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PubMed2000

Techniques used by manipulative physiotherapists in the management of headaches.

This study aimed to identify the techniques used by manipulative physiotherapists in the management of headaches. Two hundred and two patients with headache presented to 44 Victorian trained manipulative physiotherapists (MPTs) who completed questionnaires to determine techniques used. Upper cervical (O-C3) passive accessory intervertebral movement was the most frequently used technique (84.7 per cent). Techniques such as manipulation (42.1 per cent), soft tissue massage (35.6 per cent), postural education/advice (30.2 per cent), muscle stretches (29.2 per cent), traction (26.7 per cent) and postural exercises (21.3 per cent) were usually introduced during the initial consultation, whereas passive physiological intervertebral movements (17.3 per cent), muscle retraining (16.8 per cent) and neural techniques (5.4 per cent) were more commonly introduced in later sessions. The low incidence of muscle retraining was surprising and may not reflect contemporary practice. The results indicate that the clinicians studied employ a diverse range of techniques in the management of headaches.

Journal Article↗
PubMed2006

Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study.

BACKGROUND AND PURPOSE: Providing active assistance to complete desired arm movements is a common technique in upper extremity rehabilitation after stroke. Such active assistance may improve recovery by affecting somatosensory input, motor planning, spasticity or soft tissue properties, but it is labor intensive and has not been validated in controlled trials. The purpose of this study was to investigate the effects of robotically administered active-assistive exercise and compare those with free reaching voluntary exercise in improving arm movement ability after chronic stroke. METHODS: Nineteen individuals at least one year post-stroke were randomized into one of two groups. One group performed 24 sessions of active-assistive reaching exercise with a simple robotic device, while a second group performed a task-matched amount of unassisted reaching. The main outcome measures were range and speed of supported arm movement, range, straightness and smoothness of unsupported reaching, and the Rancho Los Amigos Functional Test of Upper Extremity Function. RESULTS AND DISCUSSION: There were significant improvements with training for range of motion and velocity of supported reaching, straightness of unsupported reaching, and functional movement ability. These improvements were not significantly different between the two training groups. The group that performed unassisted reaching exercise improved the smoothness of their reaching movements more than the robot-assisted group. CONCLUSION: Improvements with both forms of exercise confirmed that repeated, task-related voluntary activation of the damaged motor system is a key stimulus to motor recovery following chronic stroke. Robotically assisting in reaching successfully improved arm movement ability, although it did not provide any detectable, additional value beyond the movement practice that occurred concurrently with it. The inability to detect any additional value of robot-assisted reaching may have been due to this pilot study's limited sample size, the specific diagnoses of the participants, or the inclusion of only individuals with chronic stroke.

Journal Article↗
PubMed2005

Rapid increases in ventilation accompany the transition from passive to active movement.

We used a novel movement transition technique to look for evidence of a rapid onset drive to breathe related to the active component of exercise in humans. Ten volunteers performed the following transitions in a specially designed tandem exercise chair apparatus: rest to passive movement, passive to active movement, and rest to active movement. The transition from rest to active exercise was accompanied by an immediate increase in ventilation, as was the transition from rest to passive leg movement (Delta = 6.06 +/- 1.09 l min(-1), p < 0.001 and Delta = 3.30 +/- 0.57 l min(-1), p = 0.002, respectively). When subjects actively assumed the leg movements, ventilation again increased immediately and significantly (Delta = 2.55 +/- 0.52 l min(-1), p = 0.032). Ventilation at the first point of active exercise was the same when started either from rest or from a background of passive leg movement (p = 1.00). We conclude that the use of a transition from passive to active leg movements in humans recruits a ventilatory drive related to the active component of exercise, and this can be discerned as a rapid increase in breathing.

Adult↗
PubMed1988

Problems and limitations of ECG baseline estimation and removal using a cubic spline technique during exercise ECG testing: recommendations for proper implementation.

