Comparative kinematic and electromyographic assessment of clinician- and device-assisted sit-to-stand transfers in patients with stroke

Effects of Different Assistive Seats on Ability of Elderly in Sit-To-Stand and Back-To-Sit Movements

The ability to perform sit-to-stand (STS) and back-to-sit (BTS) movements is important for the elderly to live independently and maintain a reasonable quality of life. Accordingly, this study investigated the STS and BTS motions of 28 healthy older adults (16 male and 12 female) under three different seat conditions, namely nonassisted, self-designed lifting seat, and UpLift seat. The biomechanical data were acquired using a three-dimensional (3D) motion analysis system and force plates, and were examined by one-way repeated-measures ANOVA to investigate the effects of the different seat conditions on the joint angle, joint moments, and movement duration time (α = 0.05). No significant difference was observed in the STS duration among the three test conditions. However, the BTS duration was significantly increased in the UpLift seat condition. Moreover, the peak flexion angle of the hip during STS motion was also significantly higher in the UpLift condition. For both motions (STS and BTS), the lifting seats significantly decreased the knee and hip joint moments, but significantly increased the ankle joint moment. Moreover, compared to the nonassistive seat, both assistive lifting seats required a greater ankle joint strength to complete the STS and BTS motions.

Lumbar Spine Kinematics in Asymptomatic People When Changing Body Position From Sitting to Standing

OBJECTIVE

The purpose of this study was to assess the lumbar spine kinematics in 3 movement axes in asymptomatic individuals in the sit-to-stand (STS) movement performed in a habitual, flexion, or extension manner.

METHODS

There were 30 participants (16 women, 14 men), aged 23 to 37 years. Each participant performed an STS test. We registered the total time of the STS movement and the maximum acceleration of the lumbar spine in the vertical, anteroposterior, and mediolateral axes. The examination of the movement pattern was performed with the use of a BTS G-sensor device.

RESULTS

The highest movement dynamics in the lumbar spine were observed during the STS performed in a habitual manner in the 3 axes (P < .01). The lowest movement dynamics ere associated with the extension STS pattern. The flexion pattern differed from the habitual one in total performance time in both groups (P < .01). There were no significant differences in kinematic lumbar spine between sexes.

CONCLUSION

The kinematics of the STS movement for asymptomatic individuals were characterized by significant variability in the maximum acceleration in the 3 axes. The highest movement dynamics were observed during the STS performed in a habitual manner, and the lowest dynamics with the extension pattern of STS.

Reliability and minimal detectable change of the 'Imperial Spine' marker set for the evaluation of spinal and lower limb kinematics in adults

Objectives

As a step towards the comprehensive evaluation of movement in patients with low back pain, the aim of this study is to design a marker set (three rigid segment spine, pelvic and lower limb model) and evaluate the reliability and minimal detectable change (MDC) of this marker set in healthy adults during gait and sit to stand (STS) tasks using three dimensional motion capture.

Results

The ‘Imperial Spine’ marker set was used to assess relative peak angles during gait and STS tasks using the minimum recommended sample size (n = 10) for reliability studies with minimum Intraclass Correlation Coefficient (ICC) of 0.70, optimum ICC 0.90 and 9 trials replicated per subject per task. Intra- and inter-tester reliability between an experienced and inexperienced user was examined. ICC, mean, standard error (SEM), Bland Altman 95% limits of agreement (LOA) and MDC were computed.

ICC values demonstrated excellent intra- and inter-tester reliability in both tasks, particularly in the sagittal plane (majority ICCs > 0.80). SEM measurements were lower in gait (0.8–5.5°) than STS tasks (1°-12.6°) as were MDC values. LOA demonstrated good agreement. The ‘Imperial Spine’ marker set is reliable for use in healthy adults during functional tasks. Future evaluation in patients is required.

Comparison of Healthcare Workers Transferring Patients Using Either Conventional Or Robotic Wheelchairs: Kinematic, Electromyographic, and Electrocardiographic Analyses

Objectives. The aim of this study was to compare the musculoskeletal and physical strain on healthcare workers, by measuring range of motion (ROM), muscle activity, and heart rate (HR), during transfer of a simulated patient using either a robotic wheelchair (RWC) or a conventional wheelchair (CWC). Methods. The subjects were 10 females who had work experience in transferring patients and another female adult as the simulated patient to be transferred from bed to a RWC or a CWC. In both experimental conditions, ROM, muscle activity, and HR were assessed in the subjects using motion sensors, electromyography, and electrocardiograms. Results. Peak ROM of shoulder flexion during assistive transfer with the RWC was significantly lower than that with the CWC. Values for back muscle activity during transfer were lower with the RWC than with the CWC. Conclusions. The findings suggest that the RWC may decrease workplace injuries and lower back pain in healthcare workers.

Manual Handling in Aged Care: Impact of Environment-related Interventions on Mobility

The manual handling of people (MHP) is known to be associated with high incidence of musculoskeletal disorders for aged care staff. Environment-related MHP interventions, such as appropriate seated heights to aid sit-to-stand transfers, can reduce staff injury while improving the patient's mobility. Promoting patient mobility within the manual handling interaction is an endorsed MHP risk control intervention strategy. This article provides a narrative review of the types of MHP environmental controls that can improve mobility, as well as the extent to which these environmental controls are considered in MHP risk management and assessment tools. Although a range of possible environmental interventions exist, current tools only consider these in a limited manner. Development of an assessment tool that more comprehensively covers environmental strategies in MHP risk management could help reduce staff injury and improve resident mobility through auditing existing practices and guiding the design of new and refurbished aged care facilities.

