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Physical rehabilitation as an agent for recovery after spinal cord injury.

date: 2007 May;18(2):183-202
author: Behrman AL1, Harkema SJ
publication: Phys Med Rehabil Clin N Am

 

PubMed ID:  17543768

Abstract

The initial level of injury and severity of volitional motor and clinically detectable sensory impairment has been considered the most reliable for predicting neurologic recovery of function after spinal cord injury (SCI). This consensus implies a limited expectation for physical rehabilitation interventions as important in the facilitation of recovery of function. The development of pharmacologic and surgical interventions has always been pursued with the intent of altering the expected trajectory of recovery after SCI, but only recently physical rehabilitation strategies have been considered to improve recovery beyond the initial prognosis. This article reviews the recent literature reporting emerging activity-based therapies that target recovery of standing and walking based on activity-dependent neuroplasticity. A classification scheme for physical rehabilitation interventions is also discussed to aid clinical decision making.

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Preliminary results on the mobility after whole body vibration in immobilized children and adolescents

date: 01/01/2007
author: Semler, O., Fricke, O., Vezyroglou, K., Stark, C., Schoenau, E.
publication: J Musculoskelet Neuronal Interact 2007; 7(1):77-81
pubmed_ID:17396011 
The present article is a preliminary report on the effect of Whole Body Vibration (WBV) on the mobility in long-term immobilized children and adolescents. WBV was applied to 6 children and adolescents (diagnoses: osteogenesis imperfecta, N=4; cerebral palsy, N=1; dysraphic defect of the lumbar spine, N=1) over a time period of 6 months. WBV was applied by a vibrating platform constructed on a tilt-table. The treatment effect was measured by alternations of the tilt-angle of the table and with the “Brief assessment of motor function” (BAMF). All 6 individuals were characterized by an improved mobility, which was documented by an increased tilt-angle or an improved BAMF-score. The authors concluded WBV might be a promising approach to improve mobility in severely motor-impaired children and adolescents. Therefore, the Cologne Standing-and-Walking-Trainer powered by Galileo is a suitable therapeutic device to apply WBV in immobilized children and adolescents.

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Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta

date: 06/01/2008
author: Semler O, Fricke O, Vezyroglou K, Stark C, Stabrey A, Schoenau E.
publication: Clinical Rehabilitation, Vol. 22, No. 5, 387-394 (2008)
pubmed_ID: 18441035
Abstract
Objective: To evaluate the effect of whole body vibration on the mobility of long-term immobilized children and adolescents with a severe form of osteogenesis imperfecta. Osteogenesis imperfecta is a hereditary primary bone disorder with a prevalence from 1 in 10000 to 1 in 20000 births. Most of these children are suffering from long-term immobilization after recurrent fractures. Due to the immobilization they are affected by loss of muscle (sarcopenia) and secondary loss of bone mass.

Subjects: Whole body vibration was applied to eight children and adolescents (osteogenesis imperfecta type 3, N=5; osteogenesis imperfecta type 4, N=3) over a period of six months.

Interventions and results: Whole body vibration was applied by a vibrating platform (Galileo Systems) constructed on a tilting-table. Success of treatment was assessed by measuring alterations of the tilting-angle and evaluating the mobility (Brief Assessment of Motor Function). All individuals were characterized by improved muscle force documented by an increased tilting-angle (median = 35 degrees) or by an increase in ground reaction force (median at start=30.0 [N/kg] (14.48?134.21); median after six months = 146.0 [N/kg] (42.46?245.25).

Conclusions: Whole body vibration may be a promising approach to improve mobility in children and adolescents severely affected with osteogenesis imperfecta.

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Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

date: 03/01/2005
author: Zabel, R J.; McMillan, A G.; Salem, Y
publication: Pediatric Physical Therapy:Volume 17(1)Spring 2005p 93
pubmed_ID:
Outside_URL:
PURPOSE/HYPOTHESIS: The purpose of this study was to determine the effects of prolonged standing on several gait variables in ambulatory children with spastic cerebral palsy.
NUMBER OF SUBJECTS: Six children with spastic derebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4 – 9.8).
MATERIALS/METHODS: A reverse baseline design (A-B-A) was used. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Three dimensional gait analysis was performed before and after each phase. The Modified Ashworth Scale was used to measure muscle tone. Anaylsis of variance (ANOVA) for repeated measures was used to test for changes in gait measures across four measurement sessions.
RESULTS: Stride length (P < 0.001), speed (P < 0.001), stride time (P < 0.001), stance phase time (P < 0.005), and muscle tone (P < 0.02) improved significantly following the intervention period. No significant differences were found in swing phase time, double support time, foot angle, knee flexion angle, knee moment or ankle power.
CONCLUSIONS: The results of this study suggest that children with spastic cerebral palsy could benefit from a prolonged standing program to improve their gait.
CLINICAL RELEVANCE: Prolonged standing may improve gait in children with cerebral palsy.

