Neurologic Physical Therapy Research Articles

신경계물리치료에서의 근거중심실기(1) -임상의사결정과정에 EBP 적용하기-

신경계물리치료에서의 근거중심실기(1) -임상의사결정과정에 EBP 적용하기-

Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force

Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force

The Academy of Neurologic Physical Therapy's Educational Plan

The Academy of Neurologic Physical Therapy's Educational Plan

JNPT Congratulates Academy of Neurologic Physical Therapy Members Honored With APTA Awards

JNPT Congratulates Academy of Neurologic Physical Therapy Members Honored With APTA Awards

Treatment for Vestibular Disorders: How Does Your Physical Therapist Treat Dizziness Related to Vestibular Problems?

Dizziness is very common, but it is never normal. Dizziness can make performing daily activities, work, and walking difficult. Many people get dizzy when they turn their head, which can cause problems with walking and makes people more likely to fall. Most of the time dizziness is not from a life-threatening disease. Often dizziness is because of a disorder of the vestibular (or inner ear balance) system. People can get vestibular disorders from infections in the ear, problems with the immune system, medications that harm the inner ear, and rarely from diabetes or stroke because of a lack of blood flow to the inner ear. Stress, poor sleep, migraines, overdoing some activities, and feeling sad can increase symptoms. New guidelines for the treatment of vestibular disorders were published in the April 2016 issue of the Journal of Neurologic Physical Therapy. The guideline describes which exercises are best to treat the dizziness and balance problems commonly seen with an inner ear disorder. NEW INSIGHTS Early treatment may help people to get better faster. Treatments focus on eye and head exercises plus balance exercises to help relieve dizziness and improve the ability to walk without losing balance. A physical therapist will tailor these treatments to your specific problems on the basis of a complete examination. PRACTICAL ADVICE For people with inner ear dizziness, their dizziness may get better even without treatment. For some people, their dizziness does not get better unless they are given exercises for their dizziness and balance problems. Staying active is very important and moving your head, even if it makes you dizzy, is one of the best ways to recover from your inner ear problem. Medicine is not usually needed; however, if your dizziness is very bad, your physical therapist may work with your doctor to try to make your symptoms better with medicine so you can continue doing the exercises. On the basis of your diagnosis, your best treatment may include eye and head exercises, walking exercises, balance exercises, and education about your dizziness problem. Exercises are progressed as you improve so that you are less dizzy when you sit still and also when you move around. Physical therapists are trained to customize your exercises for best recovery. For more information about the treatment of inner ear dizziness, contact a physical therapist who specializes in inner ear problems. INNER EAR TREATMENTS Evidence suggests that early treatment of inner ear problems is helpful in decreasing dizziness. Not all inner ear problems are the same and so not everyone will do every exercise. Your physical therapist will determine which exercises will help you the most on the basis of your dizziness and/or balance concerns. Figure 1 shows an example of a common exercise that might be prescribed for dizziness and imbalance as a result of your inner ear disorder.FIGURE 1: If you lose your balance in the dark or on uneven surfaces then you might do exercises that involve standing on a foam pad with your feet in different positions.This JNPT Perspectives for Patients is based on an article by Hall CD et al, titled “Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline” (J Neurol Phys Ther 2016) and was written by Courtney Hall, Susan Herdman, and Susan Whitney and illustrated by Maverick Dunavan.

Knowledge Translation

Knowledge Translation

Proposal to Change the Neurology Section's Name to the Academy of Neurologic Physical Therapy.

Proposal to Change the Neurology Section's Name to the Academy of Neurologic Physical Therapy.

