E.D. de Bruin

Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography

Objective: To evaluate the loss of trabecular and cortical bone mineral density in radius, ulna and tibia of spinal cord injured persons with different levels of neurologic lesion after 6, 12 and 24 months of spinal cord injury (SCI).Design: Prospective study in a Paraplegic Centre of the University Hospital Balgrist, Zurich.Subjects and methods: Twenty-nine patients (27 males, two females) were examined by the highly precise peripheral quantitative computed tomography (pQCT) soon after injury and subsequently at 6, 12 and in some cases 24 months after SCI. Using analysis of the bone mineral density (BMD), various degrees of trabecular and cortical bone loss were recognised. A rehabilitation program was started as soon as possible (1–4 weeks) after SCI. The influence of the level of neurological lesion was determined by analysis of variance (ANOVA). Spasticity was assessed by the Ashworth Scale.Results: The trabecular bone mineral density of radius and ulna was significantly reduced in subjects with tetraplegia 6 months (radius 19% less, P<0.01; ulna 6% less, P>0.05) and 12 months after SCI (radius 28% less, P<0.01; ulna 15% less, P<0.05). The cortical bone density was significantly reduced 12 months after SCI (radius 3% less, P<0.05; ulna 4% less, P<0.05). No changes in BMD of trabecular or cortical bone of radius and ulna were detected in subjects with paraplegia. The trabecular BMD of tibia was significantly reduced 6 months (5% less, P<0.05) and 12 months after SCI (15% less, P<0.05) in all subjects with SCI. The cortical bone density of the tibia only was decreased after a year following SCI (7% less, P<0.05). No significant difference between both groups, subjects with paraplegia and subjects with tetraplegia was found for tibia cortical or trabecular BMD. There was no significant influence for the physical activity level or the degree of spasticity on bone mineral density in all subjects with SCI.Conclusions: Twelve months after SCI a significant decrease of BMD was found in trabecular bone in radius and in tibia of subjects with tetraplegia. In subjects paraplegia, a decrease only in tibia BMD occurred. Intensity of physical activity did not significantly influence the loss of BMD in all subjects with para- and tetraplegia. However, in some subjects regular intensive loading exercise activity in early rehabilitation (tilt table, standing) can possibly attenuate the decrease of BMD of tibia. No influence was found for the degree of spasticity on the bone loss in all subjects with SCI.Spinal Cord (2000) 38, 26–32.

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

IntroductionThe effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy.Methods We searched for exercise therapy trials for cLBP published up to 15 April 2010 in Medline, Embase, Cochrane Library, Cinahl, and PEDro. Two independent reviewers selected studies according to the inclusion criteria. Data extraction: one author extracted the data of the articles.ResultsData synthesis: 16 studies with a total of 1,476 participants met the inclusion criteria. There was little evidence supporting a relationship between the changes in pain or physical function and the changes in performance for the following measures: mobility (no correlation in 9 studies, weak correlation in 1 study), trunk extension strength (7 and 2, respectively), trunk flexion strength (4 and 1, respectively) and back muscle endurance (7 and 0, respectively). Changes in disability showed no correlation with changes in mobility in three studies and a weak correlation in two; for strength, the numbers were four (no correlation) and two (weak correlation), respectively.ConclusionsThe findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.

Long-term changes in the tibia and radius bone mineral density following spinal cord injury

Design:A prospective inception cohort study with an observational analytic design in a spinal cord injury (SCI) centre hospital.Objective:To assess changes in trabecular and compact bone of the tibia and radius prospectively in subjects with SCI.Subjects:In total, 10 individuals with an acute SCI.Methods:Trabecular and compact bone density of the tibia and radius by peripheral quantitative computerised tomography.Results:Analysis of the individual gradients of the curve coefficient showed changes in trabecular bone between −0.19 and −2.46 and in cortical bone between +0.07 and −0.93 in the tibia within 34 months after the SCI. Both trabecular and cortical bone showed a group mean loss of 99 mg/cm3. No changes were observed in the radius.Conclusion:There is a major decrease in tibia mineral density over 3 years; however, no change is observed for the radius mineral content. Large interindividual differences existed in the patterns of loss in the tibia bone substance after SCI. These patterns indicate that there is no steady state of bone mineral density following 3 years of spinal cord injury.

