Factors associated with muscle function in patients with hematologic malignancies undergoing chemotherapy.

PURPOSE: Muscle dysfunction such as loss of muscle mass and decreased muscle strength is often observed in patients with hematologic malignancies. However, specific factors associated with muscle function have not been identified. The purpose of this study was to identify significant factors affecting muscle function in patients with hematologic malignancies. METHODS: This was a cross-sectional, observational study. Eighty-eight inpatients with hematologic malignancies undergoing chemotherapy were recruited. Participants were evaluated for muscle thickness and isometric knee extensor strength as indicators of muscle function, physical activity, physical symptoms, psychological distress, and self-efficacy at the start date of rehabilitation. Multiple regression analysis with muscle function as the dependent variable and clinical information and other evaluation items as explanatory variables was performed. RESULTS: Lymphocyte count, the geriatric nutritional risk index, and physical activity were significant factors associated with muscle thickness, while physical activity and self-efficacy were significant factors associated with isometric knee extensor strength. CONCLUSIONS: Nutritional status, physical activity, and self-efficacy were significant factors associated with muscle function in patients with hematologic malignancies. Rehabilitation intervention focusing on improving physical activity and nutritional status should be considered necessary for enhancing muscle function in patients with hematologic malignancies.

Physical and Occupational Therapy for a Teenager with Acute Flaccid Myelitis: A Case Report.

AIMS: The purpose of this case report is to describe the inpatient rehabilitation program of a 13-year-old boy with acute flaccid myelitis (AFM), specific to physical and occupational therapy examination, treatment, and outcomes. CASE DESCRIPTION: AFM is a rare, acute neurologic illness in children and young adults who present with weakness and/or paralysis of unknown etiology. The teenager was admitted to the program, dependent for all mobility and self-care. Interventions focused on range of motion, transfer training, self-care, power wheelchair mobility, and environmental adaptations. OUTCOMES: Weekly re-evaluations and the WeeFIM were used at admission and discharge to measure the teenager's progress. At discharge, the teenager had made small gains in his passive and active range of motion. He was independent in directing his care and able to drive his power wheelchair with supervision. DISCUSSION: Due to the scarcity of published data describing AFM, this report describes an individual's response to a rehabilitation program and will hopefully add to future research in order to provide patients and families with expectations for their recovery and ultimate level of function.

Gross Motor Outcomes After Dynamic Weight-Bearing in 2 Children With Trunk Hypotonia: A Case Series.

INTRODUCTION: Children with trunk hypotonia may have limited ability to maintain an upright weight-bearing position, resulting in decreased postural control and a delay in achieving gross motor milestones. PURPOSE: The purpose of this case series is to report the effect of a home-based dynamic standing program on postural control and gross motor activity in 2 children with trunk hypotonia. DESCRIPTIONS: Child 1 (aged 24 months, Gross Motor Function Classification Scale Level IV) and Child 2 (aged 21 months, Gross Motor Function Classification Scale Level V) participated in a standing program using the Upsee harness at home 3 days per week for 12 weeks. OUTCOMES: Both children improved their gross motor function, and Child 1 demonstrated improved trunk control in sitting. WHAT THIS CASE ADDS: The use of the Upsee harness was an effective intervention for these children with trunk hypotonia to achieve weight-bearing and improve gross motor abilities.

Relationship Between Central Hypotonia and Motor Development in Infants Attending a High-Risk Neonatal Neurology Clinic.

PURPOSE: To study the relationship between central hypotonia and motor development, and to determine the relative contribution of nuchal, truncal, and appendicular hypotonia domains to motor development. METHODS: Appendicular, nuchal, and truncal tones of high-risk infants were assessed, as was their psychomotor developmental index (PDI). Infants with peripheral hypotonia were excluded. RESULTS: We included 164 infants (mean age 9.6 ± 4 months), 36 with normal tone in all 3 domains and 128 with central hypotonia. Twenty-six of the latter had hypotonia in 1 domain and 102 had multiple combinations of 3 domains. Hypotonia domains were distributed as follows: truncal (n = 115), appendicular (n = 93), and nuchal (n = 70). Each domain was significantly associated with PDI scores (P < .001) but not with a later diagnosis of cerebral palsy. On linear regression, nuchal hypotonia had the strongest contribution to PDI scores (ß = -0.6 [nuchal], -0.45 [appendicular], and -0.4 [truncal], P < .001). CONCLUSIONS: Central hypotonia, especially nuchal tone, is associated with lowered motor development scores.

Efficacy of orthoses for children with hypotonia: a systematic review.

