Left/right judgement does not influence the effect of mirror therapy after stroke

Abstract

Purpose: To investigate the correlation between left/right judgement and the effect of mirror therapy (MT). A partial aim was to describe adverse effects of MT. Methods: This prospective follow-up study included 36 stroke patients, mean time since stroke was 33?d, SD 23. Left/right judgement is the ability to judge a pictured hand as belonging to one side of the body or the other. In this study, left/right judgement was established before the onset of MT by asking the patient to recognise left and right hands in photographs. Patients were tested before and after the intervention with the motor assessment scale (MAS) and two-point discrimination (2PD). The correlation between left/right judgement and the change of effect measured on the MAS and 2PD were tested by Spearman’s rank correlation. Results: The ability to perform left/right judgement before the onset of MT had no significant correlation with change of effect measured on the MAS and 2PD (rho ?0.169, p?=?0.363 and rho?=??0.227, p?=?0.219). Thirty-one patients completed the intervention without adverse effects. Conclusion: Left/right judgement does not influence the effect of MT. There seems to be no reason to test the ability to perform left/right judgement before the onset of MT. MT is an intervention without major adverse effects.

• Implications for Rehabilitation

• Mirror therapy (MT) is a method for treating sensory and motor disturbances post-stroke.

• It is important to clarify whether the ability to perform left/right judgement influences the effect of MT.

• In this study, left/right judgement does not influence the effect of MT.

• Based on the results of this study, testing and training left/right judgement before commencing MT cannot be recommended.

     

Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial

Abstract

Purpose: Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB. Methods: Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n?=?30) or breathing retraining plus MT (intervention; n?=?30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed. Results: At baseline, standard treatment group subjects were statistically younger (41.7?+?13.5 versus 50.8?+?13.0 years; p?=?0.001) with higher Nijmegen scores (38.6?+?9.5 versus 31.5?+?6.9; p?=?0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (?1.1, 6.6) p?=?0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance). Conclusion: Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group.

• Implications for Rehabilitation

• Dysfunctional breathing (DB) is associated with significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources.

• Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB.

• However, the results of this study suggest that MT provides no further benefit and cannot be recommended in the clinical management of this condition.

     

Efficacy of constraint-induced movement therapy and electrical stimulation on hand function of children with hemiplegic cerebral palsy: a controlled clinical trial

Purpose: The purpose of this study is to compare the efficacy of constraint therapy, constraint therapy plus electrical stimulation, and occupational therapy in the treatment of hand dysfunction. Methods: Sixty-eight children with hemiplegic cerebral palsy were randomly allocated to constraint therapy, constraint therapy plus electrical stimulation, and occupational therapy group. Three groups received 2 weeks of treatment. All participants were measured at baseline and 2 weeks, 3 and 6 months after treatment using measures of active ROM, grip strength, nine-peg hole test, upper extremity functional test, Peabody developmental motor scales (PDMS), globe rating scale, and social life ability scale. Results: Three groups improved significantly (p < 0.05). The mean improvements between baseline and the end of follow-up were respectively 12.4, 11.4 and 11.3 degrees for active ROM; 12.8, 10.5 and 8.8 mmHg for grip strength; ?22.3, ?30.7 and ?14.0 s for nine-peg hole test; 15.3, 10.3 and 10.4 for upper extremity functional test scores; 2.2, 1.8 and 1.8 for grasping scores of PDMS; 5.8, 3.7 and 2.8 for visual-motor integration scores of PDMS; 2.0, 2.5 and 0.9 for globe rating scale scores; 7.7, 5.7 and 5.3 for social life ability scale scores in constraint therapy plus electrical stimulation, constraint therapy, and occupational therapy group. The constraint therapy plus electrical stimulation group showed greater rate of improvement in upper extremity functional test scores (p < 0.05) and visual-motor integration scores of PDMS (p < 0.05) than the other two groups after treatment for 6 months. Conclusions: Constraint therapy plus electrical stimulation is likely to be best in improving hand performance in children with hemiplegic cerebral palsy.

