Conventional Rehabilitation Program Research Articles

Immediate effects of kinesio taping and vibration therapy on manual dexterity in children with unilateral spastic cerebral palsy: a randomised controlled trial

Background/Aims In children with unilateral spastic cerebral palsy, the upper extremity is usually more affected than the lower extremity. Somatosensory, functional and developmental disorders cause difficulties in hand function. The aim of this study was to assess the immediate effects of kinesio tape and vibration therapy in addition to conventional physiotherapy on gross and fine manual dexterity in children with unilateral spastic cerebral palsy. Methods A total of 45 children aged 4–18 years with mild to moderate spasticity (at levels 0, 1, 1+, 2 according to the Modified Ashworth Scale) who could grip and release an object, and those who had hand function at levels 1, 2 and 3 according to the Manual Ability Classification System and were diagnosed with unilateral spastic cerebral palsy, were included in the study. The children were randomised into three groups: vibration therapy, kinesio taping and control, with 15 children in each group. While conventional physiotherapy was regularly continued in all three groups, the kinesio taping group had kinesio tape applied to the wrist extensors, with 50% tension on the wrist and thumb and 25% tension on the fingers at the beginning of the session. The vibration therapy group received vibration to the forearm extensor muscle group at the end of the session. Vibration was applied to the widest part of the forearm extensor muscles with a 7 cm tip at a frequency of 80 Hz, amplitude of 1 mm, vibration for 10 seconds and rest for 5 seconds, for a total of 10 minutes. Gross and fine dexterity were assessed by Box and Block Test and Nine-Hole Peg Test before and after treatment. Results When the groups were compared before and after the intervention, a significant improvement was found in the Nine-Hole Peg Test scores of the kinesio taping (105.11± 66.99 vs 86.22 ± 51.88, P<0.05) and vibration therapy (61.70 ± 35.54 vs 57.29 ± 38.05, P<0.05) groups and in the Box and Block Test scores of all three groups: kinesio taping group (25.13 ± 14.33 vs 28.40 ± 14.23, P<0.05), vibration therapy group (35.00 ± 11.69 vs 39.07 ± 12.43, P<0.05), control group (34.60 ± 11.74 vs 37.80 ± 11.22, P<0.05). There was no significant difference in the Nine-Hole Peg Test scores between the groups, while a significant improvement was found in the Box-Block Test scores of the kinesio taping group compared to the vibration therapy and control groups (P<0.05). Conclusions Kinesio taping and vibration have positive immediate effects on gross and fine manual dexterity in children with unilateral spastic cerebral palsy and can be used by physiotherapists to support conventional physiotherapy and rehabilitation programmes.

Synergy-based functional electrical stimulation and robotic-assisted for retraining reach-to-grasp in stroke: a study protocol for a randomized controlled trial

BackgroundStroke survivors have long-term upper limb impairment, which impacts the quality of life (QOL) and social reintegration, but there is lack of effective therapeutic strategies and novel technologies. Customized multi-muscle functional electrical stimulation (FES) based on the muscle synergy of healthy adults and robotic-assisted therapy (RAT) have been proved efficacy respectively. Synergy-based FES combined with RAT can be a novel and more effective therapy for upper limb recovery of stroke survivors from the perspective of synergistic enhancement. However, few studies have examined the effectiveness of combined synergy-based FES and RAT, especially for motor control evaluated by reach-to-grasp (RTG) movements. The main objective of the following research protocol is to evaluate the effectiveness and efficacy, as well as adoptability, of FES-RAT and FES or RAT rehabilitation program for upper limb function improvement after stroke.MethodsThis will be an assessor-blinded randomized controlled trial involving a 12-week intervention and a 6-month follow-up. Stratified randomization will be used to equally and randomly assign 162 stroke patients into the FES + conventional rehabilitation program (CRP) group, RAT + CRP group and FES-RAT + CRP group. Interventions will be provided in 5 sessions per week, with a total of 60 sessions. The primary outcome measurements will include the Fugl-Meyer Assessment and Biomechanical Assessment of RTG movements. The secondary outcome measurements will include quality of life and brain neuroplasticity assessments by MRI. Evaluations will be performed at five time points, including at baseline, 6 weeks and 12 weeks from the start of treatment, and 3 months and 6 months following the end of treatment. A two-way analysis of variance with repeated measures will be applied to examine the main effects of the group, the time factor and group-time interaction effects.DiscussionThe results of the study protocol will provide high quality evidence for integrated synergy-based FES and RAT, and synergy-based FES alone and guide the design of more effective treatment methods for stroke rehabilitation.Trial registrationChiCTR2300071588.