One common variety of exercise-induced artifact is baseline wander resulting from movement, respiration, and poor electrode contact. Although filters can be designed to remove much of this baseline variation, they will distort the low-frequency components of the ECG complex, such as the TP-segment, the PR-segment, and, most problematically, the ST-segment. The ST-segment is the most diagnostically relevant measure of the ECG taken during exercise. While linear baseline interpolation and removal may be adequate at lower heart rates, they also will introduce significant distortions. This is particularly evident when excessive nonlinear wander is present, as seen at higher heart rates and respiration rates. A nonlinear, third-order, polynomial estimator of baseline wander, known as the cubic spline, has been used for nearly 15 years. It is a very robust technique applied to exercise ECG recordings. Since the cubic spline is not a filter and use an a priori knowledge of the shape of the ECG signal, it estimates the true baseline and avoids distortion better. The more common implementations of this technique use relatively short ECG recordings. With the advent of increasing power in computerized ECG systems, the implementation of the cubic spline algorithm for removing baseline wander in continuous, longer-duration ECG records and in real-time processing is being attempted. However, the correct application of the cubic spline to continuous recordings is not straightforward and involves a number of previously unforeseen difficulties. The accuracy and resolution of both floating point and integer operations is critical during long-term application of the cubic spline function.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1994

The relationship between occupational form and occupational performance: a kinematic perspective.

OBJECTIVES: This study examined, through kinematic analysis, the effect of occupational form on reaching performance. The hypothesis was that reaching performance would show an enhanced quality of movement in materials-based occupation (i.e., pick up a pencil and prepare to write one's own name) than in imagery-based occupation (i.e., pretend to pick up a pencil and prepare to sign one's own name) and in exercise (i.e., move the arm forward). It was further hypothesized that imagery-based occupation would elicit better performance than exercise. METHOD: The reaching performance was measured, using WATSMART (Waterloo Spatial Motion Analysis & Recording Technique), by the variables including reaction time, movement time, number of movement units, total displacement, the amplitude of peak velocity, and percentage of reach in which peak velocity occurred. A repeated-measures counterbalanced research design was used with 37 female college students. Contrast analysis was used to test the hypotheses. RESULTS: Materials-based occupation elicited enhanced quality of movement performance, as compared with imagery-based occupation and exercise. However, exercise seemed to elicit better performance than imagery-based occupation. CONCLUSION: The practical implication is that materials-based occupation might be used to elicit enhanced quality of reaching movement in occupational therapy intervention.

Adolescent↗
PubMed1997

Ventilatory response at the onset of voluntary exercise and passive movement in endurance runners.

The present study was performed to examine whether or not the ventilatory response at the onset of voluntary exercise and passive movement in endurance runners is the same as in untrained subjects. Twelve long-distance runners belonging to the varsity athletic club and 13 untrained subjects of our university participated as subjects in this study. Maximum oxygen uptake was significantly higher in the endurance runner group [mean (SD) 70.8 (4.7) ml.kg-1.min-1] than in the untrained group [49.8 (6.3) ml.kg-1.min-1]. Cardiorespiratory responses during voluntary exercise and passive movement of alternate flexion-extension of the right and left legs for about 15 s at a frequency of about 60 rpm, were determined by means of breath-by-breath techniques. Minute inspiratory ventilation (VI), tidal volume (VT), respiratory frequency (fb), cardiac output (Qc), stroke volume (SV) and heart rate (HR) increased significantly immediately at the onset of voluntary exercise and passive movement. The incremental rate for VI was greater than that for Qc. Average values and standard deviations of changes in VI were calculated as the difference between the mean of the first and second breath and the mean of five breaths preceding the exercise or movement. The rates obtained in voluntary exercise and passive movement in the endurance runner group [2.34 (0.82) and 1.72 (0.71 l.min-1), respectively] were significantly (P < 0.05) lower than those in the untrained group [4.16 (2.66) and 2.71 (1.56 l.min-1), respectively]. Also changes in VT and HR were significantly lower in the endurance group than in the untrained group with regard to both voluntary exercise and passive movement. The results suggest that the magnitude of cardiorespiratory responses at the onset of voluntary exercise and passive movement in humans is influenced by chronic endurance training for long periods.

