Improvement In Lower Extremity Strength Research Articles

A Systematic Review and Meta-Analysis of Exercise Beneficial for Locomotion in Community-Dwelling Elderly People with Sarcopenia.

Sarcopenia, in addition to aging and reduced physical activity, is a progressive skeletal muscle disorder that causes the loss of muscle mass and strength. The most prominent functional change is mobility, which contributes to a decrease in the quality of life. Therefore, we aimed to perform qualitative and quantitative analyses by synthesizing randomized controlled trials (RCTs) that evaluated exercises that affected locomotion in patients with sarcopenia. The RCTs were retrieved in April 2023 from three international electronic databases (Embase, MEDLINE, and PubMed). RCTs published after 2013 were compared with a control group that did not include exercise. Qualitative and quantitative analyses were performed on the identified studies using RevMan 5.4 and risk of bias assessment provided by Cochrane. RCTs involving 594 patients with sarcopenia were included in this study. The analysis model was synthesized as a random effects model, and the standard mean difference (SMD) was used as the effect measure. Exercise interventions were found to not change muscle mass in individuals with sarcopenia (SMD = 0.04; 95% CI: -0.15 to 0.22). However, they had positive effects on lower extremity muscle strength (SMD = 0.34; 95% CI: 0.02 to 0.66) and walking speed (SMD = 0.42; 95% CI: 0.11 to 0.72). For community-dwelling elderly people with sarcopenia, exercise intervention did not lead to an increase in reduced muscle mass, but it brought positive improvements in lower extremity strength and gait speed to improve locomotion.

Acute postoperative cauda equina syndrome following an elective gynecological procedure

We report a patient with cauda equina syndrome who presented immediately following hysterectomy. Intraoperative cauda equina syndrome is very rare, and to our knowledge, this is the first case reported following a gynecological procedure, which was unequivocally caused by a herniated intervertebral disc. A 72-year-old woman with a history of chronic low back pain and degenerative disc disease was referred to the orthopedic service after developing urinary retention, decreased rectal tone, and diminished bilateral lower extremity sensory and motor function following hysterectomy for the management of endometrial carcinoma. Magnetic resonance imaging revealed a large central disc herniation at L2/3. Due to a delay in recognition of the progressive neurological deterioration that began immediately postoperatively, decompressive surgery was performed between 48 and 72 hours after the onset of symptoms. Emergent surgical decompression including laminectomy and microdiscectomy resulted in improved bowel and urinary function but no improvement in lower extremity strength or sensation. Cauda equina syndrome is a rare but devastating condition whose recognition and management requires vigilance, communication, and early surgical involvement. This case presents novel information that cauda equina syndrome can occur immediately postoperatively from disc prolapse during unrelated procedures.

Effect of whole-body vibration therapy on lower extremity function in subacute stroke patients.

This study aimed to investigate the effect of whole-body vibration therapy on lower extremity function in subacute stroke patients. Subacute stroke patients who were able to undergo gait training were randomly divided into a vibration therapy group and a control group. All patients attended 20-min training sessions twice daily, 5 times a week for 2 weeks. Each session included 45 squats. The vibration group trained on a vibration platform and the control group trained on the ground. The degree of maximal isokinetic voluntary contraction torque was evaluated, and manual muscle tests of hip and knee flexion and extension were performed. The Berg Balance Scale, 10-m walk test, Timed Up and Go Test, and Functional Ambulation Category were used. A total of 38 patients, 20 in the vibration group and 18 in the control group, were included in the analysis. After the 2-week therapy, the vibration group showed significant improvements in lower extremity strength, balance, and gait performance. The vibration group showed significantly better performance on the Berg Balance Scale, 10-m walk test, and Functional Ambulation Category than the control group. There were no significant differences in maximal isokinetic voluntary contraction torque or manual muscle tests between the groups. Our results suggest that additional training with whole-body vibration may effectively improve the balance and gait performance of subacute stroke patients. Further studies on large populations are required to determine the therapy’s clinical efficacy.

