Effects of sling exercises on pain, function, and corticomuscular functional connectivity in individuals with chronic low back pain- preliminary study

BACKGROUND

Individuals with chronic low back pain (CLBP) exhibit altered brain function and trunk muscle activation.

AIM

This study examined the effects of sling exercises on pain, function, and corticomuscular coherence (CMC) in healthy adults and individuals with CLBP.

METHODS

Eight individuals with CLBP and 15 healthy adults received sling exercise training for 6 weeks. Before and after training, participants performed two motor tasks: rapid arm lifts and repeated trunk flexion-extension tasks, and electromyography of the trunk muscles and electroencephalography of the sensorimotor cortex were recorded. Chi-squared test and Mann-Whitney U tests were used for between group comparison, and Wilcoxon signed-rank tests were used for pre- and post-training comparison. Spearman's Rank Correlation Coefficient (Rs) was used to identify for the relationship between motor performance and Corticomuscular coherence.

RESULTS

Sling exercises significantly improved pain (median from 3 to 1, p = .01) and Oswestry Disability Index scores (median from 2.5 to 2, p = .03) in the CLBP group. During rapid arm lifts, individuals with CLBP showed lower beta CMC of the transverse abdominis and internal oblique (Tra/IO) (0.8 vs. 0.49, p = .01) and lumbar erector spinae (0.70 vs. 0.38, p = .04) than the control group at baseline. During trunk flexion-extension, the CLBP group showed higher gamma CMC of the left Tra/IO than the control group at baseline (0.28 vs. 0.16 , p = .001). After training, all CMC became statistically non-significant between groups. The training induced improvement in anticipatory activation of the Tra/IO was positively correlated with the beta CMC (rs = 0.7851, p = .02).

CONCLUSION

A 6-week sling exercises diminished pain and disability in patients with CLBP and improved the anticipatory activation and CMC in some trunk muscles. These improvements were associated with training induced changes in corticomuscular connectivity in individuals with CLBP.

Effects of different types and frequencies of early rehabilitation on ventilator weaning among patients in intensive care units: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the effects of different types and frequencies of physiotherapy on ventilator weaning among patients in the intensive care unit (ICU) and to identify the optimal type and frequency of intervention.

DATA SOURCES

PubMed, Cochrane Library, EMBASE, and Airiti Library.

STUDY SELECTION

Randomized controlled trials that provided information on the dosage of ICU rehabilitation and the parameters related to ventilator weaning were included.

DATA EXTRACTION AND MANAGEMENT

Treatment types were classified into conventional physical therapy, exercise-based physical therapy, neuromuscular electrical stimulation (NEMS), progressive mobility, and multi-component. The frequencies were divided into high (≥ 2 sessions/day or NEMS of > 60 minutes/day), moderate (one session/day, 3-7 days/week or NEMS of 30-60 minutes/day), and low (one session/day, < 3 days/week, or NEMS of < 30 minutes/day).

DATA SYNTHESIS

Twenty-four articles were included for systematic review and 15 out of 24 articles were analyzed in the meta-analysis. Early rehabilitation, especially the progressive mobility treatment exerted an optimal effect in reducing the ventilator duration in patients in the ICU (standardized mean difference [SMD] = 0.91; 95% confidence interval [CI] = 0.23-1.58; P < 0.01). Regarding the treatment frequency, the high-frequency intervention did not result in a favorable effect on ventilator duration compared with the moderate frequency of treatment (SMD = 0.75; 95% CI = -1.13-2.64; P = 0.43).

CONCLUSION

Early rehabilitation with progressive mobility is highly recommended to decrease the ventilation duration received by patients in the ICU. Depending on clinical resources and the tolerance of patients, the frequency of interventions should reach moderate-to-high frequency, that is, at least one session per day and 3 days a week.

TRIAL REGISTRATION

Registration number: PROSPERO (CRD42021243331).

A novel instrumented walker for individualized visual cue setting for gait training in patients with Parkinson's disease

Patients with Parkinson's disease suffer from gait disturbances, such as a shuffling and festinating gait, which reduces their quality of life. To circumvent this problem, external visual cues may be applied in gait training to maintain the integrity of motor function. However, conventional training methods, such as transverse lines stuck on the ground, are difficult to adjust and adapt to personalized gait ability. This study proposes a convenient instrumented wheel walker that provides gap adjustable visual cues and selectable projection modes onto the ground with and without motion relative to the user. Ten subjects with Parkinson's disease were recruited, and the efficacy of the proposed device for their gait training was assessed. We demonstrated the applicability of our device to address personalized demands in gait guidance. With a personalized setting for patients with Parkinson's disease, a significantly lengthened stride length may be achieved.

