Archives of Physical Medicine and Rehabilitation

In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy

2010-01-01

Abstract: Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy.Objective: To investigate whether in-home remotely monitored virtual reality videogame-based telerehabilitation in adolescents with hemiplegic cerebral palsy can improve hand function and forearm bone health, and demonstrate alterations in motor circuitry activation.Design: A 3-month proof-of-concept pilot study.Setting: Virtual reality videogame-based rehabilitation systems were installed in the homes of 3 participants and networked via secure Internet connections to the collaborating engineering school and children's hospital.Participants: Adolescents (N=3) with severe hemiplegic cerebral palsy.Intervention: Participants were asked to exercise the plegic hand 30 minutes a day, 5 days a week using a sensor glove fitted to the plegic hand and attached to a remotely monitored videogame console installed in their home. Games were custom developed, focused on finger movement, and included a screen avatar of the hand.Main Outcome Measures: Standardized occupational therapy assessments, remote assessment of finger range of motion (ROM) based on sensor glove readings, assessment of plegic forearm bone health with dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), and functional magnetic resonance imaging (fMRI) of hand grip task.Results: All 3 adolescents showed improved function of the plegic hand on occupational therapy testing, including increased ability to lift objects, and improved finger ROM based on remote measurements. The 2 adolescents who were most compliant showed improvements in radial bone mineral content and area in the plegic arm. For all 3 adolescents, fMRI during grip task contrasting the plegic and nonplegic hand showed expanded spatial extent of activation at posttreatment relative to baseline in brain motor circuitry (eg, primary motor cortex and cerebellum).Conclusions: Use of remotely monitored virtual reality videogame telerehabilitation appears to produce improved hand function and forearm bone health (as measured by DXA and pQCT) in adolescents with chronic disability who practice regularly. Improved hand function appears to be reflected in functional brain changes.

Effects of a 12-Week Tai Chi Chuan Program Versus a Balance Training Program on Postural Control and Walking Ability in Older People

Thierry Lelard, Pierre-Louis Doutrellot, Pascal David, Said Ahmaidi — 2010-01-01

Abstract: Lelard T, Doutrellot P-L, David P, Ahmaidi S. Effects of a 12-week Tai Chi Chuan program versus a balance training program on postural control and walking ability in older people.Objective: To compare the respective effects of 2 balance training programs: a Tai Chi (TC) program and a balance training program on static postural control and walking ability.Design: Randomized controlled trial.Setting: General community.Participants: Older subjects (N=28) participated in the study.Interventions: The TC group (n=14; mean age ± SD, 76.8±5.1y) and the balance training group (n=14; 77.0±4.5y) were both trained for 12 weeks.Main Outcome Measures: Static postural control was assessed via measurement of center of pressure sway under eyes open (EO) and eyes closed (EC) conditions. Walking speed over a 10-meter course was also assessed.Results: After the 12-week training period, there were no significant differences in walking speed or postural parameters in either the EO or EC conditions for the TC and balance training groups. Performance in the EC condition was lower than in the EO condition in pretest and posttest for the balance training and TC groups. The Romberg quotient (EO/EC ratio) was significantly higher after the balance training program than the TC program (P<.05).Conclusions: We cannot conclude that the balance training program has better effects than the TC program on postural control or walking ability. None of the outcome measures showed significant change posttraining in either the TC or the balance training groups. However, the differences described in the Romberg quotient after the training period between the TC and the balance training groups suggest that TC should be helpful to limit the deleterious effects of eye closure on postural balance.

The Effectiveness of Walking Stick Use for Neurogenic Claudication: Results From a Randomized Trial and the Effects on Walking Tolerance and Posture

2010-01-01

Abstract: Comer CM, Johnson MI, Marchant PR, Redmond AC, Bird HA, Conaghan PG. The effectiveness of walking stick use for neurogenic claudication: results from a randomized trial and the effects on walking tolerance and posture.Objectives: To determine the immediate effects of using a stick on walking tolerance and on the potential explanatory variable of posture, and to provide a preliminary evaluation of the effects of daily walking stick use on symptoms and function for people with neurogenic claudication.Design: A 2-phase study of neurogenic claudication patients comprising a randomized trial of 2 weeks of home use of a walking stick and a crossover study comparing walking tolerance and posture with and without a walking stick.Setting: A primary care–based musculoskeletal service.Participants: Patients aged 50 years or older with neurogenic claudication symptoms (N=46; 24 women, 22 men, mean age=71.26y) were recruited.Intervention: Walking stick.Main Outcome Measures: Phase 1 of the trial used the Zurich Claudication Questionnaire symptom severity and physical function scores to measure outcome. The total walking distance during a shuttle walking test and the mean lumbar spinal posture (measured by using electronic goniometry) were used as the primary outcome measurements in the second phase.Results: Forty of the participants completed phase 1 of the trial, and 40 completed phase 2. No significant differences in symptom severity or physical function were shown in score improvements for walking stick users (stick user scores − control scores) in the 2-week trial (95% confidence interval [CI], −.24 to .28 and −.10 to .26, respectively). In the second phase of the trial, the ratio of the shuttle walking distance with a stick to without a stick showed no significance (95% CI, .959–1.096) between the groups. Furthermore, the use of a walking stick did not systematically promote spinal flexion; no significant difference was shown for mean lumbar spinal flexion for stick use versus no stick (95% CI, .351°–.836°).Conclusions: The prescription of a walking stick does not improve walking tolerance or systematically alter the postural mechanisms associated with symptoms in neurogenic claudication.

