Sudden Stopping in Patients With Cerebellar Ataxia.

Sudden Stopping in Patients with Cerebellar Ataxia.

Cerebellum. 2013 Mar 20;
Serrao M, Conte C, Casali C, Ranavolo A, Mari S, Di Fabio R, Perrotta A, Coppola G, Padua L, Monamì S, Sandrini G, Pierelli F

Stopping during walking, a dynamic motor task frequent in everyday life, is very challenging for ataxic patients, as it reduces their gait stability and increases the incidence of falls. This study was conducted to analyse the biomechanical characteristics of upper and lower body segments during abrupt stopping in ataxic patients in order to identify possible strategies used to counteract the instability in the sagittal and frontal plane. Twelve patients with primary degenerative cerebellar ataxia and 12 age- and sex-matched healthy subjects were studied. Time-distance parameters, dynamic stability of the centre of mass, upper body measures and lower joint kinematic and kinetic parameters were analysed. The results indicate that ataxic patients have a great difficulty in stopping abruptly during walking and adopt a multi-step stopping strategy, occasionally with feet parallel, to compensate for their inability to coordinate the upper body and to generate a well-coordinated lower limb joint flexor-extensor pattern and appropriate braking forces for progressively decelerating the progression of the body in the sagittal plane. A specific rehabilitation treatment designed to improve the ability of ataxic patients to transform unplanned stopping into planned stopping, to coordinate upper body and to execute an effective flexion-extension pattern of the hip and knee joints may be useful in these patients in order to improve their stopping performance and prevent falls. HubMed – rehab


High-intensity vs. sham inspiratory muscle training in patients with chronic heart failure: a prospective randomized trial.

Eur J Heart Fail. 2013 Mar 19;
Marco E, Ramírez-Sarmiento AL, Coloma A, Sartor M, Comin-Colet J, Vila J, Enjuanes C, Bruguera J, Escalada F, Gea J, Orozco-Levi M

AIMS: The purpose of this study was to evaluate the effectiveness, feasibility, and safety of a 4-week high-intensity inspiratory muscle training (hi-IMT) in patients with chronic heart failure (CHF). METHODS AND RESULTS: A double-blind randomized clinical trial was carried out in 22 patients with CHF. Participants were assigned to the hi-IMT or sham-IMT group. The trainer device was a prototype of the Orygen-Dual Valve(®). The training workloads were adjusted weekly at the inspiratory pressure which allowed the performance of 10 consecutive maximal repetitions (10RM). Main outcomes were strength and endurance of the respiratory muscles assessed by maximal respiratory pressures (PImax and PEmax) and a 10RM manoeuvre, respectively. Twenty-one patients presented impairment in respiratory muscle strength and endurance. Patients in the hi-IMT group showed a significant improvement in both strength and endurance: inspiratory muscle strength in the intervention group increased 57.2% compared with 25.9% in the control group (P = 0.001). The percentage change in endurance was 72.7% for the hi-IMT group compared with 18.2% in the sham-IMT group (P < 0.001). No adverse effects occurred during the intervention. CONCLUSION: A 4-week hi-IMT with the use of the Orygen-Dual Valve(®) is shown to be an effective, feasible, and safe tool to improve weakness and fatigue of the inspiratory muscles. The key point of this study is to discuss immediate practical implications in terms of respiratory muscle dysfunction postulated as a potential prognostic factor and as an additional therapeutic target.Trials registrationNCT01606553. HubMed – rehab


Impact of knee flexion on patella length in osteoarthritic patients undergoing total knee arthroplasty.

J Orthop Sci. 2013 Mar 20;
Ishii Y, Noguchi H, Takeda M, Sato J, Ishii H, Toyabe SI

PURPOSE: This study used magnetic resonance imaging (MRI) to evaluate in vivo preoperative changes in the length of the patellar tendon (LPT) in patients undergoing total knee arthroplasty (TKA). We sought to answer two questions: first, does the LPT change with flexion? Second, does the LPT show a gender-specific pattern? METHODS: Eighty-five knees in 76 consecutive osteoarthritic patients were evaluated. The age range was 56-90 years (mean 70). The study included 62 females and 14 males. MRI was performed at full extension and at 30°, 60°, 90°, and full flexion. RESULTS: There were significantly different patterns between genders (p < 0.001). The main shortenings occurred earlier, at 30°, in females and later, at 60°, in males. In females, LPT values in full extension were significantly longer than those measured at other flexion angles. In male subjects, significant differences in LPT values were found between full extension versus 90° (p < 0.001) and full flexion (p < 0.001), and between 60° versus 90°(p = 0.030) and full flexion (p = 0.030). CONCLUSION: These differences might influence the gender-specific complications related to the extensor mechanism after TKA. These data provide useful information for surgeons attempting to achieve a satisfactory balance between joint gaps in the patellar reduced position intraoperatively. HubMed – rehab