Exploring Managers' Opinions on Planning and Designing Adult Day Care Centers

OBJECTIVE

To explore managers' opinions on planning and design of location, building type, spatial layout, and interior design of adult day care centers (ADCCs).

BACKGROUND

The planning and design of new ADCCs affect subsequent service users and workflows. Studies explore the factors affecting such planning and design using qualitative methods and from the perspective of users. Quantitative methods are rarely employed to explore factors affecting planning and opinions on the design of ADCCs from administrators' perspective.

METHODS

Stratified sampling was used to collect data from managers of ADCCs in Taiwan. A mixed-method approach with an analytic hierarchy process was used to quantify the relative importance of factors affecting location and building type selections. Participants responded to open-ended interview questions followed by focus group interviews to examine the key points for spatial layout and interior design.

RESULTS

The managers deemed support and attitudes from local residents (group weight = .208) and authorities (group weight = .187) as their first two critical location selection criteria. Regarding their opinions on the conditions of building type, those that prioritized the products and technologies of facility design were deemed the most critical (group weight = .193), followed by those that valued daylight quality (group weight = .161). Six key points of spatial layout and interior design were obtained from the focus group interviews.

CONCLUSIONS

This study provides a reference for the effective planning of operations, including geographical location, building type, spatial layout, and interior refurbishment and design.

Effects of Exercise and Nutritional Intervention on Body Composition, Metabolic Health, and Physical Performance in Adults with Sarcopenic Obesity: A Meta-Analysis

People with sarcopenic obesity (SO) are characterized by both low muscle mass (sarcopenia) and high body fat (obesity); they have greater risks of metabolic diseases and physical disability than people with sarcopenia or obesity alone. Exercise and nutrition have been reported to be effective for both obesity and sarcopenia management. Thus, we aimed to investigate the effects of exercise and nutrition on body composition, metabolic health, and physical performance in individuals with SO. Studies investigating the effects of exercise and nutrition on body composition, metabolic health, and physical performance in SO individuals were searched from electronic databases up to April 2019. Fifteen studies were included in the meta-analysis. Aerobic exercise decreased body weight and fat mass (FM). Resistance exercise (RE) decreased FM and improved grip strength. The combination of aerobic exercise and RE decreased FM and improved walking speed. Nutritional intervention, especially low-calorie high-protein (LCHP) diet, decreased FM but did not affect muscle mass and grip strength. In addition to exercise training, nutrition did not provide extra benefits in outcome. Exercise, especially RE, is essential to improve body composition and physical performance in individuals with SO. Nutritional intervention with LCHP decreases FM but does not improve physical performance.

Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke

The peripheral sensory system is critical to regulating motor plasticity and motor recovery. Peripheral electrical stimulation (ES) can generate constant and adequate sensory input to influence the excitability of the motor cortex. The aim of this proof of concept study was to assess whether ES prior to each hand function training session for eight weeks can better improve neuromuscular control and hand function in chronic stroke individuals and change electroencephalography-electromyography (EEG-EMG) coherence, as compared to the control (sham ES). We recruited twelve subjects and randomly assigned them into ES and control groups. Both groups received 20-minute hand function training twice a week, and the ES group received 40-minute ES on the median nerve of the affected side before each training session. The control group received sham ES. EEG, EMG and Fugl-Meyer Assessment (FMA) were collected at four different time points. The corticomuscular coherence (CMC) in the ES group at fourth weeks was significantly higher (p = 0.004) as compared to the control group. The notable increment of FMA at eight weeks and follow-up was found only in the ES group. The eight-week rehabilitation program that implemented peripheral ES sessions prior to function training has a potential to improve neuromuscular control and hand function in chronic stroke individuals.

Comparing the Chinese versions of two knee-specific questionnaires (IKDC and KOOS): reliability, validity, and responsiveness

BACKGROUND

The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) are knee-specific questionnaires that have been widely used and translated into numerous languages. However, the differences in the psychometric properties between the Chinese IKDC and KOOS remain unclear. The purpose of this study was to conduct a cross-cultural adaptation of the Chinese IKDC and Chinese KOOS and to compare the psychometric properties of these two measures in patients with various knee injuries from the acute stage up to 12 weeks after receiving treatment.

METHODS

The original IKDC and KOOS were translated into Chinese based on the guidelines of cross-cultural adaptation and translation protocols. One hundred and seventy-three patients with various knee injuries were recruited in this study and completed both Chinese IKDC and Chinese KOOS as well as a generic health status questionnaire (Chinese Short Form-36 [SF-36]). The reliability, internal consistency, content validity, convergent and divergent validity and responsiveness of both IKDC and KOOS were assessed with appropriate indices.

