Gain In Range Of Motion Research Articles

Influência da freqüência de alongamento utilizando facilitação neuromuscular proprioceptiva na flexibilidade dos músculos isquiotibiais

A utilização de manobras de alongamento é um dos recursos mais utilizados na prática de reabilitação. Porém, alguns parâmetros, como a freqüência, não têm sido estudados quando se utilizam as técnicas de facilitação neuromuscular proprioceptiva (FNP). O objetivo deste estudo foi analisar a freqüência ótima visando aumentar a flexibilidade dos músculos isquiotibiais, medida pela amplitude ativa de extensão do joelho. Selecionaram-se 36 sujeitos do sexo feminino (média de idade (DP) de 21,7 (1,9) anos), com limitação da flexibilidade dos músculos isquiotibiais. Os sujeitos foram distribuídos aleatoriamente em quatro grupos (n = 9). Os três grupos de alongamento receberam a intervenção cinco dias por semana durante duas semanas consecutivas. O quarto grupo, que serviu como controle, não foi alongado. Os grupos de alongamento com FNP variaram quanto à freqüência em uma, três e seis manobras por sessão. Uma análise de variância (ANOVA) foi utilizada para as medidas iniciais e finais (p < 0,05). Em seguida, foi realizada uma análise post hoc por meio do teste de Tukey (p < 0,05). A análise estatística dos dados indicou que os grupos de alongamento tiveram ganho de amplitude significativo em relação ao grupo controle, mas não entre eles mesmos. Em relação à velocidade do ganho, os grupos que utilizaram três e seis manobras alongaram (p < 0,05) mais rapidamente que o grupo que utilizou apenas uma manobra. Conclui-se, portanto, não haver diferença em relação ao ganho tardio quando se utilizam uma, três ou seis manobras de alongamento com a técnica de sustentar-relaxar nos isquiotibiais.

Results of Proximal Interphalangeal Joint Release for Extension Contractures

Management of stiffness of the proximal interphalangeal (PIP) joint of the finger remains a controversial problem. Despite the large number of papers describing the different approaches in releasing flexion and extension contractures in PIP joints, only two studies actually support their conclusions with statistical analyses. The aim of this study was twofold. The first goal was to statistically analyze the results of extensor tenolysis with dorsal capsulotomy for PIP joints in extension contractures. Secondly, the gain in range of motion (ROM) in the PIP joint following extensor tenolysis and dorsal capsulotomy was compared with that found in the literature.

Influence of preoperative range of motion on the early clinical outcome of total knee arthroplasty

To retrospectively analyze the influence of preoperative range of motion (ROM) and maximal flexion degree on the early clinical outcome of total knee arthroplasty (TKA). From January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients (81 knees), and 10 rheumatoid arthritis (16 knees). Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one <or= 90 degrees (range, 5 degrees - 90 degrees ) and the other > 90 degrees (range, 95 degrees - 140 degrees ). Finally the clinical outcomes of two groups (include ROM, maximal flexion degree, KSS score and function score) were evaluated. Three days later after operation, continuous passive motion (CPM) and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty. The patients were followed up for average 2 years 5 months (range, 10 months to 3 years 8 months). The average ROM of knee was improved to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation from 84.2 degrees (range, 5 degrees - 140 degrees ) before operation (P = 0.000); the average maximal flexion degree was decreased from 103.5 degrees (range, 25 degrees - 140 degrees ) before operation to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation (P = 0.439); KSS of knee joint was improved to 78.8 points after operation (range, 50 - 95 points) from 19.5 points (-24 - 62 points) before operation (P = 0.000). There was statistically difference between the clinical outcomes (ROM, maximal flexion degree, KSS score and function score) in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened. TKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill, abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.

