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BMC Geriatrics Apr 2022Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder, impairing balance and motor function. Virtual reality (VR) and motor imagery (MI) are... (Randomized Controlled Trial)
Randomized Controlled Trial
Combined effects of virtual reality techniques and motor imagery on balance, motor function and activities of daily living in patients with Parkinson's disease: a randomized controlled trial.
BACKGROUND
Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder, impairing balance and motor function. Virtual reality (VR) and motor imagery (MI) are emerging techniques for rehabilitating people with PD. VR and MI combination have not been studied in PD patients. This study was conducted to investigate the combined effects of VR and MI techniques on the balance, motor function, and activities of daily living (ADLs) of patients with PD.
METHODS
This study was a single-centered, two-armed, parallel-designed randomized controlled trial. A total of 44 patients of either gender who had idiopathic PD were randomly allocated into two groups using lottery methods. Both groups received Physical therapy (PT) treatment, while the experimental group (N: 20) received VR and MI in addition to PT. Both groups received assigned treatment for three days a week on alternate days for 12 weeks. The Unified Parkinson's Disease Rating Scale (UPDRS) (parts II and III), Berg Balance Scale (BBS), and Activities-specific Balance Confidence (ABC) Scale were used as outcome measures for motor function, balance, and ADLs. The baseline, 6, and 12 weeks of treatment were assessed, with a 16 week follow-up to measure retention. The data was analysed using SPSS 24.
RESULTS
The experimental group showed significant improvement in motor function than the control group on the UPDRS part III, with 32.45±3.98 vs. 31.86±4.62 before and 15.05±7.16 vs. 25.52±7.36 at 12-weeks, and a p-value < 0.001. At 12 weeks, the experimental group's BBS scores improved from 38.95±3.23 to 51.36±2.83, with p-value < 0.001. At 12 weeks, the experimental group's balance confidence improved considerably, from 59.26±5.87to 81.01±6.14, with a p-value of < 0.001. The experimental group's ADL scores improved as well, going from 22.00±4.64 to 13.07±4.005 after 12 weeks, with a p-value of < 0.001.
CONCLUSION
VR with MI techniques in addition to routine PT significantly improved motor function, balance, and ADLs in PD patients compared to PT alone.
TRIAL REGISTRATION
IRCT20200221046567N1 . Date of registration: 01/04/2020.
Topics: Activities of Daily Living; Humans; Outcome Assessment, Health Care; Parkinson Disease; Physical Therapy Modalities; Virtual Reality
PubMed: 35488213
DOI: 10.1186/s12877-022-03035-1 -
Developmental Medicine and Child... Jan 2020To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).
AIM
To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).
METHOD
We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'.
RESULTS
Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes.
INTERPRETATION
Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP.
WHAT THIS PAPER ADDS
Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.
Topics: Cerebral Palsy; Child; Child, Preschool; Family; Female; Humans; Infant; Longitudinal Studies; Male; Occupational Therapy; Outcome and Process Assessment, Health Care; Patient Satisfaction; Physical Therapy Modalities; Recreation Therapy; Severity of Illness Index; Speech Therapy
PubMed: 31353456
DOI: 10.1111/dmcn.14325 -
European Journal of Physical and... Apr 2022Hip and knee strengthening exercises are implemented in rehabilitation of patellofemoral pain patients, but typically use high loads (70% of 1 repetition maximum). This... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Hip and knee strengthening exercises are implemented in rehabilitation of patellofemoral pain patients, but typically use high loads (70% of 1 repetition maximum). This may lead to increased patellofemoral joint stress. Low load training (20-30% of 1 repetition maximum) with blood flow restriction could allow for exercise strength benefits to proximal and distal muscles with reduced joint stress and by promoting hypoalgesia.
AIM
The aim of this study was to compare hip and knee focused exercises with and without blood flow restriction in adults with patellofemoral pain for short term effectiveness.
DESIGN
A randomized observed-blind controlled trial.
SETTING
Musculoskeletal laboratories of the European University Cyprus, Nicosia, Cyprus.
POPULATION
60 volunteer patients, 18-40 years of age with patellofemoral pain.
