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.
Author: zingleader
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.
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.
Bone mineral content in preterm infants at age 4 to 16.
date: 03/01/1985
author: Helin I, Landin LA, Nilsson BE.
publication: Acta Paediatr Scand. 1985 Mar;74(2):264-7.
pubmed_ID: 3993373
Using photon absorptiometry the forearm bone mineral content (BMC) was determined in 75 children aged 4 to 16, who all had a low birth weight. Forty-five of them were born preterm AGA (27 boys, 18 girls, mean weight 1 580 g; range 920-2 060 g) and 30 preterm SGA (17 boys, 13 girls, mean weight 1510; range 940-2130 g). The results were compared with a control group of children of the same age, and analyses of covariance with age, height and weight as the covariant factors were performed. The BMC, weight and height did not differ between the children born AGA or SGA. Irrespective of AGA or SGA, the BMC was significantly decreased in boys but the difference was less pronounced and less significant when height and weight were used as covariant factors. Boys who had been born preterm had a less BMC than the control boys for their age but they were also somewhat shorter and lighter than expected with regard to their age.
Bone density and other possible predictors of fracture risk in children and adolescents with spastic quadriplegia.
date:
author: Henderson RC.
publication: Dev Med Child Neurol. 1997 Apr;39(4):224-7.
pubmed_ID: 9183259
:
Forty-three patients with spastic quadriplegia (mean age 7.9 years, range 3.3 to 17.2 years) underwent bone mineral density (BMD) measurement of the lumbar spine and were evaluated between 2.6 and 5.5 years (mean 3.8) later to determine whether this measurement had predicted risk of fracture over the subsequent period of observation. Other potential risk factors that were evaluated include body weight z score, serum vitamin D levels, previous fracture, and hip spica casting. The baseline measurements showed that BMD falls further below normal with increasing age and was more than one standard deviation below age-matched normal mean in 38 of the 43 patients. Fracture rate did not differ between those with low and those with very low spinal BMD. Similarly, serum vitamin D levels and body weight z scores were not predictive of fracture. However, fracture rate was over fourfold greater following spica casting and more than threefold greater following an initial fracture. Fracture rates in the study group were similar to those reported for age- and sex-matched normal children, though generally the location of the fractures and mechanisms of injury differed.
Bone-mineral density in children and adolescents who have spastic cerebral palsy.
date:
author: Henderson RC, Lin PP, Greene WB.
publication: J Bone Joint Surg Am. 1995 Nov;77(11):1671-81.
pubmed_ID: 7593076
Bone-mineral density was studied in a heterogeneous group of 139 children (mean age, nine years; range, three to fifteen years) who had spastic cerebral palsy. The evaluation included serum analyses and a nutritional assessment based on a dietary history and anthropometric measurements. The bone-mineral density of the proximal parts of the femora and the lumbar spine was measured with dual-energy x-ray absorptiometry and was normalized for age against a series of ninety-five normal children and adolescents who served as controls. Bone-mineral density varied greatly but averaged nearly one standard deviation below the age-matched normal means for both the proximal parts of the femora (-0.92 standard deviation) and the lumbar spine (-0.80 standard deviation). Ambulatory status was the factor that best correlated with bone-mineral density. Nutritional status, assessed on the basis of caloric intake, skinfolds, and body-mass index, was the second most significant variable. The pattern of involvement, durations of immobilization in a cast, and a calcium intake of less than 500 milligrams per day were additional factors of less significance. The age when the child first walked, previous fractures, use of anticonvulsants, and serum vitamin-D levels did not correlate with bone-mineral density after adjustment for covariance with the ambulatory status and the nutritional status. Serum levels of calcium, phosphate, alkaline phosphatase, and osteocalcin were not reliable indicators of low bone-mineral density.
