Long-term effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis

OBJECTIVE: To study the effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis. SUBJECTS: Patients after a first-ever supratentorial stroke (n = 198), who had been admitted for inpatient rehabilitaion, and patients with recently diagnosed multiple sclerosis (n =146). DESIGN: Prospective, observational study over a period of 3 years. MEASUREMENTS: Physical functioning was measured with the motor score of the Functional Independence Measure at baseline (time of diagnosis), and at 6 months, and 1 and 3 year follow-ups. Cardiovascular, respiratory, musculoskele nottal, diabetes mellitus, and other comorbidities were measured at baseline. RESULTS: Patients after stroke and multiple sclerosis with comorbidity showed a significantly lower level of physical functioning over all 4 measurements. There was no difference in the course of physical functioning between patients after stroke with and without comorbidity. In patients with multiple sclerosis, a greater decrease in physical functioning over the 3-year follow-up was found in patients with comorbidity of the musculoskeletal system compared with patients without. CONCLUSION: These findings indicate that similar improvements in physical functioning can be expected during rehabilitation of stroke patients with comorbidity compared with patients without these conditions. In patients with multiple sclerosis, musculoskeletal comorbidity requires further attention because of its association with a greater decrease in physical functionin

The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review

OBJECTIVE: To describe the effects of upper body training on the physical capacity of people with a spinal cord injury. DATA SOURCES: The databases of PubMed, CINAHL, Sport Discus and Cochrane were searched from 1970 to May 2006. REVIEW METHODS: The keywords 'spinal cord injury', 'paraplegia', 'tetraplegia' and 'quadriplegia' were used in combination with 'training'. The methodological quality of the included articles (both randomized controlled trials and controlled clinical trials) was assessed with the modified 'van Tulder et al.' checklist. Studies were described with respect to population, test design, training protocol and mode of training. The training effects on physical capacity, reflected by peak power output (PO(peak)) and oxygen uptake (VO(2peak)), were summarized. RESULTS: Twenty-five studies were included with a mean score of 8.8 out of 17 items on the quality checklist. The methodological quality was quite low, mostly because of the absence of randomized controlled trials. Therefore no meta-analysis was possible. In the 14 articles of acceptable quality the mean (SD) increase in VO( 2peak) and PO(peak,) following a period of training, was 17.6 (11.2)% and 26.1 (15.6)%, respectively. CONCLUSIONS: Due to the overall low quality of studies it is not possible to draw definitive conclusions on training effects for different lesion groups or training modes. The results of the relatively few studies with an acceptable quality seem to support the view that upper body exercise may increase the physical capacity of people with spinal cord injury. The magnitude of improvement in PO( peak) and VO(2peak), however, varies considerably among studie

Diet and foraging range of Slender-billed Gulls <i>Chroicocephalus genei</i> breeding in the Saloum Delta, Senegal

West African Slender-billed Gulls Chroicocephalus genei are considered vulnerable due to a very restricted breeding range. However, little information on their ecology is available to support conservation action. We describe diet and foraging range of Slender-billed Gulls breeding in the Saloum Delta National Park in Senegal. Diet was analysed on the basis of fish otoliths in excretion (mixture of pellets and faeces) collected near nests at the end of the incubation period between 2000 and 2015. Gulls mainly consumed fish of the families Cichlidae (25-93%), Clupeidae (0-54%) and Mugilidae (0-34%). The log-ratio proportion of Mugilidae increased significantly between 2000 and 2015, but there was no significant trend for other prey taxa. In 2014, UvA-BITS GPS-trackers were fitted to three Slender-billed Gulls to study movement and foraging range. During daytime, these gulls spent 27% of their time incubating the eggs, 10% elsewhere in the colony and 63% outside the colony on foraging trips. Foraging trips lasted on average 18 +/- 9.5 (+/- SD) hours. Total distance covered was on average 96 +/- 39 km with a maximum distance to the colony of 37 +/- 13 km. There were marked and consistent individual differences in the flight paths of the gulls. In two birds, foraging mainly took place in mangrove-bordered lagoons, salt pans, creeks, rivers and a complex of abandoned rice fields. The third bird almost exclusively explored the Atlantic coast near a fishing village in The Gambia. The home range and the foraging area of the three birds together measured 2400 and 1800 km(2), respectively. The diet components found near the nests of the three birds could only partly be related to their foraging areas

Physical activity stimulation program for children with cerebral palsy did not improve physical activity: a randomised trial