METHODS
Participants were randomly assigned to (1 reference group) hip and knee strengthening at (70% of 1 repetition maximum) or (2 experimental group) Strengthening with blood flow restriction at (30% of 1 repetition maximum at 70% of limb occlution pressure). Treatments took place 3 times per week for 4weeks and outcomes were assessed at baseline, end of treatment and at 2-month follow-up. The primary outcome was the Kujala Anterior Knee Pain Scale and secondary outcomes were worst and usual pain, pain with Single leg Squats, the maximum pain free flexion angle, the Tampa Scale of kinesiophobia, the Pain Catastrophizing Scale and isometric strength of knee extensors, hip extensors and hip abductors.
RESULTS
No difference were found for the main outcome of this study between groups. There was a significant effect of time for all outcome measures in both groups. Between group differences showed a significant difference for isometric strength of Knee extensor values at 2 month follow-up F(1,58)=5.56, P=0.02, partial η2=0.09, 459.4 (412.13, 506.64) vs. 380.68 (333.42, 427.93) and in worst pain post-treatment F(1,58)=5.27, P=0.02, partial η=0.08, 0.76 (0.48, 1.04) vs. reference group 1.30 (0.91, 1.68) with significantly better scores in the blood flow restriction group.
CONCLUSIONS
Blood flow restriction exercises of the hip and knee musculature used in this study were as effective as usual exercises of Hip and knee musculature in reducing symptoms in the short term. They also indicated greater increases in strength and reduction of worst pain post-treatment.
CLINICAL REHABILITATION IMPACT
Further research is needed to investigate the dose response relationship with longer follow-ups.
Topics: Adult; Blood Flow Restriction Therapy; Exercise Therapy; Humans; Muscle Strength; Pain; Patellofemoral Pain Syndrome; Resistance Training
PubMed: 34985237
DOI: 10.23736/S1973-9087.22.06691-6 -
British Journal of Sports Medicine May 2020To summarise recommendations and appraise the quality of international clinical practice guidelines (CPGs) for rehabilitation after ACL reconstruction.
How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II).
OBJECTIVES
To summarise recommendations and appraise the quality of international clinical practice guidelines (CPGs) for rehabilitation after ACL reconstruction.
DESIGN
Systematic review of CPGs (PROSPERO number: CRD42017020407).
DATA SOURCES
Pubmed, EMBASE, Cochrane, SPORTDiscus, PEDro and grey literature databases were searched up to 30 September 2018.
ELIGIBILITY CRITERIA
English-language CPGs on rehabilitation following ACL reconstruction that used systematic search of evidence to formulate recommendations.
METHODS
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report the systematic review. Two appraisers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to report comprehensiveness, consistency and quality of CPGs. We summarised recommendations for rehabilitation after ACL reconstruction.
RESULTS
Six CPGs with an overall median AGREE II total score of 130 points (out of 168) and median overall quality of 63% were included. One CPG had an overall score below the 50% (poor quality score) and two CPGs scored above 80% (higher quality score). The lowest domain score was 'applicability' (can clinicians implement this in practice?) (29%) and the highest 'scope and purpose' (78%) and 'clarity of presentation' (75%). CPGs recommended immediate knee mobilisation and strength/neuromuscular training. Early full weight-bearing exercises, early open and closed kinetic-chain exercises, cryotherapy and neuromuscular electrostimulation may be used according individual circumstances. The CPGs recommend against continuous passive motion and functional bracing.
CONCLUSION
The quality of the CPGs in ACL postoperative rehabilitation was good, but all CPGs showed poor applicability. Immediate knee mobilisation and strength/neuromuscular training should be used. Continuous passive motion and functional bracing should be eschewed.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Cryotherapy; Early Ambulation; Electric Stimulation Therapy; Exercise Therapy; Humans; Practice Guidelines as Topic; Range of Motion, Articular; Resistance Training
PubMed: 31175108
DOI: 10.1136/bjsports-2018-100310 -
International Journal of Environmental... Jul 2022Neurological physiotherapy adopts a problem-based approach for each patient as determined by a thorough evaluation of the patient's physical and mental well-being. Τhis... (Review)
Review
Neurological physiotherapy adopts a problem-based approach for each patient as determined by a thorough evaluation of the patient's physical and mental well-being. Τhis work aims to provide a literature review of physical therapy interventions in the elderly with neurological diseases (NDs) and discuss physiotherapy procedures and methods that utilize cutting-edge technologies for which clinical studies are available. Hence, the review focuses on acute NDs (stroke), deteriorating NDs (Parkinson's disease), and age-related cognitive impairment. The most used physiotherapy procedures on which clinical data are available are balance and gait training (robot-assisted or not), occupational therapy, classical physiotherapy, walking and treadmill training, and upper limb robot-assisted therapy. Respectively, the most often-used equipment are types of treadmills, robotic-assisted equipment (Lokomat and Gait Trainer GT1), and portable walkway systems (GAITRite), along with state-of-the-art technologies of virtual reality, virtual assistants, and smartphones. The findings of this work summarize the core standard tools and procedures, but more importantly, provide a glimpse of the new era in physiotherapy with the utilization of innovative equipment tools for advanced patient monitoring and empowerment.
