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Bradley SS, de Holanda LJ, Chau T, Wright FV. Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments. Front Neurosci 2024; 18:1398459. [PMID: 39145294 PMCID: PMC11322617 DOI: 10.3389/fnins.2024.1398459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm. Methods This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents. Discussion This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention. Clinical trial registration https://clinicaltrials.gov, identifier NCT05463211.
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Affiliation(s)
- Stefanie S. Bradley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Tom Chau
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Di Bonaventura S, Fernández Carnero J, Ferrer-Peña R. Can a specific biobehavioral-based therapeutic education program lead to changes in pain perception and brain plasticity biomarkers in chronic pain patients? A study protocol for a randomized clinical trial. PLoS One 2024; 19:e0289430. [PMID: 38241249 PMCID: PMC10798500 DOI: 10.1371/journal.pone.0289430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Chronic pain conditions are complex multifactorial disorders with physical, psychological, and environmental factors contributing to their onset and persistence. Among these conditions, the role of brain-derived neurotrophic factor (BDNF) and the impact of a specific therapeutic education (TE) on pain management have emerged as important areas of research. OBJECTIVE This study aims to investigate the effects of a specific type of therapeutic education on pain levels and BDNF concentrations. METHODS In this single-blind, randomized clinical trial, patients will be randomly assigned to one of two groups: one will receive exercise with TE and the other without TE. Assessments will be made at baseline, mid-treatment, post-intervention, and at one and eight months. OUTCOMES This study will shed light on the effectiveness of a therapeutic education (TE) program in pain management. Additionally, it will provide information on its effects on BDNF levels, a biomarker of brain plasticity, as well as on various psychosocial variables that can influence pain experience. CONCLUSION By comprehensively addressing the need to quantify brain changes more precisely in individuals with chronic pain during interventions like TE and recognizing the importance of establishing a more structured and comprehensive protocol, this study lays a solid and replicable foundation for future evidence-based treatment developments.
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Affiliation(s)
- Silvia Di Bonaventura
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Josué Fernández Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain
| | - Raúl Ferrer-Peña
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
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Xue X, Lu R, Li H, Chen Z, Sheng D, Jin Z, Liu S, Liu A, Yan X, Tang W, Chen S, Hua Y. In Vivo Characterization of Cerebellar Peduncles in Chronic Ankle Instability: A Single and Multishell Diffusion-Weighted Imaging Study. Sports Health 2024; 16:38-46. [PMID: 38112261 PMCID: PMC10732106 DOI: 10.1177/19417381231156544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Ankle sprain causes proprioceptor injuries and prolonged joint deafferentation, which might lead to maladaptive neuroplasticity in patients with chronic ankle instability (CAI), especially in the cerebellum. Previous studies have indicated the impairment of superior cerebellar peduncle (SCP), but the inferior cerebellar peduncle (ICP) and middle cerebellar peduncle (MCP) have not been fully analyzed. HYPOTHESIS The cerebellar peduncles of participants with CAI would have altered fractional anisotropy (FA) and orientation dispersion index (ODI) in comparison with healthy controls without ankle injury history. In addition, FA and ODI would be correlated with the duration or severity of the sensorimotor deficits in CAI. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A group of 27 participants with CAI and 26 healthy controls underwent diffusion-weighted imaging scanning, with the cerebellar peduncles as the regions of interest. The measures obtained by single-shell diffusion tensor imaging and the multishell neurite orientation dispersion and density imaging were used. Correlation analyses were performed to examine the potential relationship between the FA/ODI and both the normalized Y-balance scores and the durations of ankle instability. RESULTS The ipsilateral ICP of the injured ankle in participants with CAI showed significantly lower FA (Cohen d 95% CI, -1.33 to -0.21; P = 0.04) and marginally significant higher ODI (Cohen d 95% CI, 0.10 to 1.20, P = 0.08) when compared with the same measures in the control group, with the ODI being positively correlated with the duration of ankle instability (r = 0.42, P = 0.03). CONCLUSION The ICP in participants with CAI exhibited impaired integrity and a trend of abnormally organized neurites in comparison with a healthy control group. CLINICAL RELEVANCE The impairments of ICP might be an ongoing part of the pathological process of CAI, having the potential to become a target for the diagnostic evaluation of this clinical entity.
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Affiliation(s)
- Xiao’ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ziyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyin Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ailin Liu
- Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Yan
- Scientific Marketing, Siemens Healthcare Ltd., Shanghai, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Gutiérrez Espinoza H, Araya-Quintanilla F, Pinto-Concha S, Valenzuela-Fuenzalida J, López-Gil JF, Ramírez-Velez R. Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial. BMJ Open Sport Exerc Med 2023; 9:e001646. [PMID: 37780129 PMCID: PMC10537831 DOI: 10.1136/bmjsem-2023-001646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives Current evidence on the clinical effectiveness about the different types of exercises in the subacromial impingement syndrome (SIS) remains controversial. This study aims to compare the short-term (at 5 weeks) effects of a specific exercise programme with a general exercise programme on shoulder function in adults with SIS. Methods In total, 52 adults with SIS were randomly allocated to 5 weeks to perform specific exercises (experimental group, n=26) or general exercises (control group, n=26). The primary outcome was change in shoulder function, it was assessed using the Shoulder Pain and Disability Index (SPADI) from baseline to 5 weeks. Secondary end points included changes in upper limb function (Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire), pain intensity (Visual Analog Scale (VAS)) and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)). Results All participants completed the trial. The between-group differences at 5 weeks were: SPADI, 13.5 points (95% CI: 4.3 to 15.6; ƞ2=0.22; p=0.001); DASH, 10.1 points (95% CI: 5.6 to 15.2; ƞ2=0.27; p<0.001); VAS at rest, 0.2 cm (95% CI: 0.1 to 0.3; ƞ2=0.07; p=0.553); VAS on movement, 1.7 cm (95% CI: 0.9 to 2.2; ƞ2=0.24; p<0.001); and TSK, 16.3 points (95% CI: 13.2 to 15.3; ƞ2=0.33; p<0.001). All differences favoured the experimental group and effect sizes were medium to large for most outcomes. Mediation analyses showed that the effect of the specific exercises on shoulder function was mediated by kinesiophobia (β=2.800; 95% CI: 1.063 to 4.907) and pain on movement (β= -0.690; 95% CI: -1.176 to -0.271). Conclusion In adults with SIS, specific exercises may have a larger effect than general exercises. However, most differences did not reach the minimum threshold to be considered clinically important and the evidence to support exercise as standard treatment warrant further study. Trial registration number Brazilian Registry of Clinical Trials UTN number U111-1245-7878. Registered on 17 January 2020 (https://ensaiosclinicos.gov.br/rg/RBR-4d5zcg).
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Affiliation(s)
| | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Salud, Universidad San Sebastián, Santiago, Chile
| | | | - Juan Valenzuela-Fuenzalida
- Department of Morphology and Function, Faculty of Health Sciences, University of Americas, Santiago, Chile
- Departamento de Ciencias Químicas y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago, Chile
| | - José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- One Health Research Group, Universidad de las Americas, Quito, Ecuador
| | - Robinson Ramírez-Velez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Anging (CIBERFES), Instituto Carlos III, Madrid, Spain
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Tan J, Li J, Lei J, Lu S, Feng Y, Ma T, Luan L, Adams R, Song Y, Han J, Zou Y. Effects of whole-body vibration on sensorimotor deficits and brain plasticity among people with chronic ankle instability: a study protocol for a single-blind randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:88. [PMID: 37464427 DOI: 10.1186/s13102-023-00698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a form of musculoskeletal disease that can occur after a lateral ankle sprain, and it is characterized by pain, recurrent ankle sprains, a feeling of "giving way" at the ankle joint, and sensorimotor deficits. There has been increasing evidence to suggest that plastic changes in the brain after the initial injury play an important role in CAI. As one modality to treat CAI, whole-body vibration (WBV) has been found to be beneficial for treating the sensorimotor deficits accompanying CAI, but whether these benefits are associated with brain plasticity remains unknown. Therefore, the current study aims to investigate the effect of WBV on sensorimotor deficits and determine its correlation with plastic changes in the brain. METHODS The present study is a single-blind randomized controlled trial. A total of 80 participants with CAI recruited from the university and local communities will be divided into 4 groups: whole-body vibration and balance training (WBVBT), balance training (BT), whole-body vibration (WBV), and control group. Participants will be given the WBV intervention (25-38 Hz, 1.3-2 mm, 3-time per week, 6-week) supervised by a professional therapist. Primary outcome measures are sensorimotor function including strength, balance, proprioception and functional performance. Brain plasticity will be evaluated by corticomotor excitability, inhibition, and representation of muscles, as measured by transcranial magnetic stimulation. Activation of brain areas will be assessed through functional near-infrared spectroscopy. Secondary outcome measures are self-reported functional outcomes involving the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure. All tests will be conducted before and after the WBV intervention, and at 2-week follow-up. Per‑protocol and intention-to-treat analysis will be applied if any participants withdraw. DISCUSSION This is the first trial to investigate the role of brain plasticity in sensorimotor changes brought by WBV for individuals with CAI. As plastic changes in the brain have been an increasingly important aspect in CAI, the results of the current study can provide insight into the treatment of CAI from the perspective of brain plasticity. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2300068972); registered on 02 March 2023.
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Affiliation(s)
- Jingwang Tan
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Jiatao Li
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Jianbin Lei
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Shuyi Lu
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Yongjian Feng
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Tao Ma
- School of Elite Sport, Shanghai University of Sport, Shanghai, China
| | - Lijiang Luan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Yagang Song
- Department of Physical Education Teaching, Shanghai Sanda University, Shanghai, China
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, 279 Zhouzhu Highway, Shanghai, 201318, China.
- Faculty of Health, Arts and Design, Swinburne University of Technology, VIC, Hawthorn, Australia.
| | - Yu Zou
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China.
