Effect of Interferential Current Stimulation in Management of Hemiplegic Shoulder Pain

Objective

To study the immediate effects of interferential current stimulation (IFC) on shoulder pain and pain-free passive range of motion (PROM) of the shoulder in people with hemiplegic shoulder pain (HSP).

Design

Double-blind, placebo-controlled clinical trial.

Setting

Institutional physical therapy clinic, neurologic rehabilitation center.

Participants

A population-based sample of people with HSP (N=30) was recruited.

Intervention

Participants were divided into 2 groups—an IFC group and a placebo group—by using a match-paired method (age, sex, and Brunnstrom motor recovery stage). In the IFC group, participants received IFC for 20 minutes with an amplitude-modulated frequency at 100Hz in vector mode. The current intensity was increased until the participants felt a strong tingling sensation.

Main Outcome Measures

Pain intensity and pain-free PROM of the shoulder until the onset of pain were measured at baseline and immediately after treatment.

Results

Participants reported a greater reduction in pain during the most painful movement after treatment with IFC than with placebo (P<.05). The IFC group showed a greater improvement in posttreatment pain-free PROM than the placebo group in shoulder flexion (P<.01), abduction (P<.01), internal rotation (P<.01), and external rotation (P<.01).

Conclusions

This study provides evidence that IFC is effective for the relief of pain during movement and also increases the pain-free PROM of the shoulder in people with HSP.     

Effects of Cervical Spine Manual Therapy on Range of Motion,Head Repositioning,and Balance in Participants With Cervicogenic Dizziness: A Randomized Controlled Trial

Objective

To evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion (ROM), head repositioning accuracy, and balance in patients with chronic cervicogenic dizziness.

Design

Randomized controlled trial with 12-week follow-up using blinded outcome assessment.

Setting

University School of Health Sciences.

Participants

Participants (N=86; mean age ± SD, 62.0±12.7y; 50% women) with chronic cervicogenic dizziness.

Interventions

Participants were randomly assigned to 1 of 3 groups: sustained natural apophyseal glides (SNAGs) with self-SNAG exercises, passive joint mobilization (PJM) with ROM exercises, or a placebo. Participants each received 2 to 6 treatments over 6 weeks.

Main Outcome Measures

Cervical ROM, head repositioning accuracy, and balance.

Results

SNAG therapy resulted in improved (P≤.05) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks. Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks. There was a greater improvement (P<.01) after SNAGs than PJM in extension (mean difference, −7.5°; 95% confidence interval [CI], −13° to −2.0°) and right rotation (mean difference, −6.8°; 95% CI, −11.5° to −2.1°) posttreatment. Manual therapy had no effect on balance or head repositioning accuracy.

Conclusions

SNAG treatment improved cervical ROM, and the effects were maintained for 12 weeks after treatment. PJM had very limited impact on cervical ROM. There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness.     

Effects of Intensive Whole-Body Vibration Training on Muscle Strength and Balance in Adults With Chronic Stroke: A Randomized Controlled Pilot Study

Objectives

To investigate the effects of a 6-week whole body vibration (WBV) training program in patients with chronic stroke.

Design

Randomized controlled pilot trial with 6 weeks' follow-up.

Setting

University hospital.

Participants

Adults with chronic stroke (N=15) were randomly assigned to an intervention (n=7) or a control group (n=8).

Interventions

Supervised, intensive WBV training. The vibration group performed a variety of static and dynamic squat exercises on a vibration platform with vibration amplitudes of 1.7 and 2.5mm and frequencies of 35 and 40Hz. The vibration lasted 30 to 60 seconds, with 5 to 17 repetitions per exercise 3 times weekly for 6 weeks. Participants in the control group continued their usual activities and were not involved in any additional training program.

Main Outcome Measures

The primary outcome variable was the isometric and isokinetic muscle strength of the quadriceps (isokinetic dynamometer). Additionally, hamstrings muscle strength, static and dynamic postural control (dynamic posturography), and muscle spasticity (Ashworth Scale) were assessed.

Results

Compliance with the vibration intervention was excellent, and the participants completed all 18 training sessions. Vibration frequencies of both 35 and 40Hz were well tolerated by the patients, and no adverse effects resulting from the vibration were noted. Overall, the effect of intensive WBV intervention resulted in significant between-group differences in favor of the vibration group only in isometric knee extension strength (knee angle, 60°) (P=.022) after 6 weeks of intervention and in isokinetic knee extension strength (velocity, 240°/s) after a 6-week follow-up period (P=.005), both for the paretic leg. Postural control improved after 6 weeks of vibration in the intervention group when the patients had normal vision and a sway-referenced support surface (P<.05). Muscle spasticity was not affected by vibration (P>.05).

