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PubMed1988

Effects of warming up on reliability of anthropometric techniques in ankylosing spondylitis.

To determine the effect of warm-up on anthropometric measures, 10 patients with ankylosing spondylitis and 10 normal control subjects were measured over a 1-hour period by one therapist. A series of 4 measures--a modified Schober's test, finger-to-floor with the subject standing on a 23-cm stool, chest expansion, and cervical rotation using an arthrodial protractor--were repeated completely 4 times. Subjects exercised between each series (except between the third and fourth series). Intra-rater reliability was determined by comparing measurement 3 with measurement 4, and the warm-up effect was determined by comparing measurement 1 with measurement 3. The Schober's test and chest expansion are stable measures and are not affected by warm-up. However, the finger-to-floor and cervical rotation exercises require warm-up to ensure stable values for clinical or research followup of spondylitis.

Adult↗

PubMed2006

Neural adaptations to resistive exercise: mechanisms and recommendations for training practices.

It is generally accepted that neural factors play an important role in muscle strength gains. This article reviews the neural adaptations in strength, with the goal of laying the foundations for practical applications in sports medicine and rehabilitation. An increase in muscular strength without noticeable hypertrophy is the first line of evidence for neural involvement in acquisition of muscular strength. The use of surface electromyographic (SEMG) techniques reveal that strength gains in the early phase of a training regimen are associated with an increase in the amplitude of SEMG activity. This has been interpreted as an increase in neural drive, which denotes the magnitude of efferent neural output from the CNS to active muscle fibres. However, SEMG activity is a global measure of muscle activity. Underlying alterations in SEMG activity are changes in motor unit firing patterns as measured by indwelling (wire or needle) electrodes. Some studies have reported a transient increase in motor unit firing rate. Training-related increases in the rate of tension development have also been linked with an increased probability of doublet firing in individual motor units. A doublet is a very short interspike interval in a motor unit train, and usually occurs at the onset of a muscular contraction. Motor unit synchronisation is another possible mechanism for increases in muscle strength, but has yet to be definitely demonstrated. There are several lines of evidence for central control of training-related adaptation to resistive exercise. Mental practice using imagined contractions has been shown to increase the excitability of the cortical areas involved in movement and motion planning. However, training using imagined contractions is unlikely to be as effective as physical training, and it may be more applicable to rehabilitation. Retention of strength gains after dissipation of physiological effects demonstrates a strong practice effect. Bilateral contractions are associated with lower SEMG and strength compared with unilateral contractions of the same muscle group. SEMG magnitude is lower for eccentric contractions than for concentric contractions. However, resistive training can reverse these trends. The last line of evidence presented involves the notion that unilateral resistive exercise of a specific limb will also result in training effects in the unexercised contralateral limb (cross-transfer or cross-education). Peripheral involvement in training-related strength increases is much more uncertain. Changes in the sensory receptors (i.e. Golgi tendon organs) may lead to disinhibition and an increased expression of muscular force. Agonist muscle activity results in limb movement in the desired direction, while antagonist activity opposes that motion. Both decreases and increases in co-activation of the antagonist have been demonstrated. A reduction in antagonist co-activation would allow increased expression of agonist muscle force, while an increase in antagonist co-activation is important for maintaining the integrity of the joint. Thus far, it is not clear what the CNS will optimise: force production or joint integrity. The following recommendations are made by the authors based on the existing literature. Motor learning theory and imagined contractions should be incorporated into strength-training practice. Static contractions at greater muscle lengths will transfer across more joint angles. Submaximal eccentric contractions should be used when there are issues of muscle pain, detraining or limb immobilisation. The reversal of antagonists (antagonist-to-agonist) proprioceptive neuromuscular facilitation contraction pattern would be useful to increase the rate of tension development in older adults, thus serving as an important prophylactic in preventing falls. When evaluating the neural changes induced by strength training using EMG recording, antagonist EMG activity should always be measured and evaluated.

Adaptation, Physiological↗

PubMedDate not supplied

The effectiveness of constraint induced movement therapy in two young children with hemiplegia.

