Performance-Based Versus Self-Reported Outcomes Using the Hip Disability and Osteoarthritis Outcome Score After Total Hip Arthroplasty.
Dayton, Michael R.; Judd, Dana L.; Hogan, Craig A.; Stevens-Lapsley, Jennifer E., 2015-08-07 08:00:00 AM
Objective: The purpose of this study was to explore the relationship between patients' self-reported and performance-based function after total hip arthroplasty (THA). Design: Twenty-three patients (age, 61.4 +/- 8.3 yrs) undergoing primary THA for hip osteoarthritis participated. Self-reported function and recovery was measured using the Hip Disability and Osteoarthritis Outcome Score activities of daily living and pain subscales. Performance-based functional measures included the timed up and go test, the stair climbing test, and the 6-minute walk test. Outcome measures were assessed preoperatively and postoperatively at 1 and 6 mos. Results: One month after THA, performance-based function declined compared with baseline as follows: timed up and go test, -22.1% +/- 25.4%; stair climbing test, -58.5% +/- 63.6%; and 6-minute walk test, -22.6% +/- 31.7%. In contrast, self-reported function on the Hip Disability and Osteoarthritis Outcome Score Activities of Daily Living significantly improved 1 mo after THA compared with baseline: 40.8% +/- 33.3%. One to 6 mos after THA, there were significant improvements in timed up and go test, stair climbing test, and 6-minute walk test, which paralleled improvements on the Hip Disability and Osteoarthritis Outcome Score subscales, although changes were not significantly correlated. Conclusion: The disparity between changes in Hip Disability and Osteoarthritis Outcome Scores and functional performance postoperatively suggests that patients may overestimate their functional capacity early after THA, likely in response to pain improvements over the same time period. Therefore, outcomes assessment after THA should include both self-report and performance-based functional measures. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Active-Arm Passive-Leg Exercise Improves Cardiovascular Function in Spinal Cord Injury: A Case Report.
West, Christopher R.; Currie, Katharine D.; Gee, Cameron; Krassioukov, Andrei V.; Borisoff, Jaimie, 2015-08-07 08:00:00 AM
In a 43-yr-old male subject with a chronic T3 AIS A spinal cord injury, the acute cardiorespiratory responses to active upper-extremity exercise alone and combined active-arm passive-leg exercise (AAPLE) were investigated, along with the cardiorespiratory, cardiac, vascular, and body composition responses to a 6-wk AAPLE interval training intervention. AAPLE elicited superior acute maximal cardiorespiratory responses compared with upper-extremity exercise alone. In response to a 6-wk interval training regimen, AAPLE caused a 25% increase in peak oxygen uptake, a 10% increase in resting stroke volume, and a 4-fold increase in brachial artery blood flow. Conversely, there were no changes in femoral arterial function, body composition, or bone mineral density in response to training. As a potential clinical intervention, AAPLE may be advantageous over other forms of currently available exercise, owing to the minimal setup time and cost involved and the nonreliance on specialized equipment that is required for other exercise modalities. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effects of Transcutaneous Electrical Nerve Stimulation at Two Frequencies on Urinary Incontinence in Poststroke Patients: A Randomized Controlled Trial.
Liu, Yi; Xu, Gang; Luo, Ming; Teng, Hong-fei, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to compare the effects of two frequencies of transcutaneous electrical nerve stimulation (TENS) on urinary incontinence caused by stroke. Methods: Eighty-one patients with poststroke urinary incontinence were recruited and randomized into the following three groups with a 1:1 ratio: a 20-Hz TENS group, a 75-Hz TENS group, and a no-treatment control group (n = 27 per group). TENS currents were biphasic square waves with pulse durations of 150 [mu]secs and pulse frequencies of 20 Hz or 75 Hz and were applied for 30 mins once per day for 90 days. The positive electrodes were placed in the region of the second sacral level on opposite sides of the vertebral column; the negative electrodes were placed on the inside of the middle and lower third of the junction between the posterior superior iliac spine and the ischial node. Overactive Bladder Symptom Scores, Barthel Index, urodynamic values, and voiding diary parameters were assessed before and after 90 days. Results: The patients treated with 20 Hz had superior Overactive Bladder Symptom Scores, Barthel Index totals, urodynamic values, and voiding diary parameters (P < 0.05). In the 75-Hz group, values were statistically improved compared with the no-treatment group (P < 0.05), but the results were significantly inferior to those of the 20-Hz group (P < 0.05). Conclusions: Twenty-hertz TENS improved incontinence symptoms and promoted activities of daily living better than 75-Hz TENS. These results will aid future research regarding TENS parameters. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Residency and Beyond: Subspecialization Trends Among Graduating Physiatry Residents and the Musculoskeletal Curriculum.
Yang, Aaron Jay; Brakke, Rachel A.; Boimbo, Sandra; Sauerwein, Kelly; Coronado, Rogelio A.; Schumacher, Alexandra, 2015-08-07 08:00:00 AM
Previous studies and informal surveys have demonstrated a trend among graduating physiatry residents who desired to practice in an outpatient musculoskeletal (MSK)- or spine-type setting. However, there has been no updated information on the current trend among graduating residents as well as sparse information on gauging if current trainees feel prepared on graduation to treat patients with such disorders. This article describes a prospective survey of graduating chief residents during the 2013-2014 academic year in which 72% of chief residents planned to pursue a fellowship. A total of 54% of those chief residents planned to pursue a pain, sports, or spine fellowship. Seventy-five percent of the responding chief residents reported that most of the residents in their program felt that the current amount of required rotations in MSK, sports, spine, or pain medicine was adequate and 85% felt comfortable practicing in a noninterventional spine or MSK position after graduation without a fellowship. The results of this survey provide an updated perspective on the current trends among graduating residents as well as how residents perceive their MSK curriculum. These results may prove useful when evaluating MSK curriculums and shaping resident education to maximize career goals. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury: Differences by Language and Insurance Status.
Moore, Megan; Jimenez, Nathalia; Rowhani-Rahbar, Ali; Willis, Margaret; Baron, Kate; Giordano, Jessica; Crawley, Deborah; Rivara, Frederick P.; Jaffe, Kenneth M.; Ebel, Beth E., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to explore associations between English proficiency, insurance status, outpatient rehabilitation service availability, and travel time for children with traumatic brain injury. Design: The authors used an ecologic cross-sectional design. Data were analyzed from a cohort of 82 children with moderate to severe traumatic brain injury and rehabilitation providers in Washington State. Main measures included availability and travel time to services. Results: Less than 20% of providers accepted children with Medicaid and provided language interpretation. Mental health services were most limited. Adjusted for median household income, multilingual service availability was lowest in counties with greater language diversity; for every 10% increase in persons older than 5 yrs speaking a language other than English at home, there was a 34% decrease in availability of multilingual services (prevalence ratio, 0.66; 95% confidence interval, 0.48-0.90). Adjusted for education and Medicaid status, children from Spanish-speaking families had significantly longer travel times to services (mean, 16 additional minutes to mental health; 9 to other therapies). Conclusions: Children in households with limited English proficiency and Medicaid faced significant barriers in availability and proximity of outpatient rehabilitation services. Innovative service strategies are needed to equitably improve availability of rehabilitation for children with traumatic brain injury. Similar studies in other regions will inform one's understanding of the scope of these disparities. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.From Wheelchair to Cane: Elective Transtibial Amputations in a Patient with Spina Bifida.
Mayo, Amanda; Berbrayer, David, 2015-08-07 08:00:00 AM
Spina bifida is associated with foot deformities, which may lead to foot ulcers, osteomyelitis, and limb amputation. Calcanectomy and Symes amputations have been reported successful in spina bifida. There is lack of evidence for transtibial amputations. This case describes a 27-yr-old woman with L4 level spina bifida who underwent bilateral transtibial amputations. She ambulated with bilateral ankle foot orthoses and canes until age 22. At age 22, she had bilateral foot reconstructive surgeries complicated by nonunion, ulcerations, and osteomyelitis. She was using a wheelchair by age 25. She had elective bilateral transtibial amputations at age 27 for progressive osteomyelitis. Four weeks after amputations, she was fit with bilateral prostheses. On completion of 2 mos of rehabilitation, she ambulated with a cane. This case demonstrates good functional outcomes after transtibial amputations in a young spina bifida patient. Prosthetic fitting should be considered for similar, previously high functioning spina bifida patients with transtibial amputation(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Comment on: Evaluation of Stress and Pain in Young Children with Cerebral Palsy During Early Developmental Intervention Programs.
Rivenburgh, Tiffany, 2015-08-07 08:00:00 AM
Ultrasound-Guided Glenohumeral Joint Injection Using the Posterior Approach.
Chen, Carl P.C.; Lew, Henry L.; Hsu, Chih-Chin, 2015-08-07 08:00:00 AM
Ultrasound-Guided Injection for the Treatment of Carpal Tunnel Syndrome.
Hong, Jia-Pei; Lew, Henry L.; Lee, Chih-Hong; Tang, Simon F.T., 2015-08-07 08:00:00 AM
Syringomyelia: From the Cervicomedullary Junction to the Conus.
Yeh, Peter Chia; Jayaram, Prathap; Paily, Paul, 2015-08-07 08:00:00 AM
Asymmetrical Lower Extremity Loading Early After Anterior Cruciate Ligament Reconstruction Is a Significant Predictor of Asymmetrical Loading at the Time of Return to Sport.
Labanca, Luciana; Laudani, Luca; Menotti, Federica; Rocchi, Jacopo; Mariani, Pier Paolo; Giombini, Arrigo; Pigozzi, Fabio; Macaluso, Andrea, 2015-08-07 08:00:00 AM
Objectives: The aim of this study was to examine whether asymmetrical lower limb loading early after anterior cruciate ligament reconstruction (1 mo) can predict asymmetrical lower limb loading at the time of return to sport (6 mos) and whether other early predictors as knee joint range of motion or maximal isometric strength affect this relationship. Design: Ground reaction forces were measured during a sit-to-stand task 1 mo after anterior cruciate ligament reconstruction and a vertical countermovement jump 6 mos after anterior cruciate ligament reconstruction in 58 athletes. Other early postoperative measurements were knee joint range of motion (2 wks, 1 mo, and 2 mos after surgery) and maximal isometric strength of the knee extensor and flexor muscles (2 mos after surgery). Linear regression models were developed using side-to-side limb symmetry index (LSI) of countermovement jump as the dependent variable. Results: LSI of sit-to-stand task 1 mo after surgery was a significant independent predictor of LSI of countermovement jump 6 mos after surgery. After accounting for deficits in knee joint range of motion and LSI of maximal isometric strength ([DELTA]R 2 = 0.35, P < 0.01), LSI of sit-to-stand task predicted LSI of countermovement jump ([DELTA]R2 = 0.14 P < 0.01). Conclusions: Asymmetrical lower extremity loading 1 mo after anterior cruciate ligament reconstruction is an early predictor of asymmetrical lower extremity loading 6 mos after surgery. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Addition of Suprascapular Nerve Block to a Physical Therapy Program Produces an Extra Benefit to Adhesive Capsulitis: A Randomized Controlled Trial.
