手部动力支具在多区肌腱损伤修复术后的应用

【】目的：探讨手部动力支具在多区肌腱修复术后的临床应用效果。方法：选取2016年6月～2018年6月我院收治的81例肌腱损伤患者,采用随机数表法分为支具治疗组45例和对照组36例,分别予安装手部动力支具功能锻炼及常规治疗,患指肌腱修复后功能用TAM[总主动活动度测定法(total active movement,TAM)]评定。结果：随访3个月,支具组综合优良率为87.9％,对照组综合优良率为63.9％ ,两组间差异有显著性意义(P<0．05);支具治疗组二次松解手术率明显低于常规治疗组,组间数据对比差异显著(X₂=3.854,p=0.048),且未发生不良反应。结论：手部动力支具能较明显地减轻肌腱修复术后粘连的发生,降低二次手术的几率,由此可见手部动力支具在在肌腱修复术后的康复治疗是安全有效的。     

Gait Training in Acute Spinal Cord Injury Rehabilitation—Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project

Objectives

To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI).

Six-Minute Walk Test Performance in Persons With Multiple Sclerosis While Using Passive or Powered Ankle-Foot Orthoses

Objective

To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).

Impact of Physical Activities on Frailty in Community-Dwelling Older Women

Aims: The aim of the study was to determine whether increased physical activities (PA) affect frailty for old women, 75 years and older (OO), compared to 60–74 years old (YO). Methods: This cross-sectional study measured 19 frailty indicators (muscle strength and endurance, balance, gait characteristics, and function), using 46 community-dwelling women. PA were divided into three levels by caloric expenditure per week (<2,000 kcal/week, 2,000–3,999 kcal/week, >4,000 kcal/week). Results: As PA level increased, a gap (=difference) between OO and YO narrowed for step length and function, but for quadriceps strength and endurance, a gap widened. Conclusions: Frailty progresses with aging but older women who engage in a high level of physical activity (>4,000 kcal/week) can increase mobility and functional capacity, but not for muscle strength and endurance. Starting regular resistance training activities early in the aging process is critical to improve or maintain muscle quality to offset age-related frailty.     

Efficacy of pulsed high-intensity laser therapy on pain,functional capacity,and gait in children with haemophilic arthropathy

Aim: The aim of this study was to evaluate the effects of pulsed high-intensity laser therapy (HILT) on pain, functional capacity, and gait in children with haemophilia.

Methods: Thirty children with haemophilia type A with ages ranging from 9 to 13 years were selected for this study. They were assigned randomly, into two equal treatment groups. The laser group received the traditional physical therapy programme plus active laser (total energy of 1500 J through three phases/3 sessions/week), whereas the placebo group received the same physical therapy programme plus placebo laser over three consecutive months. Baseline and post-treatment assessments used the visual analogue scale (VAS) to evaluate pain, a 6-min walk test (6MWT) to evaluate functional capacity, and the GAITRite^® system to evaluate gait parameters.

Results: Children in the laser group showed significant improvement in pain, functional capacity, and gait parameters compared to those in the placebo group (p?Conclusions: HILT is an effective modality in reducing pain, increasing functional capacity, and improving gait performance in children with haemophilic arthropathy.

• Implications for Rehabilitation

• Haemophilic arthropathy due to recurrent joint bleeding leads to physical, psychological, and socioeconomic problems in children with haemophilia and reduces their quality of life.

• Early physiotherapeutic interventions help to prevent and treat the sequelae of recurrent haemarthrosis.

• High-intensity laser therapy has been introduced as non-invasive and an effective physiotherapy modality for rapid pain control, with consequent improvement in children’s quality of life.

• High-intensity laser therapy should be used as an adjunct to exercise programme in the rehabilitation of children with haemophilic arthropathy.

     

Quantitative assessment of the effects of 6 months of adapted physical activity on gait in people with multiple sclerosis: a randomized controlled trial

Purpose: The purpose of this study is to quantitatively assess the effect of 6 months of supervised adapted physical activity (APA i.e. physical activity designed for people with special needs) on spatio-temporal and kinematic parameters of gait in persons with Multiple Sclerosis (pwMS).