Constraint induced movement therapy (CIMT) for hemiplegia involves constraining use of the unaffected limb while providing intensive shaping and practice of movements in the hemiplegic limb. The technique had been shown to be highly effective in improving upper limb function in adults following stroke, but there is only a limited literature on the use of this intervention in children. This paper provides a brief overview of the theory and background of this procedure, and reviews the literature on use of the technique in children. It then provides detailed case reports for two hemiplegic children, ages 19 and 38 months, each of whom underwent a trial of CIMT. Both children made significant gains in upper arm function that were reflected in a variety of domains, including aspects of everyday functional limb use. Gains persisted to variable degrees and some unexpected new gains were noted following cessation of CIMT. Practical challenges for the children, parents, and therapists in implementing this intensive but promising intervention are also discussed.

Child, Preschool↗

PubMed2005

Patient-cooperative strategies for robot-aided treadmill training: first experimental results.

Task-oriented repetitive movements can improve motor performance in patients with neurological or orthopaedic lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate, and document neurological and orthopedic rehabilitation. This paper deals with the application of "patient-cooperative" techniques to robot-aided gait rehabilitation of neurological disorders. We define patient-cooperative to mean that, during movement, the technical system takes into account the patient's intention and voluntary efforts rather than imposing any predefined movements or inflexible strategies. It is hypothesized that such cooperative robotic approaches can improve the therapeutic outcome compared to classical rehabilitation strategies. New cooperative strategies are presented that detect the patient's voluntary efforts. First, this enables the patient increased freedom of movement by a certain amount of robot compliance. Second, the robot behavior adapts to the existing voluntary motor abilities. And third, the robotic system displays and improves the patient contribution by visual biofeedback. Initial experimental results are presented to evaluate the basic principle and technical function of proposed approaches. Further improvements of the technical design and additional clinical testing is required to prove whether the therapeutic outcome can be enhanced by such cooperative strategies.

Exercise Test↗

PubMedDate not supplied

Effects of a controlled exercise trial on pain in nursing home residents.

OBJECTIVES: To report preliminary data relevant to the effects of an exercise and toileting intervention on pain among incontinent nursing home (NH) residents. DESIGN: A randomized controlled intervention trial. SETTING AND PARTICIPANTS: Fifty-one incontinent residents in one skilled NH. INTERVENTION: The intervention was implemented by research staff for a total of 4 times a day (every 2 hours), 5 days a week, for 32 weeks. Residents were provided with incontinence care and assistance to either walk or, if nonambulatory, wheel their chairs, and to repeat sit-to-stand movements. MEASUREMENTS: Pain was measured in two ways at baseline and again at 32 weeks: (1) a count of the number of verbal expressions and pain behaviors during a standardized physical performance assessment; and (2) a modified Geriatric Pain Measure administered in a one-on-one interview format. RESULTS: There were significant differences between intervention and control groups on all physical performance measures over time, with the intervention group remaining stable and the control group showing a significant decline in sit-to-stand, walking, and wheelchair propulsion endurance. Both groups showed mild to moderate pain at baseline according to each of the two pain measures, while there were no significant changes in pain reports between groups over time based on either measure. There was, however, a trend for pain to increase in the intervention group. CONCLUSIONS: No significant changes in pain reports were attributable to exercise despite significant improvements in physical performance. In fact, there was a tendency for pain reports to increase with exercise. These preliminary findings suggest that exercise alone may be ineffective for pain management among incontinent NH residents. Care providers should consider that exercise to improve physical function may increase pain symptoms, requiring preemptive analgesia, other pain control strategies, or modified exercise techniques for this frail segment of the NH population.

Aged↗

PubMed1989

Wheelchair propulsion technique at different speeds.

To study wheelchair propulsion technique at different speeds, five well-trained subjects propelled a wheelchair on a treadmill. Measurements were made at four belt speeds of 0.56-1.39 m/s and against slopes of 2 and 3 degrees. Cardiorespiratory data were collected. Three consecutive strokes were filmed. Using markers on subject, wheelchair and treadmill frame a kinematic analysis was performed. Considerable inter-individual differences in propulsion style were found, but also general changes relative to speed occurred in the group as a whole. Cycle time decreased with speed, predominantly as the result of a shorter push time while push angle remained constant and the movement ranges of trunk and arms shifted with speed. It is concluded that despite different propulsion styles, general and continuous adaptations to speed changes occurred, mainly by flexion of the trunk and arms.

