[Active exercises in water for advanced age women as the way to improve their physical workability and to correct body composition]

Water gymnastics is a suitable practice for those for whom ordinary exercising could be difficult, for example, people with joint problems, the paralysis, overweight or simply clumsy people. In water these people feel lighter, it takes less effort to exercise, and people get a good training load in a short time. Water gymnastics does not endanger joints or overload the spinal column, and even muscles will not hurt after exercising in water. In addition, water strengthens the body.

[Identity of the cardiological rehabilitation with patients with implanted cardioverter-defibrillator]

Implantable cardioverter defibrylator - ICD saves people's life and it protections against sudden cardiac death. Myocardial infarction in the past is the most often factor of the sudden cardiac death risk. The controlled physical activity and psychologists therapeuthical sessions are very important in improvement of quality of life for patients who have implanted ICD.

Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study

OBJECTIVES

To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.

DESIGN

A randomized clinical trial.

SETTING

Supervised physiotherapy (PT) training and home-based EMS.

PARTICIPANTS

Patients (N=38; 14 men, 24 women) with bilateral PFPS.

INTERVENTIONS

One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40 Hz, with a pulse duration of .2 6ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80 mA.

MAIN OUTCOME MEASURES

Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.

RESULTS

Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.

CONCLUSIONS

A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.

Activation of the trapezius muscle during varied forms of Kendall exercises

The trapezius muscle plays a crucial role in maintaining proper shoulder mechanics and is often considered a source of weakness and dysfunction in patients.

OBJECTIVES

The purpose of this study was to investigate the activation patterns of the middle and lower trapezius during four prone horizontal abduction exercises of the glenohumeral joint (GHJ).

METHODS

The muscle activation patterns of 19 female and 13 male volunteers were measured using surface EMG during horizontal arm abduction exercises commonly used in rehabilitative settings. Each subject performed 10 repetitions of horizontal abduction (ABD) at each position using only the weight of the arm. Function was assessed during shoulder horizontal abduction while positioned at: 75 degrees , 90 degrees , 125 degrees and 160 degrees of GHJ ABD. Electromyographic activity was collected during the concentric phase during each test repetition in the lower (LTRAP) and middle trapezius (MTRAP). A repeated measure ANOVA was performed followed by Bonferroni's post hoc test.

RESULTS

The MTRAP had significantly greater recruitment at 90 degrees and 125 degrees , compared to 160 degrees . Similarly, results for the lower trapezius indicated that recruitment at 90 degrees and 125 degrees was significantly greater than 160 degrees .

CONCLUSION

Most significant muscle activation for the middle and lower trapezius occurred at 90 degrees and 125 degrees of GHJ ABD. For the clinician, training at 90 degrees is easy to identify, and provides maximal activation, negating the need for multiple training angles.

Vestibular rehabilitation for unilateral peripheral vestibular dysfunction

BACKGROUND

Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or post-operatively. The dysfunction is characterized by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation (VR).

OBJECTIVES

To assess the effectiveness of vestibular rehabilitation in the adult, community dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction.

SEARCH STRATEGY

The search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 1 2007, MEDLINE (1950 to 2007) and EMBASE (1974 to 2007). The date of the last search was March 2007.

SELECTION CRITERIA

Randomised trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. Comparisons sought were: Vestibular rehabilitation versus control (placebo etc.). Vestibular rehabilitation versus other treatment (non-vestibular rehabilitation e.g. pharmacological). Vestibular rehabilitation versus another form of vestibular rehabilitation. Outcome measures that were considered included: frequency and severity of dizziness or visual disturbance; changes in balance impairment, function or quality of life; measure/s of physiological status with known functional correlation.

DATA COLLECTION AND ANALYSIS

Both authors independently extracted data and assessed trials for quality.

MAIN RESULTS

Thirty-two trials were identified and eleven were excluded because of mixed/unclear vestibular pathology, leaving twenty-one trials in the review. Included studies addressed the effectiveness of vestibular rehabilitation against control/sham interventions, non-vestibular rehabilitation interventions or other forms of vestibular rehabilitation, by comparing the subjects in each group who had significant resolution of symptoms and/or improved function. Individual and pooled data showed a statistically significant effect in favour of the vestibular rehabilitation over control or no intervention. The exception to this was when movement based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo, where the latter was shown to be superior in cure rate in the short term. There were no reported adverse effects.

AUTHORS' CONCLUSIONS

There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation provides a resolution of symptoms in the medium term. However there is evidence that for the specific diagnostic group of benign paroxysmal positional vertigo, physical (repositioning) manoeuvres are more effective in the short term than exercise based vestibular rehabilitation. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.

Functional benefit of power training for older adults

Aging leads to significant losses in muscle mass, strength, and the ability to independently perform activities of daily living (ADL). Typically, standard resistance training (RT) has been used to reduce these losses in function by maintaining or even increasing muscle strength in older adults. Increasing strength does not necessarily, however, result in an increase in the ability to perform ADL. There is now research suggesting that muscle power is more closely associated with the performance of ADL than muscle strength is, so training for muscle power might lead to more beneficial results in functional performance. This review of studies investigating the effect of training on ADL performance in older adults indicated that standard RT is effective in increasing strength in older adults, but power training that contains high-velocity contractions might be a more optimal means of training older adults when the emphasis is on increasing the performance of ADL.

