A Holistic Approach for Physiotherapy Rehabilitation of Girdlestone Arthroplasty With Infection and Concomitant Contralateral Spastic Hemiplegic Cerebral Palsy: A Case Report.

Girdlestone arthroplasty is a traditional approach for complicated infections occurring with contralateral spastic hemiplegic cerebral palsy, which presents intricate challenges in rehabilitation. In this case report, an 18-year-old girl came to a multispecialty hospital with a history of falls. She was an identified case of femoral head dislocation with acute osteomyelitis and a history of spastic hemiplegic cerebral palsy. She underwent girdlestone arthroplasty with additional upper tibial and ankle pin traction. After that, she was referred to physiotherapy management. To further aid recovery, rehabilitation protocol included a combination of static exercises, ankle pumps on the affected side, and stretching, bimanual hand-arm training with lower limb training on the unaffected side to reduce spasticity. Once the stitches were removed and traction discontinued, the focus shifted to improving mobility through basic activities like rolling and transitioning to sitting, gradually progressing to standing with the assistance of a walker and bimanual hand-arm training with lower limb training for spasticity. Outcome measures like functional independence measure, numerical pain rating scale, range of motion, and manual ability classification system were used to record patient progress during rehabilitation. This case report serves the crucial role physiotherapy plays in the treatment of orthopedic and neurological conditions in younger patients, with the ultimate goal of regaining functional independence and enhancing overall quality of life.

Construct validity, responsiveness, minimal detectable change, and minimal clinically important difference of the stroke self-efficacy questionnaire in individuals receiving stroke rehabilitation.

PURPOSE: To assess the clinimetric properties of the Stroke Self-Efficacy Questionnaire (SSEQ) and estimate the minimal detectable change (MDC) and minimal clinically important difference (MCID) from the database of our randomized controlled trials (RCT) of individuals receiving stroke rehabilitation. METHODS: We retrieved the pre- and post-intervention scores of the SSEQ and Stroke Impact Scale (SIS) from 80 stroke survivors. The analysis of clinimetric properties was performed using: (1) confirmatory factor analysis and item response theory modeling (IRT) for construct validity; (2) standardized response mean and Glass's delta for responsiveness; (3) MDC based on the standard deviation (SD) or standard error of measurement (SEM) of the SSEQ change scores; (4) MCID determined by the external anchor-SIS; (5) conditional MDC (cMDC) derived from the IRT analysis. RESULTS: There was a bi-factorial construct with excellent model-data fit and marked responsiveness. The MDC determined by the SD and SEM were 1.5 and 3.0, respectively, and the MCIDs were 3.3 and 3.7. CONCLUSIONS: This study confirmed that SSEQ is a valid and reliable assessment tool for patients receiving stroke rehabilitation. We also provided practical threshold values, especially demonstrating the benefit of using individualized cMDC, to help clinicians better interpret the change in the SSEQ scores.

This study indicated that the Stroke Self-Efficacy Questionnaire (SSEQ) is reliable and may involve a bi-factor structure.The SSEQ total scale and the activity domain were highly responsive to change.The self-management domain of the SSEQ was moderately responsive.Using conditional minimal detectable change (cMDC) along with MDC may improve the interpretability of treatment change.

A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia.

The purpose of this study is to investigate the efficacy of bilateral upper-limb training (BULT) in helping people with upper-limb impairments due to stroke or brain illness regain their previous level of function. Patients recuperating from a stroke or cerebral disease were given the option of undergoing BULT or conventional training to enhance their upper-limb function. Participants were randomly allocated to one of the several different fitness programs. Results from the action research arm test, Box and block test, Wolf motor function test, Fugal-Meyer evaluation, and any other tests administered were taken into account. Some researchers have found that exercising with BULT for just 30 min per day for 6 weeks yields significant results. There were a total of 1,411 individuals from 10 randomized controlled trials included in this meta-analysis. Meta-analysis findings revealed that biofeedback treatment outperformed conventional rehabilitation therapy in reducing lower leg muscular strain, complete spasm scale score, electromyography score, and inactive ankle joint range of motion. An analysis of the literature found that BULT improved limb use in people who had suffered a stroke and hemiplegia but it did not provide any additional benefit over unilateral training.

