Effect of a pulmonary rehabilitation program combined with cognitive training on exercise tolerance and cognitive functions among Tunisian male patients with chronic obstructive pulmonary disease: A randomized controlled trial.

BACKGROUND: Cognitive impairment has been well described in patients with Chronic Obstructive Pulmonary Disease (COPD) in addition to cardiorespiratory disability. To reduce this impairment, researchers have recommended the use of single or combined exercise training. However, the combined effect of cognitive training (CT) and pulmonary rehabilitation (PR) program on selective cognitive abilities in patients with COPD has not been fully evaluated. Therefore, we aimed to assess the impact of PR combined with CT on 6 minutes walking test (6MWT) and cognitive parameters in Tunisian males' patients with COPD. METHODS: Thirty-nine patients with COPD were randomly assigned to an intervention group (n = 21, age = 65.3 ± 2.79) and a control group (n = 18, age = 65.3 ± 3.2). The intervention group underwent PR combined with CT, and the control group underwent only PR, three times per week for 3 months. The primary outcomes were 6MWT (6 minutes walking test -6MWT-parameters) and cognitive performance, as evaluated by Montreal cognitive assessments (MOCA) and P300 test. Secondary outcomes were patient's characteristics and spirometric data. These tests were measured at baseline and after 3 months of training programs. RESULTS: Results showed a significant improvement of the 6MWT distance after the rehabilitation period in both groups (p < .001). Moreover, both groups showed significant improvement (p < .001) in cognitive performance including MOCA score and P300 test latency in three midline electrodes. However, the improvement in cognitive performance was significantly greater in the PR+CT group than the PR group. CONCLUSION: In conclusion, although PR alone improves 6MWT parameters and cognitive function, the addition of CT to PR is more effective in improving cognitive abilities in patients with COPD. This combined approach may provide clinicians with a complementary therapeutic option for improving cognitive abilities in patients with COPD.

Effect of adding neuromuscular electrical stimulation training to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: randomized clinical trial.

OBJECTIVE:: To investigate the effectiveness of neuromuscular electrical stimulation added to pulmonary rehabilitation on walking tolerance and balance in patients with chronic obstructive pulmonary disease (COPD). DESIGN:: Randomized clinical trial. SETTING:: Outpatient, Faculty of Medicine of Sousse, Tunisia. SUBJECTS:: A total of 45 patients with COPD were assigned to an intervention group ( n = 25) or a control group ( n = 20). INTERVENTIONS:: The intervention group underwent a neuromuscular electrical stimulation added to pulmonary rehabilitation, and the control group underwent only a pulmonary rehabilitation, three times per week during six months. MAIN MEASURES:: Measures were taken at baseline and after six months of training. A stabilometric platform, time up and go, Berg balance scale tests, 6 minute walking test, and the maximal voluntary contraction were measured. RESULTS:: In the intervention group, an increase in an exercise tolerance manifested by a longer distance walked in 6 minute walking test 619.5 (39.6) m was observed in comparison to the control group 576.3 (31.5) m. The values of the time up and go, Berg balance scale, and maximal voluntary contraction in the intervention group at follow-up were significantly higher than those in the control group ( P = 0.02, P = 0.01, P = 0.0002, respectively). The center of pressure in the mediolateral and in the anteroposterior directions, as well as the center of pressure area was significantly more improved in open eyes and closed eyes in the intervention group compared to the control group ( P < 0.001). CONCLUSION:: The neuromuscular electrical stimulation added to pulmonary rehabilitation group benefited from better walking tolerance and greater balance improvement than the only pulmonary rehabilitation.

Anthropometric, Psychosocial, Physiological, and Postural Observances During Ramadan in Men With Chronic Obstructive Pulmonary Disease.

This study aimed to carry out a Ramadan observance (RO) on anthropometric, psychosocial, physiological, and postural characteristics of patients with chronic obstructive pulmonary disease (COPD). Twenty COPD patients were evaluated. Tests performed 1 week before Ramadan (C), and during the second (R-2) and the fourth weeks of Ramadan (R-4) included standard anthropometry, spirometry, a quality of life questionnaire (VQ11), a 6-minute walking test (6MWT), measurement of maximal voluntary contraction force of the quadriceps (MVC), Timed Get Up and Go (TUG), Berg Balance Scale (BBS), and Unipedal Stance (UST). During R-2, there were significant decreases in forced vital capacity and forced expiratory volumes, 6MWT distance, MVC, BBS, and UST, with significant increases in TUG and significant changes in VQ11. During R-4, there was some recovery, but all variables remained significantly different from initial control data. To conclude, RO adversely affects pulmonary function, exercise performance, postural balance, and quality of life in COPD, with some recovery by the R-4. Although a number of functional consequences remain to be elucidated, functional losses were insufficient to limit daily living in our sample, but further studies are recommended in those with more severe COPD, paying particular attention to postural disturbances and a possible increase in the risk of falls.

The Effect of Adding Neuromuscular Electrical Stimulation with Endurance and Resistance Training on Exercise Capacity and Balance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.

