Rationale of the Combined Use of Inspiratory and Expiratory Devices in Improving Maximal Inspiratory Pressure and Maximal Expiratory Pressure of Patients With Chronic Obstructive Pulmonary Disease

Battaglia E, Fulgenzi A, Ferrero ME. Rationale of the combined use of inspiratory and expiratory devices in improving maximal inspiratory pressure and maximal expiratory pressure of patients with chronic obstructive pulmonary disease.

Objective

To examine the rationale of the combined use of a new expiratory device in association with a previously assessed inspiratory device in improving 3 indicators of the respiratory muscle strength, for example, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and dyspnea grade.

Design

Randomized trial.

Setting

Home-based pulmonary rehabilitation.

Participants

Adults (N=32; mean age, 68y).

Main Outcome Measure

We instructed 32 patients with mild to very severe COPD to use the devices, and randomized them in a 1:1 ratio: they were assigned to the sham training control group (16 patients who trained at a load not able to improve MIP and MEP) or to the training group (16 patients). The patients trained at home twice daily for 15 minutes, 7 days a week, for 12 months. MIP and MEP as well as dyspnea perception were evaluated at 1, 6, and 12 months from the beginning of the training. The impact of additional work of breathing was measured at baseline and after the use of the expiratory device.

Results

The patients who performed the respiratory training showed significant and progressive improvements of MIP (81±4 at 12 months vs 57±7 as basal values expressed in cm H₂O; P<.05) and MEP (97±2 at 12 months vs 62±4 as basal values; P<.05) at the end of the training. In addition, they showed a significant reduction of dyspnea perception (1.18±0.29 vs 2.93±0.32 as basal values; P<.05) at the end of the training.

Conclusions

This study suggests that home exercise with the combined use of our expiratory and inspiratory devices leads to a significant improvement of respiratory muscle function in patients with mild to very severe COPD.     

Cardiovascular and metabolic responses during functional electric stimulation cycling at different cadences

Fornusek C, Davis GM. Cardiovascular and metabolic responses during functional electric stimulation cycling at different cadences.

Objective

To determine the influence of pedaling cadence on cardiorespiratory responses and muscle oxygenation during functional electric stimulation (FES) leg cycling.

Design

Repeated measures.

Setting

Laboratory.

Participants

Nine subjects with T4 through T10 spinal cord injury (SCI) (American Spinal Injury Association grade A).

Interventions

FES cycling was performed at pedaling cadences of 15, 30, and 50 revolutions per minute (rpm).

Main Outcome Measures

At each cadence, heart rate, oxygen uptake, and cardiac output were recorded during 35 minutes of cycling. Near infrared spectroscopy was used to quantify quadriceps muscle oxygenation.

Results

All pedaling cadences induced similar elevations in cardiorespiratory metabolism, compared with resting values. Higher average power output was produced at 30rpm (8.2±0.7W, P<.05) and 50rpm (7.9±0.5W, P<.05) compared with 15rpm (6.3±0.6W). Gross mechanical efficiency was significantly higher (P<.05) at 30 and 50rpm than at 15rpm. Quadriceps muscle oxygenation did not differ with pedaling cadences.

Conclusions

Cardiorespiratory responses and muscle metabolism adjustments during FES leg cycling were independent of pedal cadence. FES cycling at a cadence of 50rpm may not confer any advantages over 30 or 15rpm for cardiovascular fitness promotion in persons with SCI.     

Metabolic and Biomechanical Effects of Velocity and Weight Support Using a Lower-Body Positive Pressure Device During Walking

Grabowski AM. Metabolic and biomechanical effects of velocity and weight support using a lower-body positive pressure device during walking.

Objectives

To determine how changes in velocity and weight support affect metabolic power and ground reaction forces (GRFs) during walking using a lower-body positive pressure (LBPP) device. To find specific velocity and weight combinations that require similar aerobic demands but different peak GRFs.

Design

Repeated measures.

Setting

University research laboratory.