Use of virtual reality technique for the training of motor control in the elderly. Some theoretical considerations.

Virtual augmented exercise, an emerging technology that can help to promote physical activity and combine the strengths of indoor and outdoor exercise, has recently been proposed as having the potential to increase exercise behavior in older adults. By creating a strong presence in a virtual, interactive environment, distraction can be taken to greater levels while maintaining the benefits of indoor exercises which may result in a shift from negative to positive thoughts about exercise. Recent findings on young participants show that virtual reality training enhances mood, thus, increasing enjoyment and energy. For older adults virtual, interactive environments can influence postural control and fall events by stimulating the sensory cues that are responsible in maintaining balance and orientation. However, the potential of virtual reality training has yet to be explored for older adults. This manuscript describes the potential of dance pad training protocols in the elderly and reports on the theoretical rationale of combining physical game-like exercises with sensory and cognitive challenges in a virtual environment.ZusammenfassungEine durch virtuelle Realität ergänzte Bewegungsausführung stellt eine neue und sich schnell entwickelnde Technologie dar. Sie fördert die Lust zur Bewegung, vereinigt die Vorteile von Indoor- und Outdooraktivitäten und vermag sogar das Bewegungsverhalten von älteren Menschen zu verbessern. Eine starke Ablenkung von der eigentlichen Bewegungsausführung, verursacht durch ein überzeugendes Gefühl des Eintauchens in eine virtuell-interaktive Umgebung, kann dazu führen, dass sich die Meinung über Bewegung vom Negativen zum Positiven hin wendet. Neuste Erkenntnisse mit jungen Personen zeigen, dass das Training in einer virtuellen Umgebung Vergnügen bereitet, die Gemütslage und den Energielevel anhebt. Bei älteren Menschen kann eine virtuell-interaktive Umgebung die Haltungskontrolle beeinflussen und auch als Sturzprophylaxe dienen, in dem sie die sensorischen Bereiche stimuliert, die für die Kontrolle des Gleichgewichts und der Orientierung zuständig sind. Dennoch muss das Potenzial eines Trainings in einer virtuellen Umgebung bei älteren Menschen noch weiter erforscht werden. Dieser Artikel beschreibt die Möglichkeiten eines Einsatzes von elektronischen Tanzmatten bei älteren Menschen und erklärt die theoretischen Hintergründe der Kombination von körperlicher Aktivität mit gleichzeitigen sensorisch-kognitiven Aufgaben in einer virtuellen Umgebung.

Clinical factors associated with gait alterations in diabetic patients

Aim  To identify clinical factors associated with gait alterations in patients with Type 2 diabetes.

Evaluation of exercise capacity after severe stroke using robotics-assisted treadmill exercise: A proof-of-concept study

BACKGROUND Robotics-assisted treadmill exercise (RATE) with focus on motor recovery has become popular in early post-stroke rehabilitation but low endurance for exercise is highly prevalent in these individuals. This study aimed to develop an exercise testing method using robotics-assisted treadmill exercise to evaluate aerobic capacity after severe stroke. METHODS Constant load testing (CLT) based on body weight support (BWS) control, and incremental exercise testing (IET) based on guidance force (GF) control were implemented during RATE. Analyses focussed on step change, step response kinetics, and peak performance parameters of oxygen uptake. RESULTS Three subjects with severe motor impairment 16-23 days post-stroke were included. CLT yielded reasonable step change values in oxygen uptake, whereas response kinetics of oxygen uptake showed low goodness of fit. Peak performance parameters were not obtained during IET. CONCLUSION Exercise testing in post-stroke individuals with severe motor impairments using a BWS control strategy for CLT is deemed feasible and safe. Our approach yielded reasonable results regarding cardiovascular performance parameters. IET based on GF control does not provoke peak cardiovascular performance due to uncoordinated walking patterns. GF control needs further development to optimally demand active participation during RATE. The findings warrant further research regarding the evaluation of exercise capacity after severe stroke.

