The suspension of facility-based rehabilitation services and restricted mobility at the onslaught of the coronavirus disease 2019 (COVID-19) pandemic forced healthcare workers to explore new methods of providing patient care. This case report presents a 40-year-old female who underwent osteotomy with iliac crest bone graft and intramedullary nailing with quadricepsplasty to correct the leg length discrepancy and knee extension contracture that developed secondary to multiple bone injuries sustained in a vehicular accident 17 months before admission. The in-hospital postoperative rehabilitation was prematurely terminated due to the COVID-19 lockdown. The client was discharged with pain and swelling of the right lower limb, knee flexion of 0–25°, and an ankle plantar flexion contracture. She had moderate to severe difficulty in walking, bathing, toileting, and lower garment dressing, needing assistance to complete these tasks. Telerehabilitation was done over three months using both synchronous and asynchronous methods. Gains from the remote program were independence in all the self-care activities with no difficulty in performing them. The patient was able to return to work. Gains in knee and ankle mobility were minimal. Telerehabilitation using available technologies can be used to continue patient care amidst barriers to face-to-face rehabilitation in a low-resource country
Telerehabilitation ; Telemedicine ; COVID-19 ; Osteotomy

Coronavirus disease 2019 (COVID-19) caused unprecedented disruptions in the lives of people, inducing a change in social behavior because of quarantine and physical distancing measures for health safety. It greatly affected not only the general population but also the healthcare system, forcing healthcare providers and consumers to adjust from the traditional mode of in-person consultation to telemedicine to enable safe and prompt delivery of adequate and efficient patient care. A 35-year-old female was diagnosed with acromegaly secondary to pituitary macroadenoma, presenting as a 10-year history of weight gain, amenorrhea, hand and feet enlargement, coarse facial features, and bilateral vision loss. Patient then underwent craniotomy, right petrosal cranialization of frontal sinus, and tumor excision during the height of the pandemic in a COVID-19 referral center. Post-operatively, she was assisted in all activities of daily living. She was discharged after a few days of in-patient rehabilitation in order to decrease risk of contracting COVID-19. Telerehabilitation was then done using both asynchronous and synchronous methods while the patient stayed at home. Given the patient’s functional and visual disabilities, it was a challenge to do the traditional telerehabilitation techniques that highly rely on intact visual senses. We hereby share our experiences in providing virtual care amid these challenges towards achieving the patient’s optimal rehabilitation goals.

BACKGROUND

The Philippine General Hospital (PGH) is a tertiary government hospital that serves as the national referral center for Filipinos from across the country. In partnership with Latter-Day Saint Charities (LDSC), PGH has been serving patients in need of mobility devices, such as wheelchairs, through in-person services from screening to assessment, measurement, assembly, fitting, and mobility training. Given the patients’ barriers to in-person follow-up consultations, regular healthcare provision has been challenging. The use of telerehabilitation, a form of telemedicine, has emerged as a practical and innovative solution, but it needs further evaluation.

The study aimed to determine the wheelchair recipients’ perceived barriers to in-person and virtual follow-up consultations.

This cross-sectional study involved a purposive sample of 413 patients who received a wheelchair from the LDSC through PGH. An original survey was prepared to determine patients’ perceived barriers to actual in-person and potential virtual follow-up consultations. Consent was obtained prior to data collection. After the pretest and pilot testing were conducted, the final version of the survey was administered either electronically or through individual phone interviews. Descriptive statistics was used to analyze and present the data.

A total of 113 wheelchair recipients participated, with an average of 42.9 years of age. The majority resided outside Metro Manila (53.1%), and 86.7% were within the income bracket of less than PhP 9,520 per month. The majority received a standard type of wheelchair (85.8%). The top 3 reasons hindering compliance to in-person consultation follow-ups were accessibility issues (82.3%), costs of travel (79.6%), and distance to hospital/wheelchair assessor (71.7%). With respect to potential virtual follow-ups, 72% expressed willingness to experience telemedicine/telerehabilitation in the future, despite having neither prior awareness (50.4%) nor experience (74.3%) of it. The majority had access to mobile phones (98.2%), and 67% had stable internet access.

The main barriers to in-person follow-ups were related to accessibility, costs, and travel. Telehealth or telerehabilitation in particular, despite patients’ interest and willingness to try it, still has yet to be optimized in our country. Internet connectivity can still be improved, as well as our stakeholders’ level of telehealth awareness. Future efforts to improve and sustain the uptake of telehealth solutions are recommended, as well as studies comparing the cost-effectiveness of in-person versus virtual consultations especially among persons with lived experiences of disability.