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One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke.

date: 09/01/2007
author: Tihanyi TK, Horváth M, Fazekas G, Hortobágyi T, Tihanyi J.
publication: Clin Rehabil. 2007 Sep;21(9):782-93.
pubmed_ID: 17875558
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/17875558
OBJECTIVE: To determine the effect of whole body vibration on isometric and eccentric torque and electromyography (EMG) variables of knee extensors on the affected side of stroke patients. DESIGN: A randomized controlled study. SETTING: A rehabilitation centre. SUBJECTS: Sixteen patients (age 58.2+/-9.4 years) were enrolled in an inpatient rehabilitation programme 27.2+/-10.4 days after a stroke. INTERVENTIONS: Eight patients were randomly assigned to the vibration group and received 20 Hz vibration (5 mm amplitude) while standing on a vibration platform for 1 minute six times in one session. Patients in the control group also stood on the platform but did not receive vibration. MAIN MEASURES: Maximum isometric and eccentric torque, rate of torque development, root-mean-squared EMG, median frequency of vastus lateralis, and co-activation of knee flexors. RESULTS: Isometric and eccentric knee extension torque increased 36.6% and 22.2%, respectively, after vibration (P<0.05) and 8.4% and 5.3% in the control group. Vibration increased EMG amplitude 44.9% and the median frequency in the vastus lateralis by 13.1% (all P<0.05) without changes in the control group (10.6% and 3.9%). Vibration improved the ability to generate mechanical work during eccentric contraction (17.5%). Vibration reduced biceps femoris co-activation during isometric (8.4%, ns) and eccentric (22.5%, P<0.05) contraction. CONCLUSION: These results suggest that one bout of whole body vibration can transiently increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke.

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Cardiac output and blood pressure during active and passive standing.

date: 03/16/1996
author: Tanaka H, Sjöberg BJ, Thulesius O.
publication: Clin Physiol. 1996 Mar;16(2):157-70.
pubmed_ID: 8964133
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/8964133
The present study compared the haemodynamic pattern of active and passive standing. We used non-invasive techniques with beat-to-beat evaluation of blood pressure, heart rate and stroke volume. Seven healthy subjects, aged 24-41 (mean 30) years were examined. Finger blood pressure was continuously recorded by volume clamp technique (Finapres), and simultaneous beat-to-beat beat stroke volume was obtained, using an ultrasound Doppler technique, from the product of the valvular area and the aortic flow velocity time integral in the ascending aorta from the suprasternal notch. Measurements were performed at rest, during active standing and following passive tilt (60 degrees). Active standing caused a transient but greater reduction of blood pressure and a higher increase of heart rate than passive tilt during the first 30s (delta mean blood pressure: -39 +/- 10 vs. -16 +/- 7 mmHg, delta heart rate: 35 +/- 8 vs. 12 +/- 7 beats m-1 (active standing vs. passive tilt; P < 0.01). There was a significantly larger increase in cardiac output during active standing (37 +/- 24 vs. 0 +/- 15%, P < 0.01) and a more marked decrease in total peripheral resistance (-58 +/- 11 vs. -16 +/- 17%, P < 0.01). A precipitous rise in intra-abdominal pressure (43 +/- 22 mmHg) could be observed upon rising only in active standing. This was interpreted as an indication of translocation of blood to the thorax. There was no significant difference in haemodynamic changes during the later stage of standing (1-7 min) between both manoeuvres. These results suggest that active standing causes a marked blood pressure reduction in the initial phase which seems to reflect systemic vasodilatation caused by activation of cardiopulmonary baroreflexes, probably due to a rapid shift of blood from the splanchnic vessels in addition to the shift from muscular vessels associated with abdominal and calf muscle contraction. Moreover, the ultrasound Doppler technique was found to be a more adequate method for rapid beat-to-beat evaluation of cardiac output during orthostatic manoeuvres.

