Clinical Rehabilitation Programs Research Articles

Anesthesia Literature Review

Anesthesia Literature Review

Expected for acquisition movement exercise is more effective for functional recovery than simple exercise in a rat model of hemiplegia

Background and purposeThe use of novel rehabilitative approaches for effecting functional recovery following stroke is controversial. Effects of different but effective rehabilitative interventions in the hemiplegic patient are not clear. We studied the effects of different rehabilitative approaches on functional recovery in the rat photochecmical cerebral infarction model.MethodsTwenty-four male Wistar rats aged 8 weeks were used. The cranial bone was exposed under deep anesthesia. Rose bengal (20 mg/kg) was injected intravenously, and the sensorimotor area of the cerebral cortex was irradiated transcranially for 20 min with a light beam of 533-nm wavelength. Animals were divided into 3 groups. In the simple-exercise group, treadmill exercise was performed for 20 min every day. In the expected for acquisition movement-training group, beam-walking exercise was done for 20 min daily. The control group was left to recover without additional intervention. Hindlimb function was evaluated with the beam-walking test.ResultsFollowing cerebral infarction, dysfunction of the contralateral extremities was observed. Functional recovery was observed earlier in the expected for acquisition training group than in the other groups. Although rats in the treadmill group recovered more quickly than controls, the beam-walking group had the shortest overall recovery time.ConclusionsExercise facilitated functional recovery in the rat hemiplegic model, and expected for acquisition exercise was more effective than simple exercise. These findings are considered to have important implications for the future development of clinical rehabilitation programs.

Patient Activation through Counseling and Exercise – Acute Leukemia (PACE-AL) – a randomized controlled trial

BackgroundPatients with acute leukemia experience a substantial symptom burden and are at risk of developing infections throughout the course of repeated cycles of intensive chemotherapy. Physical activity in recent years has been a strategy for rehabilitation in cancer patients to remedy disease and treatment related symptoms and side effects. To date, there are no clinical practice exercise guidelines for patients with acute leukemia undergoing induction and consolidation chemotherapy. A randomized controlled trial is needed to determine if patients with acute leukemia can benefit by a structured and supervised counseling and exercise program.Methods/designThis paper presents the study protocol: Patient Activation through Counseling and Exercise – Acute Leukemia (PACE-AL) trial, a two center, randomized controlled trial of 70 patients with acute leukemia (35 patients/study arm) following induction chemotherapy in the outpatient setting. Eligible patients will be randomized to usual care or to the 12 week exercise and counseling program. The intervention includes 3 hours + 30 minutes per week of supervised and structured aerobic training (moderate to high intensity 70 - 80%) on an ergometer cycle, strength exercises using hand weights and relaxation exercise. Individual health counseling sessions include a self directed home walk program with a step counter. The primary endpoint is functional performance/exercise capacity (6 minute walk distance). The secondary endpoints are submaximal VO2 max test, sit to stand and bicep curl test, physical activity levels, patient reported outcomes (quality of life, anxiety and depression, symptom prevalence, intensity and interference). Evaluation of clinical outcomes will be explored including incidence of infection, hospitalization days, body mass index, time to recurrence and survival. Qualitative exploration of patients’ health behavior and experiences.DiscussionPACE-AL will provide evidence of the effect of exercise and health promotion counseling on functional and physical capacity, the symptom burden and quality of life in patients with acute leukemia during out patient management. The results will inform clinical practice exercise guidelines and rehabilitation programs for patients undergoing treatment for acute leukemia. Optimizing the treatment and care pathway may ease the transition for patients from illness to the resumption of everyday activities.Trial registrationClinicalTrials.gov Identifier: NCT01404520.

Life is Movement (Aristotle, 4th century BC).

Life is Movement (Aristotle, 4th century BC).

1006 The impact of 3 week clinical rehabilitation program after radical prostatectomy on early continence status

1006 The impact of 3 week clinical rehabilitation program after radical prostatectomy on early continence status

Does clinical rehabilitation impose sufficient cardiorespiratory strain to improve aerobic fitness?