Topics: Aged; Exercise Therapy; Gait; Humans; Parkinson Disease; Physical Therapy Modalities; Stroke Rehabilitation; Walking
PubMed: 35954587
DOI: 10.3390/ijerph19159233 -
European Journal of Physical and... Feb 2022Stroke is the most common cause of disability in Western Countries. It can lead to loss of mobility, capability to walk and ultimately loss of independence in activities... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stroke is the most common cause of disability in Western Countries. It can lead to loss of mobility, capability to walk and ultimately loss of independence in activities of daily living (ADL). Several rehabilitative approaches have been proposed in these years. Robot-assisted gait rehabilitation (RAGT) plays a crucial role to perform a repetitive, intensive, and task-oriented treatment in stroke survivors. However, there are still few data on its role in subacute stroke patients.
AIM
The aim of the present study was to assess the efficacy of RAGT for gait recovery in subacute stroke survivors.
DESIGN
Systematic review with meta-analysis.
SETTING
The setting of the study included Units of Rehabilitation.
POPULATION
The analyzed population was represented by subacute stroke patients.
METHODS
PubMed, Scopus, Web of Science, CENTRAL, and PEDro were systematically searched until January 18, 2021, to identify randomized controlled trials (RCTs) presenting: stroke survivors in subacute phase (≤6 months) as participants; exoskeleton robots devices as intervention; conventional rehabilitation as a comparator; gait assessment, through qualitative scales, quantitative gait scales or quantitative parameters, as outcome measures. We also performed a meta-analysis of the mean difference in the functional ambulation category (FAC) via the random effect method.
RESULTS
Out of 3188 records, 14 RCTs were analyzed in this systematic review. The 14 studies have been published in the last 14 years (from 2006 to 2021) and included 576 stroke survivors, of which 306 received RAGT, and 270 underwent conventional rehabilitation. Lokomat robotic system was the most investigated robotic exoskeleton by the RCTs included (N.=9), albeit the meta-analysis demonstrated a non-significant difference of -0.09 in FAC (95% CI: -0.22.0.03) between Lokomat and conventional therapy. According to the PEDro scale, 11 (78.5%) were classified as good-quality studies, two as fair-quality studies (14.3%), and one as poor-quality study (7.1%).
CONCLUSIONS
Taken together, these findings showed that RAGT might have a potential role in gait recovery in subacute stroke survivors. However, further RCTs comparing the efficacy of RAGT with conventional physical therapy are still warranted in the neurorehabilitation field.
CLINICAL REHABILITATION IMPACT
This systematic review provides information on the efficacy of RAGT in allowing subacute stroke patients to perform high-intensity gait training with a lower physical burden on PRM professionals.