Reciprocal Inhibition, Successive Inhibition, Autogenic Inhibition, or Stretch Perception Alteration

PURPOSE: Proprioceptive neuromuscular facilitation (PNF) stretches are widely used in athletics and rehabilitation. While it has been established that they are superior in range of motion (ROM) increases to the slow or static stretch, the mechanisms responsible remain an enigma. This study was conducted to determine if the neurophysiological mechanisms proposed by Knott and Voss (30), Kabat (28, 29) and Granit (18) are responsible for the success of the PNF stretches or whether the alteration of the stretch perception is a better explanation of ROM gains. METHODS: Eighteen subjects ages 17 to 44 performed 3 stretches: slow stretch and PNF stretches contract-relax (CR) and contract-relax agonist-contract (CRAC) in randomized order. The stretch intensity was controlled to a subjective “4” on a digital pain scale. The stretch force was measured and compared between the slow stretch and CR stretch. EMG data were collected from the semitendinosus and quadriceps muscles via surface and wire electrodes and analyzed for reciprocal inhibition, successive induction and autogenic inhibition. RESULTS: Reciprocal inhibition was not evident; the results indicated an elevated rather than an inhibited EMG during the antagonist contraction, possibly representing co-contraction. Similarly, autogenic inhibition was not evident, the expected inhibited and therefore lower EMG values were higher than baseline. We did confirm the presence of successive induction. Our study also showed that the success of PNF stretches most likely stems from an alteration of the stretch perception by possibly raising the pain threshold. We also established that there exists an order effect in the alteration of stretch perception. During the fourth CR stretch trial a significantly greater amount of stretching force was tolerated than during the first trial. CONCLUSION: Previous neurophysiological explanations for mechanisms of PNF stretching are found to be inadequate. The alteration of stretch perception seems to play a greater role in the success of PNF stretches. At least 4 trials of the CR stretch are recommended to get the greatest ROM gain.

Total Knee Arthroplasty in Stiff and Ankylosed Knees

A retrospective study was done to evaluate the results of total knee arthroplasty performed on 84 knees in 53 patients with spontaneously ankylosed knees, having a preoperative arc of movement between 0° and 20°(average, 14°). The difficulties encountered in surgical exposure were managed by using various extensile exposure techniques. Follow-up ranged from 4 to 15 years (average, 9 years). The average postoperative arc of movement at final follow-up was 75°, with a significant average gain of 61° ( P < .01). The average extensor lag was 6°. Four knees had a residual flexion contractures of 5° or less. Total knee arthroplasty in ankylosed knees can achieve correction of deformity with a significant gain in range of motion and marked improvement in quality of life.

Surgical approaches for nonneurogenic elbow heterotopic ossification with ulnar neuropathy.

Few reports are available concerning elbow heterotopic ossification (HO) and its optimal management in nonneurologic or nonburn patients after repetitive elbow manipulation. The unique anatomic relationship of the ulnar nerve at the elbow renders it rather vulnerable to injury when elbow HO occurs medially or posteromedially and extends into the vicinity of the cubital tunnel. A total of 16 consecutive patients without neurologic injury were diagnosed with heterotopic ossification formation in the elbow and referred to the Upper Extremity Unit of Chang Gung Memorial Hospital. All 16 patients were diagnosed with ulnar palsy, and 14 were found to have sensory dysfunction and muscle wasting for an average of 5.2 months. Fourteen of 16 patients achieved functional range of motion or more after surgery. The final gain in range of motion averaged 80.3 degrees. All except one had complete neurologic recovery postoperatively. The patient who had ulnar palsy for 1 year presurgery did not achieve any neurologic recovery. Forceful and repetitive manipulation may add further damage to an already stiffened elbow and should be avoided in an elbow after immobilization or surgery. Early surgical resection of HO and ulnar nerve decompression followed by gentle and aggressive physical therapy terminate the vicious cycle and yield encouraging results.

Intelligent stretching of ankle joints with contracture/spasticity

An intelligent stretching device was developed to treat the spastic/contractured ankle of neurologically impaired patients. The device stretched the ankle safely throughout the range of motion (ROM) to extreme dorsiflexion and plantarflexion until a specified peak resistance torque was reached with the stretching velocity controlled based on the resistance torque. The ankle was held at the extreme position for a period of time to let stress relaxation occur before it was rotated back to the other extreme position. Stretching was slow at the joint extreme positions, making it possible to reach a larger ROM safely and it was fast in the middle ROM so the majority of the treatment was spent in stretching the problematic extreme ROM. Furthermore, the device evaluated treatment outcome quantitatively in multiple aspects, including active and passive ROM, joint stiffness and viscous damping and reflex excitability. The stretching resulted in considerable changes in joint passive ROM, stiffness, viscous damping and reflex gain. The intelligent control and yet simple design of the device suggest that with appropriate simplification, the device can be made portable and low cost, making it available to patients and therapists for frequent use in clinics/home and allowing more effective treatment and long-term improvement.