Adult↗
PubMedDate not supplied

Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study.

Recent studies show that rapid, nearly simultaneous, stereotypical repetitive fine motor movements can degrade the sensory representation of the hand and lead to a loss of normal motor control with a target task, referred to as occupational hand cramps or focal hand dystonia. The purpose of this prospective follow-up study was to determine whether symptomatic patients in jobs demanding high levels of repetition could be relieved of awkward, involuntary hand movements following sensory discriminative retraining complemented by a home program of sensory exercises, plus traditional posture, relaxation, mobilization, and fitness exercises. Twelve patients participated in the study. They all had occupational hand cramps, as diagnosed by a neurologist. Each patient was evaluated by a trained, independent research assistant before treatment and three to six months after treatment, by use of a battery of sensory, motor, physical, and functional performance tests. Care was provided by a physical therapist or a supervised physical therapist student in an outpatient clinic. Patients were asked to stop performing the target task and to come once a week for supervised treatment that included 1) heavy schedules of sensory training with and without biofeedback to restore the sensory representation of the hand, and 2) instructions in stress-free hand use, mirror imagery, mental rehearsal, and mental practice techniques designed to stop the abnormal movements and facilitate normal hand control. Patients were instructed in therapeutic exercises to be performed in the home to improve postural alignment, reduce neural tension, facilitate relaxation, and promote cardiopulmonary fitness. Following the defined treatment period, all patients were independent in activities of daily living, and all but one patient returned to work. Significant gains were documented in motor control, motor accuracy; sensory discrimination, and physical performance (range of motion, strength, posture, and balance). This descriptive study that includes patients with occupation-related focal hand dystonia provides evidence that aggressive sensory discriminative training complemented by traditional fitness exercises to facilitate musculoskeletal health can improve sensory processing and motor control of the hand.

Adult↗
PubMed1999

Gaze-shift dynamics in subjects with and without symptoms of convergence insufficiency: influence of monocular preference and the effect of training.

We studied gaze-shift dynamics during several gaze-shift tasks and during reading, in five subjects with convergence insufficiency (C.I., a diminished ability to converge), and in ten subjects without C.I. Furthermore, we studied the effect of vergence training in order to verify previous claims that orthoptic exercises can improve vergence performance. We recorded binocular eye movements with the scleral coil technique. Subjects switched fixation between nearby and distant light emitting diodes (LEDs) arranged in isovergence arrays (distances 35 and 130 cm) in a dimly lit room. In both the C.I. and non-C.I. group, two classes of subjects occurred: vergence responders and saccadic responders. During pure vergence tasks, saccadic responders made saccades with no or little vergence; vergence responders made vergence movements with no or small saccadic components. In saccadic responders, fixation of nearby targets was monocular. Subjects with a preferred eye, according to our determination, used the preferred eye. The five C.I. subjects showed idiosyncratic responses with insufficient vergence during most trials. They all had a tendency to alternate fixation between the left and right eye. Vergence-version tasks always elicited larger vergence components than pure vergence tasks. During a reading task, vergence angles were more accurate than during gaze-shifts between LEDs. After the pre-training sessions, nine subjects (one of which had C.I.) practised a pure vergence task three times a day for at least 2 weeks. Vergence amplitudes of four of these subjects were larger after training. We conclude that vergence training can change oculomotor performance. Although C.I. is often associated with abnormal vergence dynamics, there are no typical C.I. vergence dynamics. Unstable monocular preferences may play a role in the aetiology of C.I.

Adult↗
PubMed2005

Short-term effects of electrical stimulation superimposed on muscular voluntary contraction in postural control in elderly women.

