1,721,316 research outputs found
The Efficiency of Manual Therapy and Sacroiliac and Lumbar Exercises in Patients with Sacroiliac Joint Dysfunction Syndrome
No full textThe Efficiency of Manual Therapy and Sacroiliac and Lumbar Exercises in Patients with Sacroiliac Joint Dysfunction Syndrome
No full textFacilitating person-centred task-oriented training with a human-centred developed rehabilitation technology in neurorehabilitation
No full textBackground
For persons with central nervous system diseases (PwCNS) a person-centred task-
oriented rehabilitation approach seems important to regain or maintain functional
ability in daily life activities (ADL). However, rehabilitation services struggle to provide
this approach and to provide the optimal rehabilitation time of 6 hours per day.
Rehabilitation technology has proven to increase the person’s motivation and
adherence to therapy. The use of rehabilitation technology may also be able to
increase rehabilitation time without decreasing the quality of therapy or increasing the
therapists’ workload.
Aim
To investigate the effect of additional person-centred task-oriented training with a
customised rehabilitation technology on functional performance and ADL in PwCNS
and whether individualised goals are more explicitly trained in the intervention group.
Methods and materials
A multicentre single-blinded randomised controlled trial was performed in PwCNS.
The control group received treatment-as-usual. The intervention group received
treatment-as-usual and additional training with a customised technology during 6
weeks, 3x/week, 45min/session under supervision of a trained professional.
Assessments were performed at baseline, after 3 and 6 weeks of training, and at 6
weeks follow-up. The primary outcome measures were Wolf Motor Function Test,
Manual Ability Measure-36 (MAM-36) and Canadian Occupational Performance
Measure (COPM). Additionally, the trained and untrained goals of both groups were
compared to investigate whether the individualised goals were more explicitly trained
in the intervention group.
Results
Forty-five PwCNS (age 59.07 ± 16.42) performed the full protocol. Both the control
and intervention group improved over time on the primary outcome measures, mainly
during the 6-week training period. Significant differences between control and
intervention group were found regarding MAM-36 after 6 weeks of training in favour
of the intervention group. In the control group, the distribution of untrained versus
trained COPM goals was about 50%. While in the intervention group, more than 85%
of the COPM goals were implemented in the treatment-as-usual and additional
intervention programme.
Conclusions
Additional training with a customised rehabilitation technology can enhance
treatment-as-usual and may facilitate a person-centred task-oriented approach in
PwCNS. This intervention might be used to increase therapy time in the future but
research into independent use by PwCNS is necessary
Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial
No full textBACKGROUND: Attentional distraction from pain has been shown to be largely ineffective for obtaining a hypoalgesic effect in patients with chronic pain when compared to a control condition. It has been hypothesized that this may be due to the non-engaging types of distraction that have been used so far. Moreover, it is suggested that the hypoalgesic effects of distraction may be attenuated by pain-related cognitions and emotions, as they may increase the attention to pain. METHODS: In this randomized controlled trial, patients with chronic nonspecific low back pain in the intervention group (n = 42) performed a single exercise session with nonimmersive VR games, while those in the control group (n = 42) performed the same exercises without VR games. We investigated whether VR distraction had a hypoalgesic effect during and immediately after the exercises, and whether it reduced the time spent thinking of pain during the exercises. We further explored whether pain-related fear, pain catastrophizing and baseline pain intensity moderated the effects of VR distraction. RESULTS: VR distraction had a hypoalgesic effect during (Cohen's d = 1.29) and immediately after (Cohen's d = 0.85) the exercises, and it also reduced the time spent thinking of pain (Cohen's d = 1.31). Preliminary exploratory analyses showed that pain-related fear, pain catastrophizing and baseline pain intensity did not moderate the effects of VR distraction. CONCLUSIONS: Large effect sizes of VR distraction induced hypoalgesia were observed. This suggests that nonimmersive VR games can be used when it is deemed important to reduce the pain during exercises in patients with chronic nonspecific low back pain. TRIAL REGISTRATION: NCT02679300. This trial was registered on 10 February 2016.status: Publishe
Facilitating person-centred task-oriented training with a human-centred developed rehabilitation technology in neurorehabilitation
No full textBackground
For persons with central nervous system diseases (PwCNS) a person-centred task-
oriented rehabilitation approach seems important to regain or maintain functional
ability in daily life activities (ADL). However, rehabilitation services struggle to provide
this approach and to provide the optimal rehabilitation time of 6 hours per day.
