Qualitative perspectives on aquatic exercise initiation and satisfaction among persons with multiple sclerosis

Purpose: To identify the individual and social experiences underlying the initiation and satisfaction with aquatic exercise among persons with MS.

Methods: A convenience sample (n?=?45) of persons aged?≥18 with MS who had engaged in water-based exercise within the previous six months completed a 60–90?min semi-structured telephone interview regarding their aquatic exercise experiences.

Results: An aquatic exercise history was not a prerequisite for the adoption of aquatic exercise. Rather, participants described aquatic exercise routines as stemming from recognition of a decline in physical function combined with encouragement and invitations to join aquatic programs. Despite regular visits, health care providers were not a common source of information regarding the feasibility of aquatic exercise. Participants’ aquatic activities included MS-specific and generalized aquatics courses, with class satisfaction resting on the instructor, class “fit” and a feeling of acceptance.

Conclusion: Communication regarding local aquatic opportunities is critical for ensuring aquatics engagement among persons with MS. Providers could play a stronger role in emphasizing the feasibility and benefits of aquatic programs. In addition, persons with MS should be encouraged to try local MS and more generalized aquatic programs in order to identify a program matching their social and physical goals.

• Implications for Rehabilitation

• Directed communication regarding aquatic opportunities is essential to prompting the initiation of aquatic exercise

• Both MS-specific and general aquatics classes can provide positive exercise experiences for persons with MS

• A history of regular exercise or aquatic experiences is not a prerequisite for the initiation of aquatic exercise among persons with MS

• Health care provider visits may represent missed opportunities for promoting aquatics; providers should consider the suitability of aquatics for all patients with MS, regardless of the patient’s exercise history.

     

Effect of orofacial exercises on oral aperture in adults with systemic sclerosis

Purpose: To examine the effect of a home orofacial exercise program on increasing oral aperture among adults with systemic sclerosis (SSc). Method: Forty-eight adults with SSc were assigned randomly to the multifaceted oral-health intervention or usual dental care control group. Participants with an oral aperture of <40?mm in the intervention group received an orofacial exercise program, which included daily manual mouth-stretching and oral-augmentation exercises twice a day with a total of 6 minutes for 6 months. The outcome measure was oral aperture which was measured at baseline, 3-months, and 6-months intervals. Results: A significantly larger increase in oral aperture for participants received the orofacial exercise program was found when compared to those in the usual care at 3 months (P?=?0.01), but not at 6-months evaluation. Participants’ adherence rate to the exercise program was low (48.9%). Conclusions: The orofacial exercise program intervention for adults with SSc and microstomia did not show significant improvement at 6 months. In addition to the low exercise adherence rate, insufficient frequencies, repetitions, and durations of the orofacial exercises may contribute to these results.

Implications for Rehabilitation

• Microstomia in adults with systemic sclerosis (SSc) has profound impacts on their quality of life.

• Orofacial exercise programs have the potential to improve the size of oral aperture.

• Brief daily orofacial home exercises for 6 months did not result in a significant increase in the size of oral aperture.

     

Rehabilitation of activities of daily living in virtual environments with intuitive user interface and force feedback

Purpose: To investigate the feasibility of using a virtual rehabilitation system with intuitive user interface and force feedback to improve the skills in activities of daily living (ADL).

Method: A virtual training system equipped with haptic devices was developed for the rehabilitation of three ADL tasks – door unlocking, water pouring and meat cutting. Twenty subjects with upper limb disabilities, supervised by two occupational therapists, received a four-session training using the system. The task completion time and the amount of water poured into a virtual glass were recorded. The performance of the three tasks in reality was assessed before and after the virtual training. Feedback of the participants was collected with questionnaires after the study.

Results: The completion time of the virtual tasks decreased during the training (p?<?0.01) while the percentage of water successfully poured increased (p?=?0.051). The score of the Borg scale of perceived exertion was 1.05 (SD?=?1.85; 95% CI?= 0.18–1.92) and that of the task specific feedback questionnaire was 31 (SD?= 4.85; 95% CI?= 28.66–33.34). The feedback of the therapists suggested a positive rehabilitation effect. The participants had positive perception towards the system.

Conclusions: The system can potentially be used as a tool to complement conventional rehabilitation approaches of ADL.

