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1.
Luiz Alfredo Braun Ferreira Veronica Cimolin Hugo Pasini Neto Luanda André Colange Grecco Roberta Delasta Lazzari Arislander Jonathan Lopes Dumont Manuela Galli Claudia Santos Oliveira 《Journal of bodywork and movement therapies》2018,22(3):792-797
Introduction
Recovering the ability to walk is an important goal of physical therapy for patients who have survived cerebrovascular accident (stroke). Orthotics can provide a reduction in plantar flexion of the ankle, leading to greater stability in the stance phase of the gait cycle. Postural insoles can be used to reorganize the tone of muscle chains, which exerts an influence on postural control through correction reflexes. The aim of the present study was to perform kinematic and spatiotemporal analyses of gait in stroke survivors with hemiparesis during postural insole usage.Material and Methods
Twenty stroke victims were randomly divided into two groups: 12 in the experimental group, who used insoles with corrective elements specifically designed for equinovarus foot, and eight in the control group, who used placebo insoles with no corrective elements. Both groups were also submitted to conventional physical therapy. The subjects were analyzed immediately following insole placement and after three months of insole usage. The SMART-D 140® system (BTS Engineering) with eight cameras sensitive to infrared light and the 32-channel SMART-D INTEGRATED WORKSTATION® were used for the three-dimensional gait evaluation.Results
Significant improvements were found in kinematic range of movement in the ankle and knee as well as gains in ankle dorsiflexion and knee flexion in the experimental group in comparison to the control group after three months of using the insoles.Conclusion
Postural insoles offer significant benefits to stroke survivors regarding the kinematics of gait, as evidenced by gains in ankle dorsiflexion and knee flexion after three months of usage in combination with conventional physical therapy. 相似文献2.
Background
Cerebral palsy (CP) is one of the most disabling syndromes in children. To our knowledge, there has not yet been any reported evaluation by ultrasonography of the effect of CP on distal femoral cartilage. The value of understanding this effect on cartilage is that sonographic evaluation of cartilage thickness may help physicians to predict the joint health of these children.Objective
To determine whether femoral cartilage thickness in patients with CP is different from that in healthy control subjects.Design
Cross-sectional study.Setting
National tertiary rehabilitation center.Patients
The study included 40 patients with diplegic CP (23 male and 17 female) and 51 healthy control subjects (29 male and 22 female).Methods
Demographic and clinical characteristics were recorded. Cartilage thicknesses were measured.Main Outcome Measure
Cartilage thickness measurements were taken from the medial and lateral condyles, and intercondylar areas of both knees.Results
Both groups were similar in terms of age, gender, and weight (P > .05). The mean cartilage thickness measurements of the medial condyle and intercondylar area of knees in the CP group were significantly less than those in the healthy control group (all P < .05). There was moderate negative correlation between age and all femoral cartilage thickness measurements in the CP group. There was no correlation between age and femoral cartilage thickness measurements in the healthy group. There was a negative correlation between Gross Motor Functional Classification System levels and cartilage thickness in the CP group. The highest cartilage thickness measurements were detected in level 1 patients, and the lowest measurements were detected in level 5 patients.Conclusion
This study showed that patients with CP have a thinner femoral cartilage than healthy control subjects. Management of patients with CP should include close surveillance.Level of Evidence
III 相似文献3.
Background
Ideally, high-stakes examinations assess 1 dimension of medical knowledge to produce precise estimates of a candidate’s performance. It has not been reported whether the American Board of Physical Medicine and Rehabilitation Part 1 Certification Examination (ABPMR-CE-1) is unidimensional or not.Objective
To examine the ABPMR-CE-1 to measure how many dimensions it assesses.Design
Retrospective observational study.Setting
We assessed examination results from the 2015 ABPMR-CE-1.Participants
A total of 489 deidentified candidates taking the 2015 ABPMR-CE-1.Methods
A 1-parameter Item Response Theory (IRT) measurement model was utilized. A Principal Components Analysis (PCA) of standardized residual correlations was used to detect multidimensionality.Main Outcome Measure
Number of primary dimensions reflected in the 325 test questions.Results
The results of the dimensionality analysis indicated that the ABPMR-CE-1 examination is highly unidimensional from a psychometric perspective. Expert content review of the substantive content of small contrasting clusters of questions provided additional assurance of the unidimensional nature of the examination.Conclusions
The ABPMR-CE-1 appears indeed to measure a single construct, which suggests a sound structure of the examination. It closely approximates the assumption of statistical unidimensionality.Level of Evidence
Not applicable. 相似文献4.
