Electromyographic responses during time get up and go test in water (wTUG)

Aquatic therapy following arthroscopic rotator cuff repair enables faster improvement of Constant score than land-based therapy or self-rehabilitation therapy

PURPOSE

To compare the clinical and functional outcomes of arthroscopic rotator cuff repair over a period of 2 years using three postoperative rehabilitation modalities: aquatic therapy, land-based therapy, and self-rehabilitation therapy. The null hypothesis was that aquatic therapy would provide no difference in Constant score compared to land-based therapy and self-rehabilitation therapy.

METHODS

A prospective study was performed on subjects scheduled for arthroscopic rotator cuff repair between 2012 and 2017 that complied with the following criteria: (i) small to medium sized symptomatic supraspinatus and/or infraspinatus tendon tears, (ii) low to moderate tendon retraction according to Patte, and (iii) fatty infiltration stage ≤2. Patients were allocated to perform either aquatic therapy, land-based therapy, or self-rehabilitation therapy for 2-4 months. Independent observers blinded to the study design collected Constant score, SSV, and patient satisfaction at 2 months, 3 months, 6 months, 1 year and 2 years.

STUDY DESIGN

Level III, cohort study RESULTS: At 2 months follow-up, patients performing aquatic therapy had significantly higher Constant scores (p < 0.001) and SSV (p < 0.001) compared to those performing land-based therapy or self-rehabilitation therapy. At 3 months follow-up, patients performing aquatic therapy had significantly higher Constant scores (p < 0.001), and SSV (p < 0.001), both of which exceeded the respective minimal clinically important differences (MCIDs) of 10.4 and 12. Patients performing aquatic therapy continued to have significantly higher Constant scores and SSV at 6 months, 1 year, and 2 years.

CONCLUSION

Aquatic therapy has a very limited positive effect on clinical outcomes at 3 months after surgery, but yields no relevant improvements on function or satisfaction at 1 to 2 years follow-up.

Correlation between timed up and go test and skeletal muscle tensiomyography in female nursing home residents

OBJECTIVES

Tensiomyography (TMG) derived contraction time (Tc) and amplitude (Dm) are related to muscle fibre composition and to muscle atrophy/tone, respectively. However, the link between mobility and TMG-derived skeletal muscle contractile properties in older persons is unknown. The aim of the study was to correlate lower limb skeletal muscle contractile properties with balance and mobility measures in senior female residents of retirement homes in Austria.

METHODS

Twenty-eight female participants (aged from 67-99 years) were included in measurements of contractile properties (TMG) of four skeletal muscles: vastus lateralis, vastus medialis, biceps femoris and gastrocnemius medialis. Their balance and mobility performance was measured using a timed up and go test (TUG).

RESULTS

Time needed to complete TUG is negatively correlated to biceps femoris (r= -0.490; p= 0.008), vastus lateralis (r= -0.414; p=0.028) and vastus medialis (r= -0.353; p=0.066) Dm and positively correlated to vastus lateralis Tc (r=0.456; p=0.015). Overall, vastus lateralis Tc and vastus medialis Dm explained 37% of TUG time variance.

CONCLUSIONS

Our study demonstrates that TMG-derived quadriceps muscle contractile parameters are correlated with the balance and mobility function in female nursing home residents.

Identification of Tools for the Functional and Subjective Assessment of Patients in an Aquatic Environment: A Systematic Review

Aquatic therapy is one of the most common treatments for alleviating musculoskeletal pathologies. Its effectiveness has been evaluated with functional tests and questionnaires. Functional tests are used in aquatic therapy; however, in most cases, they are carried out in a non-aquatic environment and, as such, their results may differ from those of tests performed in an aquatic environment. A systematic review was performed to assess the accuracy of functional tests and patient-reported outcomes to assess aquatic therapy interventions. The authors conducted a literature search in July 2019. In total, 70,863 records were identified after duplicates removed. Of these, 14 records were included about functional tests assessment in aquatic environment and 725 records for questionnaires. The majority of the tests had also been assessed in a dry environment, allowing differences and similarities between the tests in the two environments to be observed. Different variables have been assessed in tests included in the present systematic review (cardiorespiratory, neuromuscular, kinematic, physiological, kinetic responses and rating of perceived exertion) which are included in the manuscript. Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and the 12-item Short Form Health Survey were the assessments most commonly used by the different authors.

