Task-specific Exercise Research Articles

Effectiveness of task specific trunk movement training exercise protocol in rehabilitation of infants and children with high predictive value of cerebral palsy

Effectiveness of task specific trunk movement training exercise protocol in rehabilitation of infants and children with high predictive value of cerebral palsy

Nutritional Considerations in Exercise-Based Heat Acclimation: A Narrative Review.

In addition to its established thermoregulatory and cardiovascular effects, heat stress provokes alterations in macronutrient metabolism, gastrointestinal integrity, and appetite. Inadequate energy, carbohydrate, and protein intake have been implicated in reduced exercise and heat tolerance. Classic exercise heat acclimation (HA) protocols employ low-to-moderate-intensity exercise for 5-14days, while recent studies have evolved the practice by implementing high-intensity and task-specific exercise during HA, which potentially results in impaired post-HA physical performance despite adequate heat adaptations. While there is robust literature demonstrating the performance benefit of various nutritional interventions during intensive training and competition, most HA studies implement few nutritional controls. This review summarizes the relationships between heat stress, HA, and intense exercise in connection with substrate metabolism, gastrointestinal function, and the potential consequences of reduced energy availability. We discuss the potential influence of macronutrient manipulations on HA study outcomes and suggest best practices to implement nutritional controls.

1897 Older stroke survivors and rehabilitation therapists’ views on home-based resistance exercise for upper limbs

Abstract Introduction Upper limb recovery after stroke depends on participating in personalised task-specific exercise programmes. However, older adults with stroke find it challenging to maintain an optimal level of engagement with such exercise programmes due to personal and environmental factors. The aim of this study was to explore the views of stroke survivors and rehabilitation therapists on home-based resistance exercises for upper limbs. Method A qualitative study of semi-structured virtual and in-person interviews was conducted between January and March 2023 in England. Participants were 11 older adults >65 years (6 females (55%), with chronic stroke (>1 year after a stroke) and moderate to severe disabilities. Twenty rehabilitation therapists were also interviewed (3 physiotherapists, and 17 Action for Rehabilitation from Neurological Injury (ARNI) instructors). The group was asked about perceived personal and environmental barriers and facilitators as well as expectations of resistance exercises in relation to upper limb neurorehabilitation programmes. Interview sessions were audio recorded for transcription and thematic data analysis. The study was approved by Sheffield Hallam University ethics committee (reference number: AA43961583). Results Both groups mentioned that the main barrier to performing upper-limb exercises is weakness in the paretic arm affecting grip strength with consequent adverse impact on adherence to a home-based programme and poor patient motivation. Patients also reported safety concerns such as dropping equipment and being dependent on a carer to undertake regular exercises. Stroke survivors preferred a program that activates the paretic arm and is relevant to their daily functional activities. They preferred simple exercise instructions and demonstrations through visual aids and video materials. Patients also valued regular feedback on adjusting their exercise dose, monitoring progress over time, and ongoing encouragement. Conclusions Our study showed that designing home-based resistance exercises for upper limb in older stroke survivors should be individualised, functionally orientated, and motivational.

Exercise and Behavior: Adjuncts to Pro-Myogenic Compounds for Enhancing Mobility in Older Adults.

Physical activity and exercise training exert multiple and varied beneficial effects on a wide array of human tissues, making them therapeutic modalities that can prevent and treat age-related decline in physical function. The Molecular Transducers of Physical Activity Consortium is currently working to elucidate the molecular mechanisms underlying how physical activity improves and preserves health. Exercise training, especially when task specific, is an effective intervention for improving skeletal muscle performance and physical function in everyday activities. As seen elsewhere in this supplement, its adjunctive use with pro-myogenic pharmaceuticals may prove to be synergistic in effect. Behavioral strategies aiming to promote exercise participation and sustain adherence are being considered as additional adjuncts to further improve physical function in comprehensive, multicomponent interventions. One application of this combined strategy may be to target multimodal pro-myogenic therapies in prehabilitation to optimize physical preoperative health to enhance functional recovery postsurgery. We summarize here recent progress on biological mechanisms of exercise training, behavioral approaches to exercise participation, and the role task-specific exercise plays in synergy with pharmacologic therapies with a particular focus on older adults. Physical activity and exercise training in multiple settings should serve as the baseline standard of care around which other therapeutic interventions should be considered when the goal is restoring or increasing physical function.