Bisphosphonates to treat osteopenia in children with quadriplegic cerebral palsy: a randomized, placebo-controlled clinical trial.
date: 11/01/2002
author: Henderson RC, Lark RK, Kecskemethy HH, Miller F, Harcke HT, Bachrach SJ.
publication: J Pediatr. 2002 Nov;141(5):644-51.
pubmed_ID: 12410192
OBJECTIVE: To evaluate in a double-blind, placebo-controlled clinical trial the safety and efficacy of intravenous pamidronate to treat osteopenia in nonambulatory children with cerebral palsy. STUDY DESIGN: Six pairs of subjects generally matched within each pair for age, sex, and race completed the protocol. One member of each pair randomly received plain saline placebo, the other pamidronate. Drug/placebo was administered intravenously daily for 3 consecutive days, and this 3-day dosing session was repeated at 3-month intervals for one year. Evaluations were continued for 6 months after the year of treatment. Bone mineral density (BMD) was measured in the distal femur, a site specifically developed for use in this contracted population, and the lumbar spine. RESULTS: In the metaphyseal region of the distal femur, BMD increased 89% +/- 21% (mean +/- SEM) over the 18-month study period in the pamidronate group compared with 9% +/- 6% in the control group. Age-normalized z scores increased from -4.0 +/- 0.6 to -1.8 +/- 1.0 in the pamidronate group and did not significantly change in the control group (-4.2 +/- 0.3 to -4.0 +/- 0.3). The first dosing with pamidronate caused a transient drop in serum calcium that was asymptomatic and not treated. No other potentially adverse effects were noted. CONCLUSIONS: In this small controlled clinical trial, pamidronate was found to be a safe and very effective agent to increase BMD in nonambulatory children with cerebral palsy.
Quantifying weight-bearing by children with cerebral palsy while in passive standers.
date: 12/01/2007
author: Herman D, May R, Vogel L, Johnson J, Henderson RC.
publication: Pediatr Phys Ther. 2007 Winter;19(4):283-7.
pubmed_ID: 18004195
PURPOSE: Children who are nonambulatory are placed into standers with the goal of providing benefits from weight-bearing. The purpose of this study was to quantify weight-bearing loads by children with cerebral palsy while in standers. METHODS: Electronic load-measuring footplates were fabricated specifically for this study. Weight-bearing loads were continuously measured in 19 children who were nonambulatory during routine 30-minute standing sessions (3-6 sessions/child, total 110 sessions). RESULTS: Weight-bearing ranged widely (23%-102%) with a mean of 68% of body weight. There was some variation over the course of a session and between different sessions, but more variance was noted between subjects. CONCLUSIONS: Actual weight borne in a stander is quite variable, and in some instances only a fraction of actual body weight. Further studies are required to delineate relevant factors and identify ways to maximize weight-bearing loads while in a stander.
Orthostasis and transcapillary fluid shifts.
date: 01/01/1995
author: Hinghofer-Szalkay HG.
publication: J Gravit Physiol. 1995;2(1):P131-3.
pubmed_ID:Â 11538896
Postural blood volume changes aggravate the regulation of arterial blood pressure and perfusion vis-a-vis the hydrostatic effects of orthostasis, ie, blood pooling below the hydrostatic indifferent points and reduced cardiac preload. Corresponding problems surface with extended passive standing, particularly in highly trained, dehydrated, or otherwise compromised subjects, or after long-lasting immobilization, as with space flight.
Effect of standing on spasticity, contracture, and osteoporosis in paralyzed males.
date: 01/01/1993
author: Kunkel CF, Scremin AM, Eisenberg B, Garcia JF, Roberts S, Martinez S.
publication: Arch Phys Med Rehabil. 1993 Jan;74(1):73-8.
pubmed_ID: 8420525
The effect of “standing” in a frame on spasticity (clinical assessment and H-reflex), contracture (lower extremity joint range of motion), and osteoporosis (dual photon absorptiometry) was studied in six paralyzed males (mean age 49 yr) who had been confined to wheelchairs for an average of 19 years. Standing time averaged 144 hours over a mean of 135 days. Clinical Assessment measured reflexes, tone, and clonus in the legs. Results revealed no important differences between initial and final scores for clinical assessment and joint range of motion. In three subjects for whom H-reflexes were found, latency and amplitude were not altered by “standing.” Bone density was normal in the lumbar spine but significantly reduced in the femoral neck. “Standing” did not modify the bone density in any site. A follow-up interview revealed that 67% of subjects continued to “stand” and felt healthier because of it. In summary, “standing” had no ill effects, did not alter measured variables, and had a positive psychological impact.