Implications for Rehabilitation

• Children with hemiplegic cerebral palsy have major hand dysfunction problems that not only restrict activity and participation but also lead to secondary impairment.

• Constraint therapy, constraint therapy plus electrical stimulation and occupational therapy, is the technique available to these children. However, strong evidence for efficacy of the three interventions is still lacking.

• This study shows that all the three interventions improve hand performance and perceived changes. However, constraint therapy plus electrical stimulation is the most effective. Use of constraint therapy is advantageous in improving involved hand function and perceived changes.

     

Hospital rehabilitation for patients with obesity: a scoping review

Purpose: To explore the evidence on rehabilitation for hospitalized patients with obesity.

Methods: Medline, Embase, CENTRAL, CINAHL, and PubMed were searched from 1994 to May 2016. Grey literature was hand-searched. Two reviewers independently selected studies examining patients with obesity receiving hospital-based therapy for a physical impairment. One reviewer extracted the data and a second reviewer verified a random sample.

Results: Thirty-nine studies (two trials, 37 observational) were included. Patients underwent rehabilitation following orthopaedic surgery (n?=?25), neurological conditions (n?=?7), acute medical illnesses (n?=?3), or various procedures (n?=?4). Three studies investigated the effectiveness of a specific rehabilitation program in patients with obesity; however, two lacked a control group, precluding inferences of causal associations. Most studies compared functional outcomes across patients in different BMI categories (n?=?33). There was much variability in the rehabilitation components, intensity, and providers used across the studies. The most frequent components were gait training and mobility (n?=?17) and training in assistive devices (n?=?12). Across the 50 outcomes measured, length of hospital stay (n?=?24) and Functional Independence Measure (n?=?15) were assessed most frequently.

Conclusions: Evidence to guide rehabilitation for patients with obesity is sparse and weak. Rigorous comparative studies with clearly defined interventions and consensus outcome measures are needed.

• Implications for Rehabilitation

• Obesity rates have dramatically increased among patients requiring rehabilitation following joint arthroplasty, stroke, injury, or an acute medical event.

• There are currently no guidelines by which to define best practice for rehabilitating patients with obesity and comparative studies on rehabilitation programs are needed.

• Professional development focused on patient-centered rehabilitation and sensitivity training is known to promote quality care, reduce weight bias, and improve patient satisfaction.

• Access to and knowledge about equipment is necessary to promote patient and health care provider safety.

     

Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial

Purpose: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial. Method: We recruited 113 patients suffering from chronic WAD grades I–III and several years’ duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2. Results: From baseline to post-treatment, the BAT group increased their physical functioning (median 5, IQR?=?15) more than the ET group (median?=?0, IQR?=?15), p?=?0.032, effect size ?0.54. Three months after the end of treatment, the BAT group had less bodily pain (m?=?17.5, 95% CI 6.9–17.6) than the ET group (m =?4.9, 95% CI ?0.1 to 9.8), p?=?0.044, effect size ?0.4. The BAT group had also increased their social functioning (m?=?13.3, 95% CI 6.6–19.9) more than the ET group (m?=?3.5, 95% CI ?3 to 9.9), p?=?0.037, effect size ?0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups. Conclusions: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD.

• Implications for Rehabilation

• Chronic whiplash-associated disorders are disabling and incur great costs to society often through inability to work.

• Exercise therapy (ET) may alleviate symptoms of chronic WAD.

• Basic body awareness therapy (BAT) is often a component of multimodal pain rehabilitation programs.

• In this randomized comparative trial, BAT increased physical functioning and led to greater pain reduction and social functioning 3 months after the end of treatment.