To investigate the cardiorespiratory strain experienced by patients over a day and during different types of rehabilitation therapies during a clinical rehabilitation programme. In addition, to investigate the use of the Borg scale as an instrument to monitor exercise intensity. An observational, cross-sectional study. Rehabilitation centre in the Netherlands. Eleven people after stroke (age range 20-71 years), 9 people with a lower limb amputation (age range 21-66 years) and 11 people with a spinal cord injury (age range 28-65 years). All participants were inpatients undergoing clinical rehabilitation. Frequency distribution of percentage heart rate reserve (%HRR) and length of time heart rate (HR) > 40%HRR over one day, and mean %HRR, length of time HR > 40%HRR and HR > 70%HRR during different types of rehabilitation therapies were compared with the American College of Sports Medicine guidelines for achieving an aerobic training effect. The correlation coefficient between the Borg scale score and %HRR was assessed. Patients' mean HR was 114 min/day (standard deviation 92) > 40%HRR, of which 1 h was spent in therapy. In 5 out of 10 rehabilitation therapies (fitness, hydrotherapy, walking group, wheelchair group and cycling/handbike group) a mean HR > 40%HRR was reached and more than half of the time was spent > 40%HRR. A moderate correlation (R = 0.56) was found between Borg scale score and %HRR. All outcome measures showed large variation between and within patients. In general, patients in a clinical rehabilitation programme experience adequate cardiorespiratory strain to potentially induce an aerobic training effect. The large variation in cardiorespiratory strain, however, necessitates individual monitoring to ensure proper exercise intensity. The Borg scale was shown to be of limited value for this monitoring, and therefore the use of HR monitors during rehabilitation should be considered.

The Effect of Self-directed Exercise Using a Task Board on Pain and Function in the Upper Extremities of Stroke Patients

[Purpose] We evaluated the effect of self-directed exercise using a task board on function and pain in the upper extremities of stroke patients [Subjects and Methods] We used the one group pre-post test design. Seven stroke patients who were selected based on the inclusion criteria participated in the program once a week for 10 weeks. The self-directed exercise comprised 5 stages that were divided according to the level of difficulty. The exercise was performed for 60 minutes using a special task board that we designed. The FMA (Fugl-Meyer Motor Assessment), VAS (Visual Analogue Scale), and speed of stacking were assessed to evaluate the amount of use of the affected arm at before and after intervention. [Results] The scores of the VAS and FMA, but not that of the speed of stacking cups, were improved. There was no significant correlation between the changes in VAS, FMA, and the speed of stacking cups. [Conclusion] The findings suggest that self-directed exercise with the task board could improve the levels of function and pain in the upper extremities. We suggest that self-directed exercise can be utilized as a clinical rehabilitation program and improve therapeutic effects.

Pulmonary rehabilitation in clinical routine: A follow-up study

The effect of rehabilitation for chronic obstructive pulmonary disease has been well-documented in randomized controlled trials. Evidence-based guidelines support rehabilitation programmes for chronic obstructive pulmonary disease, but knowledge of their outcome in clinical practice is limited. The aim of this study was to assess the outcome of a clinical routine rehabilitation programme for chronic obstructive pulmonary disease implemented by a Danish regional hospital. Changes in walk-distance (6-min walk-distance test; 6MWD), dyspnoea (Medical Research Council dyspnoea scale; MRC) and health-related quality of life (Short-Form 36; SF-36) were compared between and within completers and non-completers from baseline to the end of clinical routine rehabilitation, and at 6 and 12 months. The 8-week clinical routine rehabilitation comprised bi-weekly 90-min sessions of patient education and physical training. The hospital treated 521 patients during the study period. Of these, 175 were invited to join the study, 148 participated at baseline, and 98 at the 12-month follow-up. Completers' 6MWD was sustained from baseline to the end of clinical routine rehabilitation, but had declined by 12 months. Dyspnoea and health-related quality of life did not change. Seventy-five percent of completers felt better or much better after rehabilitation. The failure of completers to achieve expected outcomes shows a need for a stronger implementation effort and continuous quality control. Successful implementation in clinical routine requires targeted recruitment and overall programme improvement in general, and a stronger focus on physical training and staff competences.