Is it Feasible to Use a Low-Cost Wearable Sensor for Heart Rate Monitoring within an Upper Limb Training in Spinal Cord Injured Patients?: A Pilot Study.

(1) Background: Cervical spinal cord injury (SCI) patients have impairment in the autonomic nervous system, reflected in the cardiovascular adaption level during the performance of upper limb (UL) activities carried out in the rehabilitation process. This adaption level could be measured from the heart rate (HR) by means of wearable technologies. Therefore, the objective was to analyze the feasibility of using Xiaomi Mi Band 5 wristband (XMB5) for HR monitoring in these patients during the performance of UL activities; (2) Methods: The HR measurements obtained from XMB5 were compared to those obtained by the professional medical equipment Nonin LifeSense II capnograph and pulse oximeter (NLII) in static and dynamic conditions. Then, four healthy people and four cervical SCI patients performed a UL training based on six experimental sessions; (3) Results: the correlation between the HR measurements from XMB5 and NLII devices was strong and positive in healthy people (r = 0.921 and r = 0.941 (p < 0.01) in the static and dynamic conditions, respectively). Then, XMB5 was used within the experimental sessions, and the HR oscillation range measured was significantly higher in healthy individuals than in patients; (4) Conclusions: The XMB5 seems to be feasible for measuring the HR in this biomedical application in SCI patients.

A functional near-infrared spectroscopy study of the effects of video game-based bilateral upper limb training on brain cortical activation and functional connectivity.

Video game-based therapies are widely used in rehabilitation. Compared with conventional bilateral upper limb training (CBULT), the effects of video game-based bilateral upper limb training (VGBULT) on brain cortical activation and functional connectivity, still not fully clear. We have developed a VGBULT system, and measured the brain activity of 20 elderly subjects (10 male, mean age = 62.4 ± 5.8) while performing CBULT and VGBULT tasks by using functional near infrared spectroscopy (fNIRS). The results showed that the cerebral cortex of the two groups both showed significant activation (p < 0.05), compared with the baseline; In the VGBLUT group, the activation of motor cortex (MC) and prefrontal cortex (PFC) was stronger, and the functional connectivity between PFC and MC was also enhanced. This study showed that VGBULT is potentially more beneficial for the elderly neural activities and cognitive control, and provides a theoretical basis for future research and development of such rehabilitation products. Moreover, fNIRS is a reliable tool for tracking brain activation in the evaluation of retraining regimens.

Cortical mapping of active and passive upper limb training in stroke patients and healthy people: A functional near-infrared spectroscopy study.

Active exercise for upper limb training has been widely used to improve hemiplegic upper limb function, and its effect may be boosted by extrinsic visual feedback. The passive movement of the hemiplegic upper limb is also commonly used. We conducted a functional near-infrared spectroscopy experiment to compare cortical activation during the following three conditions: active left upper limb movement (on the hemiplegic sides in stroke patients), with or without extrinsic motor performance visual feedback (LAV, LAnV), and passive left upper limb movement (hemiplegic sides in stroke patients) (LP) in stroke patients and healthy controls. Twenty patients with right hemispheric stroke and 20 healthy controls were recruited for this study. Hemodynamic changes were detected during left upper limb movements (on the hemiplegic sides in stroke patients) under the above three conditions in the sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC). There was no significant difference in the level of cortical activation between patients with stroke and healthy subjects during the three conditions. Both the LAV and LAnV induced significantly higher activation in the contralateral SMA and PMC than in the LP. Extrinsic visual feedback led to additional activation in the contralateral PMC and SMA, but this was not statistically significant. Our study indicates that active upper-limb movement appears to induce higher cortical activation than that elicited by passive movement in both stroke patients and the healthy population. Extrinsic motor performance in the form of visual feedback provided during active movement may facilitate sensorimotor areas over the contralateral hemisphere.