Conclusions

These preliminary results suggest that intensive WBV might potentially be a safe and feasible way to increase some aspect of lower limb muscle strength and postural control in adults with chronic stroke. Further studies should focus on evaluating how the training protocol should be administered to achieve the best possible outcome, as well as comparing this training protocol to other interventions.     

Impact of Resistance Training in Chronic Obstructive Pulmonary Disease Patients During Periods of Acute Exacerbation

Objective

To evaluate the effects of whole-body resistance training on exercise capacity, health-related quality of life (HRQOL), and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease.

Design

Randomized controlled trial.

Setting

University hospital.

Participants

Patients (N=46) were randomized to either a control group (CG) or training group (TG), and 29 patients completed the study.

Intervention

Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs (2 sets of 8 repetitions each), and the initial load was set at 80% of the 1-repetition maximum load.

Main Outcome Measures

Patients were evaluated on the second day of hospitalization, at hospital discharge, and 30 days postdischarge. Patients were evaluated on the basis of the 6-minute walking distance (6MWD), HRQOL, muscle strength, systemic inflammatory markers, and level of physical activity in daily life (PADL).

Results

The CG showed a reduction in the strength of lower-limb muscles (P<.05) but not in the 6MWD (P>.05). In contrast, patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization (P<.05). The TG also improved the impact domain in HRQOL after hospitalization. No improvement in PADL was observed in the TG. Finally, a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization.

Conclusions

Our results suggest that resistance training during hospitalization improves the 6MWD, HRQOL, and lower-limb muscle strength, without altering the levels of systemic inflammation. However, future research should explore this intervention in larger randomized trials.     

Effect of Ischemic Compression on Trigger Points in the Neck and Shoulder Muscles in Office Workers: A Cohort Study

Objective

The purpose of this study was to determine the short-term effect of ischemic compression (IC) for trigger points (TPs) on muscle strength, mobility, pain sensitivity, and disability in office workers and the effect on disability and general pain at 6-month follow-up.

Methods

Nineteen office workers with mild neck and shoulder complaints received 8 sessions of IC in which deep pressure was given on the 4 most painful TPs identified during examination. Outcome measures were general neck and shoulder complaints on a Numeric Rating Scale, Neck Disability Index (NDI), neck mobility (inclinometer), muscle strength (dynamometer), and pain sensitivity (Numeric Rating Scale and algometry). Subjects were tested at baseline (precontrol), after a control period of no treatment of 4 weeks (postcontrol), and after a 4-week intervention training (posttreatment). At 6-month follow-up, pain and disability were inquired.

Results

The results showed a statistically significant decrease in general neck/shoulder pain at posttreatment (P = .001) and at 6-month follow-up (P = .003) compared with precontrol and postcontrol. There was no significant main effect for NDI scores. Pressure pain threshold increased at posttreatment in all 4 treated TPs (P < .001). There was a significant increase in mobility and strength from precontrol/postcontrol to posttreatment (P < .05).

Conclusion

This study has demonstrated that a 4-week treatment of TPs for IC resulted in a significant improvement in general neck and shoulder complaints, pressure pain sensitivity, mobility, and muscle strength in the short term in a small sample of office workers with mildly severe chronic pain. At 6-month follow-up, there was a further decrease in general pain, but no change in NDI scores.     

Effectiveness of Home Exercise on Pain,Function, and Strength of Manual Wheelchair Users With Spinal Cord Injury: A High-Dose Shoulder Program With Telerehabilitation

Objective

To test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized.

Design

A pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk).

Setting

Subjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center.

Participants

A convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination.

Interventions

A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing.

Main Outcome Measures

Primary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius.

Results

Pain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ²₂=5.10, P=.014), DASH Index (χ²₂=5.41, P=.012), and SRQ (χ²₂=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points.

Conclusions

A high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.     

Efficacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial

Objective

To evaluate the efficacy of low-level laser therapy (LLLT) applied to acupuncture points on the knee joint in combination with exercise and advice in patients with knee osteoarthritis.

Design

Randomised, double-blind, comparative clinical trial.