Prism adaptation: is this an effective means of rehabilitating neglect?

Aim: Controversy exists as to whether prism adaptation improves the symptoms of neglect. The purpose of this review is to investigate the efficacy of prism adaptation techniques in the rehabilitation of neglect. Methods: A literature review was conducted using the search engines Pubmed, Medline, Embase, Ovid, Google scholar and http://pcwww.liv.ac.uk/~rowef/index_files/Page646.htm. Study and review abstracts from the literature search were analysed and marked for inclusion if they contained the following terms in reference to visual neglect: ‘visual inattention’, ‘visual neglect’, ‘stroke’, ‘cerebro-vascular accident’, ‘rehabilitation’ and ‘prism adaptation’. Only journals written in English with full text access were included in this review. Results: Neglect is now known as a multi-component disorder and recent studies have suggested using a combination therapy approach for the rehabilitation of neglect. There have been promising reports when prism adaptation has been used in combination with other methods of rehabilitation. However, there is not yet an adequate amount of evidence to definitively guide rehabilitation and thus additional research is advocated. Conclusion: Although negative results have been reported, the majority of studies advocate the use of prism adaptation. However, there is not yet enough evidence to incorporate prism adaptation into the clinical rehabilitation programme for neglect patients. Further studies need to concentrate on the clinical significance of improvements in neglect symptoms and the extent to which improvements extend to the everyday lives of patients.

A corrected version of the Timed-25 Foot Walk Test with a dynamic start to capture the maximum ambulation speed in multiple sclerosis patients

No clinical test is currently available and validated to measure the maximum walking speed (WS) of multiple sclerosis (MS) patients. Since the Timed 25-Foot Walk Test (T25FW) is performed with a static start, it takes a significant proportion of the distance for MS patients to reach their maximum pace. In order to capture the maximum WS and to quantify the relative impact of the accelerating phase during the first meters, we compared the classical T25FW with a modified version (T25FW(+)allowing a dynamic start after a 3 meters run-up. Sixty-four MS patients and 30 healthy subjects performed successively the T25FW and the T25FW(+). The T25FW(+)was performed faster than the T25FW for the vast majority of MS and healthy subjects. In the MS population, the mean relative gain of speed due to the dynamic start on T25FW(+) was independent from the EDSS and from the level of ambulation impairment. Compared to healthy subjects, the relative difference between dynamic versus static start was more important in the MS population even in patients devoid of apparent gait impairment according to the T25FW. The T25FW(+)allows a more accurate measurement of the maximum WS of MS patients, which is a prerequisite to reliably evaluate deceleration over longer distance tests. Indirect arguments suggest that the time to reach the maximum WS may be partially influenced by the cognitive impairment status. The maximum WS and the capacity of MS patients to accelerate on a specific distance may be independently regulated and assessed separately in clinical trials and rehabilitation programs.

Acute effects of locomotor training on neuromuscular and metabolic profile after incomplete spinal cord injury

Locomotor training (LT) enhances walking in individuals with spinal cord injuries (SCIs). We tested the acute effects of 4 days of LT using BWSTT combined with Robotic Locomotor therapy compared to BWSTT twice weekly. Two non-ambulatory participants with an American Spinal Injury Association Impairment Scale (AIS) D. Both received LT for 2 weeks as a portion of their clinical inpatient rehabilitation program and both used wheelchairs as their primary method of mobility. Over a 2 week period, one participant received a total of 8 visits consisting of manual BWSTT (twice weekly) combined with Robotic locomotor therapy (twice weekly). The other participant preformed manual BWSTT (twice weekly) for a total of 4 visits. Resting energy expenditure, body composition, muscle strength, submaximal oxygen consumption (VO2) and blood lactate during LT were measured pre and post-training. The average maximum voluntary contraction of both knee extensor muscle groups increased by 28-34% with associated reduction in spasticity to the BWSTT participant. Two week interventions resulted in a downward shift of the lactate concentrations for both participants, increase in resting energy expenditure and shift in substrate utilization. A clinical paradigm of incorporating BWSTT with robotic locomotor therapy for 4 days/ week did not provide additional physiological benefits to skeletal muscle strength, spasticity or metabolic profile compared to twice weekly of LT using BWSTT.