The effect of passive lower limb training on heart rate asymmetry.

Objective.Heart rate asymmetry (HRA) is an approach for quantitatively assessing the uneven distribution of heart rate accelerations and decelerations for sinus rhythm. We aimed to investigate whether automatic regulation led to HRA alternation during passive lower limb training.Approach.Thirty healthy participants were recruited in this study. The protocol included a baseline (Pre-E) and three passive lower limb training trials (E1, E2 and E3) with a randomized order. Several variance-based HRA variables were established. Heart rate variability (HRV) parameters, i.e. mean RR, SDNN, RMSSD, LF (n.u.), HF (n.u.) and VLF (ms2), and HRA variables, i.e. SD1a, SD1d, SD2a, SD2d, SDNNaand SDNNd, were calculated by using 5 min RR time series, as well as the normalized HRA variables, i.e. C1a, C1d, C2a, C2d, Caand Cd.Main results.Our results showed that the performance of HRA was distinguished. The normalized HRA was observed with significant changes in E1, E2 and E3 compared to Pre -E. Moreover, parts of non-normalized HRA variables correlated with HRV parameters, which indicated that HRA might benefit in assessing cardiovascular modulation in passive lower limb training.Significance.In summary, this study suggested that passive training led to significant HRA alternation and the application of HRA gave us the possibility for autonomic assessment.

Impact of enhanced recovery nursing combined with limb training on knee joint function and neurological function after total knee arthroplasty in patients with knee osteoarthritis.

OBJECTIVE: To investigate the impact of enhanced recovery after surgery (ERAS) nursing combined with limb training on knee joint function and neurological function after total knee arthroplasty in patients with knee osteoarthritis (KOA). METHODS: Eighty-six patients with KOA after TKA were randomly divided into two groups, group A and group B, with 43 patients in each group. Group A was given ERAS nursing, and group B was given limb rehabilitation training combined with ERAS nursing. The changes in knee joint function and neurological function were observed. RESULTS: There was no significant difference in the time to get out of bed for the first time, first bowel movement time after the surgery, hospital stay and hospital costs between the two groups (P>0.05). There was no significant difference in VAS scores between the two groups before the operation and 1 d after the operation (P>0.05). Three days and seven days after the operation, the VAS scores in the two groups both decreased, and the VAS scores of group B were higher than those of group A (P<0.05). There was no significant difference in the excellent rate of Judet scores and Lysholm scores between the two groups (P>0.05), but the two indicators in the two groups all increased at three and six months after the operation, and the two indicators in group B were higher than those of group A (P<0.05). There was no significant difference in NIHSS scores between the two groups before the operation (P>0.05). Fifteen and thirty days after the operation, the NIHSS scores of the two groups both decreased, and the NIHSS scores of group B were lower than those of group A (P<0.05). After the nursing care, the scores of health knowledge level, self-care concept, self-care responsibility and self-care skills in group B were higher than those in group A (P<0.05). The incidence of complications in group B during nursing was lower than group A (P<0.05). CONCLUSION: The enhanced recovery after surgery nursing combined with limb training has a better effect on KOA patients after TKA. It can significantly improve knee joint function, limb motor ability and neurological function, increase patients' cognition of disease and reduce the incidence of complications, compared with simple enhanced recovery after surgery nursing.

A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation.

Background: Stroke survivors can remain impaired in body functions, activity, and participation. A novel rehabilitation regimen is required to obtain scientific evidence and to help clinicians determine effective interventions for stroke. Mirror therapy (MT) and bilateral upper limb training (BULT) are based on the tenet of bilateral movement practice; however, the additional effect of bilateral robotic priming combined with these two therapies is unclear. Objectives: This study examined the effects of two hybrid therapies, robotic priming combined with MT and robotic priming combined with BULT, in stroke survivors. Methodology: The study randomized 31 participants to groups that received robotic priming combined with MT (n = 15) or robotic priming combined with BULT (n = 16). Outcome measures included the Fugl-Meyer Assessment (FMA), the revised Nottingham Sensory Assessment (rNSA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and accelerometer data. Results: Both groups showed statistically significant within-group improvements in most outcome measures. Significant between-group differences and medium-to-large effect sizes were found in favor of the group that received robotic priming combined with MT based on the FMA distal part subscale scores, FMA total scores, and accelerometer data. Conclusion: Robotic priming combined with MT may have beneficial effects for patients in the improvements of overall and distal arm motor impairment as well as affected arm use in real life. Additional follow-up, a larger sample size, and consideration of the effect of lesion location or different levels of cognitive impairment are warranted to validate our findings in future studies. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03773653.