Participants

Forty-nine patients with knee osteoarthritis were assigned at random into two groups: active laser group (n = 26) and placebo laser group (n = 23).

Intervention

Using a gallium aluminium arsenide laser device, patients received either active or placebo LLLT at five acupuncture points on the affected knee during nine sessions.

Outcome measures

Patients were assessed using a visual analogue scale (VAS) and the Saudi Knee Function Scale (SKFS) at baseline, the fifth treatment session, the last treatment session, 6 weeks post intervention and 6 months post intervention.

Results

VAS scores showed a significant improvement in the active laser group compared with the placebo laser group at 6 weeks post intervention [mean difference −1.3, 95% confidence interval (CI) of the difference −2.4 to −0.3; P = 0.014] and 6 months post intervention (mean difference −1.8, 95% CI of the difference −3.0 to −0.7; P = 0.003) using the independent samples test. SKFS scores also showed a significant improvement in the active laser group compared with the placebo laser group at the last treatment session (median difference −15, 95% CI of the difference −27 to −2; P = 0.035) and 6 months post intervention (median difference −21, 95% CI of the difference −34 to −7; P = 0.006) using the Mann–Whitney U test.

Conclusions

The results demonstrate that short-term application of LLLT to specific acupuncture points in association with exercise and advice is effective in reducing pain and improving quality of life in patients with knee osteoarthritis.     

Efficacy of a static progressive stretch device as an adjunct to physical therapy in treating adhesive capsulitis of the shoulder: a prospective,randomised study

Background

Stress relaxation and static progressive stretch are techniques used for non-surgical restoration of shoulder range of motion for patients with adhesive capsulitis.

Objectives

To compare a static progressive stretch device plus traditional therapy with traditional therapy alone for the treatment of adhesive capsulitis of the shoulder.

Design

Prospective, randomised controlled trial.

Participants

Sixty patients with adhesive capsulitis of the shoulder were assigned at random to an experimental group or a control group.

Interventions

Both groups received three traditional therapy sessions per week for 4 weeks. In addition, the experimental group used a static progressive stretch device for 4 weeks.

Main outcome measures

The primary outcome measure was shoulder range of motion (active and passive shoulder abduction, and passive shoulder external rotation). The secondary outcome measures were function [measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire] and pain [measured using a visual analogue scale (VAS)].

Results

At baseline, there were no differences between the two groups. However, after the intervention, there were significant (P < 0.05) differences between the groups for all outcome parameters: 0.3 for mean VAS scores [95% confidence interval (CI) −0.6 to 1.1], −10.1 for DASH scores (95% CI −21.0 to 0.9), 21.2° for shoulder passive external rotation (95% CI 16.8 to 25.7), 26.4° for shoulder passive abduction (95% CI 17.4 to 35.3), and 27.7° for shoulder active abduction (95% CI 20.3 to 35.0). At 12-month follow-up, the differences between the groups were maintained and even increased for mean shoulder range of motion, VAS scores and DASH scores, with significant differences (P < 0.001) between the groups: −2.0 for VAS scores (95% CI −2.9 to −1.2), −53.8 for DASH scores (95% CI −64.7 to −42.9), 47.9° for shoulder passive external rotation (95% CI 43.5 to 52.3), 44.9° for shoulder passive abduction (95% CI 36.0 to 53.8), and 94.3° for shoulder active abduction (95% CI 87.0 to 101.7).

Conclusion

Use of a static progressive stretch device in combination with traditional therapy appears to have beneficial long-term effects on shoulder range of motion, pain and functional outcomes in patients with adhesive capsulitis of the shoulder. At 12-month follow-up, the experimental group had continued to improve, while the control group had relapsed.     

Effects of Stimulating Hip and Trunk Muscles on Seated Stability,Posture, and Reach After Spinal Cord Injury

Objective

To determine the stimulated strength of the paralyzed gluteal and paraspinal muscles and their effects on the seated function of individuals with paralysis.

Design

Case series with subjects acting as their own concurrent controls.

Setting

Hospital-based clinical biomechanics laboratory.

Participants

Users (N=8) of implanted neuroprostheses for lower extremity function with low-cervical or thoracic level injuries.

Interventions

Dynamometry and digital motion capture both with and without stimulation to the hip and trunk muscles.