• Implications for rehabilitation

• Rehabilitation of activities of daily living can be facilitated using computer-assisted approaches.

• The existing approaches focus on cognitive training rather than the manual skills.

• A virtual training system with intuitive user interface and force feedback was designed to improve the learning of the manual skills.

• The study shows that system could be used as a training tool to complement conventional rehabilitation approaches.

     

Patient-directed therapy during in-patient stroke rehabilitation: stroke survivors’ views of feasibility and acceptability

Abstract

Purpose: Patient-led therapy, in which patients work outside therapy sessions without direct supervision, is a possible way to increase the amount of therapy stroke patients’ receive without increasing staff demands. Here, we report patients’ views of patient-led mirror therapy and lower limb exercises. Method: 94 stroke survivors with upper and lower limb limitations at least 1-week post-stroke undertook 4 weeks of daily patient-led mirror therapy or lower limb exercise, then completed questionnaires regarding their experience and satisfaction. A convenience random sample of 20 participants also completed a semi-structured telephone interview to consider their experience in more detail and to capture their longer term impressions. Results: Participants were generally positive about patient-led therapy. About 71% found it useful; 68% enjoyed it; 59% felt it “worked” and 88% would recommend it to other patients. Exercise was viewed more positively than the mirror therapy. Difficulties included arranging the equipment and their position, particularly for more severe strokes, loss of motivation and concerns about working unsupervised. Conclusions: Patient-led mirror therapy and lower limb exercises during in-patient rehabilitation is generally feasible and acceptable to patients but “light touch” supervision to deal with any problems, and strategies to maintain focus and motivation are needed.

• Implications for Rehabilitation

• Most stroke patients receive insufficient therapy to maximize recovery during rehabilitation. As increases in staffing are unlikely there is an imperative to find ways for patients to increase the amount of exercise and practice of functional tasks they undertake without increasing demands on staff.

• Patient-led therapy (also known as patient-directed therapy or independent practice), in which patients undertake exercises or functional tasks practice prescribed by a professional outside formal therapy sessions is one way of achieving this. It is widely used in community-based rehabilitation but is uncommon in hospital-based stroke care.

• We explored the feasibility and acceptability of two types of patient-led therapy during hospital-based stroke care; mirror therapy for the upper limb and exercises (without a mirror) for the lower limb. Here, we report patients’ experiences of undertaking patient-led therapy.

• Patient-led mirror therapy and lower limb exercises during in-patient stroke rehabilitation is generally feasible and acceptable to patients but “light touch” supervision to deal with any problems, and strategies to maintain focus and motivation are needed.

     

The Cerebral Palsy Kinematic Assessment Tool (CPKAT): feasibility testing of a new portable tool for the objective evaluation of upper limb kinematics in children with cerebral palsy in the non-laboratory setting

Purpose: Efficacy of treatment to improve upper-limb activity of children with cerebral palsy (CP) is typically evaluated outside clinical/laboratory environments through functional outcome measures (e.g. ABILHAND kids). This study evaluates CPKAT, a new portable laptop-based tool designed to objectively measure upper-limb kinematics in children with CP. Methods: Seven children with unilateral CP (2 females; mean age 10 years 2 months (SD 2 years 3 months), median age 9 years 6 months, range 6 years 5 months, MACS II–IV) were evaluated on copying, tracking and tracing tasks at their homes using CPKAT. CPKAT recorded parameters relating to spatiotemporal hand movement: path length, movement time, smoothness, path accuracy and root mean square error. The Wilcoxon signed ranks test explored whether CPKAT could detect differences between the affected and less-affected limb. Results: CPKAT detected intra-limb differences for movement time and smoothness (aiming), and path length (tracing). No intra-limb tracking differences were found, as hypothesised. These findings are consistent with other studies showing that movements of the impaired upper limb in unilateral CP are slower and less smooth. Conclusion: CPKAT provides a potential solution for home-based assessment of upper limb kinematics in children with CP to supplement other measures and assess functional intervention outcomes. Further validation is required.

• Implications for Rehabilitation

• This paper demonstrates the feasibility of evaluating upper limb kinematics in home using CPKAT, a portable laptop-based evaluation tool.

• We found that CPKAT is easy to set-up and use in home environments and yields useful kinematic measures of upper limb function.

• CPKAT can complement less responsive patient reported or subjectively evaluated functional measures for a more complete evaluation of children with cerebral palsy.