Klç, Zeynep; Filiz, Meral Bilgilisoy; Çakr, Tuncay; Toraman, Naciye Füsun, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to compare the efficacy of suprascapular nerve block plus physical therapy (PT) with PT alone for the treatment of adhesive capsulitis of the shoulder. Design: Forty-one patients with adhesive capsulitis were randomly assigned to the injection group (n = 19) or PT-alone control group (n = 22). All patients received PT consisting of electrotherapy, range of motion, stretching, and strengthening exercises. The patients in the injection group received suprascapular nerve block before PT. Pain was assessed using the Brief Pain Inventory-Short Form, and functional status was assessed with the total Constant score. Results: In both groups, significant differences were found in all parameters of the Brief Pain Inventory-Short Form compared with baseline levels apart from walking ability in the last 24 hrs (P = not applicable). However, the differences of mean pain severity in the last 24 hrs at first to second and first to third assessments, pain severity at that time at first to second assessments, percentage improvement at second to third assessments, general activity in the last 24 hrs at first to second and first to third assessments, and enjoyment of life in the last 24 hrs at first to second and first to third assessments were statistically significant in favor of the injection group (P < 0.05). Conclusions: The current study supports that suprascapular nerve block is a safe and well-tolerated method. PT was found to be effective in reducing pain severity and functional disability, and the addition of suprascapular nerve block to PT improved functional status and pain levels in patients with adhesive capsulitis. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Bilateral Homonymous Quadrantanopsia due to Optic Radiation Injury in a Patient with Traumatic Brain Injury.
Seo, You Sung; Kim, Seong Ho; Jang, Sung Ho, 2015-08-07 08:00:00 AM
Clinical Efficacy of Mudpack Therapy in Treating Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Studies.
Xiang, Jie; Wu, Dongying; Li, Jian'an, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to evaluate the clinical efficacy of mudpack therapy for the treatment of knee osteoarthritis and identify the likely factors associated with the high heterogeneity of combined studies. Design: The Medline, Embase, and Cochrane Library databases were systematically searched for randomized controlled trials in which mudpack therapy was used to treat knee osteoarthritis. Results: Ten publications that reported the results from a total of 1010 subjects were included in this meta-analysis. Meta-analysis of improvement in joint function at the final follow-up visit suggested, given that the follow-up time was less than 4 mos, that the combined effect size of four studies was -0.30 (-0.62 to 0.02) and the difference did not reach the level of statistical significance. When the follow-up time reached 4 mos, the combined effect size was -1.10 (-2.07 to -0.14) and the difference was significant. The I2 values of the two groups were 21.4% and 93.8%. Conclusion: Functional improvement of the knee joint in patients treated with mudpack therapy was not significantly different from that of control subjects at the end of the 4-mo follow-up. The quality of current publications was a factor causing heterogeneity. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Comment on: Functional Outcomes of Patients with Amputation Receiving Chronic Dialysis for End-Stage Renal Disease.
Caner, Jessica, 2015-08-07 08:00:00 AM
Importance of Image Guidance in Glenohumeral Joint Injections: Comparing Rates of Needle Accuracy Based on Approach and Physician Level of Training.
Mattie, Ryan; Kennedy, David J., 2015-08-07 08:00:00 AM
Objective: This study compared the accuracy of blind glenohumeral joint (GHJ) injections between physical medicine and rehabilitation interventional fellows (inexperienced provider) and a sports medicine board-certified physical medicine and rehabilitation attending physician (experienced provider) using either an anterior or posterior approach. Methods: A retrospective analysis of 162 consecutive patients comprising 165 GHJ injections was performed. All GHJ injections were initially placed via anatomic landmark guidance by either an experienced or an inexperienced provider. Contrast medium using live fluoroscopy was injected to determine if intra-articular placement had been obtained. Results: The overall accuracy of a blind GHJ injection, regardless of the provider level of experience, was 45.5%. The inexperienced provider was accurate 37.6% of the time, and the experienced provider was accurate 64.6% of the time. The difference in provider accuracy based on level of experience was shown to be statistically significant at P less than 0.05. There was no statistically significant difference between the anterior and posterior approaches regardless of physician level of experience. Conclusions: The results of this study suggest that image guidance is an important utility for accurate navigation into the GHJ space regardless of the level of training. Neither the anterior nor the posterior approach proved to be significantly more accurate. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Exercise Training Inhibits the Nogo-A/NgR1/Rho-A Signals in the Cortical Peri-infarct Area in Hypertensive Stroke Rats.
Li, Chao; Wen, HongMei; Wang, QingMei; Zhang, ChanJuan; Jiang, Li; Dou, ZuLin; Luo, Xun; Zeng, JinSheng, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to test the hypothesis that exercise training promotes motor recovery after stroke by facilitating axonal remodeling via inhibition of the Nogo-A/NgR1 and Rho-A pathway. Design: A distal middle cerebral artery occlusion model was generated in stroke-prone renovascular hypertensive rats. Stroke-prone renovascular hypertensive rats were randomly divided into a control group, an exercise training group, and a sham group. Motor function was measured using the grip strength test. Axon and myelin remodeling markers, growth-associated protein 43, myelin basic protein, Tau, and amyloid precursor protein were detected by immunofluorescence. The expression of Nogo-A, NgR1, and Rho-A was demonstrated by immunofluorescence and Western blotting in the peri-infarction area at 7, 14, 28, and 52 days after distal middle cerebral artery occlusion. Results: Grip strength was higher in the exercise training group (P < 0.05). Exercise training increased the expression of growth-associated protein 43, myelin basic protein (at 7, 14, and 28 days), and Tau (at 7 and 14 days), and decreased the expression of axonal damage amyloid precursor protein (at 7 and 14 days), compared with the control group. The protein levels of Nogo-A (at 7 and 14 days), NgR1 (at 7, 14, and 28 days), and Rho-A (at 14 and 28 days) were reduced after exercise training. Conclusions: Exercise training promotes axonal recovery, which is associated with functional improvement after cerebral infarction. Down-regulation of the Nogo-A/NgR1/Rho-A may mediate the axonal remodeling induced by exercise training. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Brake Response Time Is Significantly Impaired After Total Knee Arthroplasty: Investigation of Performing an Emergency Stop While Driving a Car.
Jordan, Maurice; Hofmann, Ulf-Krister; Rondak, Ina; Götze, Marco; Kluba, Torsten; Ipach, Ingmar, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to investigate whether total knee arthroplasty (TKA) impairs the ability to perform an emergency stop. Design: An automatic transmission brake simulator was developed to evaluate total brake response time. A prospective repeated-measures design was used. Forty patients (20 left/20 right) were measured 8 days and 6, 12, and 52 wks after surgery. Results: Eight days postoperative total brake response time increased significantly by 30% in right TKA and insignificantly by 2% in left TKA. Brake force significantly decreased by 35% in right TKA and by 25% in left TKA during this period. Baseline values were reached at week 12 in right TKA; the impairment of outcome measures, however, was no longer significant at week 6 compared with preoperative values. Total brake response time and brake force in left TKA fell below baseline values at weeks 6 and 12. Brake force in left TKA was the only outcome measure significantly impaired 8 days postoperatively. Conclusion: This study highlights that categorical statements cannot be provided. This study's findings on automatic transmission driving suggest that right TKA patients may resume driving 6 wks postoperatively. Fitness to drive in left TKA is not fully recovered 8 days postoperatively. If testing is not available, patients should refrain from driving until they return from rehabilitation. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.A Rare Cause of Shoulder Pain: Pseudotumor Deltoideus.
Adiguzel, Emre; Ata, Emre; Demir, Yasin; Tok, Fatih; Tan, A. Kenan, 2015-08-07 08:00:00 AM
Development of an IRT-Based Short Form to Assess Applied Cognitive Function in Outpatient Rehabilitation.
McDonough, Christine M.; Ni, Pengsheng; Coster, Wendy J.; Haley, Stephen M.; Jette, Alan M., 2015-08-07 08:00:00 AM
Objective: Item response theory and computerized adaptive testing methods allow the development of a large calibrated item bank from which different subsets of questions can be selected for administration and scored on a common scale. The objective of this study was to develop an outpatient rehabilitation self-report short form for the Activity Measure for Post-Acute Care Applied Cognition item bank. Design: Using data from a convenience sample of 235 rehabilitation outpatients, item content and item response theory-based test information function parameters were used in item selection. Internal consistency reliability, intraclass correlation coefficient (ICC), and percentage at the lowest (floor) and highest (ceiling) scores were evaluated for the short form and full item bank. Results: A 15-item short form was developed. The internal consistency of the short form was 0.86. The ICC3,1 for the short form and item bank was 0.97 (95% confidence interval, 0.94-0.98). No floor effects were noted, and ceiling effects were 27.66% (short form) and 26.38% (full item bank). Conclusions: The Applied Cognition outpatient short form demonstrated acceptable psychometric properties and provides a bridge to item response theory-based measurement for settings where point-of-care computing is not available. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Osteomalacia as a Cause of Chronic Low Back and Buttock Pain: A Visual Vignette.
Oh, Hyun-Mi; Oh, Jeehae; Kim, Keon-Tae; Lee, Jong In, 2015-08-07 08:00:00 AM
Sleep Transcutaneous vs. End-Tidal CO2 Monitoring for Patients with Neuromuscular Disease.
Won, Yu Hui; Choi, Won Ah; Lee, Jang Woo; Bach, John Robert; Park, Jinyoung; Kang, Seong-Woong, 2015-08-07 08:00:00 AM
Objective: This study compared transcutaneous carbon dioxide partial pressure (PtcCO2) and end-tidal carbon dioxide partial pressure (PetCO2) monitoring during sleep for patients with neuromuscular disease. Design: This is a retrospective study of patients whose PtcCO2 and PetCO2 were monitored before they began using noninvasive mechanical ventilation. The outcomes were divided into four groupings: group 1, both PtcCO2 and PetCO2 are greater than or equal to 49 mm Hg; group 2, PtcCO2 is greater than or equal to 49 mm Hg but PetCO2 is less than 49 mm Hg; group 3, PtcCO2 is less than 49 mm Hg but PetCO2 is greater than or equal to 49 mm Hg; and group 4, both PtcCO2 and PetCO2 are less than 49 mm Hg. Results: A total of 39 subjects (mean [SD] age, 27.7 [19.3] yrs) were enrolled. PtcCO2 values were significantly higher than PetCO2 values (P < 0.001). The intraclass correlation coefficient between maximal and mean values of PtcCO2 and PetCO2 was 0.612 and 0.718, respectively. Bias and limits of agreement between PtcCO2 and PetCO2 were -7.5 mm Hg and -21.3 to 6.3 mm Hg for maximal values and -4.8 mm Hg and -14.8 to 5.3 mm Hg for mean values. Group 2 included 19 (48.7%) and group 3 included 3 (7.6%) patients who showed discrepancy of hypercapnia between two methods. Conclusions: Maximum PtcCO2 was significantly greater than maximum PetCO2 for both groups and, therefore, tends to be higher than PetCO2 in this population. This should be taken into consideration when assessing patients for sleep hypoventilation. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effects of Combined Resistive Underwater Exercises and Interferential Current Therapy in Patients with Juvenile Idiopathic Arthritis: A Randomized Controlled Trial.
Elnaggar, Ragab K.; Elshafey, Mohammed A., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to verify the effects of combined resistive underwater exercises and interferential current on the peak torque of the quadriceps and hamstrings and pain levels in patients with juvenile idiopathic arthritis. Design: This is a randomized controlled study; 30 children with polyarticular juvenile idiopathic arthritis were randomly distributed into two groups: the control group (n = 15) received the traditional physical therapy program and the study group (n = 15) received resistive underwater exercises and interferential current therapy. Peak torque of the quadriceps and hamstrings and pain levels were evaluated before treatment, 1 mo later, and after 3 mos using the HUMAC NORM, CSMI Testing and Rehabilitation Isokinetic System and visual analog scale, respectively. Results: In the control group, all measures showed significant differences (P < 0.05) after 1 mo except peak torque of left quadriceps and pain levels, and significant differences were found after 3 mos (P < 0.05) in all. In the study group, all measures showed significant differences after 1 and 3 mos (P < 0.05) and there were significant differences between groups after 1 and 3 mos in favor of the study group (P < 0.05). Conclusion: The combination of resistive underwater exercises and interferential current therapy is a potentially valuable treatment for patients with juvenile idiopathic arthritis. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Quadriceps Fat Pad Impingement and Synovial Hypertrophy with Mild to Moderate Lipoma Arborescens.
