Claire Peel

Oxygen consumption using the K2 telemetry system and a metabolic cart.

The purpose of this study was to compare measurements of oxygen consumption (VO2), ventilation (VE), and respiratory rate (RR) between a relatively new portable, telemetry system (K2) and a system that has been shown to be valid and reliable. Duplicate measurements were made at rest and during four levels of exercise in 10 subjects. Heart rate values were comparable for exercise at the same work level during gas collection using the two systems, indicating that the metabolic stresses were similar. Oxygen consumption measurements were significantly lower using the K2 system compared with a metabolic measurement cart (MMC). There was no significant difference in VE, but RR was lower for measurements made with the MMC. Compared with the MMC, the K2 system uses a slightly different formula to calculate VO2 because the content of carbon dioxide in expired air is not measured. To determine differences resulting from the method of calculating VO2, MMC measurements were applied to the formula used by the K2 system, and K2 values were adjusted using the RER values obtained from the MMC. There were no differences between these calculated values and the values obtained directly from either the MMC or the K2 system. Consequently, we concluded that the lower VO2 values obtained with the K2 system were attributed to the method of collecting and analyzing expired air, rather than to the method of calculating VO2.

Exercise Program Implementation Proves Not Feasible during Acute Care Hospitalization

Functional decline during hospitalization occurs in up to 65% of older adults. This study determined the feasibility of an inpatient followed by an in-home exercise program for patients with limited ambulatory ability on hospital admission. Patients aged >or=60 years who were admitted to the hospital with an acute medical illness associated with limited ambulatory ability were eligible for the study. Of 76 eligible patients, 10 were recruited, with only 1 patient completing the 24-week exercise program. Barriers to recruitment included illness severity, short hospital stays, and patient refusal. Hospital readmission during the in-home exercise program occurred for three of the seven exercise group participants. In the exercise group, four of the seven patients participated in at least 3 weeks of exercise posthospitalization. Qualitative interviews suggested most patients believed exercise to be beneficial, but this interest did not translate into adherence to this study protocol. Initiation of an inpatient exercise program was not feasible in the study population. The in-home program was more feasible but target criteria need refinement.

Facilitating the use of implicit memory and learning in the physical therapy management of individuals with Alzheimer disease: a case series.

BACKGROUND AND PURPOSE Physical rehabilitation of individuals with Alzheimer disease (AD) is often complicated by impairments in explicit memory and learning. Rehabilitation strategies that facilitate the use of the preserved implicit memory system may be effective in treating patients with AD. The purpose of this case series is to describe the application of these strategies, including high-repetition practice, errorless learning (EL), and spaced retrieval, to the physical therapy management of individuals with moderate AD. CASE DESCRIPTION Three women aged 89 to 95 years with moderate AD who resided in an assisted living facility participated in physical therapy to address their mobility limitations. INTERVENTION Twelve physical therapy sessions were scheduled over a period of 4 weeks. Interventions were individually designed to address the mobility needs of each patient, and rehabilitation strategies based on implicit learning principles were integrated into the interventions. OUTCOMES All patients participated in at least 10 of the 12 physical therapy sessions. Improvements in performance of objective measures of balance were observed in all patients, although only 1 patients balance score exceeded the minimal detectable change. No significant clinical change was observed in any patients on the Timed Up and Go Test or self-selected gait speed. DISCUSSION Principles of implicit learning were integrated into the interventions for these patients with moderate AD. However, the feasibility of applying the EL paradigm was limited. Further research on the effectiveness of EL, spaced retrieval, and other rehabilitation strategies that facilitate implicit learning of mobility skills in patients with AD is needed to promote optimal physical therapy outcomes in this patient population.

Gevolgen van cardiovasculaire medicatie voor patiëntreacties na oefeningen

Het bewaken en controleren van fysiologische reacties bij de patient op inspanning en vaststellen of de reacties juist zijn op basis van de anamnese en de toestand van het moment maken deel uit van de taak van de fysiotherapeut. Veel cardiovasculaire geneesmiddelen hebben het vermogen om reacties op zowel kort als langdurig oefenen te veranderen. Kennis van deze materie helpt therapeuten bij de evaluatie van de veiligheid en geschiktheid van oefeningen en bij het evalueren van het effect van de training.