Early Stages Of Rehabilitation Research Articles

Effectiveness of an Unexpected Disturbance Program in the Early Stage of Rehabilitation in Athletes With Unilateral Knee Ligament Injury.

Sensorimotor, proprioceptive, and neuromuscular programs are critical for the successful rehabilitation of injured athletes, and these decrease reinjury rates. To investigate the effects of an unexpected disturbance program (UDP) on balance and unilateral strength metrics in athletes with unilateral knee ligament injury. A 3-week parallel-group experimental design consisting of 9 rehabilitation sessions. National Sports Institute. Twenty-one national-level athletes (age 21.4 [4.4]y, body mass 63.9 [10.8]kg, height 169.0 [10.2]cm) who had sustained a unilateral knee ligament injury. An UDP program designed to evoke rapid sensorimotor responses was compared with traditional training and a nonexercise control group. Unilateral total, anteroposterior, and mediolateral sway with eyes open and closed and unilateral isometric strength. Traditional exercises tended to outperform the UDP when unilateral balance testing was performed with eyes open; however, balance improvement following UDP tended to be greater in the eyes-closed condition. Significant strength gains in both the injured and uninjured legs were only observed following the UDP. This increase in unilateral isometric strength was 23.4 and 35.1 kg greater than the strength improvements seen in the traditional rehabilitation and control groups (P < .05). UDP could improve neural aspects of rehabilitation to improve rehabilitation outcomes by improving strength, sensorimotor function, and proprioception. Given the complementary adaptations, an UDP could provide an effective adjunct to traditional rehabilitation protocols and improve return-to-play outcomes.

Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use

BackgroundIn the early stages of rehabilitation after primary amputation, residual limb soft tissues have not been mechanically conditioned to support load and are vulnerable to damage from prosthetic use. There is limited quantitative knowledge of skin and soft tissue response to prosthetic loading. MethodsAn in-vivo protocol was developed to establish suitable measures to assess tissue tolerance during loading representative of early prosthesis use. Ten participants without amputation one participant with trans-tibial amputation were recruited, and pressure applied to their calf in increments from 20 to 60 mmHg. Measurements were recorded at relevant skin sites including interface pressures, transcutaneous oxygen (TCPO2) and carbon dioxide (TCPCO2) tensions and inflammatory biomarkers. FindingsAt the maximum cuff pressure, mean interface pressures were between 66 and 74 mmHg, associated with decreased TCPO2 values. On the release of pressure, the ischaemic response was reversed. Significant upregulation (p < 0.05) in inflammatory biomarker IL-1α and its antagonist IL-1RA were observed at all sites immediately following loading. InterpretationThe protocol was successful in applying representative prosthetic loads to lower limb tissues and monitoring the physiological response, both in terms of tissue ischemia and skin inflammation. Results indicated that the measurement approaches were sensitive to changes in interface conditions, offering a promising approach to monitor tissue status for people with amputation.

Designing and Developing Four Games for Rehabilitation of the Wrist Complex and Forearm Complex: An Action Research

Introduction: Virtual reality (VR) games are among the rehabilitation strategies that, while effective, are attractive to the individual and facilitate and encourage proper movement. In this study, four VR games were designed and assessed to encourage the movements of the forearm and wrist complexs. Materials and Methods: The games were designed using the leap motion device, a small non-tactile device with good spatial resolution. Cameras were responsible for detecting the depth and distance of the hand from the device, and the infrared sensors were responsible for detecting hand movements. In order to determine the level of attractiveness of the game for people with upper motor neuron disorders, three individuals aged 18 to 41 were randomly selected from among the people referred to the physiotherapy department of Al-Zahra Educational and Medical Center, Tehran, Iran. Results: The effectiveness of the games was confirmed by board members of department of physical therapy. Three games were applicable in the early stages of rehabilitation for all three participants. One game could not be used in the early stages of rehabilitation due to the complexity of the required movement. Conclusion: The four designed games required the basic movements required for daily and self-care activities and seemed to appeal the younger users.

