Rehabilitation and physical medicine related research

Revisiting Physiologic and Psychologic Triggers that Increase SpasticityThe study concluded that although self-reports indicate a strong possibility of increasing spasticity, without objective examination, the true effects of these triggers on spasticity remain inconclusive. Most studies reviewed here were performed in the spinal cord injury population; therefore, it is not known whether these triggers induce similar effects in persons with other neurologic etiologies.
Objective: The aims of this study were to systematically identify and summarize the literature examining the impact of physiologic and psychologic triggers on spasticity and discuss the evidence supporting various types of triggers.
Design: PubMed, EMBASE, CINAHL, and PEDro databases were searched using specific keyword combinations. Only studies using clinical tests or self-reports of spasticity were included.
Results: A total of 1152 articles were scanned for relevance, and of 44 relevant articles, 24 were reviewed. Pregnancy, posture, cold, circadian rhythm, and skin conditions increased spasticity and were measured using objective clinical tests. Self-reports of spasticity suggest that triggers such as bowel- and bladder-related issues, menstrual cycle, mental stress, and tight clothing can all increase spasticity. No literature evidence of increase in spasticity in response to heterotopic ossification, hemorrhoids, deep vein thrombosis, fever, and sleep patterns was found.
PHADKE, CHETAN P.; BALASUBRAMANIAN, CHITRALAKSHMI K.; ISMAIL, FAROOQ; BOULIAS, CHRIS
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

Does Flexibility Influence the Ability to Sit and Rise from the Floor?The study concluded that although seemingly simple tasks, the actions of sitting and rising from the floor are also partially dependent on flexibility in male and female subjects of a wide age range. Future studies should explore the potential benefit of regular flexibility exercises for these actions.
Objective: The purpose of this study was to establish whether flexibility influences the ability to sit and rise from the floor.
Design: Subjects aged 6–92 yrs (n = 3927 [2645 men]) performed the Sitting-Rising Test (SRT) and the Flexitest on the same laboratory visit. The SRT evaluates components of musculoskeletal function by assessing the subject’s ability to sit and rise from the floor, which was scored from 0 to 5, with 1 point being subtracted from 5 for each support used (hand/knee). The subject’s final SRT score, varying from 0 to 10, was obtained by adding the sitting and rising scores. The Flexitest evaluates the maximum passive range of motion of 20 body joint movements. For each one of the movements, there are five possible scores, 0–4, in a crescent mobility order. Adding the results of the 20 movements provides an overall flexibility score called the Flexindex (FLX).
Results: The SRT score differed when the Flexindex results were stratified into quartiles: 6–26, 27–35, 36–44, and 45–77 (P < 0.001). The SRT and Flexindex scores were moderately and positively associated (r = 0.296; P < 0.001). In addition, the subjects with an SRT score of 0 are less flexible for all 20 Flexitest movements than those scoring 10 are.
BRITO, LEONARDO BARBOSA BARRETO; ARAÚJO, DENISE SARDINHA MENDES SOARES DE; ARAÚJO, CLAUDIO GIL SOARES DE
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

The Hemodynamic Actions of Insulin Are Blunted in the Sublesional Microvasculature of Healthy Persons with Spinal Cord InjuryThe study concluded that the hemodynamic actions of insulin are markedly blunted in the sublesional microvasculature of persons with SCI, most likely as a result of impaired sublesional sympathetic nervous system control.
Objective: The aim of this study was to gain a better understanding of the hemodynamic actions of insulin on cutaneous microcirculation in persons with spinal cord injury (SCI).
Design: A prospective, open-label, nonrandomized, placebo-controlled investigation was performed in an otherwise healthy cohort of persons with SCI (n = 10) and in an age- and sex-matched cohort of control subjects whose neurologic function is intact (n = 10). Laser Doppler flowmetry characterized the peak blood perfusion unit (BPU) response (percent change from baseline) to insulin or placebo iontophoresis above and below the neurologic level of injury.
Results: Placebo iontophoresis did not result in any statistically significant changes in BPU. In the arm, insulin iontophoresis resulted in a 20% mean increase in BPU in the control group and a 9% mean increase in the SCI group. In the leg, insulin iontophoresis resulted in an 81% mean increase in BPU in the control group and a 29% mean increase in BPU in the SCI group. The relative effect of insulin on the lower extremity BPU response was significantly greater in the control group compared with the SCI group (77% vs. 35%, respectively).
LA FOUNTAINE, MICHAEL F.; RIVERA, DWINDALLY ROSADO; RADULOVIC, MIROSLAV; BAUMAN, WILLIAM A.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

Measurements of Anteroposterior and Intersidal Asymmetry in Patients with Diabetic Peripheral NeuropathyThe study concluded that measurements of asymmetric weight bearing may indicate the clinical significance of mild diabetic peripheral neuropathy similar as other screening tools. Asymmetric weight-bearing pattern may be useful for evaluating patients in the early period of diabetes mellitus because proper management would prevent further complications and improve quality-of-life.
Objective: The aim of this study was to investigate the anteroposterior and intersidal asymmetric weight bearing and plantar pressure in patients with mild diabetic peripheral neuropathy.
