Osteoarthritis and therapeutic exercise.
Explore the source record for details and available documents.
Exercise Therapy↗
Biomedical subjects
Sue Ann Sisto
Publications and source records attributed to Sue Ann Sisto.
The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station.
OBJECTIVE: To compare the inter- and intrarater reliability of a portable dynamometer anchoring station (DAS) to a handheld dynamometer (HHD). DESIGN: Repeated-measures design. SETTING: Human performance and movement analysis laboratory. PARTICIPANTS: Fifteen healthy participants, ages 23 to 44 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three consecutive measures of peak bilateral isometric strength were obtained for hip abduction, extension, and flexion by 2 investigators by using the DAS and the HHD after a 1-hour rest period. This testing scenario was repeated 1 week later. Intraclass correlation coefficients (ICCs) were used to determine reliability. RESULTS: Interrater ICCs of average peak strength ranged from.84 to.92 (hip flexors),.69 to.88 (hip abductors), and.56 to.80 (hip extensors). Intrarater ICCs ranged from.59 to.89 for tester A and from.72 to.89 for tester B using the DAS, and from.67 to.81 for the HHD across muscle groups. CONCLUSIONS: The DAS showed good intrarater reliability for hip flexion and abduction, whereas the HHD demonstrated higher reliability for hip extension. The results support the use of dynamometers that are quick and reliable and that reduce tester bias during hip strength assessment.
Adult↗
Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial.
OBJECTIVE: Deterioration of calf muscle pump function is associated with progression of chronic venous insufficiency (CVI). We postulated that a supervised exercise program would improve calf muscle strength and venous hemodynamics in patients with CVI. METHODS: We recruited 31 patients for this randomized, prospective trial. Inclusion criteria required the presence of skin changes or ulceration (CEAP 4, 5, 6), and duplex ultrasound scanning (reflux or scarring) and air plethysmographic (APG) evidence of CVI. Subjects were randomized into control (n = 13) and therapy (n = 18) groups. Class II (30-40 mm Hg) compression hosiery was given to all. The experimental group received physical therapy designed specifically to strengthen calf musculature. Dynamic strength and power were measured with a Biodex II dynamometer (Biodex Medical Systems, Shirley, NY) at slow and fast speeds. Reflux (venous filling index) and calf pump function (ejection fraction, residual volume fraction) were measured with APG. Quality-of-life questionnaires and venous severity scores were also administered. Outcomes were compared 6 months after initiation of exercise. Probability of treatment effect was tested with univariate analysis of variance, with control for baseline values. RESULTS: Demographic variables and medical comorbidities were not different between groups. After 6 months of intervention, indicators of calf pump function returned to a normal range in the therapy (experimental) group. Mean residual volume fraction was improved in the exercise group (-8.75 +/- 4.6 vs 3.4 +/- 2.9 in the control group; P <.029). Mean ejection fraction was increased in the exercise group (3.48 +/- 2.7 vs -1.4 +/- 2.1 in the control group; P <.026). Reflux, while substantially greater than the normal value of 2.0 mL/s in both groups, was unchanged. The exercise regimen improved isokinetic peak torque/body weight at both slow speed (3.1 +/- 1.4 in the therapy group vs -1.0 +/- 1.1 in the control group; P <.05) and fast speed (2.8 +/- 0.9 in the therapy group vs - 0.3 +/- 0.6 in the control group; P <.03). No changes were observed in quality-of-life or severity scores. CONCLUSIONS: Calf muscle pump function and dynamic calf muscle strength were improved after a 6-month program of structured exercise. Directed physical conditioning of the calf musculature may prove beneficial for patients with or without alternative management options for severe CVI. Further research on exercise for patients with CVI is warranted.
Aged↗
Dynamic stability during walking following unilateral total hip arthroplasty.
The purpose of this study was to examine dynamic stability, defined as the vertical projection of the center of mass (COM) to the base of support (BOS) mediolaterally during walking in 16 healthy and 16 unilateral total hip arthroplasty (THA) persons. There was a significant effect of side for double limb support (DLS) for the healthy group and between groups but not significant for single limb support. The dynamic stability pattern for the THA group was to hold the COM in the midline during a longer DLS phase demonstrating a different motor control strategy compared to healthy adults.