A comprehensive analysis of the velocity-based method in the shoulder press exercise: stability of the load-velocity relationship and sticking region parameters.

The purpose of this study was threefold: i) to analyse the load-velocity relationship of the shoulder press (SP) exercise, ii) to investigate the stability (intra-individual variability) of this load-velocity relationship for athletes with different relative strength levels, and after a 10-week velocity-based resistance training (VBT), and iii) to describe the velocity-time pattern of the SP: first peak velocity [Vmax1], minimum velocity [Vmin], and second peak velocity [Vmax2]. This study involves a cross-sectional (T1, n = 48 subjects with low, medium and high strength levels) and longitudinal (T2, n = 24 subjects randomly selected from T1 sample) design. In T1, subjects completed a progressive loading test up to the 1RM in the SP exercise. The barbell mean, peak and mean propulsive velocities (MV, PV and MPV) were monitored. In T2, subjects repeated the loading test after 10 weeks of VBT. There were very close relationships between the %1RM and velocity attained in the three velocity outcomes (T1, R2: MV = 0.970; MPV = 0.969; PV = 0.954), being even stronger at the individual level (T1, R2 = 0.973-0.997). The MPV attained at the 1RM (~0.19 m·s-1) was consistent among different strength levels. Despite the fact that 1RM increased ~17.5% after the VBT programme, average MPV along the load-velocity relationship remained unaltered between T1 and T2 (0.69 ± 0.06 vs. 0.70 ± 0.06 m·s-1). Lastly, the three key parameters of the velocity-time curve were detected from loads > 74.9% 1RM at 14.3% (Vmax1), 46.1% (Vmin), and 88.7% (Vmax2) of the concentric phase. These results may serve as a practical guideline to effectively implement the velocity-based method in the SP exercise.

Influence of muscle fatigue on electromyogram-kinematic correlation during robot-assisted upper limb training.

INTRODUCTION: Studies on adaptive robot-assisted upper limb training interactions do not often consider the implications of muscle fatigue sufficiently. METHODS: To explore this, we initially assessed muscle fatigue in 10 healthy subjects using two electromyogram features, namely average power and median power frequency, during an assist-as-needed interaction with HapticMaster robot. Since robotic assistance resulted in a variable fatigue profile across participants, a completely tiring experiment, without a robot in the loop, was also designed to confirm the results. RESULTS: A significant increase in average power and a decrease in median frequency were observed in the most active muscles. Average power in the frequency band of 0.8-2.5 Hz and median frequency in the band of 20-450 Hz are potential fatigue indicators. Also, comparing the Spearman's correlation coefficients (between the electromyogram average power and the kinematic force) across trials indicated that correlation was reduced as individual muscles were fatigued. CONCLUSIONS: Confirming fatigue indicators, this study concludes that robotic assistance based on user's performance resulted in lesser muscle fatigue, which caused an increase in electromyogram-force correlation. We now intend to utilise the electromyogram and kinematic features for auto-adaptation of therapeutic human-robot interactions.

Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity. METHODS: Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval. RESULTS: Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control. CONCLUSION: Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805).

The Impact of Upper Limb Training with Breathing Maneuver in Lung Function, Functional Capacity, Dyspnea Scale, and Quality of Life in Patient with Stable Chronic Obstructive of Lung Disease.