Early Mobilization Following Gastro-Intestinal and Gynecological Cancer Surgeries

Context: There has been an increase in the incidence of gastrointestinal and gynaecological cancers and advancement in surgeries has made surgical treatment more for these participants more feasible. Aim: To evaluate the effect of structured early mobilization programs in postoperative gastrointestinal and gynaecological cancer patients on 30second chair stand test, functional assessment of cancer therapy-general (FACT-G) and length of hospital stay. Settings and Design: This was a clinical trial conducted at tertiary care hospital on gastrointestinal and gynecological cancer patients. Materials and Methods: Participants diagnosed with gastro-intestinal (n = 23) and gynaecological (n = 17) cancers who underwent surgery were included in the study. Lower extremity strength was assessed using 30 s chair stand test and the quality of life (QOL) was assessed using the FACT-G Scale. Length of hospital stay was noted from the postoperative day 1 till the day of discharge. Statistical Analysis Used: Wilcoxon Test and Spearman's rank correlation coefficient test were used for analysis. Results: Early mobilization program in postoperative gastro-intestinal and gynecological surgery participants showed improvement in the lower extremity strength in terms of 30 s chair stand test (P = 0.001). Moreover, improvements were also observed in the components of QOL viz., physical (P = 0.004), social (P = 0.041) and functional (P = 0.004) components. Conclusion: The study findings demonstrate improvement in lower extremity strength in terms of 30 s chair stand test and QOL according to FACT-G.

Electrical Stimulation Therapies for Active Duty Military with Patellofemoral Pain Syndrome: A Randomized Trial.

Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder among military service members that causes knee pain, quadriceps strength loss, and impaired motor performance in otherwise healthy individuals. PFPS poses a threat to the health, fitness, and subsequent readiness of the total force. The goal of rehabilitation for military service members with PFPS is to regain physical capacity of strength and function and to reduce pain, in order to restore readiness in this population. The randomized controlled trial reported here compared an active home exercise program (HEP) alone with three different electrical stimulation treatment regimens implemented concurrently with HEP postulated improvements in lower extremity strength and physical functional performance while also reducing pain in active duty military diagnosed with PFPS. After baseline testing, 130 active duty military members with PFPS were randomized to 1 of 4 treatment groups: (1) neuromuscular electrical stimulation (NMES) with HEP; (2) transcutaneous electrical nerve stimulation (TENS) with HEP; (3) combined NMES/TENS with HEP; (4) active HEP only. The primary outcome measure was degree of change in knee flexion and extension strength over 9weeks. Secondary outcomes were physical functional performance and knee pain. The primary analyses used repeated measures, linear mixed-effects models with a random effect for subject, time as a continuous variable, group as a categorical variable, and a group and time interaction to test for differences in change over time among the groups. All three electrical stimulation treatment groups improved in knee extension strength in the PFPS limb to a greater extent than the HEP alone group over the 9-week treatment period. The NMES and NMES/TENS groups improved to a greater extent than the HEP alone group in knee flexion strength in the PFPS limb. The reported pain improved over time for all treatment groups with no significant group differences. All three stimulation groups performed better on the 6-min walk test than the HEP alone group. The findings from this study showed that all three electrical stimulation with HEP treatment groups showed greater improvement in strength compared to the HEP alone group. These findings could offer alternative forms of rehabilitation for AD military with PFPS as these treatment regimens can be easily implemented at home station or during deployment.

Self-Managed Strength Training for Active Duty Military With a Knee Injury: A Randomized Controlled Pilot Trial.