Mortality After Discharge From Acute Care Hospitalization With Traumatic Brain Injury: A Population-Based Study

2010-01-01

Abstract: Ventura T, Harrison-Felix C, Carlson N, DiGuiseppi C, Gabella B, Brown A, DeVivo M, Whiteneck G. Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study.Objective: To characterize mortality after acute hospitalization with traumatic brain injury (TBI) in a socioeconomically diverse population.Design: Population-based retrospective cohort study.Setting: Statewide TBI surveillance program.Participants: Colorado residents with TBI discharged alive from acute hospitalization between 1998 and 2003 (N=18,998).Interventions: Not applicable.Main Outcome Measures: Vital status at the end of the study period (December 31, 2005) and statewide population mortality rates were used to calculate all-cause and cause-specific standardized mortality ratios (SMRs) and life expectancy compared with population mortality rates. The influence of demographics, injury severity, and comorbid conditions on time until death was investigated using age-stratified Cox proportional hazards modeling.Results: Patients with TBI carried about 2.5 times the risk of death compared with the general population (SMR=2.47; 95% confidence interval [CI], 2.31–2.65). Life expectancy reduction averaged 6 years. SMRs were largest for deaths caused by mental/behavioral (SMR=3.84; 95% CI, 2.67–5.51) and neurologic conditions (SMR=2.79; 95% CI, 2.07–3.77) and were smaller but significantly higher than 1.0 for an array of other causes. Injury severity and older age increased mortality among young people (age <20y). However, risk factors for mortality among adults age 20 and older involved multiple domains of demographics (eg, metropolitan residence), injury-related measures (eg, falls versus vehicular incidents), and comorbidity (eg, ≥3 comorbid health conditions versus none).Conclusions: TBI confers an increased risk of mortality in the months and years after hospital discharge. Although life expectancy is reduced across the population, the excess in mortality lessens as time since injury increases. Specific risk factors (eg, high injury severity, poor general health) pose an especially high threat to survival and should prompt an increased vigilance of health status, especially among younger patients.

Effect of Intrathecal Baclofen Bolus Injection on Lower Extremity Joint Range of Motion During Gait in Patients With Acquired Brain Injury

Terry S. Horn, Stuart A. Yablon, John W. Chow, Jae E. Lee, Dobrivoje S. Stokic — 2009-11-16

Abstract: Horn TS, Yablon SA, Chow JW, Lee JE, Stokic DS. Effect of intrathecal baclofen bolus injection on lower extremity joint range of motion during gait in patients with acquired brain injury.Objectives: To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia.Design: Case series.Setting: Tertiary care rehabilitation center.Participants: Adults (N=28) with muscle hypertonia due to stroke, trauma, or anoxia.Interventions: 50-μg ITB bolus injection via lumbar puncture (75 and 100μg in 2 cases).Main Outcome Measures: Ashworth score, self-selected gait speed, and sagittal plane ROMs in hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.Results: A significant decrease in the mean Ashworth score on the more involved side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at different intervals after ITB bolus injection. Ankle ROM significantly increased on the more involved (13° to 15°, P<.01) and less involved (22° to 24°, P<.05) sides. ROM significantly improved, significantly worsened, or showed no significant change in 42%, 34%, and 24% of individual joints, respectively. The peak change in ROM did not coincide with the peak decrease in Ashworth score. Peak changes in ROM and speed coincided more often (P<.001) in participants who increased gait speed after ITB bolus compared with those who decreased speed. The absolute change in ROM after ITB bolus injection correlated better with the concurrent changes in speed (r=.41, P<.001) than with the baseline speed (r=.18, P<.05).Conclusions: ITB bolus injection produces variable changes in joint ROM during gait, with significant improvements in the ankles only. Timing and magnitude of peak changes in ROM are associated with concurrent changes in speed but not muscle hypertonia.

