Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: A pilot study

BACKGROUND/PURPOSE

Mirror therapy (MT) has been recommended as a simple, inexpensive approach to treat motor dysfunction. The use of a mesh glove (MG) was suggested to normalize muscle tone that ameliorates motor impairment. Combining two efficient treatment protocols might maximize the benefits from training. This study investigated the effects of MT combined with MG (MG + MT) versus MT alone on motor performance and daily function after stroke.

METHODS

Sixteen patients with chronic unilateral stroke were recruited. A randomized two-group pretest and posttest design was used to randomly assign participants to MG + MT or MT groups. MT involves repetitive bimanual, symmetrical movement practice in which the individual moves the affected limb as much as she/he could while watching the reflective illusion of the unaffected limb's movements from a mirror. The MG + MT group wore a MG on the affected hand during the MT. The Modified Ashworth scale of muscle spasticity (MAS), Action Research Arm Test (ARAT), Box and Block Test (BBT), and Functional Independence Measure (FIM) were administered to evaluate spasticity, and motor and daily function.

RESULTS

The results for the BBT (p = 0.013), total scores (p = 0.031), grasping subscales (p = 0.036) of ARAT, and FIM transfer scores (p = 0.013) presented significantly large effects in favor of the MG + MT group.

CONCLUSION

Combining MG with MT significantly improves manual dexterity, grasping, and transfer performance. Adding the MG component into the MT likely increased the richness of sensory input and improved the movement performance more than MT alone.

The effects of Pilates on metabolic control and physical performance in adolescents with type 1 diabetes mellitus

Physical activity is a substantial method in the management of children and adolescents with Type 1 diabetes mellitus but it is not considered as a treatment for diabetes. The aim of this study was to investigate the effects of Pilates exercises on metabolic control and physical performance in patients with type 1 diabetes mellitus. Thirty one sedentary patients with type 1 diabetes mellitus, ranging in age from 12 to 17 (experimental group, n=17 and control group, n=14) were submitted to 12 weeks of Pilates training. Participants underwent tests to determine the physical performance and metabolic control before and after 12 weeks of Pilates session. At the end of study, there were significant alterations in physical performance of the study group. Peak power, mean power, vertical jump and flexibility of study group increased. There were no alterations for this parameters in the control group. There was no significant difference for glycated hemoglobin (HbA1c) in both groups.

CONCLUSIONS

Physical performance increased via Pilates exercises in the patients with type 1 DM. However there were no changes in metabolic control. In the present study, the positive effects of exercise on metabolic control could not be shown in patients with Type 1 DM.

Defining Pilates exercise: a systematic review

OBJECTIVES

To describe Pilates exercise according to peer-reviewed literature, and compare definitions used in papers with healthy participants and those with low back pain.

DESIGN

A systematic review of literature was conducted. A search for "pilates" within the maximal date ranges of the Cochrane Library, Medline, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, ProQuest: Nursing and Allied Health Source, Proquest: Medical and Health Complete, Scopus, Sport Discus, and Web of Science, was undertaken. To be included, papers needed to describe Pilates exercise, and be published in English within an academic, peer-reviewed journal. There were no restrictions on the methodological design or quality of papers. Content analysis was used to record qualitative definitions of Pilates. Frequencies were calculated for mention of content categories, equipment, and traditional Pilates principles. Frequencies were then compared statistically in papers with healthy participants and those with low back pain.

RESULTS

119 papers fulfilled inclusion criteria. Findings suggest that Pilates is a mind-body exercise that focuses on strength, core stability, flexibility, muscle control, posture and breathing. Exercises can be mat-based or involve use of specialised equipment. Posture was discussed statistically significantly more often in papers with participants with low back pain compared to papers with healthy participants. Traditional Pilates principles of centering, concentration, control, precision, flow, and breathing were discussed on average in 23% of papers. Apart from breathing, these principles were not mentioned in papers with low back pain participants.

CONCLUSIONS

There is a general consensus in the literature of the definition of Pilates exercise. A greater emphasis may be placed on posture in people with low back pain, whilst traditional principles, apart from breathing, may be less relevant.