Acceleration↗

PubMed2005

[Evaluation of respiratory failure due to sequelae of tuberculosis].

Though the mortality of tuberculosis in Japan has been extremely rapidly depressed from about 150 deaths per 100,000 in 1950 down to about 4 in 1985 during the period of a couple of decades after the World War II. However, the declining trend of the mortality and the morbidity seem to be leveling off now and the morbidity of the tuberculosis remain on the almost same level which are much higher than that of the developed countries. We have to make the progress in the field of the new diagnostic technique and the creation of the new drugs applying the most frontier science and the social system supporting the completion of the treatment for every patient. On the other hand, it is also very important to take care of those who have been suffering from the sequelae of the pulmonary tuberculosis, which include chronic respiratory failure, cor pulmonale, and non-TB chronic pulmonary secondary infections. Among the sequelae we focus to the respiratory failure. Among the patients with various chronic respiratory diseases, there are many who are not hypoxic at rest but are hypoxic during physical exercise in the daily life. The pulmonary exercise test by treadmill or ergometer which needs a lot of work is the standard method to detect the exercise hypoxia. But this test is too complicated to come into wide use in the daily clinical study in Japan. Another exercise test has been eagerly expected for a long period. We newly developed a method to detect the exercise hypoxia in the patients' daily life without burdening the additional physical activities. The device of the new method consists of a portable pulse oxymeter with a built-in accelerometer which measures the oxygen saturation percutaneously and also measures simultaneously the vertical acceleration of the subject's physical movement by the accelerometer. The appropriate evaluation of exercise hypoxia of the patients with respiratory disturbances due to pulmonary tuberculosis sequelae, especially exercise hypoxia, should be performed widely all over the daily clinical examination by such a method as described in this report. Further the system of the evaluation of the exercise respiratory disturbances should be introduced in the various social regimen which concern with the disability due to the respiratory disturbances. We wish our society will be more matured society in which the patients with respiratory disturbances can afford to fully enjoy their lives. Both the frontier science against the tuberculosis and the measures against the sequelae of the pulmonary tuberculosis are one of our important challenges today.

Exercise Test↗

PubMed1991

Casuistry as methodology in clinical ethics.

This essay focuses on how casuistry can become a useful technique of practical reasoning for the clinical ethicist or ethics consultant. Casuistry is defined, its relationship to rhetorical reasoning and its interpretation of cases, by employing three terms that, while they are not employed by the classical rhetoricians and casuists, conform, in a general way, to the features of their work. Those terms are (1) morphology, (2) taxonomy, (3) kinetics. The morphology of a case reveals the invariant structure of the particular case whatever its contingent features, and also the invariant forms of argument relevant to any case of the same sort: these invariant features can be called topics. Taxonomy situates the instant case in a series of similar cases, allowing the similarities and differences between an instant case and a paradigm case to dictate the moral judgment about the instant case. This judgment is based, not merely on application of an ethical theory or principle, but upon the way in which circumstances and maxims appear in the morphology of the case itself and in comparison with other cases. Kinetics is an understanding of the way in which one case imparts a kind of moral movement to other cases, that is, different and sometimes unprecedented circumstances may move certain marginal or exceptional cases to the level of paradigm cases. In conclusion, casuistry is the exercise of prudential or practical reasoning in recognition of the relationship between maxims, circumstances and topics, as well as the relationship of paradigms to analogous cases.

Bioethical Issues↗

PubMed2005

A new electrode configuration for recording electromyographic activity in behaving mice.

With the increasing use of normal and genetically modified mice in the field of motor physiology, there is a need for a simple and reliable technique for recording electromyographic (EMG) activity in behaving mice. Here, we describe a new method for the fabrication and implantation of fine EMG recording electrodes into multiple muscles of adult mice. This method minimizes surgical damage to the muscles and the connecting leads have only a modest influence on leg movements when electrodes are implanted into distal muscles. We demonstrate that excellent EMG recordings can be obtained during walking, swimming and scratching for the vastus lateralis, tibialis anterior and gastrocnemius muscles in normal adult mice. EMG recordings were also made in a mutant EphA4 mouse to demonstrate the utility of the method for examining motor patterns in genetically modified animals. We also developed a method for constructing highly reflective markers that could be viewed over a range of orientations to measure the kinematics of legs movements during stepping. A commercial motion analysis system was used to track six markers during walking and to synchronize video and EMG data during walking sequences.