Yasar, Evren; Adgüzel, Emre; Kesikburun, Serdar; Demir, Yasin; Ilica, Turan, 2015-08-07 08:00:00 AM
Sonographic Tracking of the Upper Limb Peripheral Nerves: A Pictorial Essay and Video Demonstration.
Wu, Chueh-Hung; Chang, Ke-Vin; Özçakar, Levent; Hsiao, Ming-Yen; Hung, Chen-Yu; Shyu, Shaw-Gang; Wang, Tyng-Guey; Chen, Wen-Shiang, 2015-08-07 08:00:00 AM
Ultrasound has been the most useful imaging tool for musculoskeletal disorders whereby peripheral nerve lesions constitute a substantial portion. High-resolution ultrasound enables elaboration of peripheral nerve morphology and reciprocal anatomy. However, limited literature is available for delineating standard positions and tracking skills. The present article incorporates a series of ultrasound images and videos to demonstrate how to scan the suprascapular, axillary, musculocutaneous, median, ulnar, and radial nerves. Overall, the authors aim to demonstrate the relevant nerve tracking techniques as regards the upper extremity. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effectiveness of Shoe Stiffening Inserts for First Metatarsophalangeal Joint Osteoarthritis: A Proof-of-Concept Study.
Jerilyn, Tan X.; Menz, Hylton B.; Murley, George S.; Munteanu, Shannon E., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to determine the feasibility of shoe stiffening inserts to reduce pain in first metatarsophalangeal joint osteoarthritis. Design: Thirty-one participants with first metatarsophalangeal joint osteoarthritis were prescribed shoe stiffening inserts and were evaluated at baseline and at 1 and 3 mos. The primary outcome measure was foot pain, assessed using the foot pain domain of the Foot Health Status Questionnaire (possible score ranges from 0 to 100). Secondary outcome measures included foot-related disability (foot function domain of the Foot Health Status Questionnaire), self-reported treatment effectiveness, use of rescue medication and other co-interventions, and adverse events. Results: At 1 and 3 mos, statistically significant improvements in foot pain and foot-related disability were observed (mean difference at 3 mos: foot pain = 18.8, 95% confidence interval, 13.3-24.3; foot function = 11.8, 95% confidence interval, 4.3-17.3). Treatment was reported to be effective by 78% of participants. Few participants (4%) reported using pain-relieving medication. Minor adverse events were reported by 30% of participants. Conclusions: Full-length shoe stiffening inserts may be an effective intervention in first metatarsophalangeal joint osteoarthritis. However, further controlled studies are required. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effects of Tai Chi and Multimodal Exercise Training on Movement and Balance Function in Mild to Moderate Idiopathic Parkinson Disease.
Zhang, Tian-Yu; Hu, Yong; Nie, Zhi-Yu; Jin, Rong-Xiang; Chen, Fei; Guan, Qiang; Hu, Bin; Gu, Chun-Ya; Zhu, Ling; Jin, Ling-Jing, 2015-08-07 08:00:00 AM
Objective: The primary aim of this study was to investigate the effects of two different patterns of rehabilitation training on movement and balance function in patients with idiopathic Parkinson disease. Design: Forty patients with Parkinson disease were randomized into the tai chi group (n = 20) or the multimodal exercise training group (n = 20). Outcome measures were assessed at baseline and after 12 wks of exercise. Balance was assessed using the Berg Balance Scale, and movement was assessed by the Unified Parkinson's Disease Rating Scale-Motor Examination, stride length, gait velocity, and Timed Up and Go Test. Results: The multimodal exercise training group improved significantly in movement from baseline, and a reduction in balance impairment was observed for the multimodal exercise training group. The questionnaire results after training showed that the multimodal exercise training is easy to learn and adhere to. No major adverse events were noted in both groups. Conclusions: This multimodal exercise training could improve motion function and benefit balance function in patients with Parkinson disease. The multimodal exercise training is easy to learn and practice. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Cardiopulmonary Resuscitation Interface Adapted for Postextubation Continuous Noninvasive Ventilatory Support.
Bach, John R.; Saporito, Louis Ralph, 2015-08-07 08:00:00 AM
The authors report that a new oral interface designed for cardiopulmonary resuscitation and use during anesthesia permitted the successful extubation of an "unweanable" 27-yr-old woman with nemaline rod myopathy to continuous noninvasive ventilatory support. She had failed two previous extubation attempts. Tracheotomy and institutional care were avoided as a result. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Long-Term Functioning of Patients with Aneurysmal Subarachnoid Hemorrhage: A 4-yr Follow-up Study.
Boerboom, Wendy; Heijenbrok-Kal, Majanka H.; Khajeh, Ladbon; van Kooten, Fop; Ribbers, Gerard M., 2015-08-07 08:00:00 AM
Objectives: The aim was to study changes over time for multiple outcomes based on the International Classification of Functioning, Disability, and Health in patients with aneurysmal subarachnoid hemorrhage and to compare long-term outcomes with norms. Design: A prospective cohort study with 4-yr follow-up was conducted. Main outcome measures were as follows: Center for Epidemiologic Studies-Depression Scale, Fatigue Severity Scale, Trail Making Test A and B, Barthel Index, Sickness Impact Profile-68, Impact on Participation and Autonomy Questionnaire, Social Support List-12, Multidimensional Health Locus of Control Scales, COOP-WONCA Charts, and Short Form-36 Health Survey. Results: Seventy-six patients with aneurysmal subarachnoid hemorrhage were included. Measurements were done at T1 = 0.4 yrs (SD, 0.3 yrs) and T2 = 3.9 yrs (SD, 0.7 yrs) after onset. Significant improvements over time were found for Barthel Index (T1 = 18.5; T2 = 19.5; P = 0.023), Trail Making Test B (T1 = 119.4; T2 = 104.6; P = 0.025), Social Support List-12 total score (T1 = 31.1; T2 = 32.7; P = 0.042) and esteem support (T1 = 10.2; T2 = 10.9; P = 0.027), Multidimensional Health Locus of Control Scales (physician-orientation) (T1 = 21.8; T2 = 19.2; P = 0.020), and Short Form-36 Health Survey (role-emotional) (T1 = 54.6; T2 = 73.9; P = 0.048). Center for Epidemiologic Studies-Depression Scale, Fatigue Severity Scale, Sickness Impact Profile-68, and Short Form-36 Health Survey scores remained stable over time. A decline was found for COOP-WONCA (overall-health) (T1 = 2.3; T2 = 2.7; P = 0.021). At 4-yr follow-up, proportions of depression (27%) and fatigue (60%) were larger and scores on the Fatigue Severity Scale (mean [SE], 4.3 [0.2]), Trail Making Test A (mean [SE], 51.3 [3.9]), and Trail Making Test B (mean [SE], 104.4 [0.2]) were significantly worse than norm scores. Conclusions: Many patients with aneurysmal subarachnoid hemorrhage had fairly good long-term outcomes, but problems in executive functioning, mood, and fatigue still exist at long-term follow-up. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.COMORBIDITIES AND BEHAVIORAL INVOLVEMENT IN THE REHABILITATION OF PATIENTS WITH AMPUTATION ON CHRONIC DIALYSIS.
Arneja, Amarjit S.; Hiebert, Brett M.; Tappia, Paramjit S.; O'Keeffe, Kieran, 2015-08-07 08:00:00 AM
Efficacy of Proprioceptive Exercises in Patients with Subacromial Impingement Syndrome: A Single-Blinded Randomized Controlled Study.
Dilek, Banu; Gulbahar, Selmin; Gundogdu, Mehtap; Ergin, Burcu; Manisali, Metin; Ozkan, Mustafa; Akalin, Elif, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to evaluate the effectiveness of proprioceptive exercises on shoulder proprioception, range of motion, pain, muscle strength, and function in patients with subacromial impingement syndrome. Design: Sixty-one patients with subacromial impingement syndrome participated in this prospective, single-blind randomized controlled trial. All patients were randomly divided into two groups: control group (conventional physiotherapy, n = 30) and intervention group (proprioceptive exercise and conventional physiotherapy, n = 31). The primary outcome measures were sense of kinesthesia and active and passive repositioning for proprioception at 0 degrees and 10 degrees external rotation at 12 wks. The secondary outcome measures were pain at rest, at night, and during activities of daily living with the visual analog scale (0-10 cm), the Western Ontario Rotator Cuff index, the American Shoulder and Elbow Surgeons index, range of motion, and isometric muscle strength at both 6 and 12 wks. Results: After treatment, significant improvement was found in range of motion, pain, isometric muscle strength, kinesthesia at 0 degrees external rotation, and functional tests in both groups. The intervention group showed a significant improvement in kinesthesia at 10 degrees external rotation and active and passive repositioning at 10 degrees external rotation. When groups were compared, there were no statistically significant differences in any of the parameters at 12 wks. Conclusions: Although proprioceptive exercises may provide better proprioceptive acuity, no additional positive effect on other clinical parameters was observed. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Association of Strength Measurement with Rotator Cuff Tear in Patients with Shoulder Pain: The Rotator Cuff Outcomes Workgroup Study.
Miller, Jennifer Earle; Higgins, Laurence D.; Dong, Yan; Collins, Jamie E.; Bean, Jonathan F.; Seitz, Amee L.; Katz, Jeffrey N.; Jain, Nitin B., 2015-08-07 08:00:00 AM
Objective: This study examines the association between strength measurements and supraspinatus tear in patients with shoulder pain. This study characterized determinants of abduction strength among patients with tears. Design: A total of 208 patients with shoulder pain were recruited. Strength was tested using a handheld dynamometer. Supraspinatus tears were diagnosed by combination of clinical assessment and blinded magnetic resonance imaging review. Associations of supraspinatus tear with patient characteristics and strength measurements (abduction, internal rotation and external rotation) were assessed using multivariable logistic regression models. Results: Patients with supraspinatus tear had decreased abduction strength (P = 0.02) and decreased external rotation strength (P < 0.01). When adjusted for age, sex, tear laterality, and body mass index, decreased abduction strength (odds ratio, 1.18/kg; 95% confidence interval, 1.06-1.32) and decreased external rotation strength (odds ratio, 1.29/kg; 95% confidence interval, 1.14-1.48) were associated with supraspinatus tear. In patients with tear, age 60 yrs or older, female sex, and visual analog scale pain score were significantly associated with decreased abduction strength but tear size, fatty infiltration, and atrophy were not. Conclusions: Decreased abduction and external rotation strength were associated with supraspinatus tear in patients with shoulder pain. In this cohort, the abduction strength of patients with tears was influenced by demographic factors but not tear characteristics. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Physiatry Reviews for Evidence in Practice (PREP), Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist.
Kumbhare, Dinesh; Robinson, Lawrence, 2015-08-07 08:00:00 AM
The busy clinically active physiatrist who wishes to practice evidence-based medicine has a daunting challenge to keep up to date with the significant amount of new information that is developing and available across the wide spectrum of medical literature. Accordingly, the authors have developed a method to survey the applicable medical literature to identify pertinent and clinically relevant articles. These articles are then critically appraised and presented in a standard format with clinically applicable conclusions. The authors will be presenting these reviews in future issues of the American Journal of Physical Medicine & Rehabilitation. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Framework for Assessment of the Usability of Lower-Extremity Robotic Exoskeletal Orthoses.
Bryce, Thomas N.; Dijkers, Marcel P.; Kozlowski, Allan J., 2015-08-07 08:00:00 AM
Persons with neurologic conditions such as spinal cord injury, stroke, and multiple sclerosis often lose the ability to stand and walk. Robotic hip-knee-ankle-foot exoskeletal orthoses have become commercially available and may allow some of these people to stand and walk again. These devices may also have applications beyond mobility, such as exercise, amelioration of secondary complications related to lack of ambulation, and the promotion of neuroplasticity. The authors present a framework for assessment of the usability of robotic exoskeletal orthoses available now or in the near future. The framework contains six modules: Functional applications, Personal factors, Device factors, External factors, Activities, and Health outcomes. Metrics and measures are suggested for each framework factor. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Resident-Perceived Benefit of a Diagnostic and Interventional Musculoskeletal Ultrasound Curriculum: A Multifaceted Approach Using Independent Study, Peer Teaching, and Interdisciplinary Collaboration.