RESULTS

The Chinese IKDC showed excellent reliability (ICC = 0.97) and strong internal consistency (Cronbach alpha = 0.87). The Chinese KOOS also presented good reliability with ICCs ranging from 0.89 to 0.95 and internal consistency (Cronbach alpha coefficients ranging from 0.76 to 0.97). The content validity of these two questionnaires were excellent, yielding no floor or ceiling effects. Both the Chinese IKDC and KOOS were highly associated with the physical component summary (PCS) score and weakly related to the mental component summary (MCS) score of the SF-36. Responsiveness to change was large (effect size =0.95) for the Chinese IKDC and moderate (effect sizes = 0.49~0.60) at 12-week after physical therapy.

CONCLUSION

Both the Chinese IKDC and KOOS demonstrated good psychometric properties. However, the Chinese IKDC was more sensitive to changes over a period of 2, 4, 8, 12 weeks of physical therapy than the Chinese KOOS. The ROC analyses revealed a value of area under the curve (0.83 for the Chinese IKDC and 0.67-0.79 for the subscales of Chinese KOOS). Minimal clinically important difference values were 9.8 for the Chinese IKDC and 0.79, 0.76, 0.76, 0.76, 0.67 for the Symptoms, Pain, Activities of Daily Living, Sport/Recreation, and Quality of Life subscales of Chinese KOOS, respectively. The current study provides information for clinicians and researchers to use these appraisal tools for Chinese-speaking patients with various knee disorders.

Influence of Accelerometer Placement and/or Heart Rate on Energy Expenditure Prediction during Uphill Exercise

Studies using a triaxial accelerometer and heart rate (HR) simultaneously for estimating energy expenditure (EE) during uphill exercise are rare. Exploring the optimal location for placing the accelerometer for predicting EE during uphill exercise is essential. Sixteen healthy male participants (M ± SEM; age 25.00 ± 0.61 years; body weight 74.13 ± 2.51 kg; body height 1.74 ± 0.01 m; body mass index 24.30 ± 0.63 kg/m²) exercised on a treadmill under 12 conditions (4 speeds and 3 gradients) on 3 days. Triaxial accelerometers, an HR recorder, and a metabolic measurement system were simultaneously used. Accelerometer outputs from various anatomical locations (upper arm, chest, lower back, waist, thigh, and instep) showed significant positive correlations with EE (0.819, 0.846, 0.816, 0.820, 0.672, and 0.669, respectively; p < .05). The linear regression equation for changes in HR showed the highest coefficient of determination (r²) of .837 with 87.9% reliability. When the HR signal was included, the r² value (> .842) and reliability (87.9%) between the accelerometer outputs and EE improved. Accelerometer outputs from the waist position alone provide highly accurate EE values. Using both accelerometer outputs and HR for EE estimation during uphill exercise is feasible and improves the accuracy of EE prediction.

Factors Associated With Recommendations for Assistive Technology Devices for Persons With Mobility Limitations Using Workplace Accommodation Services

The objective of this study was to identify the interactions between impairment-related and work-related factors associated with recommendations for specific assistive technology devices (ATDs) for persons with mobility limitations who used workplace accommodation (WA) services. A retrospective and secondary data analysis was conducted on 132 WA service users with mobility limitations in Taipei City from 2008 to 2012 using chi-square automatic interaction detector (CHAID). The CHAID analyses revealed interactions between impairment-related factors (difficulty walking and upper extremity pain) and work-related factors (frequent moving around outdoors), which were significantly associated with the recommendation of powered wheelchairs ( p < .05). Interactions between the impairment-related factor (difficulty walking) and the work-related factor (frequent sitting for long periods of time) were associated with the recommendation of ergonomic chairs ( p < .001) for persons with mobility limitations. By identifying the interactions between impairment-related and work-related factors in recommending workplace ATDs for persons with mobility limitations, this study provides evidence-based ATDs recommendations for persons with mobility limitations.

Application of the Transtheoretical Model to Exercise Behavior and Physical Activity in Patients after Open Heart Surgery

PURPOSE

To assess exercise behavior and physical activity levels after open heart surgery.

METHODS

This prospective cohort study included 130 patients (70.8% male, aged 61.0 ± 12.2 years, 53.8% coronary bypass grafting) who underwent open heart surgery. The exercise behavior and physical activity of these patients were assessed at the 3- and 6-month follow-up appointments. Additional interviews were also conducted to further assess exercise behavior. Physical activity duration and metabolic equivalents were calculated from self-reported questionnaire responses. Moreover, possible related demographic factors, clinical features, participation in cardiac rehabilitation programs, and physical activity levels were additionally evaluated.

