Author: zingleader

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The effects of lower-extremity functional electric stimulation on the orthostatic responses of people with tetraplegia.

date: 2005 Jul;86(7):1427-33.
author: Chao CY.
publication: Arch Phys Med Rehabil
PubMed ID:16003676

 

Abstract

OBJECTIVE:

To determine whether application of functional electric stimulation (FES) to lower-limb muscles during postural tilting improves orthostatic tolerance in people with tetraplegia.

DESIGN:

A crossover design.

SETTING:

A rehabilitation hospital.

PARTICIPANTS:

Sixteen acute and chronic subjects with tetraplegia (15 men, 1 woman) with complete motor function loss at the C3-7 levels were recruited. Time since injury ranged from 2 to 324 months (mean, 118.9+/-104.2 mo).

INTERVENTION:

Subjects were tested on a progressive head-up tilting maneuver with and without the application of FES at 0 degrees , 15 degrees , 30 degrees , 45 degrees , 60 degrees , 75 degrees , and 90 degrees continuously for up to 1 hour. FES was administered to 4 muscle groups including the quadriceps, hamstrings, tibialis anterior, and gastrocnemius muscles bilaterally at an intensity that provided a strong, visible, and palpable contraction. This was to produce a muscle pumping mechanism during the tilting maneuver.

MAIN OUTCOME MEASURES:

Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, perceived presyncope score, and the overall duration of orthostatic tolerance, that is, the time that subjects could tolerate the tilting maneuver without developing severe hypotension or other intolerance symptoms.

RESULTS:

When the tilt angle was increased, the subjects’ SBP and DBP tended to decrease, whereas the heart rate tended to increase in both testing conditions. Adding FES to tilting significantly attenuated the drop in SBP by 3.7+/-1.1 mmHg (P = .005), the drop in DBP by 2.3+/-0.9 mmHg (P = .018), and the increase in heart rate by 1.0+/-0.5 beats/min (P = .039) for every 15 degrees increment in the angle of the tilt. FES increased the overall mean standing time by 14.3+/-3.9 min (P = .003).

CONCLUSIONS:

An FES-induced leg muscle contraction is an effective adjunct treatment to delay orthostatic hypotension caused by tilting; it allows people with tetraplegia to stand up more frequently and for longer durations.

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Orthostatic hypotension following spinal cord injury: impact on the use of standing apparatus

date: 2009;24(3):237-42
author: Chelvarajah R.
publication: NeuroRehabilation
PubMed ID19458431

 

Abstract

INTRODUCTION:

Upright posture confers numerous medical and social benefits to a spinal cord injured (SCI) patient. Doing so is limited by symptoms of orthostatic hypotension. This is a common secondary impairment among tetraplegic sufferers.

OBJECTIVE:

Establish the proportion of SCI patients who are restricted from using standing apparatus, such as standing frames and standing wheelchairs, because of inducing symptomatic orthostatic hypotension or the fear of developing these disabling symptoms.

STUDY DESIGN:

Survey conducted by Internet-accessible electronic questionnaire. Questionnaire validated for reliability and accuracy.

RESULTS:

293 respondents. Mean age 44.6; 76% male. Median time from injury: 7 years. 38% suffered with orthostatic hypotension; majority were complete injuries and all (except one – T12) were T5 or above level. 52% replied that they were using standing wheelchairs or frames. Of these, 59 (20% of total) stated that orthostatic hypotension symptoms were limiting the use of their upright apparatus. Of those who did not use standing wheelchairs or frames, 16 (5.5% of total) reported that this was because of the fear of worsening their orthostatic hypotension.

CONCLUSION:

Orthostatic hypotension restricts standing apparatus use in a large proportion (a total of 25.5% of respondents in this survey) of SCI patients.