[Evaluation of factors determining the efficiency of kinesotherapy in acute ischemic stroke patients]

The aim of this paper was to evaluate factors influencing the efficiency of kinesotherapy in acute ischemic stroke patients during the first rehabilitation stage. Forty patients with stroke, aged between 45 and 74 years, were enrolled in the study. The individual kinesotherapy of 30-45 minutes duration was applied for stroke patients 5 times a week. The efficiency of kinesotherapy was assessed by the modified Functional independence measure scale and the Motor assessment scale before and after treatment. Information about patient's gender, age, weight, brain lesion localization, stroke localization, the depth of lesion, aphasia, number of comorbidities, the beginning of kinesotherapy, patient's motivation and family member participation in the rehabilitation was taken according to a research protocol. The motor function of stroke patients significantly (p<0.05) improved after kinesotherapy sessions at the end of the first stage of rehabilitation. The lower efficiency (p<0.05) of kinesotherapy for acute stroke patients was determined by the brain lesion localization in the left hemisphere and middle cerebral artery, hemiplegia, sensomotor aphasia, and low motivation of the patient.

A description of training characteristics and its association with previous musculoskeletal injuries in recreational runners: a cross-sectional study

BACKGROUND

Running is one of the most popular physical activities in the world and the number of runners has increased over the past 40 years. One of the consequences of the growing running popularity is the increase of musculoskeletal injuries.

OBJECTIVES

To describe the routines, training characteristics and history of injury in recreational runners and to evaluate possible associations between the routines and training characteristics with previous musculoskeletal running-related injuries.

METHODS

A total of 200 runners participated in this study. The participants completed an electronic form containing questions about personal characteristics, running experience, training characteristics, type of running shoes, foot type and previous injuries history over the last 12 months. The data were analyzed descriptively as well as by using logistic regression models.

RESULTS

The majority of the runners was male, aged 43.0 (SD=10.5) years-old, have a body mass index of 24.2 (IQR=4.3) kg/m², and had training volume of 35.0 (IQR=28.0) kilometers per week. Fifty-five percent of runners had injuries over the last 12 months. The most prevalent injuries observed were tendinopathies and muscle injuries. The variable that showed an association with previous running-related injuries was running experience from 5 to 15 years (Odds Ratio (OR)=0.2; 95%CI=0.1 to 0.9).

CONCLUSIONS

The prevalence of running-related injuries over the last 12 months was 55%. The variable running experience was associated with the absence of previous musculoskeletal running-related injuries.

Fascicle-tendon behavior of the gastrocnemius and soleus muscles during ankle bending exercise at different movement frequencies

The present study investigated the effect of movement frequencies on the behavior of fascicles and tendons of synergistic muscles. Seven male subjects performed ankle bending (calf-raise) exercises at four movement frequencies (1.33, 1.67, 1.84, and 2.00 Hz), performed with an identical range of ankle joint motion. The fascicle and tendon behavior of medial gastrocnemius (MG) and soleus (SOL) was measured by ultrasonography while kinematic and kinetic parameters of the ankle were recorded. The torque of ankle joint was larger at higher exercise frequencies. The length change of muscle decreased and that of tendon increased at higher frequencies both for MG and for SOL, with no significant inter-muscle differences in the relative changes of muscle or tendon lengths to that of MTU. Changes of pennation angles and electromyographic activities as a function of movement frequency were also comparable for MG and SOL. These results suggest that under a stretch-shortening cycle action, the muscle-tendon interaction is altered by the movement frequency toward greater use of tendon elastic energy to provide greater MTU power at a higher frequency. Results also suggest that the movement frequency dependence of fascicle and tendon behavior is comparable between MG and SOL.

Vestibular rehabilitation for unilateral peripheral vestibular dysfunction

BACKGROUND

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2007.Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or postoperatively. The dysfunction is characterised 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

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The most recent search was 1 July 2010, following a previous search in March 2007.

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

Both authors independently extracted data and assessed trials for risk of bias.

MAIN RESULTS

We included 27 trials, involving 1668 participants, in the review. Trials addressed the effectiveness of VR against control/sham interventions, medical interventions or other forms of VR. Individual and pooled data showed a statistically significant effect in favour of VR over control or no intervention. The exception to this was when movement-based VR was compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), 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 VR 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 VR provides a resolution of symptoms and improvement in functioning in the medium term. However, there is evidence that for the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of VR.

Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: a randomized controlled study

BACKGROUND

There are very few randomized controlled studies on exercise in cancer patients. Consequently, there are no guidelines available with regard to the exercises that can be recommended and difficulties are encountered in the clinical practice as to which exercise is more suitable to the patients.

AIM

The purpose of this study was to investigate the impact of pilates exercises on physical performance, flexibility, fatigue, depression and quality of life in women who had been treated for breast cancer.

DESIGN

Randomized controlled trial.

SETTING

Out patient group, Department of Physical Medicine and Rehabilitation and Medical Oncology Department, University Hospital.

POPULATION

Fifty-two patients with breast cancer were divided into either pilates exercise (group 1) and control group (group 2).

METHODS

Patients in Group 1 performed pilates and home exercises and patients in group 2 performed only home exercises. Pilates exercise sessions were performed three times a week for a period of eight weeks in the rehabilitation unit.

MAIN OUTCOME MEASURES

Subjects were assessed before and after rehabilitation program, with respect to, 6-min walk test (6MWT), modified sit and reach test, Brief Fatigue Inventory (BFI), Beck Depression Index (BDI) and the European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC QLQ-C30) and EORTC QLQ BR23.

RESULTS

After the exercise program, improvements were observed in Group 1 in 6-minute walk test, BDI, EORTC QLQ-C30 functional, and EORTC QLQ-C30 BR23 functional scores (P<0.05). In contrast, no significant improvement was observed in Group 2 after the exercise program in any of parameters in comparison to the pre-exercise period (P>0.05). When the two exercise groups were compared, there were significant differences in 6MWT in pilates-exercise group (P<0.05).

CONCLUSION

Pilates exercises are effective and safe in female breast cancer patients. There is a need for further studies so that its effect can be confirmed.

CLINICAL REHABILITATION IMPACT

This study addressed the effects of pilates exercise, as a new approach, on functional capacity, fatigue, depression and quality of life in breast cancer patients in whom there are doubts regarding the efficacy and usefulness of the exercise.

Living AnatoME: Teaching and learning musculoskeletal anatomy through yoga and pilates

Living AnatoME, a program designed in 2004 by two medical students in conjunction with the Director of Anatomy, teaches musculoskeletal anatomy through yoga and Pilates. Previously offered as an adjunct to the Gross Anatomy course in 2007, Living AnatoME became an official part of the curriculum. Previous research conducted on the program demonstrated its efficacy in providing relaxation and well-being to students who attended. In 2007, with all 144 gross anatomy students required to participate in a 1.5 hour Living AnatoME session on the upper and lower limbs, the impact of the program on students' comprehension of musculoskeletal anatomy was analyzed through the administration of 25-question pre- and post-tests, gauging knowledge in the following domains: upper limb, lower limb, muscle function, palpation, attachment/location, clinical correlate, and control (i.e., material not emphasized during the intervention). Analysis of postintervention tests revealed significant improvement in total Living AnatoME scores as well as in the domains of upper limb, muscle function, and palpation, indicating the possible efficacy of Living AnatoME in teaching anatomy. Performance on control questions also improved, although not significantly, which may indicate the role of other variables (e.g., additional study time) in increased performance.

Heart Failure Exercise And Training Camp: effects of a multicomponent exercise training intervention in patients with heart failure

BACKGROUND

This study tested the effects of a multicomponent exercise training intervention called "Heart Failure Exercise And Training Camp" (HEART CAMP). The intervention was theoretically derived from Bandura's social cognitive theory.

METHODS

An experimental repeated-measures design was used. Participants were randomized to the HEART CAMP intervention group (n = 22) or the attention control group (n = 20). Participants were compared on self-efficacy for exercise, symptoms, physical function, and quality of life over 12 weeks.

RESULTS

The intervention group had a 31% increase in cardiac exercise self-efficacy and significantly fewer symptoms compared with the attention control group. Quality of life increased significantly in both groups.

CONCLUSION

A theory-based intervention improved self-efficacy for exercise and symptoms in patients with heart failure.

Electrical activity of external oblique and multifidus muscles during the hip flexion-extension exercise performed in the Cadillac with different adjustments of springs and individual positions

BACKGROUND

Despite of the widepread use of Pilates in Physical Therapy, there are few studies that have assessed the muscle electrical activation during Pilates exercises.