The Legacy of Dr. Roy Shephard: Canada’s New Risk Stratification Strategy and Clinical Exercise Prescription Guidelines

Dr. Roy Shephard is regarded widely as the leading authority in the exercise sciences and health promotion. His influence is legendary, including in the promotion of the health benefits of physical activity for those living with chronic disease and disability. His esteem within the field has in large part affected the way in which the medical community accepted exercise science as a viable and essential therapeutic intervention. His research challenged directly theories that were held to be true, demonstrating clearly the need for exercise in the effective secondary and tertiary care of chronic disease. The result of his influence can be measured directly by the establishment of clinical exercise rehabilitation programs across Canada (and the world) for a variety of chronic conditions. His work also highlighted the clear need for clinical practice guidelines for various chronic conditions. The development of Canada’s new clinical exercise guidelines is in large part owing to the pioneering work of Dr. Shephard. His work on the new risk stratification strategy (i.e., the PAR-Q+ and ePARmed-X+) and related clinical guidelines reflect his continued influence and importance to the field. All exercise scientists and young Canadian academics owe an enormous amount of gratitude to Dr. Shephard for his vision, dedication, innovation, and compassion for others.

Foot Clearance in Walking and Running in Individuals with Ankle Instability

Background Foot positioning before heel strike has been attributed to chronic ankle instability injury mechanics, and may play a role in developing and perpetuating chronic ankle instability. Purpose This study was undertaken to determine if a group of individuals with mechanical instability (MI) or a group with functional instability (FI) of the ankle joint demonstrate less foot-floor clearance and a more inverted and plantar flexed position of the foot during the terminal swing phase of the running and walking cycles when compared with a group of ankle sprain copers who had an injury but no residual instability. Study Design Controlled laboratory study. Methods Three-dimensional motion analysis was performed on 3 groups (n = 11 male athletes each) differentiated based on ankle injury history and ligamentous laxity during walking and running on a raised platform. Results The MI group (14.8° ± 12.0°) demonstrated greater maximum foot external rotation than the FI (3.2° ± 6.0°) and coper groups (2.9° ± 11.0°) (P = .01; ηp2 = .25) during running and greater rotation than the coper group during walking (3.3° ± 6.1° vs -4.5° ± 4.1°; P = .03; ηp2 = .21). The FI group (6.1° ± 3.2°) had greater plantar flexion at minimum than the MI group (0.1° ± 3.5°) during walking (P = .02; ηp2 = .25). Other group differences demonstrated large effect sizes, but not statistical significance, including unstable groups having lower minimum metatarsal height than copers during running. Conclusion Differences in foot and leg position during terminal swing were observed between MI and FI groups and copers. Greater plantar flexion and lower minimum metatarsal height may increase risk for inadvertent contact and thus episodes of instability. Clinical Relevance Rehabilitation programs may need to address terminal swing to improve mechanics and avoid potential episodes of giving way at the ankle.

The Motor Function and Activities of Daily Living Capacity of Seismic Wounded Patients in Intensive Care Unit Ward in 5.12 Wenchuan Earthquake of China