Cerebral Palsy in Children as a Risk Factor for Malnutrition

Aim: The main aim of this study was to determine some malnutrition risk factors among children with cerebral palsy (CP). Children with CP often require the assistance of physical therapy centers. Experience suggests that, apart from physical disabilities, this group often suffers from malnutrition. Methods: Data were gathered in the hospital among 128 children aged 3-18 years who were suffering from CP. The children were admitted from 2011 to 2013 to the Center for Neurological Physical Therapy for children in the Regional Hospital No. 2. St. Queen Jadwiga in Rzeszow (RORE). Statistical analyses were conducted for data on gender, age, type of CP, motor function level according to Gross Motor Function Classification Scale (GMFCS), body mass index (BMI) and hemoglobin levels in blood. Results: The risk of anemia differs based on gender - the risk is 6 times greater among boys than among girls (p = 0.0398). Risk of malnutrition is 3.5 times higher in children with tetraplegia than in children with diplegia or hemiplegia (p = 0.0043). Higher GMFCS scores are connected to greater proportions of malnourished children (for BMI z-score <-1.64, p = 0.0010). Conclusions: Among children with CP, malnourishment risk factors are male gender for anemia and tetraplegia and high GMFCS values.

Dual task training as a therapeutic strategy in neurologic physical therapy: a literature review

Discuss the possibilities of in the ambit of neurological rehabilitation. Methods: A survey was conducted in PUBMED, MEDLINE, LILACS, and PEDro, using the keywords dual task associated with each of the following terms separately: treatment, physical therapy, rehabilitation, exercise, training, divided attention, executive functions, and attentional demands. We selected only clinical trials that used training in adults with neurological disease. Results: From the 2,024 articles found, 1,017 were excluded because they are duplicate. Among the remaining 1,007 articles, 998 were excluded after reviewing the abstracts. Nine articles were selected that included patients with stroke, brain injuries, Alzheimer's, and Parkinson's disease. Most articles used gait as the primary task, and in six studies the second was cognitive. The training programs ranged between a total of 9 and 48 hours of training. Conclusion: Dual training appears to improve gait, cognition, automation skills, and transference of learning, suggesting that this may be a valuable strategy for neurological rehabilitation. Nevertheless, it is still necessary to explain which tasks are more efficient and how long the learning retention lasts.

GBS following Tumour Excision: Physiotherapy Management

This case report discusses the clinical presentation of a 70 year old male developing pure motor paraplegia with bladder and bowel incontinence, following a tumour removal surgery of buccal mucosa carcinoma. The clinical presentation was a less commonly seen variant of GBS and the diagnosis was confirmed on electro-physiology. The case summary highlights the chief findings of neurological examination, investigations, medical and physical therapy management of the patient. The physical therapy assessment and the exercises progressed over the 6-month period are mentioned in detail. Physiotherapy management of GBS during the acute stage focuses on respiratory care, and preventing complications like muscle atrophy, contractures, pressure sores through passive movements, positioning, splinting etc. Later in the recovery phase emphasis is on progressive strengthening of muscles, improving functional outcome and building up patient’s endurance. Individual with incomplete recovery may benefit from orthotic support, gait aids and other assistive devices.

The effect of a rehabilitational sliding machine and conventional neurological physical therapy on the balance of patients with hemiplegia.

[Purpose] The purpose of this study was to investigate the effects of exercise using a rehabilitational sliding machine and conventional neurological physical therapy on the balance of stroke patients. [Subjects] Forty patients with hemiplegia resulting from stroke were divided into a rehabilitational sliding machine exercise group (ST group, n=20) and a conventional neurological physiotherapy group (C group, n=20). [Methods] The STG underwent training with a rehabilitation sliding machine for 30 minutes per day, five times per week for eight weeks. The CG underwent training with a conventional neurological physiotherapy for 30 minutes per day, five times per week for eight weeks. [Results] The balance ability of both groups significantly improved. Although there were significant differences between the groups, the CG showed weight bearing on the affected side, an anterior range within the stability limits standing, and a posterior range within the stability limits standing. [Conclusion] The results of this study suggest that conventional neurological physiotherapy is a more dedicated, effective intervention than rehabilitational sliding training methods.

Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy.

[Purpose] The purpose of the study was to evaluate the effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy. [Subjects] Sixteen children (9 males, 7 females) with spastic diplegic cerebral palsy were recruited and randomly assigned to the conventional neurological physical therapy group (CG) and virtual reality training group (VRG). [Methods] Eight children in the control group performed 45 minutes of therapeutic exercise twice a week for eight weeks. In the experimental group, the other eight children performed 30 minutes of therapeutic exercise and 15 minutes of a training program using virtual reality twice a week during the experimental period. [Results] After eight weeks of the training program, there were significant differences in eye-hand coordination and visual motor speed in the comparison of the virtual reality training group with the conventional neurological physical therapy group. [Conclusion] We conclude that a well-designed training program using virtual reality can improve eye-hand coordination in children with cerebral palsy.

