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1.
J Neurol Phys Ther ; 2021 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-34864777

RESUMO

BACKGROUND: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. METHODS: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. RESULTS: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. DISCUSSION: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. LIMITATIONS: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. DISCLAIMER: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).

2.
Artigo em Inglês | MEDLINE | ID: mdl-34590504

RESUMO

Background: An ongoing longitudinal study in six European sites includes a 3-monthly assessment of forced vital capacity (FVC), slow vital capacity (SVC), peak cough flow (PCF), and Sniff nasal inspiratory pressure (SNIP). The aim of this interim analysis was to assess the potential for SNIP to be a surrogate for aerosol generating procedures given COVID-19 related restrictions. Methods: This was a prospective observational study. Patients attending six study sites with King's Stage 2 or 3 ALS completed baseline FVC/SVC/SNIP/PCF and repeated assessments 3 monthly. Data were collected from March 2018 to March 2020, after which a COVID-19 related study suspension was imposed. Correlations between the measures were calculated. A Bayesian multiple outcomes random-effects model was constructed to investigate rates of decline across measures. Results: In total, 270 cases and 828 assessments were included (Mean age 65.2 ± 15.4 years; 32.6% Female; 60% Kings stage 2; 81.1% spinal onset). FVC and SVC were the most closely correlated outcomes (0.95). SNIP showed the least correlation with other metrics 0.53 (FVC), 0.54 (SVC), 0.60 (PCF). All four measures significantly declined over time. SNIP in the bulbar onset group showed the fastest rate of decline. Discussion: SNIP was not well correlated with FVC and SVC, probably because it examines a different aspect of respiratory function. Respiratory measures declined over time, but differentially according to the site of onset. SNIP is not a surrogate for FVC and SVC, but is a complementary measure, declining linearly and differentiating spinal and bulbar onset patients.


Assuntos
Esclerose Amiotrófica Lateral , COVID-19 , Idoso , Idoso de 80 Anos ou mais , Esclerose Amiotrófica Lateral/diagnóstico , Teorema de Bayes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Capacidade Vital
3.
Artigo em Inglês | MEDLINE | ID: mdl-34092157

RESUMO

Forced vital capacity (FVC) is an essential respiratory measurement for assessment and monitoring of patients with Amyotrophic Lateral Sclerosis (ALS). Our clinic rapidly implemented remote assessment of FVC after COVID-19 related restrictions on respiratory testing were imposed, using mini-spirometers and video consultation. We sought to evaluate the patient's experiences of performing remote respiratory assessments to guide future development and optimisation of the service. Twenty-five patients completed surveys. The mean age was 65.2 years and average time from diagnosis was 17.04 (2-99) months. Seventy-two percent (n = 18) required help from a caregiver to perform the tests. Ninety-two percent (n = 23) of patients reported that overall, they were satisfied and were happy to continue with remote respiratory assessment. Reducing the number of clinic visits for review and assessment was valued by 92% (n = 23) and reducing the risk associated with COVID-19 was valued by 96% (n = 24). The highest frequency reported as acceptable for performing the remote breathing assessments was monthly (60%, n = 15), followed by every second month (28%, n = 7). Remote respiratory testing is viewed positively by patients. These technologies used in combination with video-consultations and other novel forms of remote monitoring implemented in response to the COVID-19 crisis will continue to be valuable tools for clinical care in future. However, further evaluation of the validity of remote respiratory assessment is required.

