Posts Tagged Physical and rehabilitation medicine

[WEB SITE] European Rehabilitation Robotics School

Who We Are


The wide spectrum of employment in PRM (Physical and Rehabilitation Medicine) of Robotics and New Technologies is a concrete reality, but PRM training Centres offering proper programs are sparse at national and international level and skills needed to appropriately apply robotics are usually achieved “on the field” by rehabilitation professionals without any prior specific education.
The inter-professional cooperation, so strongly needed in research and clinical activities, is very weak in Health facilities and between medical professionals with engineers and other ICT experts.
The actual gap is mostly educational and there is a great need to enhance training and knowledges for PRM physicians (and the same for Physiotherapists, Speech Therapists, Occupational Therapists, Orthotics and Engineers).


European Society of PRM (ESPRM) promotes, through Scientific Committe on Robotics and in cooperation UEMS PRM Section and Board an innovative approach based on a summer annual School (Robotic Rehabilitation Summer School-R2S2) with the main goals to enhance scientific information and foster education in Robotics applications.
The educational programme is developed in the frame of the theoretical knowledge and evidence-based approach provided by recent researches indications and international publications, while exploiting the technical support of IISART and other Companies which carry out research and productions in this field in connection with growing technical and clinical experiences realized all over the Europe.

What We Do



The purpose of the School is to harmonize and increase the level of knowledge concerning the use of robotics in rehabilitation, for PRM physicians (and if possible all rehabilitation professionals) to enhance collaboration, communication and sharing, both on a clinical and research basis.
Students will be able at the end of the Sessions to plan and manage routinely and daily therapies integrating robotics and new technologies; they will have the basis for financial or organizational issues for such therapies and, finally, they will be able to design and realize proper research trials aimed at assessing the efficacy, effectiveness and efficiency of robotic rehabilitation. School Courses are open to European PRM physicians and students.

It is a fundamental tool to maintain and increase all over the year and places the activity:

Before School/On Line

Educational material (slides packages, webinars etc) will be available on-line from 2 months before practical session for all enrolled students.

Post School/On-Line

All educational materials will be available online for all students; a “meet the experts” service will be available also for six months after the end of the School/On-Site.

Visit SITE —>  European Rehabilitation Robotics School

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[Systematic Review] of Mobile Health Applications in Rehabilitation – Full Text

Article Outline

  1. Methods
    1. Data sources
    2. Study selection
      1. Inclusion criteria
      2. Exclusion criteria
    3. Data extraction
    4. Data synthesis and analysis
  2. Results
    1. Stroke apps
    2. Musculoskeletal apps
    3. Spinal cord injury apps
    4. Traumatic brain injury apps
    5. Cardiac apps
    6. Pulmonary apps
    7. Neurological apps
    8. Cancer and pain apps
    9. Nonspecific and general rehab apps
    10. Measurement tools apps
    11. Study designs and quality
  3. Discussion
    1. Emergent themes
    2. Study limitations
    3. Future recommendations
    4. Integration potential and barriers
    5. Factors that will impact integration
    6. Regulation of medical mobile applications
  4. Conclusions
  5. Supplementary data
  6. References



To conduct systematic review to better define how medical mobile applications (apps) have been used in environments relevant to physical medicine and rehabilitation.

Data Sources


Study Selection

A 10-year date limit was used, spanning publication dates from June 1, 2006, to June 30, 2016. Terms related to physical medicine and rehabilitation as well as mobile apps were used in 10 individual search strategies.

Data Extraction

Two investigators screened abstracts and applied inclusion and exclusion criteria. Full-length articles were retrieved. Duplicate articles were removed. If a study met all criteria, the article was reviewed in full.

Data Synthesis

Specific variables of interest were extracted and added to summary tables. Summary tables were used to categorize studies according themes, and a list of app features was generated.


The search yielded abstracts from 8116 studies, and 102 studies were included in the systematic review. Approximately one-third of the studies evaluated apps as interventions, and the remaining two-thirds of the studies assessed functioning of the app or participant interaction with the app. Some apps may have positive benefits when used to deliver exercise or gait training interventions, as self-management systems, or as measurement tools.