Knee injuries among active duty military are one of the most frequent musculoskeletal injuries and are often caused by exercise or intense physical activity or combat training. These injuries pose a threat to force readiness. Our objective was to assess feasibility (including recruitment and retention rates) of three self-managed strengthening strategies for knee injuries and determine if they resulted in improvements in lower extremity strength, function, pain, and activity compared to usual physical therapy (PT) in military members. A pilot study using a randomized controlled trial was conducted at three outpatient military medical treatment facilities. After baseline testing, 78 active duty military members with a knee injury were randomized to 1-4 trial arms: (1) neuromuscular electrical stimulation (NMES) applied to the quadriceps muscle; (2) graduated strength walking using a weighted vest (WALK); (3) combined NMES with strength walking (COMBO); (4) usual PT alone. All groups received usual PT. The primary outcome was the rates of change in knee extensor and flexor strength over 18 weeks. Secondary outcomes explored the rates of change in functional performance, pain, and activities of daily living scale (ADLS). The primary analysis for the endpoints used repeated measures, linear mixed-effects models. This study was approved by Institutional Review Boards at all facilities. The randomized sample (N = 78) included 19 participants in the PT-only, 20 in the WALK, 19 in the NMES and 20 in the COMBO groups. At baseline, there were no group differences. Fifty of the participants completed the 18-week study. The completers and non-completers differed at baseline on injury mechanism, with more completers injured during sports (45% vs 29%), and more non-completers during military training (36% vs 18%). Also, they differed in uninjured knee extension (completers 28% weaker), and uninjured knee flexion (completers 22% weaker). Adherence for self-reported daily step logs showed that the WALK group was 15% below goal and COMBO group 6% below goal. The 300 PV muscle stimulator showed the NMES group completed 34% of recommended stimulation sessions and the COMBO group 30%.Knee extension strength in the injured knee found only the COMBO group having a statistically higher improvement compared to PT-only (Change over 18 weeks: 10.6 kg in COMBO; 2.1 kg in PT-only). For the injured knee flexion changes, only the COMBO showed significant difference from PT-only (Change over 18 weeks: 7.5 kg in COMBO; -0.2 kg in PT-only). Similarly, for the uninjured knee, only the COMBO showed significant difference from PT-only in knee extension (Change over 18 weeks: 14.7 Kg in COMBO; 2.7 kg in PT-only) and knee flexion (Change over 18 weeks: 6.5 kg in COMBO; -0.2 kg in PT-only). Overall pain improved during the study for all groups with no significant group differences. Similarly, function and ADLS significantly improved over 18 weeks, with no significant group differences. Knee extensor strength improvements in the COMBO group were significantly higher compared to usual PT. Pain, functional measures, and ADLS all improved during the study with no group differences. Further research is required to confirm these findings.

Changes in lower extremity strength may be related to the walking speed improvements in children with cerebral palsy after gait training

BackgroundCerebral palsy (CP) has a high probability of resulting in lower extremity strength and walking deficits. Numerous studies have shown that gait training has the potential to improve the walking abilities of these children; however, the factors governing these improvements are unknown. AimsThis study aimed to evaluate the relationship between change in lower extremity strength, walking speed and endurance of children with CP following gait training. Methods and proceduresEleven children with CP (GMFCS levels=II-III) completed a gait training protocol three days a week for six weeks. Outcome measures included a 10m fast-as-possible walk test, 6min walking endurance test and lower extremity strength. Outcomes and resultsThe group results indicated there were improvements in walking speed, walking endurance and lower extremity strength. In addition, there was a positive correlation between percent change in lower extremity strength and walking speed and a negative correlation between the percent change in lower extremity strength and the child’s age. ConclusionsOur results imply that changes in lower extremity strength might be related to the degree of the walking speed changes seen after gait training. Younger children may be more likely to show improvements in lower extremity strength after gait training.

Contemporary Single-Center Experience With Prophylactic Cerebrospinal Fluid Drainage for Thoracic Endovascular Aortic Repair in Patients at High Risk for Ischemic Spinal Cord Injury

To review rates of permanent paraplegia and lumbar drain-related complications in patients undergoing thoracic endovascular aortic repair (TEVAR) surgery with prophylactic cerebrospinal fluid (CSF) drainage at the authors' institution. Retrospective cohort study. Tertiary care, academic medical center. Patients who underwent TEVAR with a high risk for ischemic spinal cord injury and prophylactic lumbar CSF drainage over a 5-year period. None. One hundred and two patients underwent TEVAR with lumbar CSF drainage. Thirty-day mortality was 5.9%, and the rate of permanent paraplegia was 2%. Drain complications occurred in 4 (3.9%) patients, but no patient experienced permanent injury related to CSF drainage. Two patients in the cohort had complete resolution of paraplegia with increased CSF drainage and mean arterial blood pressure increases aimed to increase spinal cord perfusion pressure by 25%. A third patient experienced improvement in lower extremity strength but remained paraplegic, and a fourth patient demonstrated no improvement in symptoms. The 6 patients taking clopidogrel experienced no bleeding complications, and there were no apparent risk factors for bleeding in the 5 patients who had bloody drain output or in 1 patient who developed an epidural hematoma. Prophylactic CSF drainage was associated with low paraplegia and drain-related complication rates. These data further support the safety of prophylactic CSF drainage in patients undergoing TEVAR with a high risk for ischemic spinal cord injury.