4.
J Neurol ; 267(Suppl 1): 24-35, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33048219

RESUMO

Vestibular rehabilitation (VR) is practiced across Europe but little in this area has been quantified. The aim of this study was to investigate current VR assessment, treatment, education, and research practices. This was an online, cross-sectional survey with 39 VR specific questions and four sections: demographics, current practice, education, and research. The survey was disseminated through the Dizzynet network to individual therapists through country-specific VR special interest groups. Results were analysed descriptively. A thematic approach was taken to analyse open questions. A total of 471 individuals (median age 41, range 23 - 68 years, 73.4% women), predominately physiotherapists (89.4%) from 20 European countries responded to the survey. They had worked for a median of 4 years (range < 1 - 35) in VR. The majority (58.7%) worked in hospital in-patient or out-patient settings and 21.4% in dedicated VR services. Most respondents specialized in neurology, care of the elderly (geriatrics), or otorhinolaryngology. VR was reported as hard/very hard to access by 48%, with the main barriers to access identified as lack of knowledge of health care professionals (particularly family physicians), lack of trained therapists, and lack of local services. Most respondents reported to know and treat benign paroxysmal positional vertigo (BPPV 87.5%), unilateral vestibular hypofunction (75.6%), and cervicogenic dizziness (63%). The use of vestibular assessment equipment varied widely. Over 70% used high-density foam and objective gait speed testing. Over 50% used dynamic visual acuity equipment. Infrared systems, Frenzel lenses, and dynamic posturography were not commonly employed (< 20%). The most frequently used physical outcome measures were the Clinical Test of the Sensory Interaction of Balance, Functional Gait Assessment/Dynamic Gait Index, and Romberg/Tandem Romberg. The Dizziness Handicap Inventory, Visual Analogue Scale, Falls Efficacy Scale, and the Vertigo Symptom Scale were the most commonly used patient reported outcome measures. Adaptation, balance, and habituation exercises were most frequently used (> 80%), with virtual reality used by 15.6%. Over 70% reported knowledge/use of Semont, Epley and Barbeque-Roll manoeuvres for the treatment of BPPV. Most education regarding VR was obtained at post-registration level (89.5%) with only 19% reporting pre-registration education. There was strong (78%) agreement that therapists should have professionally accredited postgraduate certification in VR, with blended learning the most popular mode. Three major research questions were identified for priority: management of specific conditions, effectiveness of VR, and mechanisms/factors influencing vestibular compensation and VR. In summary, the survey quantified current clinical practice in VR across Europe. Knowledge and treatment of common vestibular diseases was high, but use of published subjective and objective outcome measures as well as vestibular assessment varied widely. The results stress the need of improving both training of therapists and standards of care. A European approach, taking advantage of best practices in some countries, seems a reasonable approach.


Assuntos
Tontura , Doenças Vestibulares , Adulto , Idoso , Estudos Transversais , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Doenças Vestibulares/epidemiologia , Doenças Vestibulares/terapia , Adulto Jovem
5.
Eur J Pediatr ; 179(11): 1823-1832, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32468158

RESUMO

There is a lack of reliable and valid measurement tools to assess neck function in infants with congenital muscular torticollis, and most physiotherapists use visual estimation, which has not been adequately tested for reliability in this population. We examined the reliability of visual estimation of head tilt and active neck rotation in the upright position, on infants with congenital muscular torticollis by physiotherapists. We recruited 31 infants and 26 physiotherapists. Therapists rated videos of infants' head position in the frontal plane (tilt) and transverse plane (active rotation) using visual estimation, on two occasions at least one week apart. Overall, inter-rater reliability was good (mean ICC, 0.68 ± 0.20; mean SEM, 5.1° ± 2.1°). Rotation videos had better reliability (mean ICC, 0.79 ± 0.14) than head tilt videos (mean ICC, 0.58 ± 0.20). Intra-rater reliability was excellent (mean ICC, 0.85 ± 0.08). Both head tilt and rotation had excellent reliability (mean ICC, 0.84 ± 0.08 for head tilt and 0.85 ± 0.09 for rotation). There was no correlation between intra-rater reliability and clinical experience.Conclusion Visual estimation had excellent intra-rater reliability in the assessment of neck active rotation and head tilt on infants with congenital muscular torticollis. Visual estimation had acceptable inter-rater reliability in the assessment of neck active rotation but not of head tilt. There was a wide variation in reliability with no correlation between reliability and clinical experience. Assessment tools for head tilt that are more psychometrically robust should be developed. What is Known: • A thorough assessment of infants presenting with torticollis is essential, using assessment tools with robust psychometric properties • Visual estimation is the most commonly used method of assessment of neck function in infants with torticollis What is New: • Visual estimation had excellent intra-rater reliability in the assessment of neck active rotation and head tilt in the upright position in videos of infants and acceptable inter-rater reliability in the assessment of rotation but not of head tilt • Physiotherapists' clinical experience had minimal relationship with reliability.


