Improvements In Functional Mobility Research Articles

Effect of a home-based exercise program on functional mobility and quality of life in elderly people: protocol of a single-blind, randomized controlled trial

BackgroundElderly people have high rates of functional decline, which compromises independence, self-confidence, and quality of life (QoL). Physical exercise leads to significant improvements in strength, balance, functional mobility, and QoL, but there is still reduced access to this therapeutic strategy due to difficulties in locomotion to training centers or lack of adaptation to the exercise environment.Methods/designThe purpose of this clinical trial will be to verify the effect of a progressive and semi-supervised, home-based exercise program on the functional mobility, and in the QoL of sedentary elderly people. This is a protocol of a consecutive, single-center, single-blind, and randomized controlled trial. The design, conduct, and report follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Sedentary elderly people will be enrolled, and randomly allocated into two groups. The intervention group will perform exercises in their own home and the control group will not perform exercises. The evaluations will occur at study enrollment and after 3 months of intervention, and will be performed using the functional mobility Timed Up & Go (TUG) test and sociodemographic and QoL questionnaires. In the statistical analysis, comparisons of mean and correlation analyses will be performed. The primary expected outcome is the improvement in functional mobility verified through the TUG test and the secondary outcome is the improvement in QoL verified by the WHOQOL-OLD.DiscussionThe lack of scientific evidence demonstrating the benefits of semi-supervised home exercise on functional mobility and QoL in elderly people represents an obstacle to the development of guidelines for clinical practice and for policy-makers. The World Health Organization highlighted the importance of musculoskeletal health programs for elderly people, and the exercise program described in this protocol was designed to be viable, easy to implement, and inexpensive, and could be performed at the home of elderly subjects after receiving only guidelines and follow-up via periodic visits. Based on these facts, we hope that this study will demonstrate that a well-structured, home-based exercise program can be effective in improving functional mobility and QoL of sedentary elderly people, even without constant supervision during exercise.Trial registrationRegistro Brasileiro de Ensaios Clínicos (ReBEC), Identifier: RBR-3cqzfy. Registered on 2 December 2016.

Plantar stimulation in parkinsonians: From biomarkers to mobility - randomized-controlled trial.

The decrease of Brain-Derived Neurotrophic Factor (BDNF) serum levels has been related to the pathophysiology of several neurodegenerative diseases as well as to neural plasticity and rehabilitation. Automated Mechanical Peripheral Stimulation (AMPS) has been investigated as a complementary therapy for Parkinson Disease (PD). (1) to investigate the effects of AMPS on BDNF and Cortisol serum levels of subjects with PD; (2) to evidence the interplay between BDNF and Cortisol serum levels and the functional mobility improvement after AMPS treatment. Thirty-three subjects with PD were randomized into two groups: effective stimulation (AMPS, n = 16) or placebo stimulation (AMPS SHAM, n = 17). Fourteen healthy aged-matched subjects were included as a reference group. Each AMPS group received eight sessions of treatment using a commercial medical device (Gondola™). BDNF and Cortisol serum levels, spatiotemporal gait parameters and TUG test were assessed at baseline and after eight sessions of treatment. After the treatment, AMPS group showed significantly higher levels of BDNF and lower levels of Cortisol compared to AMPS SHAM. AMPS group also showed a positive effect on gait pattern as a higher improvement on gait velocity, stride length, and TUG performance was shown. Effective AMPS treatment increased BDNF and decreased Cortisol serum levels and produced improvements in functional mobility.

Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial

Objective: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. Design: A single-blind controlled clinical trial. Setting: University Hospital of Rion, Greece. Subjects: A total of 52 participants following total knee replacement. Outcome measures: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). Intervention: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3–5 sessions/week (35–45 minutes). Results: Consistently greater improvements (F2,98 = 4.3 to 24.8; P < 0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8 ± 2.9 seconds vs. 4.6 ± 2.6 seconds); balance (2.1 ± 0.9° vs. 0.7 ± 1.2°); joint position error (13.8 ± 7.3° vs. 6.2 ± 9.1°); Knee Outcome Survey Activities of Daily Living Scale (44.2 ± 11.3 vs. 26.1 ± 11.4); and pain (5.9 ± 1.3 cm vs. 4.6 ± 1.1 cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3–6.5. Conclusions: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.