Design: A total of 102 subjects were enrolled in this study. Plantar pressure and anteroposterior and intersidal weight-bearing patterns on a foot plate were measured using Gaitview while standing and during dynamic walking. The subjects were evaluated with nerve conduction study, vibration sensory threshold (VST), and Diabetic Neuropathy Symptom (DNS) scores.
Results: The subjects were classified into normal nerve conduction study and mild diabetic peripheral neuropathy groups according to the results of the nerve conduction study tests. The two groups differed significantly in asymmetric weight-bearing pattern, DNS score, and VST. The sensitivities of anteroposterior and intersidal asymmetry were similar to those of DNS score and VST, with significant correlations between asymmetric weight bearing and VST and DNS scores. In contrast, highest plantar pressure did not differ significantly in the two groups and was not significantly correlated with nerve conduction study, VST, or DNS score.
LEE, SOOK JOUNG; CHUN, MIN HO; KIM, BO RYUN; KANG, YUJEONG; KIM, DAE YUL; PARK, JOONG-YEOL
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

Clinical Significance of the Double-Peak Sensory Response in Nerve Conduction Study of Normal and Diabetic PatientsThe study concluded that the double-peak response represents the far distal nerve pathophysiology. The authors suspect that they will find an increasing role in diagnosing the peripheral neuropathy, which starts at the distal nerve in centripetal pattern.
Objective: The aim of this study was to understand the meaning of the double-peak responses in digital nerve conduction study in normal and diabetic patients.
Design: This was a cross-sectional and correlative study. Sixty healthy subjects (10 people per decade from 20 to 79 yrs of age; 26 men; mean age, 48 yrs) and 60 diabetic patients (10 people per decade from 22 to 79 yrs of age; 36 men, mean age, 53 yrs) were included. The composite score of the nerve conduction study was obtained. Orthodromic sensory nerve conduction studies were performed on the median nerves using submaximal stimulation. The latencies and amplitudes of first and second peaks were measured. The Toronto clinical scoring system for diabetic neuropathy was applied to all diabetic patients.
Results: The first and second peak latencies of both 3- and 4-cm interpeak distance in diabetic patients were significantly increased compared with those of age-matched control subjects (P < 0.05). The correlation between the Toronto clinical scoring system and first and second peak latency and amplitude were significantly high, and the correlation between the composite score and first and second peak latency and amplitude was also related.
JOA, KYUNG-LIM; KIM, CHANG- HWAN
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

Isokinetic Testing in Patients with Neuromuscular Diseases: A Focused ReviewThe study concluded that isokinetic testing is an important part of the comprehensive evaluation and rehabilitation of patients with NMD. Research has demonstrated its efficacy in providing clinically relevant information. When integrated with a complete history, physical examination, and functional evaluation, isokinetic testing and exercise can be a valuable tool for the clinician in the assessment, rehabilitation, and performance enhancement of patients with NMD. Such equipment, however, has several disadvantages, rendering it usually impractical in the clinical setting.
Objective: This literature review aimed to study the use of isokinetic testing in patients with neuromuscular diseases (NMDs) and to identify directions for future research of isokinetic testing.
Design: The MEDLINE (January 1, 1965, to July 1, 2010), Cumulative Index to Nursing and Allied Health (1980 to May 2010), and Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2009) electronic databases were searched. The literature search was conducted using the keywords muscle assessment, muscle strength, evaluation, isokinetic, neuromuscular diseases, muscle fatigue, functional test, rehabilitation, and literature search. Relevant references cited in the selected articles were also considered, regardless of the year of publication.
Results: The search strategy yielded 13 articles involving a variety of patients with known NMDs. All studies demonstrated that isokinetic dynamometry is appropriate and safe for ambulatory patients with NMDs. Isokinetic testing has proven to be reliable (intratest/intertest correlation coefficient ranged from 0.65 to 0.98), with the proximal muscles having the highest reliability, and sensitive to disease progression and to the effects of various therapeutic interventions. However, isokinetic testing has never gained wide acceptance, partly because of concerns about stabilizing the dynamometer and the subject during the test and of the lack of standardized protocols for isokinetic strength measurement.
EL MHANDI, LHASSAN; BETHOUX, FRANÇOIS
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

The Relationship of the Energetic Cost of Slow Walking and Peak Energy Expenditure to Gait Speed in Mid-to-Late LifeThe study concluded that in older persons with substantially reduced peak walking capacity, the energetic cost of walking is associated with gait speed, particularly when peak walking capacity nears the minimum level considered necessary for independent living. Thus, optimal habilitation in older frail persons may benefit from both improving fitness and reducing the energetic cost of walking.
Objective: Peak energy expenditure is highly correlated with usual gait speed; however, it is unknown whether the energetic cost of walking is also an important contributor to usual gait speed when considered as a component of peak walking capacity.
Design: The energetic cost of 5 mins of slow treadmill walking (0.67 m/sec), peak overground walking energy expenditure, and usual gait speed over 6 m were assessed cross-sectionally in 405 adults aged 33 to 94 yrs in the Baltimore Longitudinal Study of Aging.