     

The Ronnie Gardiner Rhythm and Music Method – a feasibility study in Parkinson’s disease

Abstract

Purpose: To assess the feasibility of the novel intervention, Ronnie Gardiner Rhythm and Music (RGRM?) Method compared to a control group for patients with Parkinson’s disease (PD). Method: Eighteen patients, mean age 68, participating in a disability study within a neurological rehabilitation centre, were randomly allocated to intervention group (n?=?12) or control group (n?=?6). Feasibility was assessed by comparing effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by two-dimensional motion analysis, secondary outcomes: mobility, cognition, quality of life, adherence, adverse events and eligibility). Results: Univariable analyses showed no significant differences between groups following intervention. However, analyses suggested that patients in the intervention group improved more on mobility (p?=?0.006), cognition and quality of life than patients in the control group. There were no adverse events and a high level of adherence to therapy was observed. Conclusions: In this disability study, the use of the RGRM? Method showed promising results in the intervention group and the adherence level was high. Our results suggest that most assessments chosen are eligible to use in a larger randomized controlled study for patients with PD.

• Implications for Rehabilitation

• The RGRM? Method appeared to be a useful and safe method that showed promising results in both motor and cognitive functions as well as quality of life in patients with moderate PD.

• The RGRM? Method can be used by physiotherapists, occupational, speech and music therapists in neurological rehabilitation.

• Most measurements were feasible except for Timed-Up-and-Go.

     

An exploration of knowledge and practice of patient handling among undergraduate occupational therapy students

Abstract

Purpose: To explore knowledge and practice relating to patient handling among final year occupational therapy students in the Republic of Ireland. Method: We conducted a survey of final year students in three out of four occupational therapy programs in the Republic of Ireland (n?=?81). The survey measured students’ knowledge of manual handling principles and techniques and explored their experiences and ability to apply this knowledge to clinical situations. Results: All students (n?=?81) had undertaken training in patient handling. Just under half of students (n?=?35, 43.2%) had received additional training outside of the university setting. Overall knowledge of safe patient handling principles techniques and risk assessment was low (Mean Score?=?15.71/28; SD?=?3.81). Participants who received additional training achieved a lower mean total score (M?=?13.89, SD?=?3.54) than those who only undertook university-based training (M?=?18.11; SD?=?2.66; t(79)?=??5.87; p?<?0.05). The majority of participants reported intermittent use of taught principles while on clinical practice placements (n?=?50, 61.8%) Reasons for not using taught principles included; selection of alternative technique by supervisor (n?=?30, 56.6%); lack of available equipment (n?=?13, 24.5%) and lack of time (n?=?13, 24.5%). Conclusions: While occupational therapy students in Ireland receive training in safe patient handling they appear to have limited knowledge of best practice and experience difficulties in applying their learning to clinical situations. There is an urgent need to consider the effectiveness of current educational strategies in this area.

• Implications for Rehabilitation

• Safe patient handling is a key component in preventing musculoskeletal injury among rehabilitation professionals

• The extent to which pre-professional training prepares rehabilitation professionals to practice safe patient handling is unclear

• Occupational therapy students in this study had limited knowledge of safe patient handling and had difficulty applying their learning to clinical practice

• Alternative education models are required to support development of safe patient handling skills.

• Educators may wish to consider how safe patient handling can be embedded across curricula to avoid the challenges of once off instruction and massed practice.

     

Effects of hand-training in persons with myotonic dystrophy type 1 – a randomised controlled cross-over pilot study

Abstract

Purpose: To investigate the effects of a hand-training programme on grip, pinch and wrist force, manual dexterity and activities of daily living, in adults with myotonic dystrophy type 1 (DM1). Method: In this randomised controlled trial with a crossover design, 35 adults with DM1 were, after stratification for grip force, assigned by lot to two groups. Group A started with 12 weeks of hand training, while group B had no intervention. After a wash-out period of 12 weeks, where none received training, the order was reversed. The Grippit® was used as primary outcome measure and the hand-held Microfet2? myometer, the Purdue Pegboard, the Canadian Occupational Performance Measure (COPM) and the Assessment of Motor and Process Skills (AMPS) were secondary outcome measures. Assessments were performed before and after training and control periods, i.e. four times altogether. Results: Ten persons dropped out and 13 had acceptable adherence. Intention-to-treat analyses revealed significant intervention effects for isometric wrist flexor force (p?=?0.048), and for COPM performance (p?=?0.047) and satisfaction (p?=?0.027). On an individual level, improvements were in general showed after a training period. Conclusion: The hand-training programme had positive effects on wrist flexor force and self-perception of occupational performance, and of satisfaction with performance. No evident detrimental effects were shown.