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Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Weaker Quadriceps Corticomuscular Coherence in Individuals after ACL Reconstruction during Force Tracing. Med Sci Sports Exerc 2023; 55:625-632. [PMID: 36730761 DOI: 10.1249/mss.0000000000003080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare quadriceps corticomuscular coherence (CMC) and force steadiness between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a force tracing task. METHODS Individuals with ACLR ( n = 20) and controls ( n = 20) performed a knee extension force-control task at 50% of maximal voluntary effort. Electrocortical activity, electromyographic activity, and torque output were recorded concurrently. CMC in beta (13-30 Hz) and gamma (31-80 Hz) frequency bands was assessed using partial directed coherence between the contralateral motor cortex (e.g., C4-C2-Cz electrodes) and the ipsilateral quadriceps muscles (e.g., left vastus medialis and lateralis). Force steadiness was quantified using root-mean-square error and coefficient of variation. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) were assessed using peak knee extension strength and active motor threshold as a priori covariates. RESULTS Participants with ACLR had lower gamma band connectivity bilaterally when compared with controls (vastus medialis: d = 0.8; vastus lateralis: d = 0.7). Further, the ACLR group demonstrated worse quadriceps force steadiness (root-mean-square error, d = 0.5), lower involved limb quadriceps strength ( d = 1.1), and higher active motor threshold ( d = 1.0) compared with controls. CONCLUSIONS Lower quadriceps gamma band CMC in the ACLR group suggests lower cortical drive (e.g., corticomotor decoupling) to the quadriceps compared with matched controls. Further, the ACLR group demonstrated worse quadriceps force steadiness, suggesting impaired ability to modulate quadriceps neuromuscular control. Notably, CMC differences were present only in the gamma frequency band, suggesting impairments may be specific to multisensory integration and force modulation.
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Affiliation(s)
| | - Jochen Baumeister
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, GERMANY
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL
| | - Amanda M Murray
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
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ERTURAN S, BURAK M, ELBASAN B. Eylem Gözlem Terapisi ile Unilateral Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin Geliştirilmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1094792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Eylem Gözlem Terapisi (EGT) hareketlerin izlenmesi sonrası aynı hareketlerin taklit edilmesi ile merkezi sinir sistemi restorasyonunu destekleyen nörorehabilitasyon temelli bir tedavi yaklaşımıdır. Serebral palsi, parkinson, inme, ortopedik yaralanmalar, alzheimer ve konuşma bozuklukları gibi pek çok hastalıkta, fonksiyonu gerçekleştiren nöral yapıları aktive etmek için nörofizyolojik mekanizmadan yararlanan yeni bir rehabilitasyon yaklaşımı olarak bilinir. Sağlıklı bireylerde ve nörolojik veya ortopedik etkilenimi olan bireylerde yapılan araştırmalar; EGT uygulamasının gözlemcinin motor sisteminde kolaylaştırmayı indüklediği ve eylem-algı eşleştirme mekanizmasını desteklediği bilinir. Bu derleme, Serebral Palsi (SP) tanılı çocuklarda üst ekstremiteye yönelik uygulanan EGT programlarının kullanımı ve etkinliği ile ilgili mevcut bilgileri gözden geçirmek amacıyla planlanmıştır. EGT kullanımının farklı koşullara kolayca adapte edilebilmesi, nöral plasitisiteyi destekleyerek motor öğrenmeyi fasilite etmesi ve ekonomik olması nedeniyle, SP’li çocukların üst ekstremite rehabilitasyonunda kullanımının uygun olduğu; ancak protokol, süre ve uygulama şekli açısından optimal uygulama prensiplerinin belirlenebilmesi için daha detaylı çalışmalara ihtiyaç olduğu düşünülmektedir.
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Affiliation(s)
- Sinem ERTURAN
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
| | - Mustafa BURAK
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
| | - Bülent ELBASAN
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Gutiérrez-Monclus R, Valenzuela-Fuenzalida J, Román-Veas J, Campos-Jara C. Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2022; 108:103323. [PMID: 35589085 DOI: 10.1016/j.otsr.2022.103323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/25/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to determine whether surgical treatment is more effective than conservative treatment in terms of functional outcomes in elderly patients with distal radius fractures (DRFs). METHODS An electronic search of the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases was performed, from inception until July 2021. The eligibility criteria for selecting studies were randomized clinical trials that compared surgical versus conservative treatment in subjects older than 60 years with DRFs. Two authors independently performed the search, data extraction, and assessed risk of bias (RoB) using the Cochrane RoB tool. RESULTS Twelve trials met the eligibility criteria, and nine studies were included in the quantitative synthesis. For volar plate versus cast immobilization at 1-year follow-up, the mean difference (MD) for PRWE was -5.36 points (p=0.02), for DASH was -4.03 points (p=0.02), for grip strength was 8.32% (p=0.0004), for wrist flexion was 4.35 degrees (p=0.10), for wrist extension was -1.52 degrees (p=0.008), for pronation was 2.7 degrees (p=0.009), for supination was 4.88 degrees (p=0.002), and for EQ-VAS was 2.73 points (p=0.0007), with differences in favor of volar plate. For K-wire versus cast immobilization at 12 months, there were no statistically significant differences in wrist range of motion (p>0.05). CONCLUSIONS There was low to high evidence according to GRADE ratings, with a statistically significant difference in functional outcomes in favor of volar plate versus conservative treatment at 1-year follow-up. However, these differences are not minimally clinically important, suggesting that both types of management are equally effective in patients older than 60 years with DRFs. LEVEL OF EVIDENCE I; Therapeutic (Systematic review and meta-analysis of randomized clinical trials).
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha Street 700, Santiago, Chile.
| | - Felipe Araya-Quintanilla
- Rehabilitation in Health Research Center (CIRES), University of the Americas, Manuel Montt Avenue 948, Santiago, Chile
| | - Cristian Olguín-Huerta
- Rehabilitation in Health Research Center (CIRES), University of the Americas, Manuel Montt Avenue 948, Santiago, Chile
| | | | - Juan Valenzuela-Fuenzalida
- Departamento de Ciencias Químicas y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago, Chile
| | | | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha Street 700, Santiago, Chile
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Gibt es eine Wechselwirkung zwischen Ernährungsfaktoren und chronischen muskuloskelettalen Schmerzen? Eine systematische Übersichtsarbeit. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1867-3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chung YC, Chen CY, Chang CM, Lin YL, Liao KK, Lin HC, Chen WY, Yang YR, Shih YF. Altered corticospinal excitability of scapular muscles in individuals with shoulder impingement syndrome. PLoS One 2022; 17:e0268533. [PMID: 35576229 PMCID: PMC9109916 DOI: 10.1371/journal.pone.0268533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study is to assess and compare corticospinal excitability in the upper and lower trapezius and serratus anterior muscles in participants with and without shoulder impingement syndrome (SIS). Fourteen participants with SIS, and 14 without SIS were recruited through convenient sampling in this study. Transcranial magnetic stimulation assessment of the scapular muscles was performed while the participants were holding their arm at 90 degrees scaption. The motor-evoked potential (MEP), active motor threshold (AMT), latency of MEP, cortical silent period (CSP), activated area and center of gravity (COG) of cortical mapping were compared between groups using the Mann-Whitney U tests. The SIS group demonstrated following significances, higher AMTs of the lower trapezius (SIS: 0.60 ± 0.06; Comparison: 0.54 ± 0.07, p = 0.028) and the serratus anterior (SIS: 0.59 ± 0.04; Comparison: 0.54 ± 0.06, p = 0.022), longer CSP of the lower trapezius (SIS: 62.23 ± 22.87 ms; Comparison: 45.22 ± 14.64 ms, p = 0.019), and posteriorly shifted COG in the upper trapezius (SIS: 1.88 ± 1.06; Comparison: 2.76 ± 1.55, p = 0.048) and the serratus anterior (SIS: 2.13 ± 1.02; Comparison: 3.12 ± 1.88, p = 0.043), than the control group. In conclusion, participants with SIS demonstrated different organization of the corticospinal system, including decreased excitability, increased inhibition, and shift in motor representation of the scapular muscles.
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Affiliation(s)
- Ya-Chu Chung
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Ying Chen
- School of Physical Therapy, Chang Gung University, Tao-Yuan City, Taiwan
| | - Chia-Ming Chang
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Yin-Liang Lin
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kwong-Kum Liao
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Wen-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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11
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Brown MR, Personius KE, Langan J. Participants with mildly-disabling chronic neck pain perform differently during explicit compared to implicit motor learning of a reaching task. PLoS One 2022; 17:e0266508. [PMID: 35390088 PMCID: PMC8989223 DOI: 10.1371/journal.pone.0266508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 03/22/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic musculoskeletal (CMSK) pain associated with musculoskeletal disorders like low back pain or neck pain are the leading causes of disability. While CMSK pain has the potential to negatively influence motor learning, there is limited research to understand the impact of CMSK on motor learning. In order to examine differences in motor learning between individuals with and without CMSK we modified a serial reaction time task to assess motor learning of a repetitive reaching task. The paradigm was used to assess both explicit and implicit motor learning. In a cross-sectional study design, seventeen participants with chronic neck pain (CNP) (5 males) and 21 controls (8 males) were recruited. In addition, physical, cognitive, sensorimotor, disability and pain assessments were used to examine differences between individuals with and without CNP. All participants with CNP were categorized as having mild disability. There was no difference in cognitive assessments and minimal differences in physical measures between groups. Examining motor learning, groups with and without CNP demonstrated similar outcomes in both explicit and implicit motor learning. There was one notable performance difference between groups in the reaching task, the group with CNP demonstrated slower reaching movements outward and inward during blocks without explicit information. This may suggest a cautious approach to movement with reduced explicit information. Findings from this study provide insight on motor learning in individuals with mildly-disabling CNP, further research is necessary to examine how instruction can impact peak performance in people with CMSK pain.
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Affiliation(s)
- Michael R. Brown
- Rehabilitation Science Department, School of Public Health and Health Professions, University at Buffalo SUNY, Buffalo, New York, United States of America
- * E-mail:
| | - Kirkwood E. Personius
- Rehabilitation Science Department, School of Public Health and Health Professions, University at Buffalo SUNY, Buffalo, New York, United States of America
| | - Jeanne Langan
- Rehabilitation Science Department, School of Public Health and Health Professions, University at Buffalo SUNY, Buffalo, New York, United States of America
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12
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2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. J Orthop Sports Phys Ther 2022; 52:11-28. [PMID: 34972489 DOI: 10.2519/jospt.2022.10952] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952.