Luz, Jennifer; Siddiqui, Imran; Jain, Nitin B.; Kohler, Minna J.; Donovan, Jayne; Gerrard, Paul; Borg-Stein, Joanne, 2015-08-07 08:00:00 AM
Musculoskeletal ultrasound (MSUS) training is now a required component of physiatry residency, but formal curriculum guidelines are not yet required or established. The authors' objective was to assess the educational value of a collaborative residency MSUS training program. The authors designed a structured MSUS training curriculum for residents based on the authors' experience and previous literature. Twenty-five residents participated in this MSUS curriculum designed by faculty and chief residents. Resident volunteers were trained by the faculty as "table trainers" who taught their peers in small groups. Hands-on MSUS training sessions were led by a Physical Medicine and Rehabilitation faculty MSUS expert. A Likert scale-formatted questionnaire assessed resident-perceived value of the curriculum. Response rate was 96% (22 of 23). Self-reported MSUS knowledge comparing precurriculum and postcurriculum implementation resulted in significant improvement (P = 0.001). Peer teaching was highly valued, with 86% of residents rating it "very" or "extremely" beneficial (mean [SD] score, 3.9 [1.1]). Self-guided learning, by supplemental scanning and reading, was rated "beneficial" or "very beneficial" by 73% of residents (3.0 [0.7]). The authors' successful pilot program may serve as a teaching model for other residency programs. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Strengthening Rehabilitation for People with Disabilities: A Human Rights Approach as the Essential Next Step to Accelerating Global Progress.
Skempes, Dimitrios; Bickenbach, Jerome, 2015-08-07 08:00:00 AM
Atypical Location of Low-Back Pain in a High School Basketball Player.
Cardozo, Eliana; Chang, Richard G.; Sneag, Darryl B.; Wyss, James, 2015-08-07 08:00:00 AM
RE: "REVIEW OF SECONDARY HEALTH CONDITIONS IN POST-POLIO SYNDROME" BY MCNALLEY TE, JENSON MP, TRUITT AR, SCHOMER KG, BAYLOR C, MOLTON IR: AM J PHYS MED REHABIL 2015;94: 139-45.
LaBan, Myron M., 2015-08-07 08:00:00 AM
COLOR SCALING IN SONOELASTOGRAPHY.
Koçyigit, Figen; Koçyigit, Ali; Karabulut, Nevzat, 2015-08-07 08:00:00 AM
AUTHOR REPLY TO "COLOR SCALING IN SONOELASTOGRAPHY".
Wu, Chueh-Hung; Wang, Tyng-Guey, 2015-08-07 08:00:00 AM
Use of Continuous Femoral and Sciatic Nerve Catheters to Facilitate a Multidisciplinary Inpatient-Based Rehabilitation Plan in a Child with Lower Extremity Type 1 Complex Regional Pain Syndrome.
De Mesa, Charles; Chu, Isaac; Furukawa, Kenneth; Sheth, Samir, 2015-08-07 08:00:00 AM
Association Between Sagittal Balance and Scoliosis in Patients with Parkinson Disease: A Cross-sectional Study.
Bissolotti, Luciano; Donzelli, Sabrina; Gobbo, Massimiliano; Zaina, Fabio; Villafañe, Jorge Hugo; Negrini, Stefano, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to describe the association between scoliosis and sagittal balance parameters in Parkinson disease patients. Design: This is a cross-sectional study. Results: Fifty percent of the cohort presented a scoliosis larger than 11 degrees; 84% of the patients with scoliosis presented a thoracolumbar curve, 10% presented a thoracic one, and 6% presented a lumbar one. The group with scoliosis curves presented a lower spinosacral angle (111.6 [21.9] degrees vs. 121.7 [9.8] degrees, P < 0.05), whereas thoracic kyphosis, lumbar lordosis, and spinopelvic angle were similar. Pelvic incidence, pelvic tilt, and sacral slope were not statistically different. In the scoliosis group, the authors found negative correlations for lumbar lordosis/spinopelvic angle, sacral slope/spinosacral angle, and lumbar lordosis/pelvic tilt. Moreover, the sacral slope/pelvic tilt correlation was positive in patients without scoliosis and negative in others. The two groups did not present differences regarding age, years of disease, Hoehn-Yahr score, and Unified Parkinson Disease Rating Scale-motor section. Conclusions: Pelvic parameters were similar in the two groups, whereas spinosacral angle was lower in patients with scoliosis. The prevalence of scoliosis in Parkinson disease was higher than what was previously described and the thoracolumbar spine was the mostly affected. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.RESPONSE TO THE LETTER TO THE EDITOR ON "REVIEW OF SECONDARY HEALTH CONDITIONS IN POSTPOLIO SYNDROME".
McNalley, Thomas E., 2015-08-07 08:00:00 AM
Gait Efficiency on an Uneven Surface Is Associated with Falls and Injury in Older Subjects with a Spectrum of Lower Limb Neuromuscular Function: A Prospective Study.
Zurales, Katie; DeMott, Trina K.; Kim, Hogene; Allet, Lara; Ashton-Miller, James A.; Richardson, James K., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to determine which gait measures on smooth and uneven surfaces predict falls and fall-related injuries in older subjects with diabetic peripheral neuropathy. Design: Twenty-seven subjects (12 women) with a spectrum of peripheral nerve function ranging from normal to moderately severe diabetic peripheral neuropathy walked on smooth and uneven surfaces, with gait parameters determined by optoelectronic kinematic techniques. Falls and injuries were then determined prospectively over the following year. Results: Seventeen subjects (62.9%) fell and 12 (44.4%) sustained a fall-related injury. As compared with nonfallers, the subject group reporting any fall, as well as the subject group reporting fall-related injury, demonstrated decreased speed, greater step width (SW), shorter step length (SL), and greater SW-to-SL ratio (SW:SL) on both surfaces. Uneven surface SW:SL was the strongest predictor of falls (pseudo-r2 = 0.65; P = 0.012) and remained so with inclusion of other relevant variables into the model. Post hoc analysis comparing injured with noninjured fallers showed no difference in any gait parameter. Conclusion: SW:SL on an uneven surface is the strongest predictor of falls and injuries in older subjects with a spectrum of peripheral neurologic function. Given the relationship between SW:SL and efficiency, older neuropathic patients at increased fall risk appear to sacrifice efficiency for stability on uneven surfaces. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.The Comatose Patient, Second Edition.
Zasler, Nathan D., 2015-08-07 08:00:00 AM
Aerobic Interval Training Elicits Different Hemodynamic Adaptations Between Heart Failure Patients with Preserved and Reduced Ejection Fraction.
Fu, Tieh-Cheng; Yang, Ning-I; Wang, Chao-Hung; Cherng, Wen-Jin; Chou, Szu-Ling; Pan, Tai-Long; Wang, Jong-Shyan, 2015-08-07 08:00:00 AM
Objective: This investigation explored how aerobic interval training influences central or peripheral hemodynamic response(s) to exercise in patients with heart failure (HF) with preserved ejection fraction (HFpEF) or those with HF with reduced ejection fraction (HFrEF). Design: One hundred twenty HF patients were divided into four groups: HFpEF and HFrEF with aerobic interval training (3-min intervals at 40% and 80% VO2peak for 30 mins/day, 3 days/wk for 12 wks) and general health care groups. Exercise hemodynamics in the heart, frontal cerebral lobe, and vastus lateralis muscle, and oxygenation in the frontal cerebral lobe and vastus lateralis muscle were measured before and after the intervention. Results: Aerobic interval training significantly (1) improved pumping function with enhanced peak cardiac power index in the HFrEF group and improved diastolic function with reduction of the E/E' ratio in the HFpEF group, (2) increased blood distribution to the frontal cerebral lobe/vastus lateralis muscle and O2 extraction by vastus lateralis muscle during exercise in the HFpEF group compared with the HFrEF group, (3) heightened VO2peak in both HFpEF and HFrEF groups and lowered the VE/VCO2 slope in the HFpEF group, and (4) increased the Short Form-36 physical/mental component scores and decreased the Minnesota Living with Heart Failure questionnaire score in both HFpEF and HFrEF groups. Conclusions: Aerobic interval training effectively enhances cardiac hemodynamic response to exercise in HFrEF patients while increasing the delivery/use of O2 to exercising skeletal muscles and frontal cerebral lobe tissues in HFpEF patients, thereby improving global/disease-specific quality-of-life measures in these HF patients. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Ultrasound Imaging Facilitated the Detection of a Double Crush Radial Nerve Injury.
Chang, Ke-Vin; Hung, Chen-Yu; Özçakar, Levent, 2015-08-07 08:00:00 AM
Efficacy of Ultrasound in the Diagnosis of Biceps Tendon Dislocation.
Demir, Yasin; Aras, Berke; Aydemir, Koray; Tan, Arif Kenan, 2015-08-07 08:00:00 AM
Re: Handheld Dynamometry for Plantar Flexors?.
Kahn, Michelle; Williams, Gavin, 2015-08-07 08:00:00 AM
Handheld Dynamometry for Plantar Flexors?.
Robinson, Lawrence R., 2015-08-07 08:00:00 AM
Selective Injury of Fornical Column in a Patient with Mild Traumatic Brain Injury.
Jang, Sung Ho; Kwon, Hyeok Gyu, 2015-08-07 08:00:00 AM
Influence of Submaximal Exercise on Postural Control in Older Adults.
Palm, Hans-Georg; van Uden, Christian; Riesner, Hans-Joachim; Lang, Patricia; Friemert, Benedikt, 2015-08-07 08:00:00 AM
Objective: The authors conducted this cross-sectional study to assess the influence of submaximal exercise on postural stability as measured by computerized dynamic posturography (CDP) and compared this study's CDP results with clinical balance tests such as the Berg Balance Test and the Timed Up and Go test using a descriptive/explorative approach. Design: Forty-three participants performed two exercise tasks (6-min walk test and stair climbing). CDP and established scores (Berg Balance Test and Timed Up and Go test) were used to assess postural instability. Results: Despite significant pulse rate increases (approximately 20%, P < 0.05), no clear differences in CDP results were found after completion of either exercise task. The overall stability index scores for all subjects remained unchanged (P = 0.98). A descriptive analysis showed that excellent Berg Balance Test and Timed Up and Go test results were associated with good CDP results. Conclusions: Submaximal exercise did not adversely affect postural stability in these older adults. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Physical Trauma and Infection as Precipitating Factors in Patients with Fibromyalgia.
Jiao, Juan; Vincent, Ann; Cha, Stephen S.; Luedtke, Connie A.; Kim, Chul H.; Oh, Terry H., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to evaluate both precipitating factors in patients with fibromyalgia and any differences in clinical presentation, symptom severity, and quality-of-life between those with and without precipitating physical trauma or infection. Design: In a retrospective cross-sectional study, the authors compared patient characteristics and fibromyalgia symptom severity and quality-of-life with the Fibromyalgia Impact Questionnaire and the Short Form-36 Health Survey in patients seen in a fibromyalgia treatment program. Results: Of 939 patients, 27% reported precipitating factors (trauma, n = 203; infection, n = 53), with the rest having idiopathic fibromyalgia (n = 683). Patients with precipitating trauma were more likely to have worse Fibromyalgia Impact Questionnaire physical function than patients with idiopathic onset (P = 0.03). Compared with patients with idiopathic onset and precipitating trauma, patients with precipitating infection were more likely to have worse Short Form-36 Health Survey physical component summary (P = 0.01 and P = 0.003) but better role emotional (P = 0.04 and P = 0.005), mental health index (P = 0.02 and P = 0.007), and mental component summary (P = 0.03 and P = 0.004), respectively. Conclusions: One-fourth of this study's patients with fibromyalgia had precipitating physical trauma or infection. Patients with precipitating infection had different sociodemographic characteristics, clinical presentation, and quality-of-life from the idiopathic and trauma groups. Further studies are needed to look into the relationships between precipitating events and fibromyalgia. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Differential Impact and Use of a Telehealth Intervention by Persons with MS or SCI.