RESULTS

Six months after hospital discharge, most patients were in the action (39.2%) and maintenance (37.7%) stages. Other subjects were in the precontemplation (11.5%), contemplation (5.4%), and preparation (6.2%) stages. The average physical activity level was 332.6 ± 377.1 min/week and 1198.1 ± 1396.9 KJ/week. Subjects in the action and maintenance stages exercised an average of 399.4 ± 397.6 min/week, significantly longer than those in other stages (116.2 ± 176.2 min/week, p = 0.02). Subjects that participated in outpatient cardiac rehabilitation programs after discharge may have the better exercise habit. Gender had no significant effect on exercise behavior 6 months after hospital discharge.

CONCLUSIONS

Most subjects following open heart surgery may maintain regular exercise behavior at 6 months after hospital discharge. Physical activity levels sufficient for cardiac health were achieved by subjects in the active and maintenance stages. Outpatient cardiac rehabilitation programs are valuable for encouraging exercise behavior after heart surgery.

KEY WORDS

Exercise behavior; Open heart surgery; Physical activity; Transtheoretical model.

Investigating the Effects of Peripheral Electrical Stimulation on Corticomuscular Functional Connectivity Stroke Survivors

BACKGROUND

Electrical stimulation (ES) in the periphery can induce brain plasticity and has been used clinically to promote motor recovery in patients with central nervous system lesion. Electroencephalogram (EEG) and electromyogram (EMG) are readily applicable in clinical settings and can detect real-time functional connectivity between motor cortex and muscles with EEG-EMG (corticomuscular) coherence.

OBJECTIVE

The purpose of this study was to determine whether EEG-EMG coherence can detect changes in corticomuscular control induced by peripheral ES.

METHODS

Fifteen healthy young adults and 15 stroke survivors received 40-min electrical stimulation session on median nerve. The stimulation (1-ms rectangular pulse, 100 Hz) was delivered with a 20-s on-20-s off cycle, and the intensity was set at the subjects' highest tolerable level without muscle contraction or pain. Both before and after the stimulation session, subjects performed a 20-s steady-hold thumb flexion at 50% maximal voluntary contraction (MVC) while EEG and EMG were collected.

RESULTS

Our results demonstrated that after ES, EEG-EMG coherence in gamma band increased significantly for 22.1 and 48.6% in healthy adults and stroke survivors, respectively. In addition, after ES, force steadiness was also improved in both groups, as indicated by the decrease in force fluctuation during steady-hold contraction (-1.7% MVC and -3.9%MVC for healthy and stroke individuals, respectively).

CONCLUSIONS

Our results demonstrated that EEG-EMG coherence can detect ES-induced changes in the neuromuscular system. Also, because gamma coherence is linked to afferent inputs encoding, improvement in motor performance is likely related to ES-elicited strong sensory input and enhanced sensorimotor integration.

Ultrasound-Guided Hyaluronic Acid Injections for Trigger Finger: A Double-Blinded, Randomized Controlled Trial

OBJECTIVES

To investigate the effects of ultrasound-guided injections of hyaluronic acid (HA) versus steroid for trigger fingers in adults.

DESIGN

Prospective, double-blinded, randomized controlled study.

SETTING

Tertiary care center.

PARTICIPANTS

Subjects with a diagnosis of trigger finger (N=36; 39 affected digits) received treatment and were evaluated.

INTERVENTIONS

Subjects were randomly assigned to HA and steroid injection groups. Both study medications were injected separately via ultrasound guidance with 1 injection.

MAIN OUTCOME MEASURES

The classification of trigger grading, pain, functional disability, and patient satisfaction were evaluated before the injection and 3 weeks and 3 months after the injection.

RESULTS

At 3 months, 12 patients (66.7%) in the HA group and 17 patients (89.5%) in the steroid group exhibited no triggering of the affected fingers (P=.124). The treatment results at 3 weeks and 3 months showed similar changes in the Quinnell scale (P=.057 and .931, respectively). A statistically significant interaction effect between group and time was found for visual analog scale (VAS) and Michigan Hand Outcome Questionnaire (MHQ) evaluation (P<.05). The steroid group had a lower VAS at 3 months after injection (steroid 0.5±1.1 vs HA 2.7±2.4; P<.001). The HA group demonstrated continuing significant improvement in MHQ at 3 months (change from 3wk: steroid -2.6±14.1 vs HA 19.1±37.0; P=.023; d=.78).