Participants

Healthy volunteer subjects (N=10).

Interventions

Subjects walked 1.00, 1.25, and 1.50m/s on a force-measuring treadmill at normal weight (1.0 body weight [BW]) and at several fractions of BW (.25, .50, .75, .85 BW). The treadmill was enclosed within an LBPP apparatus that supported BW.

Main Outcome Measures

Metabolic power, GRFs, and stride kinematics.

Results

At faster velocities, peak GRFs and metabolic demands were greater. In contrast, walking at lower fractions of BW attenuated peak GRFs and reduced metabolic demand compared with normal weight walking. Many combinations of velocity and BW resulted in similar aerobic demands, yet walking faster with weight support lowered peak GRFs compared with normal weight walking.

Conclusions

Manipulating velocity and weight using an LBPP device during treadmill walking can reduce force yet maintain cardiorespiratory demand. Thus, LBPP treadmill training devices could be highly effective for rehabilitation after orthopedic injury and/or orthopedic procedures.     

Exploring Actical Accelerometers as an Objective Measure of Physical Activity in People With Multiple Sclerosis

Kayes NM, Schluter PJ, McPherson KM, Leete M, Mawston G, Taylor D. Exploring Actical accelerometers as an objective measure of physical activity in people with multiple sclerosis.

Objective

To assess the feasibility, acceptability, and psychometric properties of Actical accelerometers in people with multiple sclerosis (MS).

Design

Participants attended 2 testing sessions 7 days apart in which they completed 6 activities ranging in intensity while wearing an Actical accelerometer and Polar heart rate monitor. Perceived exertion was recorded after each activity.

Setting

University research center.

Participants

People (N=31) with a definite diagnosis of MS were purposefully selected, aiming for diversity in level of reported disability, age, sex, and type of MS.

Interventions

Not applicable.

Main Outcome Measures

Actical accelerometer, Polar S810i and RS800sd heart rate monitors, Borg rating of perceived exertion, six-minute walk test (6MWT), 30-second chair stand test.

Results

Accelerometers had good feasibility and acceptability in people with MS. Test-retest reliability was poor for sedentary and free-living activities, with low to moderate intraclass correlation coefficients (.00-.75), but was better for more vigorous or rhythmic activities (.85-.90). Bland-Altman 95% limits of agreement for average accelerometer counts were wide, ranging from ±16 (newspaper reading) to ±1330 (6MWT). Validity was not established with 95% prediction intervals showing high variability for all activities.

Conclusions

The psychometric problems highlighted here suggest Actical accelerometers should be used with caution in people with MS as a measure of physical activity, particularly when measuring comparatively sedentary or free-living activities.     

Examining the Relationship Between Cognition and Driving Performance in Multiple Sclerosis

Schultheis MT, Weisser V, Ang J, Elovic E, Nead R, Sestito N, Fleksher C, Millis SR. Examining the relationship between cognition and driving performance in multiple sclerosis.

Objective

To identify cognitive predictors of driving performance after multiple sclerosis (MS).

Design

Prospective design examining predictive value of cognitive measures on driving performance.

Setting

All data were collected in an outpatient research setting and an outpatient driver rehabilitation program.

Participants

Participants were community-dwelling persons (N=66) with clinically defined MS (86% relapsing-remitting, 14% progressive) with a mean age of 43.47 years. All were active drivers who met vision requirements established by their respective states, and none required adaptive driving equipment.

Intervention

Not applicable.

Main Outcome Measures

Participants were administered a comprehensive neuropsychologic assessment and a clinical behind-the-wheel (BTW) driving evaluation. Additional measures of driving performance included history of traffic violations and collisions (since MS onset).

Results

Logistic regression indicated that information processing speed (Symbol Digit Modality Test [SDMT]) was the strongest predictor of BTW performance. A logistic regression revealed that the strongest predictors of collision and violation frequency were visuospatial learning and recall (7/24 Spatial Recall Test [SPART 7/24]).

