Efficacy of Repetitive Transcranial Magnetic Stimulation over the Supplementary Motor Area on Motor Function in Parkinson's Disease: A Meta-Analysis.

OBJECTIVES: The objective of this study was to assess the effect of repetitive transcranial magnetic stimulation (rTMS) on the supplementary motor area (SMA) in motor function in Parkinson's disease (PD) patients. METHOD: Databases searched included 5 databases from October 7,2022 to January 4, 2023. The Cochrane Bias Risk Assessment Tool was used for quality assessment. Standardized mean differences (SMDs) were calculated using a random-effects model. Outcome measure is the motor function examination of the motor part of Unified Parkinson's Disease Rating Scale (UPDRS-III). RESULTS: Seven studies totaling 374 patients were included. Meta-analysis showed that stimulation of SMA significantly improved motor function in PD patients compared with sham stimulation (SMD = -1.24; 95% CI, -2.24 to -0.24; P = 0.02; I 2 = 93%). Stimulation of the same target (SMA), subgroup analysis showed that high-frequency rTMS (HF-rTMS) is more effective than low-frequency rTMS (LF-rTMS) in improving motor function in PD (SMD = -1.39; 95% CI, -2.21 to -0.57; P = 0.04; I 2 = 77.2%). CONCLUSIONS: Overall, rTMS over SMA had a statistically significant improvement in motor function in PD patients, and HF-rTMS is statistically significantly more effective than LF-rTMS.

The effects of intermittent stretching following a 4-week static stretching protocol: a randomized trial.

Stretching is performed in rehabilitation and sports conditioning programs. It is not known how often during a week stretching needs to be performed to maintain flexibility. Therefore, the purpose of this study was to determine the influence of intermittent stretching (i.e., 2-3 days/week) on hip range of motion (ROM) following a 4-week, daily stretching program. This study used a randomized, single-blind, test-retest design. Healthy adult subjects, age 18 to 50 years, were randomly assigned to 1 of 2 static stretching protocols: (a) standard protocol or (b) intermittent protocol. All subjects stretched their hamstrings daily for the first 4 weeks. The standard group discontinued all stretching after 4 weeks. The intermittent group continued to stretch 2 to 3 days per week for an additional 4 weeks. All subjects were measured for hip ROM weekly for the full 8 weeks. Thirty-two subjects completed the study (standard group = 14; intermittent group = 18, mean age 24.6 years). Mean hip ROM increased (p < 0.05) for both groups from before protocol (PRE) to Week 4 (standard group gain from 71.4 +/- 18.5 degrees to 90.6 +/- 20.5 degrees and intermittent group gain from 68.6 +/- 15.7 degrees to 89.1 +/- 16.8 degrees). During the final 4 weeks, mean hip ROM decreased (p < 0.05) for the standard group from 90.6 +/- 20.5 degrees to 83.9 +/- 20.3 degrees. Mean hip ROM for the intermittent group did not decrease during the final 4 weeks of the study (89.1 +/- 16.8 degrees to 93.2 +/- 14.9 degrees, p > 0.05). Intermittent stretching (i.e., 2 or 3 days/week) is sufficient to maintain ROM gains acquired from a prior static stretching program. Clinicians and trainers may educate their clients of the benefits of intermittent stretching to maintain flexibility.

Differences in the Limits of Stability Between Older Rolling Walker Users and Older Single-Tip-Cane Users - A Preliminary Study.

PURPOSE: To identify the differences in the limits of stability (LOS) between older rolling walker and single-tip-cane users. DESIGN: This was a matched paired t-test design with repeated measure. METHODS: Eighteen older subjects were matched based on age, gender, and functional level. The subjects were assessed using the multidirectional reach test initially and 5-month later in four directions: forward, backward, leftward, and rightward. FINDINGS: Initially, there were no differences between cane users and rolling walker users in the LOS in all directions. However, 5-month later, the cane users who held their canes in their right hand had significantly better stability in forward and rightward reach than the walker users (p < .05). Further, the walker users demonstrated significantly decreased functional reach in forward reach (p < .05). CONCLUSION: Cane users might have better stability than walker users in the forward direction and in the direction toward the side holding the cane. This study may provide guide for clinicians including nurses for selecting appropriate rehabilitative interventions for older adults using walkers and canes.