Virtual Reality Technology to Enhance Conventional Rehabilitation Program: Results of a Single-Blind, Randomized, Controlled Pilot Study in Patients with Global Developmental Delay.

Global developmental delay (GDD) is a complex disorder that requires multimodal treatment involving different developmental skills. The objective of this single-blind, randomized, controlled pilot study is to evaluate the feasibility and effectiveness of conventional rehabilitation programs integrated with the BTs-Nirvana virtual reality system. Patients with GDD aged 12 to 66 months were enrolled and treated for a 48-session cycle. Patients were randomized into two groups, (1) conventional treatment and (2) conventional treatment supplemented with the use of BTs-Nirvana, in a 1:1 ratio. Before and after treatments, areas of global development were tested with the Griffiths-III Mental Developmental Scale and the clinical indicator of global improvement were measured with the Clinical Global Impressions-Improvement (CGI-I). Feasibility was confirmed by the high retention rate. The experimental group presented a significantly improvement in General Quotient (GQ) after treatment (GQ, p = 0.02), and the effect of the two treatments was significantly different in both the GQ (t =2.44; p = 0.02) and the Foundations of Learning subscale (t =3.66; p < 0.01). The overall improvement was also confirmed by the CGI-I (p = 0.03). According to these preliminary data, virtual reality can be considered a useful complementary tool to boost the effectiveness of conventional therapy in children with GDD.

Proprioceptive Exercises in Hemiplegia Improve Balance and Spatiotemporal Parameters

Abstract Objective It was planned to investigate the effects of proprioceptive exercises applied to patients with hemiplegia on muscle tone, balance, perception, posture, mobility, and spatiotemporal parameters. Materials and Methods 70 participants with hemiplegia were randomized to an experimental group (conventional stroke rehabilitation program+proprioceptive exercise, 30 sessions) and a control group (conventional stroke rehabilitation program, 30 sessions). Timed Up and Go (TUG) Test, Modified Ashworth Scale (MAS), Posture Assessment Scale for Stroke Patients (PASS), Mini-Mental State Examination (MMSE), Rivermead Mobility Index (RMI), Spatiotemporal parameters (cadence, maximum plantar pressure, total weight transfer, step cycle duration, swing phase, step length and foot angle), and Berg Balance Scale (BERG) were applied on all participants before and after treatment. Results When the intra-group values were compared before and after the treatment, TUG, PASS, MMSE, RMI and BERG values increased significantly. MAS upper extremity and MAS lower extremity values decreased significantly. (p&lt;0.01). In the comparison between the groups, one of the spatiotemporal parameters, cadence, total weight transfer, and maximum plantar pressure values, increased significantly after the treatment. Step cycle duration, swing phase, step length and foot angle values decreased significantly after the treatment. (p&lt;0.01) Conclusion Unlike the literature, proprioceptive exercises that we add to the conventional rehabilitation program can be used to improve muscle tone, balance, perception, postural control, mobility, and spatiotemporal parameters.

Effects of Motor Rehabilitation on Balance and Functional Activities in Elderly Patients with Peripheral Neuropathy and Recurrent Falls.

To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM (p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH (p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.

Effects of adding interactive videogames to conventional rehabilitation program on radiological progression and upper extremity motor function in patients with hemiplegic stroke: a preliminary study

Objectives To investigate the effects of adding interactive videogames to conventional rehabilitation programmes on radiological progression and upper extremity functional status. Patients and Methods A total of 18 patients with hemiplegic stroke were randomized into two groups as conventional rehabilitation (control) group (n = 9), and the conventional rehabilitation + interactive videogames (intervention) group (n = 9). Each group received a 4-week program (5 days/week). Radiological progression (diffuse tensor imaging), and upper extremity functional status (upper extremity motor functioning part of the Fugl Meyer Assessment, self-care part of the Functional Independence Measure (FIM), and Motor Activity Log) were assessed at baseline and 4-week later. Results While no changes were detected in radiological status in the intervention group (p > 0.05), some regions on the affected side were improved significantly in the control group (p < 0.05). Total upper extremity motor functioning part of the Fugl Meyer Assessment scores and the self-care part of the FIM scores significantly improved in both groups (p < 0.05). No differences were detected in the amount of changes between groups (p > 0.05). Conclusion According to our results, adding videogames to a conventional rehabilitation program does not seem enhancing the radiological progression or the functional status of the upper extremities.

Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program.

The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient's rehabilitation program, a list of operative guidelines is provided. We describe various applications of the ISEO exercise program in terms of frequency and intensity. An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. DERR1-10.2196/35757.

Transcranial direct current stimulation combined with bodyweight support–tai chi footwork for motor function of stroke survivors: a study protocol of randomised controlled trial

IntroductionOur previous studies have proposed the bodyweight support–t’ai chi (BWS-TC) footwork training for stroke survivors with severe motor dysfunction and fear of falling, and have proven its positive effects for...

Evaluation of the impact of a smartphone application on adherence to home exercise program for people with chronic low back pain: research protocol for a pilot randomised controlled trial

IntroductionMultidisciplinary rehabilitation programmes are highly recommended for individuals with the most disabling low back pain (LBP). However, the long-term adherence to regular home exercise is often poor. We aim to...

Enhanced Recovery after Surgery Rehabilitation Protocol in the Perioperative Period of Orthopedics: A Systematic Review

Enhanced recovery after surgery (ERAS) is a surgical rehabilitation protocol of increasing interest to clinicians in recent years, with the aim of faster and better recovery of patients after surgery. Our main focus in this review is to analyze the effectiveness of ERAS rehabilitation protocols in orthopedic surgery. By comparing the post-operative recovery of patients receiving the ERAS rehabilitation program with that of patients receiving the conventional rehabilitation program, we observed whether the patients who have received the ERAS rehabilitation program could recover better and faster, thereby achieving the aim of a shorter hospital stay and reducing the incidence of complications. We conducted the literature searches in PubMed, MEDLINE, Web of Science, Cochrane Reviews, EMBASE and other databases on clinical studies related to orthopedic surgery regarding the effectiveness of rehabilitation using ERAS rehabilitation protocols compared with conventional rehabilitation protocols. A systematic review was performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. If there was variability in the rehabilitation data of the patients between the two subgroups, it was considered that there was a difference in the rehabilitation effect of the ERAS rehabilitation protocol and the conventional rehabilitation protocol on the patients. The application of ERAS rehabilitation protocols can shorten patients' hospital stay and reduce their expenses. In addition, patients with ERAS rehabilitation protocols will have fewer postoperative complications, while patients will have less postoperative pain than those with conventional rehabilitation, facilitating better postoperative recovery.

Feasibility and effects of cognitive–motor exergames on fall risk factors in typical and atypical Parkinson’s inpatients: a randomized controlled pilot study

BackgroundPeople with Parkinson`s disease (PD) often suffer from both motor and cognitive impairments. Simultaneous motor and cognitive training stimulates neurobiological processes which are important especially for people with PD. The aim of this study is to test the feasibility and effects of simultaneous cognitive–motor training in form of exergames in the setting of inpatient rehabilitation of persons with PD.MethodsForty participants (72.4 ± 9.54 years; Hoehn and Yahr stage 1–4) were randomly assigned to either the intervention group, which trained five times a week in addition to the conventional rehabilitation program, or the control group, which underwent the standard rehabilitation treatment only. Primary outcome was feasibility (measured by adherence rate, attrition rate, occurrence of adverse events, system usability scale (SUS), and NASA TLX score). In addition, various cognitive (Go/No-Go test, reaction time test (RTT), color word interference test (D-KEFS) and Trail Making Test A and B (TMT)) and motor (preferred gait speed, maximum gait speed, dual-task gait speed, Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and 5 times Sit-to-Stand (5xStS)) tests were conducted before and after the intervention phase in order to determine training effectsResultsAdherence rate was 97%, there were just two dropouts due to reasons unrelated to the study and there were no adverse events. The mean NASA TLX value was 56.2 and the mean value of the SUS was 76.7. Significant time–group interaction effects were observed for the 5xStS, the SPPB, the RTT, the Go/No-Go test and the D-KEFS 2.DiscussionExergaming, as applied in this study, showed to be feasible, safe and likely effective for the improvement of cognitive and motor functions of PD inpatients. Because of this future randomized controlled trials with a main focus on testing the efficacy of this new intervention are warranted.Trial registration: The study has been registered at ClinicalTrials.gov (ID: NCT04872153).

