Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis.

To conduct a systematic review and meta-analysis on the effects of electrical stimulation therapy (EST) on healing pressure ulcers in individuals with spinal cord injury (SCI). CINAHL, The Cochrane Library, PubMed, SCOPUS, EMBASE, Nursing & Allied Health and Dissertation & Theses databases were searched for relevant English language articles from the date of inception to 31 January 2014. Separate searches were conducted in Google Scholar and academic journals specialised in wound care. Two reviewers independently assessed study eligibility. Studies were included if EST was used to treat pressure ulcers in individuals with SCI. A total of 599 articles were screened, and 15 studies met the inclusion criteria. A meta-analysis with five studies demonstrated that EST significantly decreased the ulcer size by 1·32%/day [95% confidence interval (CI): 0·58-2·05, P < 0·001] compared to standard wound care (SWC) or sham EST. Another meta-analysis conducted with four studies showed that EST increased the risk of wound healing by 1·55 times compared with standard wound care or sham EST (95% CI: 1·12 to 2·15, P < 0·0001). Because of the wide array of outcome measures across studies, a single meta-analysis could not be conducted. EST appears to be an effective adjunctive therapy to accelerate and increase pressure ulcer closure in individuals with SCI.

Cueing and gait improvement among people with Parkinson's disease: a meta-analysis.

OBJECTIVE: To compare the relative efficacy of visual versus auditory cueing on gait among individuals with Parkinson's disease (PD). DATA SOURCES: A systematic search was completed up to September 2011, using the following databases: EMBASE, Scopus, Medline, CINAHL, and PubMed. STUDY SELECTION: Four authors searched the databases using the following terms: Parkinson's disease (including abbreviations), gait, cadence, step, pace, cueing, cues, and prompt. All studies that evaluated the effect of cueing on gait in PD were selected by consensus of 2 pairs of authors who reviewed the titles and abstracts. Each pair of authors then applied the inclusion and exclusion criteria to each study, and 25 articles were chosen. Inclusion criteria were cueing studies that reported pre- and postoutcome measures of gait parameters. Exclusion criteria were lack of data and studies that evaluated gait aids. DATA EXTRACTION: Gait measures of cadence, stride length, and velocity, before and after cueing, were collected from each study. If data were represented in graphs, a pair of authors extracted the data points individually, then compared and averaged values. DATA SYNTHESIS: The data were synthesized using a meta-analysis based on cue type. Auditory cueing demonstrated significant improvement of cadence (Hedge g=.556; 95% confidence interval [CI], .291-.893), stride length (Hedge g=.497; 95% CI, .289-.696), and velocity (Hedge g=.544; 95% CI, .294-.795). In contrast, visual cueing significantly improved stride length only (Hedge g=.554; 95% CI, .072-1.036). CONCLUSIONS: The findings suggest that auditory cueing is more effective for treating gait disorders in PD. Further research is needed to determine the optimum auditory cueing strategy for gait improvements.

Motor learning and the use of videotape feedback after stroke.

BACKGROUND: Efforts have been made to apply motor learning theories to the rehabilitation of individuals following stroke. Motor learning poststroke has not been well investigated in the literature. This research attempted to fill the gap regarding motor learning applied to practice. PURPOSE: This two-group research study attempted to determine the effectiveness of an experimental therapy combining videotape feedback with occupational therapy compared to only occupational therapy in learning the motor skill of donning socks and shoes after stroke. METHOD: Ten participants were randomly assigned to one of the two groups and all participants were videotaped during pretest and up to 10 treatment sessions aimed at donning socks and shoes. Only one group viewed their videotape replay. The acquisition of donning socks and shoes was measured using the socks and shoes subtests of the Klein-Bell Activities of Daily Living Scale and their scores on the Canadian Occupational Performance Measure. RESULTS: There was no significant difference between the two groups and both groups improved. However, the group that received videotape feedback thought they performed better and were more satisfied with their ability to don shoes, lending support for the use of videotape feedback poststroke to improve satisfaction with performance.

Force-plate analyses of balance following a balance exercise program during acute post-operative phase in individuals with total hip and knee arthroplasty: A randomized clinical trial.

