Quantitative evaluation of the stretch reflex before and after hydro kinesy therapy in patients affected by spastic paresis

The Effect of Therapeutic Whirlpool and Hot Packs on Hand Volume During Rehabilitation After Distal Radius Fracture: A Blinded Randomized Controlled Trial

BACKGROUND

Edema is a possibility with all heating modalities due to the increase in local blood flow caused by vasodilation. Despite the frequent application of superficial heat modalities, their relative effect on hand volume has not been determined for the upper extremity. The objective of this study was to compare the immediate effects of hot packs and whirlpool on hand volume for patients with distal radius fracture (DRF) and to determine whether any changes in volume between these modalities were still present 30 minutes after heat application. Finally, to determine whether there were any differences in volume change between groups after 3 repeated therapy visits.

METHODS

Sixty patients with clinically healed DRFs were divided into 2 groups. Half received therapeutic whirlpool at each therapy visit, and the other half received a moist hot pack treatment for 3 consecutive visits. Hand volume was measured before heat, after heat, and at the end of each 30-minute therapy session.

RESULTS

There was a significant difference between groups immediately after heat application, as patients in the whirlpool group experienced an initial volume increase greater than those who received a hot pack. When remeasured after a hand therapy session approximately 30 minutes later, this group difference in volume change was no longer significant. The overall change in volume from enrollment in the study to completion of the study 3 weeks later was not statistically different between groups.

CONCLUSION

Whirlpool is a potential consideration when selecting a heat modality for patients with DRF.

Implementation of an iPod wireless accelerometer application using machine learning to classify disparity of hemiplegic and healthy patellar tendon reflex pair

The characteristics of the patellar tendon reflex provide fundamental insight regarding the diagnosis of neurological status. Based on the features of the tendon reflex response, a clinician may establish preliminary perspective regarding the global condition of the nervous system. Current techniques for quantifying the observations of the reflex response involve the application of ordinal scales, requiring the expertise of a highly skilled clinician. However, the reliability of the ordinal scale approach is debatable. Highly skilled clinicians have even disputed the presence of asymmetric reflex pairs. An alternative strategy was the implementation of an iPod wireless accelerometer application to quantify the reflex response acceleration waveform. An application enabled the recording of the acceleration waveform and later wireless transmission as an email attachment by connectivity to the Internet. A potential energy impact pendulum enabled the patellar tendon reflex to be evoked in a predetermined and targeted manner. Three feature categories of the reflex response acceleration waveform (global parameters, temporal organization, and spectral features) were incorporated into machine learning to distinguish a subject's hemiplegic and healthy reflex pair. Machine learning attained perfect classification of the hemiplegic and healthy reflex pair. The research findings implicate the promise of machine learning for providing increased diagnostic acuity regarding the acceleration waveform of the tendon reflex response.

Implementation of a smartphone as a wireless gyroscope application for the quantification of reflex response

The patellar tendon reflex constitutes a fundamental aspect of the conventional neurological evaluation. Dysfunctional characteristics of the reflex response can augment the diagnostic acuity of a clinician for subsequent referral to more advanced medical resources. The capacity to quantify the reflex response while alleviating the growing strain on specialized medical resources is a topic of interest. The quantification of the tendon reflex response has been successfully demonstrated with considerable accuracy and consistency through using a potential energy impact pendulum attached to a reflex hammer for evoking the tendon reflex with a smartphone, such as an iPhone, application representing a wireless accelerometer platform to quantify reflex response. Another sensor integrated into the smartphone, such as an iPhone, is the gyroscope, which measures rate of angular rotation. A smartphone application enables wireless transmission through Internet connectivity of the gyroscope signal recording of the reflex response as an email attachment. The smartphone wireless gyroscope application demonstrates considerable accuracy and consistency for the quantification of the tendon reflex response.

The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review

Objective:

To summarize evidence on the effects of aquatic therapy on mobility in individuals with neurological diseases.

Data sources:

MEDLINE, EMBASE, PsycInfo, CENTRAL, CINAHL, SPORTDiscus, PEDro, PsycBITE and OT Seeker were searched from inception to 15 September 2014. Hand-searching of reference lists was performed in the selected studies.