Management of knee pain and stiffness after total knee arthroplasty

This article reviews 33 patients who presented with persistent pain, inadequate knee motion, or both after total knee arthroplasty. Of 33 patients, 26 had inadequate motion treated by closed manipulation, arthroscopic manipulation, or a modified open release manipulation. In 23 patients, these procedures were successful. Of the 26 patients, 85% had a history of previous knee surgery or diabetes mellitus. The average gain in range of motion was not different in comparing early (<12 weeks) manipulation versus late (>12 weeks) manipulation. Seven of the 33 patients presenting with pain, swelling, inadequate motion, or snapping sensations had either failure of bonding between the polymethyl methacrylate and the components (4 patients) or painful fibrous intra-articular bands (3 patients). These patients were treated successfully either by recementing the components or by arthroscopic fibrous band release.

Effect of cessation and resumption of static hamstring muscle stretching on joint range of motion.

Single group repeated measures. To determine the effects of cessation and resumption of a hamstring muscle stretching protocol on knee range of motion (ROM). It is generally accepted that stretching exercises result in an increase in ROM. The ability to maintain ROM once stretching has ceased and the ability to regain ROM after resumption of the stretching exercise is not well-known. Evaluated the effect of 6 weeks of static hamstring stretching, 4 weeks with cessation from stretching, and 6 weeks with resumption of stretching on knee ROM in 18 inactive college students (12 men, 6 women, mean age 21.0 years). The hamstring stretching consisted of 2 30-second stretches per day, 5 days per week. Knee ROM was measured before and after each of the above phases with an active knee extension test. Mean knee ROM increased after the initial stretching period (143+/-11 to 152+/-9 degrees), decreased to baseline following the cessation period (145+/-8 degrees) and again increased following the resumption of stretching but was not different from the initial gains (154+/-10 degrees). Unlike the stretch limb, the control limb ROM did not change over the 4 measurement times. There was no retention of knee ROM 4 weeks following a 6-week stretching protocol and a subsequent stretching period did not enhance the gain of knee ROM over the initial stretching period.

Alcohol neurolysis of the sciatic nerve in the treatment of hemiplegic knee flexor spasticity: Clinical outcomes

Chua KSG, Kong K-H. Alcohol neurolysis of the sciatic nerve in the treatment of hemiplegic knee flexor spasticity: clinical outcomes. Arch Phys Med Rehabil 2000;81:1432-5. Objective: To study clinical outcomes after 50% to 100% alcohol neurolysis of the sciatic nerve in the treatment of chronic hemiplegic knee flexor spasticity. Design: Case series using a convenience sample. Setting: Rehabilitation teaching hospital. Patients: Eight patients (mean age, 55.1 ± 12.1yr; mean duration to block, 4.4 ± 3.7mo) with chronic hemiplegia and severe spasticity (modified Ashworth scale [MAS] score < 2) secondary to cerebrovascular accidents (n = 5) and traumatic brain injuries (n = 3). Two patients were ambulant, 6 were wheelchair-bound. Interventions: Fifty percent to 100% alcohol neurolysis of the sciatic nerve using repetitive electric stimulation to localize the sciatic nerve. Main Outcome Measures: MAS score, gain in knee range of motion (ROM), and visual inspection of gait at 0, 1, and 6 months postneurolysis. Nonparametric tests were used in statistical analysis. Results: The mean preinjection MAS score was 2.8 ± 0.7, which improved to 1.4 ± 0.7 at 1 month (p =.005), and 1.8 ± 0.9 (p =.01) and 1.9 ± 1.1 (p =.02) at 3 and 6 months postinjection, respectively. The mean gain in knee ROM was 34.4° ± 15.7° at 1 month postinjection and was maintained at 6 months postinjection. Improvements in gait were noted in both ambulant patients, and improved positioning in 3 of 6 wheelchair-bound patients. The incidence of dysesthetic pain was 0%. Conclusion: Fifty percent to 100% alcohol neurolysis of the sciatic nerve is a safe and effective method for treatment of hemiplegic knee flexor spasticity, with therapeutic effects lasting 6 months. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

The use of low-load prolonged stretch devices in rehabilitation programs in the Pacific northwest.