Conclusions

These findings indicate that information processing and visuospatial skills are predictive of driving performance among persons with MS. These measures (SDMT and SPART 7/24) may serve as screening methods for identifying the potential impact of cognitive impairment on driving. Furthermore, the findings raise questions regarding the appropriateness of the BTW evaluation to evaluate driving difficulties accurately among individuals with MS.     

Physiotherapists’ perceptions of clients from culturally diverse backgrounds

Objectives

The aim of this study was to identify the perceptions, attitudes and beliefs of physiotherapists towards clients of non-English-speaking backgrounds.

Design

Qualitative methods of semi-structured interviews and observations were used to conduct an exploratory study.

Setting

Three hospitals in New South Wales, Australia.

Participants

Six physiotherapists from the hospitals were interviewed and other physiotherapists were observed.

Results

Some participants acted towards clients from cultural minorities based on stereotypes, whilst other participants with limited cultural knowledge incorrectly presumed that they were proficient at cross-cultural interactions. Cultural assimilation was favoured by one physiotherapist.

Conclusion

Physiotherapists need to be aware of their own cultural biases, and be willing to undergo a change within themselves to interact effectively and provide quality care to clients from non-English-speaking backgrounds.     

Mechanical and Sensorimotor Implications With Ankle Osteoarthritis

Hubbard TJ, Hicks-Little C, Cordova M. Mechanical and sensorimotor implications with ankle osteoarthritis.

Objective

To understand the mechanical and sensorimotor adaptations that may occur with ankle osteoarthritis (OA).

Design

Case-control.

Setting

Biodynamics research laboratory.

Participants

Subjects with ankle OA (n=8; 4 males, 4 females) were matched to healthy controls (n=8; 4 males, 4 females).

Interventions

Not applicable.

Main Outcome Measures

Mechanical joint stability was assessed with an instrumented ankle arthrometer. Static balance was measured using a force platform during a double-legged stance. Isometric ankle/foot complex strength in the sagittal and frontal plane was assessed with a handheld dynamometer. Last, subjective level of function was assessed using the foot and ankle disability index.

Results

There were significant group × side interactions for anterior displacement, inversion rotation, eversion rotation, ankle isometric strength, and the foot and ankle disability index (P<.05). The affected ankle of the OA group demonstrated significantly more mechanical stiffness, more impairments in ankle/foot isometric strength, and less subjective level of function than the matched controls. Additionally, the ankle OA group exhibited significantly more center of pressure displacement, total velocity, and medial-lateral velocity (P<.05).

Conclusions

These limitations observed in joint laxity, postural control, muscle strength, and perceived function provide evidence that patients with ankle OA display a number of characteristics that affect joint stability and overall function. These identified impairments necessitate the need for rehabilitation and exercise programs to be developed to help improve joint stability and function in patients with ankle OA.     

Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation

Horn SD, Deutscher D, Smout RJ, DeJong G, Putman K. Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation.

Objective

To describe racial differences in patient characteristics, nontherapy ancillaries, physical therapy (PT), occupational therapy (OT), and functional outcomes at discharge in stroke rehabilitation.

Design

Multicenter prospective observational cohort study of poststroke rehabilitation.

Setting

Six U.S. inpatient rehabilitation facilities.

Participants

Black and white patients (n=732), subdivided in case-mix subgroups (CMGs): CMGs 104 to 107 for moderate strokes (n=397), and CMGs 108 to 114 for severe strokes (n= 335).

Interventions

Not applicable.

Main Outcome Measure

FIM.

Results

Significant black-white differences in multiple patient characteristics and intensity of rehabilitation care were identified. White subjects took longer from stroke onset to rehabilitation admission and were more ambulatory prior to stroke. Black subjects had more diabetes. For patients with moderate stroke, black subjects were younger, were more likely to be women, and had more hypertension and obesity with body mass index greater than or equal to 30. For patients with severe stroke, black subjects were less sick and had higher admission FIM scores. White subjects received more minutes a day of OT, although black subjects had significantly longer median PT and OT session duration. No black-white differences in unadjusted stroke rehabilitation outcomes were found.

