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De Jong L.D.,Hanze University of Applied Sciences, Groningen | De Jong L.D.,University of Groningen | Dijkstra P.U.,University of Groningen | Gerritsen J.,Center for Rehabilitation | And 2 more authors.
Journal of Physiotherapy | Year: 2013

Question: Does static stretch positioning combined with simultaneous neuromuscular electrical stimulation (NMES) in the subacute phase after stroke have beneficial effects on basic arm body functions and activities? Design: Multicentre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Forty-six people in the subacute phase after stroke with severe arm motor deficits (initial Fugl-Meyer Assessment arm score ≤ 18). Intervention: In addition to conventional stroke rehabilitation, participants in the experimental group received arm stretch positioning combined with motor amplitude NMES for two 45-minute sessions a day, five days a week, for eight weeks. Control participants received sham arm positioning (ie, no stretch) and sham NMES (ie, transcutaneous electrical nerve stimulation with no motor effect) to the forearm only, at a similar frequency and duration. Outcome measures: The primary outcome measures were passive range of arm motion and the presence of pain in the hemiplegic shoulder. Secondary outcome measures were severity of shoulder pain, restrictions in performance of activities of daily living, hypertonia, spasticity, motor control and shoulder subluxation. Outcomes were assessed at baseline, mid-treatment, at the end of the treatment period (8 weeks) and at follow-up (20 weeks). Results: Multilevel regression analysis showed no significant group effects nor significant time × group interactions on any of the passive range of arm motions. The relative risk of shoulder pain in the experimental group was non-significant at 1.44 (95% CI 0.80 to 2.62). Conclusion: In people with poor arm motor control in the subacute phase after stroke, static stretch positioning combined with simultaneous NMES has no statistically significant effects on range of motion, shoulder pain, basic arm function, or activities of daily living. © 2013 Australian Physiotherapy Association.


Da Costa S.P.,University of Groningen | Van Der Schans C.P.,University of Groningen | Zweens M.J.,Martini Hospital Groningen | Boelema S.R.,University Utrecht | And 3 more authors.
Journal of Pediatrics | Year: 2010

Objective: To determine whether the development of sucking patterns in small-for-gestational age (SGA) preterm infants differs from appropriate-for-gestational age (AGA) preterm infants. Study design: We assessed sucking patterns in 15 SGA and 34 AGA preterms (gestational age ≤36 weeks) longitudinally from 34 to 50 weeks postmenstrual age (PMA) using the Neonatal Oral-Motor Assessment Scale (NOMAS). At each measurement, we scored sucking as normal, dysfunctional, or disorganized. We examined the development of their sucking patterns in relation to clinical characteristics. Results: SGA preterms developed a normal sucking pattern later than did AGA preterms (median, 50 versus 44 weeks PMA, P = .002). At term-equivalent age, none of the SGA and 38% of the AGA preterms showed normal sucking (P < .05); at 48 to 50 weeks PMA this was 54% and 81%, respectively (P = .064). Abnormal sucking including "incoordination" and dysfunctional sucking were more prevalent in SGA preterms than in AGA preterms (median, 11% versus 0% per infant, P < .05). A higher gestational age and z-score for birth weight were predictive of normal sucking at 50 weeks PMA. Conclusions: SGA preterms developed a normal sucking pattern later than AGA preterms. Many AGA preterms also developed a normal mature sucking pattern only after they had reached term age. Copyright © 2010 Mosby Inc. All rights reserved.