• Thus, CPKAT can help guide a multi-disciplinary team to more effective intervention and rehabilitation for children with cerebral palsy.

     

Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy

Purpose state: Determine the efficacy of Move-it-to-improve-it (Mitii?), a multi-modal web-based program, in improving Executive Function (EF) in children with unilateral cerebral palsy (UCP).

Method: Participants (n?=?102) were matched in pairs then randomized to: intervention (Mitii? for 20 weeks; n?=?51; 26 males; mean age?=?11 years 8 months (SD?=?2 years 4 months); Full Scale IQ?=?84.65 (SD?=?15.19); 28 left UCP; GMFCS-E&;R (I?=?20, II?=?31) or waitlist control (n?=?50; 25 males; mean age?=?11 years 10 months (SD?=?2 years 5 months); Full Scale IQ?=?80.75 (SD?=?19.81); 20 left UCP; GMFCS-E&;R (I?=?25, II?=?25). Mitii? targeted working memory (WM), visual processing (VP), upper limb co-ordination and physical activity. EF capacity was assessed: attentional control (DSB; WISC-IV); cognitive flexibility (inhibition and number-letter sequencing DKEFS); goal setting (D-KEFs Tower Test); and information processing (WISC-IV Symbol Search and Coding). EF performance was assessed via parent report (BRIEF). Groups were compared at 20 weeks using linear regression (SPSS 21).

Results: There were no significant between group differences in attentional control (DSB; p?=?0.20;CI=??0.40,1.87); cognitive flexibility (Inhibition, p?=?0.34; CI=??0.73,2.11; number/letter sequencing, p?=?0.17; CI=??0.55,2.94); problem solving (Tower; p?=?0.28; CI=??0.61,2.09), information processing (Symbol; p?=?0.08; CI=??0.16, 2.75; Coding; p?=?0.07; CI=??0.12,2.52) or EF performance (p?=?0.13; CI=??10.04,1.38).

Conclusion:In a large RCT, Mitii^TM did not lead to significant improvements on measures of EF or parent ratings of EF performance in children with UCP.

• Implications for rehabilitation

• A large RCT of the multi-modal web based training; Move It to Improve It (Mitii^TM) improves motor processing, visual perception, and physical capacity but does demonstrate statistically significant improvements or clinical significance in executive function in children with mild to moderate unilateral cerebral palsy (UCP).

• Mitii^TM training completed by an intervention group was highly variable with few children reaching the target dosage of 60?h. Technical issues including server and internet connectively problems lead to disengagement with the program.

• Web-based training delivered in the home has the potential to increase therapy dose and accessibility, however, Mitii^TM needs to be tailored to include tasks involving goal-setting, more complex problem solving using multi-dimensional strategies, mental flexibility, switching between two cognitively demanding tasks, and greater novelty in order to increase the cognitive component and challenge required to drive changes in EF.

     

Recovery-related anxiety and disability following upper limb injury: the importance of context

Abstract

Purpose: Anxiety following traumatic upper limb injury is common and may affect rehabilitation outcomes. Most previous research has focused on psychiatric anxiety disorders among those with severe injuries. The aims of this study were to determine the prevalence of anxiety among patients with mild to moderate traumatic upper limb injuries, to investigate the correlation between anxiety and disability, and to provide preliminary validation of the Recovery-Related Anxiety Questionnaire (RRAQ). Method: Eighty-four adults with a recent traumatic upper limb injury completed the State & Trait Anxiety Inventory (STAI), the Pain Anxiety Symptoms Scale (PASS-20), the RRAQ and the shortened Disability of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Prevalence rates of anxiety were calculated and linear regression analysis was used to identify predictors of QuickDASH scores. Results: All participants reported some anxiety, with higher levels of recovery-related anxiety than general anxiety. In linear regression analysis, the four types of anxiety accounted for 29% of the variability in QuickDASH scores. The RRAQ accounted for 19% of the variability in QuickDASH scores. Conclusions: Recovery-related forms of anxiety appear to be more common and more strongly associated with disability than general anxiety symptoms for patients with mild to moderate traumatic upper limb injuries.

• Implications for Rehabilitation

• Following mild to moderate traumatic upper limb injury, anxiety about the injury and recovery is common.

