Kathleen M Gill-Body

Can Tai Chi improve vestibulopathic postural control

OBJECTIVES To evaluate the rationale and scientific support for Tai Chi as an intervention for vestibulopathy and to offer recommendations for future studies. DATA SOURCES A computer-aided search, including MEDLINE and Science Citation Index, to identify original Tai Chi studies published in English; relevant references cited in the retrieved articles were also included. STUDY SELECTION A preliminary screening selected all randomized controlled trials (RCTs), non-RCTs, case-control studies, and case series that included Tai Chi as an intervention and had at least 1 outcome variable relevant to postural stability. DATA EXTRACTION Authors critically reviewed studies and summarized study designs and outcomes in a summary table. DATA SYNTHESIS Twenty-four Tai Chi studies met screening criteria. No studies specifically studying Tai Chi for vestibulopathy were found. Collectively, the 24 studies provide sometimes contradictory but generally supportive evidence that Tai Chi may have beneficial effects for balance and postural impairments, especially those associated with aging. Ten RCTs were found, of which 8 provide support that Tai Chi practiced alone, or in combination with other therapies, can reduce risk of falls, and/or impact factors associated with postural control, including improved balance and dynamic stability, increased musculoskeletal strength and flexibility, improved performance of activities of daily living (ADLs), reduced fear of falling, and general improvement in psychologic well-being. Studies using other designs support the results observed in RCTs. CONCLUSIONS At present, few data exist to support the contention that Tai Chi specifically targets the impairments, functional limitations, disability, and quality of life associated with peripheral vestibulopathy. There are, however, compelling reasons to further investigate Tai Chi for vestibulopathy, in part because Tai Chi appears useful for a variety of nonvestibulopathy etiologic balance disorders, and is safe. Especially needed are studies that integrate measures of balance relevant to ADLs with other psychologic and cognitive measures; these might help identify specific mechanisms whereby Tai Chi can remedy balance disorders.

Vestibular rehabilitation: Useful but not universally so ☆

OBJECTIVE: Although vestibular rehabilitation (VR) is gaining popularity, few data support its utility in improving locomotor stability, and no good predictors exist of whom will benefit most. STUDY DESIGN AND SETTING: A double-blind, placebo-controlled randomized trial of vestibular rehabilitation was conducted at a large tertiary care hospital on 124 patients (59 ± 18 years old) with unilateral (n = 51) or bilateral (n = 73) vestibular hypofunction, of whom 86 completed a 12-week intervention. Of these 86, 27 returned for long-term (1-year) follow-up testing. The primary outcome measure was locomotor stability. RESULTS: Group A (6 weeks of VR) significantly (P < 0.01) increased their gait velocity and stability compared with group B (6 weeks of strengthening exercise), but there was a smaller difference (P = 0.05) between groups at 12 weeks, when both had had VR; there were no group differences at 1 year. Of the 86 who completed the intervention, 52 (61%) had clear locomotor gains. CONCLUSION AND SIGNIFICANCE: VR is helpful for most patients in providing locomotor stability, but further work is needed to determine the factors that prevent VR from being effective for all patients with vestibulopathy.

An Integrated Framework for Decision Making in Neurologic Physical Therapist Practice

Decision-making frameworks are used by clinicians to guide patient management, communicate with other health care providers, and educate patients and their families. A number of frameworks have been applied to guide clinical practice, but none are comprehensive in terms of patient management. This article proposes a unifying framework for application to decision making in the management of individuals who have neurologic dysfunction. The framework integrates both enablement and disablement perspectives. The framework has the following attributes: (1) it is patient-centered, (2) it is anchored by the patient/client management model from the Guide for Physical Therapist Practice, (3) it incorporates the Hypothesis-Oriented Algorithm for Clinicians (HOAC) at every step, and (4) it proposes a systematic approach to task analysis for interpretation of movement dysfunction. This framework provides a mechanism for making clinical decisions, developing clinical hypotheses, and formulating a plan of care. Application of the framework is illustrated with a case example of an individual with neurologic dysfunction.

