Laurie A. Malone

Gait Training With Progressive External Auditory Cueing in Persons With Parkinson's Disease

OBJECTIVE To investigate the progressively increasing external auditory cues during mobility training with persons with Parkinsons disease (PD). DESIGN Experimental. SETTING General community. PARTICIPANTS Convenience sample of persons with PD (N=12) who walked independently. INTERVENTIONS Gait training to external auditory cues was based on a participants comfortable walking pace. Training external auditory cues rates were increased if patients were able to maintain or increase stride length with increasing external auditory cues rate. Movement synchronization was not monitored during training. Participants trained for 30min/session, 3 sessions/wk, for 8 weeks. MAIN OUTCOME MEASURES Walking velocity, stride length, and cadence. RESULTS Participants trained at a mean maximal rate of 157bpm. They showed a significant (P<.01) increase in walking velocity, stride length, and cadence after 8 weeks of training. CONCLUSIONS Walking velocity, stride length, and cadence can significantly improve when community-dwelling persons with PD participate in progressive mobility training.

Boosting in athletes with high-level spinal cord injury: knowledge, incidence and attitudes of athletes in paralympic sport

Autonomic dysreflexia (AD) is unique to individuals with spinal injuries (SCI) at T6 or above and can be voluntarily induced. Although AD improves wheelchair racing performance in some athletes, it also elicits exaggerated blood pressure, which could be dangerous. The International Paralympic Committee considers AD doping and banned its use. Purpose. The purpose of this study is to evaluate AD knowledge, incidence and attitudes (KIA) of Paralympians with SCI. Methods. An existing questionnaire was modified to include questions of AD KIA, validated by three experts and piloted with a small sample. It was administered on-line, mailed to members of a scientific network and distributed during the Beijing Paralympic Games. Fisher Exact test was used to evaluate differences across gender, injury and education. Results. Of 99 participants, 54.5% had previously heard of AD while 39.4% were unaware; 16.7%, all males, had used AD to enhance performance. Participants reported that AD was (1) useful for middle (78.6%) and long distance (71.4%), marathon (64.3%) and wheelchair rugby (64.3%); (2) somewhat dangerous (48.9%), dangerous (21.3%) or very dangerous (25.5%) to health. Results were not influenced by age, injury level or injury duration. Conclusions. Findings indicate the need for educational programmes directed towards enhancing the AD knowledge of rehabilitation professionals, coaches and trainers working with SCI individuals.

Physiological Responses of Skilled Players During a Competitive Wheelchair Tennis Match

The purpose of this study was to determine heart rate (HR, b·min−1) response during competitive match play of 6 men who were skilled wheelchair (WC) tennis players. Each participant completed an arm crank ergometer test that measured HR via a telemetry device and &OV0312;O2 via open circuit spirometry from rest until fatigue (&OV0312;O2peak). Each athlete participated in 2 competitive singles matches during which HRs were recorded in 5-second intervals and &OV0312;O2 was estimated using the corresponding HR values recorded during the arm ergometer tests. Data analysis revealed an average playing intensity of 69.4 ± 8.9% of HRpeak and 49.9 ± 14.5% of &OV0312;O2peak. In conclusion, it is recommended that skilled adult WC tennis players perform off-court aerobic conditioning as part of their training program, because the intensity of a competitive WC tennis match is sufficiently high enough to stress the cardiovascular system.

Exercise intensity during wheelchair rugby training.

Abstract The purpose of this study was to determine the ability of individuals with a cervical spinal cord injury to achieve and sustain a cardiorespiratory training intensity during wheelchair rugby. Nine wheelchair rugby players completed a continuous peak exercise test on a SciFit Pro I arm ergometer with stage increases each minute to determine peak heart rate and power output. Approximately one week after peak exercise testing, heart rate was recorded (every 5 s) during three regularly scheduled rugby training sessions. Data were analysed to determine the number of continuous minutes that participants spent above 70% of heart rate reserve under various rugby training activities. The percent of time spent at or above 70% heart rate reserve varied across participants and conditions. Continuous pushing was the least variable training condition among participants with the sample averaging greater than 73% of time above the target heart rate. Scrimmage training was highly variable across participants with a range of 0% to 98% of time above the criterion. Results of this study indicate that wheelchair rugby training enables some participants to reach a training intensity associated with improved cardiorespiratory fitness, and that the type (or kind) of training activity dictates the extent to which individuals sustain such a threshold.