OBJECTIVES: Typical rehabilitation programs following total hip arthroplasty and total knee arthroplasty include joint range of motion and muscle-strengthening exercises. Balance and balance exercises following total hip arthroplasty and total knee arthroplasty have not received much attention. The purpose of this study was to determine whether an intervention of balance exercises added to a typical rehabilitation program positively affects patients' balance. METHODS: A total of 63 patients were provided with outpatient physical therapy at their home. Patients were randomly assigned to either typical (n = 33) or balance (n = 30) exercise group. The typical group completed seven typical surgery-specific joint range of motion and muscle-strengthening exercises, while the balance group completed the typical exercises plus three balance exercises. After 5 weeks of administering the rehabilitation program, patients' balance was assessed on a force plate using 95% ellipse area of the center of pressure amplitude. RESULTS: Patients in the balance group demonstrated significant reduction in the 95% ellipse area for the anterior and posterior lean standing conditions (p < 0.01). CONCLUSION: Balance exercises added to the typical outpatient physical therapy program resulted in significantly greater improvements in balance for participants with total hip arthroplasty or total knee arthroplasty, compared to the typical exercise program alone. Physical therapists might consider the use of balance exercises to improve balance in individuals in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty.

The impact of reacher length on electromyography activity and task.

BACKGROUND: Reachers are common assistive devices prescribed to help individuals carry out their day-to day activities. PURPOSE: The purpose of this study was to examine the effect of muscle activity in the arm and forearm when using two commercially available reachers of different lengths. METHOD: Fifteen women between the ages of 23 and 25 performed a reaching activity that simulated moving a soup can from a cupboard to a counter. Surface electromyography was used to measure the muscle activity in the arm and forearm and to gain an understanding of the relative contributions of different muscles when using the short-handled reach in comparison to the long-handled reacher. RESULT: The results showed no significant differences between the short and the long reacher conditions for any of the muscles investigated. PRACTICE IMPLICATIONS. The length of a reacher does not necessarily affect the amount of muscle strength required in some muscles and may not be a major factor in the therapist's choice of reacher length.

The multidimensional impact of total laryngectomy on women.

UNLABELLED: Based on society's expectations of what defines the norms for what is deemed "masculine" and "feminine", and a propensity for society's members to adhere to these expectations, women may face a unique set of circumstances and pressures following surgical treatment for laryngeal cancer. This is primarily due to the changes that occur to women's physical, psychological, and social functioning when dealing with cancer diagnosis and treatment outcomes. Because of concerns related to physical disfigurement, acoustic and perceptual changes to one's voice, and threat of the psychological sequelae associated with total laryngectomy (TL) (or, the surgical removal of one's voicebox and surrounding structures), there is an increased potential for violation of social expectations that cross these areas of functioning. As such, efforts that seek to better understand the potentially differential impact of TL on women and identify the specific needs they may have leading up to and after such treatment pursuant to contemporary societal expectations are warranted. Thus, this paper provides an examination of the potentially differential impact of TL on women. In addressing this position, this paper examines the unique challenges women may face postlaryngectomy through the framework of the International Classification of Functioning, Disability, and Health (ICF). Through the use of the ICF, this paper will provide an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as facilitators or barriers to women's societal reintegration secondary to TL. LEARNING OUTCOMES: Readers will be able to describe the multiple factors that may contribute to the differential impact of total laryngectomy (TL) on women. More specifically, readers will gain an understanding about women's physical, psychological, and social functioning secondary to TL. This paper also provides readers with exposure to the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework. This framework provides readers with an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as either facilitators or barriers to the societal reintegration of women secondary to TL.

Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial.

OBJECTIVES: To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty. METHODS: Patients who had total hip arthroplasty (n = 30) or total knee arthroplasty (n = 33) were seen in their residence 1-2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33) or typical plus balance (TE + B, n = 30) exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1) the Berg Balance Scale, (2) the Timed Up and Go test, (3) the Western Ontario McMaster Universities Osteoarthritis Index, and (4) the Activities-specific Balance Confidence Scale. RESULTS: Post-intervention scores for all four outcome measures were significantly improved (p < 0.01) over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01). CONCLUSION: Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone.

Hemiplegic shoulder pain: implications for occupational therapy treatment.

BACKGROUND: Hemiplegic shoulder pain is common after stroke causing hemiplegia. It adversely affects the recovery of arm function and independence in activities of daily living. Subluxation, abnormal tone and limited range of motion or capsular constrictions have been reported as potential causes. Other factors such as rotator cuff tears, brachial plexus injury, shoulder-hand syndrome and other pre-existing pathological conditions may also be associated with hemiplegic shoulder pain. The etiology remains unclear, but hemiplegic shoulder pain may result from a combination of the above factors. SCOPE: This literature review examines the possible causes of hemiplegic shoulder pain and discusses the implications for occupational therapy treatment. Occupational therapy interventions include proper positioning, facilitation of movement through purposeful therapeutic activities, increasing passive range of motion, implementation of external supports and treatment of shoulder-hand syndrome. PRACTICE IMPLICATIONS: Understanding the processes involved will assist with effective assessment, treatment and prevention of hemiplegic shoulder pain. This will facilitate clients' participation in rehabilitation programs and move them towards attainment of optimal function.

