Michal Katz-Leurer

Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke

Objectives. The first aim of this study was to evaluate the within-session reliability of sitting balance measures by assessing forward and lateral reach while sitting in both healthy subjects and patients post- stroke. The second aim was to evaluate the ability to document change in reaching while sitting over time in patients post-stroke. The third aim was to compare sitting balance results by the modified functional reach test (MFRT) to the Balance Master (BM), motor and function assessments. Design. Data were collected on two occasions: Two to three weeks post-event and again six weeks later. On each occasion within-session reliability was tested using the intra-class correlations (ICC). The tests were performed three times; the second and third attempts were compared in order to test the within-session reliability. For assessing the concurrent validity, the MFRT results were compared with the BM results, Stroke Assessment Scale (SAS) and the Functional Independence Measure (FIM) score using Pearson correlations. Setting. In-patient rehabilitation department. Participants. Patients after a first ischemic stroke 14 – 21 days post-event were recruited from the inpatient rehabilitation department at Hadassah University Hospital, Jerusalem, Israel. Excluded were patients with brain stem lesions and/or bilateral signs or hemorrhagic events as diagnosed by Computerized Tomography, patients with Mini-Mental State Examination < 20, those who were not able to sit unsupported for 10 sec and those who could stand without support for more than 30 sec. Main Outcome Measures. The MFRT, performed while sitting in forward and sideward directions. Results. The MFRT in all directions on both occasions exhibited high reliability (intra-class correlation coefficient range, 0.90 – 0.97). The responsiveness to the paretic side was high (effect size 0.80) and moderate for the forward and non-paretic side (effect size 0.57 – 0.60). A significant moderate correlation was found between MFRT and BM on both occasions. Conclusion. The MFRT while sitting can be reliably measured and may serve as a useful outcome measure in individuals with stroke 2 – 8 weeks post-event.

The effects of a `home-based' task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury

Objectives: To evaluate the feasibility and the ability to recruit and retain children with severe traumatic brain injury or cerebral palsy, and their families, to a simple home-based exercise programme and to assess the immediate and short-term effects of such intervention on reducing impairment and improving function. Study design: Randomized clinical trial. Participants: Twenty children aged 7—13 years, with traumatic brain injury (N = 10) or cerebral palsy (N = 10) who were independent ambulators. Five children from each group were randomly assigned to a control group — regular daily activities, or to an experimental group — regular daily activities plus a home-based task-oriented exercise programme of sit-to-stand and step-up exercise, for six weeks. Outcome measures: Feasibility: The number of participants who completed the programme protocol. Efficacy: Timed Up and Go Test and Functional Reach Test were used as functional balance tests. Maximal isometric strength was assessed by using a hand-held dynamometer; walking performance was assessed by the 10 m walk test, 2-minute walk test and Energy Expenditure Index. Results: Nine children completed all parts of the training programme. At the end of the intervention period an increase of 3—4 cm in the mean Functional Reach Test and a reduction of 1.6 ± 2.1 seconds in the Timed Up and Go Test were noted (P<0.01) in the experimental group while no changes were noted in the control group. In all other outcomes assessed no significant differences were noted between groups. The positive change in balance performance in the experimental group was maintained during a six-week follow-up period. Conclusions: A home-based task-oriented exercise programme can improve balance performance in children with spastic cerebral palsy or severe traumatic brain injury.

Relationship between balance abilities and gait characteristics in children with post-traumatic brain injury.

Objectives: To quantify the differences in gait variability and balance performance between typically developed (TD) children and children with post-traumatic brain injury (TBI) and to determine the association between gait variability and functional balance in both groups. Design: Cross-sectional study. Setting: Physical therapy department of a paediatric and adolescent rehabilitation hospital. Participants: A convenience sample of 24 children post-TBI and 24 TD age and sex matched controls. Intervention: Not applicable. Main outcome measure: Step length, step time and base width variability measured with an electronic walkway; timed up and go (TUG) test and functional reach test (FRT) as a functional balance test. Results: Base width and step time variability showed no significant difference between the groups. However, children post-TBI had significantly greater variability in step length in comparison to healthy controls. The functional balance abilities of children post-TBI were significantly limited compared to TD children. A significant linear inverse correlation was found between balance performance and step length variability only among children with a TBI. Conclusion: Ambulatory children post-severe TBI had decreased balance performance, decreased gait speed and increased step length variability as compared to age-matched healthy controls.

Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study

BackgroundLymphedema is an adverse effect of breast cancer surgery. Aqua lymphatic therapy (ALT) is a novel treatment for limb volume reduction.ObjectiveThe aim of this study was to examine whether ALT is a safe method and whether there are differences in adherence, limb volume, and quality of life between women who perform only self-management treatment and women who participate as well in ALT.DesignDesign of the study was single-blind randomized clinical trial.SettingThe setting was in a hydrotherapy pool, 1.2xa0m depth, and a temperature of 32–33°С.PatientsForty-eight women (56u2009±u200910xa0years), with a 12.8% lymphedema relative volume, participated in the study.InterventionThe control group was instructed to perform the self-management treatment. The study group joined a weekly session of ALT for 3xa0months in addition to the self-management therapy.MeasurementsAdherence was assessed by a self-reported diary, limb volume by a water displacement device, quality of life by the Upper Limb Lymphedema Questionnaire (ULL27), prior to, and after the intervention period.ResultsThere was no episode of arm infection or aggravation in limb volume during the study period. ALT had a positive, statistically and clinically significant immediate effect on limb volume but no long-term effect was noted. The adherence rate to ALT was significantly higher than the adherence to self-management therapy. QOL improved in the study group.ConclusionALT was found to be a safe method, with high adherence, in treating women who suffer from mild to moderate lymphedema. A significant immediate and insignificant long-term effect on limb volume was noted.

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

OBJECTIVESnTo assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.nnnDESIGNnA parallel randomised single-blind clinical trial.nnnPARTICIPANTSnFifty patients aged 65 years or over with knee osteoarthritis.nnnINTERVENTIONSnThe study group (n=25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n=25) were given a brief course in short-wave diathermy treatment.nnnMAIN OUTCOME MEASURESnPatients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.nnnRESULTSnAt 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) -12.3 to -6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was -9.0 points (95%CI -14.5 to -3.4).nnnCONCLUSIONnA simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.

Functional balance tests for children with traumatic brain injury: within-session reliability.

Purpose: To assess the within-session reliability of the Modified Functional Reach Test (MFRT) and the Timed Up and Go (TUG) test in children with traumatic brain injury (TBI) and children with typical development (TD). Methods: A convenience sample of 24 children with TBI and 24 children with TD matched for age and sex were tested. Following 1 practice trial, 3 trials of the MFRT and TUG were completed and recorded for each child. Results: Within-session reliability for the MFRT was excellent [children with TBI (intraclass correlation coefficient, ICC (1,1) = 0.92–0.97), children with TD (ICC (1,1) = 0.94–0.95)]. Within-session reliability for the TUG test was good [children with TBI (ICC (1,1) = 0.86), children with TD (ICC (1,1) = 0.85)]. The average of the first and second trials showed the least measurement error for the TUG test. Conclusion: Within-session reliability values are excellent for the MFRT and good for the TUG test in children with TBI.

Testing knee extension and flexion strength at different ranges of motion: an isokinetic and electromyographic study

The main objective of this study was to explore the mechanical and electrical output of thigh muscles derived from a range of motion (RoM) of 90° (0–90° flexion, LR) and the three successive RoMs: 0–30° (SR1), 30–60° (SR2) and 60–90° (SR3). Thirteen men took part in the study. In view of the torque–velocity relationship and in order to render the test conditions as equivalent as possible, LR was tested at 90°/s while the corresponding velocity for all SRs was 30°/s. The findings indicated very good agreement between LR and SR2 in terms of absolute strength (particularly the concentric), within muscle eccentric to concentric strength ratios, between muscles (agonist to antagonist) strength ratios and the normalized IEMG (expressed inxa0μV/Nm). An agreement was also noted between the mean eccentric peak torque of the knee flexors at LR and SR1 and between the mean eccentric peak torque of the knee extensors at LR and SR3. However, in general there was a lesser agreement between LR and SR1 or SR3. It is suggested that testing thigh muscles in the middle sector of knee motion (SR2) yields strength and EMG data that are close and well correlated with those derived from testing the knee along the commonly used (0–90°) RoM.