Translation of Fit & Strong! for Use by Hispanics With Arthritis: A Feasibility Trial of ¡En Forma y Fuerte!

This study evaluated the feasibility and effectiveness of translating the evidence-based program, Fit & Strong!, into a Spanish program, ¡En Forma y Fuerte!. A single-group, quasi-experimental design (n = 34, mean age = 58.8 [8.1], 87.2% female, 87.2% reported speaking mostly Spanish) was used to assess implementation feasibility and the impact of ¡En Forma y Fuerte! on arthritis-related outcomes in Hispanics with arthritis. Significant improvements in lower-extremity strength, perceived physical function, and pain were observed from baseline to 8weeks (p < .05); these improvements were maintained at 6months. Significant improvements in aerobic endurance and stiffness were observed from baseline to 6months (p < .05). No major program adaptations (other than language) were observed or reported. However, the instructors provided several suggestions for program improvements, including adjusting the literacy level and length of the program. Findings suggest ¡En Forma y Fuerte! is feasible and effective, potentially providing a much-needed program for older Hispanics with arthritis.

Cytomegalovirus Polyradiculopathy in the Modern Age of Human Immunodeficiency Virus Therapies

Abstract Cytomegalovirus (CMV) polyradiculopathy in human immunodeficiency virus–infected patients is an increasingly rare disease given the widespread availability of effective antiretroviral therapy. Here, we describe a case of CMV polyradiculopathy in a man following the initiation of antiretrovirals. The patient presented with a 2-week history of rapidly progressing bilateral lower extremity weakness resulting in paraplegia; he was diagnosed with CMV polyradiculopathy based on cerebrospinal fluid and magnetic resonance imaging findings. Treatment with ganciclovir, foscarnet, and antiretroviral therapy resulted in rapid reduction of CMV viral load in cerebrospinal fluid and halting of disease progression. Six months after presentation, the patient continues to show improvement in lower extremity strength and has regained the ability to ambulate without assistance for short distances.

Comparison of 2 Different Exercise Approaches: Tai Chi Versus Otago, in Community-Dwelling Older Women.

Regular exercise can delay age-related risk factors and can maintain or improve physical health and activity in older adults leading to a decrease in fall risk. The purpose of this study was to compare 2 different interventions for fall prevention, tai chi (TC) and Otago, by examining lower extremity strength, balance, and spatiotemporal gait parameters in community-dwelling older women. We performed a randomized trial in which subjects were assigned to 1 of 2 groups: the TC group (n = 21; age, 72.8 ± 4.7 years, range: 65-83 years), which participated in a modified Sun-style TC exercise program; and the Otago group (n = 24; age, 71.5 ± 3.6 years, range: 65-79 years), which participated in the Otago exercise program. The Timed Up and Go (TUG) test, functional reach (FR) test, one-leg standing (OLS) test, 5 times sit-to-stand test (5×STS), 30-second sit-to-stand (30s STS) test, and gait parameters (gait velocity, step length, step width, stride time, and cadence) were measured before and after the intervention. Both groups showed statistically significant improvements in balance (TUG and OLS tests), lower extremity strength (5×STS and 30s STS tests), and spatiotemporal gait parameters, except for step width and step length (P < .05). The Otago group showed a significantly improved FR, whereas the TC group showed a significantly improved step length after the intervention (P < .05). Furthermore, the Otago group exhibited greater improvements in the TUG (P < .001), FR (P < .001), 5×CST (P < .01), and 30-second CST (P < .01) tests: a faster cadence (P < .001) and shorter stride time (P < .001) when compared with the TC group. The TC group showed greater improvements in the OLS test, step length, and step width (P < .01) and faster gait velocity (P < .05) than the Otago group. The findings from this study support the efficacy of the TC and Otago exercise programs in improving mobility in this sample of subjects. Furthermore, the Otago group showed greater improvement in lower extremity strength, whereas the TC group showed greater improvement in balance (OLS test). Also, the TC group showed a greater improvement in gait velocity after TC training program compared with the Otago exercise program. However, this study does not elucidate which exercise program is a more effective intervention method with older women for fall prevention.