Effect of Task Specific Exercise Program in Improving Balance for Patients Between T6-T12 Spinal Cord Injuries - A Review Study

Effect of Task Specific Exercise Program in Improving Balance for Patients Between T6-T12 Spinal Cord Injuries - A Review Study

1200 EFFECT OF BALANCE TRAINING AFTER HIP FRACTURE SURGERY: A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED STUDIES

Abstract Introduction Hip Fracture Surgery (HFS) can result in balance impairment which is associated with an increased risk of falls in the elderly as well as limitations in their mobility. Balanced Training (BT) is a rehabilitation method used aiming to minimize the balance impairments post HFS. BT options include stepping, balance task-specific exercise, standing on one leg, yoga. Our main outcome is to evaluate the effect of BT on the physical functioning of elderly patients post an HFS. Methods We conducted a systematic review using the PubMed-Medline, Cochrane Library and Embase databases to locate randomized controlled trials which compared BT with standard care post HFS. The Cochrane’ Library Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used as our template for the review. Results Overall, nine randomised controlled trials were selected, comprising a total of 712 patients, all aged 65 years of age and older. With regards to the type of BT rehabilitation: four trials used step-ups (n=500), three trials used balance task-specific exercise (n=170) and two studies used standing on one leg (n=42). The BT group demonstrated improvement in physical functioning post HFS compared to the control group (Standardised Mean Difference (SMD) = 0.410). Moreover, all functional parameters which include, lower limb strength, performance task and health related quality of life, were also improved in the BT group. Conclusion Evidently, the results demonstrate an improvement of physical functioning by BT post HFS. Furthermore, the positive effects on all functioning parameters were apparent. As a result, the implementation of BT in postoperative rehabilitation programs in elderly patients with hip fractures should be considered. Reference [1] Monticone M, Ambrosini E, Brunati R, et al. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clin Rehabil. 2018;32:340–351.

Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis.

falls among older adults are common and can have devastating consequences. A novel task-specific exercise modality, gait adaptability training (GAT), has shown promising preventive effects. This systematic review and meta-analysis synthesise the evidence regarding GATs effect on falls and fall-related fractures in community-dwelling older adults. electronic databases (PubMed, EMBASE, CINAHL, CENTRAL) were systematically searched from inception to 18 June 2020. Additional sources include searches of trial registrations, manual screening of reference lists and requests to experts. We included randomised controlled trials (RCTs) evaluating the effect of GAT on falls with at least 6-month follow-up among community-dwelling people aged 60+ years. Two reviewers independently screened studies against eligibility criteria, extracted relevant information and appraised studies for bias. Random-effects meta-analytic models were employed to pool effect estimates. eleven studies with 1,131 participants were included. A meta-analysis in which an outlier study was excluded showed that GAT reduces fall rates by 42% (incidence rate ratio 0.58, 95% confidence interval [CI] 0.39-0.81, I2 = 0.00%; moderate certainty; seven RCTs). Moreover, proportion with fall-related fractures and proportion of fallers was reduced by 81% (risk ratio [RR] 0.19, 95% CI 0.06-0.56, I2 = 0.00%; very low certainty; two RCTs) and 43% (RR 0.57, 95% CI 0.4-to 0.8, I2 = 47.08%; low certainty; 11 RCTs), respectively. our results show that GAT significantly reduces the number of falls and prevents fall-related fractures in older community dwellers. GAT is a promising and feasible exercise modality; however, studies of high quality should be conducted to support a robust conclusion. PROSPERO; CRD42020191051.

Parents' Perspectives on a Computer Game-Assisted Rehabilitation Program for Manual Dexterity in Children With Cerebral Palsy: Qualitative Analysis of Expectations, Child Engagement, and Benefits.