The peculiarities of cognitive and emotional-volitional spheres of the patients with post-stroke neurological dysfunctions

The subject of this research is the peculiarities of cognitive (memory, attention) and emotional-volitional (manifestations of anxiety and depression, motivation towards recovery) spheres of the patients with severe dysfunctions of cerebral circulation of ischemic type in the early and late rehabilitation period. The relevance of this topic is defined by commonness of the ischemic stroke, growing number of incapacitating consequences, and mortality rate in Russia. Ischemic stroke leads to the change of physical, social and psychological status of a patient, worsening of quality of life, and unfavorable prognosis for recovery. The scientific novelty consists in assessment of the dynamics of indicators in cognitive and emotional-volitional spheres of the post-stroke patients at various states of rehabilitation treatment. It is determined that the highest positive dynamics in cognitive and emotional-volitional spheres is observed at the early stage of rehabilitation. The resource and deficiency characteristics, which are most important for selecting the target of psychological interventions, are determined for each group of patients. In the cognitive sphere are noted veracious differences in the capacity of auditory-verbal short-term and long-term memory, memory for images, allocation and shifting of attention. In the emotional-volitional sphere &amp;ndash; the indicators of depression and anxiety, motivation towards recovery. The presented data underlines the need for simultaneous provision of psychological rehabilitation and medication interventions for fullest readaptation of a patient to life at all stages of rehabilitation. &amp;nbsp;

Mental activity of the children during the early stage of rehabilitation after acute severe brain damage

Children who have suffered brain damage form a large group of patients in need of rehabilitation. For rehabilitation, patients require not only surgical, neurosurgical, traumatological, pharmacological and other medical support, but also the creation of special conditions for psychiatric care, psychological and pedagogical correction of their psychophysical potential. Neurological, motor and mental consequences of severe injuries of the nervous system in children lead to a high degree of disability with a subsequent restriction of their life, where social maladaptation and a violation of the quality of life are the primary problems. An integrated approach with differentiated qualified help will increase the effectiveness of rehabilitation programs and help the children adapt when they return to their normal environment. To identify the characteristics of mental activity during the recovery of the level of consciousness in children after acute severe brain damage at an early stage of rehabilitation. We examined 210 children under the age of 18 years with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus) who were admitted for treatment and rehabilitation. Clinical-psychopathological, pedagogical methods were used for examination as well as diagnostic scales, questionnaires. The main differentiating signs were divided into three groups, depending on the mental activity of the child, the level of consciousness: Group 1 - 37 (18%) patients with mental activity with physical, cognitive and social abilities with the minimal '+' consciousness (a-/hyperkinetic mutism with emotional reactions, understanding of speech); 2-nd group - 67 (32%) patients with dominant manifestations of physical and cognitive abilities with the minimal '-' consciousness (a-/hyperkinetic mutism without emotional manifestations and understanding of speech); 3rd group - 106 (50%) children with a weak manifestation of mental activity (physical abilities) in a vegetative status/exit from a vegetative status. Three variants of mental activity in children after acute severe brain injuries were distinguished - from minimal involuntary reactions or their absence during the vegetative status/exit from the vegetative status to arbitrary actions according to the instructions of an adult with a minimum '+' consciousness. Understanding the dynamics of the recovery of children's mental activity after neurotrauma may make it possible to have a differentiated approach to psychiatric, psychological and pedagogical rehabilitation in order to correct the recovery of mental functions in pediatric patients, and to prevent the developmental disorders as the child grows.

Ability of Isokinetic Dynamometer to Predict Isotonic Knee Extension 1-Repetition Maximum

Resistance training exercise prescription is often based on exercises performed at a percentage of a 1-repetition maximum (1RM). Following knee injury, there is no consensus when a patient can safely perform 1RM testing. Resistance training programs require the use of higher loads, and loads used in knee injury rehabilitation may be too low to elicit gains in strength and power. A maximum isometric contraction can safely be performed during early stages of knee rehabilitation and has potential to predict an isotonic knee extension 1RM. To determine whether a 1RM on an isotonic knee extension machine can be predicted from isometric peak torque measurements. Descriptive laboratory study. University research laboratory. A total of 20 (12 males and 8 females) healthy, physically active adults. An isokinetic dynamometer was used to determine isometric peak torque (in N·m). 1RM testing was performed on a knee extension machine. Linear regression was used to develop a prediction equation, and Bland-Altman plots with limits of agreement calculations were used to validate the equation. There was a significant correlation (P < .001, r = .926) between peak torque (283.0 [22.6]N·m) and the knee extension 1RM (69.1 [22.6]kg). The prediction equation overestimated the loads (2.3 [9.1]kg; 95% confidence interval, -15.6 to 20.1kg). The results show that isometric peak torque values obtained on an isokinetic dynamometer can be used to estimate 1RM values for isotonic knee extension. Although the prediction equation tends to overestimate loads, the relatively wide confidence intervals indicate that results should be viewed with caution.