Results: Mean (SD) energy expenditures during slow and peak sustained walking were 8.9 (1.4) and 18.38 (4.8) ml/ kg/ min, respectively. Overall, the energetic cost of slow walking as a percentage of peak walking energy expenditure was strongly associated with usual gait speed; however in stratified analyses, this association was maintained only in those with peak walking capacity below 18.3 ml/ kg/ min, the threshold associated with independent living.
SCHRACK, JENNIFER A.; SIMONSICK, ELEANOR M.; FERRUCCI, LUIGI
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

Effect of Eccentric Strengthening on Pain, Muscle Strength, Endurance, and Functional Fitness Factors in Male Patients with Achilles TendinopathyThe study concluded that eccentric strengthening was more effective than concentric strengthening in reducing pain and improving function in patients with Achilles tendinopathy; therefore, regular eccentric strengthening is important for patients in a clinical setting.
Objective: The aim of this study was to investigate the effect of eccentric strengthening on pain, muscle strength, endurance, and functional fitness factors in Achilles tendinopathy patients.
Design: Thirty-two male patients with Achilles tendinopathy were assigned to either the experimental group that performed eccentric strengthening or the control group that performed concentric strengthening (n = 16, both groups) for 8 wks (50 mins per day, three times per week). A visual analog scale, an isokinetic muscle testing equipment, the side-step test, and the Sargent jump test were used to assess pain, muscle strength, endurance, and functional fitness factors before and after the intervention.
Results: In comparison with the control group, the experimental group showed significant improvement in pain, ankle dorsiflexion endurance, total balance index, and agility after the intervention (P < 0.05). However, there was no significant difference in dexterity between the two groups.
YU, JAEHO; PARK, DAESUNG; LEE, GYUCHANG
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

Use of a Squatting Movement as a Clinical Marker of Function After Total Knee ArthroplastyThe study concluded that on the first outpatient visit, individuals who had primary unilateral knee arthroplasty placed more body weight over the uninvolved side for the three weight-bearing positions. With high probability, the asymmetry index for both squatting angles identified perceived functional difficulty. As rehabilitation visits increased, there was a direct association to improved interlimb weight-bearing symmetry when squatting to 60 degrees.
Objective: The aims of this study were to evaluate weight bearing during standing and 30- and 60-degree squats approximately 1 wk and 2 mos after surgery and determine whether weight bearing during squatting could be a better clinical marker than standing for identifying perceived functional limitation approximately 1 wk after surgery. A further objective was to determine whether age, body mass index, and number of outpatient visits over the course of rehabilitation predicted weight bearing during a squat approximately 2 mos after surgery.
Design: The percentage of body weight placed over both limbs during stand and 30- and 60-degree squats in 38 patients (25 women and 13 men) who had primary unilateral knee arthroplasty was determined. An asymmetry index would be used as a marker that could discriminate between those who perceived at least moderate difficulty with functional tasks and those who perceived only slight or no difficulty with functional activities based on the physical function dimension of the Western Ontario McMaster Universities Osteoarthritis index approximately 1 wk after surgery. Stepwise regression was conducted to determine whether clinical characteristics predicted weight-bearing asymmetry at discharge. Results: At initial visit (first observation), and compared with the uninvolved side, individuals placed significantly less body weight over the involved or operated limb for stand and 30- and 60-degree squats.
Results were similar at last rehabilitation visit (second observation). Identifying at least moderate self-reported difficulty with functional tasks based on the receiver operator characteristic curve for the asymmetry index for the stand position was 0.64, whereas for the 30- and 60-degree squats, the area under the curve was 0.81 and 0.89, respectively. At discharge from rehabilitation, there was a moderate to good direct relationship (r = 0.70) between the number of rehabilitation visits completed and the weight-bearing asymmetry index for the 60-degree squat.
ROSSI, MARK D.; EBERLE, THOMAS; ROCHE, MARTIN; BRUNT, DENIS; WONG, MARLON; WAGGONER, MATTHEW; BLAKE, ROBERT; BURWELL, BROOKE; BAXTER, AMY
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

The Effects of Interdisciplinary Team Assessment and a Rehabilitation Program for Patients with Chronic Pain
The study concluded that both interdisciplinary assessment and rehabilitation program seem to be effective in chronic pain rehabilitation, at least for women. Further studies are needed to investigate potential sex differences, as well as content and duration for optimal pain rehabilitation programs.
Objective: The aim of this study was to evaluate the effects of interdisciplinary team assessment and a 4-wk rehabilitation program in chronic pain patients.
Design: This was a longitudinal cohort study evaluating interdisciplinary pain rehabilitation measures in a specialist care setting. A total of 93 women (42.2 ± 9.5 yrs) with chronic musculoskeletal pain (median pain duration, 8 yrs) were evaluated at assessment and at the start and end of the rehabilitation program. Pain intensity measured with a visual analog scale, pain dimensions measured with the Multidimensional Pain Inventory, and anxiety and depression measured with the Hospital Anxiety and Depression Scale were registered.