What can the first 2 months tell us about outcomes after anterior cruciate ligament reconstruction?

Substantial research has been conducted on anterior cruciate ligament reconstruction (ACLR) to evaluate patient outcomes. However, little attention has been given to outcomes during the early phase of recovery and how early deficits affect both short- and long-term outcomes. To identify relationships between demographic (age, sex, and body mass index [BMI]) and intraoperative (isolated ACLR versus primary ACLR + secondary procedures), and postoperative (range-of-motion [ROM] and peak isometric knee-extension force [PIF]) variables during the first 2 months after ACLR using self-reported outcomes. Cohort study. Outpatient orthopaedic hospital. A total of 63 patients (38 men, 25 women; age = 33.0 ± 12.1 years; BMI = 26.3 ± 6.5 kg/m(2)) who underwent ACLR. Demographic, intraoperative, and postoperative variables were collected at 1 and 2 months after ACLR and were compared with International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form scores at 1, 2, and ≥12 months. Significant relationships were identified between ≥12-month IKDC scores and the 1-month (Pearson correlation, r = 0.283, r(2) = 0.08; P = .025) and 2-month (r = 0.301, r(2) = 0.09; P = .017) IKDC scores. After controlling for other variables, we found that the PIF ratio measures at 1 and 2 months were positively associated with 1- and 2-month IKDC scores (P < .001) and BMI was negatively associated with both 1- and 2-month IKDC scores (P < .05). One-month IKDC scores were related to the 1-month difference in knee-flexion ROM (P = .04). The IKDC scores during the first 2 months were positively correlated with patients' perceptions of function on long-term IKDC scores. It also appears that improvements in lower extremity strength and flexion ROM deficits were positively associated with short-term IKDC scores. Higher BMI was negatively associated with patients' perceptions of function on short-term IKDC scores.

Tai Chi intervention for older adults using assistive devices in a senior living community: a pilot study

Aim: To examine whether a 6-form Tai Chi (TC) programme is effective in improving balance among older adults using an assistive device (walker or cane) for daily mobility. Method: Seventeen qualified subjects participated in a 12-week study (3 times a week, 60 minutes each session). The outcomes measured were the Fall Efficacy Scale (FES), Tinetti Performance Oriented Mobility Assessment (POMA), Single Leg Stance (SLS), and Chair Stand Test (CST). Findings: Thirteen subjects completed the whole programme and performed significantly better on the post test than the pre test in FES (P=.001), POMA (P=.001), and SLS (P=.001), but no difference identified in CST (P=.131) after Bonferroni adjustment. Conclusion: These results indicate that the 6-form TC programme can benefit older assistive device users by reducing fear of falling and improving balance, but offers no clear improvement in lower extremity strength.

The Effects Of Resistance Training On Muscular Strength And Ankle-brachial-index In Those With Osteoarthritis

Knee osteoarthritis (OA) is a primary cause of disability in adults. The negative consequences associated with physical inactivity and OA necessitates the need for investigation into methods of prevention and treatment. PURPOSE: To investigate the effects of a resistance training program on muscular strength and ankle-brachial-index (ABI) in an osteoarthritic population. METHODS: Fifteen subjects, 14 females and one male, were randomly assigned to an intervention group (6 females, 1 male, age=67.50 ± 5.13yrs, height=164.69 ± 5.88cm, mass=89.47±19.29kg) or control group (6 females, age=72.10±9.31yrs, height=164.69±5.39cm, mass=81.55±23.42kg). Peak torque/body weight isometric lower extremity muscular strength (hip, knee and ankle) and ABI was measured in all subjects at the start of the study and again 4 weeks later. The intervention group participated in a resistance-training program for the lower extremity three days per week. The control group refrained from any strength training. Both groups participated in twenty minutes of cardiovascular activity during the four week study. RESULTS: No differences were observed between groups (intervention, control) or across time (pre, four weeks) for muscular strength variables, and ABI (p >.05). Trends towards significance was seen with changes in hip abductor strength (p= 0.6) and ABI, knee extensor strength and ABI (p= 0.08). CONCLUSION: The current study suggests that a four-week resistance training program for the lower-body may not be enough to demonstrate significant improvements in muscular strength and ABI. Although there were no significant improvements in lower extremity strength, there did appear to be relationship with strength increases and ABI. Therefore further research should continue to examine strength and potential improvement in vascular function in those with OA.

