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.
Category: Research and Articles
Pathologic fractures in severely handicapped children and young adults.
date: 08/01/1990
author: Lee JJ, Lyne ED.
publication: J Pediatr Orthop. 1990 Jul-Aug;10(4):497-500.
pubmed_ID: 2358490
The incidence (42%) of vitamin D abnormalities is high in severely handicapped children and young adults who sustain fractures, especially those who sustain multiple fractures. Fractures occur primarily in the lower extremity and heal with simple immobilization. In patients with normal vitamin D levels, a history of a significant traumatic event should be identified and child abuse ruled out. Vitamin D-deficient patients respond to nutritional and vitamin D supplementation, with decreased fracture incidence.
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.
Health status of children with moderate to severe cerebral palsy.
date: 06/01/2001
author: Liptak GS, O’Donnell M, Conaway M, Chumlea WC, Wolrey G, Henderson RC, Fung E, Stallings VA, Samson-Fang L, Calvert R, Rosenbaum P, Stevenson RD.
publication: Dev Med Child Neurol. 2001 Jun;43(6):364-70. Comment in: Dev Med Child Neurol. 2001 Jun;43(6):363.
pubmed_ID: 11409824
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/11409824
The aim of the study was to evaluate the health of children with cerebral palsy (CP) using a global assessment of quality of life, condition-specific measures, and assessments of health care use. A multicenter population-based cross-sectional survey of 235 children, aged 2 to 18 years, with moderate to severe impairment, was carried out using Gross Motor Function Classification System (GMFCS) levels III (n = 56), IV (n = 55), and V (n = 122). This study group scored significantly below the mean on the Child Health Questionnaire (CHQ) for Pain, General Health, Physical Functioning, and Impact on Parents. These children used more medications than children without CP from a national sample. Fifty-nine children used feeding tubes. Children in GMFCS level V who used a feeding tube had the lowest estimate of mental age, required the most health care resources, used the most medications, had the most respiratory problems, and had the lowest Global Health scores. Children with the most severe motor disability who have feeding tubes are an especially frail group who require numerous health-related resources and treatments. Also, there is a relationship among measures of health status such as the CHQ, functional abilities, use of resources, and mental age, but each appears to measure different aspects of health and well-being and should be used in combination to reflect children’s overall health status.
Spontaneous fractures in the brain-crippled, bedridden patient.
date: 10/01/1976
author: Miller PR, Glazer DA.
publication: Clin Orthop Relat Res. 1976 Oct;(120):134-7.
pubmed_ID: 975648
Outside_URL:
This report deals with the treatment of 31 spontaneous fractures which occurred in 50 institutionalized patients who were bedridden primarily because of severe cerebral palsy associated with brain injury. More than one-half of the group sustained a spontaneous fracture. Satisfactory healing of all fractures with a minimum of complications occurred without any immobilization or realignment. In 4 patients with delayed compound wounds, the treatment consisted of resection of the protruding portion of the bone after allowing the bony protrusion to wall itself off.
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.
Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years.
date: 11/01/2008
author: Alekna V, Tamulaitiene M, Sinevicius T, Juocevicius A.
publication: Spinal Cord. 2008 Nov;46(11):727-32. Epub 2008 Apr 29.
pubmed_ID: 18443599
STUDY DESIGN: Prospective study on patients with spinal cord injuries. OBJECTIVES: To evaluate the loss of bone mineral density (BMD) in various body regions of patients with spinal cord injury (SCI) and its dependence on weight bearing activities during 2 years post injury. METHODS: BMD of the whole body was measured in patients with SCI. Baseline measurement was performed in 6-16 weeks after SCI, the second and the third-respectively 12 and 24 months after injury. Fifty-four subjects were selected and divided into two groups: standing and non-standing. From these groups 27 pairs were made according to gender, age and height. RESULTS: There was found to be a well-marked decrease in BMD values for lower extremities, but there was no significant difference between paraplegic and tetraplegic patients 1 and 2 year after injury. Leg BMD reduced by 19.62% (95% CI, 17-22%) in the standing group and by 24% (95% CI, 21-27%) in non-standing group during the first year. Two years after SCI patients in standing group had significantly higher leg BMD-1.018 g/cm(2) (95% CI, 0.971-1.055 g/cm(2)) than in the non-standing group-0.91 g/cm(2) (95% CI, 0.872-0.958 g/cm(2)) (P<or=0.0001). CONCLUSION: SCI patients who performed daily standing >or=1 h and not less than 5 days per week, had significantly higher BMD in the lower extremities after 2 years in comparison to those patients who did not perform standing.
