Author: zingleader

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Comparison of orthostatic reactions of patients still unconscious within the first three months of brain injury on a tilt table with and without integrated stepping. A prospective, randomized crossover pilot trial

date: 2008 Dec;22(12):1034-41.
author: Luther MS1, Krewer C, Müller F, Koenig E.
publication:Clin Rehabil.
pubmed_ID:19052242

 

Abstract

OBJECTIVE:

To determine whether passive leg movement during tilt table mobilization reduces the incidence of orthostatic dysfunction in mobilization of patients being comatose or semi-comatose early after brain injury.

DESIGN:

Randomized crossover pilot trial using sequential testing.

SETTING:

Neurorehabilitation hospital.

SUBJECTS:

Nine patients still unconscious within the first three months of brain injury (5 men, 4 women; age 51 +/- 20 years).

INTERVENTION:

Patients were subjected once to a conventional tilt table and once to a tilt table with an integrated stepping device.

MAIN OUTCOME MEASURE:

The number of syncopes/presyncopes (orthostatic hypotension, tachypnoea, increased sweating) during interventions.

RESULTS:

One patient had presyncopes on both devices, six patients had presyncopes on the conventional tilt table but not on the tilt table with integrated stepping, and two patients did not exhibit presyncopal symptoms on either device. There were significantly more incidents on the tilt table without than on the one with an integrated stepping device (P < 0.05) at tilts of 50 or 70 degrees respectively.

CONCLUSION:

Patients tolerate greater degrees of head-up tilt better with simultaneous leg movement.

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The pieces fall into place”: the views of three Swedish habilitation teams on conductive education and support of disabled children.

date: 2003 Mar;26(1):11-20.
author: Lind L.
publication: Int J Rehabil Res.
pubmed_ID: 12601263

 

Box 47 308, SE-100 74 Stockholm, Sweden.

Abstract

A survey concerning how Swedish habilitation staff view the support of disabled children and their families was conducted in 2001. It focused on what support the staff knew about, offered and considered good for the children and parents, and on how they viewed conductive education. Interviews were conducted with 25 team members in three habilitation teams in the south of Sweden. The results show that the support habilitation staff most feel children need is the opportunity to investigate their surroundings, play with other children, meet other children in the same situation and try out different activities. The support that parents are felt to need is mainly aid and housing adaptation, relief, financial help, information, medical knowledge, emotional support and to meet others in the same situation. The staff gave information pertaining to different methods of treatment only if the parents specifically asked for it. What the habilitation teams recommended were contracture prophylaxis, motor skills exercises, riding, swimming, splints, standing shells, surgery, injections and medicines. The habilitation staff were of the opinion that conductive education is focused purely on intensive mobility training.

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Whole-body vibration alters blood flow velocity and neuromuscular activity in Friedreich’s ataxia.

date: 2011 Mar;31(2):139-44.
author: Herrero AJ1, Martín J, Martín T, García-López D, Garatachea N, Jiménez B, Marín PJ.
publication: Clin Physiol Funct Imaging.
pubmed_ID:21078065

Abstract

The purpose of this study was to investigate the effects of whole–body vibration (WBV) on blood flow velocity and muscular activity after different vibration protocols in Friedreich’s ataxia (FA) patients. After two familiarization sessions ten patients received six 3 min WBV treatments depending on a combination of frequency (10, 20 or 30 Hz) and protocol (constant or fragmented). Femoral artery blood flow velocity, vastus lateralis (VL) and vastus medialis (VM) electromyography (EMG), and rate of perceived exertion were registered. Peak blood velocity was increased with respect to basal values after 1, 2 and 3 min of WBV (14·8%, 18·8% and 19·7%, respectively, P<0·001). Likewise, mean blood velocity was increased with respect to basal values after 1, 2 and 3 min of WBV (17·3%, 19·4% and 16·6%, respectively, P<0·001). EMG amplitude of VL and VM was increased (39% and 23%, respectively, P<0·05) and EMG frequencies decreased during the application of WBV. The results of this study suggest that higher frequencies (30 Hz) produce a greater increase in blood flow velocity and rate of perceived exertion. WBV is an effective method to increase blood flow and to activate muscle mass in patients with Friedreich’s ataxia, and could therefore be considered to be incorporated in rehabilitation programs of this collective.

 

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Factors affecting prescription and implementation of standing-frame programs by school-based physical therapists for children with impaired mobility

date: 2009 Fall;21(3):282-8. doi: 10.1097/PEP.0b013e3181b175cd
author: Taylor K.
publication: Pediatr Phys Ther.
pubmed_ID:19680071

 

Abstract

PURPOSE:

The purpose of this study was to investigate factors considered in the prescription and implementation of standing–frame programs by school–based physical therapists.