OBJECTIVE

Verify the influence of different spring adjustments and individual positions on the electrical activation of multifidus (MU) and oblique external (OE) muscles during hip flexion-extension (HFE) exercise on the Cadillac.

METHODS

Eight women practicing Pilates exercises for at least six months performed 10 repetitions of HFE in the following situations: Lower Spring, spring fixed at 30 cm in relation to level which the individuals were positioned. Higher Spring, spring fixed at 90 cm in relation to level which the individuals were positioned. Near Position, distance of 10 cm from the fixed spring. Distant Position, distance of 30 cm from the fixed spring. Kinematic and eletromyographic data (EMG) were collected simultaneously and the MU and OE muscles were monitored. Each movement of HFE was splitted in two phases (extension and flexion). The EMG signal was calculated and normalized using the maximal voluntary contraction (MVC). The Wilcoxon test was used to investigate differences between the situations (p < 0.05).

RESULTS

MU muscle presented muscle activation values ranging from 10 to 20 % MVC, and the highest muscle activation in the lower spring and in the near position. OE muscles presented muscle activation values ranging from 20 to 45% MVC, and the highest values in the higher spring and in the distant position.

CONCLUSION

MU and OE muscles presented a distinct electrical activation during different available spring adjustments and individual positions.

Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis

Our objective was to assess the effects of differing modes of impact exercise on bone density at the hip and spine in premenopausal women through systematic review and meta-analysis. Electronic databases, key journals and reference lists were searched for controlled trials investigating the effects of impact exercise interventions on lumbar spine (LS), femoral neck (FN) and total hip (TH) bone mineral density (BMD) in premenopausal women. Exercise protocols were categorised according to impact loading characteristics. Weighted mean difference (WMD) meta-analyses were undertaken. Heterogeneity amongst trials was assessed. Fixed and random effects models were applied. Inspection of funnel plot symmetry was performed. Trial quality assessment was also undertaken. Combined protocols integrating odd- or high-impact exercise with high-magnitude loading (resistance exercises), were effective in increasing BMD at both LS and FN [WMD (fixed effect) 0.009 g cm(-2) 95% CI (0.002-0.015) and 0.007 g cm(-2) 95% CI (0.001-0.013); P = 0.011 and 0.017, respectively]. High-impact only protocols were effective on femoral neck BMD [WMD (fixed effect) 0.024 g cm(-2) 95% CI (0.002-0.027); P < 0.00001]. Funnel plots showed some asymmetry for positive BMD outcomes. Insufficient numbers of protocols assessing TH BMD were available for assessment. Exercise programmes that combine odd- or high-impact activity with high-magnitude resistance training appear effective in augmenting BMD in premenopausal women at the hip and spine. High-impact-alone protocols are effective only on hip BMD in this group. However, diverse methodological and reporting discrepancies are evident in published trials.

Plyometric training improves power and agility in Jamaica's national netball team

OBJECTIVE

Plyometric training is widely used in conditioning, power training and in prevention and rehabilitation of injuries in some sports. This study sought to investigate the effect of a three-week plyometric training programme on jump performance and agility in Jamaican national netball players.

METHOD

Eighteen national netballers participated in a Plyometric training programme. Subjects were evaluated using the Vertical Jump Test, the Broad Jump Test and the Illinois Agility Test prior to the start of the programme and at week 3.

DATA ANALYSIS

The data were analysed using SPSS version 12 for Windows. A One-Sample Kolmogorov-Smirnov Test showed normal distribution of data and a paired samples t-test was used to determine whether the mean change in jump performance and agility was significant.

RESULTS

All eighteen subjects completed the three weeks of training. Three subjects were shown to be outliers at week 3 and this resulted in data from 15 subjects being analysed. At the end of the three weeks, there were significant improvements in Vertical Jump Scores (p = 0.023), Broad Jump Scores (p = 0.002) and Agility scores (p = 0.045).

CONCLUSION

Three weeks of Plyometric training can lead to significant improvements in jump performance and agility and should be integrated into the national training programme at intervals yet to be determined.

Cough and swallowing dysfunction

The symptom of cough may result from a multitude of etiologies involving different parts of the aerodigestive tract. This article focuses on the association of cough and swallowing dysfunction in the sense that cough may be an indicator of swallow dysfunction and in the importance of cough in preventing aspiration and aspiration-related disorders. Whereas these associations have been known for a long time, research is starting to connect the dots, allowing targeting of strategies aimed at diagnosing and preventing illness in certain dysphagic patients.