The effect of positioning on the hand function of boys with cerebral palsy.
date: 08/01/1989
author: Noronha J, Bundy A, Groll J.
publication: Am J Occup Ther. 1989 Aug;43(8):507-12.
pubmed_ID: 2774051
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/2774051
The effect of positioning (sitting and prone standing) on the hand function of 10 boys (mean age = 12.5 years, SD = 1.2 years) with spastic diplegic cerebral palsy was studied. Two groups of subjects were tested twice (Tests 1 and 2) with the Jebsen-Taylor Hand Function Test (Jebsen, Taylor, Treischmann, Trotter, & Howard, 1969; Taylor, Sand, & Jebsen, 1973) to measure rate of manipulation. In addition, a scale modified from Hohlstein (1982) was used to measure quality of grasp on each subtest of the Jebsen-Taylor test. No significant differences between the mean scores of the two groups were found on the total scores of the Jebsen-Taylor test, either between Tests 1 and 2 or between sitting and prone standing. When the data from Tests 1 and 2 were combined, it was found that on one subtest–simulated feeding–the subjects performed significantly faster while in a prone standing position. On another subtest–picking up small objects–the subjects performed significantly faster while in a sitting position. Except during the simulated feeding subtest, the quality of the subjects’ grasp was observed to be mature and tailored to the objects manipulated. This paper presents considerations for analyzing positioning in relation to upper extremity tasks.
Osteomalacia associated with anticonvulsant drug therapy in mentally retarded children.
date: 08/01/1975
author: Tolman KG, Jubiz W, Sannella JJ, Madsen JA, Belsey RE, Goldsmith RS, Freston JW.
publication: Pediatrics. 1975 Jul;56(1):45-50.
pubmed_ID: 1161362
A survey of 289 severely retarded inpatients at a school for retarded children in American Fork; Utah revealed 67 patients with osteomalacia as defined by hypocalcemia, hypophosphatemia, elevated serum alkaline phosphatase levels, and appropriate bone changes. Investigation of the variables which might influence bone mineralization revealed no differences in age, sex, physical activity, sunshine exposure, or dietary intake of vitamin D between the osteomalacia and nonosteomalacia groups. However, all of the patients with osteomalacia were receiving anticonvulsant medications, either phenobarbital, diphenylhydantoin, or both. Duration of anticonvulsant therapy was the most important contributing factor to the development of osteomalacia. Seventy-five percent of patients who had received anticonvulsants for more than ten years had osteomalacia. The single most costly medical problem at the school is the treatment of pathologic bone fractures due to demineralized bone.
A randomized trial evaluation of the Oswestry Standing Frame for patients after stroke.
date: 06/19/2005
author: Bagley P, Hudson M, Forster A, Smith J, Young J.
publication: Clin Rehabil. 2005 Jun;19(4):354-64.
pubmed_ID: 15929503
BACKGROUND: Standing is believed to have benefits in addressing motor and sensory impairments after stroke. One device to facilitate standing for severely disabled patients is the Oswestry Standing Frame. OBJECTIVE: To evaluate the effectiveness of the Oswestry Standing Frame for severely disabled stroke patients. DESIGN: A single centre, randomized controlled trial. SETTING: An inpatient stroke rehabilitation unit. SUBJECTS: Patients were recruited if they had a clinical diagnosis of stroke, were medically stable and unable to achieve any score on the Trunk Control Test or unable to stand in mid-line without the assistance of two therapists. INTERVENTION: The intervention (n = 71) and control (n = 69) groups both received usual stroke unit care but the intervention group also received a minimum of 14 consecutive days’ treatment using the standing frame. MAIN OUTCOME MEASURES: The primary outcome measure was the Rivermead Mobility Index (RMI). Secondary measures included the Barthel Index; the Rivermead Motor Assessment; the balanced sitting and sitting to standing components of the Motor Assessment Scale; the Trunk Control Test and the Hospital Anxiety and Depression Scale. Blind assessment was undertaken at baseline, six weeks, 12 weeks and six months post stroke. Information on resource use was also collected. RESULTS: There was no statistically significant difference between groups in any of the outcome measures or for resource use. Mann-Whitney U-tests for the RMI change from baseline scores to six weeks, 12 weeks and six months post stroke were p = 0.310; p = 0.970 and p = 0.282, respectively. CONCLUSION: Use of the Oswestry Standing Frame did not improve clinical outcome or provide resource savings for this severely disabled patient group.