Characteristics of a Mild Head Injury Subgroup With Extreme, Persisting Distress on the Rivermead Postconcussion Symptoms Questionnaire

2010-01-01

Abstract: Kirsch NL, de Leon MB, Maio RF, Millis SR, Tan-Schriner CU, Frederiksen S. Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms Questionnaire.Objective: To examine baseline variables and identify characteristics of participants with extremely high reports of symptoms (ie, outliers) 12 months after mild head injury (MHI).Design: A prospective cohort study of MHI with and without loss of consciousness (LOC) and/or posttraumatic amnesia (PTA) recruited from and interviewed at the emergency department (ED), with a follow-up telephone interview at 12 months.Setting: Level II community hospital ED.Participants: Participants (n=58) with MHI and LOC less than or equal to 30 minutes and/or PTA less than 24 hours and participants (n=173) with MHI but no PTA/LOC. Inclusion criteria: age greater than or equal to 18 years, less than or equal to 24 hours after injury, Glasgow Coma Scale score greater than or equal to 13, and discharge from the ED. Fourteen (6%) participants had extremely high scores on the Rivermead Postconcussion Symptoms Questionnaire (RPQ).Main Outcome Measures: RPQ and questions on health services use and litigation.Results: Characterizing the outlier cases are prior head injury, preinjury disability, history of substance use, unemployment, and elevated somatic symptoms at the ED. At 12 months, outliers had higher use of health services and litigation.Conclusions: The existence of a subgroup with a distinctive pattern of baseline characteristics in combination with elevated somatic symptoms at the time of presentation to the ED suggests that further taxonomic distinctions may be warranted for the MHI population, each requiring appropriately targeted interventions for addressing symptomatic complaints.

Influence of Sex and Age on Inpatient Rehabilitation Outcomes Among Older Adults With Traumatic Brain Injury

2010-01-01

Abstract: Graham JE, Radice-Neumann DM, Reistetter TA, Hammond FM, Dijkers M, Granger CV. Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury.Objective: To assess the influence of sex and age on inpatient rehabilitation outcomes in a large national sample of older adults with traumatic brain injury (TBI).Design: Prospective case series.Setting: Eight hundred forty-eight inpatient rehabilitation facilities that subscribe to the Uniform Data System for Medical Rehabilitation.Participants: Patients (n=18,413) age 65 years and older admitted for inpatient rehabilitation after TBI from 2005 through 2007.Interventions: None.Main Outcome Measures: Rehabilitation length of stay, discharge FIM motor and cognitive ratings, discharge setting, and scheduled home health services at discharge.Results: Mean age ± SD of the sample was 79±7 years, and 47% were women. In multivariable models, higher age was associated with shorter lengths of stay (P<.001), lower discharge FIM motor and cognitive ratings (P<.001), and greater odds of home health services at discharge (P<.001). Women demonstrated shorter lengths of stay (P=.006) and greater odds of being scheduled for home health services at discharge (P<.001) than men. The sex-by-age interaction term was not significant in any outcome model. Sex differences and trends were consistent across the entire age range of the sample.Conclusions: Sex and age patterns in rehabilitation outcomes among older adults with TBI varied by outcome. The current findings related to rehabilitation length of stay may be helpful for facility-level resource planning. Additional studies are warranted to identify the factors associated with returning to home and to assess the long-term benefits of combined inpatient rehabilitation and home health services for older adults with TBI.

Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

2010-01-01

Abstract: Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.Objective: To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.Design: Population-based cohort study.Setting: A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.Participants: Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0–2 points] score) in Short Portable Mental Status Questionnaire [0–10 points]) and able to walk before the fracture.Interventions: Not applicable.Main Outcome Measure: Walking ability and ADLs index at 4-month and 12-month follow-up.Results: Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1–7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52–22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44–19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8–3.5; P<.001), while type of surgery was not (P=.376).Conclusions: Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.

Prognosis of Limitations in Activities in Osteoarthritis of the Hip or Knee: A 3-Year Cohort Study

