Biomechanics of elastic resistance in therapeutic exercise programs.
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Biomechanical Phenomena↗
Biomedical subjects
D C Sobush
Publications and source records attributed to D C Sobush.
Functional and oximetric assessment of patients after lung reduction surgery.
OBJECTIVE: The goal of this study was to clarify the issue of functional oxygen requirement by regimented exercise oximetry in patients undergoing lung reduction surgery. METHODS: Thirty-seven patients underwent lung reduction surgery and were followed up for at least 3 months. Patients routinely completed a 6-week program of cardiopulmonary rehabilitation. Preoperative and postoperative spirometry, dyspnea scores, 6-minute walk distances, respiratory mechanics, and exercise oximetry were recorded. RESULTS: After the operation, patients had a 37% increase in forced vital capacity and a 59% increase in forced expiratory volume in 1 second. Six-minute walk distance increased from 913 +/- 310 feet before the lung reduction operation to 1202 +/- 274 feet 6 months after the operation (p < 0.001). Maximal inspiratory and expiratory pressures were significantly increased in 16 patients after lung reduction surgery. Perceived dyspnea was significantly improved. Exercise pulse oximetry demonstrated that 83% of patients met American Thoracic Society criteria for supplemental oxygen use before lung reduction surgery. After the operation, 70% of patients continued to meet American Thoracic Society criteria for supplemental oxygen use. Notably, 10 patients with exertional desaturation while breathing room air discontinued supplemental oxygen use because of a reduction in dyspnea. CONCLUSIONS: These findings demonstrate significant subjective and functional improvements related to lung reduction surgery. Exercise-induced hypoxia was not reversed by lung reduction surgery. Discontinuance of supplemental oxygen use owing to reduction in dyspnea and improved physical performance may not be warranted in lieu of continued exertional desaturation.
Adult↗
The lennie test for measuring scapular position in healthy young adult females: a reliability and validity study.
Normal scapular rest position is neither adequately described nor agreed upon by authorities. The purpose of this study was to devise and describe a reliable and valid test (the Lennie Test) to measure scapular position, including normal scapular rest position. Fifteen healthy females (age 19-21 years) participated in the study. Horizontal and vertical scapular position in the frontal plane was quantified by three different investigators using a scoliometer and caliper. Same-day radiographs were used to validate scapular position surface measurements. The medial borders of the scapulae were found to be parallel to the thoracic midline. The scapulae were on average 17.19 +/- 1.85 cm apart (at the level of the root of the scapulae) with the dominant arm scapula being on average 0.49 +/- 0.74 cm lower than the nondominant scapula. This difference in height between scapulae was not statistically significant (p > .01). Correlation coefficients between skin surface and radiograph measurements of scapular position ranged from .43 to .82. Intertester intraclass correlation coefficients for surface measurements of scapular position ranged from .64 to .86. The Lennie Test was found to have moderate to high intertester reliability and to provide an accurate measurement of the anatomical location of the scapulae based on X-ray verification. Surface landmark measurements for scapular position were on average within 0.56 cm and within 1.7 degrees of the measurements made from X-rays for linear and angular position, respectively. We propose the use of the Lennie Test in populations, healthy or otherwise, where scapular position needs to be objectively measured.
Adult↗
An electromyographic analysis of hip abductor muscle activity when subjects are carrying loads in one or both hands.
