Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention.

PURPOSE: To quantify effects of motor-assisted elliptical (Intelligently Controlled Assistive Rehabilitation Elliptical [ICARE]) training on walking and fitness of a child with cerebral palsy (CP). KEY POINTS: A 12-year-old boy with walking limitations due to spastic diplegic CP (Gross Motor Function Classification System II) participated in 24 sessions of primarily moderate- to vigorous-intensity ICARE exercise. Fitness improvements were evidenced clinically across sessions by the child's capacity to train for longer periods, at faster speeds, and while overriding motor's assistance. Postintervention, the child walked faster with greater stability and endurance and more rapidly completed the modified Time Up and Go test. CONCLUSION: The child's fitness and gait improved following engagement in a moderate- to vigorous-intensity gait-like exercise intervention. RECOMMENDATIONS FOR CLINICAL PRACTICE: Integration of moderate- to vigorous-intensity motor-assisted elliptical training can promote simultaneous gains in fitness and function for children with CP.

Occupational injuries and patient lift usage among physical rehabilitation therapists.

BACKGROUND: Physical therapists (PTs) and physical therapist assistants (PTAs) are at high risk for work-related musculoskeletal pain and discomfort. OBJECTIVE: Determine the prevalence and exposure risk factors for work-related injuries (WRIs) among rehabilitation PTs and PTAs. METHODS: A cross-sectional research survey was conducted among 170 PTs and 67 PTAs at 51 free-standing rehabilitation hospitals and rehabilitation units embedded in general hospitals in the Midwestern states of Iowa, Kansas, Missouri and Nebraska. The prevalence of WRIs and significant risk factors for developing WRIs were determined for PTs and PTAs. RESULTS: The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 29.5%. Multifaceted causes were identified including frequently bending/twisting, over-exerting force during patient handling activities, inadequate lifting devices, and lack of ongoing training for mechanical lifting device usage. CONCLUSIONS: Equipment usage barriers point to a critical need for technology creation, research, and education to advance worker safety while simultaneously enhancing patient outcomes.

Kinematic and muscle demand similarities between motor-assisted elliptical training and walking: Implications for pediatric gait rehabilitation.

Many children with physical disabilities and special health care needs experience barriers to accessing effective therapeutic technologies to improve walking and fitness in healthcare and community environments. The expense of many robotic and exoskeleton technologies hinders widespread use in most clinics, school settings, and fitness facilities. A motor-assisted elliptical trainer that is being used to address walking and fitness deficits in adults was modified to enable children as young as three years of age to access the technology (Pedi-ICARE). We compared children's kinematic and muscle activation patterns during walking and training on the Pedi-ICARE. Eighteen children walked (self-selected comfortable speed), Pedi-ICARE trained with motor-assistance at self-selected comfortable speed (AAC), and trained while over-riding motor-assistance (AAC+). Coefficient of multiple correlations (CMCs) compared lower extremity kinematic profiles during AAC and AAC+ to gait. Repeated measures ANOVAs identified muscle demand differences across conditions. CMCs revealed strong similarities at the hip and knee between each motor-assisted elliptical condition and gait. Ankle CMCs were only moderate. Muscle demands were generally lowest during AAC. Over-riding the motor increased hip and knee muscle demands. The similarity of motion patterns between Pedi-ICARE conditions and walking suggest the device could be used to promote task-specific training to improve walking. The capacity to manipulate muscle demands using different motor-assistance conditions highlights Pedi-ICARE's versatility in addressing a wide range of children's abilities.

Comparative analysis of speed's impact on muscle demands during partial body weight support motor-assisted elliptical training.

