Systematic Review and Evidence-Based Clinical Recommendations for Dosing of Pediatric Supported Standing Programs.

Systematic Review and Evidence-Based Clinical Recommendations for Dosing of Pediatric Supported Standing Programs.

Pediatr Phys Ther. 2013; 25(3): 232-247
Paleg GS, Smith BA, Glickman LB

There is a lack of evidence-based recommendations for effective dosing of pediatric supported standing programs, despite widespread clinical use.Using the International Classification of Functioning, Disability, and Health (Child and Youth Version) framework, we searched 7 databases, using specific search terms.Thirty of 687 studies located met our inclusion criteria. Strength of the evidence was evaluated by well-known tools, and to assist with clinical decision-making, clinical recommendations based on the existing evidence and the authors’ opinions were provided.Standing programs 5 days per week positively affect bone mineral density (60 to 90 min/d); hip stability (60 min/d in 30° to 60° of total bilateral hip abduction); range of motion of hip, knee, and ankle (45 to 60 min/d); and spasticity (30 to 45 min/d). HubMed – rehab


Longer Length of First Stay in Intermittent Residential Programmes Is Associated with Larger Weight Loss at 1 and 2 Years.

Obes Facts. 2013; 6(3): 288-296
Martins C, Strommen M, Kulseng B

Objective: To determine if length of first stay impacts on weight loss and cardiovascular fitness, at 1 and 2 years in severely obese patients enrolled in intermittent residential programs. Methods: In a retrospective follow-up study, we assessed weight loss and changes in cardiovascular fitness (VO2 peak) at 1 and 2 years in 179 severely obese adults who participated in two intermittent residential programmes. Both programmes consisted of five stays at the Røros Rehabilitation Centre over a 2-year period, but programme A consisted of a much longer first stay compared with programme B (8 vs. 2 weeks). Results: Of 179 participants (BMI 44 ± 6 kg/m(2)), 162 completed 1-year and 117 2-year evaluation. Programme A led to significantly larger weight reduction (-20.7 ± 10.8 vs. -13.5 ± 8.1 kg and -16.0 ± 12.7 vs. -7.9 ± 11.2 kg, p < 0.0001) and improvement in VO2 peak (7.8 vs. 3.6 ml/kg/min (p < 0.0001) and 5.6 vs. 2.5 ml/kg/min (p < 0.01)) at both 1 and 2 years, compared with programme B. Intention-to-treat analysis showed similar results. Conclusion: A residential intermittent programme with a longer initial stay is associated with better weight loss and improvement in cardiovascular fitness at both 1 and 2 years. A longer follow-up is needed to clearly establish the sustainability of these programmes. Copyright © 2013 S. Karger GmbH, Freiburg. HubMed – rehab


A Post-Stroke Rehabilitation System Integrating Robotics,VR and High-Resolution EEG Imaging.

IEEE Trans Neural Syst Rehabil Eng. 2013 Jun 18;
Steinisch M, Tana MG, Comani S

We propose a system for the neuro-motor rehabilitation of upper limbs in stroke survivors. The system is composed of a passive robotic device (Trackhold) for kinematic tracking and gravity compensation, five dedicated virtual reality (VR) applications for training of distinct movement patterns, and high-resolution EEG for synchronous monitoring of cortical activity. In contrast to active devices, the Trackhold omits actuators for increased patient safety and acceptance levels, and for reduced complexity and costs. VR applications present all relevant information for task execution as easy-to-understand graphics that do not need any written or verbal instructions. HR-EEG is synchronized with kinematic data acquisition, allowing for the epoching of EEG signals on the basis of movement-related temporal events. Two healthy volunteers participated in a feasibility study and performed a protocol suggested for the rehabilitation of post-stroke patients. Kinematic data were analyzed by means of in-house code. Open source packages (EEGLAB, SPM and GMAC) and in-house code were used to process the neurological data. Results from kinematic and EEG data analysis are in line with knowledge from currently available literature and theoretical predictions, and demonstrate the feasibility and potential usefulness of the proposed rehabilitation system to monitor neuro-motor recovery. HubMed – rehab


Knee extensor muscle strength and index of renal function associated with an exercise capacity of 5 metabolic equivalents in male chronic heart failure patients with chronic kidney disease.

Clin Exp Nephrol. 2013 Jun 26;
Hotta C, Hiraki K, Watanabe S, Izawa KP, Yasuda T, Osada N, Omiya K, Kimura K

The goal of the present study was to determine knee extensor muscle strength (KEMS) and degree of renal dysfunction associated with an exercise capacity of ?5 metabolic equivalents (METs) in male chronic heart failure (CHF) patients with chronic kidney disease (CKD).In this cross-sectional study of 75 male CHF patients with CKD (65.3 ± 11.6 years), we measured clinical characteristics, peak [Formula: see text], estimated glomerular filtration rate (eGFR), and KEMS. Patients were divided into two groups by exercise capacity: ?5 METs group (n = 41) and <5 METs group (n = 34). Cutoff values for KEMS and eGFR resulting in an exercise capacity of ?5 METs were selected with ROC curves. Patients were divided into four groups according to cutoff values, and numbers of patients attaining an exercise capacity of ?5 METs were compared between groups.Age was significantly higher although eGFR, Hb, and KEMS were lower in the <5 METs versus ?5 METs group (P < 0.001). Multiple logistic regression analysis revealed a positive significant relation between KEMS and eGFR and exercise capacity of ?5 METs. Exercise capacity of ?5 METs was associated with KEMS of approximately 1.69 Nm/kg and an eGFR of 45.7 mL/min/1.73 m(2). The number of patients attaining an exercise capacity of ?5 METs in the patients who did not reach both cutoff values was significantly lower than that in any other patients (P < 0.001).KEMS and eGFR may be useful indices for predicting attainment of exercise capacity of ?5 METs in male CHF patients with CKD. HubMed – rehab