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults

BACKGROUND

The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water.

AIM

To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements.

METHODS

Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit To Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1).

RESULTS

Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent.

CONCLUSIONS

Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment.

Spatiotemporal, kinematic, force and muscle activation outcomes during gait and functional exercise in water compared to on land: A systematic review

BACKGROUND

Exercises replicating functional activities are commonly used in aquatic rehabilitation although it is not clear how the movement characteristics differ between the two environments. A systematic review was completed in order to compare the biomechanics of gait, closed kinetic chain and plyometric exercise when performed in water and on land.

METHODS

Databases including MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane library were searched. Studies were included where a functional lower limb activity was performed in water and on land with the same instructions. Standardized mean differences (SMD) and 95% confidence intervals were calculated for spatiotemporal, kinematic, force and muscle activation outcomes.

FINDINGS

28 studies included walking or running (19 studies), stationary running (three), closed kinetic chain exercise (two), plyometric exercise (three) and timed-up and go (one). Very large effect sizes showed self-selected speed of walking (SMD >4.66) and vertical ground reaction forces (VGRF) (SMD >1.91) in water were less than on land, however, lower limb range of movement and muscle activity were similar. VGRF in plyometric exercise was lower in water when landing but more similar between the two environments in propulsion. Maximal speed of movement for walking and stationary running was lower in water compared to on land (SMD>3.05), however was similar in propulsion in plyometric exercise.

INTERPRETATION

Drag forces may contribute to lower self-selected speed of walking. Monitoring speed of movement in water assists in determining the potential advantages or limitations of aquatic exercise and the task specificity to land-based function.

Toward Automating Clinical Assessments: A Survey of the Timed Up and Go

Older adults often suffer from functional impairments that affect their ability to perform everyday tasks. To detect the onset and changes in abilities, healthcare professionals administer standardized assessments. Recently, technology has been utilized to complement these clinical assessments to gain a more objective and detailed view of functionality. In the clinic and at home, technology is able to provide more information about patient performance and reduce subjectivity in outcome measures. The timed up and go (TUG) test is one such assessment recently instrumented with technology in several studies, yielding promising results toward the future of automating clinical assessments. Potential benefits of technological TUG implementations include additional performance parameters, generated reports, and the ability to be self-administered in the home. In this paper, we provide an overview of the TUG test and technologies utilized for TUG instrumentation. We then critically review the technological advancements and follow up with an evaluation of the benefits and limitations of each approach. Finally, we analyze the gaps in the implementations and discuss challenges for future research toward automated self-administered assessment in the home.

Surface electromyography during physical exercise in water: a systematic review

BACKGROUND

Aquatic exercise has been widely used for rehabilitation and functional recovery due to its physical and physiological benefits. However, there is a high variability in reporting on the muscle activity from surface electromyographic (sEMG) signals. The aim of this study is to present an updated review of the literature on the state of the art of muscle activity recorded using sEMG during activities and exercise performed by humans in water.

METHODS

A literature search was performed to identify studies of aquatic exercise movement.

RESULTS

Twenty-one studies were selected for critical appraisal. Sample size, functional tasks analyzed, and muscles recorded were studied for each paper. The clinical contribution of the paper was evaluated.

CONCLUSIONS

Muscle activity tends to be lower in water-based compared to land-based activity; however more research is needed to understand why. Approaches from basic and applied sciences could support the understanding of relevant aspects for clinical practice.