BACKGROUND AND OBJECTIVE

The Gross Motor Function Classification System – Expanded and Revised (GMFCS-E&R) is a valid tool commonly used by physicians, therapists, and potentially also by other healthcare workers even at the primary care and grassroots levels to facilitate immediate screening, appropriate referral, and management of children with disability needing mobility devices. As Filipinos comprise one of the largest diaspora populations, this study aimed to provide a Filipino version of the GMFCS-E&R and determine its internal consistency and inter- and intra-rater reliability.

A multidisciplinary group of rehabilitation professionals at Philippine General Hospital worked with linguists to translate the original English GMFCS-E&R to Filipino/Tagalog, the Philippines’ official language. Several steps were done: authorization from the original tool developers (CanChild™); forward and backward translations; semantic analysis; content analysis; pilot testing; and submission of final version to CanChild™. Internal consistency and inter- and intra-rater reliability were determined.

The Filipino GMFCS-E&R translation was formulated and underwent several modifications. The final version yielded high internal consistency (Cronbach’s alpha: 0.96) and inter- and intra-rater reliability (interclass correlation coefficients: 0.895 and 0.928, respectively).

The Filipino GMFCS-E&R is a reliable tool for use among pediatric Filipino patients for communication, clinical decision-making, registries, and research.

Background. Stroke remains a leading cause of death and disability in the Philippines, rendering its survivors unable to cope well with activities of daily living, including sexual functioning. Sexual dysfunction is an under-recognized complication post-stroke, and mobility and communication barriers among those with aphasia can further contribute to sexual dysfunction, potentially affecting their quality of life.

Objective. To determine the changes in sexual functioning among patients with aphasia and the communication methods they used to compensate for language and communication deficits.

Method. This was a descriptive cross-sectional study involving patients (?30 years old, with 1 episode of stroke, with non-fluent aphasia) and their respective sexual partners. Data were gathered using a clinician-administered questionnaire based on previous studies. Outcomes included changes in libido, coital frequency, time of resumption of sexual activity, erectile/ orgasmic ability, sexual satisfaction, and alternative methods of communication.

Results. Forty participants were included comprising of 20 patients with aphasia and their respective sexual partners. There was a decline in sexual activity among the couples, with reduced frequency of sexual intercourse. Both patients and partners reported difficulties in expressing the desire for sexual activities, hindering initiation. There was noted difficulty in ascertaining the sexual experience of patients with aphasia (i.e., whether pleasure or pain), hindering maintenance and enjoyment of the sexual act. In response to the difficulties mentioned above, sexual innuendoes as communication strategies were described by the couples.

Conclusion. The study provides baseline local data on changes in sexual functioning among stroke patients with nonfluent aphasia and their sexual partners. Sexual rehabilitation is recommended in the holistic management of patients with aphasia to train couples develop compensatory techniques to adjust to the changes in their sexual lives.

Objectives: The objective of this study was to determine the coping strategies and job satisfaction among rehabilitation medical and paramedical staff deployed to different areas at the University of the Philippines Manila Philippine General Hospital, a designated COVID-19 referral center. Method: This was a cross-sectional study that utilized total population sampling of the medical and paramedical staff of the Department of Rehabilitation Medicine deployed to other areas in PGH and who carried out non-rehabilitation-related clinical work responsibilities during the COVID-19 pandemic. Electronic informed consent was obtained from each participant. Two sets of validated and reliable self-administered online questionnaires, namely, the Brief Coping Orientation to Problems Experienced (COPE) Inventory Tool and Satisfaction of Employee in Health Care (SEHC) Survey, were used to determine coping strategies and work satisfaction, respectively. Descriptive statistics (such as frequencies, percentages, ranges, means) were used to present the data. Results: A total of 50 medical and paramedical staff participated in the study. The participants’ age ranged from 22 to 60 years (mean: 30.2 ± 8.7). The majority were single (84%), women (64%), and with a Bachelor of Science degree. Most of the participants were assigned in the orange zone, which included the COVID ward nurses’ station and donning/doffing areas; with 30% who rotated in the COVID wards. There were three types of coping strategies utilized by the department staff: (1) emotion-focused coping, (2) problem-focused coping, and (3) dysfunctional coping. Problem-focused coping was the most common general strategy (mean COPE score for all problem-focused strategies, 3.1 ± 0.9). Acceptance was the most common specific coping strategy, followed by active coping and a tie among positive reframing, planning, and self-distraction. The work satisfaction rate was at 76.9% ± 13.2. Three out of 4 participants would recommend their workplace to other healthcare workers. Conclusion The medical and paramedical staff of the Department of Rehabilitation Medicine in a COVID referral center had relatively high job satisfaction despite their health risks and changes in responsibilities among others. The majority utilized functional coping strategies to help them adapt to the work demands. The sources of motivation and values of the staff are areas for future research to help explain their positive outlook about their jobs and generally high recommendation about their workplace in the middle of the COVID-19 crisis.
Job Satisfaction ; Health Personnel