BackgroundChildren with motor impairments affecting the upper extremity benefit from task-specific therapy, such as constraint-induced movement therapy. However, there is a need to improve engagement and compliance with task-specific exercise programs that target manual dexterity for children with cerebral palsy (CP). A computer game–based rehabilitation (GRP) platform was developed that combines fine manipulation and gross movement exercises with engaging game activities appropriate for young children with CP.ObjectiveThe objectives of this qualitative analysis were to compare parents’ perspectives and opinions about expectations, challenges, and benefits between 2 interventions.MethodsA mixed methods, randomized controlled trial (RCT) was conducted to examine the feasibility and estimate the effect size of 2 exercise programs for rehabilitation of manual dexterity of children with CP using either GRP or conventional therapy. Parents of 26 of the children who completed the GRP program (n=33) and parents of 15 of the children who completed the conventional therapy program (n=27) participated in the interviews. A general conductive approach was used to analyze the data recorded during the parents’ interviews.ResultsFive themes captured the range of the parent’s experiences, viewpoints, and ideas: (1) parents’ expectations, (2) child’s engagement with therapy, (3) positive effects of the interventions, (4) challenges, and (5) improving the protocol.ConclusionsParents from both groups recognized that their expectations related to improving children’s object handling and manipulation skills including participation in activities of daily life were addressed during the 16-week therapy program. Parents perceived a change in the children’s level of independence in their daily tasks at home, school, and leisure activities.Trial RegistrationClinicalTrials.gov NCT02728375; https://clinicaltrials.gov/ct2/show/NCT02728375

Gait Kinematics and Spatiotemporal Variables after Enriched, Task-Specific Therapy in the Chronic Phase after Stroke. A Single-Subject Experimental Design Study

Objectives: In this single-subject experimental design study, we investigated the effect of late-phase stroke rehabilitation on gait pattern. Methods: A subgroup from a previous clinical study, four men in the chronic phase after stroke, received 3 weeks of enriched and task-specific therapy (ETT) consisting of task-specific exercise, socialization, sensory and cognitive stimulation in a Mediterranean climate. Spatiotemporal gait variables, kinematics and symmetry were measured before and after the intervention in an advanced gait laboratory. Statistical significance was determined with the two-standard deviation band method. Results: Subject 1 had kinematic improvements (increased knee flexion during swing and dorsiflexion during stance) and spatiotemporal gains (increased speed, double-limb support, stride length and cadence) after ETT. Subject 2 had improved swing time symmetry ratio but no spatiotemporal or kinematic improvements. Subject 3 had gains in speed, stride width and length, and knee flexion during swing. Subject 4 had a change in cadence but no gain in kinematics, nor symmetry. Conclusions: Two of the four participants had significant improvements in gait kinematics, symmetry, and spatiotemporal variables after the intervention. Future research should consider the potential effects of ETT with the aim of validating the conclusions that can be drawn from this study.

Current status and future development of acute and cardiac physiotherapies in Japan.

In recent years, the importance of early physiotherapy for rapid mental and physical functional recovery is increasing with the increasing number of older patients and high-risk patients with duplicate disorders. Increasing the effectiveness of acute physiotherapy within a shorter hospital stay is a great challenge. We published the first expert consensus of early rehabilitation in Asia in 2017. Our expert consensus will contribute to the establishment of physiotherapy in intensive care for Asian populations. The minimum standard of clinical practice for physiotherapists working in critical care settings is important to showcase physiotherapists' knowledge and abilities as medical professionals working in the intensive care unit. We are planning to release the minimum standard of clinical practice for Japanese physiotherapists working in critical care settings in 2020. Being in the forefront among nations of aging populations, Japan has a rapidly increasing number of older frail patients with heart failure. Further studies are necessary to confirm the effectiveness of task-specific exercise training considering the characteristics of frailty.

Potential Implementation of Reactive Balance Training within Continuing Care Retirement Communities.