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Lee R, James C, Edwards S, Skinner G, Young JL, Snodgrass SJ. Evidence for the Effectiveness of Feedback from Wearable Inertial Sensors during Work-Related Activities: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:6377. [PMID: 34640695 PMCID: PMC8512480 DOI: 10.3390/s21196377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 01/03/2023]
Abstract
Background: Wearable inertial sensor technology (WIST) systems provide feedback, aiming to modify aberrant postures and movements. The literature on the effects of feedback from WIST during work or work-related activities has not been previously summarised. This review examines the effectiveness of feedback on upper body kinematics during work or work-related activities, along with the wearability and a quantification of the kinematics of the related device. Methods: The Cinahl, Cochrane, Embase, Medline, Scopus, Sportdiscus and Google Scholar databases were searched, including reports from January 2005 to July 2021. The included studies were summarised descriptively and the evidence was assessed. Results: Fourteen included studies demonstrated a 'limited' level of evidence supporting posture and/or movement behaviour improvements using WIST feedback, with no improvements in pain. One study assessed wearability and another two investigated comfort. Studies used tri-axial accelerometers or IMU integration (n = 5 studies). Visual and/or vibrotactile feedback was mostly used. Most studies had a risk of bias, lacked detail for methodological reproducibility and displayed inconsistent reporting of sensor technology, with validation provided only in one study. Thus, we have proposed a minimum 'Technology and Design Checklist' for reporting. Conclusions: Our findings suggest that WIST may improve posture, though not pain; however, the quality of the studies limits the strength of this conclusion. Wearability evaluations are needed for the translation of WIST outcomes. Minimum reporting standards for WIST should be followed to ensure methodological reproducibility.
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Affiliation(s)
- Roger Lee
- School of Health Sciences, The University of Newcastle, Newcastle 2308, Australia; (C.J.); (S.J.S.)
- Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle 2308, Australia
| | - Carole James
- School of Health Sciences, The University of Newcastle, Newcastle 2308, Australia; (C.J.); (S.J.S.)
- Centre for Resources Health and Safety, The University of Newcastle, Newcastle 2308, Australia
| | - Suzi Edwards
- School of Health Sciences, The University of Sydney, Sydney 2006, Australia;
| | - Geoff Skinner
- School of Information and Physical Sciences, The University of Newcastle, Newcastle 2308, Australia;
| | - Jodi L. Young
- Department of Physical Therapy, Bellin College, Green Bay, WI 54311, USA;
| | - Suzanne J. Snodgrass
- School of Health Sciences, The University of Newcastle, Newcastle 2308, Australia; (C.J.); (S.J.S.)
- Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle 2308, Australia
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Lateral ankle instability-induced neuroplasticity in brain grey matter: A voxel-based morphometry MRI study. J Sci Med Sport 2021; 24:1240-1244. [PMID: 34281769 DOI: 10.1016/j.jsams.2021.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The deficits in sensory pathways caused by peripheral edema, pain, and inflammation of the damaged ligaments may induce maladaptive changes within the central nervous system. The purpose of this study was to determine whether patients with lateral ankle instability (LAI) exhibit morphological differences of brain grey matter when compared with healthy controls, and then assess the relationships between the observed differences and the characteristics of patients. DESIGN Cross-sectional. METHODS Thirty patients with LAI and 32 healthy controls without LAI underwent MRI scans using anatomical T1 sequences. A voxel-wise general linear model was used to compare the grey matter volume throughout the whole brain between patients and controls. Linear regression analyses were performed for the grey matter volume within the significant clusters to assess their relationship with age, sex, the existence of acute injury, pain level, sports activity level, and the duration of LAI within the patient group. RESULTS The grey matter volume of a cluster within the cerebellar vermis (Vermis_4_5 in automated anatomical labeling template) was significantly reduced in patients with LAI (Gaussian Random Field corrections with two-tailed p-cluster < 0.05 and p-voxel < 0.001). Multivariate linear regression analysis revealed that the duration of LAI tended to be passively associated with the grey matter volume of this LAI-related vermal cluster (p = 0.092). CONCLUSIONS Participants with LAI exhibited a reduced grey matter volume of a cluster within the cerebellar vermis compared with participants without LAI, and the degree of volume reduction tended to be positively associated with the duration of LAI.
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Ryan D, Fullen B, Rio E, Segurado R, Stokes D, O’Sullivan C. Effect of Action Observation Therapy in the Rehabilitation of Neurologic and Musculoskeletal Conditions: A Systematic Review. Arch Rehabil Res Clin Transl 2021; 3:100106. [PMID: 33778479 PMCID: PMC7984987 DOI: 10.1016/j.arrct.2021.100106] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the effect of action observation therapy (AOT) in the rehabilitation of neurologic and musculoskeletal conditions. DATA SOURCES Searches were completed until July 2020 from the electronic databases Allied and Complementary Medicine Database (via OVID SP), Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, MEDLINE, and the Physiotherapy Evidence Database. STUDY SELECTION Randomized controlled trials comparing AOT with standard care were assessed. Musculoskeletal (amputee, orthopedic) and neurologic (dementia, cerebral palsy, multiple sclerosis, Parkinson disease, stroke) conditions were included. There were no age limitations. Articles had to be available in English. DATA EXTRACTION Two reviewers independently screened titles, abstracts and full extracts of studies for eligibility and assessed the risk of bias of each study using the Cochrane Risk of Bias Tool. Data extraction included participant characteristics and intervention duration, frequency, and type. RESULTS The effect of AOT in different outcome measures (OMs) was referenced in terms of body structures and functions, activities and participation, and environmental factors as outlined by the International Classification of Functioning, Disability, and Health (ICF). Of the 3448 articles identified, 36 articles with 1405 patients met the inclusion criteria. Seven of the 11 meta-analyses revealed a significant effect of intervention, with results presented using the mean difference and 95% CI. A best evidence synthesis was used across all OMs. Strong evidence supports the use of AOT in the rehabilitation of individuals with stroke and Parkinson disease; moderate evidence supports AOT in the rehabilitation of populations with orthopedic and multiple sclerosis diagnoses. However, moderate evidence is provided for and against the effect of AOT in persons with Parkinson disease and cerebral palsy. CONCLUSIONS This review suggests that AOT is advantageous in the rehabilitation of certain conditions in improving ICF domains. No conclusions can be drawn regarding treatment parameters because of the heterogeneity of the intervention. AOT has been considerably less explored in musculoskeletal conditions.
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Key Words
- 10MWT, 10-m walk test
- ADL, activities of daily living
- AHA, Assisting Hand Assessment
- AOT, action observation therapy
- BBS, Berg Balance Scale
- BBT, Box and Block Test
- FOG, freezing of gait
- ICF, International Classification of Functioning Disability, and Health
- MAS, Modified Ashworth Scale
- MCID, minimum clinically important difference
- MD, mean difference
- MDC, minimal detectable change
- MI, motor imagery
- MNS, mirror neuron system
- MUUL, Melbourne Assessment of Unilateral Upper Limb Function
- Neuronal plasticity
- OM, outcome measures
- PDQ-39, 39-item Parkinson Disease Questionnaire
- ROM, range of motion
- Rehabilitation
- RoB, risk of bias
- SF-36, Short Form-36 Health Survey
- Systematic review
- TUG, Timed Up and Go
- UPDRS, Unified Parkinson Disease Rating Scale
- VAS, Visual Analog Scale
- WOMAC, Western Ontario McMaster Universities Osteoarthritis Index
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Affiliation(s)
- Deirdre Ryan
- UCD School of Public Health, Physiotherapy, and Sports Science, Dublin, Ireland
| | - Brona Fullen
- UCD School of Public Health, Physiotherapy, and Sports Science, Dublin, Ireland
| | - Ebonie Rio
- School of Allied Health, La Trobe University Melbourne, Melbourne, Victoria, Australia
| | - Ricardo Segurado
- UCD School of Public Health, Physiotherapy, and Sports Science, Dublin, Ireland
| | | | - Cliona O’Sullivan
- UCD School of Public Health, Physiotherapy, and Sports Science, Dublin, Ireland
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16
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Whife CJ, Vallence AM, Edgar DW, Wood FM. Decreased neuroplasticity in minor burn injury survivors compared to non-injured adults: A pilot study in burn injury survivors aged 45 years and older. Burns 2020; 47:327-337. [PMID: 33288329 DOI: 10.1016/j.burns.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuroplasticity is the capacity of the brain to change or adapt with experience: brain changes occur with use, disuse, and injury. Repetitive transcranial magnetic stimulation (rTMS) can be used to induce neuroplasticity in the human brain. Here, we examined rTMS-induced neuroplasticity in the primary motor cortex in burns survivors and controls without injury, and whether neuroplasticity is associated with functional recovery in burns survivors. METHODS Sixteen burn injury survivors (total body surface area of burn injury <15%) and 13 non-injured control participants were tested. Repetitive TMS (specifically, spaced continuous theta-burst stimulation[cTBS]) was applied to induce neuroplasticity 6 and 12 weeks after injury in burn survivors and in two sessions separated by 6 weeks in controls. Motor evoked potentials (MEPs) elicited by single-pulse TMS were measured before and after rTMS to measure neuroplasticity. Burns survivors completed a functional assessment 12 weeks after injury. RESULTS Non-injured controls showed decreased MEP amplitude 15-30 min after spaced cTBS in both experimental sessions. Burn survivors showed a smaller change in MEP amplitude after spaced cTBS compared to controls 6 weeks after burn injury but no difference compared to controls 12 weeks after burn injury. In burn survivors, there was a significant positive association between general health outcome (Short-Form Health Survey) and the change in MEP amplitude after spaced cTBS 12 weeks after injury (r=.73, p = .01). CONCLUSIONS The current findings suggest that burn survivors have a reduced capacity for neuroplasticity early in the recovery period (6 weeks after injury), which normalizes later in the recovery period (12 weeks after injury). Furthermore, the results provide preliminary evidence to suggest that burn survivors with normalized neuroplasticity 12 weeks after injury recover faster after burn injury.