Animals↗

PubMed2006

Contribution of the legs to double-poling performance in elite cross-country skiers.

PURPOSE: In the classical style of cross-country skiing, the double-poling (DP) technique, which is regarded as an upper-body exercise, is used on the flatter parts of a course. Limited biomechanical and physiological data are available about DP compared with other cross-country skiing techniques. The purpose of the present study was to evaluate the possible role of the lower body during DP. METHODS: Eleven elite cross-country skiers performed two incremental tests using DP roller skiing at 1 degree inclination on a treadmill with or without locking the knee and ankle joints (DPLOCKED and DPFREE). Maximal and peak oxygen uptake (VO2max and VO2peak) during classic diagonal skiing and DP, respectively, were measured. In addition, heart rate, blood lactate concentration, and maximal DP velocity (Vmax) were determined. Pole-ground reaction forces and joint angles (elbow, hip, knee, and ankle) were analyzed. RESULTS: The skiers obtained 7.7% higher VO2peak, 9.4% higher Vmax, and 11.7% longer time to exhaustion during DPFREE compared with DPLOCKED (all P < 0.05). There was a higher heart rate and blood lactate concentration in DPLOCKED at submaximal stages (all P < 0.05), with no difference in oxygen consumption. At 85% Vmax, corresponding to approximately 81% VO2peak FREE, the differences in physiological variables were accompanied by a 13.6% higher poling frequency, a 4.9% shorter poling phase, 13.3% shorter recovery phase, and 10.9% lower relative pole force in DPLOCKED (all P < 0.05). CONCLUSIONS: Movements of the knee and ankle joints are an integrative part in the skillful use of the DP technique, and restriction of the motion in these joints markedly affects both biomechanical and physiological variables, impairing DP performance.

Adult↗

PubMed2002

Over the border--the problems of uncontrolled radioactive materials crossing national borders.

Cross-border movement of radioactive materials and contaminated items, in particular metallurgical scrap, has become a problem of increasing importance. Radioactive sources out of regulatory control, now often called 'orphan sources', have frequently caused serious, even deadly, radiation exposures and widespread contamination. The United States Nuclear Regulatory Commission reported over 2,300 incidents of radioactive materials found in recycled metal scrap and more than 50 accidental smeltings of radioactive sources. A further potentially serious problem is illicit trafficking in nuclear and other radioactive materials. In 1995 the International Atomic Energy Agency (IAEA) started a programme to combat illicit trafficking in nuclear and other radioactive materials, which includes an international database on incidents of illicit trafficking, receiving reports from some 80 member states. For the period 1993-2000 the IAEA database includes 345 confirmed incidents. While from 1994-1996 the frequency declined significantly, this trend has been reversed since 1997, largely due to radioactive sources rather than nuclear material. This paper compares monitoring techniques for radioactive materials in scrap applied at steel plants and scrap yards with monitoring at borders, a completely different situation. It discusses the results of the 'Illicit Trafficking Radiation Detection Assessment Program', a large international pilot study, conducted in cooperation between the IAEA, the Austrian Government and the Austrian Research Centre Seibersdorf. The aim of this exercise was to derive realistic and internationally agreed requirements for border monitoring instrumentation. Finally the present extent of border monitoring installations is discussed.

Crime↗

PubMed1987

Isometric exercise for an individual with hemophilic arthropathy.

Several authors have described nonsurgical rehabilitative techniques for individuals with hemophilia who have single or recurrent hemarthroses. The effects of these low intensity exercise programs are not stated clearly in the literature. In this single-case experimental study, we investigated the effects of a training program of isometric exercise of at least two thirds of maximum voluntary contraction on the knee joint and surrounding muscles of a patient with hemophilia. A 12-year-old subject with severe factor-VIII deficiency and chronic knee arthroses was seen for baseline measurements, three weeks of treatment, and follow-up baseline measurements. The isometric exercise program safely increased right hamstring and quadriceps femoris muscle group strength 40% to 70% without adversely affecting knee range of motion, circumference, or skin temperature and without causing bleeding or discomfort. The use of isometric exercise programs during rehabilitation and maintenance is a promising treatment component for the total care of the individual with hemophilia.