Study of acceleration of center of mass during sit-to-stand and stand-to-sit in patients with stroke

[Purpose] The purpose of this study was to compare the center of mass during sit-to-stand and stand-to-sit activities in the timed up and go test between healthy subjects and patients with stroke. [Subjects and Methods] Thirty healthy participants and thirty patients with stroke volunteered for this study. Acceleration of the center of mass was measured using a wireless tri-axial accelerometer during sit-to-stand and stand-to-sit activities in the timed up and go test. Accelerometer data were analyzed using BTS G-studio software. [Results] The phase duration was significantly longer and the anterior-posterior, mediolateral, and vertical acceleration ranges were significantly lower during sit-to-stand for patients with stroke than for healthy controls. Further, phase duration and the mediolateral acceleration range during stand-to-sit differed significantly between healthy controls and subjects with stroke. [Conclusions] During training for the sit-to-stand activity, the focus should be all three balance dimensions, but during training for the stand-to-sit activity, the focus should be on improving mediolateral balance and asymmetrical foot positioning should be recommended.

Effects of a safe patient handling and mobility program on patient self-care outcomes

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes. METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program. RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program. CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.

Sit-to-Stand Trainer: An Apparatus for Training "Normal-Like" Sit to Stand Movement

Sit-to-stand (STS) transfer training is probably the most demanding task in rehabilitation. We have developed an innovative STS trainer that offers variable levels of mechanical support and speeds of STS transfer. In a group of neurologically intact individuals we compared kinematics, kinetics and electromyography (EMG) patterns of STS transfer assessed in three experimental conditions with increasing degree of mechanical support (MIN STS-T, MED STS-T, and MAX STS-T) to natural, unassisted STS movement (NO STS-T). The resulting ankle, knee, hip joint and trunk angles in experimental conditions MED STS-T and MIN STS-T were very similar to experimental condition NO STS-T. Vertical ground reaction forces and EMG patterns in the tibialis anterior, quadriceps and hamstrings show a clear trend toward "normal" patterns as the level of mechanical support from the device is progressively reduced. We have further tested the feasibility of the STS trainer in five stroke subjects at two levels of support showing that increased voluntary effort is needed when the support is reduced. Based on these results we conclude that negligible constraints are imposed by the device on a user's STS transfer kinematics, which is an important prerequisite for considering clinical use of the device for training in neurologically impaired.

Musculoskeletal Risk to Physical Therapists during Overground Gait Training

Background: Physical therapists have a disproportionately high risk of work-related musculoskeletal disorders (WMSDs) that may be attributed to the substantial physical support and facilitation they provide during physical rehabilitation. Over the last decade, safety efforts have focused primarily on patients. To decrease the incidence and prevalence of WMSDs, health and safety hazards affecting physical therapists need to be addressed. Method: Two semi-quantitative ergonomic assessment tools, the rapid entire body assessment (REBA) and rapid upper limb assessment (RULA), were used to evaluate a physical therapist’s posture during three overground gait training sessions, which included three sit-to-stand transfers. The tools stratified the therapist’s posture into a WMSD risk level and accompanying action level. Results: The REBA stratified the therapist’s posture into the very high risk level, implement change now during the sit-to-stand transfer and high risk level, investigate and implement change soon during overground gait. The RULA stratified the therapist’s posture into action level 4, investigate and implement change immediately for both the sit-to-stand transfer and overground gait. Conclusion: Physical therapists are at high risk for WMSDs while performing sit-to-stand transfers and overground gait training. Urgent implementation of engineering and administrative controls is needed to reduce the risk of injury for physical therapists.

Work Injuries Among Therapists In Physical Rehabilitation

Background: Physical therapists in rehabilitation settings often perform heavy lifting, repetitive forceful tasks and endure long periods of static or awkward postures. These work conditions put therapists at increased risk of work-related injuries (WRIs). Methods: A cross-sectional survey was conducted among physical therapists (PTs) and physical therapist assistants (PTAs) at 14 randomly selected rehabilitation facilities to determine the prevalence and severity of work-related injuries in physical rehabilitation. Results: A majority of respondents reported their most severe pain or discomfort within the last year affected their back, lasted 24 hours to 1 week, occurred once every 2-6 months, and was rated as moderate on the 0 to 10 pain scale. The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 32%. Sixty percent (60%) of those reporting pain/discomfort had mechanical patient lifts available within their work area. Less than half reported using mechanical patient lifts before or during/after their work-related pain. Conclusion: More than 65% of rehabilitation PTs and PTAs experienced work-related pain due to therapeutic activities including patient handling and movement. It is critical to understand therapists’ technology usage barriers, redesign technology to meet end-user needs, and develop technology-based best practices that promote both worker safety and patient outcomes.

The effect of different intensities of treadmill exercise on cognitive function deficit following a severe controlled cortical impact in rats

Exercise has been proposed for the treatment of traumatic brain injury (TBI). However, the proper intensity of exercise in the early phase following a severe TBI is largely unknown. To compare two different treadmill exercise intensities on the cognitive function following a severe TBI in its early phase, rats experienced a controlled cortical impact (CCI) and were forced to treadmill exercise for 14 days. The results revealed that the rats in the low intensity exercise group had a shorter latency to locate a platform and a significantly better improvement in spatial memory in the Morris water maze (MWM) compared to the control group (p < 0.05). The high intensity exercise group showed a longer latency and a mild improvement in spatial memory compared to the control group rats in the MWM; however, this difference was not statistically significant (p > 0.05). The brain-derived neurotrophic factor (BDNF) and p-CREB protein levels in the contralateral hippocampus were increased significantly in the low intensity exercise group. Our results suggest that 2 weeks of low intensity of treadmill exercise is beneficial for improving cognitive function and increasing hippocampal BDNF expression after a severe TBI in its early phase.