Main Outcome Measures

Isometric trunk extension moment at 0°, 15°, and 30° of flexion; seated stability in terms of simulated isokinetic rowing; pelvic tilt, shoulder height, loaded and unloaded bimanual reaching to different heights, and subjective ratings of difficulty during unsupported sitting.

Results

Stimulation produced significant increases in mean trunk extension moment (9.2±9.5Nm, P<.001) and rowing force (27.4±23.1N, P<.012) over baseline volitional values. Similarly, stimulation induced positive changes in average pelvic tilt (16.7±15.7°) and shoulder height (2.2±2.5cm) during quiet sitting and bimanual reaching, and increased mean reach distance (5.5±6.6cm) over all subjects, target heights, and loading conditions. Subjects consistently rated tasks with stimulation easier than voluntary effort alone.

Conclusions

In spite of considerable intersubject variability, stabilizing the paralyzed trunk with electrical stimulation can positively impact seated posture, extend forward reach, and allow exertion of larger forces on objects in the environment.     

Effects of eccentric exercise on trapezius electromyography during computer work with active and passive pauses

Background

The aim of this laboratory study was to investigate the effects of eccentric exercises on the trapezius muscle spatial electromyographic (EMG) activity during computer work with active and passive pauses.

Methods

Twelve healthy male subjects performed computer work with passive (relax) and active (30% maximum voluntary contraction of shoulder elevation) pauses given every 40 s over 2 days, before, immediately and 24 h after eccentric exercise. Surface EMG signals were recorded from four parts of the trapezius during computer work.

Findings

EMG amplitude during computer work decreased immediately after exercise (P < 0.05). In the clavicular and descending parts of the trapezius, the centroid of exposure variation analysis along the time axis was lower during computer work with active pauses compared with passive ones (P < 0.05). Further, lower values of relative rest time was observed during active pause (P < 0.05).

Interpretation

Eccentric exercises had a short term effect on muscle activation pattern during computer work, and decreased the muscle activity immediately after the exercises. The results of this study showed a more variable trapezius activity pattern and a lower trapezius rest with active pauses compared with passive pauses. Moreover, eccentric exercises resulted in a less variable activation pattern, decreasing the effect of active pauses.     

Botulinum Toxin Type B in the Spastic Arm: A Randomized,Double-Blind,Placebo-Controlled,Preliminary Study

Objective

To determine the efficacy and safety of 2 doses of botulinum toxin type B (rimabotulinumtoxinB, BoNT/B) in spastic upper limb muscles.

Design

Randomized, double-blind, placebo-controlled trial with a 3-month follow-up.

Setting

Tertiary care center.

Participants

Referred sample of adult hemiparetic patients (N=24) with disabling elbow flexor overactivity after stroke or traumatic brain injury.

Interventions

Injection of 10,000U of rimabotulinumtoxinB (fixed 2500U dose into elbow flexors; n=8), 15,000U (5000U into elbow flexors; n=8), or placebo (n=8) into overactive upper limb muscles selected as per investigator's discretion.

Main Outcome Measures

At 1 month postinjection, active range of elbow extension (goniometry; primary outcome); active upper limb function (Modified Frenchay Scale [MFS]); subjective global self-assessment (GSA) of arm pain, stiffness, and function; rapid alternating elbow flexion-extension movement frequency over the maximal range; elbow flexor spasticity grade and angle (Tardieu), and tone (Ashworth).

Results

No adverse effects were associated with either BoNT/B dose. Both doses improved active elbow extension versus placebo (+8.3°; 95% confidence interval, 1.1°–15.5°; analysis of covariance, P=.028). The high dose of BoNT/B also improved subject-perceived stiffness (P=.005) and the composite pain, stiffness, and function GSA (P=.017), effects that persisted 3 months from injection. No MFS change was demonstrated, although subjects with a baseline MFS <70/100 seemed more likely to benefit from BoNT/B.

Conclusions

In this short-term study, BoNT/B up to 15,000U into spastic upper limb muscles, including the elbow flexors, was well tolerated and improved active elbow extension and subject-perceived stiffness.     

Relationship Between Sleep,Pain, and Disability in Patients With Spinal Pathology

Objective

To characterize sleep and its relationship with disability and pain in patients with spine pathology.

Design

A survey study.

Setting

A university-based hospital spine clinic.

Participants

Subjects (N=121) with mixed-etiology spine pathology.

Interventions

Not applicable.