Ryan Woods Steve J. Wisniewski Daniel R. Lueders Thomas P. Pittelkow Dirk R. Larson Jonathan T. Finnoff 《PM & R》2018,10(7):730-737
Background
Accurate diagnosis of musculoskeletal disorders relies heavily on the physical examination, including accurate palpation of musculoskeletal structures. The literature suggests that there has been a deterioration of physical examination skills among medical students and residents, in part due to increased reliance on advanced imaging. It has been shown that knowledge of musculoskeletal anatomy and physical examination skills improve with the use of ultrasound; however, the literature is limited.Objective
To determine whether ultrasound can improve the ability of physicians in training (residents) to palpate the long head of the biceps tendon (LHBT) in the bicipital groove.Design
Prospective study design.Setting
Tertiary care center.Participants
Ten physical medicine and rehabilitation residents served as subjects. Exclusion criteria included the presence of any condition that precluded their ability to palpate. Three volunteers were used as models. Model exclusion criteria included anything that distorted normal shoulder anatomy or inhibited examiner palpation. Three investigators with experience performing diagnostic musculoskeletal ultrasound were used to confirm palpation attempts.Methods
Subjects attempted to palpate the LHBT bilaterally in the bicipital groove of each model. Investigators assessed the accuracy of the palpation attempt using real-time ultrasonography. Subjects participated in a 30-minute ultrasound-assisted training session learning how to palpate the LHBT in the bicipital groove with ultrasound confirmation. After the ultrasound training session, subjects again attempted to palpate the LHBT in the bicipital groove of each model with investigator confirmation.Main Outcome Measurements
LHBT palpation accuracy rates preintervention versus postintervention.Results
Pretraining LHBT palpation accuracy was 20% (12/60 attempts). Post-ultrasound training session accuracy was 51.7% (31/60 attempts; P ≤ .001).Conclusions
Our findings demonstrate that palpation accuracy improves after ultrasound assisted LHBT palpation training. These data suggest that the use of ultrasound may be beneficial when teaching musculoskeletal palpation skills to health care professionals.Level of Evidence
II 相似文献5.
Hiroyuki Tsuboi Yukihide Nishimura Takeshi Sakata Hideaki Tanina Hideki Arakawa Takeshi Nakamura Yuichi Umezu Fumihiro Tajima 《PM & R》2018,10(2):175-182
Background
Lumbar spondylolysis is a defect in the pars interarticularis that is common in young athletes; the stress distribution at the pars interarticularis is the highest in extension and rotation movements. The paraspinal muscles play an important role in stabilization of the lumbar spine; however, no study has assessed the properties of paraspinal muscles in athletes with lumbar spondylolysis.Objective
To evaluate the properties of paraspinal muscles in athletes with lumbar spondylolysis.Design
Cross-sectional study.Setting
Laboratory.Participants
Six high school baseball players with terminal-stage lumbar spondylolysis and 11 high school baseball players without organic lumbar lesions of similar anthropometric characteristics.Methods
All subjects performed the unsupported trunk holding test combined with surface electromyographic (EMG) power spectral analysis until exhaustion. The results of EMG power spectral analysis were compared between the spondylolysis and control groups.Main Outcome Measurements
The median frequency (MF) was computed from the raw EMG signal of the erector spinae and multifidus during trunk holding test using fast Fourier transform spectrum analysis. The initial MF and MF slope were calculated.Results
No significant differences in endurance time were found between the spondylolysis and control groups. The initial MF and the MF slopes of the erector spinae and multifidus were significantly lower in the spondylolysis group than in the control group.Conclusions
The results suggest lower fast-twitch motor unit recruitment in the erector spinae and multifidus of high school baseball players with terminal-stage lumbar spondylolysis compared with the control.Level of Evidence
IV 相似文献6.