Thirty-two women between 62 and 75 years old were randomized into 3 groups. Each group performed a program of 4 sessions a week over 6 weeks. Group SC (n = 11) climbed up and down stairs, group ES (n = 11) practiced electrostimulation, and group SC + ES (n = 10) superimposed the 2 activities simultaneously. Using a force platform and a seesaw platform, static and dynamic balance in eyes-open and eyes-closed conditions were analyzed before and after the programs for each group. After the programs, the results indicated that dynamic balance improved for the 3 groups, but the contribution of visual information in the control of oscillation amplitude was lower in the SC group than in the ES and SC + ES groups. In the SC + ES group, the electrical stimulation interferes with neurophysiologic afference integration in postural control in relation to voluntary movement. Voluntary exercise appears to be more efficient than electrical stimulation and the superimposed techniques to change balancing tactics in the elderly.

Adaptation, Physiological↗
PubMed1983

Correlations between ejection times measured from the carotid pulse contour and the impedance cardiogram.

Systolic time interval (STI) analysis is a commonly employed noninvasive technique for evaluating myocardial function. It requires simultaneous recording of an electrocardiogram, phonocardiogram, and the carotid pulse contour, from which left ventricular ejection time is measured. The carotid pulse contour may be difficult to record when there is subject movement, such as with exercise or other stresses utilized in aerospace medical research. Impedance cardiography is a relatively new noninvasive technique for measuring stroke volume. It also provides a measure of systolic ejection time without the necessity of recording a carotid pulse contour. The purpose of this study was to determine the correlation between left ventricular ejection time (LVET) determined from conventional STI analysis and systolic ejection time (T) obtained with impedance cardiography. The electrocardiogram, phonocardiogram, carotid pulse contour, and impedance cardiogram were monitored simultaneously in 17 male subjects 39-63 years of age (6 normotensive, 7 with established hypertension, and 4 with labile hypertension). Subjects were monitored at seated rest and during submaximal and maximal cycle ergometer exercise. Beat-by-beat analysis revealed high intrasubject correlations between LVET and T for each subject during all three activity levels. Correlations between LVET and T for the combined group of 17 subjects were: rest r = 0.990, submaximal exercise r = 0.976, maximal exercise r = 0.986; p less than 0.01. These results indicate impedance cardiography can be used in the determination of STIs for the evaluation of ventricular function, as well as for the noninvasive determination of stroke volume and cardiac output.

Adult↗
PubMed1993

Application of impedance cardiography during exercise.

Impedance cardiography has been used over the last 30 years to measure stroke volume on a beat-by-beat basis. Cardiac output has been successfully measured with either upper or lower body exercise during light or moderate workloads. With strenuous exercise, movement artifacts severely limit the acquisition of a quality impedance cardiogram. Advances in computer technology and signal conditioning techniques have created the next generation of impedance cardiograph systems. The purpose of this study was to evaluate such a system, the noninvasive continuous cardiac output monitor (NCCOM3-R7), at rest and during submaximal upright cycle exercise. In addition, the relationships between thoracic impedance (Z(o)), first derivative of the change in thoracic impedance (dZ/dt) and posture were evaluated using the NCCOM3-R7 and the Minnesota impedance cardiograph 304B (MIC). Twenty-eight healthy men and women participated. The Z(o) progressively increased when moving from the supine to seated to standing position with both instruments. However, the NCCOM3-R7 yielded lower Z(o) values and higher dZ/dt values compared with the MIC for all postures. Z(o) and dZ/dt values appear to be dependent upon factors such as posture, gender, electrical current, and characteristics of the instrumentation. Exercise cardiac output values seemed reasonable for most subjects, although population subsets exist where the accuracy must be questioned. The general consensus supported by the impedance literature and reaffirmed by the present observations is that impedance cardiography provides a reasonable estimate of the directional changes in stroke volume and cardiac output during exercise and can be used to monitor changes in thoracic fluid balance. As this technology evolves and is further refined, it will undoubtedly play an increasing role in environmental medicine, exercise stress testing, cardiac rehabilitation, and sports medicine.

Adult↗
PubMed1997

A three-paradigm treatment model using soft tissue mobilization and guided movement-awareness techniques for a patient with chronic low back pain: a case study.