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Measurement of growth in children with developmental disabilities.

date: 09/01/1996
author: Stevenson RD.
publication: Dev Med Child Neurol. 1996 Sep;38(9):855-60.
pubmed_ID: 8810718

The clinical assessment of growth is a challenging, but essential, aspect of managing the health care of children with developmental disabilities. However, with standard equipment, modest training and some patience, almost all children can be measured reliably. Once reliable measurements are obtained, the interpretation or ‘clinical meaning’ of the measurements depends on their comparison with reference data from normal populations or, when available, with condition-specific reference data. More research is needed to improve our understanding of the clinical meaning of obtained measurements. The range of normal growth for some children with disabilities, particularly CP, remains to be defined. Research in the next ten years will, hopefully, lead to the development of growth charts for children with CP, and perhaps children with other conditions, which will facilitate the clinical interpretation of growth data and lead to improved management of health care for children with developmental disabilities.

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Complications of osteotomies in severe cerebral palsy.

date: 03/01/1999
author: Stasikelis PJ, Lee DD, Sullivan CM.
publication: J Pediatr Orthop. 1999 Mar-Apr;19(2):207-10.
pubmed_ID: 10088690

Seventy-nine consecutive children with cerebral palsy who underwent osteotomies about the hip for subluxation or dislocation were studied retrospectively to determine risk factors that would correlate with postoperative complications of death, fracture, or decubitus ulcer. Except for the three patients who died, all of the children had > or = 1 year of follow-up. Twenty (25%) patients had at least one complication. Three children died; one at 1 week, one at 2 weeks, and one at 5 months after surgery. Sixteen patients sustained 25 fractures. All were managed with cast or splint immobilization in the clinic. Five patients developed decubitus ulcers requiring > or = 2 weeks of local care, but none required skin grafts or flaps. Complications occurred in 13 (68%) of 19 children with gastrostomies or tracheostomies but in only seven (12%) of the remaining 60 children. Only one (8%) of 13 ambulatory patients had a complication compared with 19 (29%) of 66 nonambulatory patients. In conclusion, ambulatory function correlates well with the risk of complications after osteotomies. A nonambulatory patient with a gastrostomy or tracheostomy is at even greater risk. Fortunately the fractures and ulcers observed in this series healed uneventfully with no operative intervention.

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Monitoring standing wheelchair use after spinal cord injury: a case report.

date: 02/04/2005
author: Shields RK, Dudley-Javoroski S.
publication: Disabil Rehabil. 2005 Feb 4;27(3):142-6.
pubmed_ID: 15823996

PURPOSE: An important issue in spinal cord injury (SCI) research is whether standing can yield positive health benefits. However, quantifying dose of standing and establishing subject compliance with a standing protocol is difficult. This case report describes a method to monitor dose of standing outside the laboratory, describes the standing patterns of one subject, and describes this subject’s satisfaction with the standing protocol. METHOD: A man with T-10 complete paraplegia agreed to have his commercially available standing wheelchair instrumented with a custom-designed logging device for a 2-year period. The micro-controller-based logger, under custom software control, was mounted to the standing wheelchair. The logger recorded date, duration, angle of standing, and start/stop times. RESULTS: The client exceeded a suggested minimum dosage of standing per month (130.4% of goal), choosing to stand for short bouts (mean = 11.57 min) at an average angle of 61 degrees, on an average 3.86 days per calendar week. He was generally very satisfied with the standing device and provided subjective reports of improved spasticity and bowel motility. CONCLUSION: This case report describes a standing and surveillance system that allow quantification of standing dose. Future controlled studies are needed to evaluate whether standing can be beneficially affect secondary complications after SCI.

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Effects of a single session of prolonged muscle stretch on spastic muscle of stroke patients.

date: 04/25/2001
author: Tsai KH, Yeh CY, Chang HY, Chen JJ.
publication: Proc Natl Sci Counc Repub China B. 2001 Apr;25(2):76-81.
pubmed_ID: 11370763

The control of spasticity is often a significant problem in the management of patients with spasticity. The aim of this study was to evaluate the effect of a single session of prolonged muscle stretch (PMS) on the spastic muscle. Seventeen patients with spastic hemiplegia were selected to receive treatment. Subjects underwent PMS of the triceps surae (TS) by standing with the feet dorsiflexed on a tilt-table for 30 minutes. Our test battery consisted of four measurements including the modified Ashworth scale of the TS, the passive range of motion (ROM) of ankle dorsiflexion, the H/M ratio of the TS, and the F/M ratio of the tibialis anterior (TA). The results indicated that the passive ROM of ankle dorsiflexion increased significantly (p < 0.05) compared to that before PMS treatment. Additionally, PMS reduced motor neuron excitability of the TS and significantly increased that of the TA (p < 0.05). These results suggest that 30 minutes of PMS is effective in reducing motor neuron excitability of the TS in spastic hemiplegia, thus providing a safe and economical method for treating stroke patients.