Results: The participants exhibited significantly improved results of pain and pain-related measures. The results were seen both after the short-term intervention in the form of the interdisciplinary assessment and after the 4-wk rehabilitation program. The improvements seen after the assessment were not related to specific interventions, such as change of medication, and therefore seem to be a result of the interdisciplinary assessment concept as such.
PIETILÄ HOLMNER, ELISABETH; FAHLSTRÖM, MARTIN; NORDSTRÖM, ANNA
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20130894-9115

Effects of Obesity on Rehabilitation Outcomes After Orthopedic TraumaThe study concluded that obese patients make significant functional improvement during rehabilitation, but at a lesser magnitude and rate as their nonobese counterparts. Even with morbid obesity, small but important functional gains can occur during rehabilitation for orthopedic trauma.
Objective: This study examined whether differences existed in inpatient rehabilitation outcomes and therapy participation in nonobese and obese patients with orthopedic trauma.
Design: This was a retrospective study of 294 consecutive patients admitted to an inpatient rehabilitation hospital. Main outcomes included participation in therapy sessions, Functional Independence Measure (FIM) ratings, walking distance and stair climb, length of stay, FIM efficiency (FIM score gain/length of stay), and discharge to home. Data were stratified by patient body mass index values (nonobese, <30 kg/m2; or obese, ≥30 kg/m2).
Results: There were no differences in therapy participation or length of stay between groups. Both total and motor FIM ratings at discharge were lower in obese patients compared with nonobese patients. FIM efficiency was significantly lower in the obese than in the nonobese group (1.5 vs. 3.1 ; 1.5 points gained per day). Walking distance and stair climb ability were similar between groups by discharge. Even morbidly obese patients attained some improvement with independence in walking.
VINCENT, HEATHER K.; SEAY, AMANDA N.; VINCENT, KEVIN R.; ATCHISON, JAMES W.; SADASIVAN, KALIA
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Tai Chi for Stroke Rehabilitation: A Focused Review
The focused review suggested that Tai Chi exercise might be beneficial with respect to balance, quality-of-life, and mental health in survivors of stroke. More rigorous randomized controlled trials are required to determine whether Tai Chi is effective in stroke rehabilitation.
The review summarizes and critically evaluates clinical trial evidence for the effectiveness of Tai Chi as a supportive therapy for stroke rehabilitation. All prospective, controlled clinical trials published in English or Chinese and involving the use of Tai Chi by survivors of stroke were searched in eight electronic databases.
Information from the included studies was extracted and synthesized. The methodological quality of all studies was assessed with the Jadad score. Five randomized controlled trials, four in English and one in Chinese, met the inclusion criteria and were reviewed. The methodological quality of the trials was moderate (Jadad score, range, 1–4; average score, 2.6). Meta-analysis was not performed because of the heterogeneity of the study conditions and outcome measures.
Three studies reported benefits of Tai Chi with respect to improved balance in participants who have had a stroke. Three studies assessed mobility function and reported no improvement after Tai Chi intervention in survivors of stroke. Improvements in quality-of-life and mental health were reported in three trials.
DING, MENG
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Relationship Between Body Mass Index and Rehabilitation Outcomes in Chronic StrokeThe study concluded that chronic stroke subjects with a higher BMI were less likely to demonstrate improvement in motor impairment and up and go functional mobility performance in response to ambulation training, irrespective of treatment intervention. Stroke rehabilitation clinicians should consider BMI when formulating rehabilitation goals. Further studies are necessary to determine whether obesity is a predictor of longer-term post-stroke motor and functional recovery.
Objective: The aim of this study was to evaluate the relationship between body mass index (BMI) and change in motor impairment and functional mobility after a gait rehabilitation intervention in chronic stroke subjects.
Design: Correlation and linear regression analyses of pretreatment and end-of-treatment Fugl-Meyer scores and modified Emory Functional Ambulation Profile scores from hemiparetic subjects (n = 108, >3 mos post stroke) who participated in a randomized controlled trial comparing two 12-wk ambulation training treatments were generated.
Results: A series of linear regression models that controlled for age, sex, stroke type, interval post-stroke, and training device found the change in the Fugl-Meyer score to be significantly negatively associated with pretreatment BMI and the change in the “up and go” modified Emory Functional Ambulation Profile score to be significantly positively associated with BMI. Changes in modified Emory Functional Ambulation Profile scores in floor, carpet, obstacles, or stair climbing were not significantly associated with BMI.
SHEFFLER, LYNNE R.; KNUTSON, JAYME S.; GUNZLER, DOUGLAS; CHAE, JOHN
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Long-term Lifestyle Intervention with Optimized High-Intensity Interval Training Improves Body Composition, Cardiometabolic Risk, and Exercise Parameters in Patients with Abdominal Obesity
The study concluded that a long-term lifestyle intervention with optimized high-intensity interval exercise improves body composition, cardiometabolic risk, and exercise tolerance in obese subjects. This intervention seems safe, efficient, and well tolerated and could improve adherence to exercise training in this population.