Mercier, Hannah W.; Ni, Pensheng; Houlihan, Bethlyn V.; Jette, Alan M., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to compare outcomes and patterns of engaging with a telehealth intervention (CareCall) by adult wheelchair users with severe mobility limitations with a diagnosis of multiple sclerosis (MS) or spinal cord injury (SCI). Design: The design of this study is a secondary analysis from a pilot randomized controlled trial with 106 participants with SCI and 36 participants with MS. Results: General linear model results showed that an interaction between baseline depression score and study group significantly predicted reduced depression at 6 mos for subjects with both diagnoses (P = 0.01). For those with MS, CareCall increased participants' physical independence (P < 0.001). No statistically significant differences in skin integrity were found between study groups for subjects with either diagnosis. All participants were similarly satisfied with CareCall, although those with MS engaged in almost double the amount of calls per person than those with SCI (P = 0.005). Those with SCI missed more calls (P < 0.001) and required more extensive support from a nurse (P = 0.006) than those with MS. Conclusion: An interactive telephone intervention was effective in reducing depression in adult wheelchair users with either MS or SCI, and in increasing health care access and physical independence for those with a diagnosis of MS. Future research should aim to enhance the efficacy of such an intervention for participants with SCI. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain: A Randomized Controlled Trial.
Beltran-Alacreu, Hector; López-de-Uralde-Villanueva, Ibai; Fernández-Carnero, Josué; La Touche, Roy, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to determine the effectiveness of a multimodal treatment in the short and medium term for disability in nonspecific chronic neck pain. Design: The design of this study is a single-blinded randomized controlled trial carried out in a university research laboratory. Forty-five patients between 18 and 65 yrs with nonspecific chronic neck pain were included in this study. Each patient was treated eight times over a 4-wk period. The sample was divided into three groups: control group, subjected to a protocol of manual therapy; experimental group 1, subjected to a protocol of manual therapy and therapeutic patient education; and experimental group 2, subjected to manual therapy, therapeutic patient education, and a therapeutic exercise protocol. Assessments were performed at baseline and at 4, 8, and 16 wks using the following measurements: the Neck Disability Index, the 11-item Tampa Scale of Kinesiophobia, the Fear Avoidance Beliefs Questionnaire, the Neck Flexor Muscle Endurance Test, and the Visual Analog Fatigue Scale. Results: The nonparametric Kruskal-Wallis test for the Neck Disability Index showed statistically significant differences between baseline outcomes and all follow-up periods (P < 0.01). In the Kruskal-Wallis test, differences were found for the Visual Analog Fatigue Scale and the Neck Flexor Muscle Endurance Test in the follow-ups at 8 and 16 wks (P < 0.05). Analysis of variance for group x time interaction showed statistically significant changes (Tampa Scale of Kinesiophobia, F = 3.613, P = 0.005; Fear Avoidance Beliefs Questionnaire, F = 2.803, P = 0.022). Minimal detectable changes were obtained in both experimental groups for the 11-item Tampa Scale of Kinesiophobia but not in the control group. Conclusion: Differences between experimental groups and the control group were found in the short and medium term. A multimodal treatment is a good method for reducing disability in patients with nonspecific chronic neck pain in the short and medium term. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Correlates of a Single-Item Quality-of-Life Measure in People Aging with Disabilities.
Siebens, Hilary C.; Tsukerman, Dmitry; Adkins, Rodney H.; Kahan, Jason; Kemp, Bryan, 2015-08-07 08:00:00 AM
Objective: Practical quality-of-life (QOL) screening methods are needed to help focus clinical decision-making on what matters to individuals with disabilities. Design: A secondary analysis of a database from a large study of adults aging with impairments focused on four diagnostic groups: cerebral palsy (n = 134), polio (n = 321), rheumatoid arthritis (n = 99), and stroke (n = 82). Approximately 20% of cases were repeated measures of the same individuals 3-5 yrs later. Functional levels, depression, and social interactions were assessed. The single-item, subjective, seven-point Kemp Quality of Life Scale measured QOL. For each diagnostic group, Kemp Quality of Life Scale responses were divided into low, average, and high QOL subgroups. Analysis of variance and Tukey honestly significant difference tests compared clinical characteristics among these subgroups. Results: Duration of disability varied among the four groups. Within each group, QOL subgroups were similar in age, sex, and duration of disability. Low mean QOL was associated with lower functional level, higher depression scores, and lower social interaction (P < 0.001) in all four groups. In contrast, high mean QOL was associated with higher social interaction (P < 0.001). Conclusion: The Kemp Quality of Life Scale relates significantly to clinically relevant variables in adults with impairments. The scale's utility in direct clinical care merits further examination. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Optimizing Electrical Stimulation for Promoting Satellite Cell Proliferation in Muscle Disuse Atrophy.
Wan, Qing; Yeung, Simon S.; Cheung, Kwok Kuen; Au, Shannon W.; Lam, Wendy W.; Li, Ying Hui; Dai, Zhong Quan; Yeung, Ella W., 2015-08-07 08:00:00 AM
Objective: The aim of this study was to investigate the optimal electrical stimulation (ES) protocol in attenuating disuse muscle atrophy by influencing satellite cell activity. Design: This study used a pretest-posttest design. Six ES protocols of different duration (3 hrs day-1 or 2 x 3 hrs day-1) and frequencies (2, 10, or 20 Hz) were applied on the soleus muscle in mice (n = 8 in each group) that were hindlimb-suspended for 14 days. Muscle mass, cross-sectional area and fiber-type composition, and peak tetanic force of the muscles were measured. Immunohistochemical staining was used to evaluate satellite cell content, activation, proliferation, and differentiation. Cell apoptosis was detected by TdT-mediated dUTP nick end labeling (TUNEL) assay. Results: ES at 2 Hz for 2 x 3 hrs day-1 achieved the best effect in attenuating the loss of muscle fiber cross-sectional area and force. This stimulation parameter led to a 1.2-fold increase in satellite cell proliferation and was effective in rescuing cells from apoptosis. Besides, satellite cells in the atrophic muscles required different stimulation protocols for different cellular activities such as activation, proliferation, and myogenic differentiation. Conclusions: This study showed that ES at 2 Hz for 2 x 3 hrs day-1 is the optimal protocol for counteracting muscle disuse atrophy. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Prosthetic Rehabilitation After Hip Disarticulation or Hemipelvectomy.
Kralovec, Michael E.; Houdek, Matthew T.; Andrews, Karen L.; Shives, Thomas C.; Rose, Peter S.; Sim, Franklin H., 2015-08-07 08:00:00 AM
Objective: Prosthetic rehabilitation after pelvic-level amputation (hemipelvectomy/hip disarticulation) is difficult, and because of this, many patients are never fit with a prosthetic limb. The objectives of the study were to evaluate the characteristics of successful prosthetic users and to determine what factors are associated with successful prosthetic fitting and use. Design: The authors identified 43 patients who underwent hip disarticulation/hemipelvectomy between 2000 and 2010 and were candidates for prosthetic fitting at the authors' institution. The medical records of these patients were then reviewed for pertinent demographic and medical characteristics to identify the profile of successful prosthetic users. Results: Of 43 patients, 18 (43%) successfully used a prosthetic limb. The only preoperative factor associated with unsuccessful prosthetic fitting was coronary artery disease. Specifically, age, body mass index, other medical comorbidities, and demographic characteristics were not associated with successful or unsuccessful prosthetic fitting. Successful users wore their prosthesis an average of 5.8 hrs/day, and most ambulated with one or both hands free. Conclusions: Successful prosthetic rehabilitation after hemipelvectomy and hip disarticulation is possible. Increased body mass index, advanced age, depression, and other comorbidities should not discourage prosthetic rehabilitation. Most patients that undergo prosthetic rehabilitation enjoy long periods of survival and wear their prosthesis for most of the day. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Pilot Randomized Trial Comparing Intersession Scheduling of Biofeedback Results to Individuals with Chronic Pain: Influence on Psychologic Function and Pain Intensity.
Weeks, Douglas L.; Whitney, Anthony A.; Tindall, Angelique G.; Carter, Gregory T., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to compare the effectiveness of two biofeedback schedules on long-term improvement in physical and psychologic reactivity to chronic nonmalignant pain. Design: This study is a prospective, randomized pilot trial. Methods: Twenty adults with chronic pain engaged in heart rate variability (HRV) biofeedback training for nine sessions with HRV presented visually. Two groups, formed by random assignment, were compared: The faded feedback group received concurrent visual HRV biofeedback in session 1, with the amount of biofeedback systematically reduced for ensuing sessions so that, by session 9, the participants were controlling HRV without external feedback. The full feedback group received visual HRV biofeedback continuously across all sessions. Outcome measures assessed at baseline, immediately after the program, and 3 mos after the program included pain intensity, fear-avoidance beliefs, and self-report physical functioning. Use of biofeedback skills was also assessed 3 mos after the program. Nominal variables were analyzed with [chi]2. Continuous measures were analyzed with repeated-measures analyses of variance. Results: The faded feedback schedule resulted in greater use of biofeedback skills at 3 mos and improved pain intensity and fear-avoidance beliefs after the program and at 3 mos. Physical functioning did not differ between groups. Conclusions: Systematically reducing the frequency of external visual feedback during HRV biofeedback training was associated with reduced reactivity to chronic pain. Results of this pilot study should be confirmed with a larger randomized study. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Wrestlers with Limb Deficiencies: A Descriptive Study.
Baria, Michael R.; Terry, Marisa J.; Driscoll, Sherilyn W.; Andrews, Karen L.; Soma, David B.; Prideaux, Cara C., 2015-08-07 08:00:00 AM
Objective: The objective of this study was to determine if wrestling is a safe, positive athletic option for limb-deficient individuals. Design: This descriptive study consisted of an opportunity sample of limb-deficient wrestlers, aged 5 yrs and older with at least 1 yr of experience. Participants completed a questionnaire regarding health, satisfaction, and achievements. Descriptive statistics were used for analysis. Results: Sixteen male wrestlers reported nine below-the-knee, five above-the-knee, and three below-the-elbow limb deficiencies. There were nine congenital deficiencies and seven amputations acquired during childhood. Two individuals won National Collegiate Athletic Association championships, and seven competed collegiately. All reported a positive impact on quality-of-life, 87% reported no difficulty finding acceptance with the team, and 50% experienced wrestling-related residual limb complications. Associations between (1) residual limb complications before and during wrestling and (2) skin breakdown before and during wrestling did not demonstrate statistical significance (P = 0.30 and 0.1189, respectively). Conclusions: This study suggests that wrestling is a safe, positive sport for limb-deficient individuals, that it fosters competitive equality between impaired and nonimpaired participants, and that it has a positive impact on health and quality-of-life. The incidence of residual limb complications warrants monitoring. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Self-Reported Poor Work Ability-An Indicator of Need for Rehabilitation? A Cross-Sectional Study of a Sample of German Employees.