BACKGROUND: Exercise tolerance is one of the main impacts of COPD. COPD patients often experience dyspnea and fatigue after doing daily activities using their limb parts, even in simple thing such as lifting or grooming. Nowadays, many pulmonologists concerned in pulmonary rehabilitation to modify some limb training with breathing manoeuvre to get positive impact in stable COPD patient. AIM: The purpose of this study is to examine the impact of this modified upper limb training in lung function, functional capacity, dyspnea scale, and quality of life in patients with stable COPD. METHOD: This was a quasi-experimental study held in 2017 on 22 stable COPD patients (based on GOLD 2018 criteria). Patients were given modified upper limb training with breathing manoeuvre that leads and monitored by a physiotherapist and physician in 10-20 minutes twice a week for 8 weeks. Before and after completed all sessions of training, we measured pulmonary functions test include FEV1 and FVC, functional capacity by 6 MWT, dyspnea scale by mMRC, and quality of life by CAT assessment. Statistical analysis was performed by Wilcoxon and paired t-test. RESULTS: There was an improvement of lung function, both FEV1 (40.7 ± 13.8 to 47.3 ± 14.2; p-value 0.001) and FVC (50.7 ± 14.1 to 54.1 ± 14.7; p-value: 0.207) after training. There was a significant change of functional capacity in 6 MWT mean (277.3 ± 80.8 to 319.1 ± 78.3; p-value: 0.001). There was an improved quality of life after training, measured by decreasing in CAT score (23.9 ± 5.5 to 18.3 ± 5.2; p-value: 0.000). There was no significant change in the mMRC scale (p-value: 0.429). CONCLUSION: There was an improvement of lung function, functional capacity, and quality of life in stable COPD after upper limb training with breathing manoeuvre in stable COPD patients.

Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study.

BACKGROUND: Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury. The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper extremity exoskeleton in addition to an inpatient rehabilitation program. In addition, changes of motor functions were examined. METHODS: Ten stroke patients with a severe upper extremity paresis were included. They were offered to perform a semi-autonomous training with a gravity-supported, computer-enhanced device (Armeo®Spring, Hocoma AG) six times per week for 4 weeks. Feasibility was evaluated by weekly structured interviews with patients and supervisors. Motor functions were assessed before and after the training period using the Wolf Motor Function Test (WMFT). The Wilcoxon Signed Rank Test was used for assessing pre-post differences. The Pearson correlation co-efficient was used for correlating the number of completed sessions with the change in motor function. Acceptance of the device and the level of satisfaction with the training were determined by a questionnaire based on visual analogue scales. RESULTS: Neither patients nor supervisors reported side effects. However, one patient had to be excluded from analysis because of transportation difficulties from the ward to the treatment facility. Therefore, analysis was based on nine patients. On average, 13.2 (55%) sessions were realized. WMFT results showed significant improvements of proximal arm functions. The number of sessions correlated with the degree of shoulder force improvement. Patients rated the exercises to be motivating, and enjoyable and would continue using the Armeo®Spring at home if they had the opportunity. CONCLUSION: Using an upper extremity exoskeleton for semi-autonomous training in an inpatient setting is feasible without side effects and is positively rated by the patients. It might further support the recovery of upper extremity function. TRIAL REGISTRATION: The trial was retrospectively registered. Registration number ISRCTN42633681 .

Can response time be trained with bilateral limb training in children with Down syndrome?

AIMS: Response time (RT), that is, the time taken to respond is known to be delayed in children with Down syndrome (DS). We performed a pilot study to evaluate whether bilateral limb training can be used to train RT, in children with DS. SETTINGS AND DESIGN: 10 children with DS (5 males) were recruited from a special school in a suburban region using convenience sampling. SUBJECTS AND METHODS: Response time was measured using an indigenously developed RT Analyzer, before and after intervention, from right and left hand. Structured bilateral limb training was given for a period of 4 weeks, using low-cost, locally available materials, in community settings. STATISTICAL ANALYSIS USED: The Wilcoxon signed ranks test was used for statistical analysis. RESULTS: Significant improvements in RT following 4 weeks of intervention were seen in the left hand (P = 0.006) but not in the right hand (P = 0.104). CONCLUSIONS: Response time can be trained in children with DS using 4 weeks of bilateral limb training activities using low-cost, locally available materials.