Forces produced at the hip joint as a result of hip abductor muscle contractions while carrying loads reach several times body weight (BW). Physical therapists often advise patients with hip osteoarthritis in ways to minimize these forces as a means of reducing the pain associated with carrying loads. The purpose of this study was to use surface electromyography (EMG) to quantify the relative demands placed on the hip abductors while carrying loads in one hand or in both hands. Thirty asymptomatic college-aged subjects walked while carrying loads of 10% and 20% of BW unilaterally and loads of 10%, 20%, and 40% of BW bilaterally. Signals from foot switches allowed a computer to average the EMG data over the phase of gait when the foot was in complete contact with the ground. All EMG data were normalized to a percentage of the EMG voltage produced during no-load walking (%EMG). Our prime dependent variable was the %EMG averaged over both hip sides of all subjects' multiple walking trials. Our major analysis involved a multifactorial analysis of variance for repeated measures with method of carry (unilateral or bilateral) and load as the two main independent variables. Results demonstrated that both the amount of the load and the method of load carry made a significant difference in regard to the amount of hip abductor EMG produced. Of particular note was the fact that the bilateral 20% of BW condition produced statistically less %EMG (when averaged over both sides) than did the unilateral 20% of BW condition. Persons with hip disease should be aware that hip joint forces may be reduced by the bilateral method of carrying loads.
Adult↗
An electromyographic analysis of the hip abductor muscles during a standing work task.
Research data strongly suggest that osteoarthritis of the hip occurs statistically more often on the right side. A possible contributing factor to this right-sided bias in frequency may be that the articular cartilage on the right hip is subjected to relatively higher muscular-based forces throughout a lifetime. As an initial attempt to study this possibility, this research examined healthy persons to determine the existence of a "dominant" hip similar to that expressed for handedness. Electromyographic (EMG) analysis was used to compare the electrical activity between the right and left hip abductor muscles during a standardized standing work task using 40 right-handed and 40 left-handed healthy subjects. Analysis of the data showed that the hip muscle on the side of the subject's handedness produced higher normalized EMG activity than did the opposite hip; however, the differences were not all statistically significant. The trend of this data set, however, warrants further research into a possible association between hip dominance, asymmetrical muscle use, and the development of hip osteoarthritis.
Adult↗
Spinal effects of head-down tilting. Part 1--Low back contour changes.
The purpose of this study was to compare the effects of two methods of inversion therapy and four common exercise positions on the shape of the low back. We studied 25 healthy subjects in six exercise positions: 1) inverted with lower limbs extended (ILLE), 2) standing, 3) supine, 4) inverted with lower limbs flexed (ILLF), 5) sitting, and 6) hooklying. A manual measurement system was used to determine low back contours (LBCs) from S2 upward for 19 cm at 1-cm intervals. Contour data were reduced to mean contour values (MCVs). Results showed that the standing and sitting positions produced the largest and smallest MCVs, respectively (p less than .01). The ILLF MCV was smaller (p less than .05) than both supine MCVs but not appreciably different from the ILLE MCV. The ILLE and ILLF positions significantly reduced (p less than .01) MCVs compared with the standing position. Neither position decreased the MCV as much as the sitting position. These results support the use of inversion therapy to reduce the depth of the LBC when sitting is inappropriate.
Adult↗
Influence of aerobic fitness on cardiovascular responses during slow head-down tilting.
This study examined the influence of cardiorespiratory fitness (CRF) on mean heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to slow head-down tilting. Twenty-four young, healthy volunteers were tilted randomly from the horizontal plane to -30, -60, and -90 degrees with lower limbs extended or flexed. A multivariate analysis of variance between three independent variables (level of CRF, tilt angle, and lower limb position) and three dependent variables (mean HR, SBP, and DBP) was performed on the cardiovascular changes from an initial horizontal baseline value (absolute change) and from a horizontal value that immediately preceded tilting angles (relative change). The results for significant absolute cardiovascular changes indicated a CRF influence on HR increase (F = 6.42, p less than .05), a tilt-angle influence on SBP increase (F = 9.56, p less than .001), and DBP increase (F = 6.49, p less than .01) and an interaction influence between CRF level and limb position for DBP (F = 5.83, p less than .05). Significant relative cardiovascular change was noted for tilt-angle influence on HR (F = 9.04, p less than or equal to .001). We conclude, therefore, that physical therapists should consider the CRF of individuals and the tilt angle to be used before they conduct slow head-down tilting for therapy.
Adult↗
Providing resistive breathing exercise to the inspiratory muscles using the PFLEX device. Suggestion from the field.