Bethge, Matthias; Spanier, Katja; Neugebauer, Tjark; Mohnberg, Inka; Radoschewski, Friedrich Michael, 2015-08-07 08:00:00 AM
Objective: The purpose of this study was to assess associations of self-reported work ability as measured by the Work Ability Index (WAI) with modifiable behavioral and occupational health risks, health service utilization, and intended rehabilitation and pension requests. Design: This is a cross-sectional study of a random sample of German employees aged 40-54 yrs on sickness benefits in 2012 (trial registration: DRKS00004824). Results: In total, 1312 male and 1502 female employees were included in the analyses. Low WAI scores (i.e., <37 points) were associated with a higher prevalence of occupational and behavioral health risks; a higher likelihood of frequent visits to general, somatic, and psychologic specialists as well as hospital stays; and four to six times higher risks of intended rehabilitation and pension requests. A two-item version of the WAI was as strongly associated with intended rehabilitation and pension requests as the total score. Conclusions: This study indicates that the WAI is a sensitive screening tool to identify workers on sick leave with a probable need for rehabilitation. The WAI could support the assessment of need for rehabilitation by occupational health services in return-to-work strategies, which include the opportunity to access multiprofessional rehabilitation. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Comparison of Pain Score Reduction Using Triamcinolone vs. Betamethasone in Transforaminal Epidural Steroid Injections for Lumbosacral Radicular Pain.
McCormick, Zachary; Kennedy, David J.; Garvan, Cynthia; Rivers, Evan; Temme, Kate; Margolis, Shana; Zander, Emily; Rohr, Ashley; Smith, Matthew C.; Plastaras, Christopher, 2015-08-07 08:00:00 AM
Objective: Although the comparative efficacy of particulate vs. nonparticulate steroids for the treatment of radicular pain with transforaminal epidural steroid injection has been investigated, there is minimal literature comparing particulate steroids. The authors aimed to determine whether transforaminal epidural steroid injection with triamcinolone or betamethasone, two particulate corticosteroids, more effectively reduces lumbosacral radicular pain. Design: This is a longitudinal cohort study of 1021 patients (1568 transforaminal epidural steroid injections) who received betamethasone or triamcinolone between January 2006 and October 2007 in an academic spine center. The frequency of greater than 50% pain reduction was compared between groups. Results: This study included 42.4% (433) male and 57.6% (588) female patients, with a mean (SD) age of 54.1 (16.7) yrs. Betamethasone and triamcinolone were used in 78.8% (1235) and 21.2% (333) of subjects, respectively. Significantly more patients who received triamcinolone (44.4% [95% confidence interval, 36.2%-52.8%]) experienced greater than 50% pain reduction at short-term follow-up (1-4 wks) compared with patients who received betamethasone (26.8% [95% confidence interval, 22.7%-31.4%]). Conclusions: Patients who received transforaminal epidural steroid injection with triamcinolone reported more frequent pain relief of greater than 50% at short-term follow-up compared with those who received betamethasone. These findings further develop the literature on comparative effectiveness in epidural steroid injections. However, given the exploratory and retrospective nature of this investigation, further study is needed. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Education and Visual Information Improves Effectiveness of Ultrasound-Guided Local Injections on Shoulder Pain and Associated Anxiety Level: A Randomized Controlled Study.
Karkucak, Murat; Cilesizoglu, Nurce; Capkin, Erhan; Can, Ipek; Batmaz, Ibrahim; Kerimoglu, Servet; Onder, Mustafa Avni; Karaca, Adem; Ayar, Ahmet, 2015-08-07 08:00:00 AM
Objective: Local injections are widely used in patients with a painful shoulder. The aim of this study was to evaluate the possible impact of patients' visual information on the effectiveness of ultrasound (US)-guided local injections on anxiety levels and shoulder pain. Design: A total of 151 patients, scheduled for local injection owing to shoulder pain, were randomly assigned into two groups in a consecutive order. Patients in group I (n = 72) were provided information related to US findings and allowed to watch the procedures from the monitor, whereas patients in group II (n = 79) received the injection only without any collaboration. Data were collected from both groups immediately before and after injections through visual analog scale and questionnaire (the State-Trait Anxiety Inventory [STAI] forms 1 and 2). Results: US-guided local injections provided significant improvement of anxiety and pain in both groups, irrespective of providing visual information. Group I and group II comparisons with respect to the visual analog scale, STAI 1, and STAI 2 yielded significant difference only for postinjection STAI 2 in group I (P = 0.006). Intragroup comparisons revealed significant differences between preinjection and postinjection values (group I: visual analog scale, P = 0.001; STAI form 1, P = 0.001; STAI form 2, P = 0.002; group II: visual analog scale, P = 0.001; STAI form 1, P = 0.002; STAI form 2, P = 0.042). There was no significant difference between the groups in terms of postinjection satisfaction levels from the procedures (P = 0.824). Conclusions: Performing US-guided shoulder injections with patient visual information provides positive contributions to coping with pain and anxiety. In particular, the patient collaboration-based US-guided injections have positive consequences on patients' long-standing "trait-anxiety" levels. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis: A Controlled Clinical Trial.
Ferreira, Ana Paula Silva; Pegorare, Ana Beatriz Gomes de Souza; Salgado, Pedro Rippel; Casafus, Filemón Silva; Christofoletti, Gustavo, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to investigate the effects of two programs for strengthening the pelvic floor on the urinary incontinence of patients with multiple sclerosis (MS). Design: This is a prospective study of the clinical trial type, monitored for 6 mos, in which 24 women in the moderate stage of MS participated in a program of exercises for strengthening the pelvic floor-associated (experimental group) or not (control group) with electrotherapy. The variables analyzed were as follows: quality-of-life, overactivity of the bladder, perineal contraction, and level of anxiety and depression. The statistical procedures involved multivariate analyses of repeated measurements, with a significance of 5%. Results: Initial homogeneity being observed in the anthropometric and clinical variables, both protocols resulted in improvements in quality-of-life (P = 0.001), overactive bladder (P = 0.001), perineal contraction (P = 0.004), and level of anxiety (P = 0.001) and depression (P = 0.001), in relation to the initial comparison. The association of electrotherapy with strengthening exercises increased the improvement of the patients regarding overactive bladder (P = 0.039) and perineal contraction (P = 0.001), in comparison with the control group. Conclusions: The results reinforce the benefit of exercises for strengthening the musculature of the pelvic floor in women with overactive bladder in MS and demonstrate a potential of the action when associated with electrotherapy. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effect of 10-Week Supervised Moderate-Intensity Intermittent vs. Continuous Aerobic Exercise Programs on Vascular Adhesion Molecules in Patients with Heart Failure.
Aksoy, Sibel; Findikoglu, Gulin; Ardic, Fusun; Rota, Simin; Dursunoglu, Dursun, 2015-08-07 08:00:00 AM
Objective: Abnormal expression of cellular adhesion molecules may be related to endothelial dysfunction, a key feature in chronic heart failure. This study compares the effects of 10-wk supervised moderate-intensity continuous aerobic exercise (CAE) and intermittent aerobic exercise (IAE) programs on markers of endothelial damage, disease severity, functional and metabolic status, and quality-of-life in chronic heart failure patients. Design: Fifty-seven patients between 41 and 81 yrs with New York Heart Association class II-III chronic heart failure and with a left ventricular ejection fraction of 35%-55% were randomized into three groups: nonexercising control, CAE, and IAE, which exercised three times a week for 10 wks. Endothelial damage was assessed by serum markers of vascular cell adhesion molecule-1, serum intercellular adhesion molecule-1, and nitric oxide; disease severity was measured by left ventricular ejection fraction and N-terminal probrain natriuretic peptide; metabolic status was evaluated by body composition analysis and lipid profile levels; functional status was evaluated by cardiorespiratory exercise stress test and 6-min walking distance; quality-of-life was assessed with Left Ventricular Dysfunction-36 and Short-Form 36 questionnaires at the baseline and at the end of the 10th week. Results: Significant decreases in serum vascular cell adhesion molecule-1 or serum intercellular adhesion molecule-1 in IAE and CAE groups after training were found, respectively. Resting systolic and diastolic blood pressure, peak systolic and diastolic blood pressure, 6-min walking distance, and the mental health and vitality components of Short-Form 36 improved in the CAE group, whereas left ventricular ejection fraction and 6-min walking distance improved in the IAE group compared with the control group. Conclusions: Both moderate-intensity CAE and IAE programs significantly reduced serum markers of adhesion molecules and prevented the change in VO2 in patients with chronic heart failure. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effect of Electrical Stimulation and Vibration Therapy on Skeletal Muscle Trophism in Rats with Complete Spinal Cord Injury.
Butezloff, Mariana M.; Zamarioli, Ariane; Maranho, Daniel A.; Shimano, Antonio C., 2015-08-07 08:00:00 AM
Objective: The goals of this work were to analyze the skeletal muscle changes after complete spinal cord injury (SCI) in rats and to compare the effects of electrical stimulation and whole-body vibration on prevention of muscle hypotrophy in these animals. Design: Seven-week-old male Wistar rats were divided into four groups: (1) sham operation (sham, n = 12), (2) SCI (n = 10), (3) SCI + electrical stimulation (n = 9), and (4) SCI + whole-body vibration (n = 9). Complete SCI was generated by surgical transection of the cord at the T10 level. Therapies were initiated 3 days after the surgery and continued for 30 days at a frequency of 3 days per week, 20 mins per day. The animals were killed on day 33 after injury for subsequent analyses. Results: SCI caused a significant decrease in muscle mass and fibers, perimeter measurements, and mechanical resistance to traction as well as an increase in fibrotic tissue. Electrical stimulation, but not whole-body vibration, resulted in significant partial muscle hypotrophy prevention. Conclusions: Electrical stimulation may be a potentially beneficial therapeutic modality to prevent muscle hypotrophy after SCI. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Improved Walking Claudication Distance with Transcutaneous Electrical Nerve Stimulation: An Old Treatment with a New Indication in Patients with Peripheral Artery Disease.
Labrunée, Marc; Boned, Anne; Granger, Richard; Bousquet, Marc; Jordan, Christian; Richard, Lisa; Garrigues, Damien; Gremeaux, Vincent; Sénard, Jean-Michel; Pathak, Atul; Guiraud, Thibaut, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to determine whether 45 mins of transcutaneous electrical nerve stimulation before exercise could delay pain onset and increase walking distance in peripheral artery disease patients. Design: After a baseline assessment of the walking velocity that led to pain after 300 m, 15 peripheral artery disease patients underwent four exercise sessions in a random order. The patients had a 45-min transcutaneous electrical nerve stimulation session with different experimental conditions: 80 Hz, 10 Hz, sham (presence of electrodes without stimulation), or control with no electrodes, immediately followed by five walking bouts on a treadmill until pain occurred. The patients were allowed to rest for 10 mins between each bout and had no feedback concerning the walking distance achieved. Results: Total walking distance was significantly different between T10, T80, sham, and control (P < 0.0003). No difference was observed between T10 and T80, but T10 was different from sham and control. Sham, T10, and T80 were all different from control (P < 0.001). There was no difference between each condition for heart rate and blood pressure. Conclusions: Transcutaneous electrical nerve stimulation immediately before walking can delay pain onset and increase walking distance in patients with class II peripheral artery disease, with transcutaneous electrical nerve stimulation of 10 Hz being the most effective. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Combining Afferent Stimulation and Mirror Therapy for Improving Muscular, Sensorimotor, and Daily Functions After Chronic Stroke: A Randomized, Placebo-Controlled Study.