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via Systematic Review of Mobile Health Applications in Rehabilitation – Archives of Physical Medicine and Rehabilitation


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[Abstract] Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription


The purpose of this paper is to discuss how knowledge of the biomechanics of walking can be used to inform the prescription of resistance exercises for people with mobility limitations. Muscle weakness is a key physical impairment that limits walking in commonly occurring neurological conditions such as cerebral palsy, traumatic brain injury and stroke. Few randomised trials to date have shown conclusively that strength training improves walking in people living with these conditions. This appears to be because

1) the most important muscle groups for forward propulsion when walking have not been targeted for strengthening, and

2) strength training protocols have focused on slow and heavy resistance exercises, which do not improve the fast muscle contractions required for walking.

We propose a theoretical framework to improve exercise prescription by integrating the biomechanics of walking with the principles of strength training outlined by the American College of Sports Medicine (ACSM), to prescribe exercises that are specific to improving the task of walking. The high angular velocities that occur in the lower limb joints during walking indicate that resistance exercises targeting power generation would be most appropriate. Therefore, we propose the prescription of plyometric and ballistic resistance exercise, applied using the ACSM guidelines for task-specificity, once people with neurological conditions are ambulating, to improve walking outcomes. This new theoretical framework for resistance training ensures that exercise prescription matches how the muscles work during walking.

via Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription – Archives of Physical Medicine and Rehabilitation

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[BOOK] White Book on Physical and Rehabilitation Medicine in Europe. Introductions, Executive Summary, and Methodology. – Full Text PDF

The White Book (WB) of Physical and Rehabilitation Medicine (PRM) in Europe is produced by the 4 EuropeanPRM Bodies (European Academy of Rehabilitation Medicine – EARM, European Society of PRM – ESPRM, European Union of Medical Specialists – PRM Section, European College of PRM-ECPRM served by the European Union of Medical Specialists-PRM Board) and constitutes the reference book for PRM physicians in Europe. It has now reached its third edition; the first was published in 1989 and the second in 2006/2007. The WB has multiple purposes, including providing a unifying framework for European countries, to inform decision-makers on European and national level, to offer educational material for PRM trainees and physicians and information about PRM to the medical community, other rehabilitation professionals and the public. The WB states the importance of PRM, a primary medical specialty that is present all over Europe, with a specific corpus disciplinae, a common background and history throughout Europe. PRM is internationally recognized and a partner of major international bodies, including the World Health Organization (WHO). PRM activities are strongly based on the documents of the United Nations (UN) and WHO, such as the Convention of the Rights of Persons with Disabilities (2006), the World Report on Disability (2011), the WHO Global Disability Action Plan 2014-2021 (2014) and the WHO initiative “Rehabilitation 2030: a call for action” (2017). The WB is organized in 4 sections, 11 chapters and some appendices. The WB starts with basic definitions and concepts of PRM and continues with why rehabilitation is needed by individuals and society. Rehabilitation focuses not only on health conditions but also on functioning. Accordingly, PRM is the medical specialty that strives to improve functioning of people with a health condition or experiencing disability. The fundamentals of PRM, the history of the PRM specialty, and the structure and activities of PRM organizations in Europe are presented, followed by a thorough presentation of the practice of PRM, i.e. knowledge and skills of PRM physicians, the clinical field of competence of PRM, the place of the PRM specialty in the healthcare system and society, education and continuous professional development of PRM physicians, specificities and challenges of science and research in PRM. The WB concludes with the way forward for the specialty: challenges and perspectives for the future of PRM.

via White Book on Physical and Rehabilitation Medicine in Europe. Introductions, Executive Summary,… – Abstract – Europe PMC


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[White Book] White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development: shaping the future of PRM – Full Text PDF

