The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison.

OBJECTIVE: To evaluate the effect of an arm sling on gait speed and energy efficiency of patients with hemiplegia. DESIGN: A randomized crossover design. SETTING: A rehabilitation department of a university hospital. SUBJECTS: Thirty-seven outpatients with hemiplegia were included in this study. INTERVENTIONS: All patients walked on a 20-m walkway twice on the same day, randomly with and without an arm sling, at a self selected speed. MAIN MEASURES: The heart rate, gait speed, oxygen cost and oxygen rate were measured on all patients. We analysed all values with and without an arm sling and also compared them after all patients being stratified according to demographic and clinical characteristics. RESULTS: When we compared the heart rate between walking with (90.7 ± 17.2 beats/min) and without (91.2 ± 18.6 beats/min) the arm sling, it was significantly decreased while walking with the arm sling. When we compared the gait speed between walking with (32.8 m/min) and without (30.1 m/min), it was significantly increased with the arm sling walking. The O(2) rate in hemiplegic patients walking with the arm sling was significantly decreased by 7%, compared to walking without arm sling (5.8 mL/kg min and 6.2 mL/kg min, respectively). The O(2) cost in hemiplegic patients walking without arm sling was significantly 1.4 times greater than walking with it (0.2 mL/kg m and 0.3 mL/kg m, respectively). CONCLUSION: An arm sling can be used to improve the gait efficiency.

Use of the novel myokinetic stretching technique to ameliorate fibrotic mass in congenital muscular torticollis: an experimenter-blinded study with 1-year follow-up.

OBJECTIVE: To investigate the effect of the myokinetic stretching technique (MST) on morphological changes and associated clinical outcomes. METHOD: Infantile torticollis (N=32, 17 males) between 1 and 5 months of age (50.56 +/- 20.74 days) were treated with the MST for approximately 30 minutes per session, 5 times a week at university hospital. Diagnostic real-time ultrasound imaging was used on both unaffected and affected sides before and after the treatment to measure the sternocleidomastoid (SCM) muscle thickness of the involved area. Range of motion, head symmetry, and plagiocephaly with radiographs were determined. Data were analyzed using unpaired and paired t-test at p< 0.05. RESULTS: A significant reduction in SCM muscle thickness was observed after the intervention (p< 0.05). This morphological change was associated with significant improvements in passive cervical range of motion and head symmetry (p< 0.05). The mean intervention duration was 53.59 +/- 25.12 days to completely resolve the mass. These effects continued to exist one year post-intervention. CONCLUSIONS: This was the first clinical evidence that demonstrated the efficacy of MST for improving cervical motion and muscle thickness in infants with congenital muscular torticollis as well as shortening the treatment duration.