Assuntos
Fisioterapeutas , Torcicolo , Vértebras Cervicais , Humanos , Lactente , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Rotação , Torcicolo/congênito , Torcicolo/diagnóstico
6.
Int J Rehabil Res ; 43(2): 102-115, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32282571

RESUMO

Individuals with knee osteoarthritis (OA) commonly demonstrate impaired postural control. We aimed to systematically review psychometric properties of tests that assess postural control in people with knee OA and secondly, to determine domains of postural control measured by these tests. PubMed, CINAHL, Embase and Web of Science databases were searched to January 2019. Two independent review authors screened references according to eligibility criteria. The Consensus-based Standards for the selection of health Measurement Instruments were used to evaluate study methodological quality. Postural control tests identified from included studies were assessed to determine postural control constructs using the Systems Framework for Postural Control identifying nine domains. Following the screening of 2643 references, five cross-sectional studies and one longitudinal study (n = 408) were included. Four studies evaluated reliability, validity or responsiveness of three clinical measures: Community Balance and Mobility Scale, Star Excursion Balance Test and Tinetti Performance Oriented Mobility Assessment. Two assessed reliability or validity of a force platform. Results showed that evidence for reliability, validity and responsiveness of all these postural measures is limited. The most common domain of postural control assessed was 'static stability'. No study used measures that evaluated all nine postural control domains. Our results highlight limited investigation of psychometric properties specific to postural control in knee OA. The few existing ones have limitations regarding psychometric robustness and completeness regarding different domains of postural control. Future research should focus on verifying the quality of existing tools to evaluate postural control in knee OA for research and clinical purposes.


Assuntos
Teste de Esforço , Osteoartrite do Joelho/fisiopatologia , Equilíbrio Postural/fisiologia , Humanos , Psicometria , Reprodutibilidade dos Testes
7.
Cochlear Implants Int ; 21(1): 46-52, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31530102

RESUMO

Objective: Cochlear implantation is associated with vestibular impairment due to the close proximity of the structures. The aim of the study was to quantify dizziness/vertigo, gaze instability, balance and gait problems in a sample of adult cochlear implant (CI) users.Methods: An observational, cross sectional study evaluated subjective dizziness (Vestibular Rehabilitation Benefit Questionnaire (VRBQ)), balance confidence (Activities Specific Balance Questionnaire (ABC)), gait (Functional Gait Assessment (FGA) and 10m walk test), balance (Equitest Sensory Organisation Test (SOT)), and computerised dynamic visual acuity (DVA). The Dix Hallpike test was performed to test for benign paroxysmal positional vertigo (BPPV).Results: Twenty participants (n=10F), 2.8(±2.7) years post implantation, with mean age 59.3(±15.8) years were assessed. Subjective dizziness (VRBQ) was low (15.0% (±15.5)) and balance confidence was high (ABC: 82.1%±14.9). FGA scores (25.1 ± 4.4) and gait speed (1.8 (±0.3) m/sec) were below normal. Dx Hallpike was positive in 3. Gaze instability was found in 50% (DVA loss, 0.29 (± 0.16) LogMAR), while 79% demonstrated balance impairment (mean SOT score, 57.8%±14.5), with 42% falling on SOT condition 5.Discussion: Evidence of vestibular dysfunction was identified in these adult CI users.Conclusion: Access to vestibular function assessment and rehabilitation is required in adult CI users.


Assuntos
Implantes Cocleares/efeitos adversos , Tontura/epidemiologia , Transtornos Neurológicos da Marcha/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Transtornos das Sensações/epidemiologia , Doenças Vestibulares/epidemiologia , Implante Coclear/efeitos adversos , Estudos Transversais , Tontura/etiologia , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Equilíbrio Postural , Transtornos das Sensações/etiologia , Inquéritos e Questionários , Doenças Vestibulares/etiologia , Acuidade Visual
8.
J Neurol ; 266(Suppl 1): 11-18, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31385017

RESUMO

Gaze stabilisation exercises are a mainstay of vestibular rehabilitation (VR). They are frequently prescribed to patients with vestibular hypofunction with the aim of improving the gain of the vestibular ocular reflex, improving visual acuity during head movement, and reducing the symptoms of dizziness and vertigo. This review will examine current evidence that has evaluated the efficacy of gaze stabilisation exercises on VOR gain, dynamic visual acuity and oscillopsia. In addition, recent experimental studies that have employed digital technologies and newer forms of gaze stabilisation exercises will be reviewed. The implications for future clinical practice and research in the area of VR will be discussed.