Review methods:

The search included randomized controlled trials and quasi-experimental studies that investigated the use of aquatic therapy and its effect on mobility of adults with neurological diseases. One reviewer screened titles and abstracts of retrieved studies from the search strategy. Two reviewers independently examined the full texts and conducted the study selection, data extraction and quality assessment. A narrative synthesis of data was applied to summarize information from included studies. The Downs and Black Scale was used to assess methodological quality.

Results:

A total of 116 articles were obtained for full text eligibility. Twenty studies met the specified inclusion criteria: four Randomized Controlled Trials (RCTs), four non-randomized studies and 12 before-and-after tests. Two RCTs (30 patients with stroke in the aquatic therapy groups), three non-randomized studies and three before-and-after studies showed “fair” evidence that aquatic therapy increases dynamic balance in participants with some neurological disorders. One RCT (seven patients with stroke in the aquatic therapy group) and two before-and-after tests (20 patients with multiple sclerosis) demonstrated “fair” evidence on improvement of gait speed after aquatic therapy.

Conclusion:

Our synthesis showed “fair” evidence supporting the use of aquatic therapy to improve dynamic balance and gait speed in adults with certain neurological conditions.

Quantifying the deep tendon reflex using varying tendon indentation depths: applications to spasticity

The deep tendon reflex (DTR) is often utilized to characterize the neuromuscular health of individuals because it is cheap, quick to implement, and requires limited equipment. However, DTR assessment is unreliable and assessor-dependent improve the reliability of the DTR assessment, we devised a novel standardization procedure. Our approach is based on the hypothesis that the neuromuscular state of a muscle changes systematically with respect to the indentation depth of its tendon. We tested the hypothesis by progressively indenting the biceps tendons on each side of nine hemiplegic stroke survivors to different depths, and then superimposing a series of brief controlled taps at each indentation depth to elicit a reflex response. Our results show that there exists a unique indentation depth at which reflex responses are consistently recorded (termed the Reflex Threshold) with increasing amplitude along increasing indentation depth. We further show that the reflex threshold depth is systematically smaller on the affected side of stroke survivors and that it is negatively correlated with the Modified Ashworth Score (VAF 70%). Our procedure also enables measurement of passive mechanical properties at the indentation location. In conclusion, our study shows that controlling for the indentation depth of the tendon of a muscle alters its reflex response predictably. Our novel device and method could be used to estimate neuromuscular changes in muscle (e.g., spasticity). Although some refinement is needed, this method opens the door to more reliable quantification of the DTR.

Implementation of an iPhone wireless accelerometer application for the quantification of reflex response

The patellar tendon reflex represents an inherent aspect of the standard neurological evaluation. The features of the reflex response provide initial perspective regarding the status of the nervous system. An iPhone wireless accelerometer application integrated with a potential energy impact pendulum attached to a reflex hammer has been successfully developed, tested, and evaluated for quantifying the patellar tendon reflex. The iPhone functions as a wireless accelerometer platform. The wide coverage range of the iPhone enables the quantification of reflex response samples in rural and remote settings. The iPhone has the capacity to transmit the reflex response acceleration waveform by wireless transmission through email. Automated post-processing of the acceleration waveform provides feature extraction of the maximum acceleration of the reflex response ascertained after evoking the patellar tendon reflex. The iPhone wireless accelerometer application demonstrated the utility of the smartphone as a biomedical device, while providing accurate and consistent quantification of the reflex response.

WIRELESS THREE DIMENSIONAL ACCELEROMETER REFLEX QUANTIFICATION DEVICE WITH ARTIFICIAL REFLEX SYSTEM

Fundamental to the neurological examination is the deep tendon reflex. Two important tendon reflex parameters are response and latency. Response can be quantified by the NINDS Myotatic Reflex Scale; however, controversy exists with respect to the accuracy of the scale. Electrodiagnostic testing may derive parameters, similar to the validity of the reflex latency; however, such tests require highly specialized resources. Attempts have been made to develop quantified reflex devices. Two wireless three-dimensional (3D) accelerometers incorporating MEMS technology have been integrated into a device for quantifying reflex response and latency. The device is tested and evaluated using an artificial reflex system. The reflex quantification device obtained reflex response and latency parameters based on the artificial reflex device, which were bounded by a 98% confidence level with a 2% margin of error about the mean.