Empfehlungen für die Durchführung des motorischen Assessments der unteren Extremität zur ICF-basierten Verlaufsbeurteilung der Mobilität in der stationären geriatrischen Rehabilitation

Because of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.ZusammenfassungAufgrund steigender Nachfrage nach geriatrischen Rehabilitationsleistungen zwingen begrenzte Ressourcen zu objektiven und transparenten Allokationsentscheidungen. Ziel einer interdisziplinären Konsensusgruppe war die kritische Evaluierung der gängigen motorischen Assessmentverfahren der unteren Extremität und die Empfehlung geeigneter motorischer Tests zur Verlaufsbeurteilung der Mobilität in der stationären geriatrischen Rehabilitation. Die motorischen Domänen Stehen, Gehen, Gehen mit Zusatzaufgabe, Sitz-Stand-Transfer, Liegen-Sitz-Stand-Transfer vom Bett und Treppensteigen wurden zur Beurteilung der motorischen Leistungsfähigkeit der unteren Extremität und zur Formulierung von Zielen in einem motorischen Assessment empfohlen. Da nicht für alle Domänen spezifische und ausreichend validierte Testverfahren vorliegen, wurde ein künftiger Handlungsbedarf aufgezeigt. Neben einer standardisierten Erfassung der körperlichen Leistungsfähigkeit (Kapazität) ist die mobilitätsbezogene Aktivität und Teilhabe im Sinne der International Classification of Functioning, Disability, and Health (ICF) in Zukunft verstärkt miteinzubeziehen. Am Körper getragene Sensoren stellen hierbei eine vielversprechende Perspektive dar, um den Verlauf der Rehabilitation zu objektivieren.AbstractBecause of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.

The relationship between ambulatory step activity, self-reported physical functioning and standardised timed walking in patients with haematological malignancies

Purpose. This cross-sectional study investigated the degree of association between the results of ambulatory step activity monitoring (SAM), self-reported physical functioning (SRPF) and the 6-minute standardised walking test (6-MWT) in cancer patients with haematological malignancies. Method. Assessments of ambulatory SAM, SRPF and 6-MWT were assessed in 102 patients up to 122 days (mean 78 ± 35) after haematopoietic stem cell transplantation (HSCT). To determine the association between measures of walking, the Pearson product moment correlation coefficient (r) including the 95%CI and the r2 were calculated. Simple linear regression analyses were performed to estimate the ambulatory step activity from SRPF and the 6-MWT. Results. The average age was 47 years (±12) and body mass index 23.4 (±4). The correlations were low between ambulatory SAM outputs and SRPF (ranging from −0.32 to 0.34, p < 0.01), and very low between SAM outputs and 6-MWT, (ranging from 0.21 to 0.24). The correlation between SRPF and the 6-MWT was low (0.33, p < 0.01). The correlation between SRPF and the 6-MWT was low (0.33, p < 0.01). The 95%CIs were quite narrow around r. The shared variance (r2) between the SAM and SPPF ranged between 4% and 11% and the shared variance between the SAM and 6-MWT ranged between 0.5% and 18%. Linear regression yielded weak relationships and large standard errors of estimate between the SAM, SRPF and 6-MWT. Conclusions. SRPF and the 6-MWT do not reflect daily walking activity. In clinical use (e.g. to evaluate the effects of a rehabilitation program), ambulatory step activity outputs can be considered an additional outcome to assess day-to-day walking activity in patients with haematological cancer after HSCT.