• Implications for Rehabilitation

• Myotonic dystrophy type 1 (DM1) is a slowly progressive neuromuscular disease characterised by myotonia and muscle weakness and wasting.

• People with DM1 are often concerned about their ability to carry out ADL and to participate in, e.g. work, sports and hobbies when they gradually become weaker.

• This pilot study showed that a hand-training programme improved wrist flexor force and self-perception and satisfaction of occupational performance.

• Resistance training of hand muscles with a silicon-based putty can be a therapy option for people with DM1 in clinical practise.

     

Using a social robot to teach gestural recognition and production in children with autism spectrum disorders

While it has been argued that children with autism spectrum disorders are responsive to robot-like toys, very little research has examined the impact of robot-based intervention on gesture use. These children have delayed gestural development. We used a social robot in two phases to teach them to recognize and produce eight pantomime gestures that expressed feelings and needs. Compared to the children in the wait-list control group (N?=?6), those in the intervention group (N?=?7) were more likely to recognize gestures and to gesture accurately in trained and untrained scenarios. They also generalized the acquired recognition (but not production) skills to human-to-human interaction. The benefits and limitations of robot-based intervention for gestural learning were highlighted.

• Implications for Rehabilitation

• Compared to typically-developing children, children with autism spectrum disorders have delayed development of gesture comprehension and production.

• Robot-based intervention program was developed to teach children with autism spectrum disorders recognition (Phase I) and production (Phase II) of eight pantomime gestures that expressed feelings and needs.

• Children in the intervention group (but not in the wait-list control group) were able to recognize more gestures in both trained and untrained scenarios and generalize the acquired gestural recognition skills to human-to-human interaction.

• Similar findings were reported for gestural production except that there was no strong evidence showing children in the intervention group could produce gestures accurately in human-to-human interaction.

     

Short stick exercises for fall prevention among older adults: a cluster randomized trial

Abstract

Purpose: To investigate the effects of short stick exercise (SSEs) on fall prevention and improvement of physical function in older adults. Methods: A cluster randomized trial was conducted in five residential care facilities. The intervention group (n?=?51) practiced SSEs for six months, followed by routine care for six more months. The control group (n?=?54) received ordinary care for 12 months. The primary outcome measure was the number of fallers, taking into account the time to first fall using the Kaplan–Meier method. The secondary outcome measures were physical and mental functions. Results: The number of fallers was significantly lower in the intervention group (n?=?6) than in the control group (n?=?16) during the 12 months. The adjusted hazard ratio for a first fall in the intervention group compared with the control group was 0.15 (CI, 0.03 to 0.74, p?=?0.02). The fall-free period was significantly longer in the intervention group than in controls (mean?±?SD, 10.1?±?3.0 versus 9.0?±?4.1 months, p?=?0.027). The functional reach and sit and reach tests were significantly improved at three and six months. Conclusion: The SSEs appeared effective for fall prevention and improvement of physical function in older adults.

• Implications for Rehabilitation

• The newly developed short stick exercises appear an effective means of reducing falls among older adults in residential care facilities.

• The short stick exercises seem to have an immediate effect on improving physical functions.

• Effects gained by performing the short stick exercises, such as static balance, flexibility and agility may last for six months.

• The short stick exercises were found to be easy for older adults to practice continuously in residential care facilities.

     

Adapted Tango improves aspects of participation in older adults versus individuals with Parkinson’s disease

Purpose: Our aims were to determine (1) the impact of aging versus combined aging and disease on participation and (2) participation before and after a 12-week, Adapted Tango dance intervention (AT) in older adults with and without Parkinson’s disease (PD).

Methods: Participant responses to open and closed-ended questions on the Impact on Participation and Autonomy questionnaire (IPA) were recorded before, one-week-after, and three-months after 20 lessons of AT. Twenty-five older individuals with PD and 63 older adults without PD were initially enrolled and assessed, and 44 older adults and 22 individuals with PD finished the program with post-testing.