Intensive upper limb intervention with self-management training is feasible and promising for older children and adolescents with unilateral cerebral palsy.

This study explored the feasibility and preliminary effectiveness of a short (one week) intensive intervention combining Constraint Induced Movement Therapy (CIMT) and bimanual training (BiT) to improve upper limb capacity and bimanual performance guided by individual goal setting in children and adolescents with unilateral cerebral palsy aged 8-18 years. Self-management training was added to the intervention to maximize the effect of training and to empower the participants in self-monitoring the effective use of their affected hand. Functional goals (Canadian Occupational Performance Measure), unimanual capacity (Box and Block Test), bimanual performance (ABILHAND-Kids, Children's Hand-use Experience Questionnaire (CHEQ)) and amount of use (Video Observation Aarts and Aarts - determine developmental disregard (VOAA-DDD-R)) were measured at baseline, one week and four months post intervention. Twenty children (mean age 9.5 years) participated. Repeated measures ANOVA was used to measure effects over time. Compared to baseline, there were significant improvements on all outcome measures. The largest effect sizes were found for the COPM-performance and COPM-satisfaction (Cohen's d=2.09 and d=2.42, respectively). The effect size was large for the ABILHAND-Kids (d=0.86), moderate for the CHEQ (d=0.70) and Box and Block Test (d=0.56), and small for the VOAA-DDD-R (d=0.33). All effects were retained at the four months post intervention assessment. The results of this study indicate that one-week (36h) intensive CIMT-BiT combined with self-management training is a feasible and promising intervention for improving the capacity of the upper limb and its use in bimanual activities in older children and adolescents with unilateral CP.

Evaluation of effects of shoulder girdle training on strength and performance of activities of daily living in patients with chronic obstructive pulmonary disease.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have some limitations during activities of daily living that involve the arms. There is little information on the benefits of shoulder girdle training and its repercussions for activities of daily living in patients with COPD. The purpose of this study was to investigate whether shoulder girdle training with diagonal movements increases upper limb muscle strength and improves performance of activities of daily living in patients with COPD. METHODS: Thirty-five patients with moderate to severe COPD (forced expiratory volume in one second 1.22 ± 0.49 L) and aged 36-80 years were recruited. Endurance time, maximal sustained weight, oxygen saturation, heart rate, respiratory rate, dyspnea, and arm fatigue were evaluated during an incremental upper limb test and eight simulated activities of daily living before and after an 8-week exercise training program. RESULTS: A significant gain was observed for upper limb strength (P < 0.05). At the peak of the upper limb incremental test, the respiratory rate dropped from 33 to 27 breaths per minute, the Borg dyspnea score decreased from 2 to 0.5, and the upper limb fatigue score decreased from 3 to 2 (P < 0.05). No change was seen in any of these parameters during performance of activities of daily living. CONCLUSION: Although shoulder girdle training increased upper limb strength, no improvement was detected in performance of activities of daily living.

Respuesta ventilatoria al ejercicio post-entrenamiento de miembros superiores en la enfermedad pulmonar obstructiva crónica / Ventilatory response to upper limb exercise after training in COPD