2010-01-01

Abstract: van Dijk GM, Veenhof C, Spreeuwenberg P, Coene N, Burger BJ, van Schaardenburg D, van den Ende CH, Lankhorst GJ, Dekker J, on behalf of the CARPA Study Group. Prognosis of limitations in activities in osteoarthritis of the hip or knee: a 3-year cohort study.Objective: To describe the course of limitations in activities in elderly patients with osteoarthritis (OA) of the hip or knee over a follow-up period of 3 years, and to identify prognostic factors of the course of limitations in activities, focusing on body functions, comorbidity, and cognitive functioning.Design: A longitudinal cohort study with 3 years of follow-up. Measurements were conducted annually. Statistical analyses included t tests, univariate regression analyses, and multivariate regression analyses.Setting: Rehabilitation centers and hospitals (Departments of Orthopedics, Rheumatology, and Rehabilitation) in The Netherlands.Participants: Patients (N=237) with hip or knee OA.Interventions: Not applicable.Main Outcome Measures: Patient-perceived change, self-reported limitations in activities measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and observed limitations in activities (timed walking test). Prognostic factors: demographic data, clinical data, body function (pain, muscle strength, range of motion [ROM]), comorbidity, and cognitive functioning (cognitive decline, memory, attention).Results: Self-reported limitations in activities measured by the WOMAC improved slightly after 3-year follow-up. In knee OA, reduced ROM at 1-year follow-up (β=.120), increased pain at 1-year follow-up (β=−.177), and higher morbidity count (β=−.180) predicted worsening of self-reported limitations in activities. In hip OA, reduced ROM at 1-year follow-up (β=.201 for hip external rotation and β=.144 for knee extension), increased pain at 1-year follow-up (β=−.134), higher morbidity count (β=−.220), or the presence of moderate to severe cardiac disease (β=−.214) and poorer cognitive functioning (β=.181) predicted worsening of self-reported limitations in activities. Performance-based limitations in activities measured by the timed walking test did not change after 3 years of follow-up. In knee OA, decreased muscle strength at 1-year follow-up (β=−.272) and higher morbidity count (β=.199) predicted worsening of performance-based limitations in activities. In hip OA, better ROM (β=.182), higher morbidity count (β=.232), or the presence of moderate to severe cardiac and eye-ear-nose-throat disease (β=.210 and β=.188, respectively) and older age (β=.355) predicted worsening of performance-based limitations in activities.Conclusions: Overall, at the group level, limitations in activities of patients with OA of the hip or knee recruited from hospitals and rehabilitation centers seem fairly stable during the first 3 years of follow-up. However, at the level of individual patients, considerable variation occurs. Prognostic factors for worsening of limitations in activities include increased pain, reduced ROM, and decreased muscle strength at 1-year follow-up; higher morbidity count; and to a lesser extent poor cognitive functioning.

Prediction of Postoperative Ambulatory Status 1 Year After Hip Fracture Surgery

2010-01-01

Abstract: Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery.Objectives: To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status.Design: Cohort study.Setting: Twelve hospitals belonging to the regional network for hip fracture in Japan.Participants: The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers.Interventions: Not applicable.Main Outcome Measures: We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status.Results: In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (ρ=0.6, P<.001).Conclusions: In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery.

Changes in Ankle Mechanical Stability in Those With Knee Osteoarthritis

Tricia J. Hubbard, Charlie Hicks-Little, Mitchell Cordova — 2010-01-01

Abstract: Hubbard TJ, Hicks-Little C, Cordova M. Changes in ankle mechanical stability in those with knee osteoarthritis.Objective: To examine ankle joint mechanical stability in patients who had mild to moderate knee osteoarthritis (OA).Design: Case control study.Setting: Biodynamics research laboratory.Participants: Subjects with knee OA (n=15; 5 men and 10 women; mean age ± SD, 60.3±10.2y; mean mass ± SD, 93.9±18.3kg; mean height ± SD, 167.23±9.5cm) were matched to healthy controls (n=15; 5 men and 10 women; mean age ± SD, 59.6±12.6y; mean mass ± SD, 83.5±19.2kg; mean height ± SD, 169.7±12.6cm).Interventions: Not applicable.Main Outcome Measures: Mechanical ankle-subtalar joint stability was assessed with an instrumented arthrometer where ankle-subtalar joint motion for anterior/posterior displacement and inversion/eversion rotation was measured. Separate 2 × 2 mixed model analyses of variance were performed.Results: Significant group × side interactions were observed for anterior and posterior displacement (P<.05) where patients with knee OA had significantly less anterior and posterior ankle displacement compared with the control group, as well as compared with their unaffected extremity. Additionally, patients with knee OA had significantly (P<.05) less inversion/eversion rotation than their respective controls.Conclusions: These data suggest that altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. Compensatory changes in ankle joint mechanics must also be considered when addressing lower extremity functional deficits in patients with knee OA.