The effects of surface anaesthesia on the autonomic dysreflexia response during functional electrical stimulation

Recently, increases in blood pressure (BP) and concomitant bradycardia, suggestive of autonomic dysreflexia (AD), have been documented during functional electrical stimulation (FES) in individuals with a high spinal cord injury (SCI). If uncontrolled, this response could preclude the safe use of FES among such individuals. FES induced pain is partly related to stimulation of skin nociceptors. Therefore, measures to reduce skin sensitivity may reduce the risk of AD during FES. The purpose of this study was to determine if topical anaesthetic applied over the site of electrical stimulation could minimize the AD cardiovascular and hormonal responses to FES in individuals with SCI above the T6 level. Seven subjects with a SCI above T6 received FES to the quadriceps muscle of each leg under two conditions on two different testing days. The two treatment conditions, topical anaesthetic and placebo creams, were double blinded and randomized. The cream was administered to an area the size of the electrode (10×10 cm) 1 h prior to stimulation. Stimulation began at 0 mAmps and increased by 16 mAmps every 2 min until an intensity of 160 mAmps was achieved. HR and BP were measured at each stimulation intensity level. Catecholamines were analyzed three times during the stimulation protocol (pre, mid and post stimulation intensities). At the end of the stimulation protocol, FES induced isometric quadriceps contraction force at 160 mAmps intensity was measured using a hand held dynamometer. As FES stimulation intensity increased, significant rises in systolic and diastolic BP were seen, with a concomitant progressive drop in HR. The AD response to stimulation was not significantly different between the topical anaesthetic and placebo conditions. Serum catecholamine (epinephrine and norepinephrine) levels tended to rise with increasing FES intensity levels but did not reach statistical significance. The two treatment conditions did not significantly affect serum catecholamine levels or FES-induced quadriceps contraction force. In summary, FES application to the quadriceps muscle in high level SCI subjects resulted in significant increases in BP, decreases in HR (AD-like response), a trend towards elevations in catecholamine levels, and no difference in quadriceps muscular strength. However, these responses were unaffected by the use of topical anaesthetic cream on the skin at the stimulation site. This suggests that other mechanisms than skin nociception are operative in FES-induced AD.

Pain and fatigue consistency in adults with cerebral palsy

Purpose. To examine the consistency of pain and fatigue and describe pain interference with daily activities in ambulatory (AMB) and non-ambulatory (non-AMB) adults with cerebral palsy (CP) over a 3-month period. Method. A repeated measures design with 26 participants (12 AMB, 14 non-AMB) acting as their own controls. Pain and fatigue data were collected once per month for three consecutive months using the FACES pain scale and PedsQL™ Multidimensional Fatigue Scale. Pain interference with daily life was assessed using the Pain Disability Index (PDI). Results. No significant differences were found in maximum pain intensity. AMB reported significantly fewer pain sites in the whole body during month 1 than non-AMB. Fatigue was consistent across months; however, AMB reported significantly more General fatigue. Across groups, significant correlations were found between PDI and General, Resting, and Overall fatigue. Non-AMB exhibited significant correlations between total number of pain sites and General and Cognitive fatigue, as well as PDI and Overall fatigue. For the AMB group, PDI and total number of pain sites were significantly correlated. Conclusions. Pain and fatigue consistently and significantly affect adults with CP. Both factors impact the ability of adults, who have CP, to participate in daily life.

Effect of team rank and player classification on activity profiles of elite wheelchair rugby players

Abstract The aim of the current study was to establish which indicators of mobility are associated with successful wheelchair rugby performance and determine whether these indicators differed across classification. Data were collected from 11 international teams during 30 matches (353 match observations) using a radio-frequency-based, indoor tracking system across two tournaments. Players (n = 111) were first grouped by team rank as determined by their International Wheelchair Rugby Federation (IWRF) world ranking (LOW, MID, HIGH) and then into one of four groups based on their IWRF classification: Group I (0.5), Group II (1.0–1.5), Group III (2.0–2.5) and Group IV (3.0–3.5). The volume of activity (relative distance and mean speed), peak speed and time spent within classification-specific arbitrary speed zones were calculated for each individual. Although no differences were identified in the volume of activity, playing time was significantly reduced in LOW (34:51 ± 8:35) compared to MID (48:54 ± 0:51) and HIGH (45:38 ± 9:53), which was further supported by the greater number of substitutions performed by LOW. HIGH achieved greater peak speeds (3.55 ± 0.40 m · sˉ1) than LOW (3.27 ± 0.42 m · sˉ1) and MID (3.45 ± 0.41 m · sˉ1). Peak speed was further shown to be classification-dependent (P ≤ 0.005), whereby HIGH Groups III and IV players achieved greater peak speeds than LOW and MID. The time spent performing high-intensity activities was also greater in HIGH compared to LOW and MID, whilst further influenced by classification (P ≤ 0.0005). To conclude, peak speed and the ability to perform a greater number of high-intensity activities were associated with successful performance in wheelchair rugby.