Objective and subjective sleep problems and quality of life of rehabilitation in patients with mild to moderate stroke

ABSTRACTObjective: The principal objectives of this study were to investigate relationships between objective sleep parameters, that is, sleep onset latency, wake after sleep onset, number of awakenings, sleep efficiency, and sleep duration, and quality of life after mild to moderate stroke.Methods: The subjects were 112 first-time mild to moderate stroke patients admitted to a rehabilitation unit. Physical functions, depression, anxiety, quality of life, subjective insomnia, quality of sleep, and fatigue were assessed at about 20 days after stroke. Objective sleep parameters were also assessed using a wrist-worn Actiwatch.Results: Patients with insomnia had greater sleep onset latencies (p = .001), wake after sleep onset (p = .005), awoke more frequently (p = .013), and slept less efficiency (p < .001) than patients without insomnia, but total sleep durations were similar. In all participants, lower overall domain of quality of life was significantly associated with sleep onset latency (p = .009), and total insomnia severity index (p < .001), total Epworth Sleepiness Scale (p < .001), the National Institute’s Health Stroke Scale (p = .004), the Modified Barthel Index (p = .034), and Screening Tests for Aphasia and Neurologic-Communication Disorders (p = .044) scores.Conclusion: Objective sleep parameters (sleep onset latency and sleep efficiency) were found to be associated with quality of life during the early stage of rehabilitation in mild to moderate stroke patients.

Effectiveness of the device for electrostimulation with bio-control “trenar-01” in the rehabilitation of patients with motor deficiency after cerebral stroke

The problem of rehabilitation of patients who have suffered a stroke is relevant at present. The great importance in the processes of rehabilitation after astroke have neuroplasticity of the brain. This approach is implemented in a new class of electronic devices TRENAR® for biologically adequate movements control that are developed at The International Research and Training Center for Information Technologies in Ukraine. evaluation of the functional capabilities of the software device TRENAR-01® in the restoration of arbitrary movements of patients with impaired central motor neuronal function due to acute cerebrovascular accidental ischemic or hemorrhagic origin. Clinical-neurological examination and treatment of 30 patients with cerebral stroke were conducted. 15 electrostimulation procedures were performed on the Trenar-01® machine. After the treatment in the group of patients with acute cerebrovascular accident (23 patients), there was no effect on regression of motor deficit in only one case, when the origin of acute cerebrovascular accident was cardioembolic (with the presence of contraindications for systemic thrombolysis), in patients with long-term consequences of transmitted acute cerebrovascular accident (7 patients) there was a positive dynamics in the reduction of motor deficit. Reliably proved (p < .005) the effectiveness of training movements of the damaged limb according to the program, proceeding from arbitrary reductions of symmetrical healthy muscles in paralyzed patients. The electrostimulation with bio-control “Trenar-01” is expedient in the early stages of rehabilitation in the absence of a cognitive disorder in the patient.

Mental practice in isolation improves cervical joint position sense in patients with chronic neck pain: a randomized single-blind placebo trial.

ObjectiveThe main objective of this trial was to assess whether action observation (AO) training and motor imagery (MI) produced changes in the cervical joint position sense (CJPS) both at the end of the intervention and 10 min postintervention compared with a placebo intervention in patients with nonspecific chronic neck pain (NSCNP).MethodsA single-blind placebo clinical trial was designed. A total of 30 patients with NSCNP were randomly assigned to the AO group, MI group or placebo observation (PO) group. CJPS in flexion, extension and rotation movements in both planes were the main variables.ResultsThe results obtained in the vertical plane showed that the AO group obtained greater improvements than the PO group in the CJPS in terms of cervical extension movement both at the end of the intervention and 10 min postintervention (p = .001, d = 1.81 and p = .004, d = 1.74, respectively), and also in cervical flexion movement, although only at 10 min after the intervention (p = .035, d = 0.72). In addition, the AO group obtained greater improvements than the MI group in the CJPS only at the end of the intervention in cervical extension movement (p = .041, d = 1.17). Regarding the left rotation cervical movement, both the MI and AO groups were superior to the PO group in both planes at the end of the intervention (p < .05, d > 0.80).ConclusionsAlthough both AO and MI could be a useful strategy for CJPS improvement, the AO group showed the strongest results. The therapeutic potential of the application of mental practice in a clinical context in the early stages of rehabilitation of NSCNP should be considered.