This retrospective study examined the use of low-load prolonged stretch (LLPS) orthoses for contracture management. The records of 17 patients from skilled nursing facilities, hand clinics, and hospitals were reviewed. There was a total of 18 contractures (2 wrist, 12 elbow, 4 knee) secondary to neurological and orthopedic pathologies. Chart review focused on patient demographic information, range of motion (ROM) and functional outcomes, and wear schedules. The use of LLPS orthoses significantly increased ROM for the whole sample, which in turn significantly improved the subjects' functional outcomes. When the sample was divided into two pathology groups to compare a predominately geriatric population with neurological pathologies to a somewhat younger population with a history of musculoskeletal pathology, both groups showed a significant gain in ROM with the use of the LLPS orthoses. Use of LLPS orthoses for contractive management can mediate the losses in ROM and function that occur with joint contractures.

Análise morfométrica do reparo de ulcerações de pele de origem venosa após tratamento de fisioterapia

Skin ulceration of leg may have various etiologies, but chronic venous insufficiency is the pathological basis for this important clinical setting. Phisiotherapy treatment of patients with chronic venous diseases has shown the importance of systemic functional stimulation for achieve excellence of draining systems and functional recovering of the patient. The clinical control and skin restoration are presented by the study carried out with a patient with valvular incompetence of superficial and deep venous systems, ulcer on the dorsal and lateral face of the ankle with five-years clinic evolution and legs edema; during physical and functional examinations, patient has presented muscle shortening, limitation of range of motion of ankle and deambulation difficulty. After seven-months ambulatory treatment, consisting of one hour session per week, there was a reduction of edema, verified through sequential perimeter of leg, gain in range of motion of ankle, verified through goniometry and total recovery of skin ulcers. Tissue restoration of ulcers was controlled through morphometric analysis.

Arthroscopic management of postoperative arthrofibrosis of the knee joint: Indication, technique, and results

From October 1987 through March 1991, 58 patients with postoperative joint stiffness underwent arthroscopic fibroarthrolysis. Forty-six knees in 46 patients were followed. The indication for arthroscopic management was decreased range of motion after surgery. Eighty-seven percent had been treated by arthrotomy. Thirteen percent had been managed by arthroscopic surgery. The indication for primary surgery was a torn anterior cruciate ligament in 74%. The mean interval between arthroscopic fibroarthrolysis and follow-up was 22.1 months. The average age was 32.7 years. A modified Blauth and Jäger score was used for classification of fibroarthrosis: grade I (mild 17.4%), grade II (moderate 63%), grade III (severe 15.2%), and grade IV (bad 4.3%). The gain in range of motion was evaluated by the Cauchoix index: the results were excellent in 54.5%, good in 21.7%, and fair and poor in 23.8%. Pain was evaluated according to a modification of the Lysholm score: 80.4% of the patients experienced a reduction in pain. The sports activity level in the Tegner activity scale increased from 2.3 to 4.8. Patient satisfaction was excellent or good in 56.5% (n = 26), fair in 39.1% (n = 18), and poor in 4.3% (n = 2). On the basis of our retrospective study, we feel that arthroscopic fibroarthrolysis is of benefit to the patients with postoperative joint stiffness even after a prolonged period.

Rotational step-cut osteotomy for treatment of metacarpal and phalangeal malunion

Metacarpal and phalangeal malunion after fracture or replantation frequently causes rotational deformities with scissoring during digital flexion. Transverse osteotomy at the metacarpal base has been advocated for derotation, but this only partially corrects scissoring resulting from phalangeal malunion. We describe the results of rotational step-cut osteotomies at the site of malunion. There were twenty-three osteotomies in eighteen patients; seven metacarpal and sixteen in the proximal phalanx. The value of the technique is supported by the results; speedy healing of bone, satisfactory alleviation of deformity, and a useful gain in range of motion in many patients.