Outcomes of an exercise program for pain and fatigue management in adults with cerebral palsy

Abstract Purpose: The purpose of this exploratory pilot study was to examine the effect of exercise on pain and fatigue in adults with CP. Method: Twenty-six participants (12 ambulatory, 14 non-ambulatory; 10 males, 16 females; mean age 42.3 ± 11.2 years) enrolled in a study using a repeated measures design including baseline, intervention and follow-up phases of 12 weeks each; 20 participants completed all phases. Primary outcome measures used were the FACES pain scale, the count of body parts with pain and the PedsQL™ Multidimensional Fatigue Scale. Results: Significant beneficial changes were found in the pain and fatigue scales among the ambulatory participants during the intervention phase. However the beneficial changes diminished during the follow-up phase. Secondary outcomes examined included, pain interference, daily physical activity and health-related quality of life. Conclusion: Study outcomes suggest that exercise may provide some benefit for ambulatory adults with CP. Implications for Rehabilitation Pain and fatigue are secondary conditions experienced by many adults with cerebral palsy which have a significant impact on function and quality of life. Physical activity is an intervention which has been demonstrated to decrease both pain and fatigue in other health conditions. In a relatively small sample, this study demonstrates decreased pain and fatigue after an exercise intervention in ambulatory adults with cerebral palsy.

Recommendations for the Optimal Design of Exergame Interventions for Persons with Disabilities: Challenges, Best Practices, and Future Research

A group discussion of individuals with expertise working in the field of exergaming and rehabilitation focused on the issue of designing exergames for persons with disabilities as well as appropriate interventions using exergames. The purpose of these discussions was to develop recommendations for the design, evaluation, and application of exergames in therapy serving as potential guidelines for researchers, developers, and therapists. The following key issues were addressed: (1) Challenges in exergame design for persons with disabilities, (2) adaptation of exergames for persons with disabilities, (3) exergame interventions, and (4) future research directions. It is the hope of the group that the results of these recommendations will help improve the quality of exergame design and interventions and thereby increase opportunities for persons with disabilities to engage sustainably in exergaming.

An assessment of wrist splint and glove use on wheeling kinematics

OBJECTIVE: The purpose of this investigation was to assess whether glove and/or splint use could effectively reduce hyperextension at the wrist during wheelchair propulsion, thus potentially reducing the conditions predisposing to median nerve dysfunction, and to evaluate the overall effects of these interventions on wheeling mechanics. DESIGN: This investigation used a randomized experimental design. BACKGROUND: The upper extremities are used for weight bearing and propulsion by individuals who are wheelchair dependent. High intracarpal pressures created by hyper-extension of the wrist and repetitive high force stresses of the hands against the wheel are suggested causes of median nerve dysfunction. METHODS: The wheeling performances of 13 subjects were recorded using two SVHS video-cameras under four different glove/splint conditions. Each subject was analysed on two wheeling cycles under all four conditions. Wrist and elbow angles, joint range of motions and wheeling speed were determined. Data were analysed using a one-way analysis of variance (ANOVA), followed by Scheffé post-hoc comparisons at the 0.05 level of significance. RESULTS: The splint and the glove/splint combination significantly reduced wrist extension during wheeling, but did not alter elbow motion or maximal wheeling speed. CONCLUSIONS: Hand and wrist protection in the form of a splint or glove/splint combination can reduce hyperextension of the wrist, and therefore may be of functional value for wheelchair users. This form of protection may therefore be useful in various orthopedic conditions of the wrist or hand commonly seen in wheelchair-dependent individuals without seriously interfering with wheeling quality.