Physical Therapy Exercise Program Research Articles

Acrophobia and Pathological Height Vertigo: Indications for Vestibular Physical Therapy?

Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.

Rigidity and bradykinesia reduce interlimb coordination in Parkinsonian gait

Winogrodzka A, Wagenaar RC, Booij J, Wolters EC. Rigidity and bradykinesia reduce interlimb coordination in Parkinsonian gait. Objective To assess the influence of rigidity and bradykinesia and the extent of dopaminergic degeneration on interlimb coordination during walking in early, drug-naive patients with Parkinson’s disease (PD). Design The interlimb coordination was examined during a systematic manipulation of walking speed on a treadmill. The phase relations between arm and leg movements were related to the clinical measures of rigidity and bradykinesia as well as to the extent of dopaminergic degeneration. Setting Movement disorders outpatient clinic (including motion analysis laboratory) and a nuclear medicine department of a university hospital. Participants Twenty-nine early and drug-naive PD patients. Interventions Not applicable. Main outcome measures The interlimb coordination during walking was evaluated by studying the (continuous) relative phase relations between movements of arms and legs. The clinical assessment of rigidity and bradykinesia was performed by using the Unified Parkinson Disease Rating Scale. The dopaminergic degeneration was expressed as striatal 2β-carboxymethoxy-3β-(4-iodophenyl) tropane (β-CIT) single-photon emission computed tomography (SPECT) binding. Results The mean relative phase between arm and leg movements increased significantly with walking speed in all patients. Significant correlations were found between the rigidity and bradykinesia and the coordination measures ( P≤.007), as well as contralateral striatal [ 123I]β-CIT SPECT binding and coordination measures ( P<.001), in terms of asymmetry indices. Conclusions Early, drug-naive PD patients in this sample were able to adapt their coordination patterns when walking speed was systematically manipulated. However, bradykinesia and rigidity as well as the extent of degeneration of the dopaminergic system were associated with a limited adaptive ability (flexibility) in movement coordination. The combination of a drug treatment that controls bradykinesia and rigidity and a physical therapy exercise programs possibly using external cues mechanisms are required to obtain relevant effects on gait in PD patients.

Physiotherapy exercise programmes: Are instructional exercise sheets effective?

Effective compliance with physiotherapy exercises is only possible if patients remember the exercises accurately. The purpose of this study was to assess how well elderly in-patients remembered simple physiotherapy exercises, by comparing the ability to accurately reproduce a set of exercises in a group of patients that had received a written exercise sheet, with a group that had not. The study also aimed to investigate the relationship between memory for exercises and cognition. Sixty-four in-patients in an acute hospital were taught 3 exercises. Half of the subjects were randomised to receive exercise sheets to reinforce the teaching (Group 1). The rest of the subjects did not receive this memory aid (Group 2). Two to three days later subjects were asked to demonstrate their exercises. The accurate recall of the exercises was scored using a new assessment scale with a maximum score of 24. The mean exercise score was 17.19 for group 1 (SD = 5.91) and 16.24 for Group 2 (SD = 6.01). There was no significant difference in exercise score between groups (Mann Whitney U test p = 0.44). There was a statistically significant small positive correlation between exercise score and cognition (tau = 0.263). The study showed that older adult in-patients do not remember physiotherapy exercises effectively after a single teaching session and that their memory is not significantly improved by provision of an exercise sheet.

The effect of age on vestibular rehabilitation outcomes.

The purpose of the retrospective chart review was to compare vestibular rehabilitation outcomes in young versus older adults. Retrospective matched design. Twenty-three persons with vestibular disorders aged 20 to 40 years were matched by gender, vestibular diagnosis, and vestibular function test results to 23 older adults aged 60 to 80 years. The patients were treated with a custom-designed physical therapy exercise program. Patients completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence (ABC) scale, and the Dynamic Gait Index; number of falls; and rated the severity of their dizziness. The two-sample test, the Mann-Whitney test, and McNemar's test for correlated proportions were used to determine whether there was a difference in scores between the two age groups at the beginning and end of physical therapy. During the initial evaluation, older adults reported having statistically greater space and motion discomfort and more severe symptoms on a scale of 0 to 100. Younger adults had more impaired DGI scores and a higher proportion of caloric testing abnormalities. After rehabilitation, overall improvement was seen in both the younger and older populations. There were no statistical differences between the two groups on the DHI, the DGI, reported symptoms at discharge, or number of falls. When only the complete matched-pair data were analyzed, there were no statistically significant differences between the age groups in the proportion of patients demonstrating clinical improvement. Age does not significantly influence the beneficial effects of vestibular rehabilitation for persons with vestibular disorders.

