Thumbs up: Imagined hand movements counteract the adverse effects of post-surgical hand immobilization. Clinical, behavioral, and fMRI longitudinal observations.

Motor imagery (M.I.) training has been widely used to enhance motor behavior. To characterize the neural foundations of its rehabilitative effects in a pathological population we studied twenty-two patients with rhizarthrosis, a chronic degenerative articular disease in which thumb-to-fingers opposition becomes difficult due to increasing pain while the brain is typically intact. Before and after surgery, patients underwent behavioral tests to measure pain and motor performance and fMRI measurements of brain motor activity. After surgery, the affected hand was immobilized, and patients were enrolled in a M.I. training. The sample was split in those who had a high compliance with the program of scheduled exercises (T+, average compliance: 84%) and those with low compliance (T-, average compliance: 20%; cut-off point: 55%). We found that more intense M.I. training counteracts the adverse effects of immobilization reducing pain and expediting motor recovery. fMRI data from the post-surgery session showed that T+ patients had decreased brain activation in the premotor cortex and the supplementary motor area (SMA); meanwhile, for the same movements, the T- patients exhibited a reversed pattern. Furthermore, in the post-surgery fMRI session, pain intensity was correlated with activity in the ipsilateral precentral gyrus and, notably, in the insular cortex, a node of the pain matrix. These findings indicate that the motor simulations of M.I. have a facilitative effect on recovery by cortical plasticity mechanisms and optimization of motor control, thereby establishing the rationale for incorporating the systematic use of M.I. into standard rehabilitation for the management of post-immobilization syndromes characteristic of hand surgery.

Evaluation of Tai Chi Program Effectiveness for People with Arthritis in the Community: A Randomized Controlled Trial.

OBJECTIVE: Evaluate effectiveness of the Arthritis Foundation Tai Chi Program for community participants with arthritis. METHODS: 343 individuals were randomized to either the intervention or wait-list control group. Performance and self-reported outcome (SRO) measures were assessed at baseline and eight weeks. At one year, SROs only were assessed. Adjusted means were determined using regression models adjusting for covariates, and effect sizes (ES) were calculated. RESULTS: Average participant age was 66 years, 87% were female, and 87% were Caucasian. Among 284 (83%) participants who returned at eight weeks, balance by reach (ES = 0.30) and helplessness, sleep, and role participation satisfaction (ES = 0.24-0.54) improved significantly; pain, fatigue, and stiffness improvement (ES = 0.15-0.23) approached significance. No change was noted in mobility, lower extremity strength, or single-leg stance balance. At one year, improvements in pain, fatigue, stiffness, helplessness, and role participation satisfaction at eight weeks were maintained; 30% continued tai chi practice. CONCLUSION: Moderate effectiveness of the Arthritis Foundation Tai Chi Program was confirmed.

Effectiveness of a Tai Chi intervention for improving functional fitness and general health among ethnically diverse older adults with self-reported arthritis living in low-income neighborhoods: a cohort study.

BACKGROUND AND PURPOSE: Tai Chi (TC) is a form of low to moderate physical activity that has been shown to significantly impact health and functional fitness among older adults; the impact of TC on the health and functional fitness of older adults with arthritis is not well understood. The purpose of this study was to assess the effectiveness of a 16-week TC intervention for improving functional fitness and self-reported general health among older adults with arthritis who were born outside Canada and were residing in low-income neighborhoods. METHODS: A 16-week intervention was conducted among older adults residing in 1 of 2 specified low-income neighborhoods in Canada. The analysis was limited to those who self-reported having arthritis (n = 102). Participants were encouraged to attend 2 moderate-intensity TC sessions per week for a total of 120 minutes. Functional fitness and health were assessed at baseline and at 16 weeks. RESULTS: Average attendance was 1.1 sessions per week. Functional fitness assessment results indicated that right-hand grip strength (25.6 ± 8.2 to 26.7 ± 7.8 kg), left-hand grip strength (24.9 ± 7.3 to 26.8 ± 7.1 kg), 30-second arm curl (15.6 ± 5.0 to 18.6 ± 5.7 repetitions/30 s), Timed Up-and-Go (7.4 ± 2.6 to 6.9 ± 2.6 s), and 30-second chair stand (12.0 ± 3.9 to 15.4 ± 5.8 s) improved significantly (P < 0.05) from baseline to 16 weeks. Results from the Short Form-36 indicate that physical functioning (73.1 ± 19.9 to 80.3 ± 19.4; P = 0.001), general health (61.5 ± 20.9 to 66.0 ± 20.4; P = 0.03), vitality (61.5 ± 18.9 to 67.5 ± 20.2; P = 0.008), and mental health (74.3 ± 16.5 to 78.5 ± 17.7; P = 0.04) also improved significantly over the intervention period. Improvements in physical health and physical function scores were clinically meaningful. DISCUSSION AND CONCLUSIONS: Participating in TC for 16 weeks led to significant improvements in functional fitness and components of physical and mental health among older adults with self-reported arthritis. Tai Chi seems to be a valuable mode of physical activity for this population.

