Effects of a complex rehabilitation program on edema status, physical function, and quality of life in lower-limb lymphedema after gynecological cancer surgery.

OBJECTIVE: The purpose of this study was to investigate the effects of a complex rehabilitation (CR) program and complex decongestive therapy (CDT) on edema status, physical function, and quality of life in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery. METHODS: In this randomized pilot study, 40 patients with secondary unilateral lymphedema, after gynecologic surgery for cervical, endometrial, or ovarian cancer, that had been diagnosed based on clinical assessment and 10% volume differences between the legs were randomly assigned to the CDT (n=20) and CDT combined with CR (CRCDT; n=20) groups. CR comprised stretching, strengthening, and aerobic exercises performed for 40min, five times a week for 4weeks. Intensive CDT was administered by a physical therapist during weeks 0-2 and by the patients themselves during weeks 2-4. Limb volume, bioimpedance, muscular strength, EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30) score, 30-s chair stand test, muscular strength, and GCLQ-K (Korean version of the Gynecological Cancer Lymphedema Questionnaire) score were assessed at baseline and after 4weeks of treatment. RESULTS: The edema status, fatigue, pain, and GCLQ-K scores were significantly improved in both groups after the 4-week intervention (P<0.05). Physical function and fatigue in EORTC QLQ-C30 and the 30-s chair stand test and quadriceps muscle strength were significantly improved in the CRCDT group compared with the CDT group (P<0.05). CONCLUSIONS: CR improves physical function, fatigue, and muscular strength without increasing edema status in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery.

Comparison of hospital based and home based exercise on quality of life, and neck and shoulder function in patients with spinal accessary nerve injury after head and neck cancer surgery.

OBJECTIVES: The purpose of this study was to compare the effects of hospital-based and home-based exercise programs on quality of life (QOL) and neck and shoulder function of patients who underwent head and neck cancer (HNC) surgery. METHODS: This clinical trial included 40 patients with neck and shoulder dysfunction after HNC. The exercise program included range of motion (ROM) exercises, massage, stretching, and strengthening exercises. Twenty patients who were assigned to the hospital-based exercise group performed physical therapy for 40 min three times a week for four weeks, and the remaining 20 patients were assigned to the home-based group. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Head and Neck Questionnaire (EORTC QLQ-H&N), the Neck and Shoulder Disability Index (NDI), ROM, and numeric rating scale (NRS) were assessed before and after the exercise program. The program consisted of a 10-minute ROM to the neck and shoulder, a 10-minute massage, and 15 min of progressive resistance exercises, followed by a five-minute stretching exercise. RESULTS: There were statistically significant differences in the changes of neck and shoulder disability index (p < .05). Additionally, there were significant differences in neck extension and rotation ROM and NRS in the hospital-based group compared with the home-based group (p < .05). QOL was not significantly different between the two groups. CONCLUSIONS: Home-based exercise was effective for improving QOL, shoulder function, and pain relief. Hospital-based exercise had better effects on physical function of the neck and shoulder and reduced pain.

Comparison of gait analysis between anterior and posterior ankle foot orthosis in hemiplegic patients.

OBJECTIVE: To investigate the changes in gait patterns and Berg Balance Scale in hemiplegic patients with anterior or posterior ankle foot orthosis. DESIGN: The subjects comprised 17 hemiplegic patients who could walk independently with a cane. Gait analysis and Berg Balance Scale scores were assessed barefoot and while wearing anterior or posterior ankle foot orthosis, with a motion analysis system used to collect kinematic data. RESULTS: We observed increased walking speed, stride length, and velocity in both ankle foot orthoses compared with barefoot subjects. Excessive ankle plantar flexions at stance and swing phase were decreased after wearing anterior or posterior ankle foot orthoses. Gait analysis did not differ significantly between the anterior and posterior ankle foot orthoses. Berg Balance Scale scores did not differ significantly for barefoot and with anterior or posterior ankle foot orthosis. CONCLUSIONS: Wearing anterior ankle foot orthosis was as useful as posterior ankle foot orthosis for correcting hemiplegic gait.

A comparison of young and old using three-dimensional motion analyses of gait, sit-to-stand and upper extremity performance.

BACKGROUND AND AIMS: To investigate the gait, sit-to-stand and upper extremity performance in the elderly compared with young adults. METHODS: Individuals over 60 and under 35 years old, with no medical, neurological or orthopedic problems participated in this study. Three-dimensional motion analyses of gait, sit-to-stand and upper extremity performance were performed, and results in the two age groups were compared. RESULTS: Compared with the younger cohort, the gait pattern of the elderly included slower velocity, decreased single stance period, decreased maximal knee extension, and decreased ankle dorsiflexion and plantarflexion. On sit-to-stand, the elderly had decreased knee extension angle, minimal knee extension and maximal ankle plantarflexion moment. On hand-at-object, the elderly had reduced maximal angle of shoulder flexion and increased maximal angle of anterior pelvic tilt. On hand-to-head and hand-to-mouth, the elderly had decreased maximal angle of shoulder flexion. CONCLUSIONS: The most debilitating motion factors in the elderly were limitation of shoulder flexion and decreased knee extension and ankle plantarflexion. Therapeutic programs for elderly individuals should target maintenance of flexibility and strengthening of ankle plantarflexors, strengthening knee extensors, and maintenance of the shoulder joint ROM.