Assuntos
Terapia por Exercício/métodos , Fixação Ocular/fisiologia , Movimentos da Cabeça/fisiologia , Doenças Vestibulares/reabilitação , Vestíbulo do Labirinto/fisiologia , Humanos , Reflexo Vestíbulo-Ocular/fisiologia , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/fisiopatologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-31313597

RESUMO

Objective: Sniff nasal inspiratory pressure (SNIP) is a commonly used clinical measure of respiratory impairment in amyotrophic lateral sclerosis (ALS), which is used to guide the initiation of noninvasive ventilation (NIV). SNIP can be completed with either an occluded or an un-occluded contralateral nostril. The aim of this study was to compare occluded and un-occluded SNIP measurements and to examine the decline in occluded SNIP over time compared to the ALSFRS-R respiratory subscore. Methods: This was a prospective longitudinal study examining occluded and un-occluded SNIP scores in ALS and PLS patients recorded between 2001 and 2018. Bland and Altman graphs were plotted for occluded vs. un-occluded SNIP measurements taking account of the repeated measures nature of the data. Longitudinal models were constructed as linear mixed effects multi-level models with follow-up in ALS limited to 6 years. Results: SNIP measured with an occluded contralateral nostril was systematically higher than with an un-occluded nostril. SNIP measured using both methods declined non-linearly, particularly after 2-3 years. The best fit model for decline in occluded SNIP included a main effect and interaction between site of onset and time, with age and diagnostic delay as independent variables. This showed a linear decline in spinal onset with a floor effect in bulbar-onset ALS. Conclusion: SNIP measured with an occluded and un-occluded contralateral nostril is not interchangeable, which is relevant in interpreting thresholds for initiation of NIV. SNIP declines non-linearly, which is explained in spinal onset ALS by age and diagnostic delay, but an apparent floor effect remains in bulbar onset.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico , Diagnóstico Tardio/prevenção & controle , Doença dos Neurônios Motores/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Músculos Respiratórios
10.
BMC Musculoskelet Disord ; 20(1): 265, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153362

RESUMO

BACKGROUND: A research gap exists for optimal management of cervical radiculopathy in the first 12 weeks and short term natural history of the condition is somewhat unclear, although thought to be favourable. The primary aim of this assessor blinded, superiority, 2 parallel group randomised controlled trial is to investigate the effects of a 4 week physiotherapy programme (6-8 sessions) of manual therapy, exercise and upper limb neural unloading tape, compared to a control of weekly phone advice; on disability, pain and selected biopsychosocial measures, in acute and sub-acute cervical radiculopathy patients. A secondary aim is to identify whether any baseline variables, symptom duration or group allocation can predict outcome. METHODS: Participants are recruited from GP referrals in an urban setting, from a neurosurgery non-urgent waiting list and from self-referral through Facebook advertising. Eligible participants (n = 64) are diagnosed with radiculopathy based on a clinical prediction rule and must have symptoms of unilateral, single level, radiculopathy for between 2 and 12 weeks, without having yet received physiotherapy. Random 1:1 group allocation (using variable block sizes), allocation concealment, blinded assessment and intention to treat analysis are being employed. Treatment is provided by clinical specialist physiotherapists in primary and secondary care settings. Outcomes are measured at baseline, 4 (primary endpoint) and 12 weeks. Participants' report of pain, disability and their rating of recovery is also recorded by telephone interview at 6 months. Statistical analysis of between group differences will be performed with ANOVAs and MANOVAs, and multivariable regression analysis will be undertaken to explore predictor variables. Ethical approval for this study has been received from the Beaumont Hospital and Irish College of General Practitioners Research Ethics Committees. The trial is registered at ClinicalTrials.gov (NCT02449200). DISCUSSION: An internal pilot study to test retention and recruitment strategies led to trial expansion and this is now a multi centre trial involving 5 clinical sites. TRIAL REGISTRATION: NCT02449200 . Registered 20/05/15.