It is not uncommon for physical therapists to report difficulty in treating certain subjects with chronic idiopathic low back pain. The purpose of this case study is to present a three-paradigm model of intervention that may be adapted to the treatment of such cases. The model consists of: 1) relaxation paradigm, consisting of pain modulation procedures; 2) corrective paradigm, involving manual techniques and exercise to correct specific faulty biomechanical alignment(s) eg., pelvic asymmetry); and 3) integrative paradigm, utilizing guided movement/mobilization techniques for improving the subject's overall pattern of posture and movement. The case study of a young adult with chronic low back pain correlated with unilateral innominate bone rotation is presented to illustrate the three-paradigm approach. Over six sessions, the subject received a corrective (sessions 1-3) and an integrative treatment protocol (sessions 4-6) consisting of Rolf's method of soft tissue mobilization and Alexander's system of guided movement-awareness techniques. Before and after each session and after a 4-week follow-up, the subject was assessed for sacroiliac joint pain using a compression technique, anterior rotation of the innominate bones, pelvic angle in the standing position, and vagal tone as determined from heart rate variability. The therapist's visual analysis of sit-to-stand movement and the subject's self-reports of pain were noted. A corrective paradigm protocol of soft tissue mobilization and exercise was unsuccessful in eliminating the subject's assessed anterior rotation of the innominate bone and associated low back pain for more than 1-2 days posttreatment. Only after the implementation of a third paradigm movement/mobilization protocol did the subject begin to exhibit sustained improvement through a 4-week follow-up. Interpretations of the results, appropriate selection of corrective and integrative protocols, and physiological mechanisms are discussed.

Adult↗
PubMed2004

Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing.

OBJECTIVES: Monitoring of brachial blood pressure during exercise-electrocardiogram (ECG) testing is mandatory and changes in blood pressure (BP) can provide critical management evidence. Patient movement, mechanical vibration, artifactual sounds and observer variability make standard manual techniques problematic. This was an investigator-initiated study to assess an automated auscultatory technique of BP assessment [Tango exercise blood pressure monitor (SunTech Medical Instruments, NC, USA)] to adequately measure BP during stress-ECG testing. METHODS: Initially five fit young male volunteers underwent invasive right brachial artery BP recording using a low-compliance fluid-filled catheter with simultaneous manual and automated assessment. Secondarily, during exercise-ECG testing, the system was assessed against beat-to-beat brachial blood pressures obtained from a catheter-tip solid-state pressure manometer positioned in the ipsilateral brachial artery. RESULTS: In the supine study overall mean difference (+/-SEM) between invasive and manual blood pressures was 3.26 (1.53) and 3.89 (1.90) mmHg for diastolic BP (DBP) and systolic BP (SBP) respectively. Corresponding differences between invasive and automated results, and manual and automated were 3.68 (0.84) and -7.31 (1.83) mmHg, and -0.64 (+/-1.43) and -11.42 (+/-1.59) mmHg. During treadmill exercise-ECG testing the combined mean difference (+/-SEM) between invasive and automated SBP and DBP was 4.79 (+/-0.14) and 6.33 (+/-0.10) mmHg, respectively. CONCLUSION: Automated BP assessment during exercise-ECG testing is feasible with the use of appropriate automatic devices likely to be at least as accurate as manual BP registration. The Tango device is tolerant to exercise and provides reliable automatic BP assessment with absolute differences within an acceptable clinical range.

Adult↗
PubMedDate not supplied

[Vestibular compensation. Rehabilitation of a patient with vertigo].

Vestibular compensation is the association of neurological reorganization events that allow to recover the balance after peripheral vestibular damage. The aim of rehabilitation of the patient with vertigo is to maximize these events to achieve an earlier return of the patients to active life. An individualized vestibular rehabilitation program is used on the basis of a general protocol that includes the following four elements: a) stabilization of vision and coordination of head and eye movements; b) vestibular habituation exercises adapted on an individual basis; c) postural control exercises via biofeedback techniques; and d) a program to improve general patient conditions. It is concluded that rehabilitation therapy of vertigo should always be taken into account, both in balance alterations caused by peripheral vestibular lesions and in central nervous damage and mixed pathology.