CONCLUSIONS

Ultrasound-guided injection of HA demonstrated promising results for the treatment of trigger fingers. The optimal frequency, dosage, and molecular weight of HA injections for trigger fingers deserve further investigation for future clinical applications.

Estimating the tendency of motor unit recruitment during steady-hold and rapid contractions using surface EMG and Turns-amplitude analysis

PURPOSE

The purpose of this study was to investigate changes in the interference pattern in surface electromyography (EMG), and its relationship with the tendency of motor unit (MU) recruitment during steady-hold and rapid muscle contractions.

METHODS

Fifteen healthy adults (eight females and seven males, 22.6 ± 1.5 years old) performed steady-hold and rapid isometric contractions of the bicep brachii, adductor pollicis, and tibialis anterior muscles at various force levels. Surface EMG recordings were analyzed using Turns-Amplitude Analysis (TAA).

RESULTS

During steady-hold contractions, the number of turns per second (T/s) increased exponentially with force during submaximal contractions, and plateaued after force levels of 66, 70 and 57 % MVC for the tibialis anterior, bicep brachii and adductor pollicis muscles, respectively. These force levels were proximate to the maximal recruitment threshold (MaxRT) reported previously. The slopes of the T/s-force relationships before the MaxRT were significantly greater than the slopes after the MaxRT for all three muscles tested. During rapid contraction, the slopes of the T/s-force relationships were significantly lower than the slopes of the steady-hold contraction at 20-40 % MVC in all three muscles, and for 40-60 % MVC in TA muscles.

CONCLUSIONS

Our results suggested that the changes in the number of turns in surface EMG with respect to muscle force can be used to estimate the force levels at which the majority of the MUs to be recruited, and completion of MU recruitment was observed at lower force levels during rapid muscle contraction.

Effectiveness of a heel cup with an arch support insole on the standing balance of the elderly

Background

The use of insoles may enhance postural stability and prevent falls. The aim of this study was to design a new insole and to explore the effectiveness of the insole on the standing balance of the healthy elderly.

Methods

The study was conducted at a community hospital. Patients older than 65 years at an outpatient clinic without abnormal gait patterns, lower limb deformities, or foot pain were enrolled. The participants were assigned to good- and poor-stability groups on the basis of the stability index (SI), using the Biodex® Balance System. A heel cup with an arch support insole was provided. Participants wore the insole for 8 weeks for a minimum of 4 hours/day. A static balance test for SI was performed at the initial meeting and 8 weeks after the assigned insoles were worn for each participant.

Results

Five participants (10.0%) of 50 total did not finish the study. There were 25 patients in the good-stability group and 20 in the poor-stability group. The SI, before and after intervention, was significantly different for all 45 participants (3.244±0.688 versus 3.064±0.671; P<0.001). The differences in SI before and after the intervention both in the good-stability group (2.764±0.546 versus 2.592±0.538) and the poor-stability group (3.845±0.188 versus 3.655±0.128) were statistically significant (P<0.001). No statistically significant difference on changes of SI were seen between the two groups.

Conclusion

The results suggest a heel cup with arch support insole is effective in enhancing the standing balance of the elderly. This may be of benefit in preventing falls.

Prevalence of feeding related issues/difficulties in Taiwanese children with history of prematurity, 2003-2006

Feeding problems are common problems seen in premature infants following their discharge from the NICU. However, the prevalence of feeding issues and failure to thrive among preterm infants in Taiwan is uncertain. All former studies of prevalence and identifications of feeding issues were from western countries. Those findings are therefore not representative. The objectives of this study were to understand the proportion of feeding problems and its trend in Taiwanese children who were born prematurely as well as to identify the medical and rehabilitation needs related to feeding difficulties in children with premature history. We investigated the prevalence of feeding problems in 2003-2006 using random subjects of 5% of the enrollees in the National Health Insurance program of Taiwan. Databases used in this study include 'monthly claim summary for ambulatory care claims', 'inpatient expenditures by admissions', 'details of ambulatory care orders, etc. ICD-9 codes of preterm infants and related diagnoses were used as variables. According to this systematical sampling data, there is a rise in the percentage of children admitted to the hospital with low birth weight. High percentage of these children experienced feeding related issues/difficulties in their first 5 years of life. However, under-utilization of rehabilitation services were noted with these low birth weight children who had feeding problems. There is a high co-occurrence between low birth weight children and feeding problems in their first 5 years of life measured by frequency of hospital admissions or outpatient ambulatory care services requirement. It is recommended based on our results that children with low birth weight should be screened automatically for potential feeding difficulties during the hospital stay. Furthermore, feeding monitoring/management as well as parental education on potential risk for feeding difficulties should be incorporated in the early intervention program.

