Does walking the day of total hip arthroplasty speed up functional independence? A non-randomized controlled study

Abstract Background Few data address modalities for speeding up functional independence in subjects included in a fast-track approach after total hip arthroplasty (THA). The study aim was to assess short-term effects of mobilization and walking the day of THA (WDS) on independence, pain, function and quality of life. Methods Seventy-one patients were allocated in a study (SG: n = 36) or control (CG: n = 35) groups according to time of surgery and recovery from anesthesia. Patients who recovered lower limbs sensitivity (disappearance of sensation deficits) and motility (MRC scale ≥3 at knee, ankle and great toe extension) by 7.00 p.m. made up the SG, whereas patients who underwent surgery later and recovered from anesthesia after 7.00 p.m. made up the CG. SG underwent WDS, whereas CG performed mobilization and walking the day after surgery starting the same physiotherapy program 1 day later. Patients were evaluated for independence (Functional Independence Measure - FIM), pain (Numeric Rating Scale - NRS), hip function (Harris Hip Score - HHS) and quality of life (EuroQoL-5Dimension - EQ. 5D and EQ. 5D-VAS)the day before surgery, at 3 and 7 days in a hospital setting. Analysis of Covariance with age (SG: mean 60.9, SD 9.0; CG: mean 65.5, SD 8.9) and BMI (SG: mean 27.4, SD 2.8; CG: mean 26.7, SD 2.4) as covariates was used to assess between-group differences over time. Results Between-groups differences were observed for FIM total and motor scores (p = 0.002, mean difference: 2.1, CI95: 0.64, 3.7) and FIM self-care (p = 0.01, mean difference: 1.7, CI95: 0.41, 3) in favor of SG at 3 days. Between-group differences were found for FIM self-care (p = 0.021, mean difference: 1.2, CI95: 0.18, 2.1) in favor of SG at 7 days. FIM total and motor scores (p <  0.001), FIM self-care (p = 0.027) and transfer-locomotion (p <  0.001) and HHS (p = 0.032) decreased after surgery followed by improvements in postoperative days (p ≤ 0.001). No differences were found for NRS, EQ. 5D and EQ. 5D-VAS. Conclusions WDS produces additional benefits in patients’ independence in the first week after THA. Absence of pain aggravation or adverse effects on hip function and quality of life may allow clinicians to recommend WDS to promote discharge with functional independence

Early sleep after action observation plus motor imagery improves gait and balance abilities in older adults

Abstract Action observation plus motor imagery (AOMI) is a rehabilitative approach to improve gait and balance performance. However, limited benefits have been reported in older adults. Early sleep after motor practice represents a strategy to enhance the consolidation of trained skills. Here, we investigated the effects of AOMI followed by early sleep on gait and balance performance in older adults. Forty-five older adults (mean age: 70.4 ± 5.2 years) were randomized into three groups performing a 3-week training. Specifically, AOMI-sleep and AOMI-control groups underwent observation and motor imagery of gait and balance tasks between 8:00 and 10:00 p.m. or between 8:00 and 10:00 a.m. respectively, whereas Control group observed landscape video-clips. Participants were assessed for gait performance, static and dynamic balance and fear of falling before and after training and at 1-month follow-up. The results revealed that early sleep after AOMI training sessions improved gait and balance abilities in older adults compared to AOMI-control and Control groups. Furthermore, these benefits were retained at 1-month after the training end. These findings suggested that early sleep after AOMI may represent a safe and easy-applicable intervention to minimize the functional decay in older adults

Dispersion of Knee Helical Axes during Walking after Maximal versus Resistant Strength Training in Healthy Subjects