Conclusions

Reasons for differences in rehabilitation care between black and white subjects should be investigated to understand clinicians' choice of treatments by race. However, we did not find black-white differences in unadjusted stroke rehabilitation outcomes.     

Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury

Nash MS, Koppens D, van Haaren M, Sherman AL, Lippiatt JP, Lewis JE. Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury.

Objective

Test effects of pushrim-activated power-assisted wheelchairs (PAPAWs) on the energetics and perceptual responses to steady-state and intensity-graded wheelchair propulsion in persons with paraplegia and tetraplegia having chronic shoulder pain.

Design

Test, retest with a control condition.

Setting

Academic medical center.

Participants

Subjects (N=18) aged 19 to 70 years with chronic, motor-complete paraplegia and tetraplegia having confirmed shoulder pain.

Interventions

Study participants underwent testing on 4 randomized nonconsecutive days during either 6 minutes of steady-state or 12 minutes of intensity-graded wheelchair propulsion on stationary rollers. Participants used their own manual wheelchair and either their customary wheels or power-assist wheels attached with an axle bracket.

Main Outcome Measures

Oxygen consumption (V?o₂, L/min), distance (m), energy cost (L/m), and ratings of perceived exertion (RPE; Borg Categorical 6-20 Scale) were measured during propulsion.

Results

Significant main effects of testing were observed for V?o₂, heart rate, and RPE in both subject groups. Distances propelled were significantly increased in both groups across both tests and in each of their 2-minute exercise stages.

Conclusions

Use of PAPAWs by persons with paraplegia and tetraplegia having shoulder pain significantly lowers energy cost responses and perceived exertion compared with manual wheelchair propulsion while significantly increasing the distanced propelled.     

Energy Expenditure in Adults With Cerebral Palsy Playing Wii Sports

Hurkmans HL, van den Berg-Emons RJ, Stam HJ. Energy expenditure in adults with cerebral palsy playing Wii Sports.

Objective

To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing.

Design

Cross-sectional study.

Setting

University medical center.

Participants

Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers.

Intervention

Participants played Wii Sports tennis and boxing, each for 15 minutes in random order.

Main Outcome Measure

By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (V?o₂) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as V?o₂ during Wii Sports play divided by V?o₂ during sitting.

Results

Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing.

Conclusions

Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels.     

Physical Function, Gait, and Dynamic Balance of Transfemoral Amputees Using Two Mechanical Passive Prosthetic Knee Devices

Lythgo N, Marmaras B, Connor H. Physical function, gait, and dynamic balance of transfemoral amputees using two mechanical passive prosthetic knee devices.

Objective

To investigate the effect of the 3R90 and 3R92 (Otto Bock Healthcare) mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance (sudden stop and turn) of transfemoral amputees.

Design

Intervention study with crossover design.

Setting

University research center.

Participants

Men (N=5; mean age ± SD, 58.8±11.9y) with unilateral transfemoral amputation.

Intervention

Prosthetic knee joints (N=2; 3R90 and 3R92). Acclimatization ranged from 14 to 47 days (25.5±9.3d).

Main Outcome Measures

Physical function, gait, dynamic balance.

Results

The Timed Up and Go Test, 6-Minute Walk Test, and Four Square Step Test measures improved with the 3R92. Total scores on the Prosthesis Evaluation Questionnaire were similar for the 3R92 (82.0±6.3) and the participant's own or original device (83.9±4.8). These devices were rated higher than the 3R90 (65.5±16.8). Compared with the original device, gait velocity was significantly slower (5cm/s; P=.017) with the 3R92, but was unchanged for the 3R90. This difference was not considered clinically significant because the effect size was small (0.2). No other significant gait differences were found. Large temporal gait asymmetries observed with the original device remained with the 3R90 and 3R92 (step, ≈20%; single support, ≈30%; stance, ≈19%). Although no significant differences were found for the sudden-turn or sudden-stop tasks, the sudden-turn group success rates were highest with the original devices.