Background
Spondylolysis with and without anterolisthesis is the most common cause of structural back pain in children and adolescents, but few predictive factors have been confirmed. An association between abnormal sacropelvic orientation and both spondylolysis and spondylolisthesis has been supported in the literature. Sacral slope and other sacropelvic measurements are easily accessible variables that could aid clinicians in assessing active adolescents with low back pain, particularly when the diagnosis of spondylolysis is suspected.Objective
To examine the relationship between sacral slope and symptomatic spondylolysis in a cohort of active adolescents.Design
Case-control retrospective study.Setting
Academic outpatient physiatry practice.Patients
Seventy-four patients of primarily adolescent age (between 12 and 22 years old) with a chief complaint of low back pain and presence of lateral radiographs of the lumbar spine were enrolled. Cases (n = 37) were defined as subjects with evidence of spondylolysis on both radiograph and magnetic resonance imaging of the lumbar spine. Controls (n = 37) were defined as subjects without spondylolysis.Methods
Using a single sagittal radiograph, taken with the patient standing, a fellowship-trained interventional spine physiatrist measured the sacral slope of each subject (angle between the superior plate of S1 and a horizontal reference on sagittal imaging of the lumbosacral spine). Ages and genders were collected from medical records.Main Outcome Measurements
The primary outcome was mean sacral slope. Mean sacral slope of cases was compared with mean sacral slope of controls with the Student t-test.Results
Ages ranged from 12 to 22 for both groups, with no significant differences in age between the groups (cases: 16.8 ± 2.3 years; controls: 17.7 ± 2.7 years). The patients with spondylolysis (cases) consisted of 29 male and 8 female patients, whereas those without spondylolysis (controls) consisted of 15 male and 21 female patients (gender details for 1 patient were not available). The mean sacral slope among cases was 42.4°, whereas the mean sacral slope among controls was 37.4°. The difference achieved significance (P = .014).Conclusions
The interdependence of positional parameters, such as sacral slope, with anatomic parameters, such as pelvic incidence, can affect lumbar lordosis and therefore upright positioning and loading of the spine. Sacral slope may be an important variable for clinicians to consider when caring for young athletes with low back pain, particularly when the index of suspicion for spondylolysis is high.Level of Evidence
IV 相似文献7.
Alberto Esquenazi Abraham Alfaro Ziyad Ayyoub David Charles Khashayar Dashtipour Glenn D. Graham John R. McGuire Ib R. Odderson Atul T. Patel David M. Simpson 《PM & R》2017,9(10):960-968
Background
OnabotulinumtoxinA is approved for the treatment of upper and lower limb spasticity in adults. Guidance on common postures and onabotulinumtoxinA injection paradigms for upper limb spasticity has been developed via a Delphi Panel; however, similar guidance for lower limb spasticity has not been established.Objective
To define a clinically recommended treatment paradigm for the use of onabotulinumtoxinA for each common posture among patients with poststroke lower limb spasticity (PSLLS) and to identify the most common PSLLS aggregate postures.Design
Clinical experts provided insight regarding onabotulinumtoxinA treatment for PSLLS using an adaptation of the Delphi consensus process.Setting
Delphi panel.Participants
Ten expert clinicians in neurology and physical medicine and rehabilitation who treat PSLLS.Methods
A minimum of 2 rounds of anonymous voting occurred for each recommendation until consensus was reached (≥66% agreement). The first round was conducted via a survey; the second round was an in-person meeting.Main Outcome Measurements
Reached consensus on muscle selection for injection, overall and per-muscle dose of onabotulinumtoxinA, number of injection sites/muscle, onabotulinumtoxinA dilution, and use of localization techniques. The most common PSLLS postures were reviewed. Recommendations were tailored toward injectors with less experience.Results
Consensus was reached on targeted subsets of muscles for each posture. Doses ranged from 20 to 150 U for individual muscles and 50 to 300 U for limb postures. OnabotulinumtoxinA dilution 50 U/mL (2:1 ratio) was considered most appropriate but varied based on muscles selected (range, 2:1-4:1). Experts agreed that localization techniques for muscle identification during injection for all postures would be useful. For suboptimal response to injection, all panel members would increase the dose, and the majority (89%) would increase the number of treated muscles. The panel identified 3 common aggregating lower limb postures: (1) equinovarus foot and flexed toes; (2) extended knee and plantar flexed foot/ankle; and (3) plantar flexed foot/ankle and flexed toes. The recommended starting doses for each aggregate posture were 400 U, 400 U, and 300 U, respectively.Conclusion