Child↗

PubMed1993

[Indications, technique and results of treatment of fractures of the base of the first metacarpal bone with movement stable osteosynthesis].

We report about the indication, technique and results of 27 fractures of the base of the metacarpus I. All those fractures were treated by open reduction and screw-/plate osteosynthesis according to the AOSIF-technique. Using these implants and the technique of open reduction with an additional autologous bone graft it offers the possibility to start active motion therapy immediately after operation. Perioperative complications can be bypassed with the use of external mini-fixateur as well as in those cases of open fractures with various types of damage patterns. Total active mobility (TAM) of the thumb joints showed in our series of 27 treated fractures an active total mobility of 80% or more in 25 patients. There where three patients with wound healing disturbances. No fracture healed delayed or resulted in non union, no patient showed signs of reflex dystrophy, yet in two cases insufficient joint reconstruction had to be noted. Neither our own short followed-up results or those few cases published so far allow us a final critical judgement of the best technique in treating the fractures of the base of metacarpus I.

Adult↗

PubMed2005

Effects of mental practice on affected limb use and function in chronic stroke.

OBJECTIVE: To determine the efficacy of a mental practice (MP) protocol in increasing the function and use of the more affected limb in stroke patients. DESIGN: Randomized, controlled, multiple baseline, pre-post, case series. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Eleven patients who had a stroke more than 1 year before study entry (9 men; mean age, 62.3+/-5.1 y; range, 53-71 y; mean time since stroke, 23.8 mo; range, 15-48 mo; 10 strokes exhibiting upper-limb hemiparesis on the dominant side) and who exhibited affected arm hemiparesis and nonuse. INTERVENTION: All patients received 30-minute therapy sessions 2 days a week for 6 weeks. The sessions emphasized activities of daily living (ADLs): 6 subjects randomly assigned to the MP condition concurrently received sessions requiring daily MP of the ADLs; 5 subjects (control group) received an intervention consisting of relaxation techniques. MAIN OUTCOME MEASURES: The Motor Activity Log and Action Research Arm (ARA) test. RESULTS: Affected limb use as rated by MP patients and their caregivers increased (1.55, 1.66, respectively), as did patient and caregiver ratings of quality of movement (2.33, 2.15, respectively) and ARA scores (10.7). In contrast, the controls showed nominal increases in the amount they used their affected limb and in limb function. A Wilcoxon test on the ARA scores revealed significantly ( P =.004) greater changes in the MP group's scores. CONCLUSIONS: Participation in an MP protocol may increase a stroke patient's use of his/her more affected limb. Data further support that the protocol resulted in correlative, MP-induced, motor function improvements. The mechanisms whereby MP increases affected arm use are unknown. Perhaps using the more affected limb becomes more salient through MP, or perhaps motor schema are altered during MP to integrate limb use.

Activities of Daily Living↗

PubMed2004

Evaluation of pressure distribution under an English saddle at walk, trot and canter.

REASONS FOR PERFORMING STUDY: Basic information about the influence of a rider on the equine back is currently lacking. HYPOTHESIS: That pressure distribution under a saddle is different between the walk, trot and canter. METHODS: Twelve horses without clinical signs of back pain were ridden. At least 6 motion cycles at walk, trot and canter were measured kinematically. Using a saddle pad, the pressure distribution was recorded. The maximum overall force (MOF) and centre of pressure (COP) were calculated. The range of back movement was determined from a marker placed on the withers. RESULTS: MOF and COP showed a consistent time pattern in each gait. MOF was 12.1 +/- 1.2 and 243 +/- 4.6 N/kg at walk and trot, respectively, in the ridden horse. In the unridden horse MOF was 172.7 +/- 11.8 N (walk) and 302.4 +/- 33.9 N (trot). At ridden canter, MOF was 27.2 +/- 4.4 N/kg. The range of motion of the back of the ridden horse was significantly lower compared to the unridden, saddled horse. CONCLUSIONS AND POTENTIAL RELEVANCE: Analyses may help quantitative and objective evaluation of the interaction between rider and horse as mediated through the saddle. The information presented is therefore of importance to riders, saddlers and equine clinicians. With the technique used in this study, style, skill and training level of different riders can be quantified, which would give the opportunity to detect potentially harmful influences and create opportunities for improvement.