PURPOSE: The purpose of this systematic review of the literature was to determine the efficacy of orthoses for children with hypotonia and provide a concise summary of the state of the evidence in this area. METHODS: Fifteen search terms were used to find articles addressing children with hypotonia, orthotic use, and physical therapy. RESULTS: Ten articles met the inclusion criteria, but no level I evidence was found. Data were reported for body structure and activity components, but not participation outcomes. Current evidence suggests that foot orthoses and supramalleolar orthoses may benefit children with hypotonia; however, the evidence is low level. CONCLUSION: The evidence for efficacy of orthoses for children with hypotonia continues to have gaps with the following questions still unanswered: When is the optimal time to introduce orthoses? Are foot orthoses or supramalleolar orthoses more efficacious? Should orthoses be combined with physical therapy?

Diagnosis dialog for pediatric physical therapists: hypotonia, developmental coordination disorder, and pediatric obesity as examples.

PURPOSE: To clarify what diagnosis means for pediatric physical therapists, to provide several examples of human movement dysfunction syndromes, and to offer guidance for how pediatric physical therapists may continue this work in any clinical setting. KEY POINTS: The importance of diagnosis in pediatric physical therapy is presented along with examples of 3 different processes used to develop diagnostic labels. These processes included surveys to identify consensus opinion of clinicians, a literature review, and a combination of these 2. Hypotonia, developmental coordination disorder, and pediatric obesity are presented as examples. SUMMARY: The 3 diagnoses serve as a basis for ongoing dialogue, discussion, and development of diagnostic labels for human movement syndromes identified by pediatric physical therapists.

Mirror therapy and treadmill training for patients with chronic stroke: a pilot randomized controlled trial.

BACKGROUND: Previous lower-limb mirror therapy research has focused on non-weight bearing interventions. OBJECTIVES: The primary aim of this study was to investigate the effect and feasibility of a combination of mirror therapy and treadmill training on post-stroke lower-limb recovery compared to a placebo intervention. METHODS: All patients (N = 30) walked on a treadmill for 30 min per day, 3 days per week, for 4 weeks. The mirror therapy and treadmill training group (n = 15) walked on the treadmill while viewing a reflection of their non-paretic limb in a mirror positioned in their mid-sagittal plane. The placebo group (n = 15) received no mirror visual feedback due to an altered mirror position. PRIMARY OUTCOME MEASURES: Ten Metre Walk Test (10MWT) and Six Minute Walk Test (6MWT). SECONDARY OUTCOME MEASURES: Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Feasibility was appraised by examining participant compliance and any adverse events. RESULTS: No significant between group differences were demonstrated for the 10MWT, 6MWT or FMA-LE at post-training or 3-month follow-up assessment. A significant between group difference on the MAS was demonstrated in the reduction of ankle dorsiflexion muscle tone (p = 0.006) and ankle plantarflexion muscle tone (p = 0.01) in the mirror therapy group compared to the placebo group at post-training assessment but not at 3-month follow-up. CONCLUSION: Our study reveals that in our group of patients with chronic stroke, mirror therapy combined with treadmill training facilitated significant reductions in ankle muscle tone (p < 0.05) compared to a placebo intervention.

Interventions to improve sensory and motor outcomes for young children with central hypotonia: A systematic review.

OBJECTIVE: To evaluate evidence supporting physical and occupational therapy interventions used to improve sensory and motor outcomes for children 0-6 years with central hypotonia. METHODS: Four electronic databases were searched from 1996 to March 2017. Level of evidence and study conduct was evaluated using American Academy of Cerebral Palsy and Developmental Medicine criteria. Traffic lighting classification identified interventions that were green (proven effective), yellow (possibly effective) or red (proven ineffective or contraindicated). RESULTS: Thirty-seven articles were included. Nine studies measured orthotic interventions while four distinct studies published over nine articles measured treadmill interventions. Remaining studies measured impact of compression garments, massage, motor and sensori-motor interventions, positioning and mobility interventions. CONCLUSIONS: Green light evidence supports treadmill training (to promote ambulation and gait characteristics) and massage (to positively affect muscle tone, motor development and use of vision) for infants with Down syndrome. These interventions are considered Yellow (possibly effective) for other populations. Green light evidence supports impact of orthoses on foot alignment for ambulatory children with hypotonia, while impact on gait characteristics is Yellow light and motor development may be negatively impacted (Red light) in pre-ambulatory children. All other interventions rated Yellow (possibly effective) and therapists should monitor using sensitive outcome measures.

Intermittent Esotropia in 4 Patients With Allan-Herndon-Dudley Syndrome.

Allan-Herndon-Dudley syndrome is a rare X-linked neurologic condition caused by mutations in monocarboxylate transporter 8 ( MCT8), which leads to deficient thyroid hormone transport. Typical features include severe cognitive impairment, truncal hypotonia, spastic paraplegia, weakness, and speech difficulties. Minimal literature exists describing the ocular findings in patients with Allan-Herndon-Dudley syndrome. We describe 4 male siblings affected with Allan-Herndon-Dudley syndrome with a novel nonsense mutation (Q90X) in the MCT8 protein. All affected siblings presented with classic findings of Allan-Herndon-Dudley syndrome, and each of the siblings also developed intermittent esotropia. This group of affected siblings represents the first consistent documentation of strabismus in Allan-Herndon-Dudley syndrome, suggesting a possible association between this clinical finding and the neurologic syndrome.