The modified Delphi panel process provided consensus on common muscles and corresponding onabotulinumtoxinA treatment paradigms for postures associated with PSLLS that can be used for guidance in optimizing care delivery.Level of Evidence
V 相似文献8.
Kelly L.D. Pham Kristie F. Bjornson Marisa Osorio Kathryn B. Whitlock Teresa L. Massagli 《PM & R》2018,10(6):594-600
Background
The incidence of contact isolation for multidrug-resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation.Objective
To determine whether the use of a modified contact isolation protocol (MCI) resulted in noninferior functional outcomes compared with children without contact isolation (NCI) on inpatient rehabilitation.Design
This is a retrospective noninferiority study.Setting
One academically affiliated pediatric inpatient rehabilitation unit located in a children’s hospital.Patients
All children with any diagnosis admitted to inpatient rehabilitation from January 1, 2007, to December 31, 2014.Methods or Interventions
We compared functional outcomes for 2 groups of children.Main Outcome Measurements
Primary outcome measures included the Functional Independence Measure for Children (WeeFIM) efficiency and the change in the Developmental Functional Quotient (DFQ) for the WeeFIM. Noninferiority margins of 0.63 for the WeeFIM efficiency and 0.092 for the change in DFQ for the WeeFIM were used.Results
There were a total of 949 patients of whom 899 were NCI, 48 MCI, and 2 excluded due to missing information. Patients with MCI had functional outcomes that were noninferior to those with NCI including the WeeFIM efficiency (mean difference 0.002, 95% CI –0.38 to 0.404) and the change in DFQ for the WeeFIM (mean difference –0.05, 95% CI –0.058 to 0.003).Conclusions
The modified contact isolation protocol, having resulted in noninferior functional outcomes in inpatient rehabilitation may provide adequate contact isolation while allowing for noninferior functional outcomes. This may be a guide in the face of an ever-increasing need for contact isolation.Level of Evidence
III 相似文献9.
Kerstin Hug Caroline Stumm Isabelle Debecker Carolina Saskia Fellinghauer Claudio Peter Margret Hund-Georgiadis 《PM & R》2018,10(6):573-586
Background
Pressure ulcers (PUs) are a common and severe health condition in persons with spinal cord injury (SCI). Skin-care strategies for PU prevention are usually provided during initial rehabilitation. However, individuals with SCI often do not perform these strategies continuously, especially after discharge. The influence of psychological factors such as general self-efficacy (GSE) on the performance of PU prevention behavior has not yet been sufficiently explored.Objective
To investigate whether persons with greater levels of GSE are more likely to perform skin-care strategies for PU prevention regularly.Design
Nationwide cross-sectional survey within the Swiss Spinal Cord Injury Cohort Study.Setting
Community setting, data collection between 2011 and 2013.Participants
A total of 456 subjects with a traumatic or nontraumatic SCI living in Switzerland.Methods
Associations between GSE and PU prevention behavior were analyzed by multivariate proportional odds regression models, including potential sociodemographic, lesion-related, and lifestyle-related confounders without and with interaction terms between GSE and potential effect modifiers.Main Outcome Measurements
Self-efficacy was assessed by the GSE scale comprising 10 items. PU preventive behavior was operationalized using 5 items of an adapted version of the Spinal Cord Injury Lifestyle scale. Both measurements were components of a self-administered questionnaire.Results
Based on the regression model without interaction terms, GSE levels were not associated with skin-care PU prevention. After we included interaction terms, the final model showed statistically significant associations between GSE and 3 skin-care items with odds ratios ranging from 1.09 to 1.17 (all P < .001). The slightly positive effect of GSE on PU prevention behavior was restricted to persons who sustained their SCI at a younger age.Conclusions
GSE was generally not associated with skin-care PU prevention behavior among persons with SCI in this study. In further research, it might be of interest to assess SCI-specific concepts of self-efficacy.Level of Evidence
III 相似文献10.