• Recovery-related anxiety is more strongly associated with disability than general anxiety symptoms.

• Phrasing questions about anxiety directly associated with the recovery experience may give greater insight into the anxiety patients with mild to moderate upper limb injuries are experiencing.

• This insight may help clinicians to directly address recovery-related issues, potentially decreasing disability experienced by patients.

     

Assessing the impact of upper limb disability following stroke: a qualitative enquiry using internet-based personal accounts of stroke survivors

Purpose: Upper limb disability following stroke may have multiple effects on the individual. Existing assessment instruments tend to focus on impairment and function and may miss other changes that are personally important. This study aimed to identify personally significant impacts of upper limb disability following stroke. Methods: Accounts by stroke survivors, in the form of web-based diaries (blogs) and stories, were sought using a blog search engine and in stroke-related web-sites. Thematic analysis using the World Health Organisation’s International Classification of Functioning Disability and Health (ICF) was used to identify personal impacts of upper limb disability following stroke. Results: Ninety-nine sources from at least four countries were analysed. Many impacts were classifiable using the ICF, but a number of additional themes emerged, including emotional, cognitive and behavioural changes. Blogs and other web-based accounts were easily accessible and rich sources of data, although using them raised several methodological issues, including potential sample bias. Conclusions: A range of impacts was identified, some of which (such as use of information technology and alienation from the upper limb) are not addressed in current assessment instruments. They should be considered in post-stroke assessments. Blogs may help in the development of more comprehensive assessments.

• Implications for Rehabilitation

• A comprehensive assessment of the upper limb following stroke should include the impact of upper limb problems on social participation, as well as associated emotional, cognitive and behavioural changes.

• Using personalised assessment instruments alongside standardised measures may help ensure that these broader domains are considered in discussions between clinicians and patients.

• Rehabilitation researchers should investigate whether and how these domains could be addressed and operationalised in standard upper limb assessment instruments.

     

Health behaviour change theories: contributions to an ICF-based behavioural exercise therapy for individuals with chronic diseases

Abstract

Purpose: The purpose of this perspective is (1) to incorporate recent psychological health behaviour change (HBC) theories into exercise therapeutic programmes, and (2) to introduce the International Classification of Functioning (ICF)-based concept of a behavioural exercise therapy (BET). Methods: Relevant personal modifiable factors of physical activity (PA) were identified based on three recent psychological HBC theories. Following the principles of intervention mapping, a matrix of proximal programme objectives specifies desirable parameter values for each personal factor. As a result of analysing reviews on behavioural techniques and intervention programmes of the German rehabilitation setting, we identified exercise-related techniques that impact the personal determinants. Finally, the techniques were integrated into an ICF-based BET concept. Results: Individuals' attitudes, skills, emotions, beliefs and knowledge are important personal factors of PA behaviour. BET systematically addresses these personal factors by a systematic combination of adequate exercise contents with related behavioural techniques. The presented 28 intervention techniques serve as a theory-driven “tool box” for designing complex BET programmes to promote PA. Conclusion: The current paper highlights the usefulness of theory-based integrative research in the field of exercise therapy, offers explicit methods and contents for physical therapists to promote PA behaviour, and introduces the ICF-based conceptual idea of a BET.

• Implications for Rehabilitation

• Irrespective of the clients' indication, therapeutic exercise programmes should incorporate effective, theory-based approaches to promote physical activity.

• Central determinants of physical activity behaviour are a number of personal factors: individuals' attitudes, skills, emotions, beliefs and knowledge.

• Clinicians implementing exercise therapy should set it within a wider theoretical framework including the personal factors that influence physical activity.

• To increase exercise-adherence and promote long-term physical activity behaviour change, the concept of a behavioural exercise therapy (BET) offers a theory-based approach to systematically address relevant personal factors with a combination of adequate contents of exercise with exercise-related techniques of behaviour change.

     

The psychometric properties of the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions

Purpose: The purpose of this study is to psychometrically test the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions.

Materials and methods: One thousand and two hundred people with ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic upper limb disorders; or Primary Sjögren’s syndrome completed the Evaluation of Daily Activity Questionnaire, Health Assessment Questionnaire and Short-Form Health Survey v2. We examined internal construct validity using Rasch analysis, internal consistency, concurrent validity with the Health Assessment Questionnaire and Short-Form Health Survey v2. Participants repeated the Evaluation of Daily Activity Questionnaire to assess test–retest reliability.