The effect of tai chi on cognition in elders with cognitive impairment.

This one-arm pilot study investigated the effect of tai chi on cognition in elders with cognitive impairment. Although no significant difference existed between pre- and post-test performance on all cognition measures, a dose-response relationship was demonstrated between attendance and some cognition measures.

Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives.

OBJECTIVES: Arthritis, surgery, and traumatic injury of the knee joint are associated with long-lasting inability to fully activate the quadriceps muscle, a process known as arthrogenic muscle inhibition (AMI). The goal of this review is to provide a contemporary view of the neural mechanisms responsible for AMI as well as to highlight therapeutic interventions that may help clinicians overcome AMI. METHODS: An extensive literature search of electronic databases was conducted including AMED, CINAHL, MEDLINE, OVID, SPORTDiscus, and Scopus. RESULTS: While AMI is ubiquitous across knee joint pathologies, its severity may vary according to the degree of joint damage, time since injury, and knee joint angle. AMI is caused by a change in the discharge of articular sensory receptors due to factors such as swelling, inflammation, joint laxity, and damage to joint afferents. Spinal reflex pathways that likely contribute to AMI include the group I nonreciprocal (Ib) inhibitory pathway, the flexion reflex, and the gamma-loop. Preliminary evidence suggests that supraspinal pathways may also play an important role. Some of the most promising interventions to counter the effects of AMI include cryotherapy, transcutaneous electrical nerve stimulation, and neuromuscular electrical stimulation. Nonsteroidal anti-inflammatory drugs and intra-articular corticosteroids may also be effective when a strong inflammatory component is present with articular pathology. CONCLUSIONS: AMI remains a significant barrier to effective rehabilitation in patients with arthritis and following knee injury and surgery. Gaining a better understanding of AMI's underlying mechanisms will allow the development of improved therapeutic strategies, enhancing the rehabilitation of patients with knee joint pathology.

Physical activity programs for chronic arthritis.

PURPOSE OF REVIEW: The purpose of this review is to evaluate recent trials and studies of different types of physical activity programs for individuals with chronic arthritis and to discuss recommendations and findings from systematic reviews of physical activity interventions. RECENT FINDINGS: Recent randomized control trials of different multicomponent land-based, aquatic, Tai Chi, and strength training programs report moderate benefits after intervention and at 6 and 12 months for individuals with various types of chronic arthritis. Reported benefits include increasing physical activity, strength, and balance, improving functional status, reducing symptoms, and enhancing self-efficacy. Recent systematic reviews recommend evidence-based, land-based, aquatic, Tai Chi, and strength training programs for individuals with arthritis. SUMMARY: There is a preponderance of strong scientific evidence that both aerobic and muscle strengthening exercises, alone or in combination, are safe and moderately effective for individuals with chronic arthritis.

The oil-dispersion bath in anthroposophic medicine--an integrative review.

BACKGROUND: Anthroposophic medicine offers a variety of treatments, among others the oil-dispersion bath, developed in the 1930s by Werner Junge. Based on the phenomenon that oil and water do not mix and on recommendations of Rudolf Steiner, Junge developed a vortex mechanism which churns water and essential oils into a fine mist. The oil-covered droplets empty into a tub, where the patient immerses for 15-30 minutes. We review the current literature on oil-dispersion baths. METHODS: The following databases were searched: Medline, Pubmed, Embase, AMED and CAMbase. The search terms were 'oil-dispersion bath' and 'oil bath', and their translations in German and French. An Internet search was also performed using Google Scholar, adding the search terms 'study' and 'case report' to the search terms above. Finally, we asked several experts for gray literature not listed in the above-mentioned databases. We included only articles which met the criterion of a clinical study or case report, and excluded theoretical contributions. RESULTS: Among several articles found in books, journals and other publications, we identified 1 prospective clinical study, 3 experimental studies (enrolling healthy individuals), 5 case reports, and 3 field-reports. In almost all cases, the studies described beneficial effects - although the methodological quality of most studies was weak. Main indications were internal/metabolic diseases and psychiatric/neurological disorders. CONCLUSION: Beyond the obvious beneficial effects of warm bathes on the subjective well-being, it remains to be clarified what the unique contribution of the distinct essential oils dispersed in the water can be. There is a lack of clinical studies exploring the efficacy of oil-dispersion baths. Such studies are recommended for the future.