Efficacy of electrical stimulation as an adjunct to repetitive task practice therapy on skilled hand performance in hemiparetic stroke patients: a randomized controlled trial

Objective: To assess the effects of additional electrical stimulation to hand muscles combined with repetitive task practice therapy on skilled hand performance in stroke patients. Design: A randomized controlled study. Setting: Neurological physical therapy outpatient clinic. Subjects: Forty stroke patients of both sexes (45-65 years - 16 females and 24 males). Methods: Participants were randomly assigned into two equal groups: experimental and control groups. All patients received repetitive task practice. Those in the experimental group received additional electrical stimulation for specific hand muscles and patients in the control group received sham electrical stimulation. Treatment was provided three times/week for two months. Main outcome measures: Patients received baseline and post-treatment assessments using three-dimensional motion analysis (to evaluate range of motion of fingers abduction and extension), motor assessment scale (to assess hand motor function) and time to complete Jebsen Taylor Test (to assess hand skills). Results: Patients in the experimental group showed a significant improvement as compared with those in the control group. Motor assessment scale score was 4.25±0.63 for the experimental group and 3.35±0.74 for the control group (t=-3.50 and p= 0.0001). Time to complete Jebsen Taylor Test was 180.90±7.04 for the experimental group and 192.80±6.87 for the control group (t=4.50 and p= 0.0001). There was a significant improvement in fingers abduction and extension in both groups (in favor to the experimental group). Conclusion: Repetitive task practice therapy combined with electrical stimulation can improve skilled hand performance in terms of hand motor function, skills and range of motion in stroke patients.

Informações Somatossensoriais nos Processos da Prática Mental na Fisioterapia Neurofuncional: Estudo de Revisão

Introduction. The aims was to discuss the role of somatosensory in­formation which contributes to motor development learning, as well as its retention in the task-functions of neurological physical therapy using the mental practice as a therapeutic modality for cerebral cortex sequel. Mental practice can be defined as mental simulation of a task in order to aim functionality through the processes of motor learning, memory and motor control. The strategies of this technique is move­ment idealization that contributesto the activation of neuromotor paths; hence in the somatosensorial cortex there are areas which inter­act to identify the space that we wish to move ourselves, plan and take actions; therefore we could minimize the functional losses increasing the life quality of those individuals who suffered neurological damage which are receptive to motor recovery. Method. We analysedt books and articles references in the last ten years, from the database Medline, Scielo and Lilacs, either in Portuguese or English. Results. The results showed that the use of mental practice as a complementary resource in neurological rehabilitation. Conclusion. The mental practice is ef­ficient in activation of neuromotor paths, nevertheless to have its ap­plication in neurologic physical therapy will be unavoidable necessary to identify the lesion as a conditional factor to therapeutical modality.

Examining the Use of Constraint-Induced Movement Therapy in Canadian Neurological Occupational and Physical Therapy

To investigate the use of constraint-induced movement therapy (CIMT) in Canadian neurological occupational and physical therapy. An online survey was completed by occupational and physical therapists practising in Canadian adult neurological rehabilitation. We measured participants' practices, perceptions, and opinions in relation to their use of CIMT in clinical practice. A total of 338 surveys were returned for a 13% response rate; 92% of respondents knew of CIMT, and 43% reported using it. The majority (88%) of respondents using CIMT employed a non-traditional protocol. Self-rating of level of CIMT knowledge was found to be a significant predictor of CIMT use (p≤0.001). Commonly identified barriers to use included "patients having cognitive challenges that prohibit use of this treatment" and "lack of knowledge regarding treatment." Although the majority of respondents knew about CIMT, less than half reported using it. Barriers to CIMT use include lack of knowledge about the treatment and institutional resources to support its use. Identifying and addressing barriers to CIMT use-for example, by using continuing professional education to remediate knowledge gaps or developing new protocols that require fewer institutional resources-can help improve the feasibility of CIMT, and thus promote its clinical application.