Assuntos
Tratamento Conservador/métodos , Cervicalgia/terapia , Radiculopatia/terapia , Adulto , Fita Atlética , Vértebras Cervicais , Terapia Combinada/métodos , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Manipulações Musculoesqueléticas/métodos , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Medição da Dor , Projetos Piloto , Qualidade de Vida , Radiculopatia/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto Jovem
12.
Eur J Pediatr ; 178(5): 657-671, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30778746

RESUMO

The aim of this study was to systematically review the measurement properties of instruments which assess cervical spine function in infants with torticollis. Electronic searches were performed in MEDLINE, CINAHL, Embase, Web of Science and the Cochrane Library, combining three constructs ('torticollis', 'cervical spine assessment' and 'measurement properties'). Two reviewers independently rated the methodological quality and the quality of measurement properties of identified articles, using both the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist and quality criteria for measurement properties. Five studies, using six instruments, met the inclusion criteria and were analysed. Included instruments were the goniometer, electronic pendular goniometer, protractor, still photography, Muscle Function Scale and a range of motion limitation scale. All studies assessed reliability, and one study also assessed content validity and hypothesis testing. The methodological quality of the studies varied from poor to excellent according to the COSMIN checklist. Two instruments were found to have good measurement properties from high-quality studies: still photography for the assessment of habitual head tilt in supine and the Muscle Function Scale for the assessment of side-flexor muscle function in lateral head righting.Conclusion: This systematic review identified two reliable tools for the assessment of cervical spine function in infants with torticollis. Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in this population. What is known? • A thorough assessment of the infant presenting with torticollis is essential, in order to correctly diagnose, rule out 'red flags' and manage appropriately • Assessment tools need to have robust measurement properties in order to be of value for clinical practice and research What is new? • This systematic review identified two valid and reliable tools for the assessment of cervical spine function in infants with torticollis • Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in infants with torticollis.


Assuntos
Artrometria Articular/métodos , Vértebras Cervicais/fisiopatologia , Músculos do Pescoço/fisiopatologia , Fotografação , Índice de Gravidade de Doença , Torcicolo/fisiopatologia , Humanos , Lactente , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Torcicolo/diagnóstico
13.
Clin Biomech (Bristol, Avon) ; 59: 143-151, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30241094

RESUMO

BACKGROUND: Residual shoulder dysfunction and deformity impacts on functional performance in children with obstetric brachial plexus palsy. Clinical understanding of upper limb dynamic movement patterns is difficult with observation alone. This case-control study describes the significant kinematic differences between children with obstetric brachial plexus palsy compared to typically developing children while performing tasks of the modified Mallet Scale. METHODS: Eleven children with obstetric brachial plexus palsy (mean 10 years, range 7-15 years, Narakas group I-III) and 10 typically developing children (mean 9 years 9 months, range 6-15 years) completed three-dimensional upper limb motion analysis using the acromion method to track dynamic scapular movement. Kinematic data were captured by a 4-CODA cx1 optoelectronic tracking system. Participants performed three trials of the modified Mallet scale tasks. Local coordinate systems, segment and joint rotations were defined as recommended by the International Society of Biomechanics. FINDINGS: Joint rotation angles against time of the glenohumeral, thoracohumeral and scapulohumeral joints were calculated. Kinematic findings demonstrated increased internal rotation in all postures, reduced glenohumeral excursion, habitual "trumpet" posture of glenohumeral abduction/elevation and variability in movement strategies. Scapulohumeral rhythm during abduction task was 1.88:1 in typically developing children and 1.04:1 in children with obstetric brachial plexus palsy. INTERPRETATION: Children with obstetric brachial plexus palsy demonstrate deficient external rotation in all tasks. Despite increased postural internal rotation, ability to move through internal rotation range is compromised. The glenohumeral joint showed the greatest range deficit, contributing to abnormal scapulohumeral rhythm. Future sub-group analysis of Narakas Classification is recommended.


Assuntos
Atividades Cotidianas , Neuropatias do Plexo Braquial/fisiopatologia , Extremidade Superior/fisiopatologia , Acrômio/fisiopatologia , Adolescente , Fenômenos Biomecânicos , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Movimento , Postura , Amplitude de Movimento Articular , Escápula/fisiopatologia , Articulação do Ombro/fisiopatologia , Estudos de Tempo e Movimento
14.
Physiol Meas ; 38(3): 524-538, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28140349