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Affiliation(s)
- Casey J Whife
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Ann-Maree Vallence
- Psychology, Murdoch University, Western Australia, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia.
| | - Dale W Edgar
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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17
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Ganesh GS, Kaur P, Meena S. Systematic reviews evaluating the effectiveness of motor control exercises in patients with non-specific low back pain do not consider its principles - A review. J Bodyw Mov Ther 2020; 26:374-393. [PMID: 33992272 DOI: 10.1016/j.jbmt.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/11/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Motor control exercise (MCEs), spinal stabilization or core stability exercises were developed with the aim of restoring the coordination, control, and capacity of the trunk muscles and systematic reviews (SR) evaluating their effectiveness has shown conflicting results. This we hypothesized was due to the non-consideration of principles of neuroplasticity. The objective of this review was to review the operating definitions used in these reviews for these exercises and evaluate if these reviews have considered and satisfied the principles of these exercises in persons with NSLBP, both acute and chronic. METHODS The available evidence to address the research question was sought in the reviews published in English between January 2006 and April 2019 using the population, intervention, comparison, and outcome format. Data were extracted against the following factors: satisfy the principles of specific inclusion criteria; interventions; experience-dependent plasticity; and measure any one of the concepts of motor control. The quality of the evidence obtained was graded using the National Institute for Health and Care Excellence protocol and the quality of SRs evaluated using the R-AMSTAR. RESULTS Eleven reviews on core stability/spinal stabilization exercises and four reviews on MCE were considered in this review. The results showed that most of the studies considered by the reviews did not adhere to the principles of these exercises. CONCLUSION There is wide heterogeneity in the understanding, administration, and progression of exercises. The exercises were implemented without considering the potential for neuroplasticity of the nervous system and the principles of motor learning.
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Affiliation(s)
- G Shankar Ganesh
- Composite Regional Centre for Skill Development, Rehabilitation and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India.
| | | | - Sadhana Meena
- Department of Physiotherapy, Sports Injury Centre, Safdarjung Hospital, New Delhi, India.
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18
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Pelletier R, Purcell-Levesque L, Girard MC, Roy PM, Leonard G. Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study. J Pain Res 2020; 13:2013-2021. [PMID: 32821153 PMCID: PMC7423354 DOI: 10.2147/jpr.s256700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/17/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Older adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program. Patients and Methods A retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤0.01 was considered as statistically significant. Results The TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= −0.16 to 0.15, all p-values >0.10). Conclusion These results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.
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Affiliation(s)
- R Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - L Purcell-Levesque
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada
| | - M-C Girard
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada
| | - P-M Roy
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada
| | - G Leonard
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Worsfold C. Functional rehabilitation of the neck. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1759176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Chris Worsfold
- MSK Research Unit, University of Hertfordshire, Hatfield, Hertfordshire, UK
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20
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Galan-Martin MA, Montero-Cuadrado F, Lluch-Girbes E, Coca-López MC, Mayo-Iscar A, Cuesta-Vargas A. Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial. J Clin Med 2020; 9:E1201. [PMID: 32331323 PMCID: PMC7230486 DOI: 10.3390/jcm9041201] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic musculoskeletal pain affects more than 20% of the population, leading to high health care overload and huge spending. The prevalence is increasing and negatively affects both physical and mental health, being one of the leading causes of disability. The most common location is the spine. Most treatments used in the Public Health Services are passive (pharmacological and invasive) and do not comply with current clinical guidelines, which recommend treating pain in primary care (PC) with education and exercise as the first-line treatments. A randomized multicentre clinical trial has been carried out in 12 PC centres. The experimental group (EG) conducted a program of pain neuroscience education (6 sessions, 10 h) and group physical exercise with playful, dual-tasking, and socialization-promoting components (18 sessions in 6 weeks, 18 h), and the control group performed the usual physiotherapy care performed in PC. The experimental treatment improved quality of life (d = 1.8 in physical component summary), catastrophism (d = 1.7), kinesiophobia (d = 1.8), central sensitization (d = 1.4), disability (d = 1.4), pain intensity (d = 3.3), and pressure pain thresholds (d = 2). Differences between the groups (p < 0.001) were clinically relevant in favour of the EG. Improvements post-intervention (week 11) were maintained at six months. The experimental treatment generates high levels of satisfaction.
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Affiliation(s)
- Miguel Angel Galan-Martin
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and León Public Health System (Sacyl), 47011 Valladolid, Spain; (M.A.G.-M.); (F.M.-C.)
- Doctoral Program of Research in Health Sciences, University of Valladolid, 47005 Valladolid, Spain
| | - Federico Montero-Cuadrado
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and León Public Health System (Sacyl), 47011 Valladolid, Spain; (M.A.G.-M.); (F.M.-C.)
| | - Enrique Lluch-Girbes
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Human Physiology and Rehabilitation Sciences, Faculty of Physiotherapy, Vrije University Brussels, B-1050 Brussels, Belgium
| | | | - Agustín Mayo-Iscar
- Department of Statistics and Operational Research and IMUVA, University of Valladolid, 47005 Valladolid, Spain
| | - Antonio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Heath Sciences, University of Malaga, 19071 Málaga, Spain
- Institute of Biomedical Research in Malaga. IBIMA, 29010 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, QLD 4000, Australia
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Heneghan NR, Lokhaug SM, Tyros I, Longvastøl S, Rushton A. Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis. BMJ Open Sport Exerc Med 2020; 6:e000713. [PMID: 32341799 PMCID: PMC7173996 DOI: 10.1136/bmjsem-2019-000713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The thoracic spine is critical for athletic kinetic chain functioning yet widely overlooked in terms of specific evidenced-based exercise prescription. Thoracic mobility, motor control and strength are required to optimise performance in sport and minimise excessive load/stress on other components of the kinetic chain. OBJECTIVE To identify and evaluate mobility, motor control, work capacity and strength thoracic exercises for use in athletes. DESIGN Systematic review involving expert reviewers at key stages: searches and screening (n=1), eligibility, evaluation, data extraction and evaluation (n=3). Key databases and social media sources were searched to 16 August 2019. Eligible exercises were thoracic exercises to promote mobility, motor control, work capacity and strength. A narrative synthesis enabled an outcome-based classification of exercises, with level of evidence of individual sources informing overall level of evidence for each outcome (Oxford Centre for Evidence-based Medicine). RESULTS From 2348 sources (social media, database searches and other sources), 38 exercises were included. Sources included images, video clips and written descriptions of exercises. Exercises targeting all planes of motion were evaluated and classified according to outcome. Exercises comprised functional and non-functional exercises for mobility (n=9), work capacity (n=15), motor control (n=7) and strength (n=7). Overall level of evidence for each outcome was level 5. CONCLUSION This synthesis and evaluation of exercises has captured the scope of thoracic exercises used in 'practice'. Evaluation against an expert-derived outcome-based classification provides practitioners with a framework to facilitate exercise prescription. Evaluation of validity and effectiveness of exercises on outcomes is now required.
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Affiliation(s)
- Nicola R Heneghan
- Centre of Precision Rehabiliation for Spinal Pain (CPR Spine), School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Svein M Lokhaug
- Centre of Precision Rehabiliation for Spinal Pain (CPR Spine), School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Helsefag, Norwegian Institute of Sport Medicine, Oslo, Norway
| | - Isaak Tyros
- Edgbaston Physiotherapy Clinic, Birmingham, UK
| | | | - Alison Rushton
- Centre of Precision Rehabiliation for Spinal Pain (CPR Spine), School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK
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Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. J Clin Med 2020; 9:jcm9030702. [PMID: 32150934 PMCID: PMC7141322 DOI: 10.3390/jcm9030702] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/19/2020] [Accepted: 02/29/2020] [Indexed: 12/12/2022] Open
Abstract
Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain. This review was conducted following the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines and was registered in PROSPERO with the registration number CRD42018110782. PubMed, Web of Science, and Embase online databases were searched. After screening titles and abstracts of 20,316 articles and full texts of 347 articles, 12 eligible articles were included in this review, consisting of nine experimental and three observational studies. Seven out of nine experimental studies reported a pain-relieving effect of dietary changes. Additionally, protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold. In conclusion, plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Pinto-Concha S, Zavala-González J, Gana-Hervias G, Cavero-Redondo I, Álvarez-Bueno C. Effectiveness of supervised early exercise program in patients with arthroscopic rotator cuff repair: Study protocol clinical trial. Medicine (Baltimore) 2020; 99:e18846. [PMID: 31977882 PMCID: PMC7004761 DOI: 10.1097/md.0000000000018846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Based on the available evidence, it is difficult to make a clinical decision about the best exercise program and to establish the most favorable time to start postoperative treatment after rotator cuff (RC) repair. The aim of this trial is to evaluate the effects of adding a supervised early exercise program to standard treatment for functional improvement and pain relief compared with standard treatment alone in patients with arthroscopic RC repair. METHOD/DESIGN A total of 118 patients between the ages of 18 and 50 years with arthroscopic RC repair will be randomized to 2 treatment arms. The control group will receive a standard exercise program based on a consensus statement on shoulder rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The intervention group will receive a supervised early exercise program in combination with standard treatment. This supervised exercise program will be based on electromyographic evidence. Three evaluations will be performed: before surgery, at 6 weeks, and at 12 weeks. The primary outcome measure will be the shoulder function by the Constant-Murley questionnaire, and the secondary outcome measures will be the upper limb function by the disabilities of the arm, shoulder, and hand questionnaire; pain by the visual analog scale; and the shoulder range of motion by a goniometer. DISCUSSION We hypothesize that patients who receive a supervised early exercise program in combination with standard treatment will benefit more in respect to shoulder function, pain reduction, and range of motion than those who receive a standard exercise program. If this is confirmed, our study can be used clinically to enhance the recovery of patients with arthroscopic RC repair. TRIAL REGISTRATION Brazilian registry of clinical trials UTN number U1111-1224-4143. Registered December 18, 2018.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Rehabilitation and Health Research Center, CIRES, University of the Americas
- Physical Therapy Department, Clinical Hospital San Borja Arriaran
| | - Felipe Araya-Quintanilla
- Rehabilitation and Health Research Center, CIRES, University of the Americas
- Faculty of Health Sciences, University SEK
| | | | - Jonathan Zavala-González
- Rehabilitation and Health Research Center, CIRES, University of the Americas
- Physical Therapy Department, Clinical Hospital San Borja Arriaran
| | - Gonzalo Gana-Hervias
- Adult Orthopedic Department, Clinical Hospital San Borja Arriaran, Santiago, Chile
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Mayor Sebastián Bullo, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
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Kafri M, Atun-Einy O. From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice. Phys Ther 2019; 99:1628-1643. [PMID: 31407003 DOI: 10.1093/ptj/pzz118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2018] [Accepted: 05/05/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. PURPOSE This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning-based interventions within each conceptual framework. DATA SOURCES The data sources used were PubMed, CINAHL, and PsychInfo databases. STUDY SELECTION Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. DATA EXTRACTION Twelve of 62 relevant articles met the inclusion criteria. DATA SYNTHESIS Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. LIMITATIONS Papers published before the year 2000 were excluded. CONCLUSION The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
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Atun-Einy O, Kafri M. Physical therapists' perspectives of the construct of motor learning, and their motor learning-based practice: a qualitative study. Physiother Theory Pract 2019; 37:1377-1390. [PMID: 31742466 DOI: 10.1080/09593985.2019.1693676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: The perceptions and beliefs of physical therapists play an important role in their clinical behavior. These clinician-related aspects may contribute to the knowledge-action gap in the field of motor learning (ML). Accordingly, this study explored how a sample of physical therapists perceive ML in their practice.Methods: A qualitative phenomenological study was conducted. Twelve physical therapists with a wide range of work experience were purposefully selected. Data were collected through semi-structured interviews and analyzed using content analysis methodology. Themes and categories were identified.Results: We identified five key themes: 1) 'ML within the scope of PT' showed that participants perceived ML as a fundamental part of the profession; 2) 'Understanding of ML' showed that participants had difficulty understanding the field comprehensively; 3) 'Self-efficacy toward the topic of ML' revealed that participants had low self-efficacy about their knowledge of the topic; 4) 'Features of ML implementation' showed that physical therapists tended to implement ML intuitively; and 5) 'Barriers to implementation and ways to facilitate it' showed that lack of knowledge was perceived as a main barrier to implementation.Conclusions: Physical therapists' perceptions of and experiences with ML showed the complexity of the field and the lack of clarity regarding its theoretical content and clinical applications. There is a need to reinforce knowledge of ML among physical therapists at different levels of professional development and to promote self-efficacy toward its use, possibly by increasing ML knowledge and education while emphasizing its clinical context.