Conclusions

Gait and symmetry measures were unchanged. Gait speed was slower with the 3R92, but this was not considered to be clinically significant. Sudden-turn success rates generally were higher with the original devices. A crossover stepping movement was more difficult to implement than a side-stepping movement during sudden turns.     

Health of community-dwelling adults with mobility limitations in the United States: prevalent health conditions. Part I

Rasch EK, Hochberg MC, Magder L, Magaziner J, Altman BM. Health of community-dwelling adults with mobility limitations in the United States: prevalent health conditions. Part I.

Objective

To characterize the extent and types of prevalent health conditions among nationally representative groups of adults with mobility, nonmobility, and no limitations.

Design

Data were collected during 5 rounds of household interviews from a probability subsample of households that represent the civilian, noninstitutionalized U.S. population. With some exceptions, round 1 variables were used for this analysis.

Setting

Community.

Participants

Data were analyzed on the same respondents from the 1996 to 1997 Medical Expenditure Panel Survey (MEPS) and the 1995 National Health Interview Survey Disability Supplement. Respondents were categorized into 3 groups for analysis: those with mobility limitations, nonmobility limitations; and no limitations. The analytic sample included 13,897 MEPS adults (≥18y).

Interventions

Not applicable.

Main Outcome Measures

Number, types, and prevalence of self-reported health conditions compared across groups.

Results

On average, adults with mobility limitations had significantly more prevalent conditions (3.6) than those with nonmobility limitations (2.4), or no limitations (1.3). Greater comorbidity existed in the context of fewer personal resources and more than half of adults with mobility limitations were working age.

Conclusions

Determining factors that influence the health of adults with mobility limitations is a critical public health issue.     

Selective Tibial Neurotomy in the Treatment of Spastic Equinovarus Foot in Hemiplegic Patients: A 2-Year Longitudinal Follow-Up of 30 Cases

Deltombe T, Gustin T. Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases.

Objective

To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients.

Design

Intervention study (before-after trial) with an observational design and 2-year follow-up.

Setting

Spasticity group in a university hospital.

Participants

Hemiplegic patients (N=30) with spastic equinovarus foot.

Intervention

A selective neurotomy was performed at the level of the motor nerve branches of the tibial nerve.

Main Outcome Measures

Spasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion, gait parameters (6 min walking test), and gait kinematics (video assessment) were assessed before and at 2 months, 1 year, and 2 years after selective tibial neurotomy.

Results

Compared with preoperative values, there was a statistically significant decrease in triceps surae spasticity, an increase in gait speed, and a reduction in equinus and varus in swing and stance phases at 2 months postoperatively. This improvement persisted at 1 and 2 years after selective tibial neurotomy. Selective tibial neurotomy does not induce permanent triceps muscle weakness or triceps surae-Achilles' tendon complex shortening.

Conclusion

This study confirms the long-lasting beneficial effect of selective tibial neurotomy on spasticity, gait speed, and equinovarus deformity in the treatment of spastic equinovarus foot in hemiplegic patients.     

Knee Extensor Strength, Dynamic Stability, and Functional Ambulation: Are They Related in Parkinson's Disease?

Nocera JR, Buckley T, Waddell D, Okun MS, Hass CJ. Knee extensor strength, dynamic stability, and functional ambulation: are they related in Parkinson's disease?

Objective

To evaluate the relationship between knee extensor strength, postural stability, functional ambulation, and disease severity in Parkinson's disease (PD).

Design

A cohort study.

Setting

University research laboratory.

Participants

Patients (N=44) with idiopathic PD.

Intervention

Not applicable.