Donna Bergman Lynnette Rasmussen Kate Wan-Chu Chang Lynda J-S. Yang Virginia S. Nelson 《PM & R》2018,10(1):64-71
Background
The term self-determination refers to decision-making, goal setting, and perseverance to achieve those goals. Numerous studies have established the importance of self-determination to enhance learning and improve postschool outcomes. However, most studies evaluate students with learning disabilities, cognitive impairment, or behavioral disabilities. There is an absence of research on self-determination for adolescents with physical disabilities.Objective
To assess self-determination of adolescents with neonatal brachial plexus palsy (NBPP) compared with their typically developing peers via self-reported measures of function.Design
Case-control study.Setting
Brachial plexus clinic.Participants
Twenty adolescents with NBPP (aged 10-17 years) and their parents and 20 age/gender-matched typically developing adolescents and their parents were recruited. Non–English-speaking participants and those with other physical impairments were excluded from study.Methods
Participants completed demographic and American Institutes for Research (AIR) self-determination surveys. One of two designated occupational therapists evaluated participant physical function.Main Outcome Measurements
A demographic survey and AIR self-determination assessment were administered, and active range of motion measurements in shoulder forward flexion, elbow flexion, elbow extension, forearm pronation, and supination were obtained. Grip/pinch strength, MRC muscle strength, 9-Hole Peg Test, and Mallet scale scores also were evaluated.Results
Despite physical differences, adolescents with NBPP presented similar self-determination levels as their typically developing peers. Adolescents with NBPP rated their opportunities to engage in self-determined behaviors at school significantly lower than at home. Both adolescents with NBPP and those in the control group rated their opportunities to engage in self-determined behaviors at school significantly lower than at home.Conclusions
Adolescents with NBPP presented similar self-determination scores as their age/gender-matched typically developing peers. These results could be a reflection of our program’s patient- and family-centered care approach. Therefore, caregivers and providers should encourage personal development and fulfillment in adolescents with NBPP. Teachers and schools should be aware that opportunities for acquiring self-determination skills might be more limited at school than at home in this age group.Level of Evidence
III 相似文献11.
12.