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Affiliation(s)
- Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Galán-Martín MA, Montero-Cuadrado F, Lluch-Girbes E, Coca-López MC, Mayo-Iscar A, Cuesta-Vargas A. Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol. BMC Musculoskelet Disord 2019; 20:505. [PMID: 31679512 PMCID: PMC6825712 DOI: 10.1186/s12891-019-2889-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting. METHODS Randomised and multicentre clinical trials, which will be carried out in 10 Primary Care centres. The trial will compare the effect of a Pain Neuroscience Education program (six sessions, 10 h) and group physical exercise (18 sessions program carried out in six weeks, 18 h), with usual care physiotherapy treatment. Group physical exercise incorporates dual tasks, gaming, and reinforcement of contents of the educational program. The aim is to assess the effect of the intervention on quality of life, as well as on pain, disability, catastrophism, kinesiophobia, central sensitisation, and drug use. The outcome variables will be measured at the beginning of the intervention, after the intervention (week 11), at six months, and a year. DISCUSSION Therapeutic interventions based on active coping strategies are essential for the treatment of chronic pain and the sustainability of the Public Health System. Demonstrating whether group interventions have an effect size is essential for optimising resources in such a prevalent problem. TRIAL REGISTRATION NCT03654235 "Retrospectively registered" 31 August 2018.
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Affiliation(s)
- Miguel A. Galán-Martín
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and Leon Public Health System (Sacyl), Valladolid, Spain
- Doctoral Program of Research in Health Sciences, University of Valladolid, Valladolid, Spain
| | - Federico Montero-Cuadrado
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and Leon Public Health System (Sacyl), Valladolid, Spain
| | - Enrique Lluch-Girbes
- Department of Physical Therapy, University of Valencia, Valencia, Spain
- “Pain in motion” International Research Group, Brussels, Belgium
- Department of Human Physiology and Rehabilitation Sciences, Faculty of Physiotherapy, Vrije university Brussels, Brussels, Belgium
| | - M. Carmen Coca-López
- Castilla and Leon Regional Centre of Sports Medicine, Castilla and Leon Public Health System (Sacyl), Valladolid, Spain
| | - Agustín Mayo-Iscar
- Department of Statistics and Operational Research and IMUVA, University of Valladolid, Valladolid, Spain
| | - Antonio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Heath Sciences, University of Malaga, Málaga, Spain
- Institute of Biomedical Research in Malaga. IBIMA, Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Australia
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Whife CJ, Vallence AM, Edgar DW, Wood FM. No difference observed in short-interval intracortical inhibition in older burn-injury survivors compared to non-injured older adults: A pilot study. Burns 2019; 45:1131-1138. [DOI: 10.1016/j.burns.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022]
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Gutiérrez-Espinoza H, Tabach-Apraiz A, Oyanadel-Maldonado M. Physical therapy in patients with complex regional pain syndrome type I after distal radius fracture: a case series. J Phys Ther Sci 2019; 31:403-407. [PMID: 31037018 PMCID: PMC6451956 DOI: 10.1589/jpts.31.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/22/2019] [Indexed: 12/01/2022] Open
Abstract
[Purpose] To describe the effect of a physical therapy program in function improvement
and pain reduction in patients older than 60 years with complex regional pain syndrome
(CRPS) type I after distal radius fracture (DRF) treated conservatively. [Participants and
Methods] Fifty-four patients received a 6 weeks physical therapy program that included in
hydrotherapy, manual therapy, and exercises based on motor skill training. Two evaluations
were performed, the wrist/hand function was assessed with Patient-Rated Wrist Evaluation
(PRWE) questionnaire, the upper extremity function with the Disabilities of the Arm,
Shoulder and Hand (DASH) questionnaire, grip strength with Jamar Dynamometer, and pain
intensity with the Visual Analog Scale (VAS). [Results] At the end of the treatment, PRWE
showed a decrease of 30.9 points, DASH 34.7 points, and the VAS, 3.4 cm. The grip strength
showed an increase of 14.4%. [Conclusion] A physical therapy program based on
hydrotherapy, manual therapy, and exercises in a short term improves the function and
reduces the pain in patients older than 60 years with CRPS I after DRF treated
conservatively.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Physical Therapy School, University of the Americas: Echaurren St.140, 3rd floor, Santiago 8320000, Chile.,Physical Therapy Department, Clinical Hospital San Borja Arriaran, Chile
| | - Andrea Tabach-Apraiz
- Physical Medicine and Rehabilitation Department, Hospital San Juan de Dios, Chile
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Review of the Current Knowledge on the Role of Stem Cell Transplantation in Neurorehabilitation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3290894. [PMID: 30931325 PMCID: PMC6413404 DOI: 10.1155/2019/3290894] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/05/2018] [Accepted: 01/30/2019] [Indexed: 12/14/2022]
Abstract
The management involving stem cell (SC) therapy along with physiotherapy offers tremendous chance for patients after spinal cord injury (SCI), traumatic brain injury (TBI), stroke, etc. However, there are still only a limited number of reports assessing the impact of stem cells (SCs) on the rehabilitation process and/or the results of the simultaneous use of SC and rehabilitation. Additionally, since there is still not enough convincing evidence about the effect of SCT on humans, e.g., in stroke, there have been no studies conducted concerning rehabilitation program formation and expected outcomes. It has been shown that bone marrow-derived mesenchymal stem cell (BMSCs) transplantation in rats combined with hyperbaric oxygen therapy (HBO) can promote the functional recovery of hind limbs after SCI. An anti-inflammatory effect has been shown. One case study showed that, after the simultaneous use of SCT and rehabilitation, an SCI patient progressed from ASIA Grade A to ASIA Grade C. Such promising data in the case of complete tetraplegia could be a breakthrough in the treatment of neurologic disorders in humans. Although SCT appears as a promising method for the treatment of neurological conditions, e.g., complete tetraplegia, much work should be done towards the development of rehabilitation protocols.
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Piccoli A, Rossettini G, Cecchetto S, Viceconti A, Ristori D, Turolla A, Maselli F, Testa M. Effect of Attentional Focus Instructions on Motor Learning and Performance of Patients with Central Nervous System and Musculoskeletal Disorders: a Systematic Review. J Funct Morphol Kinesiol 2018; 3:E40. [PMID: 33466969 PMCID: PMC7739330 DOI: 10.3390/jfmk3030040] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022] Open
Abstract
Exercise is one of the main rehabilitative interventions, commonly used to improve performance and motor learning. During the application of attentional focus strategies, External Focus of Attention (EFA) aiming at the movement effect has been reported to have more efficacy than Internal Focus of Attention (IFA) aiming at movement characteristics in healthy subjects. There are not many studies that compare the EFA and IFA instructions in people with Musculoskeletal (MSK) and Central Nervous System disorders (CNS). The purpose of this systematic review is to determine if IFA or EFA, in patients with CNS or MSK, may improve performance and have some effects on motor learning. Databases used for research: PubMed, CINAHL, Cochrane Library, PEDro, PsycINFO, SCOPUS. Inclusion criteria: Randomized Controlled Trial, quasi-Randomized Controlled Trial, enrolled subjects with CNS or with MSK and compared the efficacy of EFA and IFA. The studies suggest that the EFA is better than IFA in affecting the movement execution in patients with MSK, while conflicted findings emerge in presence of CNS disorders. Studies included in the qualitative analysis showed heterogeneous methodological features in study design and conductance, so results must be interpreted with caution.