The Relationship of Transversus Abdominis and Lumbar Multifidus Activation and Prognostic Factors for Clinical Success With a Stabilization Exercise Program: A Cross-Sectional Study

Jeffrey J. Hebert, Shane L. Koppenhaver, John S. Magel, Julie M. Fritz — 2010-01-01

Abstract: Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study.Objective: To examine the relationship between prognostic factors for clinical success with a stabilization exercise program and lumbar multifidus (LM) and transversus abdominis (TrA) muscle activation assessed using rehabilitative ultrasound imaging (RUSI).Design: Cross-sectional study.Setting: Outpatient physical therapy clinic.Participants: Volunteers with current low back pain (N=40).Intervention: Not applicable.Main Outcome Measures: We examined the relationship between prognostic factors associated with clinical success with a stabilization exercise program (positive prone instability test, age <40y, aberrant movements, straight leg raise >91°, presence of lumbar hypermobility) and degree of TrA and LM muscle activation assessed by RUSI.Results: Significant univariate relationships were identified between LM muscle activation and the number of prognostic factors present (Pearson correlation coefficient [r] =−.558, P=.001), as well as the individual factors of a positive prone instability test (point biserial correlation coefficient [rpbis]=.376, P=.018) and segmental hypermobility (rpbis=.358, P=.025). The multivariate analyses indicated that after controlling for other variables, the addition of the variable “number of prognostic factors present” resulted in a significant increase in R2 (P=.006). No significant univariate or multivariate relationships were observed between the prognostic factors and TrA muscle activation.Conclusions: Decreased LM muscle activation, but not TrA muscle activation, is associated with the presence of factors predictive of clinical success with a stabilization exercise program. Our findings provide researchers and clinicians with evidence regarding the construct validity of the prognostic factors examined in this study, as well as the potential clinical importance of the LM muscle as a target for stabilization exercises.

Muscle Activation During Four Pilates Core Stability Exercises in Quadruped Position

Bergson C. Queiroz, Mariana F. Cagliari, César F. Amorim, Isabel C. Sacco — 2010-01-01

Abstract: Queiroz BC, Cagliari MF, Amorim CF, Sacco IC. Muscle activation during four Pilates core stability exercises in quadruped position.Objective: To compare the activity of stabilizing trunk and hip muscles in 4 variations of Pilates stabilizing exercises in the quadruped position.Design: Repeated-measures descriptive study.Setting: A biomechanics laboratory at a university school of medicine.Participants: Healthy subjects (N=19; mean age ± SD, 31±5y; mean weight ± SD, 60±11kg; mean height ± SD, 166±9cm) experienced in Pilates routines.Interventions: Surface electromyographic signals of iliocostalis, multifidus, gluteus maximus, rectus abdominis, and external and internal oblique muscles were recorded in 4 knee stretch exercises: retroverted pelvis with flexed trunk; anteverted pelvis with extended trunk; neutral pelvis with inclined trunk; and neutral pelvis with trunk parallel to the ground.Main Outcome Measures: Root mean square values of each muscle and exercise in both phases of hip extension and flexion, normalized by the maximal voluntary isometric contraction.Results: The retroverted pelvis with flexed trunk position led to significantly increased external oblique and gluteus maximus muscle activation. The anteverted pelvis with trunk extension significantly increased multifidus muscle activity. The neutral pelvis position led to significantly lower activity of all muscles. Rectus abdominis muscle activation to maintain body posture was similar in all exercises and was not influenced by position of the pelvis and trunk.Conclusions: Variations in the pelvic and trunk positions in the knee stretch exercises change the activation pattern of the multifidus, gluteus maximus, rectus abdominis, and oblique muscles. The lower level of activation of the rectus abdominis muscle suggests that pelvic stability is maintained in the 4 exercise positions.

Multiple Sclerosis and Postural Control: The Role of Spasticity

Jacob J. Sosnoff, Sunghoon Shin, Robert W. Motl — 2010-01-01

Abstract: Sosnoff JJ, Shin S, Motl RW. Multiple sclerosis and postural control: the role of spasticity.Objectives: To examine the association between spasticity and postural control in subjects with multiple sclerosis (MS).Design: Cross-sectional.Setting: Motor control laboratory.Participants: Subjects with MS (n=16, 2 male) and age and sex-matched subjects (n=16) participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth scale scores between 1 and 3.Interventions: Not applicable.Main Outcome Measures: Postural control was measured with a force platform that quantifies ground reaction forces and moments in mediolateral and anteroposterior directions. Postural control was indexed with anterior-posterior sway range, medial-lateral sway range, 95% elliptical area of the deviations of center of pressure (COP), velocity of COP sway, and the frequency at which 95% of spectral profile was contained. Participants with MS further underwent assessment of the soleus Hoffman reflex (H-reflex) as an index of spasticity.Results: Cluster analysis on H-reflex data identified groups of MS participants with high spasticity (n=7) and low spasticity (n=9). There were no differences in age, duration of MS, and disease severity between MS groups. There were no differences in anterior-posterior sway range between any of the groups. The high spasticity group had greater COP area, velocity, and mediolateral sway compared with the low spasticity and control group, and the low spasticity group had postural control values between the high spasticity and control groups.Conclusions: The pattern of results suggests that spasticity contributes to postural deficits observed in MS.