This study investigated the effectiveness of adding neuromuscular electrical stimulation (NMES) to endurance training (ET) and resistance training (RT) on exercise tolerance and balance in COPD patients. 42 patients were assigned randomly to the ET + RT + NMES group (n = 22) or ET + RT group (n = 20). Two training programs were performed including 72 sessions. The center of pressure (CoP) displacement in the mediolateral direction (CoPML), in the anteroposterior direction (CoPAP), and the center of pressure velocity (CoPV) were recorded using a stabilometric platform with eyes open (EO) and eyes closed (EC). Time up and go and Berg Balance Scale tests, 6-minute walking test (6MWT), and the maximal voluntary contraction (MVC) were measured before and after the intervention. The walking distance, the dyspnea, and the heart rate were improved after the training period (p < 0.001) for both groups (p < 0.05). The ET + RT + NMES group showed better improvement than the ET + RT group in terms of 6MWD. CoPML, CoPAP, and CoPV were significantly (p < 0.001; p < 0.05; p < 0.001, respectively) more improved in EO and EC conditions in the ET + RT + NMES group than the ET + RT group. BBS, TUG, and MVC values improved in both groups after the training (p < 0.001). The performances in TUG and MVC tests were significantly greater in the ET + RT + NMES group than those in the ET + RT group (p < 0.01; p < 0.001, respectively). Combining NMES, RT, and ET improves balance in patients with COPD.

Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review.

Mobility after spinal cord injury (SCI) is among the top goals of recovery and improvement in quality of life. Those with tetraplegia rank hand function as the most important area of recovery in their lives, and those with paraplegia, walking. Without hand function, emphasis in rehabilitation is placed on accessing one's environment through technology. However, there is still much reliance on caretakers for many activities of daily living. For those with paraplegia, if incomplete, orthoses exist to augment walking function, but they require a significant amount of baseline strength and significant energy expenditure to use. Options for those with motor complete paraplegia have traditionally been limited to the wheelchair. While wheelchairs provide a modified level of independence, wheelchair users continue to face difficulties in access and mobility. In the past decade, research in SCI rehabilitation has expanded to include external motorized or robotic devices that initiate or augment movement. These robotic devices are used with 2 goals: to enhance recovery through repetitive, functional movement and increased neural plasticity and to act as a mobility aid beyond orthoses and wheelchairs. In addition, lower extremity exoskeletons have been shown to provide benefits to the secondary medical conditions after SCI such as pain, spasticity, decreased bone density, and neurogenic bowel. In this review, we discuss advances in robot-guided rehabilitation after SCI for the upper and lower extremities, as well as potential adjuncts to robotics.

Effect of 6 Months of Balance Training During Pulmonary Rehabilitation in Patients With COPD.

PURPOSE: Balance impairment is recognized as an important issue for patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to examine the effect of balance training as part of pulmonary rehabilitation (PR) on balance in COPD patients. METHODS: Patients were randomly assigned to an intervention or usual care group. The intervention group underwent balance training 3 times a week for 6 months in addition to the standard PR. The control group received 6 months of the standard PR program only. Balance was assessed by the Timed Up and Go (TUG), Tinetti, Berg Balance Scale (BBS), and the Unipodal Stance (UST) tests. Balance confidence was rated using the ABC scale. Exercise tolerance was determined using a 6-Minute Walk Test. RESULTS: Following the completion of PR, the intervention group showed improvement in all balance measures. Only TUG, ABC, and UST scores were improved in the usual care group (P < .05). Results demonstrated significant between-group differences in TUG, Tinetti, BBS, and ABC scores (P < .01) and UST score (P < .05). CONCLUSIONS: Balance training incorporated into a standard PR program significantly improves scores on balance tests in COPD patients.

Balance Training in Pulmonary Rehabilitation: EFFECTS ON PSYCHOSOCIAL OUTCOMES.

PURPOSE: Balance impairment in chronic obstructive pulmonary disease (COPD) is associated with a worsening of quality of life (QOL) as related with fatigue perception, depression, and anxiety. The aim of this study was to examine the effect of balance training included in pulmonary rehabilitation (PR) on QOL, fatigue perception, depression, and anxiety in patients with COPD. METHODS: Patients were assigned randomly to an intervention or PR-only group. The intervention group underwent balance training 3 times a week for 6 months concurrently with PR. The PR-only group received 6 months of the standard PR program. Quality of life was assessed at the beginning and at the end of the program using the St. George's Respiratory Questionnaire, fatigue using the Multidimensional Fatigue Inventory, and anxiety and depression using the Hospital Anxiety and Depression Scale. Exercise tolerance was determined from the 6-minute walk test. RESULTS: After the 6 months of the intervention or PR-only, both the intervention (n = 32) and PR-only (n = 30) groups improved their QOL (activity, impact, and total) with a significant intergroup difference (P < .05) after PR. General fatigue, physical fatigue, and reduced activity decreased in both groups with an intergroup difference (P < .05). Anxiety decreased significantly in both groups with a greater change in the intervention group (P < .01). Only the intervention group had an improved depression score at the end of 6 months. CONCLUSIONS: Balance training added to PR improved health-related QOL, fatigue, and mental health in patients with COPD.