Rehab Centers: Autologous Bone Marrow Mesenchymal Stromal Cells for Regeneration of Injured Equine Ligaments and Tendons: A Clinical Report.

Autologous bone marrow mesenchymal stromal cells for regeneration of injured equine ligaments and tendons: A clinical report.

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Res Vet Sci. 2013 Feb 16;
Renzi S, Riccò S, Dotti S, Sesso L, Grolli S, Cornali M, Carlin S, Patruno M, Cinotti S, Ferrari M

The use of Mesenchymal Stromal Cells (MSCs) in orthopedic practice has recently and rapidly acquired an important role. Therapies based on the use of MSCs for the treatment of acute injuries as well as chronic inflammatory disorders are gradually becoming clinical routine. These cells have demonstrated intriguing therapeutic potentialities (i.e.: inflammation control, tissue regeneration and pathological scar prevention), that have been taken into consideration for use in both human and veterinary medicine. In particular, horses represent high performance athletes considered models for human pathologies since musculo-skeletal disorders frequently occur in this species. In the past, repair of tendon injures were performed by different methods. In particular, clinical therapy was based on ice application, bandage, box rest and controlled exercise. An alternative approach consisted on the use of corticosteroid (inflammation reduction) and other drugs (sodium hyaluronate, polysulphated glycosaminoglycans, beta aminoproprionitrile fumarate). Furthermore, surgical treatments like accessory ligament desmotomy, local irritation by line firing or pin firing were commonly used. More recently ultrasound, laser therapy, electromagnetic field therapy have been considered. Unfortunately, they did not allow complete tissue healing and quite often animals did not regain competitiveness. In order to minimize this inconvenience, the use of MSCs has been introduced as an alternative to the traditional approach since it represents a potential tool to improve tissue regeneration. Aim of this study was to evaluate the capability of MSCs to improve the functional outcome of horses affected by tendonitis and desmitis. Thirty-three breed and activity-matched horses affected by tendonitis or desmitis, were included in clinical trial scored for lesions and subdivided into two groups. Group 1 animals were treated with autologous MSCs, associated with platelet rich plasma (group 1). Bone marrow samples were collected from the sternum of the treated horses and processed in order to isolate MSCs. Following cell therapy, they were subjected to a rehabilitation period and their ability to resume training was evaluated. In this study, implanted MSCs caused no adverse reactions and thirteen out of the eighteen inoculated horses returned to race competitions. On the contrary, no improvement was seen in the twelve animals of group 2 treated with pin firing, that were not able to resume sport activity. In conclusion the clinical trial proves the safety of equine bone-marrow derived MSCs and a successful outcome of the treated animals that returned to their previous level of sport activity.
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Exercise programs for patients with cancer improve physical functioning and quality of life.

Filed under: Rehab Centers

J Physiother. 2013 Mar; 59(1): 57
McClellan R

OBJECTIVE: To review the evidence about whether physical activity exercise programs improve health indicators in adult patients after they have completed their main treatment related to cancer. DATA SOURCES: PubMed, CINAHL and Google Scholar were searched up to September, 2011. This search was supplemented by searching the Cochrane Library for systematic reviews and examining the reference lists of all selected studies. STUDY SELECTION: Randomised controlled trials involving adult patients who had completed their main treatment for cancer but who might still be receiving hormonal therapy. The effect of an exercise program was assessed on physical functions, physiological parameters, psychosocial outcomes, and quality of life compared with sedentary or no-exercise control groups. DATA EXTRACTION: Two reviewers independently extracted data and discrepancies were resolved by consensus. Risk of bias in selected studies was assessed using a checklist developed by the Scottish Inter-Collegiate Guidelines Network. DATA SYNTHESIS: Of 1505 studies initially identified by the search and 387 studies identified from additional sources, 34 studies were included for review and meta-analysis. Most studies focused on patients with breast cancer (65%) and investigated aerobic exercise programs (86%), while a smaller number investigated resistance training interventions (14%). The median duration of the exercise programs was 13 weeks. Based on quantitative pooling of available data there were statistically significant improvement in insulin-like growth factor-I, muscle strength, fatigue, depression, and quality of life in favour of exercise for patients with breast cancer. Based on quantitative pooling of data from studies of different types of cancer, there were improvements in favour of exercise in body mass index, body weight, peak oxygen consumption, distance walked in 6 minutes, handgrip strength and quality of life. For example, there was a weighted mean difference of 29m (95% CI 4 to 55) for the 6 minute walk distance in favour of exercise. Significant differences were not found on the remaining outcomes, including lean mass and flexibility. CONCLUSION: Exercise programs for patients who have completed their treatment for cancer result in positive effects in a range of health indicators including physical functioning and quality of life.
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Tai Chi training is effective in reducing balance impairments and falls in patients with Parkinson’s disease.