Aged↗
Modified constraint-induced therapy and botulinum toxin A: a promising combination.
Modified constraint-induced therapy and chemodenervation with botulinum toxin A are each efficacious in managing stroke-induced motor disorders; however, the application of these two promising modalities in combination is yet to be examined. This case study describes a 44-yr-old man who experienced a right middle cerebral artery infarct 14 mo before participating in modified constraint-induced therapy. After modified constraint-induced therapy completion, the patient exhibited substantial improvement in affected upper limb use and function but retained difficulty with finger extension secondary to hypertonicity and spasticity in the forearm flexor muscles. Selective chemodenervation of these muscles with botulinum toxin A greatly improved the patient's self-reported hand function and his scores using objective measures. The authors of this paper present this case to raise the idea of increasing treatment efficacy by combining these two modalities.
Activities of Daily Living↗
Modified constraint-induced therapy in chronic stroke.
Although efficacious, constraint-induced therapy may be difficult to implement in some outpatient settings. This case study examined the effectiveness of modified constraint-induced therapy administered to a patient with chronic stroke, learned nonuse, and a stable motor deficit in his dominant upper limb. The Fugl-Meyer Assessment of Motor Recovery and Action Research Arm Test were administered twice before intervention, and the Motor Activity Log and actigraphy were administered once. The patient then participated in half-hour, structured physical and occupational therapy sessions, emphasizing affected arm use, three times per week for 10 wk. It was concluded that modified constraint-induced therapy may be an effective method of improving affected arm function and use in chronic stroke patients exhibiting learned nonuse.
Aged↗
Algorithm for the detection of muscle activation in surface electromyograms during periodic activity.
A simple surface electromyography (EMG) activation detection algorithm was developed for improved numerical definition of initiation and deactivation of muscle activity during periodic motion when maximum voluntary contractions are impractical to obtain. For the encapsulation of activation/ deactivation periods of a signal as percentages of normal cycle parameters, two interrelated and variable thresholds of percent amplitude and duration of a normalized cycle were the analyzed inputs into an algorithm. Outputs for statistical analysis were total percent activation per cycle, standard deviation of activity per cycle, and temporal indices of where the signal turned on and off. Percent activity per cycle had a coefficient of variance of 0.24 (0.11). After the user chose whether to consider the signal for either encompassing all non-base-line activity or peak activity only, resulting coefficients of variation for percent activity were reduced to 0.16 (0.08). The results indicated the feasibility of a mathematically simple algorithm for repeatable decomposition of EMG activity. The need for a modifiable threshold parameter to incorporate varying needs of salient activity levels was also substantiated.
Algorithms↗
Virtual reality applications for motor rehabilitation after stroke.
Hemiparesis is the primary physical impairment underlying functional disability after stroke. A goal of rehabilitation is to enhance motor skill acquisition, which is a direct result of practice. However, frequency and duration of practice are limited in rehabilitation. Virtual reality (VR) is a computer technology that simulates real-life learning while providing augmented feedback and increased frequency, duration, and intensity of practiced tasks. The rate and extent of relearning of motor tasks could affect the duration, effectiveness, and cost of patient care. The purpose of this article is to review the use of VR training for motor rehabilitation after stroke.
Journal Article↗
Pushrim biomechanics and injury prevention in spinal cord injury: recommendations based on CULP-SCI investigations.
Over 50 percent of manual wheelchair users with spinal cord injury (SCI) are likely to develop upper-limb pain and injury. The majority of studies related to pain have implicated wheelchair propulsion as a cause. This paper draws from a large multisite trial and a long-standing research program to make specific recommendations related to wheelchair propulsion that may decrease the risk of upper-limb injury. The studies include over 60 subjects over 1 yr after a traumatic SCI below the second thoracic level. Specific aspects of the propulsive stroke that may relate to injury include cadence, magnitude of force, and the pattern of the hand during the nonpropulsive part of the stroke. Lower peak forces, slower cadence, and a circular propulsive stroke in which the hand falls below the pushrim during recovery may help prevent injury. In addition, wheelchair users should use the lightest weight adjustable wheelchair possible. Future work should include interventional trials and larger studies that allow for more complex statistical models that can further detail the relationship between wheelchair propulsion, user characteristics, and upper-limb injuries.
Adult↗