Validation of the Multidimensional Outcome Expectations for Exercise Scale in Ambulatory, Symptom-Free Persons With Multiple Sclerosis

Edward McAuley, Robert W. Motl, Siobhan M. White, Thomas R. Wójcicki — 2010-01-01

Abstract: McAuley E, Motl RW, White SM, Wójcicki TR. Validation of the Multidimensional Outcome Expectations for Exercise Scale in ambulatory, symptom-free persons with multiple sclerosis.Objective: To determine the psychometric properties of the 3-factor Multidimensional Outcome Expectations for Exercise Scale in a sample of ambulatory, symptom-free persons with multiple sclerosis (MS).Design: Cross-sectional validation study.Setting: Midwestern university.Participants: Community-dwelling adults (N=242) with an established definite diagnosis of MS, as corroborated by the participant's neurologist, who were relapse free for the last 30 days and ambulatory with minimal assistance.Interventions: Not applicable.Main Outcome Measures: Multidimensional Outcome Expectations for Exercise Scale, physical activity, self-efficacy, and physical health status. Confirmatory factor analyses using covariance modeling and correlational analyses were used to establish factorial and construct validity.Results: Analyses showed excellent factorial validity for the hypothesized factor structure reflecting physical, social, and self-evaluative outcome expectations. All 3 subscales were internally consistent. Theoretically, relevant correlations between outcome expectations and self-efficacy, physical activity, and physical health status were all supported.Conclusions: The Multidimensional Outcome Expectations for Exercise Scale appears to be a reliable and valid measure of outcome expectations for exercise in this limited sample of community-dwelling adults with MS. Further validation in clinical samples is warranted.

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Susan B. Williams, Caroline A. Brand, Keith D. Hill, Susan B. Hunt, Helen Moran — 2010-01-01

Abstract: Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.Objective: To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.Design: Pre-post interventional study.Setting: General community.Participants: Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.Intervention: After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.Main Outcome Measures: Falls risk (Falls Risk of Older People—Community Setting) and balance measures.Results: Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7–72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16–23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).Conclusions: An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.

Virtual Reality–Enhanced Partial Body Weight–Supported Treadmill Training Poststroke: Feasibility and Effectiveness in 6 Subjects

2010-01-01

Abstract: Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality–enhanced partial body weight–supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.Objective: To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight–supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke.Design: A before-after comparison of a single group with BWSTT intervention.Setting: University research laboratory.Participants: A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study.Intervention: Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback.Main Outcome Measures: Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed.Results: One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s.Conclusions: A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.

Intrinsic Properties of the Knee Extensor Muscles After Subacute Stroke

2010-01-01

Abstract: Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke.Objective: To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke.Design: Case-control study.Setting: Rehabilitation center research laboratory.Participants: Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12).Interventions: Not applicable.Main Outcome Measures: Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery.Results: No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001).Conclusions: The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation.

The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke

Taeyou Jung, DoKyeong Lee, Charalambos Charalambous, Konstantinos Vrongistinos — 2010-01-01

Abstract: Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.Objective: To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.Design: Comparative gait analysis.Setting: University-based aquatic therapy center.Participants: Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.Interventions: Not applicable.Main Outcome Measures: Spatiotemporal and kinematic gait parameters.Results: The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.Conclusions: The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking.

Biplanar Measurement of Thoracolumbar Curvature in Older Adults Using an Electromagnetic Tracking Device

Devinder K. Singh, Martin Bailey, Raymond Lee — 2010-01-01

Abstract: Singh DK, Bailey M, Lee R. Biplanar measurement of thoracolumbar curvature in older adults using an electromagnetic tracking device.Objectives: To develop a new biplanar method of thoracolumbar curvature measurement by using an electromagnetic tracking device and to study the effects of aging on the thoracolumbar curvature.Design: Cross-sectional study.Setting: Human movement laboratory.Participants: Healthy (N=52, 26 younger and 26 older) volunteers.Interventions: Not applicable.Main Outcome Measures: An electromagnetic tracking device was used to trace the thoracolumbar curvature by recording the positions of the spinous processes of the spine. The coordinates of the curvature were fitted with polynomial equations, and the magnitudes of thoracic kyphosis, lumbar lordosis, and lateral thoracic and lumbar curves were determined.Results: The present technique was shown to be highly reliable in measuring thoracolumbar curvature with an intraclass correlation coefficient of more than .90. The mean thoracic kyphosis (−46.95°±11.41°) in the older adults was significantly larger than that in the younger adults (−38.82°±9.86°) (P<.01). However, there were no significant differences in lumbar lordosis and lateral curvatures between the 2 subject groups.Conclusions: The present study provided evidence of an increase in thoracic kyphosis in older adults. The method of measurement presented in this study was found to provide reliable biplanar data that will be useful in a clinical setting.