Physiological and psychological responses to a 12-week BodyBalance training programme

BodyBalance is a popular mind-body program practised at numerous leisure centres throughout the western world that makes many unsubstantiated claims as to the benefits of participation. This study examines physiological and psychological responses in adults, aged (mean+/-S.D.) 43.9+/-10.9 years, to a 12-week 'BodyBalance' exercise program. An exercise intervention group (n=17) undertook three 1-h classes, each week for 12 consecutive weeks while the control group (n=17) attended three 90-min 'health lectures'. ANCOVA demonstrated significant differences between the control and exercise groups in body mass, skinfold measures, total girth circumference from six sites, maximal isometric back strength, five measures of flexibility and state anxiety. Post-hoc tests on the experimental group data showed body fat decreased significantly by 1.10+/-1.02% (t=4.44; P<0.01), girth by 4.40+/-5.80cm (t=3.13; P<0.01) and back strength increased by 17.12+/-15.39kgf (t=-4.59; P<0.01). Flexibility was also significantly enhanced with performance of the modified sit-and-reach test increasing by 5.90+/-2.56cm (t=-9.50; P<0.01), hip flexion by 9.84+/-8.41 degrees (t=-4.82; P<0.01), hip extension by 7.65+/-4.48 degrees (t=-7.04; P<0.01), hip abduction by 10.00+/-4.91 degrees (t=-8.40; P<0.01) and lateral trunk flexion by 3.06+/-5.72 degrees (t=-2.21; P<0.05). Finally, state-anxiety (STAI) was significantly reduced intra-class at weeks 1, 6 and 12 by 9.24+/-9.46 (t=4.02; P<0.01), 6.59+/-6.26 (t=4.34; P<0.01) and 7.18+/-5.50 (t=5.38; P<0.01), respectively. The findings of this study suggest mind-body exercise programs like BodyBalance could significantly benefit state-anxiety as well as strength, flexibility, and anthropometry around the trunk.

Anthroposophic vs. conventional therapy for chronic low back pain: a prospective comparative study

OBJECTIVE

To compare anthroposophic treatment (eurythmy, rhythmical massage or art therapy; counselling, anthroposophic medication) and conventional treatment for low back pain (LBP) under routine conditions.

METHODS

62 consecutive outpatients from 38 medical practices in Germany, consulting an anthroposophic (A-) or conventional (C-) physician with LBP of >or= 6 weeks duration participated in a prospective non-randomised comparative study. Main outcomes were Hanover Functional Ability Questionnaire (HFAQ), LBP Rating Scale Pain Score (LBPRS), Symptom Score, and SF-36 after 6 and 12 months.

RESULTS

At baseline, LBP duration was > 6 months in 85% (29/34) of A-patients and 54% (15/28) of C-patients (p = 0.004). Unadjusted analysis showed significant improvements in both groups of HFAQ, LBPRS, Symptom Score, SF-36 Physical Component Summary, and three SF-36 scales (Physical Function, Pain, Vitality), and improvements in A-patients of three further SF-36 scales (Role Physical, General Health, Mental Health). After adjustment for age, gender, LBP duration, and education, improvements were still significant in both groups for Symptom Score (p = 0.030), SF-36 Physical Component Summary (p = 0.004), and three SF-36-scales (Physical Function, p = 0.025; Role Physical, p = 0.014; Pain, p = 0.003), and in A-patients for SF-36-Vitality (p = 0.032). Compared to C-patients, A-patients had significantly more pronounced improvements of three SF-36 scales (Mental Health: p = 0.045; General Health: p = 0.006; Vitality: p = 0.005); other improvements did not differ significantly between the two groups.

CONCLUSION

Compared to conventional therapy, anthroposophic therapy for chronic LBP was associated with at least comparable improvements.

Effects of whole body vibration training on postural control in older individuals: a 1 year randomized controlled trial

This randomized controlled trial investigated the effects of a 12 month whole body vibration training program on postural control in healthy older adults. Two hundred and twenty people were randomly assigned to a whole body vibration group (n=94), a fitness group (n=60) or a control group (n=66). The whole body vibration and fitness groups trained three times a week for 1 year. The vibration group performed exercises on a vibration platform and the fitness group performed cardiovascular, strength, balance and stretching exercises. Balance was measured using dynamic computerized posturography at baseline and after 6 and 12 months. Whole body vibration training was associated with reduced falls frequency on a moving platform when vision was disturbed and improvements in the response to toes down rotations at the ankle induced by the moving platform. The fitness group showed reduced falls frequency on the moving surface when vision was disturbed. Thus, whole body vibration training may improve some aspects of postural control in community dwelling older individuals.

Effectiveness of canalith repositioning manoeuvers (CRM) in patients with benign paroxysmal positional vertigo (BPPV)

BPPV is the most common disorder of the vestibular system affected up to 21% of vertigo patients, characterised by short-lasting episodes of vertigo in association with rapid changes in head position. We have detected, treated and followed up 204 patients with BPPV during two years. 204 patients (163 women 41men) were enrolled in this study, at the time of evolution the duration of symptoms varied from several days to several months. We evaluated idiophatic forms of BPPV in 126 cases and secondary types BPPV in 78 cases. All patients with typical history of BPPV underwent neurological examination, including Dix-Hallpike (to detect posterior and anterior canal BPPV) and Roll Test (to detect horizontal canal BPPV). We treat patients with CRM and followed up them in 48 hours and 7 days, one month, 6 month and one year after initial management. Posterior semicircular canal was involved in 170 patients, remain 34 patients suffered from canalolithiasis of horisontal (31 patients) and anterior (3 patients) semicircular canal. After a single treatment session the symptoms disappeared completely in 139 patients, in 40 patients after twice, 16 patients after 3 times and 9 patients after 4 times maneuver sessions. No effectiveness was found in 5 patients; during follow-up 7 successfully treated patients experienced a recurrence between 1 and 6 months, in two cases after one year; they were retreated and all achieved a positive result. It is concluded that diagnosis of BPPV is simple and save, do not need expensive neuroradiological tests; CRM provides effective and long term control of symptoms in patients with BPPV.