Topics: Exoskeleton Device; Gait; Gait Disorders, Neurologic; Humans; Stroke; Stroke Rehabilitation
PubMed: 34247470
DOI: 10.23736/S1973-9087.21.06846-5 -
International Journal of Environmental... Mar 2023A stroke is a neurological condition with a high impact in terms of physical disability in the adult population, requiring specific and effective rehabilitative... (Randomized Controlled Trial)
Randomized Controlled Trial
A stroke is a neurological condition with a high impact in terms of physical disability in the adult population, requiring specific and effective rehabilitative approaches. Virtual reality (VR), a technological approach in constant evolution, has great applicability in many fields of rehabilitation, including strokes. The aim of this study was to analyze the effects of a traditional neurological physiotherapy-based approach combined with the implementation of a specific VR-based program in the treatment of patients following rehabilitation after a stroke. Participants ( = 24) diagnosed with a stroke in the last six months were randomly allocated into a control group ( = 12) and an experimental group ( = 12). Both groups received one-hour sessions of neurological physiotherapy over 6 weeks, whilst the experimental group was, in addition, supplemented with VR. Patients were assessed through the Daniels and Worthingham Scale, Modified Ashworth Scale, Motor Index, Trunk Control Test, Tinetti Balance Scale, Berg Balance Scale and the Functional Ambulation Classification of the Hospital of Sagunto. Statistically significant improvements were obtained in the experimental group with respect to the control group on the Motricity Index ( = 0.005), Trunk Control Test ( = 0.008), Tinetti Balance Scale ( = 0.004), Berg Balance Scale ( = 0.007) and the Functional Ambulation Classification of the Hospital of Sagunto ( = 0.038). The use of VR in addition to the traditional physiotherapy approach is a useful strategy in the treatment of strokes.
Topics: Adult; Humans; Stroke Rehabilitation; Pilot Projects; Postural Balance; Stroke; Physical Therapy Modalities; Virtual Reality; Video Games; Treatment Outcome
PubMed: 36981652
DOI: 10.3390/ijerph20064747 -
BMC Cancer Nov 2020Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current...
Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial.
BACKGROUND
Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema.
METHODS
Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II).
RESULTS
Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat.
DISCUSSION
It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations.
LIMITATIONS
The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation.
TRIAL REGISTRATION
This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.
Topics: Female; Humans; Breast Cancer Lymphedema; Compression Bandages; Edema; Exercise Therapy; Manual Lymphatic Drainage; Massage; Physical Therapy Modalities; Single-Blind Method; Treatment Outcome; Upper Extremity; Randomized Controlled Trials as Topic
PubMed: 33167921
DOI: 10.1186/s12885-020-07558-x -
BMC Neurology Mar 2022The rehabilitation of paretic stroke patients uses a wide range of intervention programs to improve the function of impaired upper limb. A new rehabilitative approach,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The rehabilitation of paretic stroke patients uses a wide range of intervention programs to improve the function of impaired upper limb. A new rehabilitative approach, called action observation therapy (AOT) is based on the discovery of mirror neurons and has been used to improve the motor functions of adult stroke patients and children with cerebral palsy. Recently, virtual reality (VR) has provided the potential to increase the frequency and effectiveness of rehabilitation treatment by offering challenging and motivating tasks. METHODS: The purpose of the present project is to design a randomized controlled six-month follow-up trial (RCT) to evaluate whether action observation (AO) added to standard VR (AO + VR) is effective in improving upper limb function in patients with stroke, compared with a control treatment consisting of observation of naturalistic scenes (CO) without any action content, followed by VR training (CO + VR).
DISCUSSION
AO + VR treatment may provide an addition to the rehabilitative interventions currently available for recovery after stroke and could be utilized within standard sensorimotor training or in individualized tele-rehabilitation.
TRIAL REGISTRATION
The trial has been prospectively registered on ClinicalTrials.gov. NCT05163210 . 17 December 2021.
Topics: Adult; Child; Humans; Mirror Neurons; Stroke; Stroke Rehabilitation; Technology; Virtual Reality
PubMed: 35317736
DOI: 10.1186/s12883-022-02640-2 -
Primary Care Mar 2020Developing and implementing a rehabilitation program is one of the most challenging patient care skills because it requires a firm grasp of the healing process and... (Review)
Review
Developing and implementing a rehabilitation program is one of the most challenging patient care skills because it requires a firm grasp of the healing process and available treatment options, which must then be serially compared with the pathologic condition of the injury and the patient's progress. This cyclical problem-based approach to rehabilitation allows clinicians to most effectively individualize the rehabilitation plan to the patient's individual needs and progress. In each phase of the rehabilitation process, problems should be identified and goals developed taking into consideration the phase of healing.
Topics: Ankle Injuries; Athletic Injuries; Collateral Ligaments; Exercise Therapy; Hamstring Muscles; Humans; Rehabilitation; Return to Sport
PubMed: 32014138
DOI: 10.1016/j.pop.2019.10.004