Action for Rehabilitation from Neurological Injury (ARNI): A pragmatic study of functional training for stroke survivors

This article has been made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 Cherry Kilbride et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This study evaluated the effectiveness of a twelve-week community-based functional training on measures of impairment, activity and participation in a group of stroke survivors. Isometric strength of the knee musculature, Centre-Of-Pressure (COP) based measures of balance, Berg Balance Scale (BBS), 10 m walk test, and the Subjective Index of Physical and Social Out come (SIPSO), were recorded at baseline, post-intervention, and after twelve weeks (follow-up). Exercise instructors delivered training once a week in a group format at a community centre. Significant improvement was noted in the BBS (p < 0.002), and 10 m walk speed (p = 0.03) post intervention which remained unchanged at follow-up. Total SIPSO score improved significantly post-intervention (p = 0.044). No other significant differences and no adverse effects were observed. It is possible that functional training provided more opportunity for the improvement of dynamic aspects of balance control that could be captured by the BBS but not with the traditional measures of balance using COP data. Results also suggest positive effects on the level of participation, and lack of association between measures of impairment and activity. Community based functional training could be effective and used to extend access to rehabilitation services beyond the acute and sub-acute stages after stroke.London Borough of Hillingdo

Mechanical and material properties of the plantarflexor muscles and Achilles tendon in children with spastic cerebral palsy and typically developing children

© 2016 The Authors. Background: Children with spastic cerebral palsy (CP) experience secondary musculoskeletal adaptations, affecting the mechanical and material properties of muscles and tendons. CP-related changes in the spastic muscle are well documented whilst less is known about the tendon. From a clinical perspective, it is important to understand alterations in tendon properties in order to tailor interventions or interpret