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Affiliation(s)
- Alessandro Piccoli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | | | - Antonello Viceconti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Andrea Turolla
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
- Fondazione Ospedale San Camillo IRCCS, 30126 Venezia, Italy
| | - Filippo Maselli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
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Pelletier R, Higgins J, Bourbonnais D. Laterality recognition of images, motor performance, and aspects related to pain in participants with and without wrist/hand disorders: An observational cross-sectional study. Musculoskelet Sci Pract 2018; 35:18-24. [PMID: 29427866 DOI: 10.1016/j.msksp.2018.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 01/15/2018] [Accepted: 01/24/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Musculoskeletal disorders are associated with altered sensory, proprioceptive and cognitive processes. Sensory processes affect the internal cortical representation of the body in space, the body schema, which in turn influences motor control. The purpose of this study was to determine if participants with wrist/hand disorders had impaired performance on a task associated with the body schema, the Left/Right Judgement Task (LRJT) and secondly how LRJT performance, motor performance, disability, pain and related aspects are associated. METHODS Fifteen healthy control participants and 15 participants with hand/wrist pain were asked to determine the laterality of images of hands. Measures of motor performance (Purdue Pegboard test), self-reported disability (Australian Canadian Hand Index), and pain related aspects (pain intensity, symptom duration, pain interference and affective distress) were recorded. RESULTS Participants with wrist/hand pain scored lower on all segments of the Purdue Pegboard test. There were differences in LRJT performance between groups for both Accuracy (p = 0.03) and Reaction Time (RT) (p < 0.01). There was no correlation between RT and Accuracy with pain intensity, pain duration, and disability. Both motor performance (r = 0.58-0.64) and LRJT performance Accuracy (r = 0.59) and RT (r = -0.56) were correlated with affective distress. A significant correlation was observed between RT and motor performance in healthy control participants (r = -0.56, p = 0.03) but not in participants with wrist/hand pain (r = -0.26, p = 0.44). CONCLUSIONS LRJT and motor performance was correlated with affective distress in participants with wrist/hand pain suggestive of complex interactions between cognitive-affective processes and sensorimotor integration.
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Affiliation(s)
- René Pelletier
- Sciences de la réadaptation, École de réadaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, H3C 3J7, Canada.
| | - Johanne Higgins
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada.
| | - Daniel Bourbonnais
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada.
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Bipedal hopping timed to a metronome to detect impairments in anticipatory motor control in people with mild multiple sclerosis. Clin Biomech (Bristol, Avon) 2018; 55:45-52. [PMID: 29684789 DOI: 10.1016/j.clinbiomech.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/30/2018] [Accepted: 04/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with mild multiple sclerosis (MS) often report subtle deficits in balance and cognition but display no measurable impairment on clinical assessments. We examined whether hopping to a metronome beat had the potential to detect anticipatory motor control deficits among people with mild MS (Expanded Disability Status Scale ≤ 3.5). METHODS Participants with MS (n = 13), matched controls (n = 9), and elderly subjects (n = 13) completed tests of cognition (Montreal Cognitive Assessment (MoCA)) and motor performance (Timed 25 Foot Walk Test (T25FWT)). Participants performed two bipedal hopping tasks: at 40 beats/min (bpm) and 60-bpm in random order. Hop characteristics (length, symmetry, variability) and delay from the metronome beat were extracted from an instrumented walkway and compared between groups. RESULTS The MS group became more delayed from the metronome beat over time whereas elderly subjects tended to hop closer to the beat (F = 4.52, p = 0.02). Delay of the first hop during 60-bpm predicted cognition in people with MS (R = 0.55, β = 4.64 (SD 4.63), F = 4.85, p = 0.05) but not among control (R = 0.07, p = 0.86) or elderly subjects (R = 0.17, p = 0.57). In terms of hopping characteristics, at 60-bpm, people with MS and matched controls were significantly different from the elderly group. However, at 40-bpm, the MS group was no longer significantly different from the elderly group, even though matched controls and elderly still differed significantly. CONCLUSIONS This new timed hopping test may be able to detect both physical ability, and feed-forward anticipatory control impairments in people with mild MS. Hopping at a frequency of 40-bpm seemed more challenging. Several aspects of anticipatory motor control can be measured: including reaction time to the first metronome cue and the ability to adapt and anticipate the beat over time.
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Atun-Einy O, Kafri M. Implementation of motor learning principles in physical therapy practice: Survey of physical therapists' perceptions and reported implementation. Physiother Theory Pract 2018; 35:633-644. [PMID: 29589787 DOI: 10.1080/09593985.2018.1456585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The field of motor learning (ML) plays a pivotal role in physical therapy (PT), and its implementation has been shown to improve intervention outcomes. The objective of this study was to assess physical therapists' ML-related self-efficacy, self-reported implementation, and environmental workplace factors. An additional aim was to report the psychometric properties of a questionnaire that was developed to assess the above-mentioned constructs. METHODS An observational, cross-sectional survey was completed by 289 physical therapists (average age: 38.7 (9.7), with 11.3 (9.7) years of experience and 74% female). Construct validity, internal consistency, and test-retest reliability were tested. The main outcome measures were the scores of the three scales of the questionnaire, referring to self-efficacy in ML, implementation of ML principles, and workplace environment features. RESULTS The questionnaire had sound psychometric qualities. Respondents perceived ML as an integral part of PT. ML-related self-efficacy and implementation of ML principles were moderate (2.95/5 (0.7) and 3.04/5(0.8), respectively). PT practice had a significant effect on ML-related self-efficacy (p = 0.035) and implementation (p = 0.0031). Respondents who had undergone ML training in their graduate program reported higher ML-related self-efficacy (p = 0.007). Respondents who had postgraduate training in ML reported significantly more extensive implementation (p = 0.024). Lack of knowledge and lack of time were perceived as the major barriers to implementation. CONCLUSIONS Level of self-efficacy might be insufficient to support the systematic implementation of ML principles in practice. Addressing impeding individual- and organizational-level factors might facilitate ML self-efficacy and implementation. Postgraduate education facilitates ML implementation.
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Affiliation(s)
- Osnat Atun-Einy
- a Department of Physical Therapy, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | - Michal Kafri
- a Department of Physical Therapy, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
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Snodgrass SJ, Farrell SF, Tsao H, Osmotherly PG, Rivett DA, Chipchase LS, Schabrun SM. Shoulder Taping and Neuromuscular Control. J Athl Train 2018; 53:395-403. [PMID: 29569944 DOI: 10.4085/1062-6050-68-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Scapular taping can offer clinical benefit to some patients with shoulder pain; however, the underlying mechanisms are unclear. Understanding these mechanisms may guide the development of treatment strategies for managing neuromusculoskeletal shoulder conditions. OBJECTIVE To examine the mechanisms underpinning the benefits of scapular taping. DESIGN Descriptive laboratory study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 15 individuals (8 men, 7 women; age = 31.0 ± 12.4 years, height = 170.9 ± 7.6 cm, mass = 73.8 ± 14.4 kg) with no history of shoulder pain. INTERVENTION(S) Scapular taping. MAIN OUTCOME MEASURE(S) Surface electromyography (EMG) was used to assess the (1) magnitude and onset of contraction of the upper trapezius (UT), lower trapezius (LT), and serratus anterior relative to the contraction of the middle deltoid during active shoulder flexion and abduction and (2) corticomotor excitability (amplitude of motor-evoked potentials from transcranial magnetic stimulation) of these muscles at rest and during isometric abduction. Active shoulder-flexion and shoulder-abduction range of motion were also evaluated. All outcomes were measured before taping, immediately after taping, 24 hours after taping with the original tape on, and 24 hours after taping with the tape removed. RESULTS Onset of contractions occurred earlier immediately after taping than before taping during abduction for the UT (34.18 ± 118.91 milliseconds and 93.95 ± 106.33 milliseconds, respectively, after middle deltoid contraction; P = .02) and during flexion for the LT (110.02 ± 109.83 milliseconds and 5.94 ± 92.35 milliseconds, respectively, before middle deltoid contraction; P = .06). These changes were not maintained 24 hours after taping. Mean motor-evoked potential onset of the middle deltoid was earlier at 24 hours after taping (tape on = 7.20 ± 4.33 milliseconds) than before taping (8.71 ± 5.24 milliseconds, P = .008). We observed no differences in peak root mean square EMG activity or corticomotor excitability of the scapular muscles among any time frames. CONCLUSIONS Scapular taping was associated with the earlier onset of UT and LT contractions during shoulder abduction and flexion, respectively. Altered corticomotor excitability did not underpin earlier EMG onsets of activity after taping in this sample. Our findings suggested that the optimal time to engage in rehabilitative exercises to facilitate onset of trapezius contractions during shoulder movements may be immediately after tape application.
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Affiliation(s)
| | - Scott F Farrell
- School of Health Sciences, University of Newcastle, Callaghan, Australia.,RECOVER Injury Research Centre, Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Southport, Australia
| | - Henry Tsao
- Emergency Department, Caboolture Hospital, Australia
| | - Peter G Osmotherly
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - Darren A Rivett
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - Lucy S Chipchase
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Campbelltown, Australia
| | - Siobhan M Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Campbelltown, Australia
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Storberget M, Grødahl LHJ, Snodgrass S, van Vliet P, Heneghan N. Verbal augmented feedback in the rehabilitation of lower extremity musculoskeletal dysfunctions: a systematic review. BMJ Open Sport Exerc Med 2017; 3:e000256. [PMID: 29018544 PMCID: PMC5623330 DOI: 10.1136/bmjsem-2017-000256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background Verbal augmented feedback (VAF) is commonly used in physiotherapy rehabilitation of individuals with lower extremity musculoskeletal dysfunction or to induce motor learning for injury prevention. Its effectiveness for acquisition, retention and transfer of learning of new skills in this population is unknown. Objectives First, to investigate the effect of VAF for rehabilitation and prevention of lower extremity musculoskeletal dysfunction. Second, to determine its effect on motor learning and the stages of acquisition, retention and transfer in this population. Design Systematic review designed in accordance with the Centre for Reviews and Dissemination and reported in line with Preferred Reporting Items for Systematic Review and Meta-analysis. Method MEDLINE, Embase, PubMed and five additional databases were searched to identify primary studies with a focus on VAF for prevention and rehabilitation of lower extremity musculoskeletal dysfunction. One reviewer screened the titles and abstracts. Two reviewers retrieved full text articles for final inclusion. The first reviewer extracted data, whereas the second reviewer audited. Two reviewers independently assessed risk of bias and quality of evidence using Cochrane Collaboration’s tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Results Six studies were included, with a total sample of 304 participants. Participants included patients with lateral ankle sprain (n=76), postoperative ACL reconstruction (n=16) and healthy individuals in injury prevention (n=212). All six studies included acquisition, whereas retention was found in five studies. Only one study examined transfer of the achieved motor learning (n=36). VAF was found to be effective for improving lower extremity biomechanics and postural control with moderate evidence from five studies. Conclusion VAF should be considered in the rehabilitation of lower extremity musculoskeletal dysfunctions. However, it cannot be unequivocally confirmed that VAF is effective in this population, owing to study heterogeneity and a lack of high-quality evidence. Nevertheless, positive effects on lower extremity biomechanics and postural control have been identified. This suggests that further research into this topic is warranted where an investigation of long-term effects of interventions is required. All stages (acquisition, retention and transfer) should be evaluated.