Rehabilitation technology has proven to increase the person’s motivation and
adherence to therapy. The use of rehabilitation technology may also be able to
increase rehabilitation time without decreasing the quality of therapy or increasing the
therapists’ workload.
Aim
To investigate the effect of additional person-centred task-oriented training with a
customised rehabilitation technology on functional performance and ADL in PwCNS
and whether individualised goals are more explicitly trained in the intervention group.
Methods and materials
A multicentre single-blinded randomised controlled trial was performed in PwCNS.
The control group received treatment-as-usual. The intervention group received
treatment-as-usual and additional training with a customised technology during 6
weeks, 3x/week, 45min/session under supervision of a trained professional.
Assessments were performed at baseline, after 3 and 6 weeks of training, and at 6
weeks follow-up. The primary outcome measures were Wolf Motor Function Test,
Manual Ability Measure-36 (MAM-36) and Canadian Occupational Performance
Measure (COPM). Additionally, the trained and untrained goals of both groups were
compared to investigate whether the individualised goals were more explicitly trained
in the intervention group.
Results
Forty-five PwCNS (age 59.07 ± 16.42) performed the full protocol. Both the control
and intervention group improved over time on the primary outcome measures, mainly
during the 6-week training period. Significant differences between control and
intervention group were found regarding MAM-36 after 6 weeks of training in favour
of the intervention group. In the control group, the distribution of untrained versus
trained COPM goals was about 50%. While in the intervention group, more than 85%
of the COPM goals were implemented in the treatment-as-usual and additional
intervention programme.
Conclusions
Additional training with a customised rehabilitation technology can enhance
treatment-as-usual and may facilitate a person-centred task-oriented approach in
PwCNS. This intervention might be used to increase therapy time in the future but
research into independent use by PwCNS is necessary
Developing an intelligent activity-based client-centred training system with a user-centred approach
No full textBACKGROUND: In neurorehabilitation, clinicians and managers are searching for new client-centred task-oriented applications which can be administered without extra costs and effort of therapists, and increase the client's motivation. OBJECTIVE: To develop and evaluate a prototype of an intelligent activity-based client-centred training (i-ACT) system based on Microsoft Kinect (R). METHODS: Within an iterative user centred process, the i-ACT prototype was developed and necessary features were established for use in neurological settings. After the test trial with a high fidelity prototype, the value, usefulness, and credibility were evaluated. RESULTS: Seven therapists participated in focus groups and 54 persons with neurological problems participated in test trials. A prototype was established based on the user's experience. Results show that clients and therapists acknowledge the value and usefulness (clients 5.71/7; therapists 4.86/7), and credibility (clients 21.00/27; therapists 14.50/27) of i-ACT. CONCLUSIONS: Therapists want to be able to record an endless range of movements and activities which enables individualised exercise programs for persons with disabilities. For therapists it is important that the system provides feedback about the quality of movement and not only results. In future work, clinical trials will be performed towards feasibility and effectiveness of i-ACT in neurorehabilitation and other rehabilitation domains.This study was part of the Technology Transfer (Tetra) project "Open intelligent rehabilitation framework for client-centred functional therapy with motion detection systems" (project number 140324) funded by Flemish Government Vlaio.Knippenberg, E (corresponding author), PXL Univ Coll, Ctr Expertise, Innovat Care, Guffenslaan 39, B-3500 Hasselt, Belgium.
