Rehabilitation Research and Practice最新文献

Background and purpose: The motor impairments related to gait and balance have a huge impact on the life of individuals with spinocerebellar ataxia (SCA). Here, the aim was to assess the possibility of retraining gait, improving cardiopulmonary capacity, and challenging balance during gait in SCA using a partial body weight support (BWS) and a treadmill. Also, the effects of this training over functionality and quality of life were investigated.

Methods: Eight SCA patients were engaged in the first stage of the study that focused on gait training and cardiovascular conditioning. From those, five took part in a second stage of the study centered on dynamic balance training during gait. The first and second stages lasted 8 and 10 weeks, respectively, both comprising sessions of 50 min (2 times per week).

Results: The results showed that gait training using partial BWS significantly increased gait performance, treadmill inclination, duration of exercise, and cardiopulmonary capacity in individuals with SCA. After the second stage, balance improvements were also found.

Conclusion: Combining gait training and challenging tasks to the postural control system in SCA individuals is viable, well tolerated by patients with SCA, and resulted in changes in capacity for walking and balance.

Aims. The purpose of the study was to develop new self-report instruments to measure the ability to walk, run, and lift objects and describe the distribution of these abilities among older Canadians. Methods. Questions were developed following a focus group. We carried out an online survey among members of the Canadian Association of Retired Persons. The distribution of each ability was described and presented graphically according to age, sex, and number of health conditions. We calculated summary scores for each ability and assessed their reliability and relationships with health status and use of health services. Results. 22% of the subjects reported difficulty walking 100 m, 15% were unable to run 10 m, and 50% had difficulty lifting 10 kg. Men reported higher abilities than women but differences according to age were small. Test-retest reliability ranged from 0.89 for walking to 0.88 for running and 0.81 for lifting. Scores for the three measures correlated with other measures of health status as expected. Conclusions. The study provided new data on self-reported walking, running, and lifting abilities among older Canadians. The new measures are valid, reliable, and easy to interpret. We expect these measures to be useful in clinical and research settings.

Individuals with unilateral impairment perform symmetrical movements asymmetrically. Restoring symmetry of movements is an important goal of rehabilitation. The aim of the study was to evaluate the effect of using discomfort-inducing devices on movement symmetry. Fifteen healthy individuals performed the sit-to-stand (STS) maneuver using devices inducing unilateral discomfort under the left sole and left thigh or right sole and right thigh and without them. 3D body kinematics, ground reaction forces, electrical activity of muscles, and the level of perceived discomfort were recorded. The center of mass (COM), center of pressure (COP), and trunk displacements as well as the magnitude and latency of muscle activity of lower limb muscles were calculated during STS and compared to quantify the movement asymmetry. Discomfort on the left and right side of the body (thigh and feet) induced statistically significant displacement of the trunk towards the opposite side. There was statistically significant asymmetry in the activity of the left and right Tibialis Anterior, Medial Gastrocnemius, and Biceps Femoris muscles when discomfort was induced underneath the left side of the body (thigh and feet). The technique was effective in causing asymmetry and promoted the use of the contralateral side. The outcome provides a foundation for future investigations of the role of discomfort-inducing devices in improving symmetry of the STS in individuals with unilateral impairment.

Objective: The aim of this randomized controlled study was to investigate the effects of insoles with a toe-grip bar on toe function and standing balance in healthy young women.

Methods: Thirty female subjects were randomly assigned to an intervention group or a control group. The intervention group wore shoes with insoles with a toe-grip bar. The control group wore shoes with general insoles. Both groups wore the shoes for 4 weeks, 5 times per week, 9 hours per day. Toe-grip strength, toe flexibility, static balance (total trajectory length and envelope area of the center of pressure), and dynamic balance (functional reach test) were measured before and after the intervention.

Results: Significant interactions were observed for toe-grip strength and toe flexibility (F = 12.53, p < 0.01; F = 5.84, p < 0.05, resp.), with significant improvement in the intervention group compared with that in the control group. Post hoc comparisons revealed that both groups showed significant improvement in toe-grip strength (p < 0.01 and p < 0.05, resp.), with higher benefits observed for the intervention group (p < 0.01). Conversely, no significant interaction was observed in the total trajectory length, envelope area, and functional reach test.