Results: Thematic analysis revealed major themes of difficulty with mobility, transportation and financial management, feelings of being forced to limit activities, and interest in work or volunteering for both groups at baseline and post-test. At post-test, additional emphasis on resilience in the face of challenges was noted. No differences were noted between groups on the IPA subscales at baseline. Quantitative analysis with a 2 (group)?×?3 (time) MANOVA revealed a main effect of time (p?p?p?=?0.073), and Family Role (p?=?0.057).

Conclusions: Adapted Tango improved aspects of participation for these cohorts of older adults with and without PD.

• Implications for Rehabilitation

• Both Parkinson’s disease and neurotypical aging can negatively impact participation in life’s activities in older adults.

• Adapted Tango is an alternative therapy that has improved quality of life and mobility in people with PD and older adults.

• Quantitative data show that Adapted Tango may improve some aspects of participation for older adults with and without PD.

• Open-ended responses reveal aging and combined aging and disease-related issues have a lasting impact upon participation.

     

Fixed multibracket dental therapy has challenges but can be successfully performed in young persons with Down syndrome

Purpose The objective of this study was to analyze the feasibility of orthodontic treatment with fixed multibracket dental appliances (FMAs) in patients with Down syndrome (DS). Methods The study sample was formed of 25 patients with DS who underwent orthodontic treatment with FMAs. Dental and skeletal characteristics, aspects of FMA treatment, retainer use and recurrences were analyzed. Results were compared with a control group of healthy, age-, sex- and PAR index-matched individuals. Results All the controls underwent a single desensitization session, whereas 2–3 sessions were necessary in 11 patients with DS (p?p?p?=?0.004). Complications were more common in patients with DS than in controls (p?=?0.003), due particularly to traumatic ulcers development. There were more failures during the maintenance phase in patients with DS than in controls (p?=?0.001). The mean duration of treatment was 37 months in patients with DS and 23 months in controls. More cemented retainers were used in the controls than in patients with DS (p?=?0.050). Conclusions It is possible to perform orthodontic treatment with FMAs in patients with DS, although treatment may take longer than usual and the frequency of complications is higher than in controls.

• Implications for Rehabilitation

• Certain dental characteristics of Down syndrome (DS) make these children firm candidates for orthodontic intervention.

• There is little literature available on orthodontic treatment in patients with DS, particularly with regard to the use of fixed appliances.

• This case–control study shows that it is possible to perform orthodontic treatment with fixed appliances in adequately selected patients with DS.

• However, in patients with DS orthodontic treatment may take longer than usual and the frequency of complications is higher than in the general population.

     

Effects of supervised slackline training on postural instability,freezing of gait,and falls efficacy in people with Parkinson’s disease

Purpose: The aim of this study was to assess whether supervised slackline training reduces the risk of falls in people with Parkinson’s disease (PD).

Methods: Twenty-two patients with idiopathic PD were randomized into experimental (EG, N?=?11) and control (CG, N?=?11) groups. Center of Pressure (CoP), Freezing of Gait (FOG), and Falls Efficacy Scale (FES) were assessed at pre-test, post-test and re-test. Rate perceived exertion (RPE, Borg’s 6–20 scale) and local muscle perceived exertion (LRPE) were also assessed at the end of the training sessions.

Results: The EG group showed significant improvements in FOG and FES scores from pre-test to post-test. Both decreased at re-test, though they did not return to pre-test levels. No significant differences were detected in CoP parameters. Analysis of RPE and LRPE scores revealed that slackline was associated with minimal fatigue and involved the major lower limb and lumbar muscles.

Conclusions: These findings suggest that slacklining is a simple, safe, and challenging training and rehabilitation tool for PD patients. It could be introduced into their physical activity routine to reduce the risk of falls and improve confidence related to fear of falling.

• Implications for Rehabilitation

• Individuals with Parkinson’s disease (PD) are twice as likely to have falls compared to patients with other neurological conditions.