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Weight bearing through lower limbs in a standing frame with and without arm support and low-magnitude whole-body vibration in men and women with complete motor paraplegia

date: 2012 Apr;91(4):300-8. doi
author: Bernhardt KA
publication: Am J Phys Med Rehabil
PubMed ID:22407161

Abstract

OBJECTIVE:

The aim of the study was to determine the proportion of body weight borne through the lower limbs in persons with complete motor paraplegia using a standing frame, with and without the support of their arms. We also examined the effect of low-magnitude whole-body vibration on loads borne by the lower limbs.

DESIGN:

Vertical ground reaction forces (GRFs) were measured in 11 participants (six men and five women) with paraplegia of traumatic origin (injury level T3-T12) standing on a low-magnitude vibrating plate using a standing frame. GRFs were measured in four conditions: (1) no vibration with arms on standing frame tray, (2) no vibration with arms at side, (3) vibration with arms on tray, and (4) vibration with arms at side.

RESULTS:

GRF with arms on tray, without vibration, was 0.76 ± 0.07 body weight. With arms at the side, GRF increased to 0.85 ± 0.12 body weight. With vibration, mean GRF did not significantly differ from no-vibration conditions for either arm positions. Oscillation of GRF with vibration was significantly different from no-vibration conditions (P < 0.001) but similar in both arm positions.

CONCLUSIONS:

Men and women with paraplegia using a standing frame bear most of their weight through their lower limbs. Supporting their arms on the tray reduces the GRF by approximately 10% body weight. Low-magnitude vibration provided additional oscillation of the load-bearing forces and was proportionally similar regardless of arm position.

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Mobility aids and transport possibilities 10-45 years after spinal cord injury

date: 2004 Dec;42(12):699-706
author: Biering-Sorensen F.
publication: Spinal Cord.
PubMed ID15289807

Abstract

STUDY DESIGN:

A cross-sectional survey with retrospective data.

OBJECTIVE:

Follow-up information on the use of mobility aids and transportation possibilities in a chronic traumatic spinal cord injury (SCI) population.

SETTING:

Clinic for Para- and Tetraplegia at Rigshospitalet, University hospital, Denmark (CPT). The uptake area is East Denmark with a population of 2.5 million inhabitants.

METHODS:

Survey on date of birth, gender, time of SCI, cause of SCI, neurological level and functional classification from medical files were combined with information concerning mobility aids and transport possibilities at the time of follow-up from a mailed questionnaire.

MATERIAL:

Individuals with traumatic SCI before 1 January 1991 were still in regular follow-up at CPT, and with sufficient medical record. A total of 279 were included, out of which 236 answered the questionnaire. Of the 193 men and 43 women injured from 1956 to 1990 the response rate was 84.6%. Age at the time of follow-up was 50.5 years in mean, and follow-up time was 24.1 years in mean. In all, 126 were paraplegic and 110 tetraplegic. Responders and nonresponders were comparable.

RESULTS:

In all, 3.4% used no special mobility aids at all. In total, 49 used crutches or rolling walkers and 26 lower extremities bracing, but mostly in combination with a wheelchair. Standing frame and stand-up wheelchair were used by men only. Manual wheelchair was used by 83.5% and electrical wheelchair by 27%, and the latter more by the tetraplegics. In all, 9.3% had neither a manual nor an electrical wheelchair. Overall, 86.4% had a passenger van or another car. Women used a car less often. Passenger vans were more often used by tetraplegics.

CONCLUSION:

Nearly all SCI participants had mobility aids of some sort, and 90.7% had either a manual or an electrical wheelchair or both. Most had a passenger van or another type of car for transportation. These facilities are important for the individuals to obtain an independent living.