Animals↗

PubMed2000

Alexander technique for chronic asthma.

BACKGROUND: "The Alexander technique" is a taught form of physical therapy involving a series of movements designed to correct posture and bring the body into natural alignment with the object of helping it to function efficiently, and is reported to aid relaxation. Some practitioners claim benefits for those who desire greater ease and efficiency of breathing, including asthmatics. OBJECTIVES: The objective of this review was to evaluate the efficacy of the Alexander technique in people with chronic, stable asthma. SEARCH STRATEGY: The specialised register of the Cochrane Airways Group, the Cochrane Complementary Medicine Field trials register and the bibliographies of relevant articles were searched. SELECTION CRITERIA: Randomised controlled trials of Alexander technique for the improvement of the symptoms of chronic, stable asthma, comparing the treatment with either another intervention or no intervention. DATA COLLECTION AND ANALYSIS: No trials were found that met the selection criteria. REVIEWER'S CONCLUSIONS: Robust, well-designed randomised controlled trials are required in order to test claims by practitioners that AT can have a positive effect on the symptoms of chronic asthma and thereby help people with asthma to reduce medication.

Asthma↗

PubMed1984

Management of pacemaker circus movement tachycardias.

DDD pacemakers were implanted in 11 patients of whom 5 had the capacity to conduct retrogradely to the atrium. Methods to prevent or terminate pacemaker circus movement tachycardia ( PCMT ) were evaluated in these patients. V-A conduction was assessed before implantation by incremental right ventricular pacing while recording right atrial electrograms. Following implantation and at quarterly outpatient clinic visits, V-A conduction and ability to initiate and sustain PCMT were systematically assessed by non-invasive techniques. PCMT could be induced non-invasively in all 5 patients. The methods used to reduce and terminate the incidence of PCMT were: 1) decreasing the atrial sensitivity; 2) stressing the V-A conduction system by programming a high upper rate with an appropriately short A-V interval; 3) programming a low lower rate; 4) avoiding the Wenckebach response (by programming a high upper rate); 5) medication; and 6) occasionally by using a magnet. PCMT was controlled in all patients, in 2 patients by programming measures only and in 2 with the addition of medication. One patient who refused medication had to be programmed into another pacing mode. We conclude that: 1) the presence of V-A conduction is not an absolute contraindication to the use of a DDD pacing system; 2) pacing the ventricle early enough to cause V-A block was the most useful method to terminate PCMT ; 3) future generation DDD pacemakers should prevent initiation of PCMTs while maintaining the possibility to synchronize to exercise-induced high atrial rates.

Adult↗

PubMed1993

A biomechanical analysis of muscle strength as a limiting factor in standing posture.

We developed a method for studying muscular coordination and strength in multijoint movements and have applied it to standing posture. The method is based on a musculoskeletal model of the human lower extremity in the sagittal plane and a technique to visualize, geometrically, how constraints internal and external to the body affect movement. We developed an algorithm to calculate the set of all feasible accelerations (i.e., the 'feasible acceleration set', or FAS) that muscles can induce. For the ankle, knee, and hip joints in the sagittal plane, this set is a polyhedron in three dimensions. Using the volume of the FAS as an indicator of overall mobility, we found that strengthening muscles on the posterior side (as opposed to the anterior) of the body would cause greater increases in mobility. Employing the experimental observations of others, we also found that acceleration constraints greatly reduce the range of feasible accelerations. We then defined a set of four basic acceleration vectors which, when used in various combinations, can produce the repertoire of postural movements. We used linear programming to find the maximum magnitudes of these vectors, and the sensitivity of these magnitudes to muscle strength, thereby delineating those muscles which, if strengthened, would cause the greatest increase in the body's ability to generate the basic acceleration vectors. For our particular model, those muscle groups were found to be hamstrings, tibialis anterior, rectus femoris, and gastrocnemius. These muscle groups would be of great importance in cases involving severely reduced muscle strength. This methodology may therefore be useful for purposes such as design of functional electrical stimulation controllers or exercises for persons at risk for falling.

Acceleration↗