Lateral band release for post-traumatic extension contracture of the proximal interphalangeal joint

In the patient with scarring of just the central band and lateral bands, there is a loss of active and passive flexion of the proximal interphalangeal (PIP) joint because the lateral bands have lost their normal volar shift. Surgical freeing of the lateral bands from the central band using parallel incisions may be required to allow full flexion of the PIP joint. This study reports on 10 patients with post-traumatic extension contracture of the PIP joint treated by lateral band release. All operations were successful, with an average gain in range of motion of 47.5 degrees. This technique is simple, quick, and can be performed effectively on an out-patient basis.

Range of Motion of the Shoulder Performed While Patient Is Anesthetized

Significant loss of shoulder range of motion (ROM) in the early stages of burn recovery is a common and frustrating complication of burn injury. Pain is a primary reason for decreased motion: it prevents the patient from cooperating in an aggressive therapy program that could minimize contracture formation. To combat loss of movement without inflicting severe pain, the performance of ROM exercises and gentle passive stretching while patients were anesthetized was used as a treatment. A total of 59 treatments were performed on 14 patients who had limited unilateral or bilateral shoulder motion. A significant gain in shoulder ROM was attained when this treatment was performed and resulted in an increase in shoulder ROM when the patient was alert after anesthesia compared with preanesthesia measurements.

Functional significance of heterotopic bone formation after total hip arthroplasty

The effects of heterotopic bone formation on hip function after arthroplasty was studied in 145 cases of total hip arthroplasty. Hip muscle strength was determined 1.8–2.9 years after the operation, using a Cybex II dynamometer. Heterotopic bone formation was seen after 75% of the operations, and in 21% significant amounts developed (Brooker's classes III and IV). The gain in range of motion after surgery was significantly less in the groups with class III or IV heterotopic bone than in those without heterotopic bone formation. Heterotopic bone did not cause pain or Trendelenburg's limp after surgery; in fact, patients with trochanteric pain had less heterotopic bone than those without this pain. Hip flexion strength was greater in men with heterotopic bone than in those without heterotopic bone. Also, men with heterotopic bone formation had a higher mean maximum strength in extension but lower mean strength in abduction than did men without heterotopic bone (NS). When only patients with unilateral hip disease were considered, the same differences were found around the healthy hip; men with heterotopic bone formation had greater strength in flexion and extension than men without heterotopic bone formation and the same tendencies were seen in women. Accordingly, heterotopic bone had no serious impact on hip muscle strength in this study.

Total knee arthroplasty in hemophilia.

Twenty-four total knee arthroplasties were performed in fourteen disabled patients with hemophilia. The average age of the patients at operation was thirty-five years. Twenty-one of the implants that were used were total condylar prostheses. Using The Hospital for Special Surgery knee-rating system after two to nine years of follow-up, the result in fifteen knees was rated as excellent; in six, as good; and in one, as fair. Two patients had a poor result that was attributable to late infection. Pain and function were markedly improved, and the average gain in range of motion was 23 degrees. Postoperative complications, in addition to the infections, included one subcutaneous hematoma, one hemolytic anemia, and one instance of inhibition to Factor VIII. The technical problems in treatment were formidable. Total knee arthroplasty in a hemophiliac can be successful, but it should be performed only with strict hematological supervision. The surgeon should be prepared to treat many potential postoperative complications.

Synovectomy for rheumatoid arthritis of the knee

Synovectomy of the knee results in a satisfactory degree of pain relief in a patient with rheumatoid arthritis. Pain relief was equally good in our series in knees with clinically active synovitis, regardless of the amount of joint destruction, provided no gross malalignment, instability, or degeneration of joint surfaces was present. In 64 per cent of the knees there was some loss of range of motion; in 13 per cent, a gain in range of motion; and in 23 per cent, no change in the total range of motion. Only two knees in the entire series underwent fibrous ankylosis. The patients' estimates of their disease activity after surgery correlated very closely with the pain relief obtained. Most of those who estimated their activity to be very low had good pain relief, while those who had more active disease had less likelihood of a satisfactory result. Although long-term satisfactory results seemed to indicate that synovitis had been effectively suppressed by surgical synovectomy, the data in this series do not prove that synovectomy prevents destruction in the rheumatoid knee.