This report describes a 6-step process for prescribing resistive inspiratory exercise using the PFLEX device, which is an inexpensive and effective method of enhancing the performance of the vital muscles of respiration. Until further clinical validation of minimal threshold guidelines for prescribing PEPs is achieved, the clinical judgment of the physical therapist remains the most important element in the prescription process.
Aged↗
Resources for vocational planning applied to the job title of PHYSICAL THERAPIST.
Industrial rehabilitation is a rapidly developing area of health care. As a result, physical therapists need to become functionally familiar with common vocational planning processes and resources. Therefore, the purpose of this article is to describe a process called Vocational Diagnosis and Assessment of Residual Employability (VDARE), which is based on the Dictionary of Occupational Titles (DOT) and Classification of Jobs (COJ) resources. We have provided the DOT and COJ classifications for the job title of PHYSICAL THERAPIST as an example of their terminology. A critique of the DOT and COJ, applied to several occupational examples, suggests these resources be used with supplemental task analyses for a given job. The physical therapist, however, can use the VDARE process and the DOT and COJ resources to identify specific and achievable job targets for clients rather than relying solely on traditional trial and error, on-the-job evaluation.
Ergonomics↗
Assessing maximal static ventilatory muscle pressures using the "bugle" dynamometer. Suggestion from the field.
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Humans↗
Physical fitness of physical therapy students.
Physical fitness norms do not exist for physical therapists or physical therapy students. This lack, in part, reflects the complexity of physical fitness and the scarcity of data reported on physical fitness norms of other populations. This report describes the methods used and the results obtained for 16 physical fitness factors of 98 female and 13 male physical therapy upperclassmen and discusses the implications of physical fitness in the practice of physical therapy. Means, standard deviations, ranges, and percentile rankings are given by sex for each of the 16 fitness factors. The purpose of this study was to begin to establish physical fitness norms. As physical fitness norms are established, it will be possible to determine how norms of physical therapists and physical therapy students compare with established values.
Adult↗
Self-selected walking velocity for functional ambulation in patients with end-stage emphysema.
PURPOSE: Considerable attention has been given to ambulation and dyspnea in the population with chronic obstructive pulmonary disease; however, previous studies leave the question of what constitutes functional ambulation in this population unanswered. This article examines ambulation for functional independence in the community for patients with-end-stage emphysema based on their self-selected walking velocity (SSWV) during a 6-minute walk (6 MW) and a timed get up and go (GUG) test. METHODS: Fifty-nine patients (28 women, 31 men; mean age of 65.1 +/- 7.2 years) referred for lung transplantation or lung volume reduction surgery (mean forced expiratory volume in 1 second [FEV1] of 0.60 +/- 0.20 L; mean FEV1 as percent of predicted [FEV1%] of 22.7 +/- 8.7%) each had a 6 MW and GUG test performed on the same day. Calculations for SSWV and estimated energy expenditure were determined using the horizontal walking formula by the American College of Sports Medicine. RESULTS: No statistically significant gender differences were identified for distance walked (235.1 +/- 92.0 m), rest time taken (33.2 +/- 58.5 seconds), actual walk time (5.5 +/- 1.0 minutes), or SSWV (42.2 +/- 13.9 m/min or 1.6 +/- 0.5 miles per hour) during the 6 MW. Men tended to walk farther and faster but rested more. The SSWV during the GUG test was similar (mean 41.8 +/- 10.9 m/min or 1.6 +/- 0.4 miles per hour) to the SSWV during the 6 MW. Estimated energy expenditure was approximately 1.6 to 3.4 metabolic equivalents (METS; mean 2.3 +/- 0.5 METS). CONCLUSION: The literature defines independent community ambulation as the ability to walk at least 332 m at a near-normal velocity of approximately 80 m/min. This study population was significantly impaired for both distance and the velocity required to ambulate independently in the community. Documentation of both rest time and walk time taken during a 6 MW test will enable SSWV to be calculated and interpreted as it relates to independent community ambulation.
Aged↗