ObjectiveTo describe the motor function and activities of daily living (ADL) functional status of the seismic wounded patients treated in the intensive care unit (ICU) ward, and to provide insight to the planning on their clinical rehabilitation program.MethodA prospective study. Trained assessor applied different common testing methods to measure the motor functions of seismic wounded patients treated in ICU: (1) Manual Muscle Testing (MMT) method to evaluate muscle strength; (2) joint angle ruler to assess joint range of motion (ROM); (3) passive joint activities to assess the muscle tension; (4) Modified Ashworth Score (MAS) to assess spasm; (5) balanced response to assess sitting balance and standing balance; (6) international generic Barthel Index Scale to evaluate ADL. Complications as related to rehabilitation were also recorded. Descriptive statistics were employed to describe the epidemiology, pattern of motor function loss and type of injuries.ResultsThe most common types of injuries in our sample of seismic wounded treated in ICU were: fracture (70%), nervous system injuries (20%), squeezing syndrome (5%) and pulmonary contusion (5%). The fracture proportion was higher in female than male (about 2:1). Amputation and paralysis occurred more in male than female (about 7:1 and 3:1 respectively). Lung infection as a complication in ICU stay was more common in female than male (4:1). We reported that most of the seismic wounded patient had early loss of motor function during the stay in ICU. Conclusion: Limited ROM, declined muscle strength, abnormal muscle tension, balance dysfunction, alteration of ADL capacity and lung infection are the main dysfunctions occurring among the seismic wounded in ICU ward. Loss of motor function can occur early and therefore active physiotherapy should start even during the stay in ICU.

Clinical Results and Rehabilitation Program for Surgical Treatment of Rotator Cuff Tears

Clinical Results and Rehabilitation Program for Surgical Treatment of Rotator Cuff Tears

Influence of electrical stimulation frequency on skeletal muscle force and fatigue

Objective The aim of this study is to determine the impact of electrical stimulation frequency on muscle force and fatigue and propose application modalities in regards to sports or clinical rehabilitation training. Methods The maximal voluntary contraction (MVC) force of the quadriceps femoris muscle was recorded before, during and after electrical stimulation in 26 healthy adults during 20-minute sessions corresponding to 60 of 5-second contractions separated by 15-second rest periods. Three different frequencies were used: 100, 50 and 20 Hz. Results With a frequency of 100 Hz, we obtained 71% of the MVC force at the beginning of the session (MVCb). The decrease in muscle force at the end of the session is significantly greater for the highest frequencies respectively 27, 33 and 38% of MVCb for 100, 50 and 20 Hz. Conclusion The impact of electrical stimulation to improve muscle force seems to be dependent on frequency, intensity pulse trains and number of contractions per session. Higher intensity and higher frequency induce stronger muscular contractions, but also a stronger decline in force and thus quick-setting muscle fatigue. Classical 20-minute training sessions with many contractions (60 or more) do not seem appropriate for sports training or clinical rehabilitation programs.

Anterior Cruciate Reconstruction Using Bone-patellar Ligament – Bone Autograft

Background: Injuries to ligaments of knee are common in our society especially in the young athletes and sports men participating in football, volleyball, rugby etc. Tears of the anterior cruciate ligament (ACL) leads to knee instability which leads to inability to participate in sports. In the none athletes ACL injury tends to decline in their level of daily activity. This is a study of ACL tears seen and managed by the author over a long period along with scientific data of clinical presentations, diagnosis, associated injuries, the ACL repair, rehabilitation protocol and the overall outcome. Objective: To review the authors experience of patients with anterior cruciate ligament tears who have been treated by bone-patellar tendon-bone autografts. That was to be achieved through clinical, radiological, athroscopy and extensive rehabilitation programme and arthroscopic review after one year follow-up. Setting: Menelik Hospital and the Nairobi Hospital. Methods: Thirty five patients with anterior cruciate ligament tear in one knee and a normal contralateral knee were evaluated and followed up for six years. Clinical history, physical evaluation, X-ray and athroscopies were done to rule out concomitant meniscal lesions and facilitate their treatment accurately. Follow up arthroscopy; physical examinations by Lachman test, pivot test and anterior drawer test were done. Subjective and objective data were obtained and reviewed to assess final outcome. Results: A total of 35 patients were seen and treated. Only 25 patients were available having been followed up fully. There were 18 males and seven females giving a male to female ratio of 2:1. The injuries were unilateral 18 (72%) on the right and seven (28%) on the left. Initial Lachman”s test was graded at 2 and 3 while anterior drawers test and pivot test at 2 and 3 respectively in all patients. Post operatively these improved to grade zero with negative pivot test in all patients. The subjective results were excellent and good in 80% of the patients, while the objective were 68% . Follow up arthroscopy showed a stable ligament at one year while follow up X-ray showed mild arthrosis. A few complications occurred with one infection and calcification of ligament in two patients, arthrofibrosis in two patients. Conclusion: This study is of clinical relevance as it shows alleviation of pain after surgical treatment of the torn ACL which has been described as the stabiliser of the knee and guardian of the Meniscus.