Effects of a Novel Microprocessor-Controlled Knee, Kenevo, on the Safety, Mobility, and Satisfaction of Lower-Activity Patients with Transfemoral Amputation

ABSTRACT Introduction Lower-activity persons with transfemoral amputation experience many comorbidities that limit their ability to satisfactorily use prosthetic knees and safely conduct their life activities. Kenevo is a novel microprocessor-controlled knee designed specifically to accommodate the needs of lower-activity individuals with transfemoral amputation. Materials and Methods A prospective observational study was conducted to collect first clinical experiences with Kenevo. Patient-reported measures were conducted to assess patient safety, mobility on level walking, stairs and ramps, as well as preference. In addition, feedback from certified prosthetists/orthotists was collected regarding fitting process, acclimation, and patient benefits. Results A total of 29 persons with amputation were fitted with Kenevo. Most of them had unilateral amputations and belonged to the K2 mobility group. Fitting the Kenevo resulted in a positive trend in the Locomotor Capabilities Index 5, Prosthetic Limb Users Survey of Mobility, and Houghton scores (p &gt; 0.05). Kenevo use resulted in a significant reduction of wheelchair dependence for many subjects. Most subjects reported improvements in level walking during various speeds and on uneven ground as well as when walking and standing on ramps and traversing stairs. More than two-thirds of the subjects reported reduction in necessary concentration and perceived exertion when walking with Kenevo. Fear of falling was reduced in 50% of the subjects, whereas the number of subjects who never fell increased from 45% to 72% (p = 0.161) and those who never stumbled from 8% to 50% (p = 0.044). Finally, 89% of the subjects preferred Kenevo to their previous fitting. Conclusions First routine fittings of the new Kenevo microprocessor-controlled knee suggest that it offers numerous advantages to lower-activity persons with amputation. Improvements in functional mobility and safety were observed. Of the subjects, 89% preferred Kenevo over their previous knee. Higher-quality research is needed to confirm the conclusions reached in this observational study.

Running-induced Functional Mobility Improvement in the Elderly Males is Driven by Enhanced Plasma BDNF Levels and the Modulation of Global Histone H4 Acetylation Status

Background: Emerging evidence point out that exercise is an epigenetic modulator and is able to alter brain-derived neurotrophic factor (BDNF) levels in different populations. However, little is known about the impact of exercise on these markers in well-trained aged individuals, making this research topic particularly relevant. Objectives: Therefore, the current study aimed at investigating the impact of the regular running practice on global histone H4 acetylation and brain–derived neurotrophic factor (BDNF) levels as well as on the functional mobility in healthy elderly males. Methods: Fifteen male volunteers aged 60 years and older were recruited. They were allocated into 2 groups: runners (RUN, n = 8) and sedentary (SED, n = 7), taking into account the question that they were sedentary or amateur street runners. Whole blood samples (15 mL) were collected for the biochemical measurements and the functional mobility assessment was performed through the timed up and go (TUG) test. The biochemical analyses were determined using specific kits, according to the manufacturer’s instructions. Results: The RUN group showed a significant increase in plasma BDNF levels (P = 0.007) and H4 hypoacetylation status (P < 0.001) in peripheral mononuclear cells (PBMCs), compared with the SED individuals. The RUN group also presented significantly lower values in TUG, an indicative of better motor performance (P = 0.02). Conclusions: Collectively, the current study data suggested that the modulation of histone H4 acetylation status might emerge as an important biomarker related to the elderly runners phenotype. The data also supported the idea that the running practice enhances peripheral BDNF levels, which could be linked to the functional mobility improvement in the elderly runners.

Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) Study.

Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity. To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery. The Teen-Longitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (≤19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers. This analysis was conducted in November 2015. Roux-en-Y gastric bypass (n = 161), sleeve gastrectomy (n = 67), or laparoscopic adjustable gastric band (n = 14). Participants completed a 400-m walk test prior to bariatric surgery (n = 206) and at 6 months (n = 195), 12 months (n = 176), and 24 months (n = 149) after surgery. Time to completion, resting heart rate (HR), immediate posttest HR, and HR difference (resting HR minus posttest HR) were measured and musculoskeletal pain concerns, during and after the test, were documented. Data were adjusted for age, sex, race/ethnicity, baseline body mass index (calculated as weight in kilograms divided by height in meters squared), and surgical center (posttest HR and HR difference were further adjusted for changes in time to completion). Of the 206 adolescents with severe obesity included in the study, 156 were female (75.7%), the mean (SD) age was 17.1 (1.6) years, and the mean (SD) body mass index was 51.7 (8.5). Compared with baseline, significant improvements were observed at 6 months for the walk test time to completion (mean, 376 seconds; 95% CI, 365-388 to 347 seconds; 95% CI, 340-358; P < .01), resting HR (mean, 84 beats per minute [bpm]; 95% CI, 82-86 to 74 bpm; 95% CI, 72-76), posttest HR (mean, 128 bpm; 95% CI, 125-131 to 113 bpm; 95% CI, 110-116), and HR difference (mean, 40 bpm; 95% CI, 36-42 to 34 bpm; 95% CI, 31-37). These changes in time to completion, resting HR, and HR difference persisted at 12 months and 24 months. Posttest HR further improved from 6 months to 12 months (mean, 113 bpm; 95% CI, 110-116 to 108 bpm; 95% CI, 105-111). There were statistically significant reductions in musculoskeletal pain concerns at all points. These data provide evidence that bariatric surgery in adolescents with severe obesity is associated with significant improvement in functional mobility and in the reduction of walking-related musculoskeletal pain up to 2 years after surgery.

Adult anti-NMDA receptor encephalitis: Which physical and rehabilitation medicine program? Case reports and literature review

Anti-NMDA (N-Methyl-D-Aspartate) receptor encephalitis (NMDA-E) is the second cause of autoimmune encephalitis in adults. The objectives of this presentation are to describe the main clinical elements and rehabilitation specificities. Three female inpatients (mean age: 25) present with moderate to severe behavioural and/or psychiatric disorders, seizures and presence of associated tumor in one patient. Presence of anti-NMDA antibodies in the cerebrospinal liquid confirmed diagnosis. Rehabilitation was focused on cognitive and behavioural remediation, dysphagia rehabilitation (2 patients) and on functional mobility improvement and regular psychiatric assessment. Functional outcome was satisfactory. Return to previous activities (high school and college) was obtained for 2 cases, respectively at 22 and 6 months of evolution. Four cases with description of rehabilitation procedures are found in literature: 3 women (mean age: 25) benefit from specific rehabilitation program (physiotherapy, neuropsychology, and speech therapy) with medium-term improvement; and 1 young girl, with physical reconditioning and neuropsychology sessions, allowing return to high school with specific adaptations. Main features for E-NMDA rehabilitation combine neurocognitive and behavioral support. Regular psychiatric monitoring is necessary. Though functional prognosis is good, return to previous activities isn’t systematic.

Effect of whole body vibration training on gait function and activities of daily living in children with cerebral palsy

Aim: The aim of this study was to examine the effects of whole body vibration (WBV) training and conventional physical therapy on spatiotemporal gait parameters, functional mobility and activities of daily living (ADL) in children with cerebral palsy (CP). Methods: A pretest–posttest control group design was used. In this 3-week trial, 24 children with spastic CP were randomly selected to either continue their physical therapy or to receive WBV in addition to their physical therapy programme. Gait analyses, the Timed Up and Go (TUG) test and the Functional Independence Measure for Children (WeeFIM) were conducted before and after training. Results: For spatiotemporal gait parameters, this study found statistically significant differences in the WBV group's walking speed (p = 0.002), step length of the affected side (p = 0.021) and step width (p = 0.007) pre- and post-training. Between the two groups, there was a statistically significant difference in step width (F = 5.326, p = 0.031) and significant improvements in the WBV group's TUG scores (p = 0.039) compared with the control group. According to the results of WeeFIM, there were no significant differences between the two groups after training. Conclusions: Administration of WBV training to children with CP in conjunction with conventional physical therapy leads to improvements in functional mobility.