Results: The 12 domains satisfied Rasch model expectations for fit, local dependency, unidimensionality and invariance by age and gender, in each musculoskeletal condition. Internal consistency was consistent with individual use (Cronbach’s α?>?0.90); concurrent validity was strong (Health Assessment Questionnaire:?r_s?=?0.60–0.92; Short-Form Health Survey v2 Physical Function:?r_s?=??0.61 to ?0.91) and test–retest reliability excellent (Intra-Class Correlation Coefficient(2,1)?=?0.77–0.96).

Conclusion: The Evaluation of Daily Activity Questionnaire satisfied Rasch model requirements for construct validity and has good reliability and validity in each MSC. The Evaluation of Daily Activity Questionnaire can be used as a measure of everyday activity in practice and research with people with musculoskeletal conditions.

• Implications for rehabilitation

• The Evaluation of Daily Activity Questionnaire evaluates users’ ability to perform common daily activities (in 12 domains) that were identified as problematic by people with seven musculoskeletal conditions (i.e., osteoarthritis, systemic lupus, ankylosing spondylitis, chronic pain, chronic upper limb conditions, systemic sclerosis, Sjogren’s syndrome).

• Most patients considered the Evaluation of Daily Activity Questionnaire was the right length and would be helpful for discussing everyday problems with an occupational therapist.

• The 12 domains have good reliability and validity and can be combined into two components: Self-Care and Mobility.

• The Evaluation of Daily Activity Questionnaire is suitable for use both in clinical practice and research and a User Manual is available for therapists and researchers.

     

Parents’ experience of undertaking an intensive cognitive orientation to daily occupational performance (CO-OP) group for children with cerebral palsy

Purpose: The purpose of this study was to explore the experience of parents of children with cerebral palsy (CP) who participated in an intensive cognitive orientation to daily occupational performance (CO-OP) group program addressing child chosen goals.

Method: Participants were six parents of children with CP who participated in a CO-OP upper limb task-specific training program. Parents participated in semi-structured interviews conducted via phone. A grounded theory approach was used. Interviews were transcribed verbatim and coded to identify categories and overarching themes of the parent experience of CO-OP.

Results: The theory of CO-OP for children with CP was one of offering a unique and motivating learning experience for both the child and the parent, differing from other therapeutic approaches that families had previously been involved in. Five categories were identified: the unique benefits of CO-OP; the importance of intensity; the child’s motivation; challenging the parent role; and the benefits and challenges of therapy within a group context.

Conclusion: Parents felt that CO-OP was a worthwhile intervention that leads to achievement of goals involving upper limb function and had the capacity to be transferred to future goals. Intensity of therapy and a child’s motivation were identified as important factors in improvements. Further studies using quantitative research methods are warranted to investigate the benefits of CO-OP for children with neurological conditions.

• Implications for rehabilitation

• The cognitive orientation to daily occupational performance (CO-OP) is a promising upper limb cognitive motor training intervention for children with cerebral palsy.

• In a small sample, parents perceived that CO-OP leads to achievement of upper limb goals.

• Intensity of therapy, the child’s motivation and the parents’ ability to “step-back” were identified as important to the success of CO-OP.

     

Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial

Purpose: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke.

Methods: In this randomized controlled trial, 43 community-dwelling subjects (65–85 years, mean age 73?±?5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n?=?20) or a control group (n?=?23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita^®). Physical function was measured using the six-minute walk test.

Results: Complete case analyses revealed reduced fat mass in the IG compared with the control (?1.5 vs. (0).13% of body weight, respectively; effect size?=0.62; p?=?0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. ?10 m, respectively, effect size =0.69, p?=?0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r?=?0.48, p?=?0.038) in the IG.

Conclusions: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke.

• Implications for rehabilitation

• This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following:

• ??Improved walking capacity was associated with a reduction in fat mass.

• ??IGF-1 is reduced, possibly indicating improved insulin sensitivity.

