Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study.

BACKGROUND: Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is acknowledged as a means of preventing or delaying frailty and loss of function in these patients. However, limited hospital resources challenge the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients. METHODS: This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises to be performed unsupervised once daily. A BandCizer Datalogger enabling measurement of the number of sets, repetitions, and time-under-tension was attached to the elastic band. The patients were instructed in performing strength training: 3 sets of 10 repetitions (10-12 repetition maximum (RM)) with a separation of 2-min pauses and a time-under-tension of 8 s. The feasibility criterion for the unsupervised progressive exercises was that 33% of the recommended number of sets would be performed by at least 30% of patients. In addition, patients and staff were interviewed about their experiences with the intervention. RESULTS: Four (27%) out of 15 patients completed 33% of the recommended number of sets. For the total sample, the average percent of performed sets was 23% and for those who actually trained (n = 12) 26%. Patients and staff expressed a general positive attitude towards the unsupervised training as an addition to the supervised training sessions. However, barriers were also described-especially constant interruptions. CONCLUSIONS: Based on the predefined criterion for feasibility, the unsupervised training was not feasible, although the criterion was almost met. The patients and staff mainly expressed positive attitudes towards the unsupervised training. As even a small training dosage has been shown to improve the physical performance of geriatric inpatients, the proposed intervention might be relevant if the interruptions are decreased in future large-scale trials and if the adherence is increased. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02702557, February 29, 2016. Data Protection Agency: 2016-42, February 25, 2016. Ethics Committee: No registration needed, December 8, 2015 (e-mail correspondence).

Modulation of the withdrawal reflex during hemiplegic gait: effect of stimulation site and gait phase.

OBJECTIVE: The objective of the study was to investigate the sensitivity of the nociceptive withdrawal reflex to stimulation of different locations on the sole of the foot during hemiplegic gait. METHODS: Reflexes were evoked by cutaneous electrical stimulation of 4 locations on the sole of the foot of 7 hemiplegic and 6 age-matched healthy persons. The stimuli were delivered at heel-contact, during foot-flat, at heel-off, and during mid-swing. Reflexes were recorded from muscles of the stimulated and the contralateral leg. Ankle, knee, and hip joints angles were recorded using goniometers. RESULTS: In the hemiplegic persons, the size of tibialis anterior reflexes, and the latency of soleus reflexes were site- and phase-modulated. In both groups, the tibialis anterior reflexes were significantly smaller with stimulation to the fifth metatarsophalangeal joint and the heel compared with the first metatarsophalangeal joint and the arch of the foot. The tibialis anterior reflexes evoked at heel-off and mid-swing were larger in hemiplegic persons than in healthy persons. Reflexes in the proximal and contralateral limb muscles were not site-modulated during hemiplegic gait. The kinematic response at the ankle joint was also different in the two groups during mid-swing. CONCLUSIONS: Hemiplegic and healthy middle-aged people presented different phase-modulation of the kinematic and muscle nociceptive reflex responses evoked by stimulation delivered on the sole of the foot. SIGNIFICANCE: The results have potential application in programs to rehabilitate hemiplegic gait.

Estimulación eléctrica y espasticidad: una revisión / Electrical stimulation and spasticity

La espasticidad puede describirse como una condición que asocia parálisis o paresia con hiperreflexia. Sus síntomas incluyen un aumento de la resistencia a la manipulación, exageración de los reflejos profundos y clonus. Entre los procedimientos útiles para su tratamiento se encuentra la aplicación de estimulación eléctrica cutánea. Se ha realizado una extensa investigación bibliográfica acerca del estado del conocimiento sobre los efectos de la estimulación eléctrica de superficie en los músculos con hipertonía espástica y se presentan los resultados obtenidos por numerosos investigadores. En estos estudios se han aplicado gran diversidad de protocolos, por lo que para realizar un análisis global de los resultados obtenidos por los distintos autores se han escogido los artículos que reportan trabajos con pacientes evaluados antes y al menos una vez después de la sesión de estimulación, y en los que el resultado de la evaluación se presentó en forma individual para cada paciente. A partir de los trabajos revisados se ha logrado contabilizar un total de 86 pacientes. Se encontró que el 80,2 por ciento de ellos disminuyó su grado de espasticidad y que sólo el 4,6 por ciento la aumentó posteriormente a la aplicación de estimulación eléctrica. Se concluye que existe evidencia suficiente para afirmar que la estimulación eléctrica de superficie representa una importante herramienta para el tratamiento de la hipertonía espástica en pacientes con lesiones en el sistema nervioso central. (AU)