External Devices Among Individuals With Spinal Cord Injury From a Developing Country

OBJECTIVE

The aim of this study was to explore the proportion, number, and type of external devices (including mobility devices, ambulatory aides, and orthotics) possessed and used by individuals with spinal cord injury (SCI) from a developing country.

DESIGN

This was a cross-sectional study.

PARTICIPANTS

A total of 163 participants with SCI from several rural communities in a developing country participated in the study from June 2018 to August 2019.

METHODS

The participants were interviewed and assessed for their SCI characteristics and the external devices (i.e., mobility devices, ambulatory aides, and orthotics) they possessed and used in their daily living.

RESULTS

Most participants (85%), who lived in rural communities with a family income of less than $3167 per year, possessed external devices (one to five types), and 80% of all participants actually used the devices (one to three types) in their daily living. Most participants with motor-complete SCI used a single device, especially a manual wheelchair, whereas those with mild lesion severity used multiple devices for their daily activities, particularly a standard walker.

CONCLUSION

Owing to budget and environmental constraints, the external devices used by individuals with SCI from a developing country are different from those reported in a developed country. The findings provide particular insights into the management of external devices for these individuals of a developing country.

The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up

Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.

The utility of upper limb loading device in determining optimal walking ability in ambulatory individuals with spinal cord injury

Background:

Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability.

Objective:

This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily (n=49).

Methods:

All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance.

Results:

The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability (p<0.05). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance (ρ=−0.351 to −0.493, p<0.05).

Conclusion:

The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.

Various Surfaces Benefited Functional Outcomes and Fall Incidence in Individuals With Spinal Cord Injury: A Randomized Controlled Trial With Prospective Data Follow-up

OBJECTIVES

To compare effects of walking training on a walking track with different surfaces (WTDS), including artificial grass, soft, and pebbles, as compared to overground walking training on the functional ability necessary for independence and incidence of falls of ambulatory individuals with spinal cord injury (SCI).

DESIGN

A randomized controlled trial (single-blinded design) with 6-month prospective fall data follow-up.

SETTING

Tertiary rehabilitation centers and several communities.

PARTICIPANTS

Independent ambulatory individuals (N=54) with SCI who walked with or without a walking device.

INTERVENTION

Participants were randomly arranged into a control group (overground walking training, n=26) or experimental group (walking training over a WTDS, n=28) for 30 min/d, 5 d/wk over 4 weeks.

MAIN OUTCOME MEASURES

The 10-m walk test, timed Up and Go test, five times sit-to-stand test, and 6-minute walk test were repeatedly measured 4 times, including before training, and after 2 and 4 weeks, and 6 months. In addition, participants were prospectively monitored for the fall data over 6 months.

RESULTS

Participants who walked with an average speed of 0.52 m/s and postinjury time >7 years could safely walk over a WTDS. They demonstrated significant improvement at 2 and 4 weeks after experimental training (P<.001), but not after control training. During the 6-month follow-up, participants in the experimental group also had the number of those who fell (n=5, 18%) fewer than those in the control group (n=12, 46%).

CONCLUSIONS

Being at a chronic SCI with ability of independent walking, participants needed a challenging task to promote their functional outcomes and minimize fall risk. The findings suggest the use of various surfaces as an alternative rehabilitation strategy for these individuals.

Visuotemporal cues clinically improved walking ability of ambulatory patients with spinal cord injury within 5 days

BACKGROUND/OBJECTIVE

The human movement system uses a variety of inputs to produce movements. The concurrent use of external information, specifically visutemporal cues, while walking could promote the walking ability of ambulatory patients with spinal cord injury (SCI). This study explored the use of visutemporal cues in rehabilitation training by subjecting ambulatory individuals with SCI to walking training with or without visuotemporal cues and then assessing the effects on their functional ability.

DESIGN

Quasi-experimental study.

SETTING

A tertiary rehabilitation center.

PARTICIPANTS

Thirty-two participants were randomly assigned to the experimental or control groups using stage of injury, severity of SCI, and baseline walking ability as criteria for group arrangement (16 participants/group).

INTERVENTIONS

The participants were trained to walk over level ground at their fastest safe speed with or without a visuotemporal cue, 30 minutes/day, for 5 consecutive days.

OUTCOME MEASURES

The 10-meter walk test, 6-minute walk test, timed up and go test, and five times sit-to-stand test.

RESULTS

The participants demonstrated significant improvement in all functional tests after the 5 days of training (P < 0.001). In addition, the improvement in the group trained using the visuotemporal cue was significantly better than that trained without using the cue.

CONCLUSIONS

Most of these participants were at a chronic stage of SCI, so the findings supported a benefit for incorporating visuotemporal cues in rehabilitation practice, particularly today when the length of rehabilitation has dramatically decreased.