Background
Prosthetic motor rehabilitation usually relies on the highly repetitive training of movements. Patients might drop out of training because the rehabilitation process is long and often discouraging. Game-based interventions provide a potentially useful alternative to standard myoelectric (electromyographic [EMG]) training and can increase engagement with training.Objective
To assess the short-term impact of a game-based rehabilitation protocol on parameters for EMG control, evaluate how game-based interventions affect patient motivation, performance, and effort, and compare the game-based intervention with a standard tool in rehabilitation (MyoBoy).Design
This randomized controlled trial included 2 patient groups and 1 control group. After establishing a baseline, the 2 patient groups received different interventions that were compared with each other and with the able-bodied control group.Setting
University hospital-based study.Participants
Fourteen patients with traumatic transradial or transhumeral upper extremity amputation and 10 able-bodied participants.Methods
For the game-based intervention, EMG proficiency was assessed before and after playing the games and 2 days later as follow-up to measure retention rate. EMG proficiency was measured using maximum voluntary contraction, proportional precision control, signal separation, and muscle endurance. Questionnaires for rating the game-based intervention and intrinsic motivation were provided after the intervention.Outcomes
Outcome measures for EMG proficiency were provisional maximum voluntary muscle contraction, precise proportional control, electrode separation, and muscle endurance. Quantitative outcome measures for participant experience were intrinsic motivation, enjoyment, pressure, exerted effort, and usefulness of the intervention. The qualitative outcome measure was the surveyed attitude toward the game-based intervention.Results
Results showed an overall improvement in EMG control, fine muscle activation, and electrode separation. Patients stated that racing games provided slightly more fun, but rhythm-based games were considered to provide better challenges for EMG control.Conclusion
Game-based interventions provide a useful addition to standard EMG training and can achieve better results in clinical outcome measures. The racing and music game genres provide solid starting points for interventions. Further studies can look at a wider range of genres and identify more specific game mechanics suitable for training.Level of Evidence
I 相似文献13.
Roberto S. Miyasato Carla Silva-Batista Tiago Peçanha David A. Low Marco T. de Mello Maria E.P. Piemonte Carlos Ugrinowitsch Cláudia L.M. Forjaz Hélcio Kanegusuku 《PM & R》2018,10(11):1145-1152
Background
Patients with Parkinson disease (PD) present cardiovascular autonomic dysfunction that impairs blood pressure control. However, cardiovascular responses during resistance exercise are unknown in these patients.Objective
To investigate cardiovascular responses during resistance exercise performed with different muscle masses in patients with PD.Design
Prospective, repeated-measures.Setting
Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo.Participants
Thirteen patients with PD (4 women, 62.7 ± 1.3 years, stages 2-3 of the modified Hoehn and Yahr scale; “on” state of medication) and 13 paired control patients without PD (7 women, 66.2 ± 2.0 years).Interventions
Both groups performed, in a random order, bilateral and unilateral knee extension exercises (2 sets, 10-12 maximal repetition, 2-minute intervals).Main Outcome Measurements
Systolic blood pressure (SBP) and heart rate (HR) were assessed before (pre) and during the exercises.Results
Independent of set and exercise type, SBP and HR increases were significantly lower in PD than the control group (combined values: +45 ± 2 versus +73 ± 4 mm Hg and +18 ± 1 versus +31 ± 2 bpm, P = .003 and .007, respectively). Independently of group and set, the SBP increase was greater in the bilateral than the unilateral exercise (combined values: +63 ± 4 versus +54 ± 3 mm Hg, P = .002), whereas the HR increase was similar. In addition, independently of group and exercise type, the SBP increase was greater in the second than the first set (combined values: +56 ± 4 versus +61 ± 4 mm Hg, P = .04), whereas the HR increases were similar.Conclusions
Patients with PD present attenuated increases in SBP and HR during resistance exercise in comparison with healthy subjects. These results support that resistance exercise is safe and well tolerated for patients with PD from a cardiovascular point of view supporting its recommendation for this population.Level of Evidence
II 相似文献14.
Brittany Bickelhaupt Sakiko Oyama Jonathan Benfield Keith Burau Shuko Lee Michelle Trbovich 《PM & R》2018,10(10):1004-1011
Background
Shoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion.Objective
To determine which arm stroke technique, pump (P) or semicircular (SC), is most energy efficient for long periods of propulsion.Design
A randomized study with repeated measures observations.Setting
The study was performed at an institutional gait analysis laboratory.Participants
18 able-bodied (AB) male participants were studied and randomized into one of 2 conditions, SC or P.Methods
Shoulder muscle fatigue was measured by changes in Borg CR10 Rate of Perceived Exertion (Borg RPE) and upper extremity strength via a handheld dynamometer. Participants were studied and assigned into one of 2 conditions of wheelchair arm propulsion patterns, SC or P group, and propelled on a wheelchair treadmill for 10 minutes.Main Outcome Measures
The primary outcomes included recordings of Borg RPE scale during continuous wheelchair propulsion and pre- and post-test dynamometer testing means for bilateral elbow and shoulder extension. Analysis of covariance, t-tests, and Kruskal-Wallis tests were used in analyzing data.Results
Although not significant (P = .23), the Borg RPE scores for the SC condition were consistently higher than the scores for the P condition. In addition, the dynamometer pre- and post-test readings demonstrated a larger decrease for the SC condition participants than for the P condition participants, but were not statistically significant.Conclusions
These data demonstrate that the SC wheelchair propulsion pattern appears to be more fatiguing to shoulder muscles than the P propulsion pattern. However, more data would need to be collected to find a significant difference.Level of Evidence
II 相似文献15.