A CLINICAL CASE OF UROLOGICAL REHABILITATION OF A CHILD WITH YATROGENIC COMPLICATIONS OF THE URINARY TRACT DUE TO A SPINAL CORD INJURY

The outcome both of patient recovery and spinal injury, in addition to a variety of clinical factors, is significantly affected by consequences and complications occurring during all periods of injury management. In acute, early and intermediate stages, complications of pelvic organs, according to different authors, are found in 77 - 100% of cases. The described clinical case serves as an illustration of irreversible complications had arisen because of improper management of a spinal cord injury (SCI) patient. An inadequate technique for urine diversion, underestimation of specific demands of the SCI patient, lack of proper positioning skills - all mentioned impacts caused inflammatory and trophic disorders. The article discusses an experience of urological rehabilitation specialists treated a child with iatrogenic complications of a urinary tract due to SCI at levels from Th8 to Th10. Particular attention is paid to mistakes made at the early rehabilitation stage and caused iatrogenic obliteration of the urethra in the area of penoscrotal angle and iatrogenic lysis of the bulbar urethra what inevitably worsened patient’s recovery and the quality of his and his family life.

The impact of exposure to immersive virtual reality on spatiotemporal gait parameters in healthy participants: a preliminary study

Following lower limb injury, some patients are not able to walk at full weight bearing and may require body weight support for ambulation during the early stages of rehabilitation. The aim of the present study was to investigate how various degrees of reduced effective body weight in a Lower Body Positive Pressure Treadmill (LBPPT), affects muscle activation levels during walking. Twelve healthy participants were instructed to walk at 2.5 km/h and 3.6 km/h on a LBPPT that provided a reduced effective body weight equivalent to 100%, 80%, 60%, 40%, and 20% of their individual body mass. Electromyography data were recorded during 20 gait cycles, from seven lower limb muscles, and segmented into a mean envelope by computing root mean square values. A two-way repeated measures ANOVA was used to test for differences in the highest root mean square value obtained, with walking speed and fractional reduction in effective body weight as factors. Significant decreases in EMG amplitude were identified in the following muscles as a result of reduced effective body weight: Vastus Medialis, Vastus Lateralis, Soleus, Gastrocnemius Medial and Lateral head (p ≤ 0.05). For Tibialis Anterior, significant reductions in EMG amplitude were only observed when effective body weight was reduced to 40% or less at a walking speed of 2.5 km/h (p ≤ 0.05). The EMG amplitude for Tibialis Anterior at 3.6 km/h and Biceps Femoris at both speeds remained unaffected at all fractional reductions (p ≥ 0.05). These findings suggests that the muscles of the lower limb respond differently to the body weight support provided by the LBPPT during walking, with the extensor muscles of the knee and ankle displaying decreased muscle activation, and the Tibialis Anterior and Biceps Femoris displaying minimal to no changes in muscle activation.

Effects of cyclic adjustment training delivered via a mobile device on psychological resilience, depression, and anxiety in Chinese post-surgical breast cancer patients.

Psychological resilience is an important ability for women with breast cancer to cope effectively with depression and anxiety. However, the demands of long-term hospital-based psychological rehabilitation interventions are not met in mainland China, where shorter hospital stays and longer home rehabilitation are common. This study examines whether a cyclic adjustment training (CAT) intervention delivered via a mobile device can improve psychological resilience, and reduce depression and anxiety symptoms, in a population of post-surgical women with breast cancer. Women with breast cancer were recruited through convenience sampling from a general hospital in Xi'an, and randomly allocated to an intervention group (n = 66), receiving CAT plus routine nursing care for 12weeks, or a control group (n = 66), receiving only routine nursing care. The primary outcome was psychological resilience. Resilience, anxiety, and depression were measured using the Connor-Davidson Resilience Scale (CD-RISC), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), respectively. A linear mixed model was applied to analyze the effects. Patients in the CAT group displayed significantly improved psychological resilience, anxiety, and depression scores (F = 19.53, P < 0.001; F = 31.85, P < 0.001; F = 26.32, P < 0.001), respectively, compared to the control group. The CAT had positive effects on improving psychological resilience and reducing the symptoms of anxiety and depression, supporting its use as an effective psychological management and intervention strategy in the early stages of long-term rehabilitation of post-surgical women with breast cancer. Chictr.org.cn ChiCTR-IOR-16008253, registered 9 April 2016.