Comparison of the original and reduced versions of the Berg Balance Scale and the Western Ontario and McMaster Universities Osteoarthritis Index in patients following hip or knee arthroplasty.

PURPOSE: To compare the original and reduced versions of the Berg Balance Scale (BBS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as completed by patients following total hip arthroplasty (THA) or total knee arthroplasty (TKA), with respect to their potential utility in clinical and research settings. METHOD: Patients with THA (n=26) or TKA (n=28) were evaluated before and after 5 to 7 weeks' participation in a home-based exercise programme. They were assessed using the original versions of the BBS and the WOMAC; scores for the reduced versions of the BBS and the WOMAC were extracted from the original versions. RESULTS: Good to excellent correlations (r≥0.80) were observed between the original and the reduced versions of the BBS and the WOMAC. The index of responsiveness, evaluated using standardized response means (SRM), was similar for the original and the reduced versions of the BBS and the WOMAC function sub-scale. CONCLUSIONS: The reduced versions of the BBS and the WOMAC provided similar information to the original versions and were equally responsive. These reduced versions comprise fewer questions and may be completed in considerably less time, which suggests that they may be advantageous for clinical and research use.

Dual task performance in a healthy young adult population: results from a symmetric manipulation of task complexity and articulation.

The ability to execute and maintain gait while performing simultaneous cognitive, verbal, or motor tasks ('dual-tasking') is beneficial in many ways. It is well-documented, however, that dual-tasking can result in cognitive or motoric interference that results in diminished gait performance, and impaired secondary task performance. When manipulating cognitive load, it is common to have participants respond verbally to stimuli. While this is an ecologically valid way to measure the effects of cognitive load on gait, it ignores the additional demands inherent in the verbal aspect of the task. In the present study, we manipulated complexity and articulation within a single working memory task, in order to examine their relative impact on continuous spatiotemporal gait parameters. Fourteen healthy young adults (11 women) aged 18-30 (M=22.14, S.D.=2.28) were asked to memorize a random, non-repeating, sequence of three, five, or seven digits. Articulation was manipulated by either having participants rehearse the digits aloud, or rehearse the digits silently during the performance of the gait task. Gait parameters were quantified with a GAITRite instrumented carpet. Velocity, step time, swing time, and stance time demonstrated a significant (p<0.05) interaction between complexity and articulation, with articulation having a greater effect at higher levels of complexity. These results suggest that verbal secondary tasks may actually create a 'triple-task' in which the cognitive complexity of the task interacts with both the articulatory demands of the response modality, and the motoric demands of the gait task.

OPTOTRAK Measurement of the Quadriceps Angle Using Standardized Foot Positions.

OBJECTIVE: While there is evidence to suggest that the magnitude of the quadriceps (Q) angle changes with alterations in foot position, a detailed quantitative description of this relationship has not been reported. Our purpose was to determine the effect of varying foot placement on the magnitude of the Q angle. DESIGN AND SETTING: A mixed between-within, repeated-measures design was used to compare Q angles derived under static weight-bearing conditions with the feet positioned in self-selected versus standardized stance positions. SUBJECTS: Twenty healthy young-adult men and women with no history of acute injury to or chronic dysfunction of the lower limbs. MEASUREMENTS: We placed light-emitting diodes bilaterally on the left and right anterior superior iliac spines, the tibial tuberosities, and the midpoints of the patellae to bilaterally define the Q angles. An OPTOTRAK motion-measurement system was used to capture x,y coordinate data at a sampling rate of 60 Hz. These data were subsequently filtered and used to calculate the magnitude of the left and right Q angles. RESULTS: A repeated-measures analysis of variance revealed that when measured statically, Q angles differed significantly between stance positions (P <.001) and limbs (P <.05). Depending on the stance adopted, mean Q angles varied from 7.2 degrees to 12.7 degrees and 11.0 degrees to 16.1 degrees in the left and right lower limbs, respectively. Q-angle measurements taken in conjunction with the Romberg foot position most closely resembled those gathered with the feet in a self-selected stance (Pearson r = 0.86 to 0.92). CONCLUSIONS: Q-angle magnitude varies with changes in foot position, increasing or decreasing as the foot rotates internally or externally, respectively. These data demonstrate the need for a standardized foot position for Q-angle measurements.