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Robotic tilt table reduces the occurrence of orthostatic hypotension over time in vegetative states

date: 2015 Jun;38(2):162-6.
author: Taveggia G.
publication: Int. J Rhabil Res.
PubMed ID:25591054

Abstract

The aim of this study is to evaluate the effects of verticalization with or without combined movement of the lower limbs in patients in a vegetative state or a minimally conscious state. In particular, we aimed to study whether, in the group with combined movement, there was better tolerance to verticalization. This was a randomized trial conducted in a neurorehabilitation hospital. Twelve patients with vegetative state and minimally conscious state 3-18 months after acute acquired brain injuries were included. Patients were randomized into A and B treatment groups. Study group A underwent verticalization with a tilt table at 65° and movimentation of the lower limbs with a robotic system for 30 min three times a week for 24 sessions. Control group B underwent the same rehabilitation treatment, with a robotic verticalization system, but an inactive lower-limb movement system. Systolic and diastolic blood pressure and heart rate were determined. Robotic movement of the lower limbs can reduce the occurrence of orthostatic hypotension in hemodynamically unstable patients. Despite the small number of patients involved (only eight patients completed the trial), our results indicate that blood pressures and heart rate can be stabilized better (with) by treatment with passive leg movements in hemodynamically unstable patients.

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Does regular standing improve bowel function in people with spinal cord injury? A randomised crossover trial

date: 2015 Jan;53(1):36-41. doi:
author: Kwok S.
publication: Spinal Cord.
PubMed ID:25366527

Abstract

STUDY DESIGN:

A randomised crossover trial.

OBJECTIVES:

To determine the effects of a 6-week standing programme on bowel function in people with spinal cord injury.

SETTING:

Community, Australia and the United Kingdom.

METHODS:

Twenty community-dwelling people with motor complete spinal cord injury above T8 participated in a 16-week trial. The trial consisted of a 6-week stand phase and a 6-week no-stand phase separated by a 4-week washout period. Participants were randomised to one of two treatment sequences. Participants allocated to the Treatment First group stood on a tilt table for 30 min per session, five times per week for 6 weeks and then did not stand for the next 10 weeks. Participants allocated to the Control First group did the opposite: they did not stand for 10 weeks and then stood for 6 weeks. Participants in both groups received routine bowel care throughout the 16-week trial. Assessments occurred at weeks 0, 7, 10 and 17 corresponding with pre and post stand and no-stand phases. The primary outcome was Time to First Stool. There were seven secondary outcomes reflecting other aspects of bowel function and spasticity.

RESULTS:

There were three dropouts leaving complete data sets on 17 participants. The mean (95% confidence interval) between-intervention difference for Time to First Stool was 0 min (-7 to 7) indicating no effect of regular standing on Time to First Stool.

CONCLUSION:

Regular standing does not reduce Time to First Stool. Further trials are required to test the veracity of some commonly held assumptions about the benefits of regular standing for bowel function

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The effect of progressive task-oriented training on a supplementary tilt table on lower extremity muscle strength and gait recovery in patients with hemiplegic stroke.

date: 2015 Feb;41(2):425-30. doi
author: Kim C-Y.
publication: Gait Posture
PubMed ID:25467171

Abstract

The purpose of this study was to determine the influence of progressive task–oriented training on a supplementary tilt table on the lower extremity (LE) muscle strength and spatiotemporal parameters of gait in subjects with hemiplegic stroke. Thirty subjects between three and nine months post stroke were included in this study. Thirty subjects were randomly allocated to a control group (CG, n1=10), experimental group I (EG1, n2=10), and experimental group II (EG2, n3=10). All of the subjects received routine therapy for half an hour, five times a week for three weeks and additionally received training on the following three different tilt table applications for 20min a day: (1) both knee belts of the tilt table were fastened (CG), (2) only the affected side knee belt of the tilt table was fastened and one-leg standing training was performed using the less-affected LE (EG1), and (3) only the affected side knee belt of the tilt table was fastened and progressive task–oriented training was performed using the less-affected LE (EG2). The effect of tilt table applications was assessed using a hand-held dynamometer for LE muscle strength and GAITRite for spatiotemporal gait data. Our results showed that there was a significantly greater increase in the strength of all LE muscle groups, gait velocity, cadence, and stride length, a decrease in the double limb support period, and an improvement in gait asymmetry in subjects who underwent progressive task–oriented training on a supplementary tilt table compared to those in the other groups. These findings suggest that progressive task–oriented training on a supplementary tilt table can improve the LE muscle strength and spatiotemporal parameters of gait at an early stage of rehabilitation of subjects with hemiplegic stroke