Main Outcome Measures

Self-reported disability (Oswestry Disability Index [ODI]), back and leg pain intensity, the effect of back or leg pain on function, and sleep (Pittsburgh Sleep Quality Index [PSQI]) assessments were completed.

Results

Severe disability was evident with a mean ODI ± SD of 54.9±14, with mean pain intensities ± SD of 50±30mm and 54±27mm of 100mm for the leg and back, respectively. The mean PSQI ± SD was 10.4±5.3, with 87% of participants scoring greater than the sleep-disordered threshold of 5. PSQI was correlated to ODI (r=.53, P<.001), and ODI without the sleep component (r=.47, P<.001). Six of the subscales of PSQI were all also significantly correlated to ODI (.25<r<.42, P<.05). Stepwise regression (ODI dependent variables; PSQI, pain intensity and function, age, body mass index as independent variables) was performed. PSQI was retained in the model along with 2 pain measures (r²=.50, P<.001). Substitution of the 7 subscales for the overall PSQI score revealed 2 subscales (sleep quality, use of sleep medications) as predictors of ODI (r²=.490, P<.001).

Conclusions

Despite its being intuitive that sleep disorders will be present in patients with spinal disorders, it was surprising that sleep quality was an independent predictor of disability along with pain. Furthermore, sleep quality is more closely correlated to disability than leg pain, which is the current focus of medical interventions.     

Plantarflexor Weakness Negatively Impacts Walking in Persons With Multiple Sclerosis More Than Plantarflexor Spasticity

Objectives

To determine whether plantarflexor (PF) spasticity or ankle strength best predicts variance in walking capacity or self-perceived limitations in walking in persons with multiple sclerosis (MS) and whether persons with MS with PF spasticity are weaker and have greater walking dysfunction than do persons with MS without PF spasticity.

Design

Cross-sectional study.

Setting

University research laboratory.

Participants

Forty-two adults with MS (mean age, 42.9±10.1y; Expanded Disability Status Scale score, median=3.0, range=0–6) and 14 adults without disability (mean age, 41.9±10.1y).

Intervention

Not applicable.

Main Outcome Measures

PF spasticity and dorsiflexion and PF maximum voluntary isometric torque were assessed using the modified Ashworth Scale and a computerized dynamometer, respectively. The Timed 25-Foot Walk Test was the primary outcome measure of walking capacity. Secondary measures included the 6-Minute Walk Test and the 12-item Multiple Sclerosis Walking Scale.

Results

PF strength was the most consistent predictor of variance in walking capacity (Timed 25-Foot Walk Test: R² change=.23–.29, P≤.001; 6-Minute Walk Test: R² change=.12–.29, P≤.012), and self-perceived limitations of walking (12-item Multiple Sclerosis Walking Scale: R² change=.04–.14, P<.18). There were no significant differences (P>.05) between persons with MS with PF spasticity and persons with MS without PF spasticity for any of the outcome measures.

Conclusions

Our study suggests a unique contribution of PF weakness to walking dysfunction in persons with MS, and highlights the importance of evaluating PF strength in this clinical population.     

Effectiveness of Global Postural Reeducation Compared to Segmental Exercises on Function,Pain, and Quality of Life of Patients With Scapular Dyskinesis Associated With Neck Pain: A Preliminary Clinical Trial

Objective

The purpose of this study was to assess the effectiveness of global postural reeducation (GPR) relative to segmental exercises (SE) in the treatment of scapular dyskinesis (SD) associated with neck pain.

Methods

Participants with SD and neck pain (n = 30) aged 18 to 65 years were randomly assigned to one of two groups: GPR and SE (stretching exercises). The upper extremity was assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire; function of the neck was estimated using the Neck Disability Index; pain severity was measured using a visual analogical scale; and health-related quality of life was assessed using the Short Form–12. Assessments were conducted at baseline and after 10 weekly sessions (60 minutes each). The significance level adopted was α < .05.

Results

For pre-post treatment comparisons, GPR was significantly associated with improvements in function of neck and upper extremities, pain, and physical and mental domains of quality of life (P < .05). Segmental exercises improved function of upper extremities and of the neck and severity of pain (P < .05). When contrasting groups, GPR was significantly superior to SE in improving pain and physical domains of the quality of life.

Conclusion

This study showed that GPR and SE had similar effects on function of the neck and upper extremity in patients with SD associated with neck pain. When comparing groups, GPR was superior to SE in improving pain and quality of life.     