Clinical Trial Registration in Physical Therapy Journals: A Cross-Sectional Study

Clinical trial registration has become an important part of editorial policies of various biomedical journals, including a few physical therapy journals. However, the extent to which editorial boards enforce the need for trial registration varies across journals. The purpose of this study was to identify editorial policies and reporting of trial registration details in MEDLINE-indexed English-language physical therapy journals. This study was carried out using a cross-sectional design. Editorial policies on trial registration of MEDLINE-indexed member journals of the International Society of Physiotherapy Journal Editors (ISPJE) (Journal of Geriatric Physical Therapy, Journal of Hand Therapy, Journal of Neurologic Physical Therapy, Journal of Orthopaedic and Sports Physical Therapy, Journal of Physiotherapy [formerly Australian Journal of Physiotherapy], Journal of Science and Medicine in Sport, Manual Therapy, Physical Therapy, Physical Therapy in Sport, Physiotherapy, Physiotherapy Research International, Physiotherapy Theory and Practice, and Revista Brasileira de Fisioterapia) were reviewed in April 2013. Full texts of reports of clinical trials published in these journals between January 1, 2008, and December 31, 2012, were independently assessed for information on trial registration. Among the 13 journals, 8 recommended trial registration, and 6 emphasized prospective trial registration. As of April 2013, 4,618 articles were published between January 2008 and December 2012, of which 9% (417) were clinical trials and 29% (121/417) of these reported trial registration details. A positive trend in reporting of trial registration was observed from 2008 to 2012. The study was limited to MEDLINE-indexed ISPJE member journals. Editorial policies on trial registration of physical therapy journals and a rising trend toward reporting of trial registration details indicate a positive momentum toward trial registration. Physical therapy journal editors need to show greater commitment to prospective trial registration to make it a rule rather than an option.

On the Front Lines But Not Engaged in the Battle

Physical inactivity and its related health conditions have reached pandemic proportions.1 Because of its greater prevalence, inactivity in the general population now may account for more disease burden and mortality than smoking.2,3 In persons with neurologic health conditions, physical inactivity and its inherent risks are often compounded by physical and/or cognitive impairments that limit balance and mobility. Indeed, the statistics are alarming regarding the extent of inactivity and the sequelae of immobility in persons with neurologic deficits.4–7 In 2005, the US Department of Health and Human Services issued “The Surgeon General's Call to Action to Improve Health and Wellness in Persons with Disabilities.” This call to action challenges health care providers to forge partnerships to provide more effective treatment, better education of future providers, and the implementation of health promotion programs.8,9 Although barriers to implementing such programs certainly exist, the neurologic physical therapy community has been too passive on this issue. Ironically, neurologic physical therapists are on the front lines of the battle to promote physical activity and exercise. Physical therapists are trained to understand that sedentary behavior is not an inevitable consequence of most neurologic conditions.10 Physical therapists are uniquely positioned to intervene at the primary and secondary prevention levels in those living with neurologic conditions.11 Unfortunately, the majority of our care is delivered in response to the onset of disability rather than in an effort to prevent it. Many of our clients are discharged from insurance-reimbursed care and left to fend for themselves in search for health, reduction of disability, and options for physical activity and exercise. Rather than leading the charge to answer the Surgeon General's call, the physical therapy community appears willing to tacitly accept as inevitable the pervasiveness of the sedentary lifestyle due to neurologic dysfunction and its deleterious consequences. Our commitment to these individuals is incomplete unless we directly provide or advocate for access to prevention and wellness care. This special topic issue of the Journal of Neurologic Physical Therapy was designed to illustrate ongoing efforts to raise our standard of prevention and wellness care. Rimmer and Yamamato outline a plan for the prevention of postrehabilitation health decline in acquired neurologic conditions (cerebrovascular accident, traumatic brain injury, or spinal cord injury) through efforts to minimize extrinsic barriers to prevention and wellness programs. To provide an explicit example of the implementation of such a wellness program poststroke, Rose and colleagues outline their partnership with the community in delivering secondary prevention services. Ellis and Motl use Parkinson disease and Multiple Sclerosis as the context for addressing intrinsic barriers to participation, such as self-efficacy and outcomes expectations. As part of this discussion, they outline novel ways of encouraging participation through virtual coaches and online support. Mulligan and colleagues provide an explicit example of partnership with persons with Multiple Sclerosis to deliver interventions designed to minimize barriers to physical activity. The remaining two articles provide explicit examples of clinical application. Rather than focus just on mobility outcomes, in a case series of persons with Parkinson disease, Tabak and colleagues outline the potential cognitive benefits of consistent exercise. Finally, Sasso and colleagues provide an example of the successful application of efficacious interventions to a home program for an individual with a long-standing spinal cord injury. It is our hope that this special topic issue will motivate readers to consider their role in prevention and wellness in neurologic physical therapy. As stated previously, there are substantial barriers to the regular provision of prevention and wellness services to our clients. However, these barriers also represent a spectrum of opportunities for contributing to the solution. Physical therapists should be engaged in determining policy, in community advocacy with stakeholders, and in the provision of resources, infrastructure, and expertise to persons with neurologic disability in the community.11