Item-specific functional recovery in children and youth with acquired brain injury.

Purpose The purpose of this study was to examine changes in item-specific functional activities and caregiver support in children and youths with acquired brain injury (ABI) in an inpatient setting using the Pediatric Evaluation of Disability Inventory (PEDI). Methods The PEDI was administered by therapy staff at admission and discharge to a consecutive sample of 94 children and youths with brain injury (62 males and 32 females; age range = one to 19 years of age) admitted to the inpatient service at Franciscan Childrens Hospital and Rehabilitation Center during a two-year, 10-month period. Individual PEDI item scores were abstracted from the medical records. Results Using the Wilcoxon matched-pairs signed rank test (two-tailed), significant differences between admission and discharge scores were found for most mobility, self-care, and social activity item groups and for all domains of caregiver support. Patterns of activity-specific improvements were contrasted between children with traumatic ABI and those with nontraumatic ABI. Conclusions Recovery in children with ABI can be detected during inpatient rehabilitation across many areas of functioning as represented by item content of the PEDI. Changes at the item level may serve as a guide for defining specific physical therapy goals for inpatient episodes. Item groups in which changes are not detected provide information about sections of the PEDI that are less relevant for hospital-based recovery of children with ABI.

Reviews of Textbooks of Motor Learning and Neuroplasticity

Purpose: This electronic book (e-book), the first book published by Tanas Publishing, provides a comprehensive summary of basic principles underlying neural plasticity as they relate to neurorehabilitation. The author’s stated purpose is to enhance understanding of the key neural and behavioral signals that drive neural plasticity so that more effective neurorehabilitation approaches can be developed and implemented in clinical practice. Central themes of the book are that neural plasticity and functional changes are associated with neurorehabilitation, and that therapists need to better understand how to specifically apply and advance interventions to optimize neural plasticity. Audience: The author states that the book is intended for clinicians (therapists) working in neurorehabilitation. It could be very useful for any health professional working with people with neurologic injury of any age, as well as faculty and students seeking to understand how evolving knowledge about neural plasticity can relate to rehabilitation after nervous system injury. Organization/Structure: Access to the e-book is managed by following a link provided by the publisher; the e-book is then downloaded as a pdf file onto a computer. The book is organized into 2 main sections: Section I: Fundamentals of Neural Plasticity, and Section II: Neural Plasticity and Neurorehabilitation. Section I (Chapters 1-5) includes a historical perspective regarding neural plasticity as well as definitions of key terms (Chapter 1); a summary of relevant animal and human studies that demonstrate the variety of changes in neuron structure and function underlying plasticity (Chapters 24); and an overview of brain organization that highlights the concepts of redundancy and interconnectivity as they relate to functional reorganization after brain injury (Chapter 5). Section II (Chapters 6-12) focuses on application of the information presented in Section I to clinical practice. Chapter 6 includes a discussion of recovery versus compensation at both the behavioral and neural levels, whereas Chapter 7 presents strategies that can be used in rehabilitation to exploit key neural

Usefulness of biomechanical measurement approaches in rehabilitation

Several of the biomechanical measurement approaches that are currently used in rehabilitation are reviewed. The reliability and validity of each approach are identified. Selected areas in which clinicians and researchers have applied kinematics, kinetics, and electromyography in an attempt to further understanding of movement dysfunction, motor performance, and response to treatment in individuals with neurologic dysfunction are analyzed to illustrate the usefulness of these approaches. The advantages of whole-body biomechanical analysis, a sophisticated approach that combines kinematics and kinetics, are presented and discussed as they relate to recent findings in patients with vestibulopathy. Many of the current applications of biomechanical analyses are in the research rather than the clinical domain. Current limitations of biomechanical approaches are discussed including their lack of interpretation standards and clear understanding of how biomechanical measures relate to functional performance.