Medical Comorbidities in Disorders of Consciousness Patients and Their Association With Functional Outcomes

Objective

To identify, for patients in states of seriously impaired consciousness, comorbid conditions present during inpatient rehabilitation and their association with function at 1 year.

Design

Abstracted data from a prospective cross-sectional observational study with data collection occurring January 1996 through December 2007.

Setting

Four inpatient rehabilitation facilities in metropolitan areas.

Participants

The study sample of 68 participants is abstracted from a database of 157 patients remaining in states of seriously impaired consciousness for at least 28 days.

Interventions

Not applicable.

Main Outcome Measure

One-year cognitive, motor, and total FIM score.

Results

The most common medical complications during inpatient rehabilitation for the study sample are active seizures (46%), spasticity (57%), urinary tract infections (47%), and hydrocephalus with and without shunt (38%). Presence of ≥3 medical complications during inpatient rehabilitation, controlling for injury severity, is significantly (P<.05) associated with poorer total FIM and FIM motor scores 1 year after injury. The presence of hydrocephalus with and without shunt (r=−.20, −.21, −.18; P ≤.15), active seizures (r=−.31, −.22, −.42), spasticity (r=−.38, −.28, −.40), and urinary tract infections (r=−.25, −.24, −.26) were significantly (P<.10) associated with total FIM, FIM cognitive, and FIM motor scores, respectively.

Conclusions

Reported findings indicate that persons in states of seriously impaired consciousness with higher numbers of medical complications during inpatient rehabilitation are more likely to have lower functional levels 1-year postinjury. The findings indicate that persons with ≥3 medical complications during inpatient rehabilitation are at a higher risk for poorer functional outcomes at 1 year. It is, therefore, prudent to evaluate these patients for indications of these complications during inpatient rehabilitation.     

Comparative Impacts of Tai Chi,Balance Training,and a Specially-Designed Yoga Program on Balance in Older Fallers

Objective

To compare the effect of a custom-designed yoga program with 2 other balance training programs.

Design

Randomized controlled trial.

Setting

Research laboratory.

Participants

A group of older adults (N=39; mean age, 74.15±6.99y) with a history of falling.

Interventions

Three different exercise interventions (Tai Chi, standard balance training, yoga) were given for 12 weeks.

Main Outcome Measures

Balance performance was examined during pre- and posttest using field tests, including the 8-foot up-and-go test, 1-leg stance, functional reach, and usual and maximal walking speed. The static and dynamic balances were also assessed by postural sway and dynamic posturography, respectively.

Results

Training produced significant improvements in all field tests (P<.005), but group difference and time × group interaction were not detected. For postural sway, significant decreases in the area of the center of pressure with eyes open (P=.001) and eyes closed (P=.002) were detected after training. For eyes open, maximum medial-lateral velocity significantly decreased for the sample (P=.013). For eyes closed, medial-lateral displacement decreased for Tai Chi (P<.01). For dynamic posturography, significant improvements in overall score (P=.001), time on the test (P=.006), and 2 linear measures in lateral (P=.001) and anterior-posterior (P<.001) directions were seen for the sample.

Conclusions

Yoga was as effective as Tai Chi and standard balance training for improving postural stability and may offer an alternative to more traditional programs.     

Effects of Physical Exercise on Plasma Levels of Brain-Derived Neurotrophic Factor and Depressive Symptoms in Elderly Women—A Randomized Clinical Trial

Objectives

To investigate the effect of 2 standardized exercise programs, muscle strength exercises (SE) and aerobic exercises (AE), on the plasma levels of brain-derived neurotrophic factor (BDNF) and depressive symptoms in 451 elderly women.

Design

A randomized controlled trial.

Setting

Belo Horizonte/MG–Brazil.

Participants

Community-dwelling older women (N=451; age, 65–89y).

Intervention

The participants were divided into 2 groups: SE and AE. Both protocols lasted 10 weeks, and 30 sessions (1-h sessions) in total were performed 3 times a week under the direct supervision of physical therapists.

Main Outcome Measures

Plasma levels of BDNF (enzyme-linked immunosorbent assay) and depressive symptoms (Geriatric Depression Scale).

Results

There was a significant difference for BDNF plasma levels between the SE and AE groups (P=.009). Post hoc analysis revealed a pre-post intervention difference in BDNF levels only for the SE group (P=.008). A statistically significant difference was found for the pre- and postintervention Geriatric Depression Scale scores in both groups (P=.001), showing that the effects of both exercise protocols were comparable regarding depressive symptoms (P=.185).