Individuals with walking limitations often experience challenges engaging in functionally relevant exercise. An adapted elliptical trainer (motor to assist pedal movement, integrated body weight harness, ramps/stairs, and grab rails) has been developed to help individuals with physical disabilities and chronic conditions regain/retain walking capacity and fitness. However, limited published studies are available to guide therapeutic interventions. This repeated measures study examined the influence of motor-assisted elliptical training speed on lower extremity muscle demands at four body weight support (BWS) levels commonly used therapeutically for walking. Electromyography (EMG) and pedal trajectory data were recorded as ten individuals without known disability used the motor-assisted elliptical trainer at three speeds [20,40, 60 revolutions per minute (RPM)] during each BWS level (0%, 20%, 40%, 60%). Overall, the EMG activity (peak, mean, duration) in key stabilizer muscles (i.e., gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus) recorded at 60 RPM exceeded those at 40 RPM, which were higher than values at 20 RPM in all but three situations (gluteus medius mean at 0% BWS, vastus lateralis mean at 20% BWS, soleus duration at 40% BWS); however, these differences did not always achieve statistical significance. Slower motor-assisted speeds can be used to accommodate weakness of gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus. As strength improves, training at faster motor-assisted speeds may provide a means to progressively challenge key lower extremity stabilizers.

Functional outcomes of patients with sternectomy after cardiothoracic surgery: a case series.

PURPOSE: One potential complication after cardiothoracic surgery involves mediastinitis, which may lead to a sternectomy. A sternectomy involves partial or total debridement of the sternum to remove infected bone. Little evidence regarding functional outcomes following sternectomy exists in literature. The purpose of this case series is to report the demographics of 6 patients admitted to a long term acute care hospital (LTACH) treated for sternectomy after open heart surgery, along with presenting length of stay (LOS) data, analyzing functional outcomes, and describing the physical therapy (PT) interventions used with these patients to obtain the reported functional outcomes. METHODS: Medical charts were reviewed retrospectively. Information in four main areas were extrapolated from the chart and further analyzed: patient demographics, length of hospital stay (acute care and LTACH), admission and discharge FIM scores, and information about the PT interventions (both numerical and descriptive). RESULTS: Patients included 5 males and 1 female with an age range of 65-78 years old (mean 70 years old, SD 4.8 years). Patients had a total mean acute care LOS of 26.33 (12.26) days and total mean LTACH LOS of 27.67 (11.74) days. Median total FIM score at admission was 80.00 [range 58.00-94.00], while the median total FIM score at discharge increased significantly to 106.50 [range 86.00-116.00] (p = 0.031). Total mean FIM score change during LTACH stay (efficiency) was 25.17 (3.25), and FIM score change per day (efficacy) was 1.23 (0.46). Median motor score had a significant increase from admission to discharge (p = 0.031). Median cognitive score did not significantly change from admission to discharge (p = 0.125). PT interventions used with this patient population were presented and described, with a mean number of PT sessions in LTACH of 27.33 (15.38) (range = 10-46). CONCLUSION: Although patients required an increased acute care LOS and an additional stay on LTACH, all 6 patients were discharged home following a course of multi-disciplinary inpatient rehabilitation on a LTACH unit. Patients are able to make significant functional gains during rehabilitation following sternectomy, as evidenced by increases in FIM score.

Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: a systematic review.

PURPOSE: To evaluate the reliability and validity of the six-minute walk test (6MWT) with respect to its ability to predict functional capacity in patients with chronic heart failure. METHODS: A systematic review was performed via 8 databases to assess relevant English language full-text articles published from January 1, 1980 to October 31, 2009. Participant characteristics, interventions, reliability, validity, and predictive value for each article with respect to functional capacity as defined by peak VO(2) levels were extracted and compared. Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scores were determined for each study. RESULTS: Fourteen studies met the selection criteria. Comparison of the studies investigating reliability shows that the 6MWT has good reproducibility. The 6MWT demonstrates moderate correlation with peak VO(2) levels, and ability to predict VO(2) (functional capacity) dependent on distance walked. Cut-off distances vary from 300 to 490 meters depending on the study; if total distance walked remains equal or less than these values, the 6MWT retains its strong predictive value. CONCLUSION: The 6MWT has good reliability, moderate validity, and a significant ability to predict functional capacity in patients with CHF who do not walk greater than 490 meters.