Evaluating Physical Therapist Students’ Clinical Performance in Acute Care: A Retrospective Analysis Comparing Student-Treated and Staff-Treated Patient Outcomes After Total Knee Arthroplasty

Introduction. The ultimate goal and primary responsibility of physical therapist (PT) education is to produce graduates who can function as competent practitioners. However, clinical effectiveness and efficiency of patient care provided by PT students are not well established. Subjects/Methods. We identified 160 patients who received primary unilateral total knee arthroplasty at a single acute care hospital in the Midwest between March 2009 and August 2010. Next, we used a retrospective cohort design to compare the outcomes for those treated by licensed PTs and physical therapist assistants (PTAs) (n = 80) to those treated by PT students (n = 80) in a collaborative clinical education model. Outcomes. Primary outcomes were the improvement in functional mobility at discharge as measured by the Functional Outcome Measure (FOM), and improvement of the provider's efficiency as measured by the change in FOM score from initial visit to final visit in relation to the number of therapy visits. Results: There were no significant differences between the functional gains achieved by each group (P = .955) or in provider efficiency (P = .594). Discussion and Conclusion: In the acute care setting, functional outcomes following primary total knee arthroplasty were similar for patients, whether treated by the physical therapy staff or PT students in a collaborative clinical education model. These results need confirmation with prospective randomized studies.

Treatment of vertebral body compression fractures using percutaneous kyphoplasty guided by a combination of computed tomography and C-arm fluoroscopy with finger-touch guidance to determine the needle entry point.

This study aimed to evaluate the results and complications of image-guided percutaneous kyphoplasty (PKP) using computed tomography (CT) and C-arm fluoroscopy, with finger-touch guidance to determine the needle entry point. Of the 86 patients (106 PKP) examined, 56 were treated for osteoporotic vertebral compression fractures and 30 for vertebral tumors. All patients underwent image-guided treatment using CT and conventional fluoroscopy, with finger-touch identification of a puncture point within a small incision (1.5 to 2 cm). Partial or complete pain relief was achieved in 98% of patients within 24 h of treatment. Moreover, a significant improvement in functional mobility and reduction in analgesic use was observed. CT allowed the detection of cement leakage in 20.7% of the interventions. No bone cement leakages with neurologic symptoms were noted. All work channels were made only once, and bone cement was distributed near the center of the vertebral body. Our study confirms the efficacy of PKP treatment in osteoporotic and oncological patients. The combination of CT and C-arm fluoroscopy with finger-touch guidance reduces the risk of complications compared with conventional fluoroscopy alone, facilitates the detection of minor cement leakage, improves the operative procedure, and results in a favorable bone cement distribution.

Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis.

BackgroundThe utility of acupuncture in managing osteoarthritis symptoms is uncertain. Trial results are conflicting and previous systematic reviews may have overestimated the benefits of acupuncture.MethodsTwo reviewers independently identified randomized controlled trials (up to May 2014) from multiple electronic sources (including PubMed/Medline, EMBASE, and CENTRAL) and reference lists of relevant articles, extracted data and assessed risk of bias (Cochrane’s Risk of Bias tool). Pooled data are expressed as mean differences (MD), with 95% confidence intervals (CI) (random-effects model).ResultsWe included 12 trials (1763 participants) comparing acupuncture to sham acupuncture, no treatment or usual care. We adjudicated most trials to be unclear (64%) or high (9%) risk of bias. Acupuncture use was associated with significant reductions in pain intensity (MD -0.29, 95% CI -0.55 to -0.02, I2 0%, 10 trials, 1699 participants), functional mobility (standardized MD -0.34, 95% CI -0.55 to -0.14, I2 70%, 9 trials, 1543 participants), health-related quality of life (standardized MD -0.36, 95% CI -0.58 to -0.14, I2 50%, 3 trials, 958 participants). Subgroup analysis of pain intensity by intervention duration suggested greater pain intensity reduction with intervention periods greater than 4 weeks (MD -0.38, 95% CI -0.69 to -0.06, I2 0%, 6 trials, 1239 participants).ConclusionsThe use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis.Systematic review registrationCRD42013005405.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6882-14-312) contains supplementary material, which is available to authorized users.

