Author: zingleader

Posted on by

Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries?

date: 2005;51(4):251-6.
author: Ben M.
publication: Aust J Physiother.
PubMed ID:16321132

 

Abstract

The purpose of this study was to determine the effects of a 12-week standing program on ankle mobility and femur bone mineral density in patients with lower limb paralysis following recent spinal cord injury. An assessor-blinded within-subject randomised controlled trial was undertaken. Twenty patients with lower limb paralysis following a recent spinal cord injury were recruited. Subjects stood weight-bearing through one leg on a tilt-table for 30 minutes, three times each week for 12 weeks. By standing on one leg a large dorsiflexion stretch was applied to the ankle and an axial load was applied to the bones of the weight-bearing leg. Ankle mobility and femur bone mineral density of both legs were measured at the beginning and end of the study. Ankle mobility (range of motion) was measured with the application of a 17 Nm dorsiflexion torque. Femur bone mineral density was measured using dual energy X-ray absorptiometry (DEXA). The effect of standing was estimated from the difference between legs in mean change of ankle mobility and femur bone mineral density. The results indicated a mean treatment effect on ankle mobility of 4 degrees (95% CI 2 to 6 degrees) and on femur bone mineral density of 0.005 g/cm(2) (95% CI -0.015 to 0.025 g/cm(2)). Tilt-table standing for 30 minutes, three times per week for 12 weeks has a small effect on ankle mobility, and little or no effect on femur bone mineral density. It is unclear whether clinicians and patients would consider such effects to be clinically worthwhile.

Posted on by

Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke

date: 2007 Jul;21(7):614-9.
author: Allison R, Dennett R.
publication: Clin Rehabil.
PubMed ID:17702703

Abstract

OBJECTIVE:

To investigate whether provision of additional standing practice increases motor recovery and mobility post stroke.

DESIGN:

A pilot randomized controlled trial.

SETTING:

A stroke rehabilitation unit in the UK.

PARTICIPANTS:

Seventeen participants, seven women and ten men, age range 51-92 admitted to the unit 6-58 days post stroke.

INTERVENTION:

Each participant was randomly allocated into a control (conventional physiotherapy) or treatment (conventional therapy plus an additional session of standing practice) group. The period of intervention ranged from 14 to 28 days dependent upon length of stay on the unit.

OUTCOME MEASURES:

The Gross Functional Tool Section of the Rivermead Motor Assessment, the Trunk Control Test and the Berg Balance Scale were used on admission to the study, at weekly intervals during the intervention, and at 12 weeks (after discharge).

RESULTS:

Of the 17 participants recruited, three withdrew from the additional intervention group citing fatigue as a barrier and 15 completed the study. Participants completing additional standing practice demonstrated higher scores in all motor measures at week 12, but this difference was not statistically significant. There was a statistically significant difference (P < 0.05) in the changes in Berg Balance score when comparing week 1 with week 12, in support of the group receiving extra standing practice.

CONCLUSIONS:

A larger study is required to establish the value of additional standing practice after stroke. This pilot demonstrates that the Gross Functional Tool Section of the Rivermead Motor Assessment and the Berg Balance Scale would be useful in such a study. Fatigue may be a significant barrier to ability to participate in more intensive programmes so screening participants for severe fatigue may be useful.

Posted on by

Comparison of the effects of body-weight-supported treadmill training and tilt-table standing on spasticity in individuals with chronic spinal cord injury.

date: 2011;34(5):488-94.
author: Adams MM, Hicks AL.
publication: J Spinal Cord Med.
PubMed ID: 22118256

Abstract

OBJECTIVE:

Determine the effects of body-weight–supported treadmill training (BWSTT) and tilt-table standing (TTS) on clinically assessed and self-reported spasticity, motor neuron excitability, and related constructs in individuals with chronic spinal cord injury (SCI).

DESIGN:

Random cross-over.

METHODS:

Seven individuals with chronic SCI and spasticity performed thrice-weekly BWSTT for 4 weeks and thrice-weekly TTS for 4 weeks, separated by a 4-week wash-out. Clinical (Modified Ashworth Scale, Spinal Cord Assessment Tool for Spinal reflexes) and self-report (Spinal Cord Injury Spasticity Evaluation Tool, Penn Spasm Frequency Scale) assessments of spasticity, quality of life (Quality of Life Index Spinal Cord Injury Version – III), functional mobility (FIM Motor Subscale), plus soleus H-reflex were measured at baseline, after the first training session and within 2 days of completing each training condition.