AbstractQuestion: In children with cerebral palsy, does a 6-month physical activity stimulation program improve physical activity, mobility capacity, fitness, fatigue and attitude towards sports more than usual paediatric physiotherapy? Design: Multicentre randomised controlled trial with concealed allocation, blinded assessments and intention-to-treat analysis. Participants: Forty-nine walking children (28 males) aged 7–13 years with spastic cerebral palsy and severity of the disability classified as Gross Motor Function Classification System level I–III. Intervention: The intervention group followed a 6-month physical activity stimulation program involving counselling through motivational interviewing, home-based physiotherapy, and 4 months of fitness training. The control group continued their usual paediatric physiotherapy. Outcome measures: Primary outcomes were walking activity (assessed objectively with an activity monitor) and parent-reported physical activity (Activity Questionnaire for Adults and Adolescents). Secondary outcomes were: mobility capacity, consisting of Gross Motor Function Measure-66 (GMFM-66), walking capacity and functional strength, fitness (aerobic and anaerobic capacity, muscle strength), self-reported fatigue, and attitude towards sport (child and parent). Assessments were performed at baseline, 4 months, 6 months and 12 months. Results: There were no significant intervention effects for physical activity or secondary outcomes at any assessment time. Positive trends were found for parent-reported time at moderate-to-vigorous intensity (between-group change ratio=2.2, 95% CI 1.1 to 4.4) and GMFM-66 (mean between-group difference=2.8 points, 95% CI 0.2 to 5.4) at 6 months, but not at 12 months. There was a trend for a small, but clinically irrelevant, improvement in the children's attitudes towards the disadvantages of sports at 6 months, and towards the advantages of sports at 12 months. Conclusions: This physical activity stimulation program, that combined fitness training, counselling and home-based therapy, was not effective in children with cerebral palsy. Further research should examine the potential of each component of the intervention for improving physical activity in this population. Trial registration: NTR2099. [Van Wely L, Balemans ACJ, Becher JG, Dallmeijer AJ (2014) Physical activity stimulation program for children with cerebral palsy did not improve physical activity: a randomised trial. Journal of Physiotherapy 60: 40–49

Methods and protocols for incremental exercise testing in tetraplegia, using arm-crank ergometry assisted by Functional Electrical Stimulation

Cervical spinal cord injury (SCI) leads to tetraplegia, with paralysis and loss of sensation in the upper and lower limbs. The associated sedentary lifestyle results in an increased risk of cardiovascular disease. To address this, we require the design of exercise modalities aimed specifically at tetraplegia and methods to assess their efficacy. This paper describes methods for arm-crank ergometry (ACE) assisted by Functional Electrical Stimulation (FES) applied to the biceps and triceps. The instrumented ergometer enables work-rate control during exercise, implemented here for incremental exercise testing during FES-ACE. Detailed protocols for the tests are given. Experimental data collected during exercise tests with tetraplegic volunteers are provided to illustrate the feasibility of the proposed approach to testing and data analysis. Incremental tests enabled calculation of peak power output and peak oxygen uptake. We propose that the high-precision exercise testing protocols described here are appropriate to assess the efficacy of the novel exercise modality, FES-ACE, in tetraplegia

Comparison of muscle strength, sprint power and aerobic capacity in adults with and without cerebral palsy

Objective: To compare: (i) muscle strength, sprint power and maximal aerobic capacity; and (ii) the correlations between these variables in adults with and without cerebral palsy. Design: Cross-sectional study. Subjects: Twenty adults with and 24 without cerebral palsy. Methods: Isometric and isokinetic knee extension strength, sprint power (mean power over the 30s (P30)), peak aerobic power output (POpeak) and oxygen uptake (VO2peak) were determined. Regression analysis was used to investigate correlations between parameters. Results: Adults with cerebral palsy had significantly lower strength (53-69%) and P30 (67%) than adults without cerebral palsy, but similar POpeak and VO2peak. In adults without cerebral palsy the only significant correlations, albeit weak, were between P30 and isometric (R-2=0.34) or isokinetic strength (R-2=0.20), as well as the correlation between P30 and VOpeak (R-2=0.26) or POpeak (R-2=0.36). Stronger correlations were found in the group with cerebral palsy between P30 and isometric (R-2=0.52) and isokinetic strength (R-2=0.71) and between P30 and VOpeak (R-2=0.75) or POpeak (R-2=0.94). Conclusion: In contrast to aerobic capacity, strength and P30 are reduced in (active) people with cerebral palsy. Stronger correlations were found between strength, P30 and POpeak in adults with cerebral palsy. Therefore, muscle strength may be the limiting factor in adults with cerebral palsy for activities involving the lower extremities, such as cycling

Lipid, lipoprotein and apolipoprotein profiles in active and sedentary men with tetraplegia

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Altered contractile properties of the quadricepts muscle in people with spinal cord injury following functional electrical stimulated cycle training

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