Rivastigmine Transdermal Patch and Physical Exercises for Alzheimer’s Disease: A Randomized Clinical Trial

To determine the effects of rivastigmine patch associated with physical exercise versus rivastigmine patch alone in quality of life (QOL), cognition, activities of daily living (ADL) and functional mobility in Alzheimer's disease (AD)subjects. A randomized, controlled, single-blinded trial was conducted in 40 patients with mild to moderate stages of AD. All patients were daily treated with rivastigmine transdermal patch at a stable dose of 4.6 mg and randomized into two groups: physical exercises or control. The exercise program consisted of aerobic, flexibility, strength and balance movements, twice a week for 6 months. Main outcomes were Quality of Life in Alzheimer's disease scale (QOL), Activities of Daily Living Questionnaire (ADL), Mini-Mental State Examination (MMSE) and "Time Up and Go Test". Thirty-four patients completed the study. After 6 months, there was a significant improvement in QOL of patients randomized to physical exercise group (P< 0.05). In both groups, there was an improvement on caregivers QOL (P>0.05). When considering cognitive functions, there was no difference between groups. The ability to perform ADL worsened in the group enrolled to RTP alone. There was an improvement in functional mobility in the group treated with RTP. Our results suggest that the association between physical exercises and RTP improves QOL in patients with AD. Cognition remained unchanged in both groups. Regarding the effect of physical exercises in ADL, further trials are necessary to confirm these results.

Evaluation of exercise training on work capacity, functional mobility, and quality of life in hemodialysis patients

IntroductionPatients with chronic renal failure are restricted in their physical and social aspects of life because of their treatment and comorbid medical conditions.Aim of the workThe aim of this study was to evaluate the effect of an exercise training program on functional work capacity, functional mobility, and quality of life (QOL) in patients with renal failure on hemodialysis.Patients and methodsThirty patients with chronic renal failure on maintenance hemodialysis participated in a regular exercise training program three times/week for 12 weeks. Each exercise session consisted of a warm up, cycle or trade mill exercises, stretching exercise, and cool down. All patients were subjected to a cardiovascular graded exercise tolerance test, the sit-to-stand-to sit test, and the 6-min walk test. A questionnaire was used to assess the QOL of the study group 1 week before and after the exercise training program. Fifteen normal individuals, age and sex matched with our patients, were used as controls to compare the respiratory function.ResultsThere was a significant improvement in work capacity before and after the training exercise program, respectively (7.24 ± 0.90 to 9.62 ± 1.1; P < 0.001); also, there was a highly significant improvement in functional mobility. The QOL had improved after the exercise training program on four of five scales of the 36 questionnaire.ConclusionA suitable exercise training program is essential for improvement of work capacity and mobility, and improvement of psychological status and QOL.

Does a torsion adapter improve functional mobility, pain, and fatigue in patients with transtibial amputation?

Turning gait is an integral part of daily ambulation and likely poses a greater challenge for patients with transtibial amputation compared with walking a straight pathway. A torsion adapter is a prosthetic component that can increase transverse plane compliance of the prosthesis and decrease the torque applied to the residual limb, but whether this will improve patients' mobility, pain, and fatigue remains unknown. Does prescription of a torsion adapter translate to improvements in (1) functional mobility and (2) self-perceived pain and fatigue in moderately active patients with lower limb amputation? Ten unilateral transtibial amputees wore a torsion or rigid adapter in random order. Functional mobility was assessed through a field measurement using an activity monitor and through a laboratory measurement using a 6-minute walk test that included turns. The residual limb pain grade assessed self-perceived pain and the Multidimensional Fatigue Inventory assessed fatigue. We found relatively small functional differences for amputees wearing a torsion adapter versus a rigid adapter. Amputees wearing a torsion adapter tended to take more low- and medium-intensity steps per day (331 ± 365 and 437 ± 511 difference in steps; effect size = 0.44 and 0.17; confidence interval [CI], 70-592 and 71-802; p = 0.019 and 0.024, respectively). They also experienced less pain interference with activities (1.9 ± 1.7 change in score; effect size = 0.83; CI, 0.3-3.4; p = 0.026) when wearing a torsion adapter. However, these patients took a similar number of total steps per day, walked a comparable distance in 6 minutes, and reported similar residual limb pain and fatigue. For a moderately active group of amputees, the torsion adapter did not translate to substantial improvements in functional mobility and self-perceived pain and fatigue. The small increases in low- and medium-intensity activities with less pain interference when wearing a torsion adapter provides evidence to support prescribing this device for amputees with difficulty navigating the household and community environments.