• This study support slackline as a simple, safe, and challenging training and rehabilitation tool for people with PD, which reduce their risk of falls and improve confidence related to fear of falling.

• Slackline in people with PD yields a low tiredness or fatigue impact and involves the major lower limb and lumbar muscles.

     

Muscle function and body composition profile in adolescents with restrictive anorexia nervosa: does resistance training help?

Purpose: The aim of this study was to analyze the effects of short-term resistance training on the body composition profile and muscle function in a group of Anorexia Nervosa restricting type (AN-R) patients. Methods: The sample consisted of AN-R female adolescents (12.8?±?0.6 years) allocated into the control and intervention groups (n?=?18 each). Body composition and relative strength were assessed at baseline, after 8 weeks and 4 weeks following the intervention. Results: Body mass index (BMI) increased throughout the study (p?=?0.011). Significant skeletal muscle mass (SMM) gains were found in the intervention group (p?=?0.045, d?=?0.6) that correlated to the change in BMI (r?=?0.51, p?p?=?0.047, d?=?0.6) and correlated (r?>?0.60) with change in BMI in both the groups. Significant relative strength increases (p?Conclusions: SMM gain is linked to an increased relative strength when resistance training is prescribed. Although FM, relative body fat (%BF), BMI and body weight (BW) are used to monitor nutritional progress. Based on our results, we suggest to monitor SMM and relative strength ratios for a better estimation of body composition profile and muscle function recovery.

• Implications for Rehabilitation

• Anorexia Nervosa Restricting Type (AN-R)

• AN-R is a psychiatric disorder that has a major impact on muscle mass content and function. However, little or no attention has been paid to muscle recovery.

• High intensity resistance training is safe for AN-R after hospitalization and enhances the force generating capacity as well as muscle mass gains.

• Skeletal muscle mass content and muscular function improvements are partially maintained for a short period of time when the exercise program ceases.

     

Association between mental health and physical activity in patients with chronic heart failure

Abstract

Purpose: Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. Methods: We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (≥68 points) group (n?=?148) and poor-MH (<68 points) group (n?=?95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. Results: PA correlated positively with MH in all patients (steps: r?=?0.46, p?<?0.001; EE: r?=?0.43, p?<?0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1?±?280.7 versus 7174.1?±?221.5 steps, p?<?0.001; 133.9?±?10.8 versus 215.9?±?8.4?kcal, p?<?0.001). Cut-off values of 5590.8 steps and 141.1?kcal were determined as PA target values associated with improved MH. Conclusions: Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.

• Implications for Rehabilitation

• Poor mental health may negatively affect physical exercise in CHF outpatients.

• In particular step counts and energy expenditure are lower in those with poor mental health.

• It may be that focused exercise training may impact positively both on mental health and physical well being.

     

Neuromuscular taping versus sham therapy on muscular strength and motor performance in multiple sclerosis patients

Purpose: Purpose of this study is to evaluate differences in leg muscles strength and motor performance between neuromuscular taping (NT) and sham tape groups. Method: Relapsing-remitting (RR) multiple sclerosis (MS) patients were recruited and randomly assigned to NT or sham tape groups. All patients underwent the treatment 5 times at 5-d intervals. They were submitted to a 6-minute walk test and isokinetic test (peak torque) at the beginning (T0), at the end (T1) and 2 months after the end of the treatment (T2). Results: Forty MS patients (38?F; 2?M; mean age 45.5?±?6.5 years) were assigned to NT group (n?=?20) and to sham tape group (n?=?20). Delta Peak Torque T1–T0 and T2–T0 between two groups were statistically significant in quadriceps (p?=?0.007; 0.000) and hamstrings (p?=?0.011; 0.007). The difference between the two groups according to 6-minute walk test was not statistically significant but in NT group it was noticed an increasing trend about the distance run. Conclusions: In this single-blind randomized controlled trial, NT seemed to increase strength in leg muscles, compared to a sham device, in RR MS patients. Further studies are needed to consider this therapy as a complement to classic physical therapy.