[email protected]
Gluteus Maximus Transfer as an Augmentation Technique for Patients With Severe Abductor Deficiency of the Hip
No full textImpaired abductor function of the hip following severe abductor deficiencies can be devastating for functionality and quality of life. Recently, gluteus maximus transfer has been proposed as a solution to these difficult problems. However, outcome results are sparse. The aim of this study was to evaluate the effects of gluteus maximus transfer on improvement of pain, disability, and quality of life in patients with severe hip abductor deficiencies. Gluteus maximus transfer was performed in 16 patients with severe disruption of the abductor muscles of the hip. Data were collected preoperatively and at 6 weeks, 3 and 6 months, and 1 to 2 years after surgery. The measurements pertained to complications, healing of the flap based on magnetic resonance imaging (MRI) findings (in 10 patients), evaluation of Trendelenburg gait and sign, and patient-reported outcome measures of pain, disability, and quality of life. Preoperatively, all patients had a positive Trendelenburg sign and reported severe pain at the level of the greater trochanter. At a mean follow-up of 20 months,the Trendelenburg sign was negative in 7 patients and the Trendelenburg gait had disappeared in 7 patients. There was an improvement in patient-reported outcome measures but not to a significant level except for the pain subscores. Two patients had a postoperative seroma that resulted in a visible bump on the lateral side. Seven of 10 repairs with MRI follow-up showed perfect ingrowth on MRI without signs of rerupture. Gluteus maximus transfer for abductor deficiency of the hip may be effective for pain relief and functional improvements.Most patients showed an improved quality of life but were not completely pain free.Corten, K (corresponding author), Hosp Zuid Oost Limburg Genk, Dept Orthoped Surg, Schiepse Bos 6, B-3600 Genk, Belgium.
[email protected]
Motivating elderly to perform physical activity through a technology-based system.
No full textIntroduction:
To age in place, elderly need to maintain their strength, flexibility and mobility by continuing
to be physical active in daily life. The intelligent Activity-based Client-centred Training (i-
ACT), developed for neurorehabilitation, may also support physical activity in elderly by
working client-centred towards their physical needs and/or wishes in a safe environment.
Objectives:
To assess the motivation, usability and credibility of i-ACT in elderly to perform physical
activity .
Method:
A cross-sectional feasibility study was performed in five elderly (day) care centres in
Flanders, Belgium. Participants received a 20-30 minutes’ trial with i-ACT consisting of
different upper and/or lower limb exercises. After the trial, the Intrinsic Motivation
Inventory, System Usability Scale, and Credibility/Expectancy Questionnaire were
administered to evaluate the motivation, usability and credibility of the participants.
Results:
Forty-eight elderly were included (20 men, 28 women, aged 81.2±8.1 years). The IMI-scores
indicate a good to very good motivation of using i-ACT (>3.40/5.00). The SUS-scores
represent a good usability (median 72.50 (67.50-85.00)), and the CEQ-scores show a high
score regarding the credibility of i-ACT (median 20.25 (16.80-24.00)), and a moderate
expectancy towards i-ACT (median 15.90 (8.60-19.60)).
Conclusion:
The i-ACT is considered user-friendly and motivates elderly to perform physical exercises.
Participant belief the i-ACT can support them in being physically active. The efficacy of i-ACT
to perform physical activity in elderly has yet to be investigated a
Technology-supported exercise therapy for patients with chronic non-specific low back pain: a feasibility study
No full textIntroduction Various technological systems supporting exercise therapy for low back pain (LBP) have been developed in recent years. One of the problems with the current technology-supported exercise therapy programs for LBP is that they mostly adopt an analytical approach.Purpose/Aim(1) To develop a functional exercise therapy program supported by sensor-based postural feedback, and (2) to evaluate this program in a pilot study.Materials and methodsTen patients with chronic non-specific low back pain and an underlying motor control impairment were recruited. The subjects participated in a rehabilitation program consisting out of 36 sessions (18 weeks). Subjects mainly performed a partially supervised exercise program that included 30 minutes of general conditioning and 90 minutes of functional motor control exercises. The motor control exercises were tailored to the patient’s specific needs and used concepts of segmentation and simplification. During these exercises, postural feedback from motion sensors (ValedoMotion, version 1.2) placed at the L1 and S1 level was provided to the patients. In addition, serious games that had to be controlled by pelvic tilts were used to improve thoracolumbar dissociation. The technological support was also available for home exercises. Primary