Early weight-bearing after anterior cruciate ligament reconstruction with hamstring grafts induce femoral bone tunnel enlargement: a prospective clinical and radiographic study

BackgroundBone tunnel enlargement following primary anterior cruciate ligament (ACL) reconstruction with soft tissue graft might be a severe disadvantage for revision surgery. The postoperative rehabilitation protocol including the non-weight-bearing periods were different depending on the surgeon or institute. To determine the relationship between femoral bone tunnel enlargement and the postoperative non-weight-bearing period after double-bundle ACL reconstruction with hamstring grafts.MethodsForty-two patients who underwent primary double-bundle ACL reconstruction with hamstring grafts were divided into two postoperative non-weight-bearing protocol groups: 1-week non-weight-bearing postoperatively (group A, n = 19); and 2-week non-weight-bearing (group B, n = 18). Five cases were excluded due to additional knee injury, pregnancy, and lost to follow-up.Bone tunnel enlargement was evaluated by computed digital radiographs (anteroposterior (A-P) and lateral views) taken on the first postoperative day and at 12 months. Each tunnel diameter was shown as a percentage to the maximum joint width of the proximal tibia in the A-P view, or a percentage of the maximum diameter of the patella in the lateral view. To determine the incidence of tunnel enlargement, percentage diameter changes of more than 10% were defined as an enlarged tunnel. The magnitude of tunnel enlargement and the standard clinical evaluation were also evaluated.ResultsThere were no significant differences between groups in the incidences of anteromedial and posterolateral bone tunnel enlargement, both in the A-P and lateral views (2 × 2 Chi-squared test). The magnitude of femoral posterolateral bone tunnel enlargement was significantly greater in group A in the A-P view (p = 0.01) and lateral view (p = 0.03) (Mann Whitney U-test). Twelve months after surgery, the Lysholm score and Tegner activity level scale were not significantly different between the groups.ConclusionsThis prospective, clinical and radiographical study showed that early weight-bearing protocol after double-bundle ACL reconstruction with hamstring grafts might have the potential risk of significant postoperative femoral bone tunnel enlargement of the posterolateral bundle. There was no significant difference in clinical outcomes by postoperative non-weight-bearing period. To reduce and prevent the femoral bone tunnel enlargement, the comprehensive management could be considered and required to establish the suitable early stage rehabilitation protocol after surgery.Trial registrationTrial registration number; UMIN000036212.Scientific title: Prospective comparisons of femoral tunnel enlargement with two different postoperative non weight bearing periods after double-bundle anterior cruciate ligament reconstruction with hamstring grafts.Registered date: 15 Mar 2019 (retrospectively registered).

Gait Asymmetry Can Predict Functional Performance Post ACL Reconstruction: A Pilot Study