[The value of intravesical electrostimulation in the treatment of acute prolonged bladder overdistension]. / Der Stellenwert der intravesikalen Elektrostimulation in der Therapie der akuten prolongierten Blasenüberdehnung.

BACKGROUND: The effectiveness of intravesical electrostimulation (IVES) in the treatment of acute prolonged bladder overdistension (PBO) was investigated. METHODS: Sixteen patients (female 11, male 5, ø 54 years) after PBO (bladder filling volume: 1317+/-320 ml) were evaluated: 11 after surgery and 5 after polytrauma, psychosomatic disorder or LV4 fracture. After exclusion of a neurogenic aetiology and a urodynamic examination, IVES was performed besides IC or suprapubic catheter. RESULTS: Group 1: six patients with a weak detrusor (p(detr. max.)<30 cmH(2)O); group 2: ten patients had detrusor acontractility. After 25 IVES sessions, group 1 showed a significant increase of p(detr. max.) (p=0.01) as well as a decrease in PVR (31% to 3% of bladder capacity, p=0.02). Group 2 had no significant increase of p(detr. max). CONCLUSIONS: Two-thirds of patients with a weak detrusor after PBO will regain balanced voiding after IVES due to detrusor reinforcement. With an acontractile detrusor only bladder sensation improves.

Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke.

BACKGROUND AND PURPOSE: To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm, the effects of change in motor function over time on the accuracy of prediction were evaluated, and a prediction model for the probability of regaining dexterity at 6 months was developed. METHODS: In 102 stroke patients, dexterity and paresis were measured with the Action Research Arm Test, Motricity Index, and Fugl-Meyer motor evaluation. For model development, 23 candidate determinants were selected. Logistic regression analysis was used for prognostic factors and model development. RESULTS: At 6 months, some dexterity in the paretic arm was found in 38%, and complete functional recovery was seen in 11.6% of the patients. Total anterior circulation infarcts, right hemisphere strokes, homonymous hemianopia, visual gaze deficit, visual inattention, and paresis were statistically significant related to a poor arm function. Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity (Action Research Arm Test >or=10 points) from 74% (positive predictive value [PPV], 0.74; 95% confidence interval [CI], 0.63 to 0.86) to 94% (PPV, 0.83; 95% CI, 0.76 to 0.91) at 6 months. No change in probabilities of prediction dexterity was found after 4 weeks. CONCLUSIONS: Based on the Fugl-Meyer scores of the flaccid arm, optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset. Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months.

Two theories of muscle strength augmentation using percutaneous electrical stimulation.

Electrical stimulation of muscle is a commonly used, well-substantiated strategy that physical therapists use to augment strength in patients with muscle weakness. Two distinctly different theories of strength augmentation using percutaneous muscle stimulation are presented. The first theory proposes that augmentation of muscle strength with electrically elicited muscle contractions occurs in a similar manner to augmentation of muscle strength with voluntary exercise. Electrically elicited muscle contractions of relatively high intensity with low numbers of repetitions strengthen muscle proportionally to the external load on the muscle in a manner that is equivalent to voluntary contraction. The second theory proposes that augmentation of muscle strength using percutaneous stimulation is fundamentally different from augmentation of strength with voluntary exercise. This theory uses the physiological differences between electrically elicited and voluntary contractions, such as the reversal of motor unit recruitment order, as a basis for argument. Both theories are partially substantiated using published literature. Strategies for testing both theories are also presented.

Response of prolonged flaccid paralysis to FNS rehabilitation techniques.

PURPOSE: The purpose of this study was to investigate the response of muscles with prolonged flaccid paralysis (a year after stroke) to two types of treatment: (1) functional neuromuscular stimulation (FNS) with surface electrodes; and (2) FNS with intramuscular (IM) electrodes (FNS-IM). A second purpose was to compare FNS-gait versus volitional gait (no FNS activation). METHOD: We used a single case study design; our patient was age 72, with flaccid paralysis of knee flexors and ankle dorsiflexors. RESULTS: Following four months of treatment with surface-stimulation, there was no change in muscle function or gait. Following treatment with FNS-IM, the patient regained partial volitional control of knee flexors and dorsiflexors; untreated muscles did not change. CONCLUSION: FNS-gait provided more normal knee and ankle dorsiflexion during swing phase versus volitional gait swing phase (no FNS activation).

The influence of adaptive seating devices on vocalization.