Quantified reflex strategy using an iPod as a wireless accelerometer application

A primary aspect of a neurological evaluation is the deep tendon reflex, frequently observed through the patellar tendon reflex. The reflex response provides preliminary insight as to the status of the nervous system. A quantified reflex strategy has been developed, tested, and evaluated though the use of an iPod as a wireless accelerometer application integrated with a potential energy device to evoke the patellar tendon reflex. The iPod functions as a wireless accelerometer equipped with robust software, data storage, and the capacity to transmit the recorded accelerometer waveform of the reflex response wirelessly through email for post-processing. The primary feature of the reflex response acceleration waveform is the maximum acceleration achieved subsequent to evoking the patellar tendon reflex. The quantified reflex strategy using an iPod as a wireless accelerometer application yields accurate and consistent quantification of the reflex response.

TENDON REFLEX AND STRATEGIES FOR QUANTIFICATION, WITH NOVEL METHODS INCORPORATING WIRELESS ACCELEROMETER REFLEX QUANTIFICATION DEVICES, A PERSPECTIVE REVIEW

The deep tendon reflex is a fundamental aspect of a neurological examination. The two major parameters of the tendon reflex are response and latency, which are presently evaluated qualitatively during a neurological examination. The reflex loop is capable of providing insight into the status and therapy response of both upper and lower motor neuron syndromes. Attempts have been made to ascertain reflex response and latency; however, these systems are relatively complex, resource intensive, with issues of consistent and reliable accuracy. The solution presented is a wireless quantified reflex device using tandem three-dimensional (3D) wireless accelerometers to obtain response based on acceleration waveform amplitude and latency derived from temporal acceleration waveform disparity. Three specific aims have been established for the proposed wireless quantified reflex device:

(1) Demonstrate the wireless quantified reflex device is reliably capable of ascertaining quantified reflex response and latency using a quantified input.

(2) Evaluate the precision of the device using an artificial reflex system.

(3) Conduct a longitudinal study respective of subjects with healthy patellar tendon reflexes, using the wireless quantified reflex evaluation device to obtain quantified reflex response and latency.

Aim 1 has led to a steady evolution of the wireless quantified reflex device from a singular 2D wireless accelerometer capable of measuring reflex response to a tandem 3D wireless accelerometer capable of reliably measuring reflex response and latency. The hypothesis for aim 1 is that a reflex quantification device can be established for reliably measuring reflex response and latency for the patellar tendon reflex, comprised of an integrated system of wireless 3D MEMS accelerometers. Aim 2 further emphasized the reliability of the wireless quantified reflex device by evaluating an artificial reflex system. The hypothesis for aim 2 is that the wireless quantified reflex device can obtain reliable reflex parameters (response and latency) from an artificial reflex device. Aim 3 synthesizes the findings relevant to aim 1 and 2, while applying the wireless accelerometer reflex quantification device to a longitudinal study of healthy patellar tendon reflexes. The hypothesis for aim 3 is that during a longitudinal evaluation of the deep tendon reflex the parameters for reflex response and latency can be measured with a considerable degree of accuracy, reliability, and reproducibility. Enclosed is a detailed description of a wireless quantified reflex device with research findings and potential utility of the system, inclusive of a comprehensive description of tendon reflexes, prior reflex quantification systems, and correlated applications.