Wearable inertial sensors are practical and inexpensive technology that can be used to detect gait asymmetries following anterior cruciate ligament reconstruction (ACLR). Specifically, individuals after ACLR walk with asymmetries in shank angular velocity (SAV) during landing, which may be indicative of abnormal knee joint loading. However, it is unknown whether these asymmetries in SAV detected at early stage of rehabilitation can predict functional performance at 6 months after ACLR. PURPOSE: To investigate whether SAV asymmetries during walking at 4 months after surgery can predict return-to-activity criteria at 6 months in individuals with ACLR. METHODS: Fourteen individuals (8 females; age= 27.79±7.9 y) with primary unilateral ACLR participated in the study. Participants were instructed to walk at a self-selected speed along a 12-meter straight walkway at 4 months after surgery. SAV peak was calculated bilaterally during landing as the first negative peak value after heel strike in the sagittal plane. The average SAV peak was calculated for each limb. At 6 months after surgery, participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), and Global Rating Score (GRS)). Inter-limb symmetry (ACLR limb/uninjured limb*100) was calculated for SAV peak and functional measures. Linear regression models were used to determine whether SAV peak at 4 months would predict functional performance at 6 months following surgery. RESULTS: Asymmetry in SAV at 4 months was a significant predictor for asymmetries in the isometric quadriceps strength (r2=0.39, p=.02), single hop for distance (r2=0.36, p=.02), triple hop for distance (r2=0.34, p=.03), and triple-crossover hop for distance (r2=0.51, p=.001), but not for the 6-meter timed hop (r2=0.17, p=.14) at 6 months. Greater SAV asymmetry was a significant predictor for worse scores on the KOS-ADLS (r2=0.49, p=.006) and GRS (r2=0.46, p=.008). CONCLUSIONS: This pilot study showed that gait asymmetry detected by inertial sensors at early stage of rehabilitation can predict functional performance at 6 months after ACLR. Implementing these sensors in clinical practice may help clinicians to monitor gait on a regular basis during rehabilitation.

Effect of body weight support on muscle activation during walking on a lower body positive pressure treadmill

Following lower limb injury, some patients are not able to walk at full weight bearing and may require body weight support for ambulation during the early stages of rehabilitation. The aim of the present study was to investigate how various degrees of reduced effective body weight in a Lower Body Positive Pressure Treadmill (LBPPT), affects muscle activation levels during walking. Twelve healthy participants were instructed to walk at 2.5 km/h and 3.6 km/h on a LBPPT that provided a reduced effective body weight equivalent to 100%, 80%, 60%, 40%, and 20% of their individual body mass. Electromyography data were recorded during 20 gait cycles, from seven lower limb muscles, and segmented into a mean envelope by computing root mean square values. A two-way repeated measures ANOVA was used to test for differences in the highest root mean square value obtained, with walking speed and fractional reduction in effective body weight as factors. Significant decreases in EMG amplitude were identified in the following muscles as a result of reduced effective body weight: Vastus Medialis, Vastus Lateralis, Soleus, Gastrocnemius Medial and Lateral head (p ≤ 0.05). For Tibialis Anterior, significant reductions in EMG amplitude were only observed when effective body weight was reduced to 40% or less at a walking speed of 2.5 km/h (p ≤ 0.05). The EMG amplitude for Tibialis Anterior at 3.6 km/h and Biceps Femoris at both speeds remained unaffected at all fractional reductions (p ≥ 0.05). These findings suggests that the muscles of the lower limb respond differently to the body weight support provided by the LBPPT during walking, with the extensor muscles of the knee and ankle displaying decreased muscle activation, and the Tibialis Anterior and Biceps Femoris displaying minimal to no changes in muscle activation.

Trapezius muscle activation levels and ratios during scapular retraction exercises: A comparative study between patients with subacromial impingement syndrome and healthy controls

BackgroundLittle is known about trapezius muscle activities during scapular retraction exercises in patients with subacromial impingement syndrome. The aim of this study was to compare upper trapezius, middle trapezius and lower trapezius muscle activity and upper/middle and upper/lower trapezius ratios between patients with subacromial impingement syndrome and healthy individuals during six scapular retraction exercises. MethodsTwenty-two patients with subacromial impingement syndrome and 22 healthy individuals participated. Upper, middle, and lower trapezius activities were measured by surface electromyography, while the participants performed six scapular retraction exercises at different shoulder abduction angles in a standing position. Upper/middle and upper/lower trapezius ratios were also calculated. Repeated-measures analyses of variance were performed to determine whether muscle activation levels and ratios differed between groups during exercises. FindingsThere was no significant exercise × group interactions for upper, middle, and lower trapezius activation levels and upper/middle and upper/lower trapezius ratios (P > .05). A main effect for the exercise was observed for the upper/middle and upper/lower trapezius ratios (P < .05). InterpretationCompared to healthy individuals, patients with subacromial impingement syndrome did not exhibit different upper, middle, and lower trapezius activity and had similar upper/middle and upper/lower trapezius ratios during the various scapular retraction exercises. Therefore, scapular retraction exercises with various shoulder abduction could be safely offered for the patients with subacromial impingement syndrome since it does not lead to abnormal compensatory trapezius muscle activity. If the goal is to minimize upper/middle and upper/lower trapezius ratios, the scapular retraction exercises at 0° shoulder abduction may be used in early stage of shoulder rehabilitation.