Effect of a modified, low-dye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise.

STUDY DESIGN: Single-group repeated measures design pre- and postintervention. OBJECTIVES: To determine if the modified low-Dye medial longitudinal arch (MLA) taping procedure places the subtalar joint into the neutral position and maintains the subtalar joint neutral (STJN) position following 10 minutes of walking. BACKGROUND: Subtalar malalignment in excessive pronation is commonly accepted as a contributing factor to a variety of musculoskeletal pathologies. The modified low-Dye MLA taping procedure is often used on the plantar surface of the foot as a short-term corrective tool for excessive foot pronation. However, research that evaluates the efficacy of this taping technique during light exercise is lacking. Measurement of navicular height is commonly used as a measure of subtalar position. METHODS AND MEASURES: Prior to the study, one tester-established reliability in the navicular drop technique measurement by initially practicing the measurements on 400 feet, followed by a reliability study performed on 29 subjects. In this study, a screening procedure excluded subjects with ankle or foot pathology, supinated feet, or neutral feet, and included only subjects with pronated feet. The study, which included 40 subjects, involved four steps: (1) measuring navicular height in the relaxed position; (2) measuring navicular height in the STJN position; (3) measuring navicular height after application of the modified low-Dye MLA taping procedure; and (4) measuring navicular height after subjects had walked for 10 minutes with the taping. RESULTS: Results indicated an intrarater intraclass correlation coefficient (ICC) for measuring navicular height of 0.96 for the right foot and 0.94 for the left foot. Repeated measures ANOVA revealed that significant differences existed (P < 0.05) among the 4 measures. A Bonferroni post hoc analysis showed a difference between relaxed stance measurements and all other measurements, and between taped-prewalking measurements and taped-postwalking measurements. In addition, no significant difference was observed between navicular height measured in STJN and the taped-prewalking and taped-postwalking conditions. The average navicular height for the taped-prewalking condition was 1.6 mm higher than that for the STJN position. For the taped-postwalking condition, the average height of the navicular was 1.2 mm lower than that of the STJN position. CONCLUSION: These results demonstrate that the modified low-Dye MLA taping procedure places the subtalar joint near the neutral position. Despite a significant reduction in the height of the navicular after the subjects walked for 10 minutes with the tape on, the height of the navicular was still not significantly different than that of the STJN position.

Superficial precooling on a 4-week static stretching regimen: a randomized trial.

BACKGROUND: The influence of superficial precooling on range of motion (ROM) as part of a stretching program has not been extensively studied. It is not clear if the analgesic effect can benefit a stretching program. HYPOTHESES: Superficial precooling will result in greater gains in ROM as part of a stretching program, compared with stretching without a precooling intervention. Superficial precooling will also result in greater retention in ROM gains following cessation of stretching, compared with stretching without a precooling intervention. STUDY DESIGN: Prospective randomized single-blind test-retest design. METHODS: Twenty-nine participants were randomly assigned to 1 of 2 static stretching protocols: a standard protocol (n, 14; age, 24.6 ± 5.4 years) or a precool protocol (n, 15; age, 25.1 ± 7.3 years). These samples allowed for 80% power for statistical significance testing. Both groups performed static hamstring stretching daily for 4 weeks. The precool group applied ice to the hamstring for 10 minutes before stretching. Both groups stretched for 4 weeks and then stopped stretching for the last 4 weeks. Hip ROM measures were obtained each week for 8 weeks. RESULTS: For the standard group, mean hip ROM increased from 71.4° ± 18.5° to 90.6° ± 20.5° and for the precool group, 71.5° ± 22.3° to 91.8° ± 20.9°. For the standard group, mean hip ROM decreased from 90.6° ± 20.5° to 83.9° ± 20.3° and for the precool group, 91.8° ± 20.9 to 85.0° ± 19.4°. There were no differences between groups at any time in the study (P > .05). CONCLUSIONS: Precooling had no beneficial effects on ROM or on retention of ROM. CLINICAL RELEVANCE: Cold application, before stretching, does not provide any benefit to a stretching program.