they “become aware of the protagonists’ and/or the spectators’ own acts of looking” (Lacan 95). Films with such moments thus “open up gaps of interpretation” together with shifts in identification and “defer the conventional process of making meaning” (Chan 95). Following Žižek’s Looking Awry, Chan also notes the audience’s awareness of “their own [extra-diegetic] act of looking as well as the gaze of the Other upon them”, which supports “the negotiation of identity and identity crisis” (96). Similarly, A Land Imagined “not only implicates the land, state and society in the precarity and marginalisation of construction workers, it seeks to involve the cinematic viewer as witness to the crime” (Lundberg and Peer 213). Lok’s and Wang’s neo-noir approach to intersubjectivity compels the audience to witness the struggles of an overlooked migrant worker through the perspective of a detective, whose investigation not only highlights the disappearance but also amplifies the often-silenced issues surrounding workers’ conditions. Yeo, too, states that the film “seeks to make complicit the audience in the search of Wang, by placing themselves in the environment of the migrant worker and living out his experience, in the process creating an empathetic need to understand the character and his world” (“A Land Imagined”). While the intersubjectivity between the characters becomes increasingly obvious in the film through their shared positions and actions in the same places, the affective strangeness of the gaze is particularly instructive on another front: the camera shot, which hints at an implied exterodiegetic narrator, also draws in the viewers and elicits their affective responses. A prime example is the scene of the morning after Wang’s Bengali dance at the worksite. While the music from the previous night persists in the background, the MLWs’ returned gaze at the audience as they set off for work in the lorry breaks the fourth wall and silently demands viewers to join them, not only in their dance but also in their harsh realities as MLWs. The audience is thus explicitly acknowledged by the marginalised and challenged to perform a reassessment of the self/other relationship (Figure 7). Fig. 7: The morning after the Bengali dance. Film Noir and the Fostering of Inclusive Communities By “melding two seemingly disparate perspectives into a singularity”, Yeo’s A Land Imagined shows that the Cavallian character and spectators can learn to “dream again and reunite in the revelry of life” (“A Land Imagined”). As shown above, in dark intervals, the film triggers viewers’ imagination or affective enactment of characters’ unexpected behaviours and consciousness and thus disrupts everyday rhythms. By internalising these new embodied processes, spectators learn to acknowledge the lived experiences of migrant communities and recognise the need to overcome the dehumanisation prevalent in the “fine” city-state. The ambivalent ending of contemporary film noir suggests “the sheer affective potential inherent in the ‘passage’ of a life’s taking place” (Killeen 205-6; 209). While the dreams of Wang, Lok, and the viewers might not coincide, the film underscores the sense of reification and triggered affective experiences shared by diverse communities in Singapore. As Yeo claims, A Land Imagined aims “not only to expose the structural exploitation at work but more importantly, humanise through understanding that they too have hopes and dreams” (“A Land Imagined”). Hence, alongside proposals for non-state entities and the employers to redress MLWs’ debility, film noir can be deliberately deployed to elicit affective responses and deep reflective empathy in the public to enhance their embodied (i.e., physical and emotional) recognition and acknowledgement of the hidden MLWs whose efforts in building the city-state and role in shaping the glocalised atmosphere of Singapore continue to be largely overlooked. The article’s analysis hence demonstrates the ways that Singapore noir such as A Land Imagined consciously unveils hidden lived experiences of marginalised communities while encouraging deviance and play in its audience to overcome strict and problematic hegemonic beliefs and social attitudes. It thus calls for more scholarly attention to noir from the Global South and Southeast Asia to unveil deeper insights into the twenty-first-century neoliberal condition of glocalisation. References “A Land Imagined. A Film by Yeo Siew Hua.” Presskit by Akanga Film Asia. Unifrance. <https://medias.unifrance.org/medias/23/243/193303/presse/a-land-imagined-presskit-english.pdf>. Augé, Marc. Non-Places: Introduction to an Anthropology of Supermodernity. Verso, 1995. Blumer, Roland, et al. “Extraocular Muscles: Proprioception and Proprioceptors.” Reference Module in Neuroscience and Biobehavioral Psychology 6 Mar. 2024. <https://doi.org/10.1016/B978-0-443-13820-1.00028-1>. Breu, Christopher, and Elizabeth A. Hatmaker. “Introduction: Dark Passages.” Noir Affect. Eds. Christopher Breu and Elizabeth A. Hatmaker. Fordham UP, 2020. 1-28. Chin, Chuanfei. “Precarious Work and Its Complicit Network: Migrant Labour in Singapore.” Journal of Contemporary Asia, 49.4 (2019): 528-51. Flory, Dan. Philosophy, Black Film, Film Noir. Pennsylvania State UP, 2008. Killeen, Padraic. The Dark Interval: Film Noir, Iconography, and Affect. Bloomsbury Academic, 2022. Lacan, Jacques. The Four Fundamental Concepts of Psycho-Analysis. Ed. Jacques-Alain Miller. Trans. Alain Sheridan. Penguin, 1979. Lundberg, Anita, and Jasmin Thamima Peer. “Singapore ‘a Land Imagined’: Rising Seas, Land Reclamation and the Tropical Film-Noir City.” eTropic: Electronic Journal of Studies in the Tropics 19.2 (2020): 201-27. Peer, Jasmine Thamima. Hidden Transcripts in Singaporean Film: An Anthropological Analysis. Honours Thesis. James Cook University, 2019. Sim, Jiaying. “A Land Imagined: Transsensorial States of Transmigration.” International Journal of Diaspora & Cultural Criticism 10.1 (2020): 31-61. Smith, Imogen Sara. In Lonely Places: Film Noir beyond the City. McFarland Publishing, 2011. Tan, Cheryl Lu-Lien. “Introduction: The Sultry City-State.” Singapore Noir. Ed. Cheryl Lu-Lien Tan. Akashic Books, 2014. Voelcker, Becca. “Interview: Yeo Siew Hua.” Film Comment, 23 Aug. 2018. <https://www.filmcomment.com/blog/locarno-interview-yeo-siew-hua/>.