The purpose of the study was to evaluate the feasibility of implementing reactive balance training (RBT) in continuing care retirement communities, as a part of typical practice in these facilities. RBT, a task-specific exercise program, consisted of repeatedly exposing participants to trip-like perturbations on a modified treadmill to improve reactive balance, and subsequently reduce fall risk. Semi-structured interviews were conducted with retirement community residents (RBT participants) and administrators, to assess the organizational context, perceptions of evidence for falls prevention, and facilitation strategies that could improve the likelihood of implementing RBT as a falls-prevention program. Contextual factors such as leadership support, culture of change, evaluation capabilities, and receptivity to RBT among administrators and health leaders at the participating retirement communities could facilitate future implementation. The cost associated with RBT (e.g. equipment and personnel), resident recruitment, and accessibility of RBT for many residents were identified as primary barriers related to the intervention. Participants perceived observable health benefits after completing RBT, had increased awareness toward tripping, and greater confidence with respect to mobility. Across interviewees potential barriers for implementation regarding facilitation revolved around the compatibility and customizability for different participant capabilities that would need to be considered before adopting RBT. RBT could fill a need in retirement communities and the findings provide areas of context, characteristics of the intervention, and facilitation approaches that could improve uptake.

Program to improve mobility in aging (PRIMA) study: Methods and rationale of a task-oriented motor learning exercise program

Walking difficulty is a common and costly problem in older adults. A potentially important yet unaddressed strategy to enhance walking ability through exercise intervention is to add a timing and coordination component in gait training (i.e. task specific timing and coordination exercise intervention) to the usual strength, endurance, and flexibility training. We describe the methods and rationale of a randomized single-blind, physical therapist supervised, exercise intervention trial to compare the effects of a standard strength, endurance, and flexibility program to a standard plus timing and coordination program in community-dwelling older adults walking slower than the desired gait speed of 1.2 m/s. Exercise sessions are twice weekly for 12 weeks. Participants are assessed at baseline, 12 weeks (post intervention), 24 weeks and 36 weeks. The primary outcome is gait speed, secondary outcomes represent components of the interventions (strength, endurance, flexibility, timing and coordination), and tertiary outcomes are measure of activity and participation (Late Life Function and Disability Instrument and physical activity). The findings of this trial will (1) establish if a standard-plus task specific timing and coordination program is superior to a standard strength and endurance program in improving mobility, activity and participation and (2) determine if the improvements are sustained over time. The information derived from this project will provide valuable insight into the prevention and management of walking difficulty, which is so common in older Americans.

Neuroplasticity in Brain Injury: Maximizing Recovery

The ability to promote greater neuroplasticity through external influencers is an emerging field of study with potentially significant consequences on the treatment of neurologic injury. Several of these methods are reviewed in this paper. Through advances in neuroscience, a clearer understanding of the complexity of the brain’s interconnectedness and its ability to adapt to the environment is leading to neurorehabilitation treatments that augment the brain’s capacity towards neuroplastic change. An increased appreciation and recognition of neuroplasticity has led to novel approaches to promote neurorecovery that increase stimulation and the release of neutrophic factors. Some of these interventions include the use of pharmacologic agents, noninvasive stimulation, mirror therapy, aerobic and task-specific exercise, and the maximization of sleep. Future research will continue to build upon this foundation by continuing to pair therapeutic interventions with rehabilitation to enhance the brain’s natural healing power and improve functional outcomes.

Rehabilitation with robotic glove (Gloreha) in poststroke patients

Background and Objectives: Stroke is a leading cause of long-term disability. Rehabilitation involving repetitive, high-intensity, and task-specific exercise is the pathway to restore motor skills. Robotic assistive devices such as Gloreha are increasingly being used in upper limb rehabilitation. The aim of this study is to explore the efficacy of robotic therapy for upper limb rehabilitation using robotic glove (Gloreha) in patients with stroke. Materials and Methods: The patients affected by stroke who were admitted to our rehabilitation unit were studied. Patients were exposed to Gloreha device rehabilitation (30 min/die), physiotherapy (1,5 hours/die), and occupational therapy (30 min/die). We measured the impairment in motor function and muscle tone using the modified Ashworth scale (MAS), the activities of daily living functional independence measure (FIM), and the finger dexterity Nine-Hole Peg test (NHPT). Results: Twelve patients (mean age = 64.5 years; male/female: 8:4) were admitted at the rehabilitation training. We found statistically significant differences between admission and discharged in terms of functional recovery using the FIM scale (pre/M = 88.33; post/M = 117.25, P = 0.01); hand training showed a better outcome using the NHPT (pre/M = 51.8; post/M = 36.33, P = 0.01). No significant changes were observed in terms of spasticity with the MAS (pre/M = 1.25; post/M = 1.08;P > 0.05). Conclusions: Rehabilitation with robotic glove (Gloreha) can positively promote functional recovery of arm function in a patient with stroke.