QUANTIFIED DEEP TENDON REFLEX DEVICE FOR RESPONSE AND LATENCY, THIRD GENERATION

Deep tendon reflex is fundamental for a neurological examination. A hyperactive reflex response is correlated with spasticity, which can also be associated with the degree of damage to the supraspinal input, essentially assessing the severity of traumatic brain injury. Clinical evaluation of the myotatic stretch reflex is provided by the National Institute of Neurological Disorders and Stroke (NINDS) Myotatic Reflex Scale (0 to 4); however, the results of the NINDS Myotatic Reflex Scale vary in terms of interpretation and lack temporal data. Deep tendon reflex can assess the severity and degree of peripheral neuropathy. Subsequent to the neurological examination, suspect patients are often referred to a specialist for definitive electrodiagnostic testing. A study by Cocito found that 28% of the prescriptions for testing were considered to be inappropriate. Therefore, the solution is a fully quantified tendon reflex evaluation system. The input force of the reflex hammer is derived from a predetermined potential energy setting. Tandem wireless three-dimensional (3D) microelectromechanical systems (MEMS) accelerometers quantify the output and latency time of the reflex. The wireless 3D MEMS accelerometers are positioned to a standard anchor point near the ankle and reflex hammer swing arm. Reflex response is quantified by the maximum and minimum components of the acceleration profile. The temporal disparity between hammer strike and response defines the latency of the reflex loop. The quantified data collected from wireless 3D MEMS accelerometers are conveyed to a portable computer. Enclosed are the initial test and evaluation and the description of such a device, which quantitatively evaluates the reflex response and latency using wireless 3D MEMS accelerometers, while demonstrating precision for reproducibility.

FOURTH GENERATION WIRELESS REFLEX QUANTIFICATION SYSTEM FOR ACQUIRING TENDON REFLEX RESPONSE AND LATENCY

An intrinsic aspect of the standard neurological examination is the deep tendon reflex. A clinician is tasked with qualitatively evaluating reflex parameters, such as reflex response and latency. The tendon reflex is capable of providing preliminary insight with respect to dysfunction of the central and peripheral nervous systems. The qualitative assessment of the tendon reflex can be classified through the implementation of an ordinal scale, such as the NINDS scale which spans five ordinal components from 0 to 4. The reliability and accuracy of the ordinal-scale method for classifying reflex characteristics have been demonstrated to be an issue of controversy. Ordinal scales lack the capacity to properly classify the temporal features of the tendon reflex. Electrodiagnostic testing traditionally provides higher fidelity evaluation of peripheral neuropathy; however, a study by Cocito et al., has discovered 28% of the prescriptions were inappropriate. The fourth-generation wireless reflex quantification system provides a less resource intensive, highly accurate, reliable, and reproducible alternative. The patellar tendon reflex is evoked through a predetermined potential energy derived swing arm attached to a standard reflex hammer. Tandem wireless 3D MEMS accelerometers quantify reflex response and latency. The reflex response maximum and minimum are acquired from the wireless 3D MEMS accelerometer positioned above the ankle joint. The latencies derived from the maximum and minimum of the reflex responses are derived from the temporal disparity relative to the acceleration waveforms of the reflex response and swing arm evoking the tendon reflex. The fourth-generation wireless reflex quantification system has been evolved with a more user-convenient wirelessly activated datalogger mode, which is subsequently downloaded to a local PC wirelessly. The wireless datalogger mode enables sampling at a greater rate relative to the real-time streaming data mode. An automated MATLAB software program is implemented for acquiring reflex parameters. Enclosed is the longitudinal study of the fourth-generation wireless reflex quantification system that demonstrates considerable precision for accuracy, reliability, and reproducibility. As a supplement to the research, a brief reflex modulation study is amended to the longitudinal study.

QUANTIFIED DEEP TENDON REFLEX DEVICE, SECOND GENERATION

The deep tendon reflex is a fundamental aspect of neurological examinations. The severity of and degree of recovery from a traumatic brain injury can be assessed by the myotatic stretch reflex. A hyperactive reflex response is correlated with spasticity, which can also be correlated with the degree of damage to the supraspinal input, in essence assessing the severity of traumatic brain injury. The myotatic stretch reflex is clinically evaluated by the National Institute of Neurological Disorders and Stroke (NINDS) reflex scale (0–4); however, this scale lacks temporal data and may also vary in interpretation. The solution is a fully quantified evaluation system of the myotatic stretch reflex, whereby a patellar hammer's force input is based on original potential energy and a microelectromechanical system (MEMS) accelerometer quantifies the output. The MEMS accelerometer is attached to a set anchor point near the ankle. The reflex amplitude is based on the maximum acceleration of the reflex response. The quantified data collected from MEMS accelerometers are transmitted by a portable computer (i.e. a Pocket PC). This paper describes a device that quantitatively evaluates the reflex response using accelerometers and that demonstrates precision for reproducibility.