Main Outcome Measures

Participants were evaluated on their isokinetic knee extensor strength. Additionally, participants completed an assessment of their postural stability (Functional Reach Test for static stability and a dynamic postural stability assessment as measured by the center of pressure-center of mass moment arm during gait initiation). Participants also underwent an evaluation of their functional ambulation as measured by a 6-minute walk test. Lastly, participants were evaluated by a neurologist specially trained in movement disorders to assess neurologic status and disease severity using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr disability score.

Results

Knee extensor strength positively correlated with dynamic postural stability and negatively correlated with disease severity. Further, dynamic postural stability was negatively correlated to disease severity and positively correlated with functional ambulation in this cohort of patients with PD (P<.05). The results also suggest that the Functional Reach Test may be a valuable assessment tool to examine postural stability in PD.

Conclusions

These findings suggest a malleable relationship between knee extensor strength, dynamic stability, and disease severity in PD. Although strength is only one piece of the puzzle in the functional outcome of PD, these findings may assist clinicians in designing appropriate interventions aimed at increasing function and decreasing fall risk in PD.     

The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial

Bombardier CH, Cunniffe M, Wadhwani R, Gibbons LE, Blake KD, Kraft GH. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial.

Objective

To determine if motivational interviewing-based telephone counseling increases health promotion activities and improves other health outcomes in people with multiple sclerosis (MS).

Design

Randomized controlled trial with wait-list controls and single-blinded outcome assessments conducted at baseline and at 12 weeks.

Setting

MS research and training center in the Pacific Northwest.

Participants

Community-residing persons (N=130) with physician confirmed MS aged 18 or older who were able to walk unassisted at least 90m (300ft).

Intervention

A single in-person motivational interview followed by 5 scheduled telephone counseling sessions to facilitate improvement in 1 of 6 health promotion areas: exercise, fatigue management, communication and/or social support, anxiety and/or stress management, and reducing alcohol or other drug use.

Main Outcome Measures

Health Promotion Lifestyle Profile II plus fatigue impact, subjective health, and objective measures of strength, fitness, and cognition. Intent-to-treat analyses of change scores were analyzed using nonparametric tests.

Results

Seventy persons were randomized to treatment and 60 to the control condition. The treatment group reported significantly greater improvement in health promotion activities, including physical activity, spiritual growth, and stress management as well as in fatigue impact and mental health compared with controls. In addition, the exerciser subgroup showed greater improvement than controls in self-selected walking speed.

Conclusions

A less intensive, more accessible approach to health promotion based on telephone counseling and motivational interviewing shows promise and merits further study.     

The segway personal transporter as an alternative mobility device for people with disabilities: a pilot study

Sawatzky B, Denison I, Langrish S, Richardson S, Hiller K, Slobogean B. The Segway Personal Transporter as an alternative mobility device for people with disabilities: a pilot study.

Objectives

To determine the functional measures that best correlate with the skill levels of people with disabilities who operate a Segway Personal Transporter, and—using a qualitative analysis—to explore subjects’ experience with the Segway.

Design

A prospective study encompassing 3 training sessions with the Segway to correlate subjects’ functional ability (eg, cognition, balance, mobility, muscle strength) with their skill level on the device.

Setting

A provincial adult rehabilitation center.

Participants

Twenty-three subjects (age range, 19−65y) with a wide range of disabilities (eg, multiple sclerosis, spinal cord injury, amputation) who could walk at least 6m with or without assistance.

Interventions

Not applicable.

Main Outcome Measures

Segway Task Assessment, Berg Balance Scale, and Timed Up & Go test.

Results

No correlation was found because all participants successfully completed the final Segway Task Assessment, regardless of scores on functional assessments.

Conclusions

The Segway is a useful device for a broad range of populations with functional disabilities. Subjects found the Segway easy to use and were excited about its potential as an assistive device for use in their communities.     

Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow

Yoon JS, Hong S-J, Kim B-J, Kim SJ, Kim JM, Walker FO, Cartwright MS. Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow.

Objective

To determine the accuracy of the ultrasonographic measurement of ulnar nerve to cubital tunnel area for diagnosis of ulnar neuropathy at the elbow.