Está poco estudiada la modificación de la respuesta ventilatoria al ejercicio de miembros superiores (MS) post-entrenamiento en la EPOC. Se realizó un estudio prospectivo, aleatorio y controlado en pacientes con EPOC, entrenando un grupo los miembros inferiores (GC) y otro adicionalmente los MS (GM). Se comparó la respuesta ventilatoria al ejercicio de MS pre y post-entrenamiento. Se estudiaron 43 pacientes, 84% varones, estadio GOLD II (moderado) 6 (14%), GOLD III (grave) 15 (35%) y GOLD IV (muy grave) 22 (51%). Veintiocho pacientes completaron el estudio. Post-entrenamiento: se observó en el grupo GM (N = 14) incrementos del V T isotiempo (p < 0.0001) y del % de capacidad inspiratoria (CI) isotiempo (8.8%, p = 0.001), mayores Ti isotiempo (29.3%, p = 0.022) y Ti/Tot isotiempo (37.4%, p = 0.0004) al ejercicio de MS. Se redujo el Te isotiempo (26%, p = 0.009). La CI isotiempo se incrementó (p = 0.01). Post-entrenamiento: en el grupo GC (N = 14) se incrementó el V T/Ti isotiempo (66.86%, p = 0.0005), y disminuyeron el Ti isotiempo (27.9%, p = 0.015) y el Ti/Tot isotiempo (22.74%, p = 0.00016) al ejercicio de MS. Se observó correlación moderada entre la Δ de frecuencia respiratoria y la Δ de CI al ejercicio de MS, post-entrenamiento solo para el grupo GM (r = -0.53, p< 0.001). Comparando ambos grupos en la respuesta al ejercicio de MS, se observó en el grupo GM, reducción del Te isotiempo (p = 0.049) y del V T/Ti (p = 0.0015), mayores Ti isotiempo (p = 0.0019), Ti/tot isotiempo (p = 0.000076) y CI (% predictivo, p = 0.01). El entrenamiento de MS modificó la respuesta ventilatoria, y también redujo el atrapamiento aéreo que se generó por el ejercicio de MS en la EPOC.

There are scarce studies evaluating the modification of ventilatory response to upper limb exercise (ULE) post-training in COPD patients. A prospective, randomized, controlled study was performed comparing two groups: training lower limbs (LL), vs. LL plus upper limb training (UL), in relation to their pre and post-training ventilatory response to ULE. A total of 43 COPD patients were included; 84% male, 6 (14%) GOLD moderate stage (II), 15 (35%) severe stage (III), and 22 (51%) very severe (IV); 28 patients completed the study. After ULE, in UL group (N = 14) a training increased isotime VT (p < 0.0001) was observed, as well as an increase in the inspiratory capacity isotime percentage (IC, 8.8%, p = 0.001), in the Ti isotime (29.3%, p = 0.022) and in the Ti/Tot isotime (37.4%, p = 0.0004). Also, Te isotime was reduced (26%, p = 0.009) and IC isotime was increased (p = 0.01) after ULE. In LL group (N = 14), training increased VT/Ti isotime (66.86%, p = 0.0005) after ULE. Also, after ULE a decrease in Ti isotime (27.9%, p = 0.015) and in Ti/Tot isotime (22.74%, p = 0.00016) were observed. A moderate correlation was observed between Δ respiratory rate and ΔIC after ULE, only for post-training in UL group (r = -0.53 , p < 0.001). Comparing both groups in relation to their responses to ULE, only in the UL group was a reduction observed in Te isotime (p = 0.049) and VT/Ti (p = 0.0015), higher Ti isotime (p = 0.0019), Ti/tot isotime (p = 0.000076) and IC isotime (% predictive, p = 0.01). UL training modified ventilatory response to ULE and it also reduced air trapping in COPD patients.

Effect of upper limb, lower limb and combined training on health-related quality of life in COPD.

OBJECTIVES: To study the effect of unsupported upper limb and lower limb exercise training and their combined influence on the exercise performance and health-related quality of life in COPD patients. MATERIALS AND METHODS: Thirty patients were randomly assigned to one of the three groups, through block randomization. Of the three groups, group A received upper limb training, group B received lower limb training, and group C received both upper and lower limb training. Patients in group A, B, and C underwent exercise training five times a week for four weeks. The outcome measures used in the study were unsupported upper limb endurance test (UULEX), Six-Minute Walk Test (6-MWT), and a Chronic Respiratory Questionnaire. Statistical analysis was performed with analysis of variance, Wilcoxon scale, and a Kruskal Wallis one way ANOVA test, and a P value of .05 was used in the study. CONCLUSION: The combined upper limb and lower limb training group showed a significant improvement in the exercise performance and health-related quality of life.