Conclusions

The present findings have demonstrated the positive effect of muscle strengthening and aerobic intervention on depressive symptoms in community-dwelling elderly women. Interestingly, only SE significantly increased the plasma levels of BDNF in our sample. The positive effects of physical exercise on depressive symptoms in the elderly were not mediated by BDNF.     

The Clinical and Sonographic Effects of Kinesiotaping and Exercise in Comparison With Manual Therapy and Exercise for Patients With Subacromial Impingement Syndrome: A Preliminary Trial

Objective

The purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome.

Methods

Randomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions.

Results

At the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P < .05). No difference was observed on ultrasound for tendon thickness after treatment in both groups (P > .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P < .05).

Conclusion

For the group of subjects studied, no differences were found between kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks.     

Guidelines for the Early Restoration of Active Knee Flexion After Total Knee Arthroplasty: Implications for Rehabilitation and Early Intervention

Objectives

To investigate the association between active knee flexion at initial (1–2wk) and final (7wk) outpatient visits after total knee arthroplasty (TKA), and to develop a guide for the expected progression of knee flexion in the subacute postoperative phase.

Design

Prospective case series.

Setting

Rehabilitation clinic.

Participants

Consecutive sample of patients (N=108) who underwent TKA between December 2007 and August 2012.

Intervention

TKA followed by a standardized, 5-week outpatient rehabilitation program (2 sessions per week) immediately after hospital discharge.

Main Outcome Measure

Active knee flexion was recorded on the patient's first outpatient visit (1–2wk) and then biweekly throughout the patient's 5-week outpatient rehabilitation program.

Results

Active knee flexion at initial (1–2wk) and final (7wk) outpatient visits were significantly correlated (r=.86, P<.001). Mean active knee flexion significantly improved (P<.001) across all patients from 90.4° at initial outpatient visit to 110° at final outpatient visit. At 7 weeks postsurgery, a value of 100° was determined as the cut-off point for an acceptable active knee flexion, which corresponded with 80° of active knee flexion at initial outpatient presentation at 1 to 2 weeks.

Conclusions

Active knee flexion at the initial outpatient visit exhibits a strong correlation with knee flexion at 7 weeks after TKA. These knee flexion guidelines may allow for the provision of individualized rehabilitation, allow practitioners to provide patients with realistic goals of progression throughout the subacute phase, and allow the early identification of patients at risk for poor long-term outcomes who may benefit from further intensive care or other early intervention.     

Handgrip Strength but not Appendicular Lean Mass is an Independent Predictor of Functional Outcome in Hip-Fracture Women: A Short-Term Prospective Study

Objective

To investigate the contribution of muscle mass and handgrip strength in predicting the functional outcome after hip fracture in women.

Design

Observational study.

Setting

Rehabilitation hospital.

Participants

White women (N=123 of 149) who were consecutively admitted to a rehabilitation hospital because of their first fracture of the hip.

Interventions

Not applicable.

Main Outcome Measures

We measured appendicular lean mass (aLM) by dual-energy x-ray absorptiometry (DXA) 21.1±8.7 (mean ± SD) days after hip fracture occurrence in the 123 women. On the same day, we assessed grip strength at the nondominant arm with a dynamometer. At the end of acute inpatient rehabilitation we measured the ability to function in activities of daily living by using the Barthel Index, and lower limb performance by using the Timed Up and Go (TUG) test.

Results

We found significant correlations between handgrip strength measured before rehabilitation and Barthel Index scores after rehabilitation (ρ=.50; P<.001), Barthel Index effectiveness (ρ=.45; P<.001), and the TUG test (ρ=−.41; P<.001). Conversely, we found no significant correlations between aLM/height² and Barthel Index scores after rehabilitation (ρ=.075; P=.41), Barthel Index effectiveness (ρ=.06; P=.53), or the TUG test (ρ=.005; P=.96). Significant associations between grip strength and all the outcome measures persisted after adjustment for 8 potential confounders, including Barthel Index scores before rehabilitation, age, number of medications, number of comorbidities, pressure ulcers, concomitant infections, time between fracture occurrence and assessment, and aLM/height².

Conclusions

Grip strength, but not DXA-assessed aLM, significantly predicted short-term functional outcome in women after a hip fracture.