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Affiliation(s)
- Marianne Storberget
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Linn Helen J Grødahl
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Suzanne Snodgrass
- School of Health Sciences (Physiotherapy), University of Newcastle, Callaghan, New South Wales, Australia
| | - Paulette van Vliet
- School of Health Sciences (Physiotherapy), University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicola Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Selbstmanagement in der Manualtherapie bei Patienten mit chronischen Rückenschmerzen. MANUELLE MEDIZIN 2017. [DOI: 10.1007/s00337-017-0291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Daniel M, Tomanová M, Hornová J, Novotná I, Lhotská L. Biomechanical analysis of INFINITY rehabilitation method for treatment of low back pain. J Phys Ther Sci 2017; 29:832-838. [PMID: 28603355 PMCID: PMC5462682 DOI: 10.1589/jpts.29.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/07/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Low back pain is a pervasive problem in modern societies. Physical rehabilitation in treatment of low back pain should reduce pain, muscle tension and restore spine stability and balance. The INFINITY® rehabilitation method that is based on a figure of eight movement pattern was proved to be effective in low back pain treatment. The aim of the paper is to estimate the effect of a figure of eight motion on the L5/S1 load and lumbar spine muscle activation in comparison to other motion patterns. [Subjects and Methods] Three-dimensional model of lumbar spine musculoskeletal system is used to simulate effect of various load motion pattern induced by displacement of the center of gravity of the upper body. Four motion patterns were examined: lateral and oblique pendulum-like motion, elliptical motion and figure of eight motion. [Results] The simple pendulum-like and elliptical-like patterns induce harmonic muscle activation and harmonic spinal load. The figure of eight motion pattern creates high-frequency spinal loading that activates remodeling of bones and tendons. The figure of eight pattern also requires muscle activity that differs from harmonic frequency and is more demanding on muscle control and could also improve muscle coordination. [Conclusion] The results of the study indicate that complex motion pattern during INFINITY® rehabilitation might enhance the spine stability by influencing its passive, active and neural components.
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Affiliation(s)
- Matej Daniel
- Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Czech Republic
| | | | - Jana Hornová
- Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Czech Republic
| | - Iva Novotná
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Czech Republic
| | - Lenka Lhotská
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Czech Republic
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Pelletier R, Higgins J, Bourbonnais D. The relationship of corticospinal excitability with pain, motor performance and disability in subjects with chronic wrist/hand pain. J Electromyogr Kinesiol 2017; 34:65-71. [PMID: 28411487 DOI: 10.1016/j.jelekin.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 03/25/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022] Open
Abstract
There is a growing body of evidence of changes in corticospinal excitability associated with musculoskeletal disorders, however there is a lack of knowledge of how these changes relate to measures of pain, motor performance and disability. An exploratory study was performed utilizing Transcranial Magnetic Stimulation to investigate differences in corticospinal excitability in the Abductor Pollicis Brevis (APB) between 15 pain-free subjects and 15 subjects with chronic wrist/hand pain and to determine how corticospinal excitability was associated with measures of pain (visual analog scale, AUSCAN™), hand motor performance (isometric and key pinch strength, Purdue Pegboard Test), disability (AUSCAN™), and spinal motoneuronal excitability. Input-output curves demonstrated increased corticospinal excitability of the APB in the affected hand of subjects with chronic pain (p<0.01). Changes in corticospinal excitability were significantly correlated with pain intensity (r=0.77), disability (r=0.58), and negatively correlated with motoneuronal excitability (r=-0.57). Corticospinal excitability in subjects with heterogeneous injuries of the wrist/hand was associated with disability and pain.
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Affiliation(s)
- René Pelletier
- Sciences de la réadaptation, École de réadaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec H3C 3J7, Canada.
| | - Johanne Higgins
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec H3C 3J7, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada.
| | - Daniel Bourbonnais
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec H3C 3J7, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada.
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Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single-blind randomized clinical study. J Hand Ther 2017; 30:242-252. [PMID: 28342739 DOI: 10.1016/j.jht.2017.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/29/2016] [Accepted: 02/06/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized clinical study. INTRODUCTION Supervised physical therapy (PT) and home exercise programs (HEPs) are frequently used in the rehabilitation of patients with distal radius fracture (DRF). However, there is no consensus as to whether unsupervised HEP provides comparable benefits to those achieved by supervised PT. PURPOSE OF THE STUDY To compare the improvements in pain and functional status between a supervised PT program and unsupervised HEP in DRF patients older than 60 years. METHODS A total of 74 patients were randomized into 2 groups. One group received 12 sessions of supervised PT (n = 37), and the other group followed an exercise program at home (n = 37). Three evaluations were performed, before the initiation of treatment, at 6-week, and 6-month follow-up. The study conducted a statistical power analysis to detect an intergroup difference score of 15 points on the Patient-Rated Wrist Evaluation (PRWE). The t-test or Mann-Whitney test was used, and it was set with a significance level of .05. RESULTS The supervised PT group showed clinically significant differences in the total PRWE score at 6 weeks (17.67 points, P = .000) in the PRWE function score (15.2 points, P = .000) and in the PRWE pain score (5.6 points, P = .039). There was also a significant difference in the total PRWE score at 6-month follow-up (17.05 points, P = .000) in the PRWE function score (14.5 points, P = .000) and in the PRWE pain score (2.5 points, P = .35). CONCLUSIONS A supervised PT program is more effective for improving function in the short- and medium-term when compared with HEP in patients older than 60 years with DRF extraarticular without immediate complications. LEVEL OF EVIDENCE 1b.
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Rossettini G, Testa M, Vicentini M, Manganotti P. The Effect of Different Attentional Focus Instructions during Finger Movement Tasks in Healthy Subjects: An Exploratory Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2946465. [PMID: 28286760 PMCID: PMC5329693 DOI: 10.1155/2017/2946465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022]
Abstract
External focus of attention (EFA) and internal focus of attention (IFA) represent commonly used strategies to instruct subjects during exercise. Several studies showed EFA to be more effective than IFA to improve motor performance and learning. To date the role of these strategies on motor performance during finger movement was less studied. The objective of the study was to investigate motor performance, patient's preference induced by IFA and EFA, and the focus during control condition. Ten healthy right-handed participants performed a finger movement task in control, EFA, and IFA conditions (counterbalanced). Errors, patient's preference, and type of attentional focus spontaneously adopted during the control condition were recorded. EFA determined less error (p < 0.01) compared to control and IFA. Participants preferred EFA against IFA and control condition. In the control group 10% of subjects adopted a purely EFA, 70% of subjects adopted a purely IFA, and 20% of subjects adopted a mixture of the two foci. Our results confirm that EFA is more effective than IFA and control in finger movement task. Due its clinical relevance, the interaction between attention and finger movement should be further investigated.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto 2, 17100 Savona, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto 2, 17100 Savona, Italy
| | | | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical Science, Surgery and Health, University of Trieste, Via Farneto 3, 34142 Trieste, Italy
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Massie CL, White C, Pruit K, Freel A, Staley K, Backes M. Influence of Motor Cortex Stimulation During Motor Training on Neuroplasticity as a Potential Therapeutic Intervention. J Mot Behav 2017; 49:111-116. [DOI: 10.1080/00222895.2016.1271298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Crystal L. Massie
- Occupational Therapy, School of Health and Rehabilitation Science, Indiana University, Indianapolis, IN
| | - Caylen White
- Department of Kinesiology, Indiana University, Indianapolis, IN
| | - Katie Pruit
- Occupational Therapy, School of Health and Rehabilitation Science, Indiana University, Indianapolis, IN
| | - Aubrey Freel
- Occupational Therapy, School of Health and Rehabilitation Science, Indiana University, Indianapolis, IN
| | - Kaylin Staley
- Occupational Therapy, School of Health and Rehabilitation Science, Indiana University, Indianapolis, IN
| | - Morgan Backes
- Occupational Therapy, School of Health and Rehabilitation Science, Indiana University, Indianapolis, IN
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Postural Stability During Single-Leg Stance: A Preliminary Evaluation of Noncontact Lower Extremity Injury Risk. J Orthop Sports Phys Ther 2016; 46:650-7. [PMID: 27374015 DOI: 10.2519/jospt.2016.6278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study with a prospective cohort design. Background Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries. Objectives To prospectively investigate whether postural stability deficits during single-leg stance predict noncontact lower extremity injuries. Methods Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed. Center-of-pressure displacement, the main outcome variable, was measured during the first 3 seconds after the time to a new stability point was reached during single-leg stance. Noncontact lower extremity injuries were recorded at a 1-year follow-up. Results Six participants sustained a noncontact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured (P = .030) and noninjured legs (P = .009) of the injured group compared to the respective matched legs of the noninjured group. The area under the receiver operating characteristic curve (AUC) analysis revealed significant discriminative accuracy between groups for the center-of-pressure displacement during the first 3 seconds after the time to a new stability point of the injured (AUC = 0.814, P = .015) and noninjured legs (AUC = 0.897, P = .004) of the injured group compared to the matched legs of the noninjured group. Conclusion This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of noncontact lower extremity injury. Further research is indicated. Level of Evidence Prognosis, level 4. J Orthop Sports PhysTher 2016;46(8):650-657. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6278.
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Beattie PF, Silfies SP, Jordon M. The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies. Braz J Phys Ther 2016; 20:580-591. [PMID: 28001268 PMCID: PMC5176195 DOI: 10.1590/bjpt-rbf.2014.0180] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 12/12/2022] Open
Abstract
Background Longitudinal studies have shown that the symptoms of chronic low back pain (CLBP) will follow an episodic trajectory characterized by periods of high and low pain intensity that can persist for many years. There is a growing belief that the contemporary approach of limiting physical therapy to short, but intense courses of treatment for (CLBP) may be sub-optimal because these limited “windows” of clinical care are not congruent with the natural history of this condition. Recent research has suggested that people with CLBP undergo substantial, and individualized long-term variations in the neural processing of nociception over time. This has led to the concept of a “unique biosignature of pain” that may explain much of the variation in a person’s clinical picture. These and other findings have led to the reconceptualization of CLBP as an individualized, and continually evolving condition that may be more suitably managed by empowering the patient toward self-management strategies that can be modified as needed over time by the PT. Objectives The purpose of this Master Class Paper is to describe an emerging approach for the treatment of CLBP that emphasizes the formation of a long-term therapeutic alliance between the patient and the PT with an emphasis on individualized, patient-preferred approaches for activity-based self-management as an alternative to the contemporary approach of short, intense episodes of care directed toward pain reduction. Conclusion Longitudinal care using assisted self-management strategies is more congruent with the natural history of CLBP than are traditional approaches for PT intervention. This approach may empower patients to undergo lifestyle changes that will favorably influence long-term outcomes; however additional research is needed.