A pilot study of twice-weekly exercise during hemodialysis in children

Few published studies have assessed the exercise capacity and/or the effect of exercise in children receiving maintenance hemodialysis (HD). The aim of this study was to determine if twice-weekly exercise for 1 h during HD could improve exercise capacity in children receiving HD. We assessed lower extremity strength (Biodex; dominant extension peak torque in 60 degrees per second, Newton-meters), grip strength (dynanometer, kilogram) and 6-min walk capacity (yards) in ten children (median age 13.6 years, range 8-25 years) at baseline and after 3 months of twice weekly exercise for 1 h during HD. Baseline assessment revealed a mean (1) Biodex of 70 +/- 32 N-m/s, (2) 6-m walk test of 589 +/- 90 yards and (3) grip strength of 23.2 +/- 10 kg, which were 50% lower than the normal value for healthy controls. Patients demonstrated significant improvements in lower extremity strength and 6-min walk test after 3 months of exercise. Our data show that twice-weekly exercise of a moderate intensity during HD can lead to exercise capacity improvement in 3 months. We identified barriers to and strategies for the successful implementation of intradialytic exercise. We suggest that intradialytic exercise intervention may be effective to improve exercise capacity in children receiving maintenance HD.

Severe Myelopathy Resulting from Melorheostosis of the Cervicothoracic Spine

Melorheostosis is a rare, noninheritable, benign sclerosing bone dysplasia. The condition was originally described in 1922 by Leri and Joanny1. The disease process is of mesodermal origin, and the minimum prevalence is believed to be 0.9 cases per million2. Melorheostosis typically affects the long bones of the skeleton with the lower extremities being more commonly involved. In addition, the bones of the hand and foot may be involved with the disease process. Involvement of the axial skeleton, especially in Garver isolation, is very rare3. We describe a unique case of a patient who had severe spinal stenosis of the lower cervical and upper thoracic spine due to melorheostosis, resulting in progressive myelopathy. Our patient was notified that data concerning the case would be submitted for publication. Athirty-five-year-old man was evaluated as an outpatient for the subjective complaint of progressive bilateral lower extremity weakness and difficulty with walking. The patient reported that the weakness had started one year prior to presentation and had been progressive in nature with substantial worsening during the previous two months. The patient stated that he was able to walk only one-half block with the assistance of a cane. He also reported difficulty rising from a seated position, with numbness of both lower extremities, and the recent development of urinary frequency. He stated that he had not had any fevers, chills, night sweats, dysuria, or urinary incontinence. The medical history was positive for a diagnosis of fibrous dysplasia due to multiple rib lesions noted on a chest radiograph made twenty years earlier. The patient was not taking any medication and had been participating in physical therapy without any notable improvement in lower extremity strength. On physical examination, the patient was 1.6 m tall and weighed 150 kg. He walked with a …

Symptomatic thoracic vertebral hemangioma: A case report and literature review

Rudnick J, Stern M. Symptomatic thoracic vertebral hemangioma: a case report and literature review. 2004;85:1544–7. Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A man in his early sixties with back pain that had not resolved with conservative treatment was seen in an outpatient physiatrist office. Subsequent workup with computed tomography scan showed a large hemangioma in the T5 vertebra extending to the posterior elements where his pain was located. Three weeks later, the patient had progressive weakness and numbness in his lower extremity. He subsequently underwent a T3–5 laminectomy, with a subtotal resection of the mass. He reported improvement in lower-extremity strength and sensation and completed a course of inpatient rehabilitation. Recognizing when to expect neurologic symptoms and the proper time to intervene can be very critical. From this case study and other similar instances, one can conclude that vertebral hemangiomas are not always benign and are capable of causing cord compression. Proper diagnosis and treatment may prevent the development of neurologic symptoms.