• Implications for Rehabilitation

• Neuromuscular taping (NT) in multiple sclerosis:

• NT is well tolerated by multiple sclerosis patients and should be a complement to classic physical therapy.

• This technique normalizes muscular function, strengthens weakened muscles and assists the postural alignment.

     

A cross-sectional observational study comparing foot and ankle characteristics in people with stroke and healthy controls

Purpose: The purpose of this study was to explore and compare foot and ankle characteristics in people with stroke and healthy controls; and between stroke fallers and non-fallers.

Methods: Participants were recruited from community groups and completed standardized tests assessing sensation, foot posture, foot function, ankle dorsiflexion and first metatarsal phalangeal joint range of motion (1st MPJ ROM), hallux valgus presence and severity.

Results: Twenty-three stroke participants (mean age 75.09?±?7.57 years; 12 fallers) and 16 controls (mean age 73.44?±?8.35 years) took part. Within the stroke group, reduced 1st MPJ sensation (p?=?0.016) and 1st MPJ ROM (p?=?0.025) were observed in the affected foot in comparison to the non-affected foot; no other differences were apparent. Pooled data (for both feet) was used to explore between stroke/control (n?=?78 feet) and stroke faller/non-faller (n?=?46 feet) group differences. In comparison to the control group, stroke participants exhibited reduced sensation of the 1st MPJ (p?=?0.020), higher Foot Posture Index scores (indicating greater foot pronation, p?=?0.008) and reduced foot function (p?=?0.003). Stroke fallers exhibited significantly greater foot pronation in comparison to non-fallers (p?=?0.027).

Conclusions: Results indicated differences in foot and ankle characteristics post stroke in comparison to healthy controls. These changes may negatively impact functional ability and the ability to preserve balance. Further research is warranted to explore the influence of foot problems on balance ability and falls in people with stroke.

• Implications for Rehabilitation

• Foot problems are common post stroke.

• As foot problems have been linked to increased fall risk among the general population we recommend that it would be beneficial to include foot and ankle assessments or a referral to a podiatrist for people with stroke who report foot problems.

• Further research is needed to explore if we can improve functional performance post stroke and reduce fall risk if treatment or prevention of foot problems can be included in stroke rehabilitation.

     

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial

Purpose: To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. Method: A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30–50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5?mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). Results: There was a statistically significant difference observed between the two groups in terms of FIM score (F?=?5.09, p?=?0.03) and MFES (F?=?3.52, p?=?0.007) but no difference was observed in terms of PPA scores (F?=?0.96, p?=?0.36). Conclusions: Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants.

• Implications for Rehabilitation

• Vibration training (VT) may assist in reducing the risk of falling among at risk older people.

• Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people.

• Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

     

Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial

Purpose: To determine the short- and long-term effectiveness of the application of Clinical Pilates in addition to physical therapy versus a physical therapy treatment alone in a population of postmenopausal women with chronic low back pain (CLBP). Methods: A single-blind randomized controlled trial with repeated measures and a follow-up period. One hundred and one patients were randomly allocated to a Pilates?+?physical therapy (PPT) group or to a physical therapy (PT) only group for six weeks. Pain and disability were measured by visual analog scale (VAS) and the Oswestry disability index respectively preintervention, after 6 weeks of treatment and after 1-year follow-up. Results: There were significant differences between groups in pain and disability after 6 weeks of treatment, with better results in the PPT group with an effect size of d?=?3.14 and d?=?2.33 for pain and disability. After 1-year follow-up, only PPT group showed better results compared with baseline with an effect size of d?=?2.49 and d?=?4.98 for pain and disability. Conclusion: The results suggest that using Clinical Pilates in addition to physical therapy provides improved results on pain management and functional status for postmenopausal woman with CLBP and that its benefits still linger after one year.

• Implications for Rehabilitation

• Chronic Low Back Pain could benefit from the Pilates practice in postmenopausal women.

• Improvement in pain and disability derived from CLBP seem to be maintained over time due to Pilates practice.

• Pilates constitutes a safe tool to be applied in older population with CLBP due to its ability to be adapted to every performance and physical level.