outcomes were pain (numeric pain rating scale), disability (Roland Morris questionnaire and patient specific functioning scale), self-efficacy (pain self-efficacy questionnaire), kinesiophobia (Tampa scale for kinesiophobia) and treatment satisfaction. Secondary outcomes were quality of life (short form-36), motivation (intrinsic motivation inventory) and credibility and expectancy of the treatment (credibility and expectancy questionnaire).ResultsExcept for treatment satisfaction, there was a significant improvement on all of the primary outcomes. The differences in median scores between baseline and post-intervention were clinically relevant for pain and disability: pain improved 3 points on the numeric pain rating scale (p< 0.05), disability was reduced by 5.5 points on the Roland Morris questionnaire (p< 0.01) and by 3 points on the patient specific functioning scale (p< 0.01). For the secondary outcomes, there was a significant improvement on two subscales of the IMI (p< 0.01) and on the physical component of the short form-36 (p< 0.001). No significant differences were found for the CEQ.ConclusionsIt is feasible to use sensor-based postural feedback in combination with functional exercises, and this approach leads to clinically important improvements in pain and disability. An adequately powered randomized controlled trial should be conducted to confirm the results from this pilot study. To assess the additional value of the postural feedback, this program should be compared to an exercise program without technological support
Biopsy samples from the erector spinae of persons with nonspecific chronic low back pain display a decrease in glycolytic muscle fibers
No full textBackground context
Low back pain (LBP) in Western Europe was classified as having the highest disability and overall burden among 291 studied conditions. For an extensive period of time evidence has accumulated related to morphological changes (e.g. atrophy and fat infiltration) of the paraspinal muscles in persons with LBP. Despite this evidence, there is limited knowledge on muscle fiber type composition of these muscles, and their relation to LBP.
Purpose
The aim of the study is to investigate differences in muscle fiber type composition between persons with non-specific chronic low back pain (NSCLBP) and healthy controls for the lumbar erector spinae (ES) and multifidus (MF) muscle.
Study design and setting
A cross sectional study took place in the REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium.
Patient sample
Twenty persons with NSCLBP (age: 44.5 ±7.42) and eighteen healthy controls (age: 39.89 ±7.90) participated in this study.
Outcome measures
The primary outcome measure was paraspinal muscle fiber type composition. Secondary outcomes consisted of physiologic measures (maximal aerobic capacity and back muscle strength) and functional measures (activity level).
Methods
Biopsy samples were taken from the lumbar ES and MF muscle at the L4 spinal level. These samples were stained using immunofluorescent antibodies against myosin heavy chains (MHC). In each sample, number and size (CSA) of type I, I/IIa, IIa, IIa/x, and IIx muscle fibers were quantified. From these data the relative cross-sectional fiber areas (RCSA) were calculated. To analyze differences in fiber type composition between healthy persons and persons with NSCLBP, a repeated measurements analysis of variance (ANOVA) was used. Secondary outcome measures were analyzed using a Student's t-test, and Wilcoxon test. This study was supported by the research fund of Hasselt University without potential conflict of interest.
Results
There were no significant differences between both groups regarding anthropometric data. There were no significant between group differences for CSA in the ES. Persons with NSCLBP displayed a non-significant (p= 0.0978) increase in the number of type I muscle fibers, and a significant decrease (p= 0.0019) in the number of type IIx muscle fibers in the ES muscle. Persons with NSCLBP also displayed a trend towards a higher (p= 0.0596) RCSA for type I fibers and a significantly lower RCSA for type IIx fibers (p= 0.0411). There were no significant between group differences within the MF. Regarding the secondary outcome measures, there was a significant between group difference in activity level (p=0.0004) and isokinetic back muscle strength (p=0.0342).
Conclusions
This is the first study to examine muscle fiber type characteristics in both the ES and MF muscle of persons with NSCLBP. Based on muscle fiber characteristics, the paraspinal muscles of persons with NSCLBP seems to display a larger oxidative potential based on an increase of the number type I fibers at the expense of type IIx glycolytic fibers.Our gratitude goes to Geert Souverijns, MD (Jessa Hospital, Department of Radiology, Belgium) who gave us the opportunity to work with a medical doctor of his department We also like to thank the Department of Pneumology (KULeuven) for their help with the immunofluorescent staining. There is no study funding sources
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