Short-term Effects of Whole-Body Vibration on Functional Mobility and Flexibility in Healthy, Older Adults

Whole-body vibration (WBV) training is a relatively new approach for enhancing muscle strength, physical performance, and flexibility. The aim of this study was to examine whether short-term WBV training by using the triple-plane vertical vibration device (ie, acceleration training [AT]) improves functional mobility and flexibility in healthy, older adults. Eighteen healthy, older adults (9 men and 9 women; mean age 69.1 years; standard deviation, 2.5 years) participated in this randomized, crossover study. Two static stretching positions, half-squatting and hamstrings stretching, were performed with (AT) and without (control [Con]) vibration stimulus (frequency, 40 Hz; amplitude, 2-4 mm). The intervention consisted of stretching for 30 seconds per set × 3 sets per position, alternating between the 2 stretching positions. The Timed Up and Go (TUG) test was measured to determine functional mobility, which is closely linked to lower extremity muscle function. Sit-and-Reach and Functional Reach tests were performed to evaluate flexibility. Only the TUG test demonstrated a significant time × intervention interaction: TUG test results improved significantly immediately and 30 minutes after the AT but not after the Con intervention. We found significant main effects of time on the Sit-and-Reach and Functional Reach results. Furthermore, the improvement rates after the AT intervention were greater than the improvement rates after the Con intervention at the immediate and 30-minute posttests. Short-term WBV training by using the triple-plane vertical vibration device elicited a significantly larger improvement in functional mobility than training without WBV. The effect on flexibility was similar with and without vibration stimulus, but there was a greater tendency to improve with WBV training in healthy, older adults. In addition, these short-term effects were maintained for about 30 minutes.

Application of TENS on Acupoints as an Important Adjunctive Tool with Task-Related Training in Stroke Rehabilitation Program- A Case Study

Stroke is an important cause of disability and there is no generally accepted method for rehabilitation of stroke survivors. Repeated practice of motor activity will enhance the sensory-motor cortex activity and the TENS is the one way to maximize that sensory input in stroke patients. A 53 year old female was the subject of this case study, who had walking impairment and spasticity in right lower limb. The treatment included 6 weeks of intervention in which TENS was applied over 4 acupoints followed by TRT exercise protocol. Before and after intervention, spasticity was measured by MAS; functional mobility was measured by TUG test and DGI. The findings of this case study showed that there was reduction in spasticity by application of TENS along with TRT and relative improvement in functional mobility up to follow-up.

Applications of yoga in Parkinson&amp;#39;s disease: a systematic literature review

Applications of yoga in Parkinson&#39;s disease: a systematic literature review Kaitlyn P RolandCentre on Aging, University of Victoria, Victoria, BC, CanadaBackground: Yoga may be applicable to persons with Parkinson&#39;s disease (PD). The adaptability of yoga to suit varying abilities is of significance to the PD population with its progressive mobility problems. The additional psychosocial benefits of yoga are important to the quality of life. This systematic review presents scientific evidence pertaining to the impact of yoga on physical function and psychological well-being in PD.Methods: A literature search was conducted for randomized controlled trials (n=1), pretest&ndash;post-test design (n=3), and case studies (n=3) with the terms &ldquo;yoga&rdquo; and &ldquo;Parkinson disease&rdquo;. The study quality was assessed with a modified version of the Downs and Black Checklist and ranged from 8 to 16. The study outcomes included functional mobility (n=6), flexibility (n=4), balance (n=4), strength (n=4), depression (n=2), sleep (n=1), and quality of life (n=1).Results: The preliminary data suggested that yoga resulted in modest improvements in functional mobility, balance, and lower-limb strength in persons with PD. This has implications for gait, postural stability, balance confidence, and functional declines related to inactivity. An improved upper- and lower-body flexibility following yoga in persons with PD is applicable to rigidity, shuffling gait, and flexed posture. The presented evidence also showed positive outcomes for mood and sleep, demonstrating yoga&#39;s benefit for self-efficacy and social support.Conclusion: This review suggests that yoga provided an alternative method for addressing some of the reversible factors that impact motor function in PD, as well as contributing to an improved psychosocial well-being. However, limitations to the design of the studies necessitate further research to validate yoga as a therapy for PD.Keywords: alternative therapy, adaptable, mobility, mood, quality of life, neurological disorders

Evaluation of the effect of exercise training program on work capacity, functional mobility, and quality of life in hemodialysis patients