RESULTS:

In comparison with TTS, a single session of BWSTT had greater beneficial effects for muscle tone (effect size (ES) = 0.69), flexor spasms (ES = 0.57), and the H/M ratio (ES = 0.50). Similarly, flexor spasms (ES = 0.79), clonus (ES = 0.66), and self-reported mobility (ES = 1.27) tended to benefit more from 4 weeks of BWSTT than of TTS. Participation in BWSTT also appeared to be favorable for quality of life (ES = 0.50). In contrast, extensor spasms were reduced to a greater degree with TTS (ES = 0.68 for single session; ES = 1.32 after 4 weeks).

CONCLUSION:

While both BWSTT and TTS may provide specific benefits with respect to spasticity characteristics, data from this pilot study suggest that BWSTT may result in a broader range of positive outcomes.

Posted on by

Prevalence of joint contractures and muscle weakness in people with multiple sclerosis

date: 2014;36(19):1588-93
author: Hoang PD1, Gandevia SC, Herbert RD.
publication: Disabil Rehabil.
pubmed_ID: 24236496

 

Abstract

OBJECTIVES:

To investigate the prevalence of joint contracture (limited passive range of joint motion) and muscle weakness in a population with multiple sclerosis (MS). A secondary aim was to establish normative data of functional tests of mobility and balance of people with MS who are still ambulant.

DESIGN:

Cross-sectional study.

SETTING:

People with MS living in metropolitan Sydney, Australia.

PARTICIPANTS:

330 people with MS living in metropolitan Sydney, Australia were randomly sampled on 23 July 2009 from the MS Australia register and invited to participate.

MAIN OUTCOME MEASURES:

Passive range of motion of large joints of the limbs and muscle strength. Tests of walking and balance were also conducted.

RESULTS:

156 people (109 females, 47 males; mean age 54.2 years; mean time since diagnosis 14.9 years) agreed to participate and were assessed. Fifty-six per cent (56%) of participants had contracture in at least one major joint of upper or lower limb. The most common site of contracture was the ankle (43.9%). Seventy per cent (70%) of participants had muscle weakness in one or more muscle groups. As muscle weakness, joint contractures were present at early stage of MS and the prevalence was associated with the progression of the disease.

CONCLUSIONS:

These data show that in addition to muscle weakness joint contractures are highly prevalent among people with MS, especially in the ankle joint. This implicates that prevention of contracture is crucial in providing rehabilitation to people with MS.

Posted on by

The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke

date: 2008 Dec;39(12):3329-34
author: Sackley C1, Brittle N, Patel S, Ellins J, Scott M, Wright C, Dewey ME.
publication: Stroke
pubmed_ID:18787199

 

Abstract

BACKGROUND AND PURPOSE:

Complications after stroke have been shown to impede rehabilitation, lead to poor functional outcome, and increase cost of care. This inception cohort study sought to investigate the prevalence of immobility-related complications during the first year after severely disabling stroke in relation to functional independence and place of residence.

METHODS:

Over a 7-month period, 600 stroke survivors were identified in the hospital through the Nottingham Stroke Register. Those who had a Barthel Index score <or=10 3 months poststroke and did not have a primary diagnosis of dementia were eligible to participate in the study. Assessments of complications were carried out at 3, 6, and 12 months poststroke.

RESULTS:

Complications were recorded for 122 stroke survivors (mean age, 76 years; 57% male). Sixty-three (52%) had significant language impairment and of the remaining 59 who were able to complete an assessment of cognitive function, 10 (8%) were cognitively impaired. The numbers of reported complications over 12 months, in rank order, were falls, 89 (73%); contracture, 73 (60%); pain, 67 (55%); shoulder pain, 64 (52%); depression, 61 (50%); and pressure sores, 26 (22%). A negative correlation was found between Barthel Index score and the number of complications experienced (low scores on the Barthel Index correlate with a high number of complications). The highest relative percentages of complications were experienced by patients who were living in a nursing home at the time of their last completed assessment.

CONCLUSIONS:

Immobility-related complications are very common in the first year after a severely disabling stroke. Patients who are more functionally dependent in self-care are likely to experience a greater number of complications than those who are less dependent. Trials of techniques to limit and prevent complication are required.

Posted on by

RESNA POSITION ON THE APPLICATION OF WHEELCHAIR STANDING DEVICES: 2013 CURRENT STATE OF THE LITERATURE

date: Dec. 23, 2013
author: Dicianno BE, Morgan A, Lieberman J, Rosen L
publication: Assit Technol.
pubmed_ID: 26910615

This article, approved by the Rehabilitation Engineering & Assistive Technology Society of North America Board of Directors on December 23, 2013, shares typical clinical applications and provides evidence from the literature supporting the use of wheelchair standers

Full Text