Conclusions: This study suggests that insoles with a toe-grip bar contribute to improvements in toe-grip strength and toe flexibility in healthy young women.

Depression of the Hoffman reflex (H-reflex) is used to examine spinal control mechanisms during exercise, fatigue, and vibration and in response to training. H-reflex depression protocols frequently use trains of stimuli; this is time-consuming and prevents instantaneous assessment of motor neuronal excitability. The purpose of this study was to determine if paired-pulse H-reflex depression is reproducible and whether paired-pulse stimulation adequately estimates the depression induced by the more traditional ten-pulse train. H-reflexes were elicited via ten-pulse trains at 0.1, 0.2, 1, 2, and 5 Hz in ten neurologically intact individuals on two separate days. We measured the depression elicited by the second pulse (H2) and the mean depression elicited by pulses 2-10 (Hmean). H2 was consistent at all frequencies on both days (r² = 0.97, p < 0.05, and ICC_(3,1) = 0.81). H2 did not differ from Hmean (p > 0.05). The results indicate that paired-pulse H-reflex depression has high between-day reliability and yields depression estimates that are comparable to those obtained via ten-pulse trains. Paired-pulse H-reflex depression may be especially useful for studies that require rapid assessment of motor neuronal excitability, such as during exercise, fatigue, and vibration, or to establish recovery curves following inhibition.

Objective: To evaluate the factor structure of Functional Independence Measure (FIM®) scale amongst people with spinal cord injury (SCI).

Methods: This was a retrospective, register-based cohort study on 155 rehabilitants with SCI. FIM was assessed at the beginning and at the end of multidisciplinary inpatient rehabilitation. The internal consistency of the FIM was assessed with Cronbach's alpha and exploratory factor analysis was employed to approximate the construct structure of FIM.

Results: The internal consistency demonstrated high Cronbach's alpha of 0.95 to 0.96. For both pre- and postintervention assessments, the exploratory factor analysis resulted in 3-factor structures. Except for two items ("walking or using a wheelchair" and "expression"), the structures of the identified three factors remained the same from the beginning to the end of rehabilitation. The loadings of all items were sufficient, exceeding 0.3. Both pre- and postintervention chi-square tests showed significant p values < 0.0001. The "motor" domain was divided into two factors with this 2-factor structure enduring through the intervention period.

Conclusions: Amongst rehabilitants with SCI, FIM failed to demonstrate unidimensionality. Instead, it showed a 3-factor structure that fluctuated only little depending on the timing of measurement. Additionally, when measured separately, also motor score was 2-dimensional, not 1-dimensional. Using a total or subscale FIM, scores seem to be unjustified in the studied population.

Objectives. This study investigated whether women experience self-presentational concerns related to rehabilitation settings and explored preferences for characteristics of the social and physical treatment environment in relation to women's Social Physique Anxiety (SPA). Methods. Two cross-sectional studies were conducted. In Study 1, female undergraduate students (n = 134) completed four questionnaires (Social Physique Anxiety Scale; three bespoke questionnaires assessing self-presentation in rehabilitation and social and physical environment preferences) with respect to hypothetical rehabilitation scenarios. Study 2 recruited injured women who were referred for physiotherapy (n = 62) to complete the same questionnaires regarding genuine rehabilitation scenarios. Results. Women with high SPA showed less preference for physique salient clothing than women with low SPA in both hypothetical (p = 0.001) and genuine settings (p = 0.01). In Study 2, women with high SPA also preferred that others in the clinic were female (p = 0.01) and reported significantly greater preference for private treatment spaces (p = 0.05). Conclusions. Self-presentational concerns exist in rehabilitation as in exercise settings. Results indicated inverse relationships between women's SPA and preference for the presence of men, physique-enhancing clothing, and open-concept treatment settings. Future studies to determine the effect of self-presentational concerns on treatment adherence are needed.