Empfehlungen für die Durchführung des motorischen Assessments der unteren Extremität zur ICF-basierten Verlaufsbeurteilung der Mobilität in der stationären geriatrischen Rehabilitation@@@Recommendation of an assessment protocol to describe geriatric inpatient rehabilitation of lower limb mobility based on ICF: Bericht eines interdisziplinären Konsensusprozesses@@@An interdisciplinary consensus process

Because of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.ZusammenfassungAufgrund steigender Nachfrage nach geriatrischen Rehabilitationsleistungen zwingen begrenzte Ressourcen zu objektiven und transparenten Allokationsentscheidungen. Ziel einer interdisziplinären Konsensusgruppe war die kritische Evaluierung der gängigen motorischen Assessmentverfahren der unteren Extremität und die Empfehlung geeigneter motorischer Tests zur Verlaufsbeurteilung der Mobilität in der stationären geriatrischen Rehabilitation. Die motorischen Domänen Stehen, Gehen, Gehen mit Zusatzaufgabe, Sitz-Stand-Transfer, Liegen-Sitz-Stand-Transfer vom Bett und Treppensteigen wurden zur Beurteilung der motorischen Leistungsfähigkeit der unteren Extremität und zur Formulierung von Zielen in einem motorischen Assessment empfohlen. Da nicht für alle Domänen spezifische und ausreichend validierte Testverfahren vorliegen, wurde ein künftiger Handlungsbedarf aufgezeigt. Neben einer standardisierten Erfassung der körperlichen Leistungsfähigkeit (Kapazität) ist die mobilitätsbezogene Aktivität und Teilhabe im Sinne der International Classification of Functioning, Disability, and Health (ICF) in Zukunft verstärkt miteinzubeziehen. Am Körper getragene Sensoren stellen hierbei eine vielversprechende Perspektive dar, um den Verlauf der Rehabilitation zu objektivieren.AbstractBecause of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.

Use of virtual reality technique for the training of motor control in the elderly@@@Einsatz der virtuellen Realität für das Training der motorischen Kontrolle bei Älteren: Some theoretical considerations@@@Einige theoretische Überlegungen

Virtual augmented exercise, an emerging technology that can help to promote physical activity and combine the strengths of indoor and outdoor exercise, has recently been proposed as having the potential to increase exercise behavior in older adults. By creating a strong presence in a virtual, interactive environment, distraction can be taken to greater levels while maintaining the benefits of indoor exercises which may result in a shift from negative to positive thoughts about exercise. Recent findings on young participants show that virtual reality training enhances mood, thus, increasing enjoyment and energy. For older adults virtual, interactive environments can influence postural control and fall events by stimulating the sensory cues that are responsible in maintaining balance and orientation. However, the potential of virtual reality training has yet to be explored for older adults. This manuscript describes the potential of dance pad training protocols in the elderly and reports on the theoretical rationale of combining physical game-like exercises with sensory and cognitive challenges in a virtual environment.ZusammenfassungEine durch virtuelle Realität ergänzte Bewegungsausführung stellt eine neue und sich schnell entwickelnde Technologie dar. Sie fördert die Lust zur Bewegung, vereinigt die Vorteile von Indoor- und Outdooraktivitäten und vermag sogar das Bewegungsverhalten von älteren Menschen zu verbessern. Eine starke Ablenkung von der eigentlichen Bewegungsausführung, verursacht durch ein überzeugendes Gefühl des Eintauchens in eine virtuell-interaktive Umgebung, kann dazu führen, dass sich die Meinung über Bewegung vom Negativen zum Positiven hin wendet. Neuste Erkenntnisse mit jungen Personen zeigen, dass das Training in einer virtuellen Umgebung Vergnügen bereitet, die Gemütslage und den Energielevel anhebt. Bei älteren Menschen kann eine virtuell-interaktive Umgebung die Haltungskontrolle beeinflussen und auch als Sturzprophylaxe dienen, in dem sie die sensorischen Bereiche stimuliert, die für die Kontrolle des Gleichgewichts und der Orientierung zuständig sind. Dennoch muss das Potenzial eines Trainings in einer virtuellen Umgebung bei älteren Menschen noch weiter erforscht werden. Dieser Artikel beschreibt die Möglichkeiten eines Einsatzes von elektronischen Tanzmatten bei älteren Menschen und erklärt die theoretischen Hintergründe der Kombination von körperlicher Aktivität mit gleichzeitigen sensorisch-kognitiven Aufgaben in einer virtuellen Umgebung.