Walking impairments after severe tibia plateau fractures. A gait pattern analysis

PurposeTibia plateau fractures are severe knee injuries which have a great impact on the patients' lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the short-term gait alternations after severe tibia plateau fractures treated with circular Ilizarov frame. Materials & methodsGait pattern evaluation was performed to patients who were treated with circular Ilizarov frame after severe tibia plateau fractures (Schatzker IV-VI), three to six months after the frame removal. Gait evaluation performed by using a force plate in a walking platform at self selected speeds. Data collected from two walking tasks for each limb. Demographic, clinical, radiological and quality of life questionnaire (SF-12v2) and COST data were also collected. ResultsThe gait pattern of sixteen patients (aged 48.8 ± 13.3 years), following treatment with circular Ilizarov frame for severe tibia plateau fractures (Schatzker IV-VI) was analysed. The tests were performed at an average of 10.4 months after the initial treatment. SF-12v2 Mental scores have returned to normal (mean 55.8 ± 11.9) but physical scores remained impaired (mean 40.6 ± 11.3). COST scores reached average levels (mean 54.1 ± 19.8).A one-way repeated measures ANOVA was conducted to compare the GRFs and gait timing data of the affected limb with the normal one. Single limb support interval was significantly reduced to the affected limb (p < 0.001) and terminal stance phase was prolonged for the normal limb (p = 0.05). The rest of the GRF and gait timing data did not reach significant differences. ConclusionsDuring the early stages of rehabilitation following severe tibia plateau fractures treated with circular Ilizarov frame, the gait pattern returns to normal curve morphology, but with reduced single limb support and terminal stance phases at the affected knee. Mental status returns to normal but symptoms and function remain impaired.

Effects of muscle energy technique on pain, range of motion and function in patients with post-surgical elbow stiffness: A randomized controlled trial

Background:Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM).Objective:To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness.Methods:An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks.Results:Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being , 95%CI(5.9,17.4) and , 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being , 95%CI(0.6,1.8) and , 95%CI(13.5,22.8) for VAS and DASH scores, respectively.Conclusion:MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.

Effect of Kinesio Taping on Arm Function in Stroke Patients in the Early Stage of Rehabilitation

Substantiation of the study. There is a lack of literature about the efficiency of Kinesio Taping methods which improve recovery of arm functions for patients after stroke in the early stage of rehabilitation. The aim of the study was to determine the effect of Kinesio Taping on the recovery of the affected arm function in stroke patients during the early stage of rehabilitation. Subjects and methods. Forty stroke patients were divided into two groups. Inclusion criteria for the subjects were: age under 75 years, affected arm muscle strength – at least 2 points, and cognitive function – at least 11 points according Mini mental state exam (moderate cognitive impairment). The patients of the frst group had only exercise therapy, while to the patients of the second group exercised together with the applied Kinesio Taping method. Patients’ affected hand strength was measured using a dynamometer, arm function was assessed by Wolf Motor test, a modifed Motor Assessment Scale and modifed Fugl-Meyer motor function impairment test. Results. After physiotherapy procedures, the evaluation of arm function with Wolf and Fugl-Meyer tests showed signifcant improvement in the both groups: in the frst group of patients, Wolf test results indicated the change and the estimated values were 49.4 ± 1.3 points, in the second group – 23.1 ± 2.0 points, Fugl-Meyer test – 31.3 ± 0.3 and 21.9 ± 0 6 points (p &lt; 0.05). In the frst group of patients, hand muscle strength improved signifcantly by 26.2 ± 2.2 kg, in the second group – 12.2 ± 1.8 kg (p &lt; 0.05). In the frst group of patients, shoulder motion recovery by JVS improved by 3.0 ± 0.1 points, in the second group – 2.1 ± 0.1 points, hand movements recovery – by 2.6 ± 0.1 and 1.7 ± 0.1 points, complex hand movements – by 2.8 ± 0.1 and 1.4 ± 0.1 points (p &lt; 0.05). Conclusions. The effect of exercises with Kinesio Taping on the affected arm function in stroke patients was signifcantly more pronounced (p &lt; 0.05) than the effect of exercises only.Keywords: stroke, arm function, Kinesio Taping, physiotherapy