RESUMO

Kinematics, measured by 3D upper limb motion analysis (3D-ULMA), can potentially increase understanding of movement patterns by quantifying individual joint contributions. Reliability in children with obstetric brachial plexus palsy (OBPP) has not been established. OBJECTIVE: This study aimed to determine between session reliability and measurement errors of 3D-ULMA using the acromion method (AM) in children with OBPP. APPROACH: Ten participants (mean 10 years, range 7-15 years, Narakas classification I-III) completed 3D-ULMA on two occasions, mean interval of 8.6 d (±2.8 d). Kinematic data were captured by a 4-CODA cx1 optoelectronic tracking system. Participants performed three trials of the modified Mallet scale tasks. Local coordinate systems, segment and joint rotations were defined as recommended by the International Society of Biomechanics. The intraclass correlation coefficient (ICC 2,K) and standard error of measurement (SEM) were calculated for task duration, range and joint angle at point of task achievement (PTA). MAIN RESULTS: Results indicated poor reliability for spatiotemporal parameters and range. Moderate to excellent reliability at PTA was observed in 19/60 variables (ICC: 0.77-0.98; SEM: 3.5°-10.4°). The Abduction Task had the highest (ICC: 0.79-0.98; SEM: 3.5°-10.3°) with External Rotation the lowest reliability. Glenohumeral and thoracohumeral elevation had the most consistent reliability. Scapular protraction/retraction had consistently poor reliability (ICC: 0-0.72; SEM: 3.5°-10.2°) with axial rotation also poor (ICC: 0.00-0.91; SEM: 6.3°-32.8°). This study determined inconsistent test-retest reliability of 3D-ULMA, using AM, to track dynamic performance of functional tasks in children with OBPP. It is the first study to outline measurement error in this population. This information permits more reliable interpretation of future studies of kinematic patterns in children with OBPP.


Assuntos
Neuropatias do Plexo Braquial/fisiopatologia , Movimento , Extremidade Superior/fisiopatologia , Adolescente , Fenômenos Biomecânicos , Criança , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
15.
Br J Sports Med ; 51(5): 442-451, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27655831

RESUMO

OBJECTIVE: Concussion symptoms normally resolve within 7-10 days but vertigo, dizziness and balance dysfunction persist in 10-30% of cases causing significant morbidity. This study systematically evaluated the evidence supporting the efficacy, prescription and progression patterns of vestibular rehabilitation therapy (VRT) in patients with concussion. DESIGN: Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis. DATA SOURCES: Electronic databases PubMed (1949 to May 2015), CINAHL (1982 to May 2015), EMBASE (1947 to May 2015), SPORTDiscus (1985 to May 2015), Web of Science (1945 to May 2015) and PEDRO (1999 to May 2015), supplemented by manual searches and grey literature. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Article or abstract of original research, population of patients with concussion/mild traumatic brain injury (mTBI) with vestibular symptoms, interventions detailing VRT, measurement of outcomes pre-VRT/post-VRT. Study type was not specified. RESULTS: Following a double review of abstract and full-text articles, 10 studies met the inclusion criteria: randomised controlled trial (n=2), uncontrolled studies (n=3) and case studies (n=5). 4 studies evaluated VRT as a single intervention. 6 studies incorporated VRT in multimodal interventions (including manual therapy, strength training, occupational tasks, counselling or medication). 9 studies reported improvement in outcomes but level I evidence from only 1 study was found that demonstrated increased rates (OR 3.91; 95% CI 1.34 to 11.34; p=0.002) of medical clearance for return to sport within 8 weeks, when VRT (combined with cervical therapy) was compared with usual care. Heterogeneity in study type and outcomes precluded meta-analysis. Habituation and adaptation exercises were employed in 8 studies and balance exercises in 9 studies. Prescription and progression patterns lacked standardisation. CONCLUSIONS: Current evidence for optimal prescription and efficacy of VRT in patients with mTBI/concussion is limited. Available evidence, although weak, shows promise in this population. Further high-level studies evaluating the effects of VRT in patients with mTBI/concussion with vestibular and/or balance dysfunction are required.


Assuntos
Concussão Encefálica/reabilitação , Doenças Vestibulares/reabilitação , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/reabilitação , Concussão Encefálica/diagnóstico , Tontura/diagnóstico , Tontura/reabilitação , Terapia por Exercício , Humanos , Modalidades de Fisioterapia , Equilíbrio Postural , Ensaios Clínicos Controlados Aleatórios como Assunto , Volta ao Esporte , Vertigem/diagnóstico , Vertigem/reabilitação , Doenças Vestibulares/diagnóstico , Vestíbulo do Labirinto/fisiopatologia
16.
Arch Phys Med Rehabil ; 96(7): 1319-1328.e1, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25842051