The Health and Quality of Life Outcomes Among Youth and Young Adults With Cerebral Palsy

2010-01-01

Abstract: Young NL, Rochon TG, McCormick A, Law M, Wedge JH, Fehlings D. The health and quality of life outcomes among youth and young adults with cerebral palsy.Objectives: To describe the health and quality of life (QoL) of youth and young adults who have cerebral palsy (CP), and to assess the impact of 3 key factors (severity, age, and sex) on these outcomes.Design: Cross-sectional survey.Setting: Participants were identified from 6 children's treatment centers in Ontario.Participants: The sample of participants (N=199) included youth (n=129; age, 13–17y) and adults (n=70; age, 23–33y) with a broad range of severity: 35% mild, 19% moderate, and 47% severe.Intervention: Not applicable.Main Outcome Measures: Health Utilities Index (HUI3), Assessment of Quality of Life (AQoL), and Self-Rated Health (SRH).Results: SRH was reported to be excellent or very good by 57% of youth and 46% of adults. Mean HUI3 scores were .30 for youth and .31 for adults. Mean AQoL scores were .28 for youth and adults. Severity of CP in childhood predicted 55% of the variance in HUI3 scores and 45% of the variance in AQoL scores. Age and sex were not significant predictors of health or QoL.Conclusions: The observed health and QoL scores were much lower than those previously reported in the literature. This is likely a result of the inclusion of those with severe CP. The scores for youth were similar to those for adults and suggest that health and QoL outcomes were relatively stable across the transition to adulthood. Youth and adults with CP have limited health status and will require health care support throughout their lives to help them optimize their well being. Longitudinal follow-up studies are essential to understand better the patterns of health in this population over time.

Effects of Aging and Tai Chi on Finger-Pointing Toward Stationary and Moving Visual Targets

Jasmine C. Kwok, Christina W. Hui-Chan, William W. Tsang — 2010-01-01

Abstract: Kwok JC, Hui-Chan CW, Tsang WW. Effects of aging and Tai Chi on finger-pointing toward stationary and moving visual targets.Objective: To examine the aging effect on speed and accuracy in finger pointing toward stationary and moving visual targets between young and older healthy subjects and whether or not Tai Chi practitioners perform better than healthy older controls in these tasks.Design: Cross-sectional study.Setting: University-based rehabilitation center.Participants: University students (n=30) (aged 24.2±3.1y), were compared with healthy older control subjects (n=30) (aged 72.3±7.2y) and experienced (n=31) (mean years of practice, 7.1±6.5y) Tai Chi practitioners (aged 70.3±5.9y).Interventions: Not applicable.Main Outcome Measures: Subjects pointed with the index finger of their dominant hand from a fixed starting position on a desk to a visual signal (1.2cm diameter dot) appearing on a display unit, as quickly and as accurately as possible. Outcome measures included (1) reaction time—the time from the appearance of the dot to the onset of the anterior deltoid electromyographic response; (2) movement time—the time from onset of the electromyographic response to touching of the dot; and (3) accuracy—the absolute deviation of the subject's finger-pointing location from center of the dot.Results: Young subjects achieved significantly faster reaction and movement times with significantly better accuracy than older control subjects in all finger-pointing tasks. Tai Chi practitioners attained significantly better accuracy than older controls in pointing to stationary visual signals appearing contralaterally and centrally to their pointing hand. They also demonstrated significantly better accuracy when the target was moving. Accuracy in Tai Chi practitioners was similar to young controls.Conclusions: Eye-hand coordination in finger-pointing declines with age in time and accuracy domains. However, Tai Chi practitioners attained significantly better accuracy than control subjects similar in age, sex, and physical activity level.