Adherence of adult cystic fibrosis patients with airway clearance and exercise regimens

BACKGROUND

Regular airway clearance and exercise form an important part of the physiotherapy management of patients with cystic fibrosis (CF). Previous research has found that adherence of these patients with physiotherapy regimens is variable and influenced by factors such as sex and disease severity. To date, the adherence of Australian patients with CF has not been investigated. The aim of this study was to measure the adherence of a sample of Australian adult patients with CF and to ascertain factors that improved or decreased their adherence with physiotherapy.

METHODS

Patients attending an Australian CF Unit were surveyed by an independent physiotherapist using a questionnaire based on the Manchester Cystic Fibrosis Compliance Questionnaire.

RESULTS

Fifty seven of the 84 patients registered with the Unit (67.9% response rate) completed the survey. Over the previous six months, 96.5% of patients reported doing some form of airway clearance, with 70.2% doing this daily or only occasionally missing one or two days. Regular exercise was performed by 91.2% of patients when well, with 77.8% also exercising regularly when unwell. The most common reasons for non-adherence with airway clearance regimens were being too busy and not being bothered. Being too busy and too tired were the most frequent reasons for decreased adherence with exercise. Frequency of performing airway clearance regimens significantly improved when patients felt unwell. Adherence with exercise regimens was significantly higher in those who worked or studied full time.

CONCLUSION

Overall, the levels of adherence with physiotherapy regimens found in this study were considered to be satisfactory and higher than those previously reported in the literature, with time related factors being the most commonly reported reasons for decreasing adherence.

Pre-emptive swallowing stimulation in long-term intubated patients

OBJECTIVE

To evaluate the effect of pre-emptive swallowing stimulation on the recovery of swallowing function in long-term intubated patients.

DESIGN AND SUBJECTS

Patients in the intensive care unit intubated for at least 48 hours due to respiratory distress from March to August 2004 were randomly divided into two groups. Fifteen patients of mean age 55.39+/-17.9 years were stimulated (experimental group) and 18 patients of mean age 61.39+/-13.5 years were not stimulated (control group). The duration of intubation was 15.59+/-6.7 days in the experimental group and 15.79+/-6.5 days in the control group. Duration of stimulation in the experimental group was 7.39+/-3.6 days. After extubation, we compared the severity of dysphagia via video-fluoroscopic swallow study.

RESULTS

There were no statistically significant differences in the percentage of aspiration and the swallowed volume between the two groups. However, oral transit time in the experimental group (0.379+/-0.07 seconds) was significantly shorter than that of the control group (0.839+/-0.10 seconds), and the oropharyngeal swallowing efficiency of the experimental group (73.39+/-17.4%/s) was significantly higher than that of the control group (50.19+/-13.0%/s).

CONCLUSION

Pre-emptive swallowing stimulation during intubation assists in the recovery of swallowing function in long-term intubated patients.

Counting Repetitions: An Observational Study of Outpatient Therapy for People with Hemiparesis Post-Stroke

Given the contemporary clinical belief that more practice is better, it is important to determine how much practice currently occurs during physical therapy (PT) and occupational therapy (OT). The purpose of this study was to examine the number of repetitions of various activities during PT and OT outpatient treatment sessions for people with hemiparesis post-stroke. We observed 36 treatment sessions and recorded the types of activities and the number of repetitions of each activity that were done. Observations were categorized and descriptive statistics were generated for each category and subcategory. Our results showed that treatment time averaged 36 minutes per session. In sessions addressing the upper extremity, the average number of repetitions per session were 39 for active-exercise movements, 34 for passive-exercise movements, and 12 for purposeful movements. In sessions addressing the lower extremity, the average number of repetitions per session were 33 for active-exercise movements, six for passive-exercise movements, and eight for purposeful movements. In sessions addressing gait, the average number of steps taken was 292. In sessions addressing transfers, the average number of repetitions per session was 11. For most categories, there was considerable variability in the number of repetitions observed. We conclude that the numbers of repetitions observed during PT and OT for people with hemiparesis post-stroke are relatively small, except for gait steps. The fact that the number of repetitions of upper extremity purposeful movements was smaller than the number of repetitions of upper extremity active- and passive-exercise movements was surprising. This finding is inconsistent with current teaching that practice of purposeful movements is an integral part of improving functional status.

Does group training during pregnancy prevent lumbopelvic pain? A randomized clinical trial

BACKGROUND

Prevention of lumbopelvic pain in pregnancy has been sparsely studied. One aim of this study was to assess if a 12-week training program during pregnancy can prevent and/or treat lumbopelvic pain. A randomized controlled trial was conducted at Trondheim University Hospital and three outpatient physiotherapy clinics. Three hundred and one healthy nulliparous women were included at 20 weeks of pregnancy and randomly allocated to a training group (148) or a control group (153).

