Rehab Centers: Patients Receiving Inpatient Rehabilitation for Lower Limb Orthopaedic Conditions Do Much Less Physical Activity Than Recommended in Guidelines for Healthy Older Adults: An Observational Study.
Patients receiving inpatient rehabilitation for lower limb orthopaedic conditions do much less physical activity than recommended in guidelines for healthy older adults: an observational study.
Filed under: Rehab Centers
J Physiother. 2013 Mar; 59(1): 39-44
Peiris CL, Taylor NF, Shields N
QUESTION: Are ambulant patients who are admitted for inpatient rehabilitation for a lower limb orthopaedic condition active enough to meet current physical activity guidelines? DESIGN: Prospective observational study. PARTICIPANTS: Adults admitted for inpatient rehabilitation for a lower limb orthopaedic condition who were cognitively alert and able to walk independently or with assistance. OUTCOME MEASURES: Participants wore an activity monitor for three full days. Daily time spent in moderate intensity physical activity was used to determine whether the levels of physical activity recommended in clinical guidelines were achieved. RESULTS: Fifty-four participants with a mean age of 74 years (SD 11) took a median of 398 (IQR 140 to 993) steps per day and spent a median of 8 (IQR 3 to 16) minutes walking per day. No participant completed a 10-minute bout of moderate intensity physical activity during the monitoring period. One participant accumulated 30 minutes of moderate intensity physical activity and nine participants accumulated 15 minutes of moderate intensity physical activity in a day. Physical activity was associated with shorter length of stay (r=-0.43) and higher functional status on discharge (r=0.39). CONCLUSIONS: Adults with lower limb orthopaedic conditions in inpatient rehabilitation are relatively inactive and do not meet current physical activity guidelines for older adults. Results of this study indicate that strategies to increase physical activity are required.
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Preventive exercises reduced injury-related costs among adult male amateur soccer players: a cluster-randomised trial.
Filed under: Rehab Centers
J Physiother. 2013 Mar; 59(1): 15-23
Krist MR, van Beijsterveldt AM, Backx FJ, Ardine de Wit G
QUESTION: Is an injury prevention program consisting of 10 exercises designed to improve stability, muscle strength, co-ordination, and flexibility of the trunk, hip and leg muscles (known as The11) cost effective in adult male amateur soccer players? DESIGN: Cost-effectiveness analysis of a cluster-randomised controlled trial. PARTICIPANTS: 479 adult male amateur soccer players aged 18-40 years. INTERVENTION: The intervention group was instructed to perform the exercises at each training session (2 to 3 sessions per week) during one soccer season. The exercises focus on core stability, eccentric training of thigh muscles, proprioceptive training, dynamic stabilisation, and plyometrics with straight leg alignment. The control group continued their usual warm-up. OUTCOME MEASURES: All injuries and costs associated with these injuries were compared between groups after bootstrapping (5000 replications). RESULTS: No significant differences in the proportion of injured players and injury rate were found between the two groups. Mean overall costs in the intervention group were €161 (SD 447) per athlete and €256 (SD 555) per injured athlete. Mean overall costs in the control group were €361 (SD 1529) per athlete and €606 (SD 1944) per injured athlete. Statistically significant cost differences in favour of the intervention group were found per player (mean difference €201, 95% CI 15 to 426) and per injured player (mean difference €350, 95% CI 51 to 733). CONCLUSIONS: The exercises failed to significantly reduce the number of injuries in male amateur soccer players within one season, but did significantly reduce injury-related costs. The cost savings might be the result of a preventive effect on knee injuries, which often have substantial costs due to lengthy rehabilitation and lost productivity. Trial registration: NTR2416. [Krist MR, van Beijsterveldt AMC, Backx FJG, de Wit GA (2013) Preventive exercises reduced injury-related costs among adult male amateur soccer players: a clusterrandomised trial.Journal of Physiotherapy59: 15-23].
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Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson’s disease: a systematic review.
Filed under: Rehab Centers
J Physiother. 2013 Mar; 59(1): 7-13
Lima LO, Scianni A, Rodrigues-de-Paula F
QUESTION: Does progressive resistance exercise improve strength and measures of physical performance in people with Parkinson’s disease? DESIGN: Systematic review with meta-analysis of randomised and quasi-randomised controlled trials. PARTICIPANTS: People with Parkinson’s disease, regardless of gender or level of disability. INTERVENTION: Progressive resistance exercise, defined as involving repetitive, strong, or effortful muscle contractions and progression of load as the participant’s abilities changed. OUTCOME MEASURES: Measures of muscle strength (maximum voluntary force production) – either continuous (force, torque, work, EMG) or ordinal (manual muscle test) – and physical performance measures: sit-to-stand time, fast and comfortable walking speeds, 6-min walk test, stair descent and ascent, the Activities-specific Balance Confidence scale, Timed Up and Go test, and the Short Physical Performance Battery. RESULTS: Four (quasi-) randomised trials were included, three of which reported data that could be pooled in a meta-analysis. Progressive resistance exercise increased strength, with a standardised mean difference 0.50 (95% CI 0.05 to 0.95), and had a clinically worthwhile effect on walking capacity, with a mean difference of 96 metres (95% CI 40 to 152) among people with mild to moderate Parkinson’s disease. However, most physical performance outcomes did not show clinically worthwhile improvement after progressive resistance exercise. CONCLUSION: This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson’s disease, but carryover of benefit does not occur for all measures of physical performance. The current evidence suggests that progressive resistance training should be implemented in Parkinson’s disease rehabilitation, particularly when the aim is to improve walking capacity.
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GRADE the evidence.
Filed under: Rehab Centers
J Physiother. 2013 Mar; 59(1): 5
Harvey LA
A Real-time EMG-driven Musculoskeletal Model of the Ankle.
Filed under: Rehab Centers
Multibody Syst Dyn. 2012 Aug; 28(1-2): 169-180
Manal K, Gravare-Silbernagel K, Buchanan TS
The real-time estimation of muscle forces could be a very valuable tool for rehabilitation. By seeing how much muscle force is being produced during rehabilitation, therapists know whether they are working within safe limits in their therapies and patients know if they are producing enough force to expect improvement. This is especially true for rehabilitation of Achilles tendon ruptures where, out of fear of overloading and causing a re-rupture, minimal therapy is typically done for eight weeks post-surgery despite animal studies that show that low-level loading is beneficial. To address this need, we have developed a biomechanical model that allows for the real-time estimation of forces in the triceps surae muscle and Achilles tendon. Forces are estimated using a Hill-type muscle model. To account for differences in neuromuscular control of each subject, the model used EMGs as input. To make this clinically useful, joint angles were measured using electrogoniometers. A dynamometer was used to measure joint moments during the model calibration stage, but was not required during real-time studies. The model accounts for the force-length and force-velocity properties of muscles, and other parameters such as tendon slack length and optimal fiber length. Additional parameters, such as pennation angle and moment arm of each muscle in the model, vary as functions of joint angle. In this paper, the model is presented and it application is demonstrated in two subjects: one with a healthy Achilles tendon and a second six months post Achilles tendon rupture and repair.
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