Effect of Gravity and Task Specific Training of Elbow Extensors on Upper Extremity Function after Stroke.

Background In individuals with hemiparetic stroke, reaching with the paretic arm can be impaired by abnormal muscle coactivation. Prior trails for improving upper extremity functions after stroke have underestimated the role of gravitational force in motor planning and execution. Objective The aims this trial were to study the effect of gravity as a facilitator for elbow extension and to estimate the immediate and retention effects of task specific training of elbow extensors on upper extremity function after stroke. Methods Twenty-six right handed patients with first ever stroke represented the sample of the study. The participants were randomly assigned into two equal groups. The study group received treatment through two phases. Phase one included training for the elbow extensors in an antigravity position. Phase two included a set of task specific exercise for 16 weeks. The control group received traditional passive stretch and range of motion exercises. Manual dexterity and upper limb function were assessed by Nine-Hole Peg Test and Fugl-Meyer upper extremity. Goniometry was used for measuring elbow extension and forearm supination active ranges of motion. Results Significant improvements were observed in Nine-Hole Peg Test, Fugl-Meyer upper extremity, and ranges of motion at postintervention and follow-up compared to preintervention at P≤0.05. Conclusions The results of this study provide an evidence that antigravity positions can be used as a centrally presented facilitator of elbow extension. Additionally, task specific training was effective in improving upper extremity function and elbow extension range of motion.

Using ramp-incremental V̇O2 responses for constant-intensity exercise selection.

Despite compelling evidence to the contrary, the view that oxygen uptake (V̇O2) increases linearly with exercise intensity (e.g., power output, speed) until reaching its maximum persists within the exercise physiology literature. This viewpoint implies that the V̇O2 response at any constant intensity is predictable from a ramp-incremental exercise test. However, the V̇O2 versus task-specific exercise intensity relationship constructed from ramp-incremental versus constant-intensity exercise are not equivalent preventing the use of V̇O2 responses from 1 domain to predict those of the other. Still, this "linear" translational framework continues to be adopted as the guiding principle for aerobic exercise prescription and there remains in the sport science literature a lack of understanding of how to interpret V̇O2 responses to ramp-incremental exercise and how to use those data to assign task-specific constant-intensity exercise. The objectives of this paper are to (i) review the factors that disassociate the V̇O2 versus exercise intensity relationship between ramp-incremental and constant-intensity exercise paradigms; (ii) identify when it is appropriate (or not) to use ramp V̇O2 responses to accurately assign constant-intensity exercise; and (iii) illustrate the technical and theoretical challenges with prescribing constant-intensity exercise solely on information acquired from ramp-incremental tests. Actual V̇O2 data collected during cycling exercise and V̇O2 kinetics modelling are presented to exemplify these concepts. Possible solutions to overcome these challenges are also presented to inform on appropriate intensity selection for individual-specific aerobic exercise prescription in both research and practical settings.

Chapter 10 - Aging

This chapter reviews studies that have examined age-related anatomic and functional changes in sensory, neuromuscular, and cognitive systems that impair the control of balance and gait. Specifically, we examine age-related changes in peripheral systems: lower-limb sensation, visual functions such as contrast sensitivity and depth perception, vestibular sense, strength, and power in the lower-limb muscle groups, as well as central factors including processing speed and executive functioning. Significant impairments in any one of the above systems can predispose older people to falls, with the risk of falling increasing substantially with the number of impairments present. There is increasing evidence that interventions aimed at addressing specific sensory and neuromuscular impairments can improve balance control and reduce fall risk. In particular, task-specific exercise can improve muscle strength, balance, gait and mobility and prevent falls in older people.