An update on brain plasticity for physical therapists

The understanding that the human brain is capable of structural and functional change throughout life has significant implications for the future of physical therapy. Cortical plasticity impacts on many areas of physical therapy including clinical practice, research and education. Although the principles of plasticity underpin developments in neurological physical therapy, relevance to musculoskeletal physical therapy is still emerging. How will key areas of musculoskeletal physical therapy change as our understanding of plasticity advances? If cortical plasticity can be harnessed, new plasticity-based therapies, that enhance performance in healthy individuals and improve pain and function in patient populations, have the potential to become the cornerstone of musculoskeletal physical therapy. In addition, common physical therapy techniques, such as electrical stimulation, require reconsideration of their clinical efficacy and application in light of new discoveries in neuroscience. The aim of this appraisal is to provide an update on brain plasticity for physical therapists in relation to clinical practice, research and education.

Variations in Limits of Stability under different Sensory Conditions among Young Adult Women

Background: Good postural stability is required for the integrated functions of visual, somatosensory and vestibular system. But there is a less evidence related to limits of stability variations under different sensory conditions in young adult women by using swaymetre. Objective: The objective of this study is to analyze the variations in limits of stability under different sensory conditions among young adult women. Methods: A total of 15 female subjects of age group between18-22 were selected based on convenient sampling. All participants were exposed to different sensory conditions for assessing the steadiness and maximum balance range by using swaymetre. These parameters were measured both in A-P and M-L directions. The study was conducted in PSG Evidence-based Neuro Rehabilitation Centre, Department of Neurological Physical Therapy, PSG Hospitals, Coimbatore. Mean difference of steadiness and maximum balance range was used as statistical stool. Results: The values obtained as mean differences of steadiness and maximum balance range with eyes open and eyes closed in A-P and M-L directions on flat and foam surfaces were real data. Obtained values of steadiness and maximum balance range were mentioned. The mean differences of steadiness with eyes open in A-P and M-L directions on flat and foam surfaces were 13.54mm & 14.60mm and with eyes closed are 49.07mm & 55.33mm respectively. The mean differences of maximum balance range with eyes open in A-P and M-L directions on flat and foam surfaces were 31.06 & 54mm and with eyes closed are 2.13mm and 49.53mm respectively. The mean differences of steadiness in A-P and M-L directions on flat surface with eyes open and eyes closed were 2.6mm and 2.14mm and on foam surface with eyes open and eyes closed were 38.13mm and 42.93mm respectively. The mean differences of maximum balance range in A-P and M-L directions on flat surface with eyes open and eyes closed were 20.06mm & 10.5mm and on foam surface with eyes open and eyes closed were 10.13mm and 6mm respectively. Conclusion: Vision, Proprioception and Vestibular system play a major role in maintaining the postural stability under different sensory conditions. This study recommends the obtained values for the limits of stability under different sensory conditions for women using swaymetre can be used as a baseline value for further studies.

Call for papers for a JNPT Special Issue on Physical Fitness, Wellness and Secondary Prevention in Neurologic Physical Therapy

Call for papers for a JNPT Special Issue on Physical Fitness, Wellness and Secondary Prevention in Neurologic Physical Therapy