In the context of the White Book of Physical and Rehabilitation Medicine (PRM), this paper deals with the education of PRM physicians in Europe. To acquire the wide field of competence needed, specialists in Physical and Rehabilitation Medicine have to undergo a well organised and appropriately structured training of adequate duration. In fact they are required to develop not only medical knowledge, but also competence in patient care, specific procedural skills, and attitudes towards interpersonal relationship and communication, profound understanding of the main principles of medical ethics and public health, ability to apply policies of care and prevention for disabled people, capacity to master strategies for reintegration of disabled people into society, apply principles of quality assurance and promote a practice-based continuous professional development. This paper provides updated detailed information about the education and training of specialists, delivers recommendations concerning the standards required at a European level, in agreement with the UEMS rules of creating a Common Training Framework, that consists of a common set of knowledge, skills and competencies for postgraduate training. The role of the European PRM Board is highlighted as a body aimed at ensuring the highest standards of medical training and health care across Europe and the harmonization of PRM physicians’ qualifications. To this scope, the theoretical knowledge necessary for the practice of PRM specialty and the core competencies (training outcomes) to be achieved at the end of training have been established and the postgraduate PRM core curriculum has been added. Undergraduate training of medical students is also focused, being considered a mandatory element for the growth of both PRM specialty and the medical community as a whole, mainly in front of the future challenges of the ageing population and the increase of disability in our continent. Finally, the problems of continuing professional development and medical education are faced in a PRM European perspective, and the role of the European Accreditation Council of Continuous Medical Education (EACCME) of UEMS is outlined.

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via White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development: shaping the future of PRM – European Journal of Physical and Rehabilitation Medicine 2018 April;54(2):279-86 – Minerva Medica – Journals

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[Abstract] Understanding community-based rehabilitation and the role of physical and rehabilitation medicine

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Community-based rehabilitation (CBR) is an accepted model to improve the delivery of rehabilitation in the community. It includes the access to health care, education, labor and accessible environments. The role of Specialists in Physical and Rehabilitation Medicine in this strategy (SPRM) is not very well defined. On the occasion of the international consultation for the WHO Action Plan for persons with disabilities, a discussion about the meaning of CBR and the role of SPRM on CBR has occurred among the International Society of Physical and Rehabilitation Medicine (ISPRM) members. The following major questions were identified; what is CBR? What is the role of Specialists in Physical and Rehabilitation Medicine (SPMR) in CBR? A review of the literature and a discussion among experts was held to answer these questions. It is of major importance to distinguish between the two concepts of CBR: The first one is the policy or management strategy of CBR that was developed by WHO about 30 years ago. The second one is the provision of basic rehabilitation services offered at the community level. CBR strategy must also addresses the need for optimal access to specialized rehabilitation services and will have a key role in the design and building of so-called “Basic Rehabilitation Services.” The authors proposed a scheme, which integrates all relevant aspects surrounding the concept of CBR; levels of care rehabilitation services and the roles proposed for SPRM. In addition, the convention for the rights of persons with disabilities and the conceptual framework of the ICF was taken into account.

via Understanding community-based rehabilitation and the role of physical and rehabilitation medicine – European Journal of Physical and Rehabilitation Medicine 2018 February;54(1):90-9 – Minerva Medica – Journals

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[Abstract] Knowledge Translation: The Bridging Function of Cochrane Rehabilitation


Cochrane Rehabilitation is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice and take decisions according to the best and most appropriate evidence in this specific field, combining the best available evidence as gathered by high-quality Cochrane systematic reviews, with their own clinical expertise and the values of patients. This mission can be pursued through knowledge translation.

The aim of this article is to shortly present what knowledge translation is, how and why Cochrane (previously known as Cochrane Collaboration) is trying to reorganize itself in light of knowledge translation, and the relevance that this process has for Cochrane Rehabilitation and in the end for the whole world of rehabilitation. It is well known how it is difficult to effectively apply in everyday life what we would like to do and to apply the scientific knowledge in the clinical field: this is called the know-do gap.

In the field of evidence-based medicine, where Cochrane belongs, it has been proven that high-quality evidence is not consistently applied in practice. A solution to these problems is the so-called knowledge translation.