Investigation of Effect of Age, Gender and Limb Dominance on Ankle Evertor/Invertor Peak Torque Ratios of Healthy Volunteers

[Purpose] To determine the ankle evertor/invertor maximal torque ratios (E/I) in the normal population which could be used as reference values during clinical evaluations and rehabilitation efforts and also to investigate the effect of age, gender and limb dominance on E/I. [Methods] Concentric ankle E/I was tested at 30 and 120 degrees/second using an isokinetic dynamometer for 79 healthy volunteers and the effects of age, gender, limb dominance on E/I were analysed. [Results] E/I values increased slightly with increasing age and there were statistically significant differences between age groups of 20-29 and 60-upper ages, and 30-39 and 60-upper ages with respect to left E/I (120 degrees/second) values. There were no significant differences between male and female subjects and between dominant and non-dominant limbs. [Conclusion] Ankle evertor/invertor peak torque ratios are affected by age but not by the dominance of the limb and the patient's gender. The ratios observed in different age groups in our study can be used as reference values in clinical evaluations and rehabilitation programs without taking into account the dominance of the limb and the patient's gender.

Is new science driving practice improvements and better patient outcomes? Applications for cardiac rehabilitation

Evidence from many clinical trials in recent years suggests that a large "treatment gap" exists between recommended therapies and the care that patients actually receive. This gap has been particularly apparent in the area of primary and secondary prevention of cardiovascular disease. In this article, three areas are discussed in which new scientific advances have not been adequately translated to clinical practice. These include: 1) the most appropriate measures to define the risks associated with obesity; 2) the under-diagnosis of obstructive sleep apnea and its relation to cardiovascular risk; and 3) the use and misuse of the exercise test and other functional status tools to predict health outcomes. Each is discussed in terms of how they should be quantified, their contribution to the estimation of cardiovascular disease risk, their response to interventions, and implications for cardiac rehabilitation. Clinical cardiac rehabilitation programs can benefit from routinely including these measures, both for their value in stratifying risk and for their importance in quantifying program efficacy. Physicians and allied health professionals should expand their routine medical evaluations and coronary risk factor profiling to include these measures.

A prospective series of musculoskeletal system rehabilitation of arthropathic joints in young male hemophilic patients

The study aims to evaluate prospective results of physical therapy interventions and rehabilitation of arthropathic joints in young male hemophilic patients. Given that the effectiveness of the therapy would be higher if therapy is provided at early ages, a series of males aged 18 years or younger were included in the study. The study is a descriptive case series of 31 hemophilic children who consecutively referred to the physical therapy and rehabilitation clinic from the pediatric hematology clinic of the same hospital over a period of 12 months. After getting their oral informed consent, all the patients underwent an intensive, 4-week clinical rehabilitation program, concomitant with factor replacement treatment. A total of 65 arthropathic joints were evaluated in the study and physical therapy interventions were applied 5 days a week for 1 h daily. The range of motion (ROM), pain, clinical evaluation and disability scores were compared and contrasted before and after the 4-week physiotherapy program. The ROM of all involved joints improved (at knee, ankle and elbow) and the scores of pain, clinical evaluation and disability revealed statistically significant improvement (P < 0.001). A multidisciplinary approach is important in the management of hemophilic arthropathy and appropriate physiotherapy combined with adequate replacement factor therapy promotes maintenance of the musculoskeletal function in male hemophilic patients.