Objective: The aim of this study was to study the impact of a combined long-term lifestyle and high-intensity interval training intervention on body composition, cardiometabolic risk, and exercise tolerance in overweight and obese subjects.
Design: Sixty-two overweight and obese subjects were retrospectively identified at their entry into a 9-mo program consisting of individualized nutritional counselling, optimized high-intensity interval exercise, and resistance training two to three times a week. Anthropometric measurements, cardiometabolic risk factors, and exercise tolerance were measured at baseline and program completion.
Results: Adherence rate was 97%, and no adverse events occurred with high-intensity interval exercise training. Exercise training was associated with a weekly energy expenditure of 1582 ± 284 kcal. Clinically and statistically significant improvements were observed for body mass (5.2 kg), body mass index (1.9 kg/m2), waist circumference (5.4 cm), and maximal exercise capacity 0.84 metabolic equivalents). Total fat mass and trunk fat mass, lipid profile, and triglyceride/high-density lipoprotein ratio were also significantly improved. At program completion, the prevalence of metabolic syndrome was reduced by 32.5% . Independent predictors of being a responder to body mass and waist circumference loss were baseline body mass index and resting metabolic rate; those for body mass index decrease were baseline waist circumference and triglyceride/high-density lipoprotein cholesterol ratio.
GREMEAUX, VINCENT; DRIGNY, JOFFREY; NIGAM, ANIL; JUNEAU, MARTIN; GUILBEAULT, VALÉRIE; LATOUR, ELISE; GAYDA, MATHIEU
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Skeletal Muscle Plasticity After Hemorrhagic Stroke in Rats: Influence of Spontaneous Physical ActivityThe study concluded that skeletal muscle adaptation occurs by 2 wks post-stroke in this model. It is muscle specific and appears to be influenced by factors other than spontaneous post-stroke physical activity.
Objective: The aim of this study was to determine the contribution of spontaneous post-stroke physical activity to skeletal muscle plasticity after stroke.
Design: A randomized controlled study was conducted of 24 young adult male Sprague-Dawley rats assigned to three experimental groups: (1) STR—hemorrhagic stroke in the right caudoputamen; (2) SHAM—procedural control; and (3) CONT—no intervention (n = 8/group). Neurologic testing was performed before and 2 wks after stroke. Spontaneous physical activity was monitored five nights per week for 1 wk preoperatively and 2 wks postoperatively. Two weeks after stroke induction, bilateral soleus and tibialis anterior muscles were harvested. Myofiber cross-sectional areas were determined, and fiber typing was performed with immunohistochemistry.
Results: STR animals demonstrated neurologic deficit in the contralesional hindlimb 2 wks after stroke. Quantity of spontaneous physical activity did not differ between groups within each of the week-long study intervals. No significant difference was found in fiber types or cross-sectional areas in the soleus muscle of STR vs. CONT groups. However, the tibialis anterior muscle of the contralesional hindlimbs of the STR animals showed atrophy in 2x and 1 + 2x myofibers, as well as type 1 hypertrophy.
SNOW, LEANN M.; LOW, WALTER C.; THOMPSON, LADORA V.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Bilevel Exercise Training and Directed Breathing Relieves Exertional Dyspnea for Male Smokers
The study concluded that the decline in exercise tolerance for male smokers can be reduced by intensive exercise training (SWEET) and comprehensive directed breathing but not by moderate training and traditional diaphragmatic breathing. Thus, some smokers can be helped despite continuing to smoke.
Objective: The purpose of this study was to compare the effects on exertional dyspnea and exercise capacity of square wave (bilevel) cycle ergometry endurance exercise training (SWEET) and comprehensive directed breathing vs. walking while pushing an OxCar and traditional diaphragmatic breathing for male smokers with normal spirometry but reduced exercise capacity.
Design: This was a prospective randomized trial of 24 unmedicated men with exertional dyspnea assigned to SWEET or OxCar groups. Both groups trained for 45 mins, 5 days a week, for 6 wks. Before, during, and after training, 32 lung function parameters were studied at ventilatory anaerobic threshold, at PWR, and during incremental exercise (30 W/3 mins).
Results: For the SWEET group, exertional dyspnea and the dyspnea index decreased during incremental exercise, at the ventilatory anaerobic threshold, and at PWR. At the ventilatory anaerobic threshold, oxygen consumption increased by 74%; minute ventilation, 30%; tidal volume, 91%; and ventilatory efficiency and oxygen pulse (O2P), 25%; and breathing rate (breathing frequency) decreased by 32% . At PWR, oxygen consumption increased by 30%; minute ventilation, 37%; breathing rate, 21%; and ventilatory efficiency and oxygen pulse, 25% . During the full incremental test, minute ventilation, breathing frequency, and heart rate (cardiac frequency) decreased significantly. In addition, there was significant improvement in SWEET intensity by 63%, constant exercise intensity at 80% of PWR by 38%, and 6-min walk test by 30%. No significant changes were observed for the OxCar group other than for the 6-min walk test, which increased by 7%.