METHODS

The outcome measures were self-reported symptoms of lumbopelvic pain (once per week or more), sick leave, and functional status. Pain drawing was used to document the painful area of the body. The intervention included daily pelvic floor muscle training at home, and weekly group training over 12 weeks including aerobic exercises, pelvic floor muscle and additional exercises, and information related to pregnancy.

RESULTS

At 36 weeks of gestation women in the training group were significantly less likely to report lumbopelvic pain: 65/148 (44%) versus 86/153 (56%) (p=0.03). Three months after delivery the difference was 39/148 (26%) in the training group versus 56/153 (37%) in the control group (p=0.06). There was no difference in sick leave during pregnancy, but women in the training group had significantly (p=0.01) higher scores on functional status.

CONCLUSIONS

A 12-week specially designed training program during pregnancy was effective in preventing lumbopelvic pain in pregnancy.

Emerging therapies in stroke rehabilitation

Traditionally, practitioners of stroke rehabilitation are taught that benefits of rehabilitation are achieved primarily through training patients in new techniques to compensate for impairments, and that neurological recovery is predominantly spontaneous in nature. Recent animal and human experiments have, however, indicated that the adult brain is capable of reorganisation and the term plasticity has been coined to describe this ability. Furthermore, it has been shown that cerebral reorganisation is use-dependent and can be manipulated via appropriate stimuli. This has resulted in a paradigm shift in the way stroke survivors should be rehabilitated and also given rise to several novel rehabilitation techniques.

Current management of syncope : focus on drug therapy

Syncope is defined as transient loss of consciousness as a result of inadequate cerebral perfusion. The causes of syncope fall into five broad categories: neurally mediated, orthostatic (the most frequent causes), cardiac arrhythmias, structural cardiovascular (relatively uncommon cause), and cerebrovascular (very rare). The initial evaluation of the syncope patient includes a detailed medical history and physical exam, and usually an ECG and echocardiogram. Thereafter, selected additional testing (e.g. ambulatory ECG recording, autonomic function testing, electrophysiologic study) may be needed on a case-by-case basis. Neurally mediated and orthostatic syncope should first be treated by conservative therapies including hydration/volume expanders and physical counter-maneuvers. Various drugs may play a role as second-line of treatment. However, apart from midodrine, randomized studies of drug therapy are largely lacking, and most agents have not proved to be predictably effective. For syncope due to cardiac arrhythmias, treatment options (depending on the specific circumstance) include ablation of the arrhythmia origin, antiarrhythmic drugs, and/or implantable devices (pacemakers and defibrillators). In the case of syncope due to structural cardiovascular defects (e.g. acute myocardial ischemia, pulmonary hypertension, obstructive cardiomyopathy), treatment is aimed at ameliorating the underlying structural defect. In brief, establishing a specific cause(s) for syncope is crucial. Only then can a potentially effective treatment strategy be contemplated.

Stroke, complex regional pain syndrome and phantom limb pain: Can commonalities direct future management?

Despite being different conditions, complex regional pain syndrome type 1, phantom limb pain and stroke share some potentially important similarities. This report examines experimental and clinical findings from each patient population. It identifies common aspects of symptomatic presentation, sensory phenomena and patterns of cortical reorganization. Based on these common findings, we argue that established principles of stroke rehabilitation are also applicable to rehabilitation of complex regional pain syndrome type 1 and phantom limb pain. In addition, we contend that promising treatment approaches for complex regional pain syndrome type 1 and phantom limb pain may be helpful in stroke rehabilitation. Examples of emerging supportive evidence for these hypotheses are provided and discussed.

[Methods of the physical medicine therapy in prevention of heterotopic ossification after total hip arthroplasty]

BACKGROUND/AIM

In the prevention of periarticular heterotopic ossification (HO), a common complication after total hip arthroplasty (THA), nonsteroidal antiinflammatory drugs (NSAID) and irradiation are used. Some theories presume that local hypoxia of the soft tissue causes HO. The aim of this study was to investigate if the early use of pulsed electromagnetic fields (PEMF) could prevent this ossification since it accelerates the circulation and oxigenation of soft tissue.

METHODS

The study included three groups of the patients with primary THA. The group C consisted of 66 patients/79 hips who had only kinesitherapy in postoperative rehabilitation. The group B consisted of 117 patients/131 hips who had PEMF and interferential current (IC) which, on average, started on the 14th day after the surgery combined with the standard kinesitherapy. The group A consisted of 117 patients/131 hips who had PEMF from the third postoperative day and IC from, on average, the 14th postoperative day with the standard kinesitherapy. The classification of HO was done on a standard AP roentgenograms of the hips, taken at least one year after the surgery.

RESULTS

The overall HO was seen in 50.63% of the group C patients, in 43.51% of the B group and in 16.67% of the group A. Severe HO (III and IV class according to Brooker) was seen in 26.58% of the group C patients and in 6.10% of the group B, but none in the group A.

CONCLUSION

According to the obtained results an early treatment with PEMF could prevent severe HO and reduce the overall HO.

Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders

OBJECTIVE

The aim of this study was to investigate the effect of a specific therapeutic jaw exercise on the temporomandibular disorders of patients with chronic whiplash-associated disorders.