Methods: Twenty-two pwMS with Expanded Disability Status Scale scores ranging from 1.5 to 5.5 were randomly assigned either to the intervention group (APA, n?=?11) or the control group (CG, n?=?11). The former underwent 6 months of APA consisting of 3 weekly 60-min sessions of aerobic and strength training, while CG participants were engaged in no structured PA program. Gait patterns were analyzed before and after the training using three-dimensional gait analysis by calculating spatio-temporal parameters and concise indexes of gait kinematics (Gait Profile Score – GPS and Gait Variable Score – GVS) as well as dynamic Range of Motion (ROM) of hip, knee, and ankle joints.

Results: The training originated significant improvements in stride length, gait speed and cadence in the APA group, while GPS and GVS scores remained practically unchanged. A trend of improvement was also observed as regard the dynamic ROM of hip, knee, and ankle joints. No significant changes were observed in the CG for any of the parameters considered.

Conclusions: The quantitative analysis of gait supplied mixed evidence about the actual impact of 6 months of APA on pwMS. Although some improvements have been observed, the substantial constancy of kinematic patterns of gait suggests that the full transferability of the administered training on the ambulation function may require more specific exercises.

• Implications for rehabilitation

• Adapted Physical Activity (APA) is effective in improving spatio-temporal parameters of gait, but not kinematics, in people with multiple sclerosis.

• Dynamic range of motion during gait is increased after APA.

• The full transferability of APA on the ambulation function may require specific exercises rather than generic lower limbs strength/flexibility training.

     

Locomotor training with partial body weight support in patients with Parkinson's disease and stroke: Its efficacy and neural mechanisms

Locomotor training with partial bodyweight support on the treadmill is applicable to neuro-rehabilitation for various gait disorders caused by neurological diseases. Although neural mechanisms for the efficacy remain unclear, recent optical neuroimaging studies using near infra-red spectroscopy have suggested that this training might modify the hierarchical locomotor control system, including several cortical motor areas and the central pattern generator in the spinal cord.     

Understanding the role of foot biomechanics on regional foot orthosis deformation in flatfoot individuals during walking

BackgroundFoot orthoses (FOs) are one of the most common interventions to restore normal foot mechanics in flatfoot individuals. New technologies have made it possible to deliver customized FOs with complex designs for potentially better functionalities. However, translating the individuals’ biomechanical needs into the design of customized FOs is not yet fully understood.Research questionOur objective was to identify whether the deformation of customized FOs is related to foot kinematics and plantar pressure during walking.MethodsThe kinematics of multi-segment foot and FOs contour were recorded together with plantar pressure in 17 flatfoot individuals while walking with customized FOs. The deformation of FOs surface was predicted from its contour kinematics using an artificial neural network. Plantar pressure map and deformation were divided into five anatomically based regions defined by the corresponding foot segments. Forward stepwise linear mixed models were built for each of the four gait phases to determine the feet-FOs interaction.ResultsIt was observed that some associations existed between foot kinematics and pressure with regional FOs deformation. From heel-strike to foot-flat, longitudinal arch angle was associated with FOs deformation in forefoot. From foot-flat to midstance, rearfoot eversion accounted for variation in the deformation of medial FOs regions, and forefoot abduction for the lateral regions. From midstance to heel-off, rearfoot eversion, longitudinal arch angle, and plantar pressure played significant role in deformation. Finally, from heel-off to toe-off, forefoot adduction affected the deformation of forefoot and midfoot.SignificanceThis study provides guidelines for designing customized FOs. Flatfoot individuals with excessive rearfoot eversion or very flexible medial arches require more support on medial FOs regions, while the ones with excessive forefoot abduction need the support on lateral regions. However, a compromise should be made between the level of support and the level of increase in plantar pressure to avoid stress on foot structures.