GIMENEZ, MANUEL; SAAVEDRA, PEDRO; MARTIN, NIEVES; POLU, JEAN MARIE; LÓPEZ, DANIEL; GÓMEZ, ARTURO; SERVERA, EMILIO
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Mind-Body Interventions for Treatment of Phantom Limb Pain in Persons with AmputationThe authors discussed the potential for usefulness of specific mind-body therapies and the relevance of their mechanisms of action to those of PLP, including targeting cortical reorganization, autonomic nervous system deregulation, stress management, coping ability, and quality-of-life. The authors recommend more and better quality research exploring the efficacy and mechanisms of action.
Phantom limb pain (PLP) is a significant source of chronic pain in most persons with amputation at some time in their clinical course. Pharmacologic therapies for this condition are often only moderately effective and may produce unwanted adverse effects.
There is growing empirical evidence of the therapeutic effectiveness of mind-body therapies for the relief of chronic pain; therefore, an exploration of their role in relieving amputation-related chronic pain is warranted. We undertook a focused literature review on mind-body interventions for patients with amputation who experience PLP. Because of study heterogeneity, only descriptive presentations of the studies are presented.
Only studies of hypnosis, imagery, and biofeedback, including visual mirror feedback, were found; studies on meditation, yoga, and tai chi/qigong were missing from the literature.
Few studies of specific mind-body therapies were dedicated to management of PLP, with the exception of mirror visual therapy.
Overall, studies were largely exploratory and reflect considerable variability in the application of mind-body techniques, making definitive conclusions inadvisable.
Nevertheless, the weight of existing findings indicates that a mind-body approach to PLP pain management is promising and that specific methods may offer either temporary or long-term relief, either alone or in combination with conventional therapies.
MOURA, VERA LUCIA; FAUROT, KETURAH R.; GAYLORD, SUSAN A.; MANN, J. DOUGLAS; SILL, MORGAN; LYNCH, CHANEE; LEE, MICHAEL Y.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Effects of Exercise Training and Detraining in Patients with Fibromyalgia Syndrome: A 3-Yr Longitudinal Study
The study concluded that a long-term exercise program can produce immediate improvements in key health domains in women with fibromyalgia. The benefits achieved with regular training can be maintained for 30 mos. The lack of difference between groups over time may be caused by attrition and consequent lack of power at the final time point.
Objective: This study aimed to evaluate the immediate effects of a 6-mo combined exercise program on quality-of-life, physical function, depression, and aerobic capacity in women with fibromyalgia syndrome and to determine the impact of repeated delivery of the intervention.
Design: Forty-one women with fibromyalgia were randomly assigned to a training group (EG; n = 21) and a control group (CG; n = 20). Quality-of-life and physical function were assessed using the 36-item Short-Form Health Survey (SF-36) and the Fibromyalgia Impact Questionnaire, and depression was measured using the Beck Depression Inventory. Physical fitness was measured using the 6-min Walk Test. Outcomes were assessed at baseline and after each 6-mo intervention, which was delivered over 30 mos (6 mos of training and 6 mos of detraining).
Results: After a 6-mo combined exercise program, there was a significant improvement in the Fibromyalgia Impact Questionnaire (P < 0.0005) for the training group over the control group. Repeated-measures analysis of variance across all time points demonstrated significant main effects for time for the Fibromyalgia Impact Questionnaire, SF-36, Beck Depression Inventory and the 6-min Walk Test, but there were no between-group interaction effects. For the EG, there were significant within-group changes in the Fibromyalgia Impact Questionnaire, SF-36, and Beck Depression Inventory at the final time point; however, there were no within-group changes for the control group. Improvement achieved for the training group were maintained during the detraining period.
SAÑUDO, BORJA; CARRASCO, LUIS; DE HOYO, MOISÉS; MCVEIGH, JOSEPH G.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Do Elderly People at More Severe Activity of Daily Living Limitation Stages Fall More?Conclusions: Risk of falling appeared greatest for those whose homes lacked accessibility features and peaked at intermediate ADL limitation stages, presumably at a point when people have significant disabilities but sufficient function to remain partially active.
Objective: The aim of this study was to explore how activity of daily living (ADL) stages and the perception of unmet needs for home accessibility features associate with a history of falling.
Design: Participants were from a nationally representative sample from the Second Longitudinal Survey of Aging conducted in 1994. The sample included 9250 community-dwelling persons 70 yrs or older. The associations of ADL stage and perception of unmet needs for home accessibility features with a history of falling within the past year (none, once, or multiple times) were explored after accounting for sociodemographic characteristics and comorbidities using a multinomial logistic regression model.
Results: The adjusted relative risk of falling more than once peaked at 4.30 (95% confidence interval, 3.29–5.61) for persons with severe limitation (ADL-III) compared those with no limitation (ADL-0) then declined for those at complete limitation (ADL-IV). The adjusted relative risks of falling once and multiple times were 1.42 and 1.85 , respectively, for those lacking home accessibility features.
HENRY-SÁNCHEZ, JOHN T.; KURICHI, JIBBY E.; XIE, DAWEI; PAN, QIANG; STINEMAN, MARGARET G.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Does Race Influence Functional Outcomes in Patients with Acute Stroke Undergoing Inpatient Rehabilitation?Conclusions: This study suggests that race does not influence rehabilitation functional outcomes in patients with acute stroke undergoing rehabilitation for the same intensity of therapy if admitted soon after their acute stroke.
