Rehab Centers: Challenging Stability Limits in Old and Young Individuals With a Functional Reaching Task.

Challenging stability limits in old and young individuals with a functional reaching task.

Filed under: Rehab Centers

Am J Phys Med Rehabil. 2013 Jan; 92(1): 36-44
Spreitzer L, Perkins J, Ustinova KI

The aim of this study was to evaluate the extent to which adding a challenge to a reach test would increase the limit of stability (LOS) in young and old individuals.While standing on a force plate, with infrared markers on bony landmarks for motion analysis, 15 old (mean [SD], 70 [7] yrs old) and 15 young (mean [SD], 24 [2] yrs old) participants completed the modified functional reach test, in which they were asked to touch the farthest target possible in a series. They were then challenged to touch additional targets (functional reach challenge test) until they lost balance.The young participants reached farther than the old participants on both the modified functional reach and functional reach challenge tests (P = 0.005 and P = 0.003), but no group differences were found in absolute distance gains seen with the addition of the challenge. The participants in both groups displaced the center of pressure farther and used 10% more of their anatomic stability allowance in the functional reach challenge test than in the modified functional reach test. The young participants increased the LOS from 80.5% to 90.9% of their anatomic allowance, whereas the old participants increased theirs from 72.1% to 82.8%.The challenge improved reaching and LOS similarly in the young and old participants, but the old participants used smaller absolute percentages of LOS. Knowing the flexibility of LOS is useful for rehabilitation practitioners in assessing balance and designing therapeutic exercises that challenge stability during performance of functional arm movements and train individuals to use their LOS safely.
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Central hypersensitivity in chronic hemiplegic shoulder pain.

Filed under: Rehab Centers

Am J Phys Med Rehabil. 2013 Jan; 92(1): 1-13
Soo Hoo J, Paul T, Chae J, Wilson RD

This study aimed to examine the association of hemiplegic shoulder pain (HSP) with central hypersensitivity through pressure-pain thresholds (PPTs) in healthy, distant tissues.This study is a cross-sectional study. A total of 40 patients (n = 20, HSP; n = 20, stroke without HSP) were enrolled in this study. PPTs were measured at the affected deltoid and the contralateral deltoid and the tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon’s rank-sum test and with linear regression analysis, controlling for sex, a known confounder of PPTs.The subjects with HSP had lower local PPTs than did the control subjects who have had a stroke when comparing the painful shoulders with the dominant shoulders of the controls and comparing the nonpainful shoulder and the tibialis anterior with the nondominant side of the controls. Similarly, those with HSP had lower PPTs compared with the controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons.The subjects with HSP have lower local and distal PPTs than the subjects without HSP. This study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this HSP.
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A new method for evaluation of mild traumatic brain injury with neuropsychological impairment using statistical imaging analysis for Tc-ECD SPECT.

Filed under: Rehab Centers

Ann Nucl Med. 2012 Dec 20;
Uruma G, Hashimoto K, Abo M

OBJECTIVE: The objective of this study was to identify specific brain lesions with regional perfusion abnormalities possibly associated with neuropsychological impairments (NPI), as sequela after mild traumatic brain injury (MTBI), using 99mTc-ethylcysteinate dimer single photon emission computed tomography (Tc-99m ECD SPECT) and its novel analytic software. METHODS: We studied 23 patients with diffuse axonal injury with NPI group (Impaired-DAI), 26 with MTBI with NPI group (Impaired-MTBI) and 24 with MTBI without NPI group (Healthy-MTBI). In each subject, Tc-99m ECD SPECT images were analyzed by easy Z score imaging system (eZIS) and voxel-based stereotactic extraction estimation (vbSEE). Segmented into lobule levels, ROIs were set in 140 areas in whole brain, and relative regional low Tc-99m ECD uptake was computed as “extent” (rate of coordinates with Z score >2.0 in the ROI). Receiver operating characteristic analysis was performed using “extent” to discriminate the three groups. RESULTS: The highest area under the curve (AUC) value for data of Impaired-DAI and Healthy-MTBI groups was obtained in ROI on the left anterior cingulate gyrus (LtACG), with AUC of 0.93, optimal “extent” cutoff value of 10.9 %, sensitivity 87.0 %, specificity 83.3 %. The highest AUC value for data of Impaired-MTBI and Healthy-MTBI groups was also in the LtACG, with AUC of 0.87, optimal “extent” cutoff value of 9.2 %, sensitivity 73.1 %, specificity 83.3 %. CONCLUSIONS: Using two analytic software packages, eZIS and vbSEE, we identified specific lesions with low regional Tc-99m ECD uptake possibly associated with NPIs after MTBI. Especially, this trend was most marked in the left anterior cingulate gyrus in MTBI patients with NPIs and those with DAI. The optimal “extent” cutoff value, as a criterion for SPECT abnormality, might help the diagnosis of NPIs after MTBI.
HubMed – rehab



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