Physical activity barriers and program preferences among indigent internal medicine patients with arthritis.

The study purpose was to determine, among indigent arthritis patients, physical activity barriers, program preference frequencies and demographic associations. A structured interview of 223 indigent, internal medicine clinic patients with self-reported arthritis was administered in a cross-sectional study design. The two most frequently reported barriers included bad health (52%) and pain (51%). The majority preferred to exercise alone (54%), close to home (76%), and in the early morning/evening (83%). The preferred method of receiving exercise information was by video or audio tape. Frequency of reported barriers was significantly associated with age, ethnicity, and gender; specific program preferences were significantly associated with age and gender only. Exercise programs for indigent patients with arthritis should be home-based with flexible scheduling. Educational material should include both video and audio tape formats. Future interventions should consider barriers related to poor health and pain while remaining responsive to age, gender, and ethnic differences. Nurses can play a pivotal role in such interventions.

Spirituality, rehabilitation, and aging: a literature review.

This focused review highlights the role of spirituality in rehabilitation. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on spirituality, rehabilitation, aging, and research. OVERALL LEARNING OBJECTIVE: To identify the current state of knowledge regarding the relationships among rehabilitation, spirituality, and aging.

Rehabilitation of the arthrofibrotic knee.

This paper describes the postoperative rehabilitation of the arthrofibrotic knee, with specific emphasis on modern rehabilitation techniques. The significance of prevention and early recognition is discussed. The importance of early motion and patellar mobility is emphasized and specific exercises to prevent and treat stiffness are described. Continuous passive motion, bracing, and exercise--on the stationary bicycle, on the treadmill, and in water--are adjuncts in the program. Strengthening is added when motion is re-established and there is no swelling or pain. Sport-specific activities are added if progress is satisfactory and motion is maintained. If pain, swelling, or stiffness develops, exercises should be discontinued. Modalities such as cryotherapy, ultrasound, electrical stimulation, rest, and manipulation can be used judiciously. Anti-inflammatory and analgesic medications should be used to prevent inflammation, to control pain, and to allow more aggressive rehabilitative exercises.

Efecto del ejercicio físico sobre la artritis reumatoide / Effect of physical exercise on rheumatoid arthritis

La artritis reumatoide es una grave poliartritis que, además, se puede acompañar de afectación general y visceral. Los autores repasan sus rasgos clínicos más determinantes, en lo que respecta a la producción de discapacidades y sus indicaciones de rehabilitación. Asimismo, su prevalencia es relativamente alta. En consecuencia, a nivel personal frecuentemente produce importantes limitaciones de la independencia funcional, lo que se traduce en enormes repercusiones socioeconómicas. Tradicionalmente se consideraba que el reposo articular era una de las bases del tratamiento. Sin embargo, recientes estudios revisados por los autores encuentran que la actividad física y el ejercicio programado son notablemente más eficaces para prevenir la discapacidad y recuperar la función. No existe unanimidad en cuanto a las pautas más idóneas ni a las clases de ejercicios concretos, incluyendo siempre ejercicio aeróbico y con ligeras resistencias. Sin embargo, sus efectos son probadamente positivos tanto sobre la movilidad articular, la fuerza muscular, la capacidad aeróbica, la masa ósea, la capacidad laboral y la independencia funcional. Además, no aumentan el dolor ni la actividad inflamatoria, sino más bien al contrario. Por ello deben incluirse sistemáticamente en el tratamiento del paciente, que podría aprenderlos primero en el servicio de Rehabilitación, para seguir practicándolos después por sí mismo continuadamente (AU)

Osteoarthritis and traumatic arthritis of the shoulder.

Glenohumeral osteoarthritis and traumatic arthritis result in a painful shoulder with impairments, functional deficits, and disability. Conservative treatment includes oral inflammatory medication, cortisone injection, or rehabilitation. Rehabilitation of the shoulder can be beneficial, but if joint destruction is advanced, surgery may be required. Postoperative rehabilitation requires the therapist to know the basics of the surgical technique so that safe and effective therapeutic intervention can be made. A successful outcome depends on effective communication and interaction among the physician, therapist, and patient. Each "team" member has a defined role in rehabilitation, and all three must fulfill their responsibilities for the desired outcome to be achieved.