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Lower extremity muscle activation and function in progressive task-oriented training on the supplementary tilt table during stepping-like movements in patients with acute stroke hemiparesis.

date: 2015 Jun;25(3):522-30
author: Kim C-Y.
publication: J Electromyogr Kinesiol.
PubMed ID:25863464

Abstract

An effective and standardized method for applying a tilt table as a supplementary treatment in the early rehabilitation of stroke patients is still missing. The aim of this study was to determine the influence of progressive task-oriented training on the tilt table on the improvement in lower extremity (LE) muscle activation and clinical function in subjects with hemiplegia due to stroke. Thirty-nine subjects with acute stroke were randomly allocated to three groups; control group, tilt table group, and task-oriented training group on the tilt table, with 13 patients, respectively. All of the subjects received the routine therapy for half an hour, and subjects in the experimental groups additionally received training on two different tilt table applications for 20min a day, five times a week for three weeks. The effect of tilt table applications was assessed using the surface electromyography (EMG) analysis during stepping-like movements on the tilt table for LE muscle activation and clinical scores for function. Our results showed that there was a significantly greater increase in the EMG patterns of the extensors and flexors of the affected leg muscles during flexion and extension movements of both legs and clinical scores in patients undergoing the progressive task-oriented training on the tilt table compared to the other groups. These findings suggest that progressive task-oriented training on the tilt table can improve LE muscle activation and clinical scores of functional performance for early rehabilitation of subjects with acute stroke.

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Non-surgical management of ankle contracture following acquired brain injury.

date: 2004 Mar 18;26(6):335-45.
author: Singer B.
publication: Disabil Rehabil
PubMed ID:15204485

Abstract

BACKGROUND AND PURPOSE:

The purpose of this study was to document the outcome of non-surgical management of equinovarus ankle contracture in a cohort of patients with acquired brain injury admitted to a specialist Neurosurgical Rehabilitation Unit.

METHODS:

This prospective descriptive study examined all patients with a new diagnosis of moderate to severe acquired brain injury (Glasgow Coma Scale score </=12) admitted for rehabilitation over a 1 year period. Ankle dorsiflexion range and plantarflexor/invertor muscle activity were evaluated weekly during the period of hospitalization. Contracture was defined as maximal passive range of motion </= 0 degrees dorsiflexion, with the knee extended, on a minimum of two measurement occasions. Patients were retrospectively allocated to one of four treatment outcome categories according to ankle dorsiflexion range, type of intervention required and response to treatment.

RESULTS:

Ankle contracture was identified in 40 of the 105 patients studied. Contracture resolved with a standard physiotherapy treatment programme, including prolonged weight-bearing stretches and motor re-education, in 23 patients. Contracture persisted or worsened in 17 of 40 cases, all of whom exhibited dystonic muscle overactivity producing sustained equinovarus posturing. Ten of 17 cases required serial plaster casting (+/- injection of botulinum toxin type A) in order to achieve a functional range of ankle motion. Remediation of ankle contracture was not considered a priority in the remaining seven patients due to the severity of their overall disability.

CONCLUSION:

The incidence of ankle contracture identified in this population was considerably less than previously reported. Reduced dorsiflexion range was remediated with standard physiotherapy treatment in over half of the cases. Additional treatment with serial casting +/- botulinum toxin type-A injection was required to correct persistent or worsening contracture in one quarter of cases. Dystonic extensor muscle overactivity was a major contributor to persistent or progressive ankle contracture.