A 3D mathematical model to predict spinal joint forces for a child with spina bifida

Children with spina bifida (SB) can exhibit excessive arm swing, trunk sway, and pelvic tilt during walking. To understand the relationship between abnormal low back forces (LBF) and gait disorders in SB, we derived a mathematical model for evaluating LBF in this population. One unimpaired child and a child with SB were tested. A 3D motion analysis system and force plate were used to collect kinematic and ground reaction force data during walking. A mathematical model created using MATLAB software was used to calculate LBF for each child. The LBF for the child with SB was three times greater in the medio-lateral direction than for the unimpaired child. In the anterior-posterior direction, the LBF for the child with SB acted mostly towards the anterior trunk. In addition, the LBF of the child with SB increased by 24.5% of body weight at the fastest walking speed.

Impaired exercise capacity in diabetic patients after coronary bypass surgery: effects of diastolic and endothelial function

OBJECTIVES

The aims of this study were to clarify the influence of cardiac diastolic and peripheral vascular function on the exercise capacity of patients with coronary bypass surgery (CABG) and diabetes mellitus (DM) by tissue Doppler imaging (TDI) and flow-mediated vasodilatation (FMD), and to investigate interrelations between exercise capacity and LV diastolic function, endothelial function and biochemical parameters.

METHODS

We analyzed the exercise capacity, TDI at the mitral annulus and FMD in 51 uncomplicated first-time CABG survivors (23 DM) at an average interval of 21.6 +/- 12.2 months after surgery.

RESULTS

Diabetics had lower E', A', VO(2)peak, (a-v)O(2) difference, and higher E/E' ratios (p < 0.05) than non-DM patients, but not FMD (p = 0.17). The A and E/E' ratios correlated negatively with VO(2)peak after age adjustment (r = -0.336, p = 0.024). In addition, HbA(1c), and triglyceride also correlated negatively with VO(2)peak (r = -0.377, -0.307, respectively, p < 0.05).

CONCLUSIONS

Diabetics after CABG had more advanced diastolic dysfunction and oxygen extraction impairment than non-DM. It suggests these factors could contribute to lower exercise capacity, risk of developing heart failure despite preserved systolic function and poorer long-term survival of diabetic patients after CABG.

Use of virtual reality to improve upper-extremity control in children with cerebral palsy: a single-subject design

BACKGROUND AND PURPOSE

Virtual reality (VR) creates an exercise environment in which the intensity of practice and positive feedback can be systematically manipulated in various contexts. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy (CP).

PARTICIPANTS

Four children with spastic CP were recruited.

METHOD

A single-subject design (A-B with follow-up) was used. All children were evaluated with 3 baseline, 4 intervention, and 2 follow-up measures. A 4-week individualized VR training program (2 hours per week) with 2 VR systems was applied to all children. The outcome measures included 4 kinematic parameters (movement time, path length, peak velocity, and number of movement units) for mail-delivery activities in 3 directions (neutral, outward, and inward) and the Fine Motor Domain of the Peabody Developmental Motor Scales-Second Edition (PDMS-2). Visual inspection and the 2-standard-deviation-band method were used to compare the outcome measures.

RESULTS

Three children who had normal cognition showed improvements in some aspects of reaching kinematics, and 2 children's change scores on the PDMS-2 reached the minimal detectable change during the intervention. The improvements in kinematics were partially maintained during follow-up.

DISCUSSION AND CONCLUSION

A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP, especially in children with normal cognition and good cooperation. The training effects were retained in some children after the intervention.

Optimization design of thumbspica splint using finite element method

De Quervain's tenosynovitis is often observed on repetitive flexion of the thumb. In the clinical setting, the conservative treatment is usually an applied thumbspica splint to immobilize the thumb. However, the traditional thumbspica splint is bulky and heavy. Thus, this study used the finite element (FE) method to remove redundant material in order to reduce the splint's weight and increase ventilation. An FE model of a thumbspica splint was constructed using ANSYS9.0 software. A maximum lateral thumb pinch force of 98 N was used as the input loading condition for the FE model. This study implemented topology optimization and design optimization to seek the optimal thickness and shape of the splint. This new design was manufactured and compared with the traditional thumbspica splint. Ten thumbspica splints were tested in a materials testing system, and statistically analyzed using an independent t test. The optimal thickness of the thumbspica splint was 3.2 mm. The new design is not significantly different from the traditional splint in the immobilization effect. However, the volume of this new design has been reduced by about 35%. This study produced a new thumbspica splint shape with less volume, but had a similar immobilization effect compared to the traditional shape. In a clinical setting, this result can be used by the occupational therapist as a reference for manufacturing lighter thumbspica splints for patients with de Quervain's tenosynovitis.