INFLUÊNCIAS DA ENFERMAGEM NA RECUPERAÇÃO DA FUNÇÃO MOTORA EM PACIENTES COM HEMIPLEGIA PÓS-AVE

ABSTRACT Introduction: The motor function of the lower limbs is of great importance for the recovery of hemiplegics post stroke. Objective: Study the influence of nursing during motor rehabilitation on the recovery of lower limb motor function in patients with hemiplegia after stroke. Methods: In this study, the 28 patients were treated with nursing intervention for motor rehabilitation in the experimental group, while the control group was treated only with a conventional rehabilitation program, and the results were compared before and after the experiment. Results: After eight weeks of the experiment, the FMA-LE scale score in the experimental group increased from 19.65 to 30.51; the TUGT assessment score increased from 38.45s to 28.61s; the FAC rating test was upgraded from 1.86 to 2.98. The maximum weight percentage on the hemiplegic side increased from 27.54±10.14% to 79.51±7.52%; the fastest 5m return speed increased from 0.22±0.03m/s to 0.54±0.07m/s. The improvement effect was less evident in the control group. Conclusion: Rehabilitation nursing promotes a positive effect on improving lower limb motor function in hemiplegic patients. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction.

To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction. Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience. There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups. Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

Use of zero-gravity robotic-assisted locomotion simulator in rehabilitation of patients with spinal trauma sequelae

In 2013, the WHO reported that 250,000 to 500,000 people worldwide are affected by traumatic spinal cord injury every year (WHO, 2013). In Russia, it is estimated that over 250,000 people suffer from disabilities as a result of spinal cord injury. This number continues to increase due to an increase in injury rate, as well as improvement in survival rate of patients affected by acute and long-term periods of traumatic spinal cord injury (TSCI). This study aimed to justify the safe and effective use of a zero-gravity robotic-assisted trainer for locomotor therapy in complex rehabilitation of patients with TSCI, as well as to compare this therapeutic approach with conventional motor rehabilitation programs that use other robotic mechanotherapy techniques. Neurological and functional disorders were assessed in 30 TSCI patients based on clinical examination and electromyography (EMG) results. All patients were classified into an intervention group and a control group by sequential randomisation. Rehabilitation programs for the intervention and control groups were alike, except for robotic mechanotherapy. Significant positive dynamic changes in motor functions, measured according to the ASIA Impairment Scale (American Spinal Cord Injury Association; Marino et al., 2003) were noted in the intervention group, in which two patients moved up to a higher level. EMG data showed a significant difference between the groups in favour of the intervention group. In addition, there was a significant difference between the two groups in postural function improvement in a seated position. Rehabilitation of patients in the intervention group involved engaging the axial muscles, facilitating an increase in strength, and improving trunk muscle control. Both groups of patients showed a significant decline in spasticity, as well as changes in their functional status. The ability of patients to perform normal daily activities also showed improvement. Our findings show that zero-gravity robotic-assisted locomotor training is a safe and effective procedure in the complex rehabilitation of patients with TSCI. This technique improves motor skills, self-care, and postural function in TSCI patients. Furthermore, we found a significant correlation between neurological and functional changes, which is indicative that this new therapeutic modality focuses on a restorative concept. Further research with a power increment is warranted.

Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients

Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions. The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids. The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted. After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation. The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.

The comparative effects of exercise type on motor function of patients with Parkinson's disease: A three-arm randomized trial.

Yang-ge dancing is a culturally specific exercise in which people are required to perform motor skills in coordination with rhythmic music. As an integrated exercise with both physical (decelerating the progression of aged-related motor function degeneration) and mental benefits, it has gained great popularity in China, especially among middle-aged and older adults. It remains largely unknown whether Yang-ge dancing (YG) can effectively improve main symptoms of Parkinson's disease (PD), while conventional exercise rehabilitation program has been recommended in the hospital setting. To this end, this study aimed to investigate the comparative effects of exercise therapy on motor function of PD patients. A sample of 51 PD patients were randomly assigned to Yang-ge dancing, conventional exercise, or conventional exercise with music. Participants in each group performed 60 min per session, five sessions per week of interventions for 4 weeks. All the participants were assessed using the Unified Parkinson's Disease Rating Scale-motor examination, Berg balance test, timed up and go test, and Purdue pegboard test. Motor performances were examined before and after intervention. All the three groups were benefited from exercise. Compared to conventional exercise, the Yang-ge dancing and conventional exercise with music had additional positive effects in mobility with reference to baseline.In addition, compared to the two conventional exercise groups (either with/without music), the Yang-ge dancing further enhanced manual dexterity. Exercise with rhythmic auditory stimulation optimized mobility in PD, while YG dance specifically contributed to improvement in manual dexterity. [https://clinicaltrials.gov/], identifier [ChiCTR2200061252].