Clinical Protocols↗
PubMed2000

The larynx during exercise.

OBJECTIVES: To develop a system capable of observing the larynx during various body movements and to investigate the relation between upper limb movements and laryngeal closure, often referred as "airtrapping." STUDY DESIGN: An endoscope capable of observing the larynx during various body movements was developed and the laryngeal state was monitored during these movements in three subjects. The output of 12 subjects' forearms was recorded with and without laryngeal closure. RESULTS: The larynx was observable even during extreme exercises such as horizontal bar exercises and vault exercises. Laryngeal closure was almost always seen during the beginning of maximum effort of the upper limbs. During constant effort, the state of the larynx varied. When the output of the upper limbs was compared with and without laryngeal closure, there was an average of 20% power loss. CONCLUSIONS: This study suggests four possible uses for this system. 1) The system could be useful to evaluate laryngeal disorders during exercise such as exercise-induced laryngomalacia. 2) The results could be used to improve the pushing exercise, a voice therapy technique. 3) The status of patients with incomplete laryngeal closure in connection with the upper limbs could be evaluated more thoroughly. 4) The technique and equipment could be used to observe the larynges during normal vocal processes that require body movement.

Adult↗
PubMed2001

The effects of a weight belt on trunk and leg muscle activity and joint kinematics during the squat exercise.

Fourteen healthy men participated in a study designed to examine the effects of weight-belt use on trunk- and leg-muscle myoelectric activity (EMG) and joint kinematics during the squat exercise. Each subject performed the parallel back squat exercise at a self-selected speed according to his own technique with 90% of his IRM both without a weight belt (NWB) and with a weight belt (WB). Myoelectric activity of the right vastus lateralis, biceps femoris, adductor magnus, gluteus maximus, and erector spinae was recorded using surface electrodes. Subjects were videotaped from a sagittal plane view while standing on a force plate. WB trials were completed significantly faster (p < 0.05) than NWB trials over the entire movement and in both the downward phase (DP) and upward phase (UP). No significant differences in EMG were detected between conditions for any of the muscle groups or for any joint angular kinematic variables during either phase of the lift. The total distance traveled by the barbell both anteriorly and vertically was significantly greater (p < 0.01) in the WB condition than the NWB condition. The velocity of the barbell was significantly greater (p < 0.01) both vertically and horizontally during both the DP and UP in the WB condition as compared with the NWB condition. These data suggest that the use of a weight belt during the squat exercise may affect the path of the barbell and speed of the lift without altering myoelectric activity. This suggests that the use of a weight belt may improve a lifter's explosive power by increasing the speed of the movement without compromising the joint range of motion or overall lifting technique.

Adult↗
PubMed2006

Passive leg movements and passive cycling do not alter arterial leg blood flow in subjects with spinal cord injury.

BACKGROUND AND PURPOSE: Subjects with a spinal cord injury (SCI) are at increased risk for cardiovascular disease-related secondary complications, such as pressure ulcers and attenuated wound healing. It has been suggested that passive exercise enhances blood flow via mechanical pump effects or reflex activation. The purpose of this study was to assess the effects of passive leg movements and passive cycling on the arterial circulation in subjects with SCI. SUBJECTS: Eight men with motor complete SCI and 8 male control subjects participated. METHODS: Echo Doppler measurements were obtained to measure leg blood flow at rest, during and after 10 minutes of standardized passive leg movements, and during and after 20 minutes of passive leg cycling. Blood pressure was measured continuously, and total vascular resistance and leg vascular resistance were calculated. RESULTS: In both groups, no changes in leg blood flow, vascular resistance, or blood pressure were observed during or after the 2 interventions. DISCUSSION AND CONCLUSION: The results of the study demonstrate that passive leg movements and passive cycling do not alter the arterial peripheral circulation in subjects with SCI or control subjects. Although the results do not support the use of passive movements or exercise for the prevention of cardiovascular disease-related secondary complications, physical therapists should not be dissuaded from using these techniques to address musculoskeletal concerns.

Adult↗