Effects of exercise training on heart rate variability after coronary angioplasty

BACKGROUND AND PURPOSE

Cardiac autonomic dysfunction is associated with risk of restenosis and cardiovascular mortality in patients after percutaneous transluminal coronary angioplasty (PTCA). Analysis of heart rate variability (HRV) is an important, widely used method for assessing cardiac autonomic regulation. The purpose of this study was to investigate the effect of exercise training on HRV in subjects after PTCA.

SUBJECTS AND METHODS

A total of 84 subjects who had undergone PTCA were recruited for this study. The subjects (age [mean+/-SD]=57.0+/-9.3 years) were randomly assigned to either an exercise group to undergo an 8-week outpatient exercise program or a control group to undergo usual care. Heart rate variability was measured for 5 minutes in the supine resting position at baseline and at the end of 8 weeks.

RESULTS

The parasympathetically modulated HRV of the subjects in the exercise group increased significantly compared with the HRV of subjects in the control group. The effects of training on HRV were independent of angioplasty type (balloon or stent) and were unrelated to whether the subjects had received previous PTCA.

DISCUSSION AND CONCLUSION

Exercise training can increase parasympathetic modulation of cardiac function in people after they have undergone successful PTCA. Our results suggest that analysis of HRV can be extended to assess the effect of exercise training on cardiac autonomic dysfunction in people after coronary angioplasty.

Development of interesting step-climbing styles

OBJECTIVES

This study was to investigate the influence of stepping styles (forward, side, and cross steppings) and inclinations (25 and 45 degrees) on cardiorespiratory responses (C-R responses).

METHODS

Twenty volunteers were recruited and randomly arranged into two ten-people groups, exercising on step-climbing machines respectively of 25 and 45 degrees of inclination. C-R responses were recorded during each test which lasted for six minutes at 50 steps per minute on a step-climbing machine.

RESULTS

The group on 25-degree inclination had significantly lower C-R responses than the group on 45-degree inclination. Although only small differences, probably statistically insignificant, were found among the three step-climbing styles, these differences showed interesting trends independent of inclination.

CONCLUSIONS

Climbing stairs with the three interesting step-climbing styles in this study could be considered as an exercise of moderate intensity (60-80% HRmax ). Climbing on 25-degree inclination at 50 steps per minute is recommended for less fit individuals because of lower cardiovascular stress as compared with on 45-degree inclination.

Effects of functional electric stimulation on upper limb motor function and shoulder range of motion in hemiplegic patients

OBJECTIVES

The present study examines functional electric stimulation (FES) applied on patients with hemiplegia of short and long duration for the purpose of upper limb motor recovery and increasing shoulder range of motion.

DESIGN

Patients with hemiplegia with subluxation participating in the study were placed into a short-duration group or a long-duration group. Subjects in each group were then randomly assigned to either the control or the experimental subgroup. The experimental groups of both short- and long-duration groups received FES therapy in which the supraspinatus and posterior deltoid muscles were induced to contract repetitively up to 6 hr a day for 6 wk. Duration of FES session and muscle contraction/relaxation ratio were progressively increased as performance improved. The experimental groups also received a second 6-wk FES therapy 6 wk after completing the first FES therapy.

RESULTS

After the first 6-wk FES therapy, the experimental group of short-duration hemiplegia showed significant improvements in motor recovery as indicated by Fugl-Meyer scores compared with the control group. Such significant improvement did not occur for the experimental group of long-duration hemiplegia. The changes in the second FES treatment program were insignificant.

CONCLUSIONS

This study suggests that patients with hemiplegia of short duration are effectively trained by FES for motor recovery.

Functional electrical stimulation on chronic and acute hemiplegic shoulder subluxation

OBJECTIVE

The present study investigated and assessed the effectiveness of a functional electrical stimulation (FES) program in the management of acute and chronic shoulder subluxation.

DESIGN

By their postonset duration, hemiplegic subjects with subluxation participating in the study were placed into a short-duration group and a long-duration group. Subjects in each group were further assigned randomly to either a control subgroup or an experimental subgroup. The experimental subgroups of both short and long duration received FES therapy in which supraspinatus and posterior deltoid were induced to contract repetitively up to 6 hr/day for 6 wk. The duration of the FES session and muscle contraction/relaxation ratio were progressively increased as performance improved.

RESULTS

The experimental subgroup of short duration showed significant improvements in reducing subluxation as indicated by x-ray compared with the control subgroup of short duration after the first FES treatment. The same effect was not shown for the experimental subgroup of long duration. The second FES treatment program only resulted in an insignificant change of shoulder subluxation for both the short- and long-duration subgroups.