Filed under: Rehab Centers

J Physiother. 2013 Mar; 59(1): 55
Tsang WW

QUESTION: Does Tai Chi improve postural control in patients with Parkinson’s disease? DESIGN: Randomised, controlled trial and blinded outcome assessment. SETTING: University clinic in USA. PARTICIPANTS: Individuals with Parkinson’s disease (Hoehn and Yahr Stage 1-4) between the age of 40 and 85 years, and ability to walk with or without an assistive device were key inclusion criteria. Mini-Mental State examination score <24 and concurrent participation in other instructor-led exercise programs were key exclusion criteria. Randomisation of 195 participants allocated 65 to each of the Tai Chi, resistance, and stretching groups. INTERVENTIONS: The Tai Chi group underwent a Tai Chi program, the resistance group 8 to 10 leg muscle strengthening exercises, while the stretching group performed stretching exercises involving the upper body and lower extremities. All three groups trained for 24 weeks (60 minutes per session, two sessions per week). OUTCOME MEASURES: The primary outcomes were two indicators of postural stability - maximum excursion and directional control derived from dynamic posturography. The secondary outcomes were stride length, gait velocity, knee flexion and extension peak torque, functional reach, timed-up-and-go test, and motor section of the Unified Parkinson's Disease Rating Scale (UPDRS III). The outcomes were measured at baseline, at 12 and 24 weeks, and 3 months after termination of the intervention. RESULTS: 185 participants completed the study. At the end of the 24-week training period, the change in maximum excursion in the Tai Chi group was significantly more than that in the resistance group (by 5%, 95% CI 1.1 to 10.0) and the stretching group (by 12%, 95% CI 7.2 to 16.7). Direction control improved significantly more in the Tai Chi group compared with the resistance group (by 11%, 95% CI 3.9 to 17.0) and the control group (by 11%, 95% CI 5.5 to 17.3). The Tai Chi group also had significantly more improvement in stride length and functional reach than the other two groups. The change in knee flexion and extension peak torque, timed-up-and-go test, and UPDRS III score in the Tai Chi group was only significantly more than that in the stretching group, but not the resistance group. The falls incidence was also lower in the Tai Chi group than the stretching group during the 6-month training period (incidence-rate ratio: 0.33, 95% CI 0.16 to 0.71). CONCLUSION: Tai Chi training is effective in reducing balance impairments in patients with mild to moderate Parkinson's disease. HubMed – rehab

 

Physiotherapists systematically overestimate the amount of time stroke survivors spend engaged in active therapy rehabilitation: an observational study.

Filed under: Rehab Centers

J Physiother. 2013 Mar; 59(1): 45-51
Kaur G, English C, Hillier S

QUESTIONS: How accurately do physiotherapists estimate how long stroke survivors spend in physiotherapy sessions and the amount of time stroke survivors are engaged in physical activity during physiotherapy sessions? Does the mode of therapy (individual sessions or group circuit classes) affect the accuracy of therapists’ estimates? DESIGN: Observational study embedded within a randomised trial. PARTICIPANTS: People who participated in the CIRCIT trial after having a stroke. INTERVENTION: 47 therapy sessions scheduled and supervised by physiotherapists (n = 8) and physiotherapy assistants (n = 4) for trial participants were video-recorded. OUTCOME MEASURES: Therapists’ estimations of therapy time were compared to the video-recorded times. RESULTS: The agreement between therapist-estimated and video-recorded data for total therapy time and active time was excellent, with intraclass correlation coefficients (ICC) of 0.90 (95% CI 0.83 to 0.95) and 0.83 (95% CI 0.73 to 0.93) respectively. Agreement between therapist-estimated and video-recorded data for inactive time was good (ICC score 0.62, 95% CI 0.40 to 0.77). The mean (SD) difference between therapist-estimated and video-recorded total therapy time, active time, and inactive time for all sessions was 7.7 (10.5), 14.1 (10.3) and -6.9 (9.5) minutes respectively. Bland-Altman analyses revealed a systematic bias of overestimation of total therapy time and total active time, and underestimation of inactive time by therapists. Compared to individual therapy sessions, therapists estimated total circuit class therapy duration more accurately, but estimated active time within circuit classes less accurately. CONCLUSION: Therapists are inaccurate in their estimation of the amount of time stroke survivors are active during therapy sessions. When accurate therapy data are required, use of objective measures is recommended.
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