Objective: Race has been shown to affect stroke-related morbidity and mortality. The purpose of this study was to determine the influence of race on rehabilitation functional outcomes in patients with an acute stroke admitted to a designated stroke rehabilitation unit.
Design: A 2-yr prospective study was conducted of 670 patients admitted to an acute stroke rehabilitation unit within 30 days after an acute stroke. Demographic data along with admission and discharge Functional Independence Measure scores were recorded in a computerized stroke database. Patients participated in a standardized rehabilitation program 5 days a week for a length of stay dependent upon their individual needs.
Results: The distribution of patients by race was 504 whites, 115 blacks, 38 Hispanics, and 13 Asians. The mean age of the study population was 70 yrs. Whites had a higher prevalence of atrial fibrillation, and blacks, Hispanics, and Asians had a higher prevalence of hypertension and diabetes mellitus. The primary and secondary functional rehabilitation outcomes were similar for all four groups after similar intensity of therapy (3.5 hrs daily).
RABADI, MEHEROZ H.; RABADI, FRENY M.; HALLFORD, GENE; ASTON, CHRISTOPHER E.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Men Recover Ability to Function Less Than Women Do: An Observational Study of 1094 Subjects After Hip FractureConclusions: In our large sample of hip-fracture patients, men had a significantly worse functional outcome than did women after acute inpatient rehabilitation.
Objective: The aim of this study was to investigate the association between sex and functional outcome after acute inpatient rehabilitation in hip-fracture patients.
Design: We investigated 1094 of 1186 people admitted consecutively to our rehabilitation hospital because of a hip fracture. Functional outcome was assessed using Barthel Index scores. Barthel Index efficiency (improvement per day of stay length) and Barthel Index effectiveness (proportion of potential improvement achieved) were calculated.
Results: The median Barthel Index score at discharge from inpatient rehabilitation was 85 in the 970 women and 75 in the 124 men (interquartile range, 65–95 in women and 60–95 in men. Both Barthel Index efficiency and effectiveness were significantly lower in men (P = 0.030 and P = 0.007, respectively). After adjustment for six confounders, we confirmed that men had lower Barthel Index scores, Barthel Index efficiency, and Barthel Index effectiveness. The risk of achieving a low Barthel Index score at the end of acute inpatient rehabilitation was higher for men than for women.
DI MONACO, MARCO; CASTIGLIONI, CARLOTTA; VALLERO, FULVIA; DI MONACO, ROBERTO; TAPPERO, ROSA
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Medical Rehabilitation of People with Spinal Cord Injury During 40 Years of Academic Physiatric Practice
Even with proper prophylaxis, deep vein thrombosis and pulmonary embolism are still common, and clinicians have paid too little attention to reducing the risk for persons with SCI of developing obesity, diabetes mellitus, and cardiovascular disease. These challenges need to be met by medical rehabilitation research, by advocating for insurance policies that support the healthcare needs of persons with SCI, and by developing comprehensive disability policies, all with the support and leadership of academic physiatrists.
ABSTRACT: There are many different paths that lead to an academic physiatric career and a lifelong interest in spinal cord injury (SCI) medicine. It is unfortunate that after decades of cellular-based research in multiple laboratories, there are still no interventions available that can reverse the neurologic loss that follows SCI. In contrast, medical rehabilitation research during the last 40 yrs has led to remarkable improvements in the lives of persons with SCI as evident in their increased life expectancy, shorter hospitalizations, fewer rehospitalizations, and more effective treatments for male sexual dysfunction and fertility, as well as spasticity, heterotrophic ossification, and neuropathic pain. Application of modern technology has improved the mobility of persons with SCI with better designed wheelchairs, decreased their dependency on others, facilitated their access to information, made communication and community integration easier, and so on. Although deaths related to urinary tract complications are now rare, better methods of managing the neurogenic bladder are still needed. Furthermore, better management methods are also needed for the neurogenic bowel, SCI pain, and osteoporosis of the paralyzed limbs.
RAGNARSSON, KRISTJAN T.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Infections in Acute Older Stroke Inpatients Undergoing RehabilitationConclusions: Infection may prolong the length of stay in acute stroke patients in a rehabilitation ward. The present study provides important information for clinicians to help identify risk factors for infection.
Objective: The present study compares the incidence of various infections among patients in acute and rehabilitation wards and examines the risk factors and pathogens involved in rehabilitation ward infections.
Design: The study included 341 acute stroke patients (age, ≥65 yrs). The assessment of risk factors was done by comparison of patients with or without infection, urinary tract infection, and pneumonia. Possible precipitating factors in each comparison were included in the statistical analysis.
Results: Ninety-five (27.9%) patients experienced infections, and the most common type in the rehabilitation ward was urinary tract infection. The frequency of incidence of pneumonia in the rehabilitation ward (6.7%) was significantly lower than in the acute ward (23.8%). Patients with infection had a longer rehabilitation ward stay compared with those without infection (30.9 vs. 18.8 days). A postvoid residual urine volume greater than 50 ml (odds ratio, 2.314) was found to be the most important risk factor for infection.