QUADRICEPS STRENGTH CHANGES ACROSS THE CONTINUUM OF CARE FOLLOWING ANTERIOR CRUCIATE LIGAMENT INJURY IN ADOLESCENT MALES AND FEMALES

Background: Deficits in quadriceps strength have consistently been observed following anterior cruciate ligament reconstruction (ACL-R) and this deficit is frequently accompanied by altered lower extremity biomechanics that could increase risk of a second ACL injury. Regaining strength is a major focus for rehabilitation; however, it is unclear how quadriceps strength of both the involved (INV) and uninvolved (UnINV) limbs change across the continuum of care. Therefore, the purpose of this study was to examine quadriceps strength from the pre-operative time point until time of return to sport (RTS) in adolescent males and females. Methods: Cohort study design was used. A total of 60 adolescents participated (Males: N = 26, Age = 15.96? 1.23 yr, Ht = 177.14? 8.13 cm, Mass = 76.23? 1.23Kg; Females: N = 34, Age = 15.32? 1.12 yr, Ht = 163.11? 6.30 cm, Mass = 61.39? 7.38Kg) in the study. Participants were included in the study if they: 1) had a primary ACL-R, 2) participated in organized high-risk sports with an intention to return to sports, 3) completed assessments at the pre-operative timepoint (Pre), 12-weeks after surgery (12wk), and at time of RTS, and 4) completed the post-operative rehabilitation program. Five isokinetic repetitions of quadriceps strength (QUADS) of the INV and UnINV limbs were assessed at Pre, 12wk, and RTS, using a Biodex dynamometer (60?/sec). Peak strength was normalized to body weight (BW-1) and averaged across 5 trials. Separate 2 (limb – INV, UnINV) X 3 (time – Pre, 12wk, RTS) repeated measures of ANOVA were performed. With significant interaction, paired t-tests were performed to compare strength between each time point in each limb and between INV and UnINV limbs at each time point. Results: There were significant side by time interactions in adolescent females (F = 6.49, p = 0.002) and males (F=16.57, p &lt; 0.001). Post hoc tests revealed that adolescent females had greater INV RTS QUADS than INV PRE QUADS (p= 0.001) and INV 12wk QUADS (p &lt; 0.001), but no significant differences were observed between any time points in the UnINV limb. Adolescent males demonstrated decreased INV 12wk QUADS compared with INV Pre QUADS (p = 0.032), greater INV RTS QUADS than INV 12wk QUADS (p &lt; 0.001). UnINV 12wk QUADS was lower than UnINV Pre QUADS (p &lt; 0.037) and UnINV RTS QUADS was greater than UnINV Pre QUADS (p &lt; 0.002). In both female and male participants, INV QUADS was significantly less than UnINV QUADS at Pre, 12wk, and RTS time points (Females: p &lt; 0.001, p=0.007, p &lt; 0.001, respectively; Males: p &lt; 0.001, p &lt; 0.001, p &lt; 0.001, respectively). Conclusion/Significance: Quadriceps strength changes differently in adolescent females and males in both the INV and UnINV limbs across the continuum of care following ACL injury. While no changes were observed in UnINV QUADS over time, adolescent females improved INV QUADS from 12wk to RTS without changes in QUADS from Pre to 12wk. Although INV RTS QUADS was greater than INV Pre QUADS, INV RTS QUADS was 27% lower than RTS UnINV QUADS. Since UnINV QUADS is expected to be decreased due to reduced activity compared to that of pre-injury, strengthening the UnINV limb in addition to the INV limb appears to be a priority during rehabilitation. For adolescent males, INV QUADS decreased from Pre to 12wk and returned near to baseline at time of RTS, but not enough to surpass the Pre QUADS. Perhaps, minimizing the reduction of QUADS between the Pre and 12wk time points through an increase of exercise load during the early stages of rehabilitation may help to improve these deficits. Unlike female adolescents, adolescent males improved UnINV strength over time. This improvement may be a compensation of the decreased QUADS of the INV limb as significant deficits of QUADS were present at each time point. [Table: see text][Table: see text]