MATERIAL AND METHODS

Ninety-four consecutive patients with whiplash-related conditions were referred to and accepted for a treatment period at a center for functional evaluation and rehabilitation during 2001-2002. The patients followed a program of physical therapy, occupational therapy, and pain management. At the start of their stay, they were examined by a physician specialized in rehabilitation medicine and also by a dentist who performed a functional examination of the stomatognathic system. Of the 93 patients who accepted participation in the study, 55 were diagnosed with temporomandibular disorders and chronic whiplash-associated disorders in accordance with the inclusion criteria. They were randomized into a jaw exercise group (n = 25), who performed specific therapeutic jaw exercises, and a control group (n = 30). Both groups undertook the whiplash rehabilitation program at the center.

RESULTS

There were no inter- or intra-group differences in symptoms and signs of temporomandibular disorders at baseline, nor at the 3-week and 6-month follow-ups, except for an increase of maximum active mouth-opening capacity in the control group.

CONCLUSIONS

In conclusion, the therapeutic jaw exercises, in addition to the regular whiplash rehabilitation program, did not reduce symptoms and signs of temporomandibular disorders in patients with chronic whiplash-associated disorders.

Application of combined botulinum toxin type A and modified constraint-induced movement therapy for an individual with chronic upper-extremity spasticity after stroke

BACKGROUND AND PURPOSE

Constraint-induced movement therapy (CIMT) is a promising intervention for retraining upper-extremity function after a stroke. The purpose of this case report is to describe the use of a combination of botulinum toxin type A (BtxA) and a modified CIMT program for a patient with severe spasticity who was unable to use his right upper extremity.

CASE DESCRIPTION

The 52-year-old patient, who had a stroke 4 years ago, did not meet the minimum motor criteria for CIMT benefit. After receiving BtxA injections targeting the elbow, wrist, and finger flexors, he completed a 4-week program of modified CIMT followed by a 5-month home exercise program.

OUTCOMES

The patient exhibited improvement in muscle tone (the velocity-dependent resistance to stretch that muscle exhibits) and in scores on several upper-extremity function tests (Modified Ashworth Scale, Motor Activity Log, Wolf Motor Function Test, Action Research Arm Test, and Fugl-Meyer Assessment of Motor Recovery). He also reported making much progress in the functional use of the involved upper extremity.

DISCUSSION

In a patient with severe flexor spasticity and nonuse of the dominant upper extremity after a stroke, a combined treatment of BtxA and modified CIMT may have resulted in improved upper-extremity use.

Changes in effective connectivity of the primary motor cortex in stroke patients after rehabilitative therapy

We used a perturb-and-measure approach, by combining transcranial magnetic stimulation (TMS) and positron emission tomography (PET), to examine changes in the primary motor area (M1) and its effective connectivity in stroke patients with chronic motor deficits (>1-year post-stroke) who underwent 3 weeks of constraint-induced movement therapy. During the 3-week period, 7 patients spent 4 h per day performing shaping exercises with the affected arm under our supervision for 14 days and wore a mitt on the unaffected arm at home in situations where safety was not compromised. Anatomical magnetic resonance imaging confirmed that all patients had lesions that encompassed the white matter; no patient had damage in the hand representation of M1. Improvements on various motor tests were observed immediately after therapy and 1 month afterwards. During the TMS/PET sessions, we applied trains of subthreshold 10-Hz repetitive TMS over the hand representation of the ipsilesional and contralesional M1s and varied the number of TMS trains delivered during each scan. The results demonstrate changes in the local response of TMS in the ipsilesional and contralesional M1, changes in the strength of interhemispheric connectivity between M1s, and changes in the effective connectivity of the ipsilesional and contralesional M1s with the non-primary motor areas, the basal ganglia, and the motor nuclei of the thalamus.

[Kinesitherapy: one of the most important aspects of medical rehabilitation]

INTRODUCTION

Kinesitherapy, as a part of physical therapy, represents one of the most important aspects of medical rehabilitation. It involves movement of various parts of the body, or of the whole body, using exercises in order to maintain, establish, develop and change functions of the locomotor apparatus and organs of locomotion.

AIM

The aim of kinesitherapy is to use all potentials of the treated patients, to achieve optimal recovery of the damaged function of locomotion.

CLASSIFICATION

Kinesitherapy includes active and passive exercises. Active exercises are divided into: active exercises with assistance, without assistance and active exercises with resistance. INDICATIONS AND CONTRAINDICATIONS: Kinesitherapy is applied in almost all medical branches in numerous pathological conditions, as well as a method of prevention. Practically, there are no absolute contraindications, and relative are extremely rare.

Effect of body-oriented psychological therapy on negative symptoms in schizophrenia: a randomized controlled trial

BACKGROUND

In order to improve the treatment of medication-resistant negative symptoms in schizophrenia, new interventions are needed. Neuropsychological considerations and older reports in the literature point towards a potential benefit of body-oriented psychological therapy (BPT). This is the first randomized controlled trial specifically designed to test the effectiveness of manualized BPT on negative symptoms in chronic schizophrenia.

METHOD

Out-patients with DSM-IV continuous schizophrenia were randomly allocated to either BPT (n=24) or supportive counseling (SC, n=21). Both therapies were administered in small groups in addition to treatment as usual (20 sessions over 10 weeks). Changes in negative symptom scores on the Positive and Negative Symptom Scale (PANSS) between baseline, post-treatment and 4-month follow-up were taken as primary outcome criteria in an intention-to-treat analysis.

RESULTS

Patients receiving BPT attended more sessions and had significantly lower negative symptom scores after treatment (PANSS negative, blunted affect, motor retardation). The differences held true at 4-month follow-up. Other aspects of psychopathology and subjective quality of life did not change significantly in either group. Treatment satisfaction and ratings of the therapeutic relationship were similar in both groups.