Lee, Ya-yun; Lin, Keh-chung; Wu, Ching-yi; Liao, Ching-hua; Lin, Jui-chi; Chen, Chia-ling, 2015-08-07 08:00:00 AM
Objective: Mirror therapy (MT) combined with mesh glove (MG) afferent stimulation (MT + MG) has been suggested as an effective intervention for motor recovery in patients with stroke. This study aimed to further determine the treatment effects of the MT + MG approach on muscular properties, sensorimotor functions, and daily function. Design: This was a single-blind, randomized, placebo-controlled study. Forty-eight participants with chronic stroke were recruited from medical centers and were randomly assigned to the MT, MT + MG, and MT with sham MG stimulation (MT + sham) groups. The intervention consisted of 1.5 hrs/day, 5 days/wk for 4 wks. Primary outcomes were the Fugl-Meyer Assessment and muscular properties (muscle tone and stiffness). Secondary outcomes included measures of sensorimotor and daily functions. Results: Compared with the MT and MT + sham groups, the MT + MG group demonstrated improved muscular properties. The MT + MG and MT + sham groups showed greater improvement in manual dexterity and daily function than the MT group did. No beneficial effects on the Fugl-Meyer Assessment and other sensorimotor outcomes were found for the MT + MG group. Conclusions: Although no significant group differences were found in the Fugl-Meyer Assessment, MT + MG induced distinctive effects on muscular properties, manual dexterity, and daily function. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Magnetic Resonance Imaging Analysis of Deep Cervical Flexors in Patients with Ossification of the Posterior Longitudinal Ligament and Clinical Implication.
Jeong, Seung-Young; Eun, Jong-Pil; Oh, Young-Min, 2015-08-07 08:00:00 AM
Objective: The purpose of this study was to analyze the cross-sectional area (CSA) of deep cervical flexors as measured by magnetic resonance imaging in ossification of the posterior longitudinal ligament (OPLL) patients with neck pain and, by implication, how this may relate to recruitment of the deep cervical flexors and sternocleidomastoid. Design: A retrospective case-control study was conducted. All 72 subjects were imaged using plain radiography, computed tomography, and magnetic resonance imaging. Results: There was a more limited cervical range of motion in the OPLL group than that in the control group. Cervical lordosis, T1 slope, and thoracic inlet angle values were significantly lower in the OPLL group than in the control group. Bilateral CSAs of the longus colli muscle and longus capitis muscle of the OPLL group were smaller than those of the control group. In addition, bilateral CSAs of the sternocleidomastoid of the OPLL subjects were greater than those of healthy subjects. Conclusions: The authors found that the OPLL patients with chronic neck pain had lesser lordotic cervical alignment, smaller deep cervical flexor CSAs, and larger sternocleidomastoid CSAs than the control group did. The authors' theory is that the sternocleidomastoids in these OPLL patients have compensatorily hypertrophied in response to presumably atrophied deep cervical flexors. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Treadmill Training Improves Forward and Backward Gait in Early Parkinson Disease.
Tseng, Ing-Jy; Yuan, Rey-Yue; Jeng, Chii, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to examine effects of treadmill training (TT) and lasting duration of training effects on forward walking (FW) and backward walking (BW) gait in Parkinson disease (PD). Design: Twenty-six early PD patients undertook a 12-wk intensive TT program using FW. A repeated-measures design compared GAITRite-measured FW and BW gait before TT, within 1 wk, and at 4 and 12 wks after TT. Results: Twenty-three PD patients, after completing TT, walked forward and backward with increased velocity, enlarged stride length, prolonged swing phase, and decreased double support phase; improvements occurred within 1 wk and remained at 4 and 12 wks after training (P < 0.01 or < 0.001). In addition, trends toward reduced posttraining swing time variability and stride length variability occurred in both directions and sustained for 12 wks. Posttraining FW and BW gait improvements were comparable. BW deficits, regardless of training, constantly exceeded FW deficits. Cadence did not differ before and after training in FW (P = 0.195) and BW (P = 0.229) and between FW and BW irrespective of TT (P = 0.124). Conclusions: A 12-wk TT program improves the 12-wk duration of FW and BW gait and can be considered a part of a rehabilitation strategy to overcome gait disturbances in early PD. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Happiness, Pain Intensity, Pain Interference, and Distress in Individuals with Physical Disabilities.
Müller, Rachel; Terrill, Alexandra L.; Jensen, Mark P.; Molton, Ivan R.; Ravesloot, Craig; Ipsen, Catherine, 2015-08-07 08:00:00 AM
Objectives: The aim of this study was to examine how the construct of happiness is related to pain intensity, pain interference, and distress in individuals with physical disabilities. Design: This study involves cross-sectional analyses of 471 individuals with a variety of health conditions reporting at least mild pain. Results: The first hypothesis that happiness mediates the relationship between pain intensity and two outcomes, pain interference and distress, was not supported. The second hypothesis was supported by a good fitting model ([chi]210 = 12.83, P = 0.23, root-mean-square error of approximation = 0.025) and indicated that pain intensity significantly mediated the effect of happiness on pain interference (indirect effect: [beta] = -0.13, P < 0.001) and on distress (indirect effect: [beta] = 0.10, P = 0.01). Happiness showed a significant direct effect on pain intensity ([beta] = -0.20, P < 0.001). A third model exploring the happiness components meaning, pleasure, and engagement fitted well ([chi]24 = 9.65, P = 0.05, root-mean-square error of approximation = 0.055). Pain intensity acted as a significant mediator but only mediated the effect of meaning on pain interference (indirect effect: [beta] = -0.07, P = 0.05) and on distress (indirect effect via pain interference: [beta] = -0.04, P = 0.05). Only meaning ([beta] = -0.10, P = 0.05), but neither pleasure nor engagement, had a significant direct effect on pain intensity. Conclusions: Participants who reported greater happiness reported lower pain interference and distress through happiness' effects on pain intensity. Experiencing meaning and purpose in life seems to be most closely (and negatively) associated with pain intensity, pain interference, and distress. Findings from this study can lay the groundwork for intervention studies to better understand how to more effectively decrease pain intensity, pain interference, and distress. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effect of High Interval Training in Acute Myocardial Infarction Patients with Drug-Eluting Stent.
Kim, Chul; Choi, Hee Eun; Lim, Min Ho, 2015-08-07 08:00:00 AM
Objective: Peak oxygen uptake (VO2peak) is a strong predictor of survival in cardiac patients. The aims of this study were to compare the effects of high interval training (HIT) to moderate continuous training (MCT) on VO2peak and to identify the safety of HIT in acute myocardial infarction patients with drug-eluting stent. Design: Twenty-eight acute myocardial infarction patients with drug-eluting stent were randomized to either HIT at 85%-95 % of heart rate reserve or MCT at 70%-85% of heart rate reserve, 3 days a week for 6 wks at a cardiac rehabilitation clinic. Primary outcome was VO2peak at baseline and after cardiac rehabilitation. Results: Both HIT and MCT groups showed significant increases in VO2peak and heart rate recovery after 6 wks of training. The 22.16% improvement in VO2peak in the HIT group was significantly greater than the 8.48% improvement in the MCT group (P = 0.021). There were no cardiovascular events related to both HIT and MCT. Conclusions: HIT is more effective than MCT for improving VO2peak in acute myocardial infarction patients with drug-eluting stent. These findings may have important implications for more effective exercise training in cardiac rehabilitation program. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Low-Intensity Wheelchair Training in Inactive People with Long-Term Spinal Cord Injury: A Randomized Controlled Trial on Propulsion Technique.
van der Scheer, Jan W.; de Groot, Sonja; Vegter, Riemer J.K.; Hartog, Johanneke; Tepper, Marga; Slootman, Hans; Veeger, DirkJan H.E.J.; van der Woude, Lucas H.V.; ALLRISC Group, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to investigate the effects of a low-intensity wheelchair training on propulsion technique in inactive people with long-term spinal cord injury. Design: Participants in this multicenter nonblinded randomized controlled trial were inactive manual wheelchair users with spinal cord injury for at least 10 yrs (N = 29), allocated to exercise (n = 14) or no exercise. The 16-wk training consisted of wheelchair treadmill propulsion at 30%-40% heart rate reserve or equivalent in rate of perceived exertion, twice a week, 30 mins per session. Propulsion technique was assessed at baseline as well as after 8, 16, and 42 wks during two submaximal treadmill-exercise blocks using a measurement wheel attached to a participant's own wheelchair. Changes over time between the groups were analyzed using Mann-Whitney U tests on difference scores (P < 0.05/3). Results: Data of 16 participants could be analyzed (exercise: n = 8). Significant differences between the exercise and control groups were only found in peak force after 8 wks (respective medians, -20 N vs. 1 N; P = 0.01; ru = 0.78). Conclusions: Significant training effects on propulsion technique were not found in this group. Perhaps, substantial effects require a higher intensity or frequency. Investigating whether more effective and feasible interventions exist might help reduce the population's risk of upper-body joint damage during daily wheelchair propulsion. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Impact of 24 Weeks of Resistance and Endurance Exercise on Glucose Tolerance in Persons with Multiple Sclerosis.
Wens, Inez; Hansen, Dominique; Verboven, Kenneth; Deckx, Nathalie; Kosten, Lauren; Stevens, An L.M.; Cools, Nathalie; Eijnde, Bert O., 2015-08-07 08:00:00 AM
Background: Recently, the authors reported an elevated prevalence of impaired glucose tolerance in individuals with multiple sclerosis (MS), compared with matched healthy controls, indicating metabolic defects that may increase comorbidity. MS also leads to a more inactive lifestyle, increasing the likelihood to develop fat accumulation, muscle wasting/weakness, and exercise intolerance. In other populations, these health complications can partly be reversed by physical exercise. Objective: The aim of this study was to determine the impact of a mild-to-moderate-intensity exercise program on glucose tolerance, ranging between normal and impaired, in persons with MS. Design: Persons with MS (mean expanded disability status scale, 3.3 +/- 0.2; mean age, 48 +/- 15 yrs) were randomized to an exercise group (n = 29) or a nonexercise control group (n = 15). Glucose tolerance, as well as muscle strength, exercise tolerance, and body composition to validate the applied exercise program, was determined in both groups at baseline and after 6, 12, and 24 wks of mild-to-moderate-intensity combined endurance and resistance training. Results: No effects on blood glucose and serum insulin were detected. However, 6 mos of exercise improved muscle strength, exercise tolerance, and lean tissue mass within the intervention group as compared with baseline. In the control group, no changes were detected. Conclusion: Twenty-four weeks of mild-to-moderate-intensity combined endurance and resistance training was not able to improve glycemic control in this cohort of persons with MS. Future research is warranted to investigate the influence of higher exercise intensities on glucose tolerance, in an attempt to remediate metabolic deficits and to decrease the prevalence of comorbidities in MS. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Investigation of the Impact of Sports, Exercise, and Recreation Participation on Psychosocial Outcomes in a Population of Veterans with Disabilities: A Cross-sectional Study.
Laferrier, Justin Z.; Teodorski, Emily; Cooper, Rory A., 2015-08-07 08:00:00 AM
Objective: The aim of this study was to investigate possible effects that participation in sports, exercise, and recreation may have on self-esteem and quality-of-life in service members/veterans with disabilities. Design: Two hundred twenty service members/veterans with disabilities who were participants in one of three annual adaptive sporting events took part in this cross-sectional study. Variables of interest were years of sport, exercise, and recreation participation since the onset of disability as well as the type of activity they engaged in. Main outcome measures were self-esteem and quality-of-life. Results: A positive relationship was found between participant quality-of-life and the number of years spent participating in sports, exercise, and recreation since the onset of their disability. A significant difference was found between pre-event and postevent self-esteem scores. A significant difference was also found in self-esteem scores between the levels of years of participation in sports, exercise, and recreation when averaged across activity type. Finally, there were significant differences found on self-esteem scores between the levels of type of activity averaged across years of participation. Conclusions: Our results indicate that participation in sports, exercise, and recreation has a positive influence on self-esteem and quality-of-life in individuals with disabilities. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Upper Esophageal Sphincter Opening During Swallow in Stroke Survivors.