     

Does a DVD improve compliance with home exercise programs for people who have sustained a traumatic hand injury? Results of a feasibility study

Abstract

Purpose: This feasibility study sought to determine if compliance and understanding of a home exercise program following a traumatic hand injury is improved when patients are provided with a DVD and a brochure when compared to using brochures only. Method: Patients who presented with a traumatic hand injury and commenced on a hand therapy protocol were randomly assigned into two groups. The control group received brochures while the experimental group were provided with exercise instructions on DVD as well as brochures. Compliance was measured through the use of exercise diaries, clinic attendance, a checklist to measure correctness and understanding of exercises and a follow-up survey. Results: No significant improvement was found in the mean exercise compliance score (p?=?0.344) between the intervention and control groups. From the survey results almost half of all participants reported that pain interfered in their ability to perform their home exercises and a third acknowledged that time limited their ability to perform their exercises. Conclusion: Findings demonstrate the multidimensional nature of compliance. The provision of DVD technology, while not shown to cause a statistically significant change in overall compliance, did help improve understanding of exercises; as such DVDs could be utilised as part of a program that facilitates the patient--therapist relationship.

• Implications for Rehabilitation

• Limited time and level of pain are highlighted as reasons for non compliance with exercise and treatment programs.

• The use of DVDs can improve understanding and execution of exercises and can be part of a treatment program that facilitates increased patient therapist contact for rural and remote clients.

     

The effect of ice skating on psychological well-being and sleep quality of children with visual or hearing impairment

Abstract

Purpose: Physical exercise and sports have a key role in preventing physical and psychiatric problems in children. However, children with a disability often experience difficulty participating in physical activity due to a lack of suitable opportunities. Participation in an accessible sport is particularly important for these children, but studies examining which sports are beneficial for which disability groups are rare. In this study, we assessed the effects of ice skating on the psychological well-being, self-concept, and sleep quality of children with hearing or visual impairment. Method: Forty students (20 visually impaired and 20 hearing impaired) aged 8–16 were included in a regular ice skating programme for three months. We examined the sleep quality, self-concept, and behavioural and emotional states of the children before and after participating in the programme. Results: There was a significant improvement in self-concept, behavioural and emotional problems, and sleep quality (p?<?0.05 for each) of the children with hearing impairment. Although the sleep quality (p?=?0.019) and emotional problem scores (p?=?0.000) of the visually impaired children improved; self-concept, peer relations and hyperactivity scores of these children worsened (p?<?0.05 for each). Conclusion: Ice skating is one of the popular sport alternatives that gives children the opportunity to exercise and have fun together. The results of this study revealed that regular ice skating programmes may have positive effects on the psychological well-being of children with hearing impairment. Despite some positive effects, caution must be use when including visually impaired children in ice skating programmes. Generalization of the study's outcomes is limited as the study group were residential students enrolled in special education institutions for children who are blind or deaf.

• Implications for Rehabilitation

• Ice skating is a community-based sport and a popular leisure activity that can also have benefits for people with disabilities.

• Ice skating and children with hearing impairment:

• Self-concept, behavioural and emotional problems, and sleep quality of the children with hearing impairment significantly improved after ice skating.

• Ice skating programmes may be considered as a rehabilitation alternative for children with hearing impairment.

• Ice skating and children with visual impairment:

• Caution must be use when including children with visual impairment in ice skating programmes because of possible negative psychological outcomes.

• Balance exercises before starting the practices on ice should be considered for preventing some possible negative outcomes in children with visual impairment.

     

Functional factors that are important correlates to physical activity in people with multiple sclerosis: a pilot study

Purpose: Identify functional factors that are important correlates to physical activity levels among people with multiple sclerosis.

Methods: A total of eight functional tests were conducted and physical activity was objectively measured (Actigraph GT3X accelerometer) for one week in 34 people with multiple sclerosis. A corrected Akaike Information Criterion analysis was performed to identify the strongest correlates with moderate-to-vigorous physical activity, total activity and sedentary time.

Results: The multiple regression analysis converged on a model for moderate-to-vigorous physical activity (R²?=?0.31, F?=?6.97, p=?0.003) that included total strength of the less-affected leg (partial r?=?0.46, p?=?0.007) and average peg test performance (partial r?=??0.30, p?=?0.087). The model for total activity (R²?=?0.40, F?=?10.51, p?<?0.001) included five times sit-to-stand performance (partial r=??0.44, p?=?0.010) and total strength of the less-affected leg (partial r?=?0.31, p?=?0.077). The model for sedentary time (R²=0.22, F?=?9.23, p?=?0.005) only included total strength of the more affected leg (r=??0.47, p?=?0.005).