CONCLUSIONS

BPT may be an effective treatment for negative symptoms in patients with chronic schizophrenia. The findings should merit further trials with larger sample sizes and detailed studies to explore the therapeutic mechanisms involved.

Effects of a Postoperative Strength-Training Program on the Walking Ability of Children With Cerebral Palsy: A Randomized Controlled Trial

OBJECTIVE

To investigate the effect of a postoperative strength-training program on the walking of children with cerebral palsy (CP).

DESIGN

Randomized controlled trial.

SETTING

Hospital rehabilitation department.

PARTICIPANTS

Thirty-nine children with CP (age range, 6-16 y). After orthopedic surgery, the control group (n=20) followed a conventional physiotherapy (PT) program, and the strength-training group (n=19) followed a strength-training program in addition to the conventional PT. Twenty-nine age-matched healthy children were used as references.

INTERVENTION

A 9-month strength-training program.

MAIN OUTCOME MEASURES

Spatiotemporal, kinematic, and kinetic parameters during gait analysis were analyzed before (E0) and 1 year after (E1) the surgery. For 22 children, a 2-year postoperative gait analysis (E2) took place as well.

RESULTS

At E1, several kinematic and kinetic parameters improved, although there was no significant difference between the groups. Spatiotemporal parameters showed a worsening at E1 and a recovery to preoperative values at E2.

CONCLUSIONS

The examined parameters may be more substantially influenced by factors such as the surgery outcome and the variability of pathologic characteristics than by the strength-training program per se. However, a more significant effect of the strength-training may appear if more intense and short-term training protocols are used, considering factors such as patients' motivations, ages, and postoperative statuses.

Relearning toward motor recovery in stroke, spinal cord injury, and cerebral palsy: a cognitive neural systems perspective

In stroke, spinal cord injury, and cerebral palsy there is denervation of target neuron centers, which are self-organizing maps (SOMs) within the neuraxis. Compensatory reinnervation occurs within those SOMs by acquiring synaptic sprouts from whatever neurons in the neighborhood. Such reorganizations are more often maladaptive than beneficial. Motor recovery, if any appears, is incomplete and compromised. Cognitive systems studies indicate that motor paralysis is due to loss of learning <--> recall balance in those compensated SOMs, which had been locked into a stability <--> plasticity dilemma. Treatment/rehabilitation should aim therefore to first restore this learning related balance. The use of botulinum toxin as a neuromotor relearning tool to improve motor recovery is discussed.

Current concepts in the management of tendon disorders

Primary disorders of tendons are common and constitute a high proportion of referrals to rheumatologists. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles, patella, elements of the rotator cuff, forearm extensors, biceps brachi and tibialis posterior tendons. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term. Significant advances have been made in understanding the pathophysiology of these conditions. Histopathological evidence, together with advances in imaging techniques, has made us more appreciative of the degenerative (rather that inflammatory) nature of these conditions. Additionally the presence of neovascularization is now well-recognized in long-standing tendinopathy. We review the mechanical, vascular and developing neural theories that attempt to explain the aetiology of degenerative tendinopathy. We also explore theories of why specific tendons (such as the Achilles and supraspinatus tendons) are particularly prone to degenerative pathology. Traditionally, treatments have placed a heavy emphasis on anti-inflammatory strategies, which are often inappropriate. Recently, however, significant advances in the practical management of tendon disorders have been made. In particular the advent of 'eccentric loading' training programmes has revolutionized the treatment of Achilles tendinopathy in some patients. This concept is currently being extended to include other commonly injured tendons. Other current treatments are reviewed, as are potential future treatments.

Katamnestische Stabilität des Körpererlebens nach stationärer Gruppenbehandlung mit Konzentrativer Bewegungstherapie

Body experience of 34 patients was investigated two years after the end of treatment with Concentrative Movement Therapy (KBT) in an in-patient integrative psychotherapy. Change in body experience at the end of treatment and after the two year period was compared to symptomatic strain and the amount of interpersonal problems. Body experience was rather restricted in the beginning of treatment. The improvement of body experience during treatment showed to be stable after two years, as did the symptomatic strain. Interpersonal problems were not reduced as much during treatment but in the follow-up period. Patients with benefit from KBT treatment through a better approach to their body, felt more bodily self-confident at the end of treatment. They also had less feelings of insecurity and apprehension concerning their body than those who could profit little from KBT. In both groups a reduction of symptomatic strain was found. Patients with little profit from KBT had higher symptomatic and interpersonal strain and more feelings of insecurity concerning their body in the beginning of the treatment. Their improvement at the time of follow-up was low. Results are discussed regarding the relevance of different elements of integrative in-patient therapy and the possibility of differential indications for body-oriented psychotherapy.

Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model

The aim of this study was to evaluate the effects of a modified version of constraint-induced (CI) movement therapy on bimanual hand-use in children with hemiplegic cerebral palsy (CP; age range 18 mo to 4 y) and to make a comparison with conventional paediatric treatment. Twenty-one children (13 females, eight males) completed the CI therapy programme and 20 children (12 males, eight females) served as a control group. Children in the CI therapy group were expected to wear a restraint glove for 2 hours each day over a period of 2 months. The training was based on principles of motor learning used in play and in motivational settings. To evaluate the effect of treatment, the Assisting Hand Assessment (AHA) was used. Assessments took place on three occasions: at onset, after 2 months, and 6 months after the first assessment. A significant interaction was found between group and AHA measure (ANOVA, F(2,74) = 5.64, p = 0.005). The children who received CI therapy improved their ability to use their hemiplegic hand significantly more than the children in the control group after 2 months, i.e. after treatment. Effect size was high after treatment and remained medium at 6 months. As the treatment was tailored to each child's capacity and interests, little frustration was experienced by the children.