Wireless accelerometer reflex quantification system characterizing response and latency

The evaluation of the deep tendon reflex is a standard aspect of a neurological evaluation, which is frequently evoked through the patellar tendon reflex. Important features of the reflex are response and latency, providing insight to status for peripheral neuropathy and upper motor neuron syndrome. A wireless accelerometer reflex quantification system has been developed, tested, and evaluated. The reflex input is derived from a potential energy setting. Wireless accelerometers characterize the reflex hammer strike and reflex response acceleration waveforms, enabling the quantification of reflex response and latency. Spectral analysis of the reflex response acceleration waveform elucidates the frequency domain, opening the potential for new reflex classification metrics. The wireless accelerometer reflex quantification system yields accurate and consistent quantification of reflex response and latency.

Association between botulinum toxin injection into the arm and changes in gait in adults after stroke

Botulinum toxin (BTX) is often used to improve arm function in persons with hemiparesis after stroke. Persons injected into the arm sometimes report changes in their gait. The purpose of this open-labeled pilot study was to investigate the association between injecting BTX into the upper limb and ankle and knee range of motion (ROM) and paretic-leg stride-time, defined as the time in seconds required to move the hemiparetic leg from initial contact of the foot to initial contact of the same foot. Gait parameters were recorded before and 4 to 6 weeks after the hemiparetic arm was injected with BTX in 13 adults with hemiparesis secondary to stroke, using a three-dimensional computerized motion analysis system. BTX injection into the paretic arm was associated with a decrease in stride-time of the paretic leg in all participants. Slower striding participants improved knee and ankle ROM in the paretic leg. There was no change in ankle and knee ROM in faster striding participants. Injection of BTX into the upper extremity is associated with a change in hemiparetic leg stride-time and ankle and knee ROM. There is a variability of response, with slow striders improving to a greater extent than fast striders.

Quadriceps force generation in patients with osteoarthritis of the knee and asymptomatic participants during patellar tendon reflex reactions: an exploratory cross-sectional study

Background

It has been postulated that muscle contraction is slower in patients with osteoarthritis of the knee than asymptomatic individuals, a factor that could theoretically impair joint protection mechanisms. This study investigated whether patients with osteoarthritis of the knee took longer than asymptomatic participants to generate force during reflex quadriceps muscle contraction. This was an exploratory study to inform sample size for future studies.

Methods

An exploratory observational cross sectional study was carried out. Two subject groups were tested, asymptomatic participants (n = 17), mean (SD) 56.7 (8.6) years, and patients with osteoarthritis of the knee, diagnosed by an orthopaedic surgeon, (n = 16), age 65.9 (7.8) years. Patellar tendon reflex responses were elicited from participants and measured with a load cell. Force latency, contraction time, and force of the reflex response were determined from digitally stored data. The Mann-Whitney U test was used for the between group comparisons in these variables. Bland and Altman within-subject standard deviation values were calculated to evaluate the measurement error or precision of force latency and contraction time.

Results

No significant differences were found between the groups for force latency (p = 0.47), contraction time (p = 0.91), or force (p = 0.72). The two standard deviation measurement error values for force latency were 27.9 ms for asymptomatic participants and 16.4 ms for OA knee patients. For contraction time, these values were 29.3 ms for asymptomatic participants and 28.1 ms for OA knee patients. Post hoc calculations revealed that the study was adequately powered (80%) to detect a difference between the groups of 30 ms in force latency. However it was inadequately powered (59%) to detect this same difference in contraction time, and 28 participants would be required in each group to reach 80% power.