Kamphuis J.F.,Center for Rehabilitation | De Kam D.,Radboud University Nijmegen | Geurts A.C.H.,Radboud University Nijmegen | Weerdesteyn V.,Radboud University Nijmegen
Stroke Research and Treatment | Year: 2013

Introduction. Improvement of postural stability is an important goal during poststroke rehabilitation. Since weight-bearing asymmetry (WBA) towards the nonparetic leg is common, training of weight-bearing symmetry has been a major focus in post-stroke balance rehabilitation. It is assumed that restoration of a more symmetrical weight distribution is associated with improved postural stability. Objective. To determine to what extent WBA is associated with postural instability in people after stroke. Methods. Electronic databases were searched (Cochrane, MEDLINE, EMBASE, and CINAHL) until March 2012. Main Eligibility Criteria. (1) Participants were people after stroke. (2) The association between WBA and postural stability was reported. Quality of reporting was assessed with the STROBE checklist and a related tool for reporting of confounding. Results. Nine observational studies met all criteria. Greater spontaneous WBA was associated with higher center of pressure (COP) velocity and with poorer synchronization of COP trajectories between the legs (two and one studies, resp.). Evidence for associations between WBA and performance on clinical balance tests or falls was weak. Conclusion. Greater WBA after stroke was associated with increased postural sway, but the current literature does not provide evidence for a causal relationship. Further studies should investigate whether reducing WBA would improve postural stability. © 2013 Jip F. Kamphuis et al.


Horstmann T.,TU Munich | Lukas C.,Medical Park Bad Wiessee St. Hubertus | Merk J.,Center for Rehabilitation | Brauner T.,Physiotherapy | Mundermann A.,University of Konstanz
International Journal of Sports Medicine | Year: 2012

The purpose of this study was to determine the long-term impact of surgical repair and subsequent 6-week immobilization of an Achilles tendon rupture on muscle strength, muscle strength endurance and muscle activity. 63 patients participated in this study on average 10.8±3.4 years after surgically repaired Achilles tendon rupture and short-term immobilization. Clinical function was assessed and muscle strength, strength endurance and muscle activity were measured using a dynamometer and electromyography. Ankle ROM, heel height during heel-raise tests and calf circumference were smaller on the injured than on the contralateral side. Ankle torques during the concentric dorsiflexion tasks at 60°/sec and 180°/sec and ankle torques during the eccentric plantarflexion task and during the concentric plantarflexion task at 60°/sec for the injured leg were significantly lower than those for the contralateral leg. The total work during a plantarflexion exercise at 180°/sec was 14.9% lower in the injured compared to the contralateral leg (p<0.001). Muscle activity for the gastrocnemius muscle during dorsiflexion tasks was significantly higher in the injured than in the contralateral limb. Limited ankle joint ROM and increased muscle activity in the injured leg suggest compensatory mechanisms to account for differences in muscle morphology and physiology caused by the injury. © Georg Thieme Verlag KG Stuttgart New York.


Uemura K.,Nagoya University | Yamada M.,Kyoto University | Nagai K.,Kyoto University | Tateuchi H.,Kyoto University | And 3 more authors.
Archives of Gerontology and Geriatrics | Year: 2012

Few studies have reported the effect of exercise intervention for improving postural control deficit in older adults at high risk of falling. We have developed a "Dual-task Switch Exercise (DSE)" program that focuses on gait initiation performance under the dual-task condition. The purpose of this study was to evaluate whether gait initiation performance could be improved by a specific exercise intervention. Eighteen participants were randomly assigned to either DSE or control groups. The DSE group received focused training to improve the ability to initiate movements quickly under the dual-task condition. The control group received steady-state walking training. After 30-min of seated training sessions, participants received 5-min individualized training sessions once a week for 24 weeks. In the pre- and post-training period, performance of the steady-state gait (10-m walking time) and gait initiation (reaction time, backward center of pressure (COP) displacement) were measured under the single- and dual-task conditions. The results of a randomized clinical trial showed that both groups showed improvement of steady-state walking time under the dual-task condition (main effect of time; p= 0.018). However, DSE was more effective in improving both the reaction time and backward COP displacement during gait initiation under the dual-task condition than control (interaction effect of time × group; reaction time, p= 0.015; COP displacement, p= 0.011). There were no significant differences in steady-state gait and gait initiation performance under the single-task condition between pre- and post-training in both groups. Only the specific exercise intervention improved gait initiation performance under the dual-task condition. © 2012 Elsevier Ireland Ltd.

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