METHODS:

A 20-item survey was mailed to 500 members of the APTA Pediatric Section and School–Based Special Interest Group. Survey questions addressed standing–frame program prescription and perceived benefits.

RESULTS:

Response rate was 77.2%. A majority of respondents rated ambulatory status for the prescription of standing–frame programs and a child‘s specific needs in the selection of a specific standing frame as very important. Respondents identified multiple benefits with pressure relief rated very important most frequently. More than 50% of respondents indicated social and educational benefits are very important. A majority of respondents prescribed standing–frame programs for 30-45 minutes daily.

CONCLUSIONS:

Variation does exist, but the majority of school–based physical therapists agree on several key factors in the prescription and implementation of standing–frame programs.

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A systematic review of supported standing programs

date: 2010;3(3):197-213. doi: 10.3233/PRM-2010-0129.
author: Glickman LB1, Geigle PR, Paleg GS.
publication: J Pediatr Rehabil Med.
pubmed_ID:PMID:21791851

 

The routine clinical use of supported standing in hospitals, schools and homes currently exists. Questions arise as to the nature of the evidence used to justify this practice. This systematic review investigated the available evidence underlying supported standing use based on the Center for Evidence-Based Medicine (CEBM) Levels of Evidence framework.

DESIGN:

The database search included MEDLINE, CINAHL, GoogleScholar, HighWire Press, PEDro, Cochrane Library databases, and APTAs Hooked on Evidence from January 1980 to October 2009 for studies that included supported standing devices for individuals of all ages, with a neuromuscular diagnosis. We identified 112 unique studies from which 39 met the inclusion criteria, 29 with adult and 10 with pediatric participants. In each group of studies were user and therapist survey responses in addition to results of clinical interventions.

RESULTS:

The results are organized and reported by The International Classification of Function (ICF) framework in the following categories: b4: Functions of the cardiovascular, haematological, immunological, and respiratory systems; b5: Functions of the digestive, metabolic, and endocrine systems; b7: Neuromusculoskeletal and movement related functions; Combination of d4: Mobility, d8: Major life areas and Other activity and participation. The peer review journal studies mainly explored using supported standers for improving bone mineral density (BMD), cardiopulmonary function, muscle strength/function, and range of motion (ROM). The data were moderately strong for the use of supported standing for BMD increase, showed some support for decreasing hypertonicity (including spasticity) and improving ROM, and were inconclusive for other benefits of using supported standers for children and adults with neuromuscular disorders. The addition of whole body vibration (WBV) to supported standing activities appeared a promising trend but empirical data were inconclusive. The survey data from physical therapists (PTs) and participant users attributed numerous improved outcomes to supported standing: ROM, bowel/bladder, psychological, hypertonicity and pressure relief/bedsores. BMD was not a reported benefit according to the user group.

CONCLUSION:

There exists a need for empirical mechanistic evidence to guide clinical supported standing programs across practice settings and with various-aged participants, particularly when considering a life-span approach to practice.

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Thirty-Degree Prone Positioning Board for Children with Gastroesophageal Reflux: Suggestion from the Field

date: 1984 Aug;64(8):1240-1.
author:Bubenko S, Flesch P, Kollar C.
publication: Phys Ther
pubmed_ID:6463113

 

 

This excerpt was created in the absence of an abstract.

Gastroesophageal reflux (GER) or chalasia in infants can be defined simply as the regurgitation of gastric contents from the abdominal stomach into the thoracic esophagus.1 Chief among its clinical manifestations is recurrent emesis during and after feedings.1,2 This symptom is present in up to 95 percent of reported cases.2 In addition, any or all of the following disorders may be present: anemia, failure to thrive, nocturnal wheeze or cough, recurrent pneumonia because of aspiration, recurrent bronchitis, near-miss sudden infant death syndrome, and abnormal head positioning (Sandifer syndrome).1,2

An important aspect of the treatment regimen for these patients is positioning during and after feeding. Numerous reports in the literature suggest an upright posture in an infant seat at 45 to 60 degrees after feeding will decrease the incidence of GER.3 Other references suggest a prone posture at 30 degrees after feeding will also decrease the incidence of GER in infants.2,4,5

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Functional status of adults with cerebral palsy and implications for treatment of children

date:  2001 Aug;43(8):516-28.
author: Bottos M1, Feliciangeli A, Sciuto L, Gericke C, Vianello A.
publication: Dev Med Child Neurol.
pubmed_ID:11508917