Zero-Gravity Robotic-Assisted Locomotion Simulator in Rehabilitation: a Prospective Randomized Clinical Study of 30 Spinal Trauma Sequelae Patients

INTRODUCTION. According to the WHO, between 250,000 and 500,000 people are affected every year with spinal cord injury (SCI) around the world. The number of disabled people as a result of spinal cord injury in Russia is estimated to be over 250,000 and is increasing due to injury rate growth and survival rate improvement of patients in the acute and long-term periods of traumatic spinal cord injury (TSCI). AIM. To justify the efficacious and safe use of a zero-gravity robotic simulator for a locomotor therapy in the complex rehabilitation of patients with SCI and compare this therapeutic approach with conventional motor rehabilitation programs using other robotic mechanotherapy techniques. MATERIAL AND METHODS. Neurological and functional disorders were analyzed in 30 patients with SCI on the basis of clinical examination and electromyography (EMG) findings. All the patients were classified into an intervention group and a control group by a sequential randomization. The rehabilitation programs for the intervention and control groups were alike, except for robotic mechanotherapy. RESULTS. A significant positive dynamic change in motor functions according to the ASIA Impairment scale was noted in the intervention group, in which 2 patients moved up to a higher level. The EMG data showed a significant difference between the groups in favor of the intervention one. A significant difference in postural function improvement was found between the intervention and control groups in a seated position. The rehabilitation of patients from the intervention group engaged the axial muscles, promoting an increase in strength and better control of the trunk muscles. A significant spasticity decrease and changes in the functional status of the patients were observed in both groups. The patients’ ability to perform normal daily activities was registered to improve. CONCLUSION. The study demonstrated that robotic musculoskeletal training in zero-gravity conditions is safe and effective in complex rehabilitation of patients with SCI and improves motor skills, self-care and postural function. A significant correlation was found between neurological and functional changes, indicative of a restorative concept of the new therapeutic modality. Further studies with increased capacity are reasonable.

Effect of Modified Constraint-Induced Movement Therapy on Upper Extremity Function for Stroke Patients with Right/Left Arm Paresis: Single-Blind Randomized Controlled Trial

Purpose: Stroke is one of the most common causes of disability because of functional, cognitive, and psychological issues. Motor deficits in the afflicted upper extremity affect about 50% of stroke survivors. To evaluate the effects of modified constraint-induced movement therapy(mCIMT) on hemiparetic right/left upper limb functions and quality of life(QOL).&#x0D; Materials and Methods: In this prospective, randomized, controlled and single-blind study, 40 patients were assigned to the right-mCIMT(n=10), left-mCIMT(n=10), or control(n=20). mCIMT was applied 4h/day, 2 weeks, 10-sessions. A conventional rehabilitation program was applied to all patients. Patients were evaluated using Fugl-Meyer Motor Assessment(FMA), Motor Activity Log(MAL), Stroke Impact Scale(SIS), Box-Block Test(BBT), the number of repetitions in shaping exercises, and the duration of task exercise.&#x0D; Results: There was a statistically significant improvement in the FMA of the left-mCIMT group(p

Is it feasible to predict maximal oxygen uptake without an ergoespirometry?