In this context, Cochrane Rehabilitation is organized to provide the best possible knowledge translation in both directions (bridging function), obviously toward the world of rehabilitation (spreading reviews), but also to the Cochrane community (production of reviews significant for rehabilitation). Cochrane is now strongly pushing to improve its knowledge translation activities, and this creates a strong base for Cochrane Rehabilitation work, focused not only on spreading the evidence but also on improving its production to make it more meaningful for the world of rehabilitation.


via Knowledge Translation: The Bridging Function of Cochrane Rehabilitation – ScienceDirect

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[Abstract] Efficacy of robot-assisted rehabilitation to functional recovery upper limb in post stroke patients: a randomized controlled study. – Eur J Phys Rehabil Med.



We evaluated the effectiveness of robotic-assisted motion and activity in additional to Physical and Rehabilitation Medicine (PRM), of the upper limb in post stroke inpatients.


A randomized controlled trial. Fifty-four patients, 57% female (mean ± SD age: 71 ±12 years), with upper limb function defecit post stroke. The experimental group received a passive mobilization of the upper limb through the robotic device ARMEO Spring and the control group received PRM for 6 consecutive weeks (5 days/week) in addition to traditional PRM. We assessed the impact on functional recovery (Functional Independence Measure-FIM scale), strength (ARM Motricity Index-MI), spasticity (Modified Ashworth Scale-MAS) and pain (Numeric Rating Pain Scale -NRPS). All patients were evaluated by a blinded observer using the outcomes tests at enrollment (T0), after the treatment (T1) and at follow up 6 weeks later (T2).


Both control and experimental groups evidenced an improvement of the outcomes after the treatment (Motricity Index, Ashworth and NRPS with p<0.05). The experimental group showed further improvements after the follow up (all outcomes with p<0.01).


In the treatment of pain, disability and spasticity in upper limb after stroke, robot-assisted mobilization associated to PRM is as effective as traditional rehabilitation.

Source: Efficacy of robot-assisted rehabilitation to functional recovery upper limb in post stroke patients: a randomized controlled study. – PubMed – NCBI

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[Abstract] Home-based telesurveillance and rehabilitation after stroke: a real-life study



Home-based telesurveillance and rehabilitation after stroke: a real-life studyBackground: After discharge from in-hospital rehabilitation, post-stroke patients should have the opportunity to continue the rehabilitation through structured programs to maintain the benefits acquired during intensive rehabilitation treatment.

Objective: The primary objective was to evaluate the feasibility of implementing an home-based telesurveillance and rehabilitation (HBTR) program to optimize the patient’s recovery by reducing dependency degree.

Method: Post-stroke patients were consecutively screened. Data were expressed as mean ±  standard deviation (SD). 26 patients enrolled: 15 were sub-acute (time since stroke: 112 ± 39 days) and 11 were chronic (time since stroke: 470 ± 145 days). For 3 months patients were followed at home by a nurse-tutor, who provided structured phone support and vital signs telemonitoring, and by a physiotherapist (PT) who monitored rehabilitation sessions by videoconferencing.

Results: 23 patients completed the program; 16.7 ± 5.2 phone contacts/patient were initiated by the nurse and 0.9 ± 1.8 by the patients. Eight episodes of atrial fibrillation that required a change in therapy were recorded in two patients. Physiotherapists performed 1.2 ± 0.4 home visits, 1.6 ± 0.9 phone calls and 4.5 ± 2.8 videoconference-sessions per patient. At least three sessions/week of home exercises were performed by 31% of patients, two sessions by 54%. At the end of the program, global functional capacity improved significantly (P < 0.001), in particular, static (P < 0.001) and dynamic (P = 0.0004) postural balance, upper limb dexterity of the paretic side (P = 0.01), and physical performance (P = 0.002). Symptoms of depression and caregiver strain also improved.

Conclusion: The home-based program was feasible and effective in both sub-acute and chronic post-stroke patients, improving their recovery, and maintaining the benefits reached during inpatient rehabilitation

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Source: Taylor & Francis Online

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