Rehabilitation Research and Practice最新文献

Background: Early postoperative physical activity in elderly patients suffering from proximal femoral fractures may reduce mortality. We hypothesized that activity trackers can reliably and objectively monitor the in-hospital mobilization, correlating with functional independence and quality of life.

Methods: Three different tracker types (Fitbit™ flex, Misfit™ Shine, and Axivity AX3) at three locations (wrist, ankle, and femur) recorded steps and signal vector magnitudes (SVM) in 22 patients. They were 81 ± 8 years old, were equally distributed between the sexes, and had an ASA score of 2.5 ± 0.6. Single protocoled activity events (n = 191) were clinically categorized into 4 levels and correlated with the monitored signals. Additionally, 2 ± 1 and 8 ± 3 days after the operation, the EuroQol-5D and the Barthel-20 index supplemented this data.

Results: All measurements at the wrist (Fitbit, Misfit) resulted in unacceptable accuracy; however, sensitivity and specificity reached around 90% using the Misfit at the ankle. Applying this combination, the correlation between real and measured steps (R² = 0.99) and the category discrimination were statistically significant (p < 0.002). A discriminant analysis featured the calculation of four activity levels based on SVM measurements using the Axivity tracker at the femur. A cluster analysis showed a 100% agreement between the clinically observed and the calculated activity levels. The amount of active minutes or periods and both the EuroQol-5D and the Barthel-20 indices significantly increased between the analyzed time points after the operation. However, only the Barthel-20 was associated with the measured activity levels (p < 0.01).

Conclusion: The Misfit and the Axivity trackers can reliably monitor activity in elderly patients after operative treatment of proximal femur fractures. However, the wear location is decisive. Objectively measured activity correlated with functional independence and quality of life.

Objective: To compare strength training, aqua-fitness, and aerobic exercise programs to discern the differences in the benefits achieved by each of the activities in older people.

Design: Double-blind randomized trial.

Setting: Controlled clinical environment.

Participants: 108 people: 54 female paired with a male of the same age (average age of 65.5 ± 5.6 years).

Interventions: Three exercise programs (aqua-fitness, aerobic exercise, and strength training) for six months.

Main outcome measures: Body Mass Index, Senior Fitness Test (which evaluated functional fitness), and the SF-12 Health Survey.

Results: Men showed greater positive changes in the aerobic exercise group for general self-perceived mental health, leg strength, and flexibility of legs and arms. The largest improvements in overall self-perceived physical health and upper limb strength were in the men of the strength training group. The women participants in the strength training group obtained greater benefits, especially in self-perceived mental and physical health and in the strength of the four limbs.

Conclusions: To maximise benefits, older people, in general, may want to consider participating in aerobic activity. Furthermore, older women would benefit greatly, both emotionally and physically, from exercise that includes strength training.

Type II diabetes (TIIDM) is characterized by high levels of blood glucose followed by excessive insulin release so that the target cells become less sensitive, developing insulin resistance and maintaining hyperglycemic levels. Physical activity is the strongest element to prevent and to manage the TIIDM, and the majority of patients do not remain in regularly active levels, because the premature fatigue in these patients decreases the adherence to the training. Contrastingly, the whole body vibration (WBV) training may improve the glucose metabolism in diabetic patients, reducing the peripheral blood sugar, decreasing the physical discomfort and perceived exertion. Therefore, the purpose of the study was to determine the effect of an acute WBV session as therapy to promote fasting decreases in insulin levels in peripheral blood in TIIDM when compared to healthy elderly. For this, fifteen healthy elderly women and fourteen diabetic elderly women, all sedentary, were allocated in diabetic or control groups, and we made an acute whole body session composed of 10 bouts lasting 2 minutes each one, separated by a 30-second rest period. The WBV was executed in a triaxial platform MY3 Power Plate® at 35 hertz and has been chosen a peak-to-peak displacement of 4 millimeters. After the protocol, both groups decreased the glycemic levels and increased lactate production in relation to the basal levels and when compared diabetic and control, where the most important results have been shown in diabetic women. This study revealed that WBV training in TIIDM has had significant beneficial effects on the control of glucose levels, still in an acute session. So that, the complete training probably will show better results about glycemic control and this finding could be especially important when prescribing exercise for elderly who are unable or unwilling to use traditional loads or who show poor exercise compliance.

Objectives: To investigate and compare the feasibility, safety, and preliminary effectiveness of home-based self-managed manual wheelchair high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) programs.

Methods: Eleven manual wheelchair users were randomly assigned to the HIIT (n = 6) or the MICT group (n = 5). Both six-week programs consisted of three 40-minute propulsion training sessions per week. The HIIT group alternated between 30 s high-intensity intervals and 60 s low-intensity intervals, whereas the MICT group maintained a constant moderate intensity. Cardiorespiratory fitness, upper limb strength, and shoulder pain were measured before and after the programs. Participants completed a questionnaire on the programs that explored general areas of feasibility.

Results: The answers to the questionnaire demonstrated that both training programs were feasible in the community. No severe adverse events occurred, although some participants experienced increased shoulder pain during HIIT. Neither program yielded a significant change in cardiorespiratory fitness or upper limb strength. However, both groups reported moderate to significant subjective improvement.

Conclusion: Home-based wheelchair HIIT appears feasible and safe although potential development of shoulder pain remains a concern and should be addressed with a future preventive shoulder exercise program. Some recommendations have been proposed for a larger study aiming to strengthen evidence regarding the feasibility, safety, and effectiveness of HIIT.