CHEN, CHIEN-MIN; HSU, HUNG-CHIH; TSAI, WEN-SAN; CHANG, CHIA-HAO; CHEN, KAI-HUA; HONG, CHANG-ZERN
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Comparison of Three Methods to Identify the Anaerobic Threshold During Maximal Exercise Testing in Patients with Chronic Heart FailureThe study concluded that in patients with chronic heart failure, RCP and HRTP, determined during cardiopulmonary exercise tests, precede the occurrence of LTP2. Target heart rates and workloads used to prescribe tailored exercise training in patients with chronic heart failure based on LTP2 are significantly higher than those derived from HRTP and RCP.
Objective: Exercise training efficiently improves peak oxygen uptake (V˙O2peak) in patients with chronic heart failure. To optimize training-derived benefit, higher exercise intensities are being explored. The correct identification of anaerobic threshold is important to allow safe and effective exercise prescription.
Design: During 48 cardiopulmonary exercise tests obtained in patients with chronic heart failure (59.6 ± 11 yrs; left ventricular ejection fraction, 27.9% ± 9%), ventilatory gas analysis findings and lactate measurements were collected. Three technicians independently determined the respiratory compensation point (RCP), the heart rate turning point (HRTP) and the second lactate turning point (LTP2). Thereafter, exercise intensity (target heart rate and workload) was calculated and compared between the three methods applied.
Results: Patients had significantly reduced maximal exercise capacity (68%; 21% of predicted V˙O2 peak) and chronotropic incompetence (74%; 7% of predicted peak heart rate). Heart rate, workload, and V˙O2 at HRTP and at RCP were not different, but at LTP2, these parameters were significantly higher. Mean target heart rate and target workload calculated using the LTP2 were 5% and 12% higher compared with those calculated using HRTP and RCP, respectively. The calculation of target heart rate based on LTP2 was 5% and 10% higher in 12 of 48 (25%) and 6 of 48 (12.5%) patients, respectively, compared with the other two methods.
BECKERS, PAUL J.; POSSEMIERS, NADINE M.; VAN CRAENENBROECK, EMELINE M.; VAN BERENDONCKS, AN M.; WUYTS, KURT; VRINTS, CHRISTIAAN J.; CONRAADS, VIVIANE M.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

Balance and Mobility Dysfunction and Falls Risk in Older People with Mild to Moderate Alzheimer DiseaseConclusions: The findings of the study highlight the value of including balance screening as a routine component of early dementia assessment. This would allow for the early detection of balance dysfunction and the introduction of balance retraining before impairments progress to more advanced levels.
Objective: This study aimed to identify the magnitude and type of balance and mobility impairments in people with Alzheimer disease by comparing their performance with that of older people without cognitive impairment.
Design: Twenty-five community-dwelling people with mild to moderate Alzheimer disease and a comparison group of 25 cognitively intact age- and sex-matched people completed a comprehensive balance and mobility assessment. This included computerized posturography measures of static and dynamic balance under various conditions, clinical balance, and mobility measures, and measures of falls and falls risk.
Results: The level of falls risk was higher in people with Alzheimer disease. Standing balance in people with Alzheimer disease was significantly impaired across a range of static and dynamic balance conditions. Activity level, gait, and mobility measures were also impaired, particularly turning and dual tasks.
SUTTANON, PLAIWAN; HILL, KEITH D.; SAID, CATHERINE M.; LOGIUDICE, DINA; LAUTENSCHLAGER, NICOLA T.; DODD, KAREN J.
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

The Effects of Visual and Auditory Cues on Freezing of Gait in Patients with Parkinson DiseaseThe study concluded that gait training using visual and auditory cues can improve PDF patient gait and that auditory cues enhance gait in PDNF patients with hypokinetic gait patterns.
Objective: The aims of this study was to investigate the effects of visual and auditory cues on the freezing of gait in Parkinson disease patients (PDF) compared with Parkinson disease patients without freezing of gait (PDNF).
Design: Fifteen PDF, 10 PDNF, and 10 age-matched healthy volunteers were recruited. Subjects walked back and forth on a 7-m walkway under three different conditions: baseline condition without cues, with visual cues, and with auditory cues. Visual cues consisted of white stripes located along the walkway. For auditory cues, a metronome was used. Gait was analyzed using three-dimensional computerized analysis.
Results: In the PDF group, both visual and auditory cues significantly affected visual-spatial and kinematic gait parameters. PDF group benefited more from visual cues than auditory cues. In the PDNF and healthy volunteer groups, visual cues significantly decreased patient velocity. Auditory cues affected some kinematic parameters on PDNF group. Compared among three groups, visual cues more positively affected the PDF group, and auditory cues more positively affected kinematic parameters in the PDNF group.
LEE, SOOK JOUNG; YOO, JONG YOON; RYU, JU SEOK; PARK, HEE KYOUNG; CHUNG, SUN JU
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 20120894-9115

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