Physical therapy outcomes for persons with bilateral vestibular loss.

The purpose of the study was to assess the efficacy of physical therapy for patients with bilateral vestibular loss. Retrospective case series. Twenty-four patients with a diagnosis of bilateral vestibular loss were identified by a retrospective chart review. Thirteen of the 24 patients met the inclusion criteria of having a moderate or greater loss of vestibular function bilaterally as rated by an otoneurologist based on the patient's vestibular function tests. These patients were treated with a custom-designed physical therapy program for a mean of 4.6 visits over an average period of 3.8 months. Patients completed the Dizziness Handicap Inventory and the Activities-specific Balance Confidence Scale at initial evaluation and discharge. Patients were asked to perform the balance and gait tasks of the Dynamic Gait Index, Sensory Organization Test of computerized dynamic posturography, and the Timed "Up and Go" test at their first and last physical therapy sessions. The number of falls in the previous 4 weeks and the use of an assistive device at initial evaluation and discharge were reported. Composite score, an overall score of clinical outcome, was calculated to determine clinically significant changes in physical performance and subjective information. On a population basis, statistically significant improvement was observed after physical therapy for each of the outcome measures including the composite score (P < .05). Clinically significant changes were demonstrated by 33% to 55% of the patients on the various outcome measures. No change was noted in the patients' risk of falling, their number of falls, and the use of assistive devices. Many patients with bilateral vestibular loss benefit from an individualized vestibular physical therapy exercise program based on improved physical function and reduced self-perceived levels of handicap.

Clinical Application of Physiotherapy with a Cognitive?behavioural Approach in Low Back Pain

The aim of this study was to investigate the effects of an integrated physiotherapy and cognitive-behavioural programme for a patient with persistent low back pain and disability. Outcome as well as comparison to a physiotherapy exercise programme was made in a controlled single-case format. The participant was a 41-year-old woman with an 18-month history of low back pain and increasing disability. The assessment involved physical function and exercise performance, disability, self-efficacy, life satisfaction and coping strategies. There were considerable improvements in performance of exercises as well as in resumed everyday activities during the integrated programme, as compared to the exercise programme. There were also marked improvements in standardized measures of disability, functional self-efficacy, and life satisfaction. All results were maintained at the 1-year follow-up. The results suggest that clinical integration of physiotherapeutic and cognitive-behavioural interventions was more effective...

Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine.

To assess the efficacy of physical therapy for patients with a diagnosis of migraine-related vestibulopathy (MRV) or vestibular dysfunction with a history of migraine headache. Retrospective case series Thirty-nine patients were identified through a retrospective chart review, 14 with a diagnosis of MRV and 25 with migraine headache. The patients were treated with a custom-designed physical therapy exercise program for a mean of 4.9 visits over a mean duration of 4 months. Patients completed the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence Scale (ABC), and the Dynamic Gait Index (DGI), reported the number of falls they had experienced in the past 4 weeks, and rated the severity of their dizziness on an analogue scale of 0 to 100 at initial evaluation and at discharge. Significant differences were seen before and after therapy in each of the outcome measures used. The average decrease in DHI score was 12 points (P < .01). ABC scores increased an average of 14 points (P < .01). Subjects increased their DGI scores an average of 4 points (P < .01). The number of patients reporting more than one fall decreased by 78% at discharge. (P < .05). Baseline symptoms of dizziness decreased an average of 11 points (P < .05). Patients with MRV and migraine headache demonstrated improvement in physical performance measures and self-perceived abilities after vestibular physical therapy.

The Effect of Treatment Goals on Patient Compliance with Physiotherapy Exercise Programmes

Treatment goals are a motivational tool commonly used by physiotherapists to improve patients' compliance with exercise programmes. This study investigated their effectiveness in meeting this aim. Sixty-six patients starting a new course of physiotherapy and having exercises as part of their treatment, were randomly allocated to one of the three experimental goal groups: physiotherapist-participant collaborative, physiotherapist-mandated, and no formally set goals. The number of sessions and repetitions they performed for each exercise was recorded in a diary Data showed there were no significant differences between the groups on overall compliance. However, analysis of range of movement and muscle strength data showed the no formally set goals group to be significantly more compliant than the physiotherapist-mandated group. Further analysis revealed that those participants in the collaborative group who had range of movement or both muscle strength and range of movement measurements were significantly more compliant with the recommended exercise repetitions than those in the physiotherapist mandated group. The results of this study indicate that treatment goals may not be a suitable motivational tool for all people, but if they are to be used in physiotherapy, collaboratively set goals appear to lead to a higher level of treatment compliance than physiotherapist-mandated goals.