Abstract

This study examined the evolution of individuals with cerebral palsy (CP) from childhood to adulthood. Seventy-two adults with a diagnosis of CP born between 1934 and 1980 were studied. Individuals were recruited and data comprehensively collected using case notes and through direct assessments of the majority of participants from three rehabilitation units in Bologna, Padua, and Rovigo in Italy. The main findings can be summarized as follows: contact with health and rehabilitation services was radically reduced once individuals reached adulthood; more individuals who were integrated into mainstream schools achieved and maintained literacy than those who had attended special schools; in a high number of participants, motor performance deteriorated once into adulthood. Independent walking or other forms of supported locomotion were lost in many on reaching adulthood. Of those who continued to walk, walking deteriorated in terms of distance. It was concluded that even though CP has been considered as predominantly a childhood pathological condition, the evolution of the effects of CP do not stop at 16 or 18 years of age. For this reason, the traditional child- (or infant-) oriented approach concentrating mainly or exclusively on the achievement of independent walking, may not be an ideal approach to children with CP. Instead a more independence-oriented therapeutic approach would be appropriate.

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Nonoperative treatment of osteogenesis imperfecta: orthotic and mobility management.

date: 1981 Sep;(159):111-22
author: Bleck E E
publication: Clinical Orthopedic Relat Re
pubmed ID: 7285447

Abstract

The problem of osteoporosis superimposed on the basic collagen defect of osteogenesis imperfecta has been approached by the use of plastic containment orthoses for the lower limbs, in addition to developmentally staged mobility devices that assist early standing and walking. The purpose of forcing early weight-bearing is to provide stress to the lower limb bones in order to minimize osteoporosis, prevent refracture and deformity, and curb subsequent immobilization osteoporosis, thus breaking a vicious cycle. Management goals are based upon adult needs for independence: efficiency in daily living activities and in mobility. These goals were reached in most of our patients via use of plastic orthoses, early weight-bearing, and electrically powered wheelchairs. Manual osteoclasis of the tibia followed by plastic orthoses utilizing principles of fluid compression to support fractured or structurally weak bones appeared successful at the time of follow-up. Intramedullary rodding of the femur was necessary in most of the 12 children with osteogenesis imperfecta congenita. Supplementary plastic orthoses have reduced the refracture rate in both the tibia and the femur. Social integration of the children was reflected by the fact that among the 12 OI congenita cases, ten were attending regular educational institutions. Twelve OI tarda children fared well, all attaining complete independence in daily living, mobility and ambulation. Seven of this group were treated with intramedullary rodding of the femur or tibia and with plastic orthoses. Five patients required no treatment.

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EFFECT OF EXERCISE, STANDING, NEGATIVE TRUNK AND POSITIVE SKELETAL PRESSURE ON BED REST-INDUCED ORTHOSTATIS AND HYPERCALCIURIA.

date: JAN 1966

author: Birkhead,N. C. ; Blizzard,J. J. ; Issekutz,B. ,Jr. ; rodahl,K.

publication:
pubmed_ID:
Outside_URL

 

Abstract : Tilt intolerance and hypercalciuria were induced in healthy subjects fed weighed diets by 18-32 days continuous bed rest in a Metabolic Ward. The effect of supplementing bed rest with daily supine bicycle exercise (2 or 4 hours), quiet standing (3 hours), or longitudinal supine skeletal pressure on orthostasis and urinary calcium was determined. Tilt tolerance was evaluated by blood pressure and heart rate response to 10 minutes of 70? head-up body tilt and urinary calcium excretion by analysis of 3- or 6-day urine collections. Supine bicycle exercise was ineffective in significantly reducing tilt intolerance or hypercalciuria. Standing decreased orthostasis in 3 of 5 subjects and decreased urinary calcium in 4 of 5 subjects. Longitudinal skeletal pressure decreased hypercalciuria in 1 of 2 subjects but did not improve tilt tolerance. Intermittent lower body negative pressure during bed rest in one subject impeded development of orthostasis but increased urine calcium. Three hours daily standing is the minimum effective duration for reversing bed rest-induced tilt intolerance and hypercalciuria while supine bicycle exercise is not a practical method for obtaining similar effects. (Author)

Descriptors :   (*CALCIUM, EXCRETION), (*RELAXATION(PHYSIOLOGY), METABOLISM), EXERCISE(PHYSIOLOGY), SKELETON, BONES, PRESSURE, URINE, TOLERANCES(PHYSIOLOGY), BLOOD, PULSE RATE, POSTURE(PHYSIOLOGY), TABLES(DATA)

Subject Categories : ANATOMY AND PHYSIOLOGY

Distribution Statement : APPROVED FOR PUBLIC RELEASE