Background
Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (ie, multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions.Objective
To examine the effects of insertion and presence of fine-wire EMG electrodes in the lumbar multifidus on muscle strength, endurance, and activation profiles during high-exertion spinal extension muscle contractions.Design
Single-blinded, repeated measures intervention trial.Setting
University clinical research laboratoryParticipants
Twenty individuals between the ages of 18-40 free of recent and current back pain.Methods
Muscle performance was assessed during 3 conditions (with [WI] and without [WO] presence of intramuscular electrodes, and insertion followed by removal [IO]). Isometric spinal extension strength was assessed with a motorized dynamometer. Muscle endurance was assessed using the Sorensen test with neuromuscular activation profiles analyzed during the endurance test.Main Outcome Measurements
Spinal extensor muscle strength, endurance, and activation.Results
Our data showed no significant difference in isometric strength (P = .20) between the 3 conditions. A significant difference in muscle endurance was found (P = .03). Post hoc analysis showed that the muscle endurance in the IO condition was significantly higher than the WO condition (161.3 ± 58.3 versus 142.1 ± 48.2 seconds, P = .04), likely due to a learning effect. All 3 conditions elicited minimal pain (range 0-4/10) and comparable muscle activation profiles.Conclusion
Our findings suggested the sonographically guided insertion and presence of fine-wire intramuscular EMG electrodes in the lumbar multifidus muscles had no significant impact on spinal extension muscle function. This study provides evidence that implementing intramuscular EMG does not affect muscle performance during high-exertion contractions in individuals with no current back pain.Level of Evidence
II 相似文献16.
17.
Background
Employment in those with disability is an important rehabilitation goal, along with achieving some measure of functional independence and is at the same time one of the most difficult goals to achieve. The number of people with disabilities participating in adaptive sports has been increasing steadily over the years. A few studies have looked at the relationship between physical fitness and employment status in those with disability, but there have been no studies that focused on the results of organized adaptive sports events affecting employment outcome.Objective
To determine whether participation in the National Veterans Wheelchair Games (NVWG) has a positive impact on employment in those with disability.Study Design
Prospective, cross-sectional survey.Setting
2015 NVWG in Dallas, Texas (nonclinic setting).Participants
A total of 338 survey participants; 36 surveys were excluded due to incompletion.Methods
Veterans who participated at the 2015 NVWG were given the opportunity to complete a 2-page survey. Survey participants received $5.00 gift card as compensation.Main Outcome Measurements
Percentage of those who perceived NVWG made a difference in attaining employment, risk ratio analyses.Results
A total of 50% of the participants stated that the NVWG made a difference in attaining employment. Those currently working were 1.5 times more likely to say that the NVWG had a positive effect on employment than those not currently working (P < .01). Those who felt that the NVWG had a positive effect on employment attended 3-4 more wheelchair games on average than those reporting that the NVWG did not have an impact on employment (P < .001). Positive responses were obtained from the Likert scale distribution.Conclusions
Our study suggests that participating in the NVWG provides psychosocial support to the veterans and may have a positive influence in employment outcomes.Level of Evidence
III 相似文献18.