Exergaming with a pediatric exoskeleton: Facilitating rehabilitation and research in children with cerebral palsy.

Effective rehabilitation of children with cerebral palsy (CP) requires intensive task-specific exercise but many in this population lack the motor capabilities to complete the desired training tasks. Providing robotic assistance is a potential solution yet the effects of this assistance are unclear. We combined a novel exoskeleton and exercise video game (exergame) to create a new rehabilitation paradigm for children with CP. We incorporated high density electroencephalography (EEG) to assess cortical activity. Movement to targets in the game was controlled by knee extension while standing. The distance between targets was the same with and without the exoskeleton to isolate the effect of robotic assistance. Our results show that children with CP maintain or increase knee extensor muscle activity during knee extension in the presence of synergistic robotic assistance. Our EEG findings also demonstrate that participants remained engaged in the exercise with robotic assistance. Interestingly we observed a developmental trajectory of sensorimotor mu rhythm in children with CP similar, though delayed, to those reported in typically developing children. While not the goal here, the exoskeleton significantly increased knee extension in 3/6 participants during use. Future work will focus on utilizing the exoskeleton to enhance volitional knee extension capability and in combination with EMG and EEG to study sensorimotor cortex response to progressive exercise in children with CP.

The significance of social rules in group training sessions

Purpose: To identify what types of social rules are involved in group interventions led by physiotherapists (PTs), and how these rules influence individual recovery.Methods: Eight patients; six women and two men, which had recently undergone elective hip or knee replacement surgery, were recruited as informants from an intervention group that investigated effect of task specific exercise. The data comprise observational notes from group training sessions and one-on-one semi-structured interviews with the eight patients. Observational notes contributed to the development of the research questions. The interviews were audio-recorded and transcribed, and a theoretically-oriented analytical approach guided by performance theory was conducted to identify the rules.Results: Several implicit rules for behavior when attending this group intervention were identified. The compulsory style enhances recovery in an explicit manner.Conclusion: When giving advice and home exercise PTs must acknowledge that the roles patients are subtly exposed to during the actual clinical encounter are probably quite different from the roles the patients can merge into outside the therapy context. This might shed some light on the notion of patient adherence/concordance.The significance of social rules in group training sessions.Implications for RehabilitationHealth professionals should be aware of the implicit social regulations of the clinical encounter. They will influence whether and how patients adhere to advice.By acknowledging that patients have different roles to merge into, depending on context, health professionals may significantly broaden our understanding of patient adherence and compliance.The social rules identified in this study contribute to individual recovery processes. We encourage health professionals to regard “group dynamics” as something that is going on during the group session, and worthwhile taking advantage of when planning and implementing group interventions.

The Underwater Treadmill as a Physical Therapy Intervention for Children with Cerebral Palsy

Cerebral Palsy is a congenital and physical disability that leads into abnormal muscle tone, dyskinesia, and muscle spasticity, which can negatively impact functional gait patterns. Using the principles of activity based programs and repetitive task specific exercises involving a treadmill in physical therapy can replicate normal gait patterns, which can improve the quality of life. There is a scarcity of research that explores the effectiveness of underwater treadmill training as a form of physical therapy intervention. As such, the purpose of the study is to examine available research that studied the benefits of aquatic therapy, land based treadmill training, and underwater treadmill training on the gait patterns in children with cerebral palsy. The researchers conducted a review of literature that focuses on beneficial effects of physical therapy interventions such as aquatic exercise, resistance training, land‐based treadmill training, as well as underwater treadmill training; then ranked them using the Oxford Level of Evidence‐based Medicine. Based on the evidence gathered, we can conclude that the physiological benefits associated with aquatic therapy in combination with the repetitive task specific exercise used with treadmill training can improve mobility and functional gait patterns of children with cerebral palsy.