Heart rate and heart rate variability at rest and during exercise in boys who suffered a severe traumatic brain injury and typically-developed controls

Objectives: To measure heart rate (HR) and heart rate variability (HRV) at rest and during exercise in children with post-severe traumatic brain injury as compared to age-matched typically-developed controls. Design: Comparative study. Setting: Out-patient rehabilitation department. Participants: Twelve boys post-severe traumatic brain injury (TBI) (aged 7–13 years) and 18 typically-developed (TD) boys matched for age. Interventions: HR and HRV were determined at rest and at a steady functional walking rate on the treadmill. Main outcome measures: HR and HRV parameters include: time domain parameters: standard deviation of the R-R interval, square root of the mean squared differences of successive R-R differences at rest and during steady-state exercise. Results: Children post-TBI demonstrated higher mean HR values at rest (TBI 91.8 ± 7.0 beats per minute vs 72.0 ± 7.1 beats per minute in controls, p < 0.05) and during exercise (TBI 123.4 ± 15.5 beats per minute vs 113.0 ± 9.1 beats per minute in controls, p < 0.05). At rest, the time domain measures of HRV were significantly lower in the TBI group (p < 0.05). Time domain mean values decreased significantly during exercise only among the TD children. Conclusions: The findings of this study suggest that among children post-severe TBI, the cardiac autonomic mechanism is less efficient at rest and less adaptive to exercise and activity as compared to TD children.

Recreational physical activities among children with a history of severe traumatic brain injury

Objective: To describe leisure time physical activity (LTPA) and physical capabilities such as balance, muscle strength and walking performance and to evaluate the associations between physical capabilities and LTPA among children post-traumatic brain injury (TBI) as compared to a peer group of typically-developed (TD) controls. Participants: Convenience sample of 15 children, 1.5–7 years post-severe TBI and 15 age- and sex-matched controls. Main outcome measures: LTPA by the Godin and Shephard (G&S) questionnaire. Balance tests—the Timed Up and Go test (TUG) and functional reach test (FRT). Maximal isometric strength was assessed by using a hand-held dynamometer; walking dynamics were recorded by an electronic mat and the 6 minute walk test and energy expenditure index (EEI). Perceived exertion was rated by the OMNI scale. Results: Children post-severe TBI participate significantly less in LTPA as compared to TD controls (pu2009<u20090.01). Walking performance was comparable between groups except for step length which was significantly shorter among children post-TBI. Hip extensor strength and balance performance were significantly lower among children post-TBI. Balance performance was positively associated with LTPA. Conclusions: This study suggests that attention should be directed towards improving balance performance as part of the training repertoire of children and adolescents with post-severe TBI. The efficacy of such a training programme, in particular its contribution to LTPA participation, should then be further assessed.

Contribution of stepping while standing to function and secondary conditions among children with cerebral palsy.

Purpose: To explore the feasibility and efficacy of stepping while standing and its effect on function and prevalence of secondary conditions among children with severe cerebral palsy. Methods: Of 22 children with severe cerebral palsy, 11 underwent treatment using a Hart Walker (HW) device, and the other 11 underwent a passive standing program. Constipation prevalence and adverse events were recorded. Bone quantitative ultrasound was performed for the tibia. The Pediatric Evaluation of Disability Inventory was used to assess activities of daily life. Results: Children exposed to the HW improved bowel function, but no added quantitative benefit to bone was observed when compared with passive standing. Children using the HW were able to take steps independently in the device, but did not reach a functional walking level. Conclusions: Providing a child who is nonambulatory the opportunity to walk may be important both for participation in activities of daily living and social roles and for preventing secondary conditions.