Responses of Six-Weeks Aquatic Exercise on the Autonomic Nervous System, Peak Nasal Inspiratory Flow and Lung Functions in Young Adults with Allergic Rhinitis

Allergic rhinitis is a chronic respiratory disease. Sympathetic hypofunction is identified in all of the allergic rhinitis patients. Moreover, allergic rhinitis is associated with decreased peak nasal inspiratory flow (PNIF) and impaired lung functions. The aim of this study was to investigate effects of six-week of aquatic exercise on the autonomic nervous system function, PNIF and lung functions in allergic rhinitis patients. Twenty-six allergic rhinitis patients, 12 males and 14 females were recruited in this study. Subjects were diagnosed by a physician based on history, physical examination, and positive reaction to a skin prick test. Subjects were randomly assigned to two groups. The control allergic rhinitis group received education and maintained normal life. The aquatic group performed aquatic exercise for 30 minutes a day, three days a week for six weeks. Heart rate variability, PNIF and lung functions were measured at the beginning, after three weeks and six weeks. There were statistically significant increased low frequency normal units (LF n.u.), PNIF and showed decreased high frequency normal units (HF n.u.) at six weeks after aquatic exercise compared with the control group. Six weeks of aquatic exercise could increase sympathetic activity and PNIF in allergic rhinitis patients.

Effects of a visuotemporal cue on walking ability of independent ambulatory subjects with spinal cord injury as compared with healthy subjects

STUDY DESIGN

An experimental, cross-sectional study.

OBJECTIVES

To investigate effects of using a visuotemporal cue on the walking ability of independent ambulatory subjects with spinal cord injury (SCI) as compared with healthy subjects.

SETTING

A tertiary rehabilitation center, Thailand.

METHODS

Forty independent ambulatory subjects with SCI and healthy subjects participated in the study (20 subjects per group). All of them were assessed for their walking speed, stride length, cadence and percents of step symmetry under two conditions, including walking at their fastest speed with and without a visuotemporal cue along a 10 m walkway.

RESULTS

When walking with a visuotemporal cue, walking speed, stride length and cadence of the subjects were significantly increased from the uncued condition (P<0.01). However, the healthy subjects showed a significantly greater increase in walking speed and cadence, whereas, subjects with SCI demonstrated significantly higher improvement in stride length as compared with the other group (P<0.001). In addition, the effects of the visuotemporal cue were significantly greater in those with less severity of SCI (P<0.01).

CONCLUSION

The findings confirm the benefits of using a visuotemporal cue to improve variables relating to walking ability in subjects with intact integrative capability of the brain but with different levels of sensorimotor deterioration. The findings suggest the use of a visuotemporal cue to improve the effectiveness of programs in sport and exercise sciences, and rehabilitation treatments.

The effects of thoracic manipulation versus mobilization for chronic neck pain: a randomized controlled trial pilot study

[Purpose] To investigate effects of thoracic manipulation versus mobilization on chronic neck pain. [Methods] Thirty-nine chronic neck pain subjects were randomly assigned to single level thoracic manipulation, single level thoracic mobilization, or a control group. The cervical range of motion (CROM) and pain ratings (using a visual analog scale: VAS) were measured before, immediately after and at a 24-hour follow-up. [Results] Thoracic manipulation significantly decreased VAS pain ratings and increased CROM in all directions in immediate and 24-hour follow-ups. The thoracic mobilization group significantly increased in CROM in most directions at immediate follow-up and right and left rotational directions at the 24-hour follow-up. Comparisons between groups revealed the CROM for the manipulation group to increase significantly more than for control subjects in most directions at immediate follow-up and flexion, left lateral flexion and left rotation at the 24-hour follow-up. The CROM for the thoracic mobilization group significantly increased in comparison to the control group in flexion at immediate follow-up and in flexion and left rotation at the 24-hour follow-up. [Conclusion] The study demonstrated reductions in VAS pain ratings and increases in CROM at immediate and 24-hour follow-ups from both single level thoracic spine manipulation and thoracic mobilization in chronic neck pain.

Therapeutic effects of traditional Thai massage on pain, muscle tension and anxiety in patients with scapulocostal syndrome: a randomized single-blinded pilot study

The purpose of this study was to investigate the therapeutic effects of traditional Thai massage (TTM) on pain intensity, pressure pain threshold (PPT), muscle tension and anxiety associated with scapulocostal syndrome (SCS). Twenty patients were randomly allocated to receive a 30-min session of either TTM or physical therapy modalities (PT: ultrasound therapy and hot pack) for 9 sessions over a period of 3 weeks. Pain intensity, PPT, muscle tension and anxiety were measured before and immediately after the first treatment session, 1 day after the last treatment session and 2 weeks after the last treatment session. Results indicated that the TTM group showed a significant improvement in all parameters after the first treatment session and at 1 day and 2 weeks after the last treatment session (p < 0.05). For all outcomes, similar changes were observed in the PT group except for PPT (p < 0.05). The adjusted post-test mean values of each assessment time point for pain intensity and muscle tension were significantly lower in the TTM group than those of the PT group (p < 0.01). In addition, the values for PPT were significantly higher in the TTM group (p > 0.05). We therefore suggest that TTM could be an alternative treatment for the patient with SCS.