CONCLUSIONS

The present study suggests that hemiplegic subjects with short postonset duration are effectively trained for shoulder subluxation by the first FES treatment program. The same FES showed not to be effective when applied to the subjects with subluxation of > 1 yr.

Effects of thoraco-lumbar electric sensory stimulation on knee extensor spasticity of persons who survived cerebrovascular accident (CVA)

Spasticity is mostly due to an excess of impulses to alpha motor neurons partly resulting from a change of interneuron activity. Low threshold afferent has been reported to change the activity in interneuron. The purpose of this study is to investigate the effects of surface spinal paravertebral stimulation on knee extensor spasticity. Ten survivors of stroke, with knee extensor spasticity, received electric stimulation for five 45-minute periods through surface electrodes applied to the skin in the twelfth thoracic and first lumbar areas. The electric stimulations had an amplitude modulated alternating current (AC), with a carrier frequency of 2500 Hz, modulated to "beats" frequency of 20 Hz. Stimulation amplitude was raised to elicit sensory stimulation. The pre- and post-treatment evaluation included the modified Ashworth scale, active torque during controlled knee movements at various velocities, and electromyographic (EMG) activity during the torque measurements. Our results indicate that nine of ten subjects demonstrated a decrease in the modified Ashworth scale post-treatment. The EMG activity of the spastic quadriceps during active knee flexion was decreased post-treatment as compared with the value before treatment. The active torque value of knee flexion or extension at 30 degrees, 60 degrees, or 90 degrees/sec of angular velocity did not change significantly post-treatment. A trend of increasing spastic quadriceps EMG activity with respect to the angular velocity during an active knee flexion was established, with Ashworth scale considered. The level of EMG activity is higher when the Ashworth scale is higher. According to our results, the surface paravertebral sensory stimulation was effective in reducing quadriceps muscle spasticity of the subjects. Both the modified Ashworth scale and the EMG activity of spastic quadriceps during eccentric contraction are suggested as sensitive tools for measuring spasticity of persons who survived cerebrovascular accident (CVA).

Effects of surface spinal cord stimulation on spasticity and quantitative assessment of muscle tone in hemiplegic patients

Spasticity after a stroke interferes with the normal function of a limb. Electric stimulation has been used in a variety of ways to decrease spasticity. The purposes of this study were (1) to quantify the effectiveness of electric stimulation on decreasing ankle spasticity and (2) to develop a quantitative assessment of muscle tone, which could be replicated in the clinic. Ten patients with hemiparesis resulting from ischemic stroke participated in the study according to the selection criteria. Their mean age was 57 yr, with a mean stroke interval of 12.5 months. Patients received electric stimulation for 45 min through surface electrodes applied to the skin in the 12th thoracic and 1st lumbar areas. All patients received five electric stimulation treatment sessions. The electrical pulses were amplitude modulated frequency beat with a carry frequency of 2500 Hz and a stimulation frequency of 20 Hz. The stimulation intensity was adjusted to each patient to produce a sensory stimulation. The pre- and posttreatment evaluation included surface electromyography activity during passive ankle dorsiflexion, passive ankle dorsiflexion resistance at different angular velocities, as measured by an isokinetic machine and the modified Ashworth scale. Our results indicate that the surface spinal cord stimulation with middle frequency modulated to low frequency for sensory stimulation on the skin of 12th thoracic and first lumbar area is effective in reducing calf muscle spasticity of hemiplegic patients. The isokinetic torque measures for spasticity are a sensitive tool to document the effects of the treatment.

Detection and distribution of aromatase in hypothalamus of the male rat

Conversion of androgen to estrogen in the rat brain is catalyzed by aromatase. An in vitro assay for aromatase activity, which quantitates the production of 3H2O during the conversion of 1 beta-3H-androstenedione to estrone, was developed and validated in the present study. The distribution of aromatase activity in discrete hypothalamic nuclei was also explored. Individual hypothalamic nuclei were microdissected from 200-micron frozen sections. Tissues from 3 animals were pooled and assayed for aromatase activity. It was found that the rate of aromatase activity was linear with time up to 1 hour, and with protein concentrations up to 900 micrograms/ml tissue homogenate. A maximal rate was obtained with a substrate concentration of 0.3 microM. The aromatase activity was heterogeneously distributed within the rat brain. The greatest amount of aromatase activity was found in the preoptic area. The suprachiasmatic nucleus also contained a high level of aromatase activity. The aromatase activities in the anterior hypothalamus, ventromedial nucleus, arcuate nucleus and dorsomedial nucleus were less than half that found in the preoptic area.