Is Transcranial Electrical Stimulation (TCES) a Safe Intervention for Children with Cerebral Palsy?

We tested the safety of transcranial electrical stimulation (TCES) applied to seven children (age range 2.5 to 7.5 years) with a confirmed diagnosis of cerebral palsy (CP). Adverse responses were assessed by negative changes in the gross motor function mea sure test (GMFM), the popliteal angle, and the occurrence of any undesired systemic responses such as seizure, nausea, vomiting, or sleep disruption. The tests first were given before the commencement of a physical therapy exercise (PTE) program com bined with a home program of TCES. The tests were repeated after 8 weeks of PTE + TCES and once again after an additional 8 weeks of PT + TCES. One of the 8- week periods involved placebo stimulation in a double-blind design. Stimulator am plitude was 0.5 mA of peak current, phase charge was 0.0166 μC, and the averaged RMS current was 249 microamperes. This level was below threshold of sensory nerve excitation, and the child did not perceive the stimulation. Electrodes were placed over the right and left temporal areas of the skull. The stimulation was applied by the par ents for 10 minutes, twice a day, 7 days each week. The total goal GMFM scores were greater after both active and placebo stimulation. The popliteal angle improved irre spective of the stimulation intervention. No adverse systemic responses were reported. These results support the hypothesis that TCES as used in this study is a safe proce dure.

P.1.172 Social aspects of mild antidepressants therapy of youth depressions accompanied by drug use

Winogrodzka A, Wagenaar RC, Booij J, Wolters EC. Rigidity and bradykinesia reduce interlimb coordination in Parkinsonian gait.To assess the influence of rigidity and bradykinesia and the extent of dopaminergic degeneration on interlimb coordination during walking in early, drug-naive patients with Parkinson’s disease (PD).The interlimb coordination was examined during a systematic manipulation of walking speed on a treadmill. The phase relations between arm and leg movements were related to the clinical measures of rigidity and bradykinesia as well as to the extent of dopaminergic degeneration.Movement disorders outpatient clinic (including motion analysis laboratory) and a nuclear medicine department of a university hospital.Twenty-nine early and drug-naive PD patients.Not applicable.The interlimb coordination during walking was evaluated by studying the (continuous) relative phase relations between movements of arms and legs. The clinical assessment of rigidity and bradykinesia was performed by using the Unified Parkinson Disease Rating Scale. The dopaminergic degeneration was expressed as striatal 2β-carboxymethoxy-3β-(4-iodophenyl) tropane (β-CIT) single-photon emission computed tomography (SPECT) binding.The mean relative phase between arm and leg movements increased significantly with walking speed in all patients. Significant correlations were found between the rigidity and bradykinesia and the coordination measures (P≤.007), as well as contralateral striatal [123I]β-CIT SPECT binding and coordination measures (P<.001), in terms of asymmetry indices.Early, drug-naive PD patients in this sample were able to adapt their coordination patterns when walking speed was systematically manipulated. However, bradykinesia and rigidity as well as the extent of degeneration of the dopaminergic system were associated with a limited adaptive ability (flexibility) in movement coordination. The combination of a drug treatment that controls bradykinesia and rigidity and a physical therapy exercise programs possibly using external cues mechanisms are required to obtain relevant effects on gait in PD patients.

Lumbar Canal Stenosis

Lumbar canal stenosis is an increasingly recognized condition in patients more than 65 years of age. The clinical syndrome is dominated by neurogenic claudication. The natural history of the Condition is not yet well described. Long-term results of surgical therapy are frequently disappointing, and reoperation is required in more than 10% of patients. Nonoperative treatment options include physical therapy exercise programs, calcitonin, analgesics, and epidural steroid injections. A clinical pathway for management of symptomatic stenosis, emphasizing an initial nonoperative approach, is suggested.

Increased group II phospholipase A2 in colonic mucosa of patients with Crohn's disease and ulcerative colitis.

The immunochemical protein content of group II phospholipase A2 (PLA2) and PLA2 enzymatic activity were measured for colonic mucosal biopsy samples obtained from patients with either Crohn's disease of the colon or ulcerative colitis, and control patients without inflammatory bowel disease. Immunoreactive group II PLA2 (IR-PLA2 II) content and PLA2 activity in actively inflamed colonic mucosa of Crohn's disease patients were significantly higher than those in inactively inflamed mucosa of Crohn's disease patients and the colonic mucosa of controls. IR-PLA2 II content and PLA2 activity in severely inflamed mucosa of ulcerative colitis patients were significantly higher than those in the colonic mucosa of the controls. Mucosal PLA2 enzymatic activity was closely correlated with mucosal IR-PLA2 II content in patients with Crohn's disease and ulcerative colitis. These results suggest that an increase in PLA2 enzymatic activity in inflamed colonic mucosa of Crohn's disease and ulcerative colitis was mainly attributed to increased protein content of group II PLA2, and that an increase in mucosal group II PLA2 may be involved in the pathogenesis of intestinal inflammation of Crohn's disease and ulcerative colitis.

Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain

This study was designed to investigate the relative efficacy of cognitive-behavioral group treatment, including relaxation training, in comparison with a control condition in a sample of 20 outpatients with chronic low back pain. Subjects in both conditions also received the same physiotherapy back-education and exercise program. The control condition included a control for the attention of the therapist in the cognitive-behavioral treatment. The combined psychological treatment and physiotherapy condition displayed significantly greater improvement than the attention-control and physiotherapy condition at post-treatment on measures of other-rated functional impairment, use of active coping strategies, self-efficacy beliefs, and medication use. These differences were maintained at 6 month follow-up on use of active coping strategies and, to a lesser degree, on self-efficacy beliefs and other-rated functional impairment.

Operant-behavioural and cognitive-behavioural treatment for chronic low back pain

Fifty-eight outpatients with chronic low back pain were randomly allocated to one of six experimental conditions. Four conditions were designated as treatment conditions and two as control conditions. The four treatment groups consisted of: cognitive treatment (either with or without relaxation training) and behavioural treatment (either with or without relaxation training). The cognitive and behavioural groups also received physiotherapy. The two control conditions consisted of: attention (physiotherapy plus discussion sessions) and no-attention (physiotherapy-only) conditions. All conditions, including the two controls, received the same physiotherapy back-education and exercise program. For the sample as a whole, improvements were obtained on measures of affective distress, functional impairment, medication use, pain-related dysfunctional cognitions and use of active coping strategies. These improvements were generally maintained at 6- and 12-month follow-ups. The combined psychological/physiotherapy treatment conditions improved significantly more than the physiotherapy-only conditions from pre to posttreatment on measures of pain intensity, self-rated functional impairment and pain-related dysfunctional cognitions. However, these differences were only weakly maintained at 6- and 12-month follow-ups. The behavioural conditions improved significantly more than the cognitive conditions from pre to posttreatment on the self-rated measure of functional impairment, but this difference was not maintained at 6- and 12-month follow-ups. Progressive relaxation training was found to make little contribution to either cognitive or behavioural treatments.

The Effects of Exercise on the Elderly and Implication for Therapy

Physical and occupational therapy activity and exercise programs have historically been directed toward the restoration of function in the disabled elderly. These professions have not focused their attention on the well or mildly impaired elderly. The current research on exercise and the elderly described here documents the positive benefits of physical activity and exercise programs for the well or mildly impaired elderly. The potential for physical and occupational therapists to provide services to the non-disabled elderly population is explored and a model program is offered as an example of this expanded role for therapists.

1688 DEVELOPMENTAL SIGNIFICANCE OF SCAPULAR RETRACTIONS IN THE LOW BIRTHWEIGHT INFANT

Although abnormal muscle tone is frequently noted in the premature infant, it is usually transient and resolves by 18 months of age. When present in preterm infants, these abnormalities do not carry the same prognostic importance as do similar abnormalities in the term infant. Scapular retractions (SR) are clinical evidence of increased shoulder girdle tone. Because the resulting “high guard” position of the arms in the infant with SR may interfere with the acquisition of developmental milestones such as midline play, transferring, rolling over and sitting, we evaluated 78 former NICU patients for the presence of SR. 25 infants (33%) developed SR by 6 months either as a component of generalized hypertonia or as compensation for truncal hypotonia. All infants received physical therapy or home exercise programs directed at these neuromuscular abnormalities. SR resolved in all patients by 18 months; only 3 (4%) had SR at 12 months. Bayley developmental scores were compared at 6, 12 and 18 months. Conclusions: Scapular retractions are common, but resolve by 12 months in most preterm infants. SR interfere with performance at 6 months, but as SR resolve, no lasting effects on development are seen. Physical therapy or exercises may help to promote resolution of this relatively common abnormality in preterm infants.

"Towards a Lower Paediatric Mortality"

<b>Background and Purpose.</b> Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient9s visual dependence and height vertigo. <b>Case Description.</b> Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. <b>Intervention.</b> Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. <b>Outcomes.</b> After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. <b>Discussion.</b> Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.