RESUMO

OBJECTIVE: To compare the effectiveness of virtual reality-based balance exercises to conventional balance exercises during vestibular rehabilitation in patients with unilateral peripheral vestibular loss (UVL). DESIGN: Assessor-blind, randomized controlled trial. SETTING: Two acute care university teaching hospitals. PARTICIPANTS: Patients with UVL (N=71) who had dizziness/vertigo, and gait and balance impairment. INTERVENTIONS: Patients with UVL were randomly assigned to receive 6 weeks of either conventional (n=36) or virtual reality-based (n=35) balance exercises during vestibular rehabilitation. The virtual reality-based group received an off-the-shelf virtual reality gaming system for home exercise, and the conventional group received a foam balance mat. Treatment comprised weekly visits to a physiotherapist and a daily home exercise program. MAIN OUTCOME MEASURES: The primary outcome was self-preferred gait speed. Secondary outcomes included other gait parameters and tasks, Sensory Organization Test (SOT), dynamic visual acuity, Hospital Anxiety and Depression Scale, Vestibular Rehabilitation Benefits Questionnaire, and Activities Balance Confidence Questionnaire. The subjective experience of vestibular rehabilitation was measured with a questionnaire. RESULTS: Both groups improved, but there were no significant differences in gait speed between the groups postintervention (mean difference, -.03m/s; 95% confidence interval [CI], -.09 to .02m/s). There were also no significant differences between the groups in SOT scores (mean difference, .82%; 95% CI, -5.00% to 6.63%) or on any of the other secondary outcomes (P>.05). In both groups, adherence to exercise was high (∼77%), but the virtual reality-based group reported significantly more enjoyment (P=.001), less difficulty with (P=.009) and less tiredness after (P=.03) balance exercises. At 6 months, there were no significant between-group differences in physical outcomes. CONCLUSIONS: Virtual reality-based balance exercises performed during vestibular rehabilitation were not superior to conventional balance exercises during vestibular rehabilitation but may provide a more enjoyable method of retraining balance after unilateral peripheral vestibular loss.


Assuntos
Terapia por Exercício/métodos , Marcha , Equilíbrio Postural , Interface Usuário-Computador , Doenças Vestibulares/reabilitação , Adulto , Idoso , Feminino , Hospitais Universitários , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Método Simples-Cego
17.
Gait Posture ; 41(2): 470-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25600175

RESUMO

Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, but data are significantly affected by inter-individual variability and requires normalisation of the sEMG signal to enable comparison between individuals. The purpose of this study was to compare two normalisation methods, a maximal method (maximum voluntary isometric contraction (MVIC)) and non-maximal peak dynamic method (PDM), on gluteus medius (GMed) activation using sEMG during three weight-bearing exercises in people with hip osteoarthritis (OA) and healthy controls. Thirteen people with hip OA and 20 controls performed three exercises (Squat, Step-Up, Step-Down). Average root-mean squared EMG amplitude based on MVIC and PDM normalisation was compared between groups for both involved and uninvolved hips using Mann-Whitney tests. Using MVIC normalisation, significantly higher normalised GMed EMG amplitudes were found in the OA group during all Step-up and down exercises on the involved side (p=0.02-0.001) and most of the Step exercises on the uninvolved side (p=0.03-0.04), but not the Squat (p>0.05), compared to controls. Using PDM normalisation, significant between-group differences occurred only for Ascending Squat (p=0.03) on the involved side. MVIC normalisation demonstrated higher inter-trial relative reliability (ICCs=0.78-0.99) than PDM (ICCs=0.37-0.84), but poorer absolute reliability using Standard Error of Measurement. Normalisation method can significantly affect interpretation of EMG amplitudes. Although MVIC-normalised amplitudes were more sensitive to differences between groups, there was greater variability using this method, which raises concerns regarding validity. Interpretation of EMG data is strongly influenced by the normalisation method used, and this should be considered when applying EMG results to clinical populations.


Assuntos
Eletromiografia/métodos , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Músculo Esquelético/fisiopatologia , Osteoartrite do Quadril/fisiopatologia , Adulto , Estudos de Casos e Controles , Teste de Esforço , Feminino , Humanos , Irlanda , Contração Isométrica , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Osteoartrite do Quadril/reabilitação , Reprodutibilidade dos Testes , Suporte de Carga
18.
Eur Spine J ; 24(1): 48-56, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24622959