Hyun-Mi Oh Geun-Young Park Young Min Choi Hyung Jung Koo Yongjun Jang Sun Im 《PM & R》2018,10(8):789-797
Background
There are no guidelines on the ideal time to inject botulinum toxin type A (BT-A) for lower leg spasticity in stroke patients. An early injection may produce unwanted weakness, interfering with gait recovery.Objective
To evaluate whether the outcomes after BT-A injection for plantarflexion spasticity can be different according to stroke chronicity.Design
A secondary analysis study from a double-blinded, randomized trial with group reclassification according to stroke chronicity.Setting
Two rehabilitation centers.Participants
Stroke participants (n = 40) with plantar flexor spasticity, treated with BT-A (200 units) into the gastrocnemius muscle.Methods
Outcome parameters were reanalyzed serially using 2-way repeated measures of analysis of variance (ANOVA), at baseline and 2, 4, and 8 weeks postinjection. Subjects were reclassified into 3 groups: early, within 6 months (n = 12); middle, between 6 months and 1 year (n = 14); and late, between 1 and 2 years from stroke onset (n = 12).Main Outcome Measures
The Modified Ashworth Scale, clonus scale, 10-m walking test, ABILOCO, and the Functional Ambulation Category.Results
The 2-way repeated measures of ANOVA showed improvement in gait and spasticity after injection in the 3 groups. Significant improvement in the Modified Ashworth Scale (P < .001) was observed, starting from the post–2 week injection period. Improvement of gait as assessed by the functional measurement ABILOCO and the Functional Ambulation Category (P < .001) were observed in all 3 groups, mostly at the post–8 week injection period.Conclusions
Our serial measurements of the outcome parameters indicated that BT-A could be expected to lead to consistent improvement in both the muscle tone and gait quality in those with plantar flexor spasticity regardless of stroke chronicity, including those injected as early as within the first 6 months.Level of Evidence
I 相似文献19.
Anat V. Lubetzky Bryan D. Hujsak Jennifer L. Kelly Gene Fu Ken Perlin 《PM & R》2018,10(11):1223-1236.e2
Background
Deficits in sensory integration and fear of falling in complex environments contribute to decreased participation of adults with vestibular disorders. With recent advances in virtual reality technology, head-mounted displays are affordable and allow manipulation of the environment to test postural responses to visual changes.Objectives
To develop an assessment of static and dynamic balance with the Oculus Rift and (1) to assess test-retest reliability of each scene in adults with and without vestibular hypofunction; (2) to describe changes in directional path and sample entropy in response to changes in visuals and surface and compare between groups; and (3) to evaluate the relation between balance performance and self-reported disability and balance confidence.Design
Test-retest, blocked-randomized experimental design.Setting
Research laboratory.Participants
Twenty-five adults with vestibular hypofunction and 16 age- and sex-matched adults.Methods
Participants stood on the floor or stability trainers while wearing the Oculus Rift. For 3 moving “stars” scenes, they stood naturally. For a “park” scene, they were asked to avoid a virtual ball. The protocol was repeated 1-4 weeks later.Outcome
Anteroposterior and mediolateral center-of-pressure directional path and sample entropy were derived from a force plate.Results
We observed good to excellent reliability in the 2 groups, with most intraclass correlations above 0.8 and only 2 at approximately 0.4. The vestibular group had higher directional path for the stars scenes and lower directional path for the park scene compared with controls, with large variability in the 2 groups. Sample entropy decreased with more challenging environments. In the vestibular group, less balance confidence strongly correlated with more sway for the stars scenes and less sway for the park scene.Conclusion
Virtual reality paradigms can shed light on the control mechanism of static and dynamic postural control. Clinical utility and implementation of our portable Oculus Rift assessment should be further studied.Level of Evidence
II 相似文献20.
Yong-Taek Lee Kwang-Soo Chun Kyung Jae Yoon Hee-Jin Park So-Yeon Lee Eugene Kim Young Sook Park Kyoung-Ho Seo 《PM & R》2018,10(2):137-145