Dorothée Debuse

Effects of hippotherapy on people with cerebral palsy from the users’ perspective: A qualitative study

Although there is now some evidence for specific effects of hippotherapy on people with cerebral palsy, these studies fail to provide a comprehensive picture of the effects of hippotherapy. This was the first qualitative study to explore the hippotherapy experience of people with cerebral palsy from a user perspective. The effects of hippotherapy and their context were of particular interest. Seventeen users aged from 4 to 63, with or without their parents, participated in focus groups or individual interviews in six centres in Britain and in Germany. The main effects of hippotherapy, as identified by users and parents, are normalisation of muscle tone, improved trunk control, improved walking ability, carryover effects of hippotherapy to activities of daily living, and increased self-efficacy, confidence, and self-esteem. This study provided unique and new insights into the context in which hippotherapy happens, as well as its effects on impairment, activity, participation, and quality of life in people with cerebral palsy. The studys findings are integrated with the existing literature on motor learning and pedagogy to try to explain the complex effects of hippotherapy as reported by users and parents. A conceptual framework that illustrates these effects and their interactions is introduced.

Low impact weight-bearing exercise in an upright posture increases the activation of two key local muscles of the lumbo-pelvic region

To date, a range of exercises have been used to improve the function of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles in people with low back pain, but uncertainty remains as to what exactly constitutes meaningful LM and TrA training. We examined the effects of exercising with a new device which combines weight-bearing, an unstable base of support (BOS) (feet), an upright posture with a relatively stable lumbo-pelvic area, and functional lower limb movement, with the aim of exploring which of these elements may be effective, in increasing LM and TrA muscle activity. Twelve non-symptomatic participants had ultrasound images taken of their LM and TrA during a range of conditions, including rest, traditional exercise approaches to LM and TrA recruitment, and exercising on the new device. Our results indicate that an unstable BOS on its own is not enough to increase LM and TrA activity, and that a combination of weight-bearing, an unstable BOS (feet), an upright posture with a relatively stable lumbo-pelvic area, and functional lower limb movement is most effective at increasing LM and TrA activity. This way of exercising appears to recruit LM more effectively than the widely used “swelling” of LM, and to cause automatic TrA and LM recruitment. Importantly, our findings also indicate LM and TrA may have slightly different roles during trunk stabilisation.

Post Space Mission Lumbo-Pelvic Neuromuscular Reconditioning: A European Perspective

Long-duration exposure to the space environment causes physical adaptations that are deleterious to optimal functioning on Earth. Post-mission rehabilitation traditionally concentrates on regaining general muscle strength, neuromuscular control, and lumbo-pelvic stability. A particular problem is muscle imbalance caused by the hypertrophy of the flexor and atrophy of the extensor and local lumbo-pelvic muscles, increasing the risk of post-mission injury. A method currently used in European human spaceflight to aid post-mission recovery involves a motor control approach, focusing initially on teaching voluntary contraction of specific lumbo-pelvic muscles and optimizing spinal position, progressing to functional retraining in weight bearing positions. An alternative approach would be to use a Functional Readaptive Exercise Device to appropriately recruit this musculature, thus complementing current rehabilitation programs. Advances in post-mission recovery of this nature may both improve astronaut healthcare and aid terrestrial healthcare through more effective treatment of low back pain and accelerated post bed rest rehabilitation.

Systematic review of countermeasures to minimise physiological changes and risk of injury to the lumbopelvic area following long-term microgravity

BACKGROUND No studies have been published on an astronaut population to assess the effectiveness of countermeasures for limiting physiological changes in the lumbopelvic region caused by microgravity exposure during spaceflight. However, several studies in this area have been done using spaceflight simulation via bed-rest. The purpose of this systematic review was to evaluate the effectiveness of countermeasures designed to limit physiological changes to the lumbopelvic region caused by spaceflight simulation by means of bed-rest. METHODS Electronic databases were searched from the start of their records to November 2014. Studies were assessed with PEDro, Cochrane Risk of Bias and a bed-rest study quality tool. Magnitude based inferences were used to assess countermeasure effectiveness. RESULTS Seven studies were included. There was a lack of consistency across studies in reporting of outcome measures. Some countermeasures were found to be successful in preventing some lumbopelvic musculoskeletal changes, but not others. For example, resistive vibration exercise prevented muscle changes, but showed the potential to worsen loss of lumbar lordosis and intervertebral disc height. CONCLUSION Future studies investigating countermeasures should report consistent outcomes, and also use an actual microgravity environment. Additional research with patient reported quality of life and functional outcome measures is advocated.

Low impact weight-bearing exercise in an upright posture achieves greater lumbopelvic stability than overground walking

The aim of this study was to determine the kinematic differences between movements on a new exercise device (EX) that promotes a stable trunk over a moving, unstable base of support, and overground walking (OW). Sixteen male participants performed EX and OW trials while their movements were tracked using a 3D motion capture system. Trunk and pelvis range of motion (ROM) were similar between EX and OW in the sagittal and frontal planes, and reduced for EX in the transverse plane. The pelvis was tilted anteriorly, on average, by about 16° in EX compared to OW. Hip and knee ROM were reduced in EX compared to OW. The exercise device appears to promote similar or reduced lumbopelvic motion, compared to walking, which could contribute to more tonic activity of the local lumbopelvic musculature.