Abstract Introduction To determine the aerobic capacity and the cardiopulmonary response to exercise is an important tool to assess functional capacity and a pronostic factor in patients with coronary artery disease (CAD). Maximal oxygen uptake (VO2) is considered the gold standard for measuring aerobic capacity, and a maximal graded exercise test is required for its direct measurement. Nevertheless, it requires long duration sessions, qualified medical personal and expensive equipment in order to perform it. These are the main reasons why its use is not widely spread in daily clinical practice and more accessible tests are needed. The aim of this study is to determine if we can predict the VO2 in patients with CAD, depending on basal characteristics of the patient. Objective To develop an equation to predict VO2 based on the 6-minute walk test (6MWT), basal characteristics and the presence of cardiovascular risk factors in patients with CAD and preserved left ventricular ejection fraction (LVEF). Methods We performed a cross-sectional prospective study with 202 patients with CAD and preserved LVEF, who were consecutively included in a conventional cardiac rehabilitation programme from March of 2019 to March of 2020 and underwent a 6-minute walk distance test and an ergoespirometry. The presence of cardiovascular risk factors, comorbidities and anthropometric variables were also evaluated. The tests were performed following ATS recommendations. The predictive equation for VO2 was obtained with a multivariate regression analysis. To assess the fit of the predictive model, we used conventional linear regression models according to the coefficient of determination (R2). A P value &amp;lt;0,05 was statistically significant. Results A total of 202 patients were analysed. The mean age was 57,5±9,3 years, mean LVEF was 61,2±6,14%, 13,4% were female, 54,4% arterial hypertension, 30,2% with diabetes, 76,7% dyslipidemia, 36,1% obese, 6,4% with peripheric artery disease, 9,4% with pulmonary disease. Correlations of the mentioned characteristics and the 6MWT with VO2 were statistically significant (p&amp;lt;0,001). Objectively measured VO2 had a significant correlation with age, gender, type II diabetes mellitus, BMI and 6MWT. Multiple regression analysis revealed the following VO2 prediction equation: 32,590-[2,784x gender (0=male/1=female)]-(0,177x age)-(2,756x DM (0=ausence/1= presence)]+(0,027x6MWT)-(0,468xBMI). There was acceptable correlation between measured and predicted VO2 max (R2=0,6). There were not stadistically significant differences between measured VO2 max by ergoespirometry and predicted VO2 max by our equation (22,52±5,82 vs 23,02±4,28, p=0,057). Conclusions Our study provides an VO2 prediction equation based on the demographical characteristics, the presence of cardiovascular risk factors and the results in the 6MWT in patients with CAD, which might be used as an alternative in the case of unavailability of an ergoespirometry. Funding Acknowledgement Type of funding sources: None.

Differences in aerobic capacity evolution and cardiovascular risk factors between diabetic and non-diabetic patients at different stages of a cardiac rehabilitation

Abstract Introduction Type 2 diabetes mellitus (DM) is an important factor that is associated with increased cardiovascular morbidity, producing disorders in different devices and systems whose mechanisms are not entirely known. This study was conducted in order to understand the evolution of aerobic capacity and the different cardiovascular risk factors (CVRF) in diabetic patients compared to non-diabetic patients. Methodology Prospective observational study. A total of 301 patients were included consecutively in a conventional cardiac rehabilitation program from January 2017 to March 2020, after one month of having had acute coronary syndrome, phase II of which lasted 2 months, who had an analysis, ergometry with spire gas analysis, and anthropometric characteristics were included. Those who had signs of ischemia in ergometry were excluded from the study. The tests were conducted as recommended by the ATS/ACCP. Results 301 patients were included, with an average age of 57.6±9.1 years, diabetics 92 (30,6%), LVEF average 56.9±9.6%, women 13.6%. Among the basal characteristics, diabetic patients had the highest prevalence of dyslipemia (89.1% vs 68.4% p s &amp;lt;0.001), HTA (62% vs 47.8% p x 0.03) and lower FEVI (55.1±10.26 vs 57.8±8.9 p-0.03), in addition to lower peak oxygen consumption (VO2 ml/kg/min) (18.8±5.0 vs 22.9±6.3 p-&amp;lt;0.001); DM being an independent predictor to obtain a lower VO2 with an OR 1.25 [IC (95%) 1.31–1.19 p&amp;lt;0.001] (Table 1). At the end of Phase II, both groups gained better control of CVRF (Table 2) including an improvement in VO2; but in the DM group the gain rate was significantly lower (0.08±0.14 Vs 0.13±0.17 p=0.02). In phase III (average follow-up 7.3 months) the benefits in the control of CVRF (Table 2) were maintained in both groups with the highest rate of increase in VO2 in patients with DM (0.07±0.2 Vs 0.02±0.13 p=0.05) (Image 1). Conclusions In our study, patients with DM undergoing an RHC program achieve better control of FRCV and aerobic capacity in a similar way to non-diabetic patients, which is maintained at 7 months of follow-up in phase III, although initially the aerobic capacity gain in diabetics is slower, achieve a higher increase in VO2 in Phase III. Funding Acknowledgement Type of funding sources: None.