Design

Patients with confirmed ulnar neuropathy at the elbow and normative, healthy volunteers were evaluated with high-resolution ultrasound. The cross-sectional areas (CSAs) of the ulnar nerve and cubital tunnel were measured with the elbow extended and flexed, and results from the 2 groups were compared.

Setting

Electromyography laboratory and radiology department of a tertiary care center.

Participants

Twenty-seven patients with ulnar neuropathy at the elbow and 20 controls.

Interventions

Not applicable.

Main Outcome Measure

The ratio of ulnar nerve to cubital tunnel CSA with the elbow flexed.

Results

The ulnar nerve, with the elbow flexed, was larger in those with ulnar neuropathy at the elbow, and this group also had larger cubital tunnels than did controls. In those with ulnar neuropathy at the elbow, the ratio of the ulnar nerve to cubital tunnel was .31, and in the controls it was .32, which was not significantly different (P=.89).

Conclusions

The ratio of ulnar nerve to cubital tunnel did not differentiate those with ulnar neuropathy at the elbow from controls.     

Community Ambulation in Older Adults: Which Internal Characteristics Are Important?

Lord SE, Weatherall M, Rochester L. Community ambulation in older adults: which internal characteristics are important?

Objective

To examine the internal characteristics of older adults independent in community ambulation to gain further understanding of the skills required for its successful execution.

Design

Exploratory factor analysis.

Setting

General community.

Participants

Healthy, community dwelling older adults (N=113) who were cognitively intact and walked outdoors independently.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal gait parameters derived from accelerometry over 6 minutes walking outdoors and a battery of measures for motor, cognitive, executive, and behavioral characteristics.

Results

Mean participant age ± SD was 75.8±7.3 years, with almost a third of the sample over 80 years. Four factors emerged from the Factor Analysis of 23 variables: motor control, self-efficacy, executive function, and cognitive-motor interference, which together explained 61.4% of common variance. Eight variables loaded onto motor control, accounting for 34.5% of common variance; 7 items loaded onto self-efficacy, which explained 12.4% of common variance; 5 variables loaded onto executive function, accounting for 8.4% of common variance; and 3 variables loaded onto cognitive-motor interference, explaining 6% of the variance.

Conclusions

Results of this study indicate that factors beyond motor control contribute to independent community ambulation in older adults, reflecting the multidimensional, complex nature of the task. Self-efficacy was shown to be more relevant than executive function to gait performance, suggesting the need for a broader approach to assessment and intervention strategies.     

Prevalence and Impact of Pain in Multiple Sclerosis: Physical and Psychologic Contributors

Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors.

Objective

To characterize the prevalence and impact of pain in veterans with multiple sclerosis (MS) and to assess their association with demographic, biologic, and psychologic variables.

Design

Cross-sectional cohort study linking computerized medical record information to mailed survey data.

Setting

Veterans Health Administration (VHA).

Participants

Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Items assessing pain intensity, pain interference, and physical and mental health functioning.

Results

Ninety-two percent of participants reported bodily pain within the prior 4 weeks, with 69% of the total sample indicating pain of moderate or higher intensity. Eighty-five percent indicated that pain caused functional interference during the past 4 weeks, with 71% of the total sample reporting pain-related interference that was moderate or greater. No significant sex or race differences emerged for the pain indices. A significant but modest relationship between increasing age and pain interference emerged (r=.05, P<.01); however, age was not significantly related to pain intensity. Multivariate regression analyses identified pain intensity (β=.73), physical health functioning (β=-.07), and mental health functioning (β=-.13) variables as significant, unique contributors to the prediction of pain interference. The interaction of pain intensity and physical functioning was also significant but of minimal effect size (β=-.03).

Conclusions

Pain is highly prevalent and causes substantial interference in the lives of veterans with MS. The functional impact of pain in veterans with MS is influenced by pain intensity, physical health, and emotional functioning. Clinical practice should take each of these domains into consideration and reflect a biopsychosocial conceptualization.