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

BACKGROUND Dysfunction of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles is associated with low back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) has shown potential as a non-specific LBP intervention by automatically recruiting LM and TrA. Loss or lordosis and altered lumbopelvic positioning has also been linked to LBP and is often trained within LM and TrA interventions. The effect that FRED exercise has on lumbopelvic positioning and lumbar lordosis is unknown. OBJECTIVES To assess the effect of FRED exercise on lumbopelvic kinematics and alignment to establish whether FRED exercise promotes a favourable lumbopelvic posture for training LM and TrA. DESIGN Within and between-group comparison study. METHOD One hundred and thirty participants, 74 experiencing LBP, had lumbopelvic kinematic data measured during over-ground walking and FRED exercise. Magnitude-based inferences were used to compare walking with FRED exercise within participants and between the asymptomatic and LBP groups, to establish the effects of FRED exercise on lumbopelvic kinematics, compared to walking, in each group. RESULTS FRED exercise promotes an immediate change in anterior pelvic tilt by 8.7° compared to walking in the no-LBP and LBP groups. Sagittal-plane spinal extension increased during FRED exercise at all spinal levels by 0.9° in the no-LBP group, and by 1.2° in the LBP group. CONCLUSIONS FRED exercise promotes a lumbopelvic position more conducive to LM and TrA training than walking in both asymptomatic people and those with LBP.

Trunk muscle activation during movement with a new exercise device for lumbo‐pelvic reconditioning

Gravitational unloading leads to adaptations of the human body, including the spine and its adjacent structures, making it more vulnerable to injury and pain. The Functional Re‐adaptive Exercise Device (FRED) has been developed to activate the deep spinal muscles, lumbar multifidus (LM) and transversus abdominis (TrA), that provide inter‐segmental control and spinal protection. The FRED provides an unstable base of support and combines weight bearing in up‐right posture with side alternating, elliptical leg movements, without any resistance to movement. The present study investigated the activation of LM, TrA, obliquus externus (OE), obliquus internus (OI), abdominis, and erector spinae (ES) during FRED exercise using intramuscular fine‐wire and surface EMG. Nine healthy male volunteers (27 ± 5 years) have been recruited for the study. FRED exercise was compared with treadmill walking. It was confirmed that LM and TrA were continually active during FRED exercise. Compared with walking, FRED exercise resulted in similar mean activation of LM and TrA, less activation of OE, OI, ES, and greater variability of lumbo‐pelvic muscle activation patterns between individual FRED/gait cycles. These data suggest that FRED continuously engages LM and TrA, and therefore, has the potential as a stationary exercise device to train these muscles.

Acute effects of active gaming on ad libitum energy intake and appetite sensations of 8-11-year-old boys

The present study examined the acute effects of active gaming on energy intake (EI) and appetite responses in 8-11-year-old boys in a school-based setting. Using a randomised cross-over design, twenty-one boys completed four individual 90-min gaming bouts, each separated by 1 week. The gaming bouts were (1) seated gaming, no food or drink; (2) active gaming, no food or drink; (3) seated gaming with food and drink offered ad libitum; and (4) active gaming with food and drink offered ad libitum. In the two gaming bouts during which foods and drinks were offered, EI was measured. Appetite sensations - hunger, prospective food consumption and fullness - were recorded using visual analogue scales during all gaming bouts at 30-min intervals and at two 15-min intervals post gaming. In the two bouts with food and drink, no significant differences were found in acute EI (MJ) (P=0·238). Significant differences were detected in appetite sensations for hunger, prospective food consumption and fullness between the four gaming bouts at various time points. The relative EI calculated for the two gaming bouts with food and drink (active gaming 1·42 (sem 0·28) MJ; seated gaming 2·12 (sem 0·25) MJ) was not statistically different. Acute EI in response to active gaming was no different from seated gaming, and appetite sensations were influenced by whether food was made available during the 90-min gaming bouts.

Reliability and Precision of Sonography of the Lumbar Multifidus and Transversus Abdominis During Dynamic Activities: Reliability of Sonography in Dynamic Activities

To determine the intrarater reliability and precision of lumbar multifidus and transversus abdominis thickness measurements using freehand sonography in a range of static and dynamic conditions.

Functional behaviour of spinal muscles after training with an exercise device developed to recruit and train postural muscles

This study investigated the effects of a single exercise session using a device developed for postural muscle training on the function of postural muscles in healthy, pain free individuals. During standardised rapid arm movements, timing of onset of electromyography (EMG) was measured using intramuscular and surface recordings of the transversus abdominis (TrA), obliquus internus abdominis (OI), obliquus externus abdominis (OE), lumbar multifidus (LM) and lumbar erector spinae (LES) muscles. A single exercise session with the device led to significantly (main effect of time: P = 0.03) earlier LES EMG onset in advance of the postural perturbation induced by rapid forward arm movements from -1 ms (SD: 32 ms) at baseline to -11 ms (SD: 27 ms) post-exercise and -16 ms (SD: 22 ms) at 10-min Wash-Out after the FRED exercise bout. The timing of EMG onset of the other trunk muscles was not affected by the single bout of exercise. A significant correlation was found between background activity and the EMG onset times of of TrA (r = 0.6; P < 0.001), OI (r = 0.59; P < 0.001), LES (r = 0.32; P = 0.046) and LMs (r = 0.77; P < 0.001). Higher levels of trunk muscle background activity were associated with later onset times. The present findings suggest that a single exposure to the postural training device can induce small changes in spinal muscle function in healthy pain free individuals.