TAMO therapy as a major component of physical therapy intervention for an infant with congenital muscular torticollis: a case report

PURPOSE

Tscharnuter Akademie for Motor Organization (TAMO) therapy is a therapeutic approach based on dynamic theories of motor control. Research evidence supporting this approach is limited. The purpose of this case report is to describe the use of TAMO therapy in the physical therapy intervention for an infant with congenital muscular torticollis (CMT). The patient was a 4.5-month-old baby boy (corrected age) with left CMT.

METHODS

Intervention included TAMO therapy, active range of motion exercise, soft tissue mobilization, and parent instruction. Changes in the amount of lateral head tilt were documented using still photography

RESULTS

The infant assumed a midline head position in the supine position by the second weekly visit and maintained a midline head alignment during all functional activities by the eighth visit.

CONCLUSION

This case report is the first attempt to describe a successful application of TAMO therapy as a major component of physical therapy intervention for an infant with CMT.

[Kinetic therapy for acute respiratory distress syndrome]

The authors evaluated the clinical and physiological effects of kinetic therapy (KT) in the treatment of acute respiratory distress syndrome (ARDS). Forty-six patients with ARDS underwent successive postural positioning in accordance with two regimens: 1) lateral, prone, contralateral, supine positions; 2) prone, lateral, contralateral, supine positions. The criterion for changing each position was the change in monitoring indices: SpO2, PaO2, and thoracopulmonary compliance (C). KT was performed until a respirator was withdrawn from the patient. In 25 patients, each maneuver of positioning was made during 30-minute propofol sedation. The control group included 24 patients with ARDS who received neither KT nor propofol sedation. KT caused a decrease in Vd/Vt, Qs/Qt and an increase in PaO2/FiO2 and C was more intensive, as compared with the control group. The duration of the patient's prone position was 3.2-0.7 hours and that of the supine position was 3.4-0.8 hours. The right and left lateral positions lasted 1.1-0.2 and 1.3-0.2 hours, respectively. KT regimen 1 was found to be more effective than KT regimen 2. Propofol sedation enhanced the efficiency of KT. The latter reduced death rates in patients with ARDS.

Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure

The authors compared the efficacy of a self-applied modified Semont maneuver (MSM) with self-treatment with a modified Epley procedure (MEP) in 70 patients with posterior canal benign paroxysmal positional vertigo. The response rate after 1 week, defined as absence of positional vertigo and torsional/upbeating nystagmus on positional testing, was 95% in the MEP group (n = 37) vs 58% in the MSM group (n = 33; p < 0.001). Treatment failure was related to incorrect performance of the maneuver in the MSM group, whereas treatment-related side effects did not differ significantly between the groups.

What should be the core outcomes in chronic pain clinical trials?

A consensus conference with representatives from academia, governmental agencies, and the pharmaceutical industry met and concluded that clinical trials designed to assess the efficacy and effectiveness of treatments for chronic pain should consider outcomes in six core domains: pain, physical functioning, emotional functioning, patient global ratings of satisfaction, negative health states and adverse events, and patient disposition. In addition, it was acknowledged that there are many secondary domains that might be of importance and should be included in trials depending on the nature of the treatment and population to whom the treatment is targeted.

Physical functioning and quality of life after cancer rehabilitation

In order to overcome cancer-related problems and to improve quality of life, an intensive multi-focus rehabilitation programme for cancer patients was developed. We hypothesised that this six-week intensive rehabilitation programme would result in physiological improvements and improvement in quality of life. Thirty-four patients with cancer-related physical and psychosocial problems were the subjects of a prospective observational study. A six-week intensive multi-focus rehabilitation programme consisted of four components: individual exercise, sports, psycho-education, and information. Measurements (symptom-limited bicycle ergometry performance, muscle force and quality of life [RAND-36, RSCL, MFI]) were performed before (T0) and after six weeks of rehabilitation (T1). After the intensive rehabilitation programme, statistically significant improvements were found in symptom-limited bicycle ergometry performance, muscle force, and several domains of the RAND-36, RSCL and MFI. The six-week intensive multi-focus rehabilitation programme had immediate beneficial effects on physiological variables, on quality of life and on fatigue.

Improvement in Parkinson's disease patients achieved by coordination dynamics therapy

Eight patients in whom Parkinson's disease had set on 5 to 10 years earlier underwent low intensity coordination dynamics therapy with on average 4 hours per week for 2.5 months. The ongoing pharmaco-therapy and the conventional fitness training for 1 to 2 hours per week were not changed. With the coordination dynamics therapy the functioning of the central nervous system (CNS) of the Parkinson's disease patients improved by 35%, as quantified by coordination dynamics measurements. Following 3 months of no coordination dynamics therapy, but further ongoing pharmaco-therapy and fitness training the CNS functioning worsened again by 21%. It is concluded that pharmaco-therapy and conventional fitness training alone cannot prevent the worsening of the CNS functioning in progressing Parkinson's disease, but additional coordination dynamics therapy can.

Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment

OBJECTIVE

Constraint-Induced Movement (CI) therapy has been found to be a promising treatment for substantially increasing the use of extremities affected by such neurologic injuries as stroke and traumatic brain injury in adults. The purpose of this study was to determine the applicability of this intervention to young children with cerebral palsy.

METHODS

A randomized, controlled clinical trial of pediatric CI therapy in which 18 children with diagnosed hemiparesis associated with cerebral palsy (7-96 months old) were randomly assigned to receive either pediatric CI therapy or conventional treatment. Pediatric CI therapy involved promoting increased use of the more-affected arm and hand by intensive training (using shaping) of the more-impaired upper extremity for 6 hours/day for 21 consecutive days coupled with bivalved casting of the child's less-affected upper extremity for that period. Children's functional upper-extremity skills were assessed in the laboratory (blinded scoring) and at home (parent ratings) just prior, after, and 3 weeks posttreatment. Treated children were followed for 6 months.

RESULTS

Children receiving pediatric CI therapy compared with controls acquired significantly more new classes of motoric skills (9.3 vs 2.2); demonstrated significant gains in the mean amount (2.1 vs 0.1) and quality (1.7 vs 0.3) of more-affected arm use at home; and in a laboratory motor function test displayed substantial improvement including increases in unprompted use of the more-affected upper extremity (52.1% vs 2.1% of items). Benefits were maintained over 6 months, with supplemental evidence of quality-of-life changes for many children.

CONCLUSION

Pediatric CI therapy produced major and sustained improvement in motoric function in the young children with hemiparesis in the study.

Weakness and strength training in persons with poststroke hemiplegia: Rationale, method, and efficacy

Several converging lines of contemporary evidence suggest that weakness presents a more serious compromise to movement function in poststroke hemiplegia than spasticity. This review examines the clinical and functional phenomena of weakness in poststroke hemiplegia, currently available evidence identifying physiologic substrates contributing to weakness, and reports of early investigations involving high-resistance training targeted at improving strength and the transfer of strength to improvements in functional capacity. Based on this information, we describe some unsolved problems and indicate some likely lines of development to increase our knowledge regarding how resistance training can be included in effective stroke rehabilitation.

Non-invasive physical treatments for chronic/recurrent headache

BACKGROUND

Non-invasive physical treatments are often used to treat common types of chronic/recurrent headache.

OBJECTIVES

To quantify and compare the magnitude of short- and long-term effects of non-invasive physical treatments for chronic/recurrent headaches.

SEARCH STRATEGY

We searched the following databases from their inception to November 2002: MEDLINE, EMBASE, BIOSIS, CINAHL, Science Citation Index, Dissertation Abstracts, CENTRAL, and the Specialised Register of the Cochrane Pain, Palliative Care and Supportive Care review group. Selected complementary medicine reference systems were searched as well. We also performed citation tracking and hand searching of potentially relevant journals.

SELECTION CRITERIA

We included randomized and quasi-randomized controlled trials comparing non-invasive physical treatments for chronic/recurrent headaches to any type of control.

DATA COLLECTION AND ANALYSIS

Two independent reviewers abstracted trial information and scored trials for methodological quality. Outcomes data were standardized into percentage point and effect size scores wherever possible. The strength of the evidence of effectiveness was assessed using pre-specified rules.

MAIN RESULTS

Twenty-two studies with a total of 2628 patients (age 12 to 78 years) met the inclusion criteria. Five types of headache were studied: migraine, tension-type, cervicogenic, a mix of migraine and tension-type, and post-traumatic headache. Ten studies had methodological quality scores of 50 or more (out of a possible 100 points), but many limitations were identified. We were unable to pool data because of study heterogeneity. For the prophylactic treatment of migraine headache, there is evidence that spinal manipulation may be an effective treatment option with a short-term effect similar to that of a commonly used, effective drug (amitriptyline). Other possible treatment options with weaker evidence of effectiveness are pulsating electromagnetic fields and a combination of transcutaneous electrical nerve stimulation [TENS] and electrical neurotransmitter modulation. For the prophylactic treatment of chronic tension-type headache, amitriptyline is more effective than spinal manipulation during treatment. However, spinal manipulation is superior in the short term after cessation of both treatments. Other possible treatment options with weaker evidence of effectiveness are therapeutic touch; cranial electrotherapy; a combination of TENS and electrical neurotransmitter modulation; and a regimen of auto-massage, TENS, and stretching. For episodic tension-type headache, there is evidence that adding spinal manipulation to massage is not effective. For the prophylactic treatment of cervicogenic headache, there is evidence that both neck exercise (low-intensity endurance training) and spinal manipulation are effective in the short and long term when compared to no treatment. There is also evidence that spinal manipulation is effective in the short term when compared to massage or placebo spinal manipulation, and weaker evidence when compared to spinal mobilization. There is weaker evidence that spinal mobilization is more effective in the short term than cold packs in the treatment of post-traumatic headache.

REVIEWERS' CONCLUSIONS

A few non-invasive physical treatments may be effective as prophylactic treatments for chronic/recurrent headaches. Based on trial results, these treatments appear to be associated with little risk of serious adverse effects. The clinical effectiveness and cost-effectiveness of non-invasive physical treatments require further research using scientifically rigorous methods. The heterogeneity of the studies included in this review means that the results of a few additional high-quality trials in the future could easily change the conclusions of our review.