Kim, Youngsun; Park, Taeok; Oommen, Elizabeth; McCullough, Gary, 2015-08-07 08:00:00 AM
Objective: Timely and efficient upper esophageal sphincter (UES) opening may be critical to safe transport of food or liquid to the stomach and to prevent aspiration during the swallow. The purpose of this study was to examine the temporal and biomechanical characteristics of the UES opening in stroke survivors. Method: Maximum duration and width of the UES opening were obtained from 15 stroke survivors with aspiration and 15 stroke survivors with no aspiration. The control group was composed of 15 normal subjects undergoing videofluoroscopic swallowing examinations. The videofluoroscopic swallowing examination protocol was as follows: two swallows of 5 ml thin liquid and two swallows of 10 ml thin liquid. Statistical comparisons were made by repeated measurements of analysis of variance, and the significance level was set at P < 0.025. Result: The stroke survivors with aspiration, the stroke survivors without aspiration, and the control group differed significantly for duration of UES opening (P < 0.01) but not maximum width of UES opening. Conclusion: Prolonged UES opening may be related to prolonged pharyngeal transition of the bolus and slower UES muscle contraction and hyolaryngeal excursion after stroke. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Benefits for Adults with Transfemoral Amputations and Peripheral Artery Disease Using Microprocessor Compared with Nonmicroprocessor Prosthetic Knees.
Wong, Christopher Kevin; Rheinstein, John; Stern, Michelle A., 2015-08-07 08:00:00 AM
Objective: Approximately 50% of people with leg amputation fall annually. Evidence suggests that microprocessor knees (MK) may decrease falls and improve prosthetic function in people with traumatic amputations. This study explored whether adults with transfemoral amputations and peripheral artery disease would have reduced falls and improved balance confidence, balance, and walking ability when using prostheses with MK compared with non-MK. Design: This was a prospective cohort study. Results: Eight subjects averaged 60.8 +/- 11.3 yrs or age and 9.5 +/- 16.1 yrs since first amputation. Four were K1-K2-level and four were K3-level functional walkers; only Houghton prosthetic use score was different between K1-K2 and K3 walkers (P = 0.03). After 48.3 +/- 38.1 wks of acclimation using MK, subjects demonstrated improvements in fear of falling, balance confidence, Timed Up-and-Go time, and rate of falls (P < 0.05). The improvements in fear of falling, balance confidence, and rate of falls had large effect sizes (d > 0.80). Average decreased Timed Up-and-Go time (12.3 secs) had a medium effect size (d = 0.34). Decreases in the number of falls correlated with faster Timed Up-and-Go speed ([rho] = -0.76) and greater balance confidence ([rho] = 0.83). Conclusions: People with peripheral artery disease and transfemoral amputations had fewer falls and improved balance confidence and walking performance when using prostheses with MK. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.
Segal, Neil A.; Glass, Natalie A.; Teran-Yengle, Patricia; Singh, Bhupinder; Wallace, Robert B.; Yack, H. John, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis. Design: Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 mos or usual care (control). Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score (primary); mobility limitations, using timed 400-m walk, chair-stand, and stair-climb tests; and symptoms, using the Knee Injury/Osteoarthritis Outcome Score at baseline, as well as at 3, 6, and 12 mos. The analyses used longitudinal mixed models. Results: There were no significant intergroup differences between the 35 gait-training (74.3% women; age, 69.7 +/- 8.2 yrs) and 21 control (57.1% women; age, 68.9 +/- 6.5 yrs) participants at baseline. At 3 mos, the gait-training participants had greater improvement in mobility disability (4.3 +/- 1.7; P = 0.0162) and symptoms (8.6 +/- 4.1; P = 0.0420). However, there were no intergroup differences detected for pain, 400-m walk, chair-stand, or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos. Conclusions: Compared with usual care, individualized gait training resulted in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis, but these effects were not sustained. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Is Pain in One Knee Associated with Isometric Muscle Strength in the Contralateral Limb?: Data From the Osteoarthritis Initiative.
Steidle-Kloc, Eva; Wirth, Wolfgang; Glass, Natalie A.; Ruhdorfer, Anja; Cotofana, Sebastian; Eckstein, Felix; Segal, Neil A., 2015-08-07 08:00:00 AM
Objective: Knee pain and muscle weakness confer risk for knee osteoarthritis incidence and progression. The purpose of this study was to determine whether unilateral knee pain influences contralateral thigh muscle strength. Design: Of 4796 Osteoarthritis Initiative participants, 224 (mean +/- SD age, 63.9 +/- 8.9 yrs) cases could be matched to a control. Cases were defined as having unilateral knee pain (numerical rating scale, >= 4/10; >=infrequent pain) and one pain-free knee (numerical rating scale, 0-1; <=infrequent pain; Western Ontario and McMaster Universities Arthritis Index, <= 1). Controls were defined as having bilaterally pain-free knees (numerical rating scale, 0-1; <=infrequent pain; Western Ontario and McMaster Universities Arthritis Index, <= 1). Maximal isometric muscle strength (N) was compared between limbs in participants with unilateral pain (cases) as well as between pain-free limbs of cases and controls. Results: Knee extensor/flexor strength in pain-free limbs of the cases was lower than that in bilaterally pain-free controls (-5.5%/-8.4%; P = 0.043/P = 0.022). Within the cases, maximum extensor/flexor strength was significantly lower in the painful limb than in the pain-free limb (-6.3%/4.1%; P < 0.0001/P = 0.015). Conclusions: These results suggest that strength in limbs without knee pain is associated with the pain status of the contralateral knee. The strength difference between unilateral pain-free cases and matched bilateral pain-free controls was similar to that between limbs in persons with unilateral knee pain. Lower strength caused by contralateral knee pain might be centrally mediated. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effectiveness of Ultrasound Guidance on Intraarticular and Periarticular Joint Injections: Systematic Review and Meta-analysis of Randomized Trials.
Huang, Zhongming; Du, Shaohua; Qi, Yiying; Chen, Guangnan; Yan, Weiqi, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to evaluate the effectiveness and accuracy of ultrasound-guided intraarticular and periarticular joint injections as compared with landmark-guided injections technique. Methods: A systematic literature search was performed in Medline, Web of Science, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and other sources. Only randomized controlled trials were included. Two reviewers independently selected and assessed each study for quality and extracted data. Results: Twelve randomized controlled trials were included in the meta-analysis. The results indicated that ultrasound-guided intraarticular and periarticular joint injections were more accurate than the landmark-guided injections (odds ratio, 0.36; 95% confidence interval, 0.22-0.60). Ultrasound-guided joint injections significantly decreased the visual analog scale scores at both 2 wks (mean difference, -9.57; 95% confidence interval, -13.14 to -5.99) (P < 0.00001) and 6 wks (mean difference, -14.21; 95% confidence interval, -18.20 to -10.21) (P < 0.00001) after injection. There was no statistically significant difference in visual analog scale score at 12 wks between ultrasound-guided and landmark-guided intraarticular and periarticular joint injections (mean difference, -4.42; 95% confidence interval, -11.71 to 2.87) (P = 0.23). Conclusions: Intraarticular and periarticular injections using ultrasound guidance significantly improves the accuracy of joint injections, and there is a significant decrease in visual analog scale scores for up to 6 wks after injection. The effect of ultrasound guidance on the long-term outcome of joint injections is inconclusive. The improved accuracy of injections was associated with pain relief. The authors recommend routine ultrasound guidance for intraarticular and periarticular injections. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Is There an Association Between Lumbosacral Radiculopathy and Painful Gluteal Trigger Points?: A Cross-sectional Study.
Adelmanesh, Farhad; Jalali, Ali; Shooshtari, Seyed Mostafa Jazayeri; Raissi, Gholam Reza; Ketabchi, Seyed Mehdi; Shir, Yoram, 2015-08-07 08:00:00 AM
Objective: The objective of this study was to compare the prevalence of gluteal trigger point in patients with lumbosacral radiculopathy with that in healthy volunteers. Design: In a cross-sectional, multistage sampling method, patients with clinical, electromyographic, and magnetic resonance imaging findings consistent with lumbosacral radiculopathy were examined for the presence of gluteal trigger point. Age- and sex-matched clusters of healthy volunteers were selected as the control group. The primary outcome of the study was the presence or absence of gluteal trigger point in the gluteal region of the patients and the control group. Results: Of 441 screened patients, 271 met all the inclusion criteria for lumbosacral radiculopathy and were included in the study. Gluteal trigger point was identified in 207 (76.4%) of the 271 patients with radiculopathy, compared with 3 (1.9%) of 152 healthy volunteers (P < 0.001). The location of gluteal trigger point matched the side of painful radiculopathy in 74.6% of patients with a unilateral radicular pain. There was a significant correlation between the side of the gluteal trigger point and the side of patients' radicular pain (P < 0.001). Conclusions: Although rare in the healthy volunteers, most of the patients with lumbosacral radiculopathy had gluteal trigger point, located at the painful side. Further studies are required to test the hypothesis that specific gluteal trigger point therapy could be beneficial in these patients. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Effects of Treadmill Training with Load on Gait in Parkinson Disease: A Randomized Controlled Clinical Trial.
Trigueiro, Larissa Coutinho de Lucena; Gama, Gabriela Lopes; Simão, Camila Rocha; Sousa, Angélica Vieira Cavalcanti de; Godeiro Júnior, Clécio de Oliveira; Lindquist, Ana Raquel Rodrigues, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to assess the effects of 3% of body weight loads (0%, 5%, and 10%) on treadmill gait training in subjects with Parkinson disease. Design: This study used a randomized controlled single-blind trial. Results: Spatiotemporal variables demonstrated significant intragroup alterations in all three groups at pretraining and posttraining, with an increase in speed (m/sec; F = 4.73, P = 0.04), stride length (m; F = 12.00, P = 0.002), and step length (m; F = 16.16, P = 0.001) and a decrease in the double-stance phase (%; F = 6.59, P = 0.02) and stance phase (%; F = 4.77, P = 0.04). Intergroup pretraining and posttraining did not exhibit significant differences (F < 2.18, P > 0.14). Angular variables showed significant intragroup alterations, with an increase in knee range of motion (F = 5.18, P = 0.03), and intergroup comparison revealed no significant changes (F < 1.87, P > 0.17). Conclusions: Posttraining improvements in speed, stride length, step length, double-stance, stance phase, and knee range of motion were observed in all groups, where no load (0%, 5%, or 10%) had any significant effect, suggesting that the influence of load did not make one experimental condition better than another. All participants benefitted from treadmill gait training, irrespective of the use of load. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.Isokinetic Assessment and Musculoskeletal Complaints in Paralympic Athletes: A Longitudinal Study.
Silva, Andressa; Zanca, Gisele; Alves, Eduardo Silva; de Aquino Lemos, Valdir; Gávea, Sebastião Augusto; Winckler, Ciro; Mattiello, Stela Márcia; Peterson, Ronnie; Vital, Roberto; Tufik, Sergio; De Mello, Marco Túlio, 2015-08-07 08:00:00 AM
Objective: The aim of this study was to assess and monitor the peak torque of the knee extensor and flexor muscles in flexion and extension and the reports of musculoskeletal complaints in members of the main Brazilian Paralympic athletics team through 1 yr. Design: Fourteen healthy athletes from both sexes were assessed three times in 1 yr. The volunteers were assessed for the presence of musculoskeletal complaints and muscle strength at three time points: (1) at the onset of the preparatory phase on December 2009, (2) at a follow-up assessment on June 2010, and (3) before actual competition on December 2010. The athletes' self-reported musculoskeletal complaints were assessed in structured interviews, and the muscle strength was assessed by means of isokinetic dynamometry. Results: The knee flexor and extensor muscle strength exhibited significant increase in both the right and left lower limbs at the second and third assessments compared with the first one (P < 0.05). Muscle imbalance was associated with knee and thigh complaints at all three assessments (P < 0.05). Conclusions: The knee flexor and extensor muscle strength exhibited a gradual increase in both lower limbs during the course of the three assessments. In parallel, muscle imbalance was associated with the occurrence of knee and thigh complaints. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
Τρίτη 11 Αυγούστου 2015
American Journal of Physical Medicine & Rehabilitation
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