Relationship between lower-extremity joint torque and the risk for falls in a group of community dwelling older adults

This clinical investigation examined 1) the relationship between lower extremity joint torque and risk for falls and 2) the effectiveness of physical therapy intervention in decreasing the risk for falls and increasing lower extremity joint torque in a group of community dwelling older adults. Twenty-two healthy adults (6 males, 16 females) ages 65 and older participated. All participants were given an extensive examination to identify risk for falls and performance on selected measures of balance, strength, and mobility, including muscle performance measured as joint torque using hand-held dynamometry and risk for falls by scores on the Berg Balance Scale (Berg, Wood-Dauphinee, Williams, and Gayton 1989), Functional Reach Test (Duncan, Weiner, Chandler, and Studentski, 1990), and the Timed “Up & Go” Test (Podsiadlo and Richardson, 1991). Participants took part in an exercise program designed to address impairments identified during the initial examination and facilitate improvement in lower extremity strength, flexibility, and balance. The Control group received no intervention, however were encouraged to continue with their normal activities, including exercise. Descriptive statistics, paired t-tests, analyses of variance, and correlational analyses were completed indicating statistically significant differences between subjects classified as Fallers and Non-fallers based on their performance on selected balance and mobility tests and joint torque measurements. Participants classified as Fallers who participated in the physical therapy intervention demonstrated increases in lower extremity joint torque and their performance on the Berg Balance Scale. Physical therapy intervention in the form of an exercise program improved lower extremity joint torque and decreased the risk for falls among the participants in this study identified as having an increased risk for falls.

High dose weekly oral prednisone improves strength in boys with Duchenne muscular dystrophy

Daily prednisone improves strength in boys with Duchenne muscular dystrophy, but side effects are almost universal. We used a different dosing regimen of prednisone to determine if benefit to boys with Duchenne muscular dystrophy might be maintained with fewer side effects. Twice weekly oral prednisone was given each Friday and Saturday (5 mg/kg/dose). This total dose is twice as high as the daily low dosage prednisone regimen (0.75 mg/kg/day). Twenty boys (8.0±1.2 years) were treated. Historical control groups included 18 untreated boys (6.1±1.6 years) and four boys (7.3±0.6 years) treated with daily prednisone. Strength (using a hand-held manometer and grip meter) and timed functional testing were measured. There was an improvement in upper extremity strength for 95% of boys ( n=20) at 6 months using quantitative strength testing. Improvement in lower extremity strength occurred in all boys with antigravity quadriceps strength (17/17). The improvement ( P=0.001 for proximal upper extremities; P=0.002 for grip; and P<0.0001 for proximal lower extremities) was significant compared to untreated boys. Sixteen boys were treated continuously for more than 12 months (22±1.5 months). Of these, 15 remained significantly stronger than prior to treatment and 8/16 showed additional gains in strength after six months of treatment. Six boys were on the weekly prednisolone 2 years or longer without interruption. All six had upper and lower extremity strength at follow-up that was as good or better than at baseline. Functional testing improved in boys less than 8 years without contractures. Three boys without antigravity quadriceps strength at the start of treatment lost the ability to walk unassisted within 6 months. Eight other boys lost the ability to ambulate unassisted between 12 and 24 months of treatment. In each, progressive contractures developed. Linear growth was maintained in all boys on weekly treatment. Obesity rates did not differ from untreated boys. Twice weekly prednisone improved strength over 6–12 months in the majority of boys, but did not slow contracture development. Sustained benefit beyond 12 months is possible with fewer side effects compared to daily prednisone.

Effects of a Group Exercise Program on Risk Factors for Falls in Frail Older Adults

Fifteen community dwelling older adults, ages 66 to 97 years, with at least one risk factor for recurrent falls, attended a thrice weekly group exercise class for 8 weeks. In post- versus preexercise comparisons, knee extensor torque at 0°/sec increased by 16.5% (p= 0.055); time to perform the stand-up test once, and five times consecutively, improved by 29.4 and 27.4%, respectively (p= 0.05,p= 0.01); gait speed for 24 feet increased by 16.5% (p&lt; 0.001); and performance of the progressive Romberg test of balance improved with a mean increase of 1.1 ± 0.9 positions (p= 0.001). Participants reported a significant increase in the mean number of times per week that they went out of their apartment/home independent of exercising, and a significant increase in the mean number of city blocks they could walk. Performance data for nine exercise participants at 1-yr postintervention are presented. A low- to moderate-intensity groups exercise program can effect improvements in lower extremity strength, gait speed, balance, and self-reported mobility function in frail older adults.