Dr. Becker Rhein-Sieg Clinic

BackgroundBetween 1957 and 1961 the substance Thalidomide was sold in West Germany and taken by many women as a sedative during pregnancy. This lead to miscarriages and infants been born with several severe malformations. The aim of this study was to describe the current situation of women impaired by Thalidomide induced embryopahty in North Rhine-Westphalia (Nordrhein-Westfalen), Germany, in comparison with the results found in a study done in 2002 by Nippert et al.MethodsQuestionnaires as well as examinations were performed. Data were compared using descriptive and inductive statistical methods.ResultsBoth studies show that women impaired by Thalidomide embryopathy face a poorer health status than women their age in the general population and live in fear of further deteriorating health. The majority can only work reduced hours or are already retired due to poor health. Most of those who need assistance are being assisted by their social environment, while professional care is still utilized in only few cases.ConclusionsAn obvious need for a shift in the provision of assistance and/or care provided was found as the social environment supporting the impaired women is also aging and therefore in high danger of breaking apart.Trial registrationThe study has been registered at German Clinical Trials Register, DRKS00010593, on 07.06.2016 retrospectively.

In the present study patients with an osteoporotic fracture were examined in order to determine how many patients decided to continue their therapy as outpatients having taken part in osteoporosis training at the Dr. Becker Rhein-Sieg Clinic. Patients who had previously suffered an osteoporotic fracture and thereafter received inpatient rehabilitation were selected for the study. Patients (n= 95) who had taken part in inpatient rehabilitation after an osteoporotic fracture were approached either via telephone or mail and were then followed up after 6 and 12months with regard to their adherence to the treatment. From a total of 95patients, after 6 months 82 % (n= 78) were contacted successfully and included in the study. 68 out of 78patients (72 %) had continued their medication. After 1 year 76 % of patients (n= 72) were successfully contacted once. Here, 62 % of patients (n= 59) had continued their medication under medical supervision. In the 1‑year follow-up period there were eight cases of falls, and one of these resulted in a peripheral fracture, which was treated conservatively. Osteoporosis-specific information and osteoporosis training of patients after osteoporotic fracture are important tools to improve the motivation and compliance of patients. One possibility to realize this is osteoporosis-specific training with video presentations and individual care and education of the patients within outpatient or inpatient rehabilitation.

Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.

In the literature many studies can be found addressing the effectiveness of individual measures and therapies within the medical rehabilitation. The duration of the rehabilitation itself is rarely taken into account. Consequently the duration of postoperative inpatient medical rehabilitation after initial implantation of alloarthroplastic hip and knee replacements in osteoarthritis of the hip or knee was the object of our analysis. In the present prospective study 100 patients each with osteoarthritis of the hip or knee were presented at a follow-up treatment postoperatively after primary implantation of alloarthroplastic hip and knee replacements. Two different scores were used (Staffelstein score, Lequesne score), which were collected at a weekly follow-up (T1-T4) to determine the degree of mobility in the initial examination of the patient and after three weeks. By setting a target score at admission of the patient to the CSO, which stood for achieving the rehabilitation objective, the rehabilitation period could be changed individually. Our study showed that the highest rehabilitation progress has been achieved in both the total hip replacement and total knee replacement in patients at the end of the second week of rehabilitation (T2-T3). Thus, in the Staffelstein score 74 % (n = 74) of hip replacement patients and 46 % (n = 46) of knee replacement patients had already reached their rehabilitation aim between T2 and T3. From the third week on there was a marked flattening of the rehabilitation progress. Also the Lequesne scores obtained confirmed these results. Based on the score-driven detection of mobility degree of rehabilitation at the beginning of the follow-up treatment, the individual design of the rehabilitation process with the active participation of the patient is possible. In a large number of cases a reduction of the rehabilitation period can be achieved to less than 21 days. This finding is particularly important in times of limited financial resources, because the saved resources can be used for other rehabilitation groups. Therefore, in a greater number of patients, a shortening of the duration of the rehabilitation is possible.

Die Fluorose (Synonym: fluorinduzierte Osteoidose) ist eine durch eine lang andauernde Fluorexposition induzierte Knochenstoffwechselstorung (endogene toxische Osteopathie).

Bei kaum einer anderen Operation ist der langfristige Therapieerfolg so entscheidend von einer fachgerechten Nachbehandlung abhangig wie beim alloplastischen Gelenkersatz [6, 20]. Dies gilt ohne Abstriche auch fur den Endoprothesenwechseleingriff. Wie bei der Erstimplantation einer Huftprothese sollte auch bei der Huftprothesenwechseloperation die Rehabilitation unmittelbar postoperativ beginnen. Ideal ist ein Beginn schon vor der Operation, um Kontrakturen des Huftgelenks bzw. huftgelenknaher Muskeln sowie Insuffizienzen der Becken-Bein-Muskulatur zu mindern. Diese Patienten konnen die Operationsfolgen deutlich besser verkraften [10, 18] und zeigen in der Regel auch einen zugigeren und komplikationsarmeren Rehabilitationsverlauf. Dies ist gerade bei dem im Vergleich zur Erstimplantation im Durchschnitt deutlich alteren Patientenklientel mit Huftprothesenwechseloperation von groser Bedeutung. Dieses praoperative Ubungsprogramm sollte neben physiotherapeutischen Elementen auch eine Schulungseinheit umfassen, in der der Patient uber die besonderen Risiken der Huftprothesenwechseloperation intensiv aufgeklart wird (ie240-01 Tabelle 8.1).