Patients with chronic renal failure are restricted in physical and social dimensions of life because of their treatment and their comorbid medical conditions. The aim of this study was to evaluate the effect of exercise training programs on functional work capacity, functional mobility, and quality of life in patients with renal failure on hemodialysis. Thirty patients with chronic renal failure on maintenance hemodialysis participated in a regular exercise training program three times per week for 12 weeks. Each exercise session consisted of warm up, cycle or treadmill exercises, stretching exercises, and cool down. All patients underwent the cardiovascular graded exercise tolerance test, the sit-to-stand-to-sit test, and the 6-min walk test. Questionnaires were used to assess the quality of life of the study group 1 week before and after the exercise training program. A total of 15 normal individuals who were age-matched and sex-matched with our patients were used as controls to compare the respiratory function. There was significant improvement in work capacity after the training exercise program compared with that before the program (from 7.24 ± 0.90 to 9.62 ± 1.1; P < 0.001); in addition, there was also a highly significant improvement in functional mobility. The quality of life was improved after the exercise training program according to four of five scales of 36 questionnaires. A suitable exercise training program is an important method for improvement of work capacity, mobility, psychological status, and quality of life.

Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: A randomized controlled trial

Knee pain is a common health problem in the elderly population, for which non-invasive treatments are recommended as a first line treatment in the management of knee pain. A randomized controlled trial was conducted to determine the effects of exercise with or without thermal therapy in community-dwelling elderly women with chronic knee pain. Women over 75 years of age with knee pain (n=150) were randomly assigned into four groups; exercise (Ex) and heat/steam generating sheet (HSGS) (n=38), Ex (n=37), HSGS (n=38), or health education (HE) (n=37). The Ex group attended a 60-min comprehensive training program twice a week for 3-months. The HSGS group placed two sheets on the knee for five hours per day. Functional fitness, visual analog scale (VAS), and Japanese knee osteoarthritis measure (JKOM) were assessed at baseline and post-intervention. The results showed VAS improvements in the Ex+HSGS and HSGS groups. Total JKOM score, muscle strength, and functional mobility significantly improved in the Ex+HSGS group compared with the HE group. The odds ratio (OR) for VAS and functional mobility improvement was more than eight times as great in the Ex+HSGS group (OR=8.60, 95% confidence interval (CI)=2.82–32.73) compared with the education group. Ex or HSGS alone were insufficient in enhancing functional fitness or improving pain and quality of life. The combined effects of both Ex and heat therapy seems to have an added benefit of decreasing pain, improving physical function and increasing quality of life. Trial Registration Number: JMA-IIA00110.

Randomized Controlled Trial of Surface Peroneal Nerve Stimulation for Motor Relearning in Lower Limb Hemiparesis

ObjectiveTo compare the motor relearning effect of a surface peroneal nerve stimulator (PNS) versus usual care on lower limb motor impairment, activity limitation, and quality of life among chronic stroke survivors. DesignSingle-blinded randomized controlled trial. SettingTeaching hospital of academic medical center. ParticipantsChronic stroke survivors (N=110; >12wk poststroke) with unilateral hemiparesis and dorsiflexion strength of ≤4/5 on the Medical Research Council scale. InterventionsSubjects were stratified by motor impairment level and then randomly assigned to ambulation training with either a surface PNS device or usual care (ankle-foot orthosis or no device) intervention. Subjects were treated for 12 weeks and followed up for 6 months posttreatment. Main Outcome MeasuresLower limb portion of the Fugl-Meyer (FM) Assessment (motor impairment), the modified Emory Functional Ambulation Profile (mEFAP) performed without a device (functional ambulation), and the Stroke Specific Quality of Life (SSQOL) scale. ResultsThere was no significant treatment group main effect or treatment group by time interaction effect on FM, mEFAP, or SSQOL raw scores (P>.05). The time effect was significant for the 3 raw scores (P<.05). However, when comparing average change scores from baseline (t1) to end of treatment (t2, 12wk), and at 12 weeks (t3) and 24 weeks (t4) after end of treatment, significant differences were noted only for the mEFAP and SSQOL scores. The change in the average scores for both mEFAP and SSQOL occurred between t1 and t2, followed by relative stability thereafter. ConclusionsThere was no evidence of a motor relearning effect on lower limb motor impairment in either the PNS or usual-care groups. However, both the PNS and usual-care groups demonstrated significant improvements in functional mobility and quality of life during the treatment period, which were maintained at 6-month follow-up.