Pelvic sarcomas are rare malignancies that can result in extensive surgeries involving bone and soft tissue resection, which can greatly improve with rehabilitation. However, due to the restrictions brought about by the COVID-19 pandemic, the rehabilitation of patients with pelvic sarcomas was affected. Limited information is also presented in the literature regarding the rehabilitation of patients with lower extremity surgeries undergoing telerehabilitation and during a pandemic. This study presents the rehabilitation process of a 43-year-old woman diagnosed with pelvic round cell sarcoma of the right gluteal area during the COVID-19 pandemic. The patient underwent wide excision, buttockectomy and internal hemipelvectomy, and we measured outcomes using the Tinetti assessment tool (TAT) and Lower Extremity Functional Scale (LEFS). A decreased risk of falls and improved functional performance were recorded using the TAT and LEFS respectively. Telerehabilitation was noted to have a good satisfaction rate among the patient and health workers. Telerehabilitation may be an effective alternative to face-to-face therapy during the COVID-19 pandemic. More studies are needed to look into the conduct of telerehabilitation intervention among patients with bone and soft tissue surgeries.
Telerehabilitation

Patients with burns are predisposed to heterotopic ossification and contracture formation. While radiographs and bone scans are used to detect heterotopic ossification, musculoskeletal ultrasound can be used to diagnose and localize the lesion in patients with contractures. A 14-year-old girl with multiple contractures of the limbs from thermal burn injury sustained three years ago underwent in-patient rehabilitation in a sub-acute burn rehabilitation unit. Despite close monitoring and daily therapy sessions, the patient had minimal improvement in the range of motion of bilateral hips. Musculoskeletal ultrasound demonstrated hyperechogenic focus on the posterolateral aspect of the bilateral hips. This report documents the advantage of diagnostic musculoskeletal ultrasound in localizing and guiding the treatment of heterotopic ossification in a burn patient with contractures.
Diagnostic Imaging ; Ossification, Heterotopic ; Burns ; Rehabilitation ; Pediatrics

Neuropathic pain has been described following an electrical injury, whether as an immediate response or a late-onset sequela. There is much information on high-voltage injuries in literature due to its dramatic presentation, but limited studies on low-voltage injuries. However, low-voltage injuries can be as diverse and may have symptoms varying from minimal cutaneous involvement to full-thickness injury. Significant injuries may result from multiple factors, including prolonged duration of exposure and a higher amount of current transmitted. We illustrate an atypical presentation of a low-voltage injury in a 17-year-old female. The patient had a low voltage electrical injury with no cutaneous burn noted on the affected extremity. She initially presented with allodynia, which seemed disproportionate to the clinical findings expected in a low-voltage injury. The patient underwent an electrodiagnostic study, which showed cervical polyradiculopathy (C5, C6, C7 polyradiculopathy) and neuromusculoskeletal ultrasonology, which showed enlarged right C5 nerve root. Medical management, daily physical and occupational therapies, and psychological management, were instituted, which resulted in significant improvement of the patient’s pain level and functional status. We describe the importance of the multimodal approach (medical and rehabilitation) in managing this atypical case.
Hyperalgesia ; Pain Management

After two years of the Coronavirus Disease 2019 (COVID-19) pandemic, cases have generally begun to decline in the different regions of the world, and consequently a lot of people are gradually returning to face-to-face interactions, including health-related activities. Based on scarce local literatures published recently, telerehabilitation was envisioned to be a viable solution to bridge the perennial gaps in the delivery of rehabilitation services across the Philippine archipelago, such as the lack of manpower and resources, aggravated by the pandemic.
Delivery of Health Care ; Telemedicine ; Telerehabilitation ; COVID-19 ; Developing Countries