This study examined the relationship between receipt of adaptive seating devices (ASD) and sophistication of early vocalizations/verbalizations. Eight nonverbal children with cerebral palsy were studied prior to and following receipt of an ASD. Total speech tokens increased for 7 of the 8 subjects and diversity of speech sounds increased for 6 subjects. A concomitant improvement in feeding independence was observed for those subjects who demonstrated the greatest increase in speech sound diversity.

Effects of continuous passive motion on the edematous hands of two persons with flaccid hemiplegia.

OBJECTIVES: This study evaluated the effect of the use of a continuous passive motion device for the edematous hands of two persons with flaccid hemiplegia. METHOD: The subjects were both 1 month post-cerebrovascular accident with left-sided hemiplegia. Each subject's routine therapy program was maintained throughout this ABA design study. During the first week, baseline data were gathered, during the second week the intervention was provided (2 hr of continuous passive motion device use), and during the third week data were gathered with treatment withdrawn. Edema was measured with a hand volumeter and finger circumference. RESULTS: The continuous passive motion device had an effect in reducing edema in the hands of the two subjects. CONCLUSION: The continuous passive motion device is a readily available tool that could enhance the treatment of edematous hands of persons with flaccid hemiplegia by offering a contribution to already established treatment protocols. Further research is needed, however, to establish guidelines for use.

Use of the Goal Attainment Scale in the treatment and ongoing evaluation of neurologically handicapped children.

Six children with multiple handicaps were treated as a pilot group by a physical therapist, occupational therapist, and a speech/language pathologist. Baseline evaluations were obtained through a compilation of traditional developmental tests. A Goal Attainment Scale technique was introduced to facilitate reevaluation of the children. The advantages of the scale were to facilitate ongoing feedback for both the professionals and the parents as well as to update specific, individualized goals in each therapeutic area. This information was also helpful to third-party payers of service. Results showed that, after an initial period of familiarization, therapists became more accurate in their expectations of progress in treatment. Therapy time spent with each child was also increased without increasing costs or preparation time for each therapist. Specifically, re-evaluation scores obtained on the Goal Attainment Scales approached a normal, expected distribution of values. The potential value of extending the system to more objectively, efficiently, and concisely display treatment results is discussed.

Orofacial development in children with Down's syndrome 12 years after early intervention with a stimulating plate.

BACKGROUND: Orofacial regulation therapy for children with Down's syndrome was introduced to Europe in Munich in 1978. Since then, many clinical studies have provided scientific evidence that this therapeutic approach enhances the orofacial function and facial appearance of children with trisomy 21. Only few long-term results have been published to date. PATIENTS AND RESULTS: In the present study, 20 children with trisomy 21 were examined more than 12 years after starting treatment in infancy with a Castillo Morales stimulating plate. The follow-up examination showed that the improved orofacial appearance resulting from the early treatment had remained stable in most cases. Although the mechanical stimulus of the stimulating plate was absent during the follow-up period, some patients revealed a lip and tongue posture superior to that recorded at baseline. CONCLUSION: According to the results of the present study, the orofacial status in early childhood is decisive for the subsequent development of the orofacial region and the long-term stability of the achieved improvements: Children with a pronounced orofacial dysfunction showed a greater stimulation-plate-induced improvement than those with initially moderate orofacial findings. This observation was confirmed by the findings of the 12-year follow-up: Children with Down's syndrome and initially slight orofacial impairment displayed only slight improvements or unchanged findings.

[The possibility of walking in the paralysed of the lower limbs (author's transl)]. / La marche chez les paralysés des membres inférieurs: ses indications et ses moyens.

The authors have studied the possibility of walking after rehabilitation and bracing in the paralysed of the lower limbs, it is variable with aetiological factors and age of patients. In children, walking after bracing is almost always indicated-it should be discussed case after case in adults. The authors analyse the role of different types of braces such as pneumatic braces and orthoptic systems using electrical stimulation. Some views on the future are exposed.

Passive tactile stimulation effects on the muscle tone of hypotonic, developmentally delayed young children.

A pilot study was performed with 13 children, 1 to 4 yr. of age, to explore an heretofore uninvestigated area. The effect of passive tactile stimulation was an increase in muscle activation and hence the muscle tone of 13 hypotonic, developmentally delayed children.

[Value of electromyographic examination in elaborating the program of rehabilitation of patients with movement disorders in the recovery period after ischemic stroke]. / Znachenie élektromiograficheskogo issledovaniia dlia sostavleniia programm reabilitatsii bol'nykh s dvigatel'nymi narusheniiami v vosstanovitel'nom periode ishemicheskogo insul'ta.

A total of 65 patients at the productive age and with a history of ischemic stroke were examined. Comprehensive clinical and electromyographic studies revealed mild and moderate motor disturbances and determined criteria of the prognosis of motor function recovery. Follow-up findings confirmed the validity of these prognostic criteria.