Objective: To determine if whole body vibration therapy (WBV) effectively improves functional outcome in patients with poststroke hemiplegia.

Materials and methods: In this single-blind RCT, WBV group (n = 10) had 40 hz frequency/4 mm amplitude vibration during 5 minutes/session, 3 days a week, for a duration of 4 weeks. The control group (n = 11) had no vibration therapy for the same duration while standing on the same platform. Patients in both of the groups did 15 minutes of stretching and active range of motion exercises before the intervention. Outcome measures were Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM), and Timed 10-Meter Walk Test (10 mWT).

Results: Only 10 mWT improved at the 1st week (p = 0.002), 1st month (p < 0.001), and 3rd month (p < 0.001) in favor of the intervention group. There was positive correlation also between 10 mWT and ankle spasticity (p < 0.001, r = 0.931).

Conclusion: This study suggests that WBV therapy may be a complementary therapy in gait rehabilitation and functional outcome of the patients with calf muscle spasticity.

Objective: This study investigated the acute residual effects induced by different frequencies of whole-body vibration (WBV) on postural control of elderly women.

Design: Thirty physically active elderly women (67 ± 5 years) were randomly divided into three groups: two experimental groups (high WBV frequency: 45 Hz and 4 mm amplitude, n = 10; low WBV frequency: 30 Hz and 4 mm amplitude, n = 10) and one control group (n = 10), with no treatment. The participants were first subjected to stabilometry tests and were then guided through three sets of isometric partial squats for 60 s while the WBV stimulation was applied. The control group was subjected to the same conditions but without the WBV stimulation. The participants were again subjected to body balance tests immediately following the end of the intervention period and again at 8, 16, and 24 min. To measure body sway control, three 60 s tests were performed at 10 s intervals for each of the following experimental conditions: (1) eyes opened and (2) eyes closed. The following variables were investigated: the average velocity of the displacement of the centre of pressure in the anterior-posterior and medial-lateral planes as well as in the elliptical area.

Results: A 3 (condition) × 5 (test) two-way repeated-measures ANOVA did not identify significant differences in the stabilometric variables, regardless of group, time, or experimental condition.

Conclusions: The effect of WBV, regardless of the stimulation frequency, did not have a significant effect immediately after or up to 24 minutes after vibration cessation, on the variables involved in the control of postural stability in physically active elderly women.

The overall aim of this study was to measure the physiological responses of firefighters from a single fire service during simulated functional firefighting tasks and to establish the relationship between physical fitness parameters and task performance. 46 males and 3 females firefighters were recruited. Firefighters' aerobic capacity levels were estimated using the Modified Canadian Aerobic Fitness Test (mCAFT). Grip strength levels, as a measure of upper body strength levels, were assessed using a calibrated J-Tech dynamometer. The National Institute for Occupational Safety and Health (NIOSH) protocol for the static floor lifting test was used to quantify lower body strength levels. Firefighters then performed two simulated tasks: a hose drag task and a stair climb with a high-rise pack tasks. Pearson's correlation coefficients (r) were calculated between firefighters' physical fitness parameters and task completion times. Two separate multivariable enter regression analyses were carried out to determine the predictive abilities of age, sex, muscle strength, and resting heart rate on task completion times. Our results displayed that near maximal heart rates of ≥88% of heart rate maximum were recorded during the two tasks. Correlation (r) ranged from -0.30 to 0.20. For the hose drag task, cardiorespiratory fitness and right grip strength (kg) demonstrated the highest correlations of -0.30 and -0.25, respectively. In predicting hose drag completion times, age and right grip strength scores were shown to be the statistically significant (p < 0.05) independent variables in our regression model. In predicting stair climb completion times, age and NIOSH scores were shown to be the statistically significant (p < 0.05) independent variables in our regression model. In conclusion, the hose drag and stair climb tasks were identified as physiological demanding tasks. Age, sex, resting heart rate, and upper body/lower body strength levels had similar predictive values on hose drag and stair climb completion times.

Turning while walking is a common daily activity. Individuals with unilateral impairment frequently perform turns asymmetrically. The purpose of the study was to investigate the effect of a discomfort-inducing textured insole on symmetry of turning. Nine healthy individuals performed turns to the right while walking with no insole, immediately after the insole was inserted in the right shoe, and after walking for six minutes with the insole. The duration of turning, displacements of pelvic markers, and perceived level of discomfort were evaluated. Utilizing the insole was associated with the increased level of perceived discomfort (p < 0.05). Moreover, using the insole was linked to changes in the displacement of two pelvic markers and larger asymmetry index while turning immediately after the insole was inserted in the right shoe as compared to no insole condition (p < 0.05). The duration of right turning increased immediately after the insole was inserted (p < 0.05) and after walking with the insole for six minutes. The results indicate that the textured insole creates asymmetry of turning in healthy individuals. The outcome provides a background for future studies focused on using a textured insole to minimize the asymmetry of turning commonly seen in individuals with unilateral impairment.

Objective: The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP.

Design: The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol.

Results: Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41).

Conclusion: The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with  IRCT2016080829269N1.

Background: In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients' motivation by adding a playful element to therapy. However, reports on user experiences are still scarce.

Methods: A qualitative investigation of patients' and therapists' perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants' perceptions and interpretations.

Results: Five key themes were identified from the patients' perspectives: (i) motivational factors, (ii) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges.

Conclusion: Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients' moods and engagement and seemed to promote a "gung-ho" spirit, so they felt that they could perform more repetitions.