Application of Rasch Analysis to Examine Psychometric Aspects of the Activities-Specific Balance Confidence Scale When Used in a New Cultural Context

2010-01-01

Abstract: Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher AG. Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context.Objective: To investigate by using Rasch analysis the psychometric properties of the Activities-Specific Balance Confidence (ABC) Scale when applied in a new Icelandic context.Design: Cross-sectional, population-based, random selection from the Icelandic National Registry.Setting: Community-based.Participants: Icelanders (N=183), 65 to 88 years old, and 48% women.Interventions: Not applicable.Main Outcome Measure: ABC, an instrument used to evaluate how confident older people are in maintaining balance and remaining steady when moving through the environment. An Icelandic translation of the ABC (ABC-ICE) scale was evaluated by implementing Rasch rating scale analysis to transform ordinal ABC-ICE scores into interval measures and evaluating aspects of validity and reliability of the scale.Results: Participants were not able to differentiate reliably between the 11 rating scale categories of the ABC-ICE. Additionally, 3 items failed to show acceptable goodness of fit to the ABC-ICE rating scale model. By collapsing categories and creating a new 5-category scale, only 1 item misfit. Removing that item resulted in a modified version of ABC-ICE with 5 categories and 15 items. Both item goodness-of-fit statistics and principal components analysis supported unidimensionality of the modified ABC-ICE. The ABC-ICE measures reliably separated the sample into at least 4 statistically distinct strata of balance confidence. Finally, the hierarchical order of item difficulties was consistent with theoretic expectations, and the items were reasonably well targeted to the balance confidence of the persons tested.Conclusions: Rasch analysis indicated a need to modify the ABC-ICE to improve its psychometric properties. Further studies are needed to determine if similar analyses of other versions of the ABC, including the original one, will yield similar results.

Indiana University School of Medicine - Accreditation Statement

2010-01-01

Journal Based CME Evaluation and Application

2010-01-01

CME Processing Fees and Application

2010-01-01

2011 Summer Archives Supplement

2010-01-01

Masthead

2010-01-01

Archives of Physical Medicine and Rehabilitation (ISSN 0003-9993) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Periodicals postage paid at New York, NY and additional mailing offices.

Editorial Board

2010-01-01

Selections From This Month in the Archives

2010-01-01

Meredith R. Golomb, MD, MSc Brenna C. McDonald, PsyD

Information for Authors

2010-01-01

The Archives of Physical Medicine and Rehabilitation is the official journal of the American Congress of Rehabilitation Medicine (ACRM). Its purpose is to publish original, peer-reviewed research and clinical reports in physical medicine and rehabilitation, and to inform rehabilitation professionals of developments that affect them in the nonclinical aspect of their practices.

Archives of Physical Medicine and Rehabilitation

In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy

Effects of a 12-Week Tai Chi Chuan Program Versus a Balance Training Program on Postural Control and Walking Ability in Older People

The Effectiveness of Walking Stick Use for Neurogenic Claudication: Results From a Randomized Trial and the Effects on Walking Tolerance and Posture

Mortality After Discharge From Acute Care Hospitalization With Traumatic Brain Injury: A Population-Based Study

Effect of Intrathecal Baclofen Bolus Injection on Lower Extremity Joint Range of Motion During Gait in Patients With Acquired Brain Injury

Characteristics of a Mild Head Injury Subgroup With Extreme, Persisting Distress on the Rivermead Postconcussion Symptoms Questionnaire

Influence of Sex and Age on Inpatient Rehabilitation Outcomes Among Older Adults With Traumatic Brain Injury

Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

Prognosis of Limitations in Activities in Osteoarthritis of the Hip or Knee: A 3-Year Cohort Study

Prediction of Postoperative Ambulatory Status 1 Year After Hip Fracture Surgery

Changes in Ankle Mechanical Stability in Those With Knee Osteoarthritis

The Relationship of Transversus Abdominis and Lumbar Multifidus Activation and Prognostic Factors for Clinical Success With a Stabilization Exercise Program: A Cross-Sectional Study

Muscle Activation During Four Pilates Core Stability Exercises in Quadruped Position

Multiple Sclerosis and Postural Control: The Role of Spasticity

Validation of the Multidimensional Outcome Expectations for Exercise Scale in Ambulatory, Symptom-Free Persons With Multiple Sclerosis

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Virtual Reality–Enhanced Partial Body Weight–Supported Treadmill Training Poststroke: Feasibility and Effectiveness in 6 Subjects

Intrinsic Properties of the Knee Extensor Muscles After Subacute Stroke

The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke

Biplanar Measurement of Thoracolumbar Curvature in Older Adults Using an Electromagnetic Tracking Device

The Health and Quality of Life Outcomes Among Youth and Young Adults With Cerebral Palsy

Effects of Aging and Tai Chi on Finger-Pointing Toward Stationary and Moving Visual Targets

Application of Rasch Analysis to Examine Psychometric Aspects of the Activities-Specific Balance Confidence Scale When Used in a New Cultural Context

Indiana University School of Medicine - Accreditation Statement

Journal Based CME Evaluation and Application

CME Processing Fees and Application

2011 Summer Archives Supplement

Masthead

Editorial Board

Table of Contents

Selections From This Month in the Archives

Information for Authors