Conclusion: These results suggest that leg strength, manual dexterity and the ability to perform functional tasks may be important correlates with physical activity levels in people with multiple sclerosis. The findings of this pilot study can inform future investigations aiming to increase physical activity levels or develop improved rehabilitation protocols for people with multiple sclerosis.

• Implications for Rehabilitation

• Physical activity is an effective means of improving the symptoms associated with multiple sclerosis.

• Participation in physical activity by people with multiple sclerosis may be affected by functional factors such as leg strength, manual dexterity and the ability to rise from a seated position.

• Bilateral leg strength differences should be assessed and addressed in people with multiple sclerosis.

     

Upper limb and eye movement coordination during reaching tasks in people with stroke

Purpose: To enhance understanding of the relationship between upper limb and eye movements during reaching tasks in people with stroke.

Methods: Eye movements were recorded from 10 control participants and 8 chronic stroke participants during a visual orienting task (Experiment 1) and a series of reaching tasks (Experiment 2). Stroke participants completed the reaching tasks using (i) their less impaired upper limb, (ii) their more impaired upper limb without support, and (iii) their more impaired upper limb, with support (SaeboMAS gravitational support and/or electrical stimulation). Participants were tested individually and completed both experiments in the same session.

Results: Oculomotor control and the coordination between the upper limb and the oculomotor system were found to be intact in stroke participants when no limb movements were required, or when the less impaired upper limb was used. However, when the more impaired upper limb was used, success and accuracy in reaching decreased and patterns of eye movements changed, with an observed increase in eye movements to the limb itself. With upper limb support, patterns of hand-eye coordination were found to more closely resemble those of the control group.

Conclusion: Deficits in upper limb motor systems result in changes in patterns of eye movement behavior during reaching tasks. These changes in eye movement behavior can be modulated by providing upper limb support.

• Implications for Rehabilitation

• Deficits in upper limb motor systems can result in changes in patterns of eye movement behavior during reaching tasks.

• Upper limb support can reduce deficits in hand-eye coordination.

• Stroke rehabilitation outcomes should consider motor and oculomotor performance.

     

The applicability of four clinical methods to evaluate arm and hand function in all stages of spinal muscular atrophy type II

Abstract

Aim: To evaluate the ability of four clinical methods to reflect arm and hand function at impairment and activity level and to determine their ability to discriminate among SMA II patients of all ages and in all stages of the disease. Methods: Fifty-two patients with SMA II (age range: 8–73 years) were assessed by means of the Egen Klassifikation 2 (EK2 scale), the Motor Function Measure Scale (MFM D3), the Manual Muscle Test (MMT) and Hand-Held Dynamometry (HHD) in full fist grip and lateral pinch grip. Patients were classified into six levels of upper limb function by means of the Brooke Upper Limb Scale, and the four methods’ ability to differentiate among patients within these levels was calculated. Modified versions of the EK2 scale (EK Upper Limb) and the MFM D3 (MFM D3 Upper Limb) were assessed in the same manner. Results: The patients’ physical abilities were best described by the MMT and EK2 while the “EK Upper Limb”, MFM D3 and MMT were best at discriminating among patients across the range of upper limb function. Quantitative muscle tests as measured by Citec? HHD were less applicable to weak patients; full fist grip could discriminate among patients at Brooke levels 3–5, and lateral pinch grip among the strongest patients. Conclusion: At the impairment level, MMT is the superior measure of muscle function in very weak patients in whom HHD cannot reflect capacity. At the activity level, the EK 2 represents daily activities whereas the MFM D3 measures motor functions. In differentiating among SMA II patients of all ages and in all stages of the disease, the ability of abbreviated versions of scales targeting upper limb function is superior to unabridged versions of these scales.

• Implications for Rehabilitation

• Evaluation of upper limb function in spinal muscular atrophy II

• Even very weak patients with SMA II have some residual upper limb function that is measurable if the right method is chosen.

• The Manual muscle test is applicable to all patients with SMA II and is useful to determine possible interventions – such as methods to drive a wheelchair or operate a computer.

• Abbreviated versions of the EK2 scale and the MFM are useful as methods to evaluate subtle changes in upper limb function resulting from disease progression or interventions.