RESUMO

PURPOSE: Gait impairment is an important feature of cervical sponydylotic myelopathy (CSM) as it can have a detrimental effect on function and quality of life. The aim of this study was to measure changes in gait in people with CSM following surgical decompression. METHODS: Thirteen participants with clinical and radiological evidence of CSM underwent three-dimensional gait analysis, using a full lower limb kinematic, kinetic and electromyography protocol, before and 12 months after decompressive surgery. RESULTS: No significant post-operative changes were detected in temporal-spatial or kinematic parameters. Kinetic data showed significant improvements in knee power absorption [mean improvement, 0.42 watts per kilogram (W/kg)], ankle plantarflexor moment (0.1 Nm/kg) and ankle power generation (0.55 W/kg). Electromyography showed a 4.7 % increase in tibialis anterior activation time. CONCLUSIONS: These findings indicate that improvement in locomotor function can be achieved after surgery. Future studies should explore the potential for further recovery of gait through targeted neuro-rehabilitation.


Assuntos
Descompressão Cirúrgica , Marcha/fisiologia , Compressão da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Fenômenos Biomecânicos , Eletromiografia , Feminino , Seguimentos , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Espondilose/complicações , Espondilose/fisiopatologia , Resultado do Tratamento
19.
Physiother Theory Pract ; 30(4): 229-35, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24328931

RESUMO

PURPOSE: Polio survivors experience declining mobility, pain and fatigue. The extent of motor fatigue and its impact on mobility and quality of life, in addition to other commonly reported impairments requires evaluation. METHODS: An observational, case-control, cross-sectional design was used to assess 30 Polio survivors and 30 age- and sex-matched controls. Muscle strength and motor fatigue were assessed using fixed dynamometry. Fatigue, pain and quality of life were assessed using the Piper Fatigue Scale, the Fatigue Severity Scale, visual analogue scales and the RAND Short Form-36, respectively. An 8-min walking test, including physiological cost index (PCI), evaluated mobility. RESULTS: A significant difference in motor fatigue was identified only in hand grip (p = 0.03). Polio survivors were significantly weaker (p < 0.001) and more fatigued (p < 0.001) than controls. Motor fatigue was not related to subjective fatigue, mobility or quality of life. Muscle strength predicted mobility. Pain and fatigue were associated with lower mental quality of life, while PCI was associated with physical quality of life. CONCLUSION: Motor fatigue has been identified in Polio survivors but was only significantly different in hand grip, using this approach. Pain, fatigue and elevated energy cost of walking negatively influenced quality of life. Motor fatigue was unrelated to subjective fatigue, mobility or quality of life.


Assuntos
Fadiga/etiologia , Fadiga Muscular , Poliomielite/fisiopatologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Força Muscular , Dor/etiologia , Poliomielite/complicações , Poliomielite/psicologia , Qualidade de Vida
20.
Gait Posture ; 39(1): 265-71, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24139682

RESUMO

BACKGROUND/AIM: Estimating the measurement error (reliability) of three dimensional gait analysis (3DGA) is crucial to interpretation of gait data. The purpose of this study was to investigate the intra-rater reliability of 3DGA and apply a novel method of visualising reliability of gait cycle waveforms. METHODS: A test re-test design was employed. A convenience sample of 30 healthy adults (18F; 12 M: mean age 30 ± 6.8 years) participated. Subjects walked along a 10 m walkway at their preferred gait speed and 3DGA data were collected using a VICON(®) 3DGA system. Testing was performed by the same investigator on two separate days within two weeks. Data from 10 trials were averaged and analysed. ANALYSIS: The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement were calculated for kinetic and kinematic data. Bland and Altman plots were applied to gait cycle waveforms. RESULTS: Spatio-temporal parameters such as cadence, step length, velocity, step time and step width were highly repeatable generating ICC's of 0.90 and above and low SEM/MDC. Range of joint movement across the gait cycle was generally more reliable than either minimum or maximum values and higher ICCs were obtained for movement in the sagittal plane. For kinematic data the standard error of measurement was low (≤ 5) for the majority of parameters. Transverse plane measurements showed poor reliability with lowest ICC's. ICCs for kinetic data ranged from 0.51 to 0.81. CONCLUSIONS: Reliability of 3DGA has been estimated for our gait laboratory. Bland and Altman plots of gait cycle waveforms provide a useful addition to reliability analysis.


Assuntos
Marcha/fisiologia , Imageamento Tridimensional/instrumentação , Movimento/fisiologia , Equilíbrio Postural/fisiologia , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Desenho de Equipamento , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
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