The connection between art, healing, and public health: a review of current literature

This review explores the relationship between engagement with the creative arts and health outcomes, specifically the health effects of music engagement, visual arts therapy, movement-based creative expression, and expressive writing. Although there is evidence that art-based interventions are effective in reducing adverse physiological and psychological outcomes, the extent to which these interventions enhance health status is largely unknown. Our hope is to establish a foundation for continued investigation into this subject and to generate further interest in researching the complexities of engagement with the arts and health.

Unipedal standing exercise and hip bone mineral density in postmenopausal women: a randomized controlled trial

The aim of this study was to test the effect of unipedal standing exercise on bone mineral density (BMD) of the hip in postmenopausal women. Japanese postmenopausal women (n = 94) were assigned at random to an exercise or control group (no exercise). The 6-month exercise program consisted of standing on a single foot for 1 min per leg 3 times per day. BMD of the hip was measured by dual-energy X-ray absorptiometry. There was no significant difference in age and baseline hip BMD between the exercise group (n = 49) and control group (n = 45). Exercise did not improve hip BMD compared with the control group. Stepwise regression analysis identified old age as a significant determinant (p = 0.034) of increased hip total BMD at 6 months after exercise. In 31 participants aged >/=70 years, the exercise group (n = 20) showed significant increase in the values of hip BMD at the areas of total (p = 0.008), intertrochanteric (p = 0.023), and Ward's triangle (p = 0.032). The same parameters were decreased in the control group (n = 11). The percent changes in hip BMD of the exercise group were not significantly different from those of the control group either in the participants with low baseline hip total BMD (<80% of the young adult mean) or high baseline hip total BMD (> or =80% of the young adult mean). In conclusion, unipedal standing exercise for 6 months did not improve hip BMD in Japanese postmenopausal women. Effect of exercise on hip total BMD was age dependent. In participants aged > or =70 years, the exercise significantly increased hip total BMD.

Eight-week traditional mat Pilates training-program effects on adult fitness characteristics

We investigated responses of adult, novice practitioners (n = 9) to an 8-week traditional mat Pilates program (P) that met 1 hr/day three times/week. Classes consisted primarily of beginner and intermediate level exercises. Compared to an active control group (C; n = 13) that showed no improvements, those in P significantly (p < .05) improved relative body fat (-1.2% BF), sit-and-reach (+7.5 cm), shoulder reach (+6.9 cm), curl-up (+14 reps), and low back extension (+7 reps) scores, as well as circumferences at the waist (-2.7 cm), chest (-1.7 cm), and arm (-0.5 cm). Baseline differences were noted only for curl-ups and low back extensions, with P being lower than C Body composition, muscular endurance, and flexibility significantly improved after 8 weeks of traditional mat Pilates.

[Evaluation of the state intervention project to improve quality of life and reduce the complications associated with aging: "Add health to your years"]

OBJECTIVE

This paper evaluates the effectiveness of a Public Health program for the elderly based on health promotion and pathologies prevention, in order to avoid complications associated with illnesses and improves the quality of life (QOL) in elderly adults (EA).

METHODS

A 12 month intervention studies used 700 EA randomized in 2 groups: intervention and control. Each group was submitted to pre-post intervention measurements that included weight, height, blood pressure (BP), cholesterol, lipids, glycaemia, cardiovascular (infarct, stroke) and bone fractures events, hospitalization, and a QOL survey. Intervention consisted of periodic physical activity to fortify muscular groups, as well as recreational activities, nutritional and food manipulation training visits. A medical student was assigned to each participant from the intervention group to assure periodical contact and to share activities. The control group continued with their normal activities during observational period.

RESULTS

The intervention group showed a significant reduction in the BP, lipids and cholesterol values compared to control group. Reduction on cardiovascular events (-31%), hip fractures (-18.2%) and number of hospital admittance (-21.1%) were obtained for group A in relation to B. The QOL survey showed 28.7% improvement for group A compared with 33.4% improvement compared with control group.

CONCLUSION

The health program with exhaustive follow-up administration, significantly reduced risk factors and complications associated with aging.