SYNOPSIS: Neck pain, headache, and/ or orofacial symptoms are potentially the first (nonischemic) symptoms of an underlying vascular pathology or blood flow limitation. If an underlying vascular pathology or blood flow limitation is not recognized by the musculoskeletal rehabilitation clinician, it can subsequently be aggravated by treatment, raising the risk of serious adverse events. We argue that clinicians can make an important, and potentially lifesaving, difference by providing specific information and advice. This is especially the case in patients with an intermediate level of concern, for example, in patients who only show a few concerning features regarding a possible underlying serious condition and for whom an initial vasculogenic hypothesis was rejected during the clinical reasoning process. We present background information to help the reader understand the context of the problem and suggestions for how clinicians can provide appropriate information and advice to patients who present with neck pain, headache, and/or orofacial symptoms.
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Het ondergaan van een eenzijdige beenamputatie is een drastische chirurgische ingreep. Mensen, die na een amputatie in staat zijn om te lopen met een prothese, zijn functioneel onafhankelijker, en hebben een hogere kwaliteit van leven dan mensen die in een rolstoel belanden. Het is daarom niet verrassend dat het herwinnen van de oopvaardigheid één van de voornaamste doelen is tijdens de revalidatie. Doel van het onderzoek was om inzicht te krijgen in de factoren die het herwinnen en onderhouden van de loopvaardigheid van mensen na een beenamputatie beïnvloeden. Gebaseerd op de resultaten van het onderzoek kan geconcludeerd worden dat de fysieke capaciteit hierbij een belangrijke rol speelt. Een relatief kleine verbetering in de capaciteit kan al resulteren in significante en klinisch relevante verbeteringen. Hoewel geavanceerde prothesen de mechanische belasting van het lopen met een beenprothese verminderen, kan een ineffectieve balanscontrole deze positieve resultaten weer tenietdoen. ABSTRACT Undergoing a lower limb amputation is a life-changing surgery. The ability to walk greatly influences the subject's functional independence and quality of life. Not surprisingly, regaining walking ability is one of the primary goals during prosthetic rehabilitation. The primary aim of the research performed was to enhance our understanding of some of the factors that influence the ability to regain and maintain walking after a unilateral lower limb amputation. Based on the results we can deduce that a person's physical capacity plays an important role in their walking ability. Relatively small improvements in capacity could lead to significant and clinically relevant improvements in people's walking ability. Furthermore, results show that sophisticated prosthetic feet can reduce the mechanical load experienced when walking with a prosthesis. Interestingly, inefficient balance control strategies can undo any positive effect of these prostheses.
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BACKGROUND: Orthopaedic Manual Therapy (OMT) is a specialized area of physiotherapy for the management of neuromusculoskeletal conditions. Although rare, adverse events after OMT are reported in literature. In 2020, the International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to OMT Intervention was presented.OBJECTIVE: To evaluate the knowledge and implementation status of OMT educational programmes regarding the 2020 International IFOMPT Cervical Framework.METHODS: An international survey with closed- and open-ended questions was conducted among all IFOMPT educational programmes using an online survey. Formal informed consent was requested at the beginning of the survey and all data were collected anonymously.RESULTS: Thirty-nine educational programmes filled in the survey. Twenty-four programmes (61.5%) had already implemented the new Framework. Four programmes (10.3%) answered that they will not implement the new Framework in their educational programme. Positional testing will be kept in about 54% of the programmes. Craniovertebral ligament testing will be kept in about 90% of the programmes. A considerable number of educational programmes still teach end range manipulations in the middle and lower cervical spine (33.3%) and upper cervical spine (25.5%).CONCLUSIONS: The dissemination and implementation of the International IFOMPT Cervical Framework among educational programmes has been successful. However, although positional testing and craniovertebral ligament testing are excluded from the Framework, most educational programmes will keep these tests in their curriculum, which raises some concern regarding the success and impact of international consensus frameworks.
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