Knee joint stability can be estimated during functional tasks through the analysis of the helical axes (HAs) dispersion. The study aimed at investigating (1) the test&ndash;retest reliability of knee HAs dispersion during walking and (2) the effects of maximal versus resistant strength training on knee HAs dispersion during walking. Thirty healthy subjects (age: 22.6 &plusmn; 2.1 years) randomized into a maximal training (MT) group and a resistance training (RT) group underwent a 2-week quadricep&ndash;hamstring strength training at 90% or 30% of the maximum voluntary contraction, respectively. Participants walked on a treadmill with clusters of retro-reflective markers placed on thighs and shanks to detect knee kinematics with an optoelectronic system. Knee HAs dispersion was assessed using mean distance (MD) and mean angle (MA) at 1 week before training start, before and after the first training session, and before and after the last training session. Moderate to excellent reliability was found for MD and MA on the sagittal plane (ICCs &ge; 0.70). No differences over time were found for MD and MA between MT and RT. HAs dispersion indexes resulted in reliable parameters for the quantification of knee stability on the sagittal plane during walking. Maximal and resistance strength training induced no knee HAs dispersion changes during walking

Early sleep after action observation and motor imagery training boosts improvements in manual dexterity

: The systematic observation and imagination of actions promotes acquisition of motor skills. Furthermore, studies demonstrated that early sleep after practice enhances motor learning through an offline stabilization process. Here, we investigated behavioral effects and neurodynamical correlates of early sleep after action observation and motor imagery training (AO + MI-training) on motor learning in terms of manual dexterity. Forty-five healthy participants were randomized into three groups receiving a 3&nbsp;week intervention consisting of AO + MI-training immediately before sleeping or AO + MI-training at least 12&nbsp;h before sleeping or a control stimulation. AO + MI-training implied the observation and motor imagery of transitive manual dexterity tasks, whereas the control stimulation consisted of landscape video-clips observation. Manual dexterity was assessed using functional tests, kinematic and neurophysiological outcomes before and after the training and at 1-month follow-up. AO + MI-training improved manual dexterity, but subjects performing AO + MI-training followed by early sleep had significantly larger improvements than those undergoing the same training at least 12&nbsp;h before sleeping. Behavioral findings were supported by neurodynamical correlates during motor performance and additional sleep-dependent benefits were also detected at 1&nbsp;month follow-up. These findings introduce a new approach to enhance the acquisition of new motor skills or facilitate recovery in patients with motor impairments

EEG connectivity in functional brain networks supporting visuomotor integration processes in dominant and non-dominant hand movements

: Objective.This study explores the changes in the organization of functional brain networks induced by performing a visuomotor integration task, as revealed by noninvasive spontaneous electroencephalographic traces (EEG).Approach.EEG data were acquired during the execution of the Nine Hole Peg Test (NHPT) with the dominant and non-dominant hands in a group of 44 right-handed volunteers. Both spectral analysis and phase-based connectivity analysis were performed in the theta (θ), mu (μ) and beta (ß) bands. Graph Theoretical Analysis (GTA) was also performed to investigate the topological reorganization induced by motor task execution.Main results.Spectral analysis revealed an increase of frontoparietal θ power and a spatially diffused reduction ofμand ß contribution, regardless of the hand used. GTA showed a significant increase in network integration induced by movement performed with the dominant limb compared to baseline in the θ band. Theμand ß bands were associated with a reduction in network integration during the NHPT. In theμrhythm, this result was more evident for the right-hand movement, while in the ß band, results did not show dependence on the laterality. Finally, correlation analysis highlighted an association between frequency-specific topology measures and task performance for both hands.Significance.Our results show that functional brain networks reorganize during visually guided movements in a frequency-dependent manner, differently depending on the hand used (dominant/non dominant)

Kinematic evaluation and reliability assessment of the Nine Hole Peg Test for manual dexterity

Background: The Nine Hole Peg Test (NHPT) is one of the most frequently used tools to assess manual dexterity. However, no kinematic parameters are provided to describe the quality of the motor performance, since time is the only score. Purpose: To investigate test-retest and intrarater reliability, correlation with clinical test score, and discriminant validity of kinematic indexes during NHPT.Study Design: A clinical measurement study.Methods: Twenty-five healthy right-handed volunteers performed the NHPT. An experienced physiotherapist administered two sessions at a 6-hour interval with two trials for dominant and non-dominant upper limbs. An optoelectronic system was used to detect NHPT performance, which was divided into nine consecutive peg-grasp, peg-transfer, peg-in-hole, hand-return phases, and one final removing phase. Outcome measures were total and single phases times, normalized jerk, mean, peak and time-to-peak of velocity, curvature index during peg-grasp and hand-return phases, and trunk 3D displacement. The statistical analysis included Intraclass Correlation Coefficients (ICCs) for test-retest and intra-rater reliability, Pearson's coefficients for correlation with the NHPT score, and paired t-tests for discriminant validity.Results: Test-retest reliability was excellent for trunk rotation (ICC: 0.91) and good to moderate for the other indexes (ICCs: 0.89-0.61). Intra-rater reliability was excellent for total and removing times (ICCs: 0.91 and 0.94) and good to moderate for the other indexes (ICCs: 0.84-0.66), except for trunk inclination (ICC: 0.37). NHPT phases, normalized jerk, mean velocity, peak of velocity, time-to-peak and curvature index correlated with total time (r-score: 0.8-0.3). NHPT phases and most kinematic indexes discriminated the dominant from non-dominant upper limb, with the greatest effect size for normalized jerk during hand-return ( d = 1.16).Conclusions: Kinematic indexes during NHPT can be considered for manual dexterity assessment. These indexes may allow for the detection of kinematic changes responsible for NHPT score variations in healthy subjects or patients with upper limb impairments.(c) 2022 Elsevier Inc. All rights reserved

Effects of Action Observation Plus Motor Imagery Administered by Immersive Virtual Reality on Hand Dexterity in Healthy Subjects

: Action observation and motor imagery (AOMI) are commonly delivered through a laptop screen. Immersive virtual reality (VR) may enhance the observer's embodiment, a factor that may boost AOMI effects. The study aimed to investigate the effects on manual dexterity of AOMI delivered through immersive VR compared to AOMI administered through a laptop. To evaluate whether VR can enhance the effects of AOMI, forty-five young volunteers were enrolled and randomly assigned to the VR-AOMI group, who underwent AOMI through immersive VR, the AOMI group, who underwent AOMI through a laptop screen, or the control group, who observed landscape video clips. All participants underwent a 5-day treatment, consisting of 12 min per day. We investigated between and within-group differences after treatments relative to functional manual dexterity tasks using the Purdue Pegboard Test (PPT). This test included right hand (R), left hand (L), both hands (B), R + L + B, and assembly tasks. Additionally, we analyzed kinematics parameters including total and sub-phase duration, peak and mean velocity, and normalized jerk, during the Nine-Hole Peg Test to examine whether changes in functional scores may also occur through specific kinematic patterns. Participants were assessed at baseline (T0), after the first training session (T1), and at the end of training (T2). A significant time by group interaction and time effects were found for PPT, where both VR-AOMI and AOMI groups improved at the end of training. Larger PPT-L task improvements were found in the VR-AOMI group (d: 0.84, CI95: 0.09-1.58) compared to the AOMI group from T0 to T1. Immersive VR used for the delivery of AOMI speeded up hand dexterity improvements

Functional and postural recovery after bilateral or unilateral total hip arthroplasty

One-stage bilateral total hip arthroplasty (THA) implies similar complication rate and hospitalization time to unilateral THA, but no studies have evaluated the functional and postural recovery in these patients. The aim of this study was to assess short-term functional and postural recovery in patients after one-stage bilateral or unilateral THA. Forty patients undergoing bilateral (n = 20) or unilateral (n = 20) THA were assessed by Timed Up and Go (TUG), Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK) and Body Weight Distribution Symmetry Index (BWDSI) during stand-to-sit (STS). Centre of Pressure (CoP) parameters and BWDSI during standing with eyes open (EO) and closed (EC) were also assessed. Data were collected one day before surgery, at three and seven days. No between-group differences were found for TUG, NRS and TSK at any time-point, showing similar mobility, pain and fear of movement in both groups. BWDSI during STS (P = 0.001) and standing (OE P = 0.007; CE P = 0.012) revealed differences over time in favor of patients with bilateral THA, who showed better symmetry in weight distribution. Shorter CoP path length was observed during standing in patients with unilateral THA (OE P = 0.023; CE P = 0.018), who mainly used their non-affected limb to maintain balance