Effect of Early Radial Shock Wave Treatment on Spasticity in Subacute Stroke Patients: A Pilot Study

Background. Spasticity is a complication that can start immediately after stroke. Radial extracorporeal shock wave therapy (rESWT) is a physical therapy tool used to manage chronic spasticity. However, the effect of rESWT's early use to treat spasticity after stroke is still not clearly investigated. The aim of this study is to evaluate the efficacy of rESWT in improving poststroke spasticity of the upper limb in patients with a recent onset of spasticity compared to conventional physiotherapy alone. Methods. 40 stroke patients were randomly assigned to experimental (EG) or control group (CG). Both groups underwent two daily sessions of conventional rehabilitation therapy (CRT) 5 days per week; the EG underwent one rESWT session a week for 4 weeks. The modified Ashworth scale (MAS) tested at the shoulder, elbow, and wrist was used as outcome measure. MAS was evaluated at baseline, after 2 and 4 rESWT session, and one month after the last session (follow-up). Results. No significant differences between groups were found at baseline in terms of age, days from onset of spasticity after stroke, and MAS at each body segment. The sample lost eight drop-out patients. Except for the shoulder MAS values, the EG showed statistically significant lower MAS values already after the second rESWT session compared to CG. This significant difference was maintained until the follow-up. The CG showed a significant increase of wrist spasticity after the second evaluation, while the EG maintained constant MAS values throughout the observational period. The elbow spasticity was significantly higher in the CG at the follow-up evaluation. Conclusion. The rESWT combined with CRT seems to be effective in avoiding the increasing progression of spasticity after stroke

Early balance training with a computerized stabilometric platform in persons with mild hemiparesis in subacute stroke phase: a randomized controlled pilot study

Background: Along with conventional therapy, novel tools are being developed in balance training for the rehabilitation of persons with stroke sequelae. The efficacy of Computerized Balance Training thus far been the object of studies only in persons with chronic stroke. Objective: To investigate the effects of an early Computerized Balance Training on balance, walking endurance and independence in activities of daily living, in persons with mild hemiparesis in subacute phase. Methods: Thirty-two persons with a recent hemiparesis (within 4 weeks from stroke onset), able to maintain a standing position for at least 30 seconds, were randomly assigned to an experimental or control group. The control group (CG) were administered conventional physiotherapy of 40 minutes twice a day, 5 times a week for 4 weeks, while the experimental group (EG) underwent conventional physiotherapy 40 minutes once a day and Computerized Balance Training once a day, 5 times a week for 4 weeks. Outcomes were evaluated by means of Berg Balance Scale (BBS), Tinetti Balance Scale (TBS), Two Minutes Walk Test (2MWT), Barthel Index (BI) and stabilometric tests. Results: Twelve participants for each group completed the training. Each group experienced 8 dropouts. The mean age (years) was 58.1 ± 20.4 for EG and 59.7 ± 14,7 for CG; the days from stroke were respectively 27.9 ± 15.5 and 20 ± 11.7. The difference between the two groups was statistically significant in experimental group for BBS (p = 0.003), for TBS (p = 0.028), for Sensory Integration and Balance tests performed with closed eyes on steady (p = 0.009) or instable surface (p = 0.023). and for 2MWT (p = 0.008). Conclusions: Computerized Balance Training is an effective therapeutic tool for balance and gait endurance improvement in persons with stroke in subacute phase

WHICH IS THE BEST WAY TO PERFORM THE PHYSIOLOGICAL COST INDEX IN ACTIVE INDIVIDUALS WITH UNILATERAL TRANS-TIBIAL AMPUTATION?

BACKGROUND: Physiological Cost Index (PCI) is a simple method used to estimate energy expenditure during walking. It is based on a ratio between heart rate and self-selected walking speed. Previous studies reported that PCI is reliable in individuals with lower limb amputation but only if there is an important walking impairment. No previous studies have investigated the correlation of PCI with the Energy Cost Walking (ECW) in active individuals with traumatic unilateral trans-tibial amputation, considering that this particular category of amputees has an ECW quite similar to healthy individual without lower limb amputation. Moreover, it is important to determine if PCI is also correlated to ECW in the treadmill test so as to have an alternative to over-ground test. OBJECTIVES: The aim of this study was to evaluate the correlation between PCI and ECW in active individuals with traumatic trans-tibial amputation in different walking conditions. The secondary aim was to evaluate if this correlation permits to determine ECW from PCI values. METHODOLOGY: Ninety traumatic amputees were enrolled. Metabolic data, heart rate and walking speed for the calculation of ECW and for PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test. FINDINGS: There is a significant correlation between ECW and PCI walking over-ground (p=0.003; R2=0.10) and on treadmill with 12% slopes (p=0.001; R2=0.11) but there is only a poor to moderate correlation around the trendline. No significant correlation was found walking on treadmill with 0% slope. The Bland-Altman plot analysis suggests that is not possible to evaluate ECW directly from PCI. CONCLUSIONS: PCI is a reliable alternative measure of energy expenditure during walking in active individuals with trans-tibial amputation when performing over-ground or at high intensity effort on treadmill. PCI is therefore useful only for monitoring a within subject assessment. Layman’s Abstract: The knowledge of the energy cost of walking in disabled people is important to improve strategies of rehabilitation or fitness training and to develop new prosthetic and orthotic components. The “gold standard” for the evaluation of the energy cost of walking is the oxygen consumption measurement with a metabolimeter, but the testing procedure is expensive and time consuming, hardly practicable in many rehabilitation centers. The Physiological Cost Index (PCI) is an indirect tool that evaluates the oxygen consumption during walking. PCI considers heart rate during walking, in relation to the speed, as an indicator of energy expenditure. The formula is “walking heart rate – resting heart rate /speed”. PCI is widely used in literature but there is not a solid evidence of a direct correlation between PCI and energy cost of walking. In particular, for individuals with unilateral trans-tibial amputation without comorbidities, no previous studies have been conducted about this correlation. It has to be noticed that individuals with unilateral trans-tibial amputation have an energy cost of walking quite similar to healthy people. Previous studies reported that in healthy people such correlation does not exist. For this reason, the aim of this study was to evaluate if and in which walking condition a linear correlation exists between PCI and Energy Cost Walking in individuals with unilateral trans-tibial amputation. Oxygen consumption measurement with a metabolimeter and PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test in 90 participants. We have found that PCI is an alternative measure of energy cost of walking when performing over-ground or with high intensity effort on treadmill (12% slope). These findings could be useful when PCI is used for monitoring a fitness training or for evaluation tests. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32953/25717 How To Cite:: Brunelli S, Sancesario A, Iosa M, Delussu A.S, Gentileschi N, Bonanni C, Foti C, Traballesi M. Which is the best way to perform the Physiological Cost Index in active individuals with unilateral trans-tibial amputation? Canadian Prosthetics & Orthotics Journal. 2019, Volume2, Issue1, No.5. https://doi.org/10.33137/cpoj.v2i1.32953. Corresponding Author:Dr. Stefano Brunelli,Fondazione Santa Lucia, IRCCS, Via Ardeatina 306, 00179 Rome, Italy.ORCID: https://orcid.org/0000-0002-5986-1564Tel. +39 0651501844; Fax +39 0651501919E-MAIL: [email protected]