Conclusion

Patients with osteoarthritis of the knee do not appear to have compromised temporal parameters or magnitude of force generation during patellar tendon reflex reactions when compared to a group of asymptomatic participants. However, these results suggest that larger studies are carried out to investigate this area further.

[Balneotherapy in the treatment of subjective symptoms of lumbar syndrome]

INTRODUCTION

Chronic low back pain is a degenerative rheumatic disease and is characterized by various symptoms and clinical signs.

BALNEOTHERAPY

Balneotherapy represents a therapy by various hot or warm baths in natural mineral waters of specific physical and chemical characteristics. When used externally, they have mechanical, chemical and thermic effects. Balneotherapy of lumbar syndrome includes: individual baths, swimming in the pool, hydrokinesitherapy, underwater massage, underwater extension, mud therapy, mud baths. The therapy should be closely monitored for optimal efficacy and it is necessary to examine: functional status of the lumbosacral region, general functional status (level of activity), lower extremities, pain measurement, use of non-steroid antirheumatic and analgesic agents. In order to follow-up the effects of therapy and establish the prognosis it is important to perform: detailed anamnesis, anthropometric measurements, socio-epidemiological research, clinical examinations.

CONCLUSION

Lumbar syndrome is usually caused by a degenerative disease of the spinal column. More than 25% of people under 45 years of age are unable to work due to chronic low back pain. That is why preventive measures, prompt diagnosis and adequate therapy are of utmost importance.

Physiotherapy approaches in the treatment of ataxic multiple sclerosis: a pilot study

OBJECTIVE

This study was planned to investigate the efficacy of neuromuscular rehabilitation and Johnstone Pressure Splints in the patients who had ataxic multiple sclerosis.

METHODS

Twenty-six outpatients with multiple sclerosis were the subjects of the study. The control group (n = 13) was given neuromuscular rehabilitation, whereas the study group (n = 13) was treated with Johnstone Pressure Splints in addition.

RESULTS

In pre- and posttreatment data, significant differences were found in sensation, anterior balance, gait parameters, and Expanded Disability Status Scale (p < 0.05). An important difference was observed in walking-on-two-lines data within the groups (p < 0.05). There also was a statistically significant difference in pendular movements and dysdiadakokinesia (p < 0.05). When the posttreatment values were compared, there was no significant difference between sensation, anterior balance, gait parameters, equilibrium and nonequilibrium coordination tests, Expanded Disability Status Scale, cortical onset latency, and central conduction time of somatosensory evoked potentials and motor evoked potentials (p > 0.05). Comparison of values revealed an important difference in cortical onset-P37 peak amplitude of somatosensory evoked potentials (right limbs) in favor of the study group (p < 0.05).

CONCLUSIONS

According to our study, it was determined that physiotherapy approaches were effective to decrease the ataxia. We conclude that the combination of suitable physiotherapy techniques is effective multiple sclerosis rehabilitation.

Paraparesia Espástica Tropical - Mielopatia associada ao vírus HTLV- I:

Introdução: A Paraparesia Espástica Tropical/Mielopatia (PET/MAH) é uma complicação crônica e progressiva associada à infecção pelo vírus HTLV-I, que além de outras afecções, ocasiona um processo inflamatório medular, predominantemente em seus níveis baixos, devido à invasão desorganizada dos linfócitos T modificados. Devido à escassez de pesquisas em Fisioterapia voltadas para a PET/MAH, o presente artigo de revisão visa adaptar abordagens em relação à reabilitação motora, com suas respectivas justificativas teóricas. Desenvolvimento: Um dos aspectos mais limitantes da doença está na fraqueza e espasticidade dos membros inferiores, com comprometimento da funcionalidade da marcha, podendo em alguns casos confinar os pacientes à cadeira de rodas. Através de uma análise detalhada da fisiopatogenia dos sintomas, acredita-se que condutas fisioterapêuticas podem amenizar as seqüelas neurológicas e promover uma melhora da qualidade de vida dos indivíduos acometidos. Conclusão: A fisioterapia, baseada nas fundamentações teóricas propostas, parece ser eficaz na recuperação funcional dos pacientes com PET/MAH.