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Affiliation(s)
- Paul F Beattie
- Doctoral Program in Physical Therapy, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sheri P Silfies
- Department of Physical Therapy & Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Max Jordon
- Physical Therapist, Mobility Research Clinic, Richland-Palmetto Health, Columbia, SC, USA
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Dingenen B, Janssens L, Claes S, Bellemans J, Staes FF. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. Clin Biomech (Bristol, Avon) 2016; 35:116-23. [PMID: 27149566 DOI: 10.1016/j.clinbiomech.2016.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/08/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies mainly focused on muscles at the operated knee after anterior cruciate ligament reconstruction, less on muscles around other joints of the operated and non-operated leg. The aim of this study was to investigate muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. METHODS Lower extremity muscle activation onset times of both legs of 20 fully returned to sport anterior cruciate ligament reconstructed subjects and 20 non-injured control subjects were measured during the transition from double-leg stance to single-leg stance in eyes open and eyes closed conditions. Analysis of covariance (ANCOVA) was used to evaluate differences between groups and differences between legs within both groups, while controlling for peak center of pressure velocity. FINDINGS Significantly delayed muscle activation onset times were found in the anterior cruciate ligament reconstructed group compared to the control group for gluteus maximus, gluteus medius, vastus medialis obliquus, medial hamstrings, lateral hamstrings and gastrocnemius in both eyes open and eyes closed conditions (P<.05). Within the anterior cruciate ligament reconstructed group, no significant different muscle activation onset times were found between the operated and non-operated leg (P>.05). INTERPRETATION Despite completion of rehabilitation and full return to sport, the anterior cruciate ligament reconstructed group showed neuromuscular control deficits that were not limited to the operated knee joint. Clinicians should focus on relearning multi-segmental anticipatory neuromuscular control strategies after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Bart Dingenen
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Luc Janssens
- KU Leuven Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; KU Leuven Cardiovascular and Respiratory Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Nederrij 133, 2200 Herentals, Belgium; Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Filip F Staes
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium
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Myers LK. Application of neuroplasticity theory through the use of the Feldenkrais Method® with a runner with scoliosis and hip and lumbar pain: A case report. J Bodyw Mov Ther 2016; 20:300-9. [DOI: 10.1016/j.jbmt.2015.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 02/02/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
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Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders. Phys Ther 2015; 95:1582-91. [PMID: 25953594 DOI: 10.2522/ptj.20140575] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/01/2015] [Indexed: 11/17/2022]
Abstract
Present interventions utilized in musculoskeletal rehabilitation are guided, in large part, by a biomedical model where peripheral structural injury is believed to be the sole driver of the disorder. There are, however, neurophysiological changes across different areas of the peripheral and central nervous systems, including peripheral receptors, dorsal horn of the spinal cord, brain stem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas associated with chronic musculoskeletal disorders, including chronic low back pain, osteoarthritis, and tendon injuries. These neurophysiological changes appear not only to be a consequence of peripheral structural injury but also to play a part in the pathophysiology of chronic musculoskeletal disorders. Neurophysiological changes are consistent with a biopsychosocial formulation reflecting the underlying mechanisms associated with sensory and motor findings, psychological traits, and perceptual changes associated with chronic musculoskeletal conditions. These changes, therefore, have important implications in the clinical manifestation, pathophysiology, and treatment of chronic musculoskeletal disorders. Musculoskeletal rehabilitation professionals have at their disposal tools to address these neuroplastic changes, including top-down cognitive-based interventions (eg, education, cognitive-behavioral therapy, mindfulness meditation, motor imagery) and bottom-up physical interventions (eg, motor learning, peripheral sensory stimulation, manual therapy) that induce neuroplastic changes across distributed areas of the nervous system and affect outcomes in patients with chronic musculoskeletal disorders. Furthermore, novel approaches such as the use of transcranial direct current stimulation and repetitive transcranial magnetic stimulation may be utilized to help renormalize neurological function. Comprehensive treatment addressing peripheral structural injury as well as neurophysiological changes occurring across distributed areas of the nervous system may help to improve outcomes in patients with chronic musculoskeletal disorders.
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Dingenen B, Janssens L, Luyckx T, Claes S, Bellemans J, Staes FF. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Hum Mov Sci 2015; 44:234-45. [PMID: 26409102 DOI: 10.1016/j.humov.2015.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022]
Abstract
The goal of this study was to evaluate muscle activation onset times (MAOT) of both legs during a transition task from double-leg stance (DLS) to single-leg stance (SLS) in anterior cruciate ligament injured (ACLI) (n=15) and non-injured control subjects (n=15) with eyes open and eyes closed. Significantly delayed MAOT were found in the ACLI group compared to the control group for vastus lateralis, vastus medialis obliquus, hamstrings medial, hamstrings lateral, tibialis anterior, peroneus longus and gastrocnemius in both vision conditions, for gluteus maximus and gluteus medius with eyes open and for tensor fascia latae with eyes closed. Within the ACLI group, delayed MAOT of tibialis anterior with eyes open and gastrocnemius with eyes closed were found in the injured leg compared to the non-injured leg. All other muscles were not significantly different between legs. In conclusion, the ACLI group showed delayed MAOT not only around the knee, but also at the hip and ankle muscles compared to the non-injured control group. No differences between both legs of the ACLI group were found, except for tibialis anterior and gastrocnemius. These findings indirectly support including central nervous system re-education training to target the underlying mechanisms of these altered MAOT after ACL injury.
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Affiliation(s)
- Bart Dingenen
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Luc Janssens
- KU Leuven Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; KU Leuven Cardiovascular and Respiratory Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Thomas Luyckx
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Steven Claes
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium; Department of Orthopedic Surgery, AZ Herentals Hospital, Nederrij 133, 2200 Herentals, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Filip F Staes
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
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Abstract
These are exciting times for physical therapists who treat people with chronic low back pain (CLBP). Many of the mysteries of this condition are starting to be revealed, and it appears that major breakthroughs are on the way. Advances in neuroimaging, coupled with increased understanding of the molecular and submolecular events associated with the symptoms of back pain, are helping us reconceptualize the etiologies and mechanisms of this condition. The result of these advances is that physical therapists now have a wide range of potential "treatment packages" that can include patient education, manual therapy, and a wide variety of exercise options for people with CLBP. The question is, "How can long-term, self-management programs become more effective?"
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Dingenen B, Janssens L, Claes S, Bellemans J, Staes FF. Postural stability deficits during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. Hum Mov Sci 2015; 41:46-58. [PMID: 25744596 DOI: 10.1016/j.humov.2015.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/13/2015] [Accepted: 02/04/2015] [Indexed: 11/15/2022]
Abstract
The goal of this study was to evaluate postural stability during the transition from double-leg stance (DLS) to single-leg stance (SLS) in anterior cruciate ligament reconstructed (ACLR) (n=20) and non-injured control subjects (n=20). All ACLR subjects had fully returned to their pre-injury sport participation. Both groups were similar for age, gender, height, weight, body mass index and activity level. Spatiotemporal center of pressure outcomes of both legs of each subject were measured during the transition from DLS to SLS in eyes open and eyes closed conditions. Movement speed was standardized. The center of pressure displacement after a new stability point was reached during the SLS phase was significantly increased in the ACLR group compared to the control group in the eyes closed condition (P=.001). No significant different postural stability outcomes were found between the operated and non-operated legs. In conclusion, the ACLR group showed postural stability deficits, indicating that these persons may have a decreased ability to stabilize their body after the internal postural perturbation created by the transition from DLS to SLS. The non-operated leg may not be the best reference when evaluating postural stability of the operated leg after ACLR, as no differences were found between legs.
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Affiliation(s)
- Bart Dingenen
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Leuven (Heverlee), Belgium.
| | - Luc Janssens
- KU Leuven Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium.
| | - Steven Claes
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Leuven, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Leuven, Belgium.
| | - Filip F Staes
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Leuven (Heverlee), Belgium.
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Dingenen B, Janssens L, Luyckx T, Claes S, Bellemans J, Staes FF. Postural stability during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Clin Biomech (Bristol, Avon) 2015; 30:283-9. [PMID: 25616933 DOI: 10.1016/j.clinbiomech.2015.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND An anterior cruciate ligament injury may lead to deteriorations in postural stability. The goal of this study was to evaluate postural stability during the transition from double-leg stance to single-leg stance of both legs in anterior cruciate ligament injured subjects and non-injured control subjects with a standardized methodology. METHODS Fifteen control subjects and 15 anterior cruciate ligament injured subjects (time after injury: mean (SD)=1.4 (0.7) months) participated in the study. Both groups were similar for age, gender, height, weight and body mass index. Spatiotemporal center of pressure outcomes of both legs of each subject were measured during the transition from double-leg stance to single-leg stance in eyes open and eyes closed conditions. Movement speed was standardized. FINDINGS The center of pressure displacement after a new stability point was reached during the single-leg stance phase was significantly increased in the anterior cruciate ligament injured group compared to the control group in the eyes closed condition (P<.001). No significant different postural stability outcomes were found between both legs within both groups (P>.05). No significant differences were found during the transition itself (P>.05). INTERPRETATION The anterior cruciate ligament injured group showed postural stability deficits during the single-leg stance phase compared to the non-injured control group in the eyes closed condition. Using the non-injured leg as a normal reference when evaluating postural stability of the injured leg may lead to misinterpretations, as no significant differences were found between the injured and non-injured leg of the anterior cruciate ligament injured group.
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Affiliation(s)
- Bart Dingenen
- KU Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Luc Janssens
- KU Leuven, Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; KU Leuven, Cardiovascular and Respiratory Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Thomas Luyckx
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Steven Claes
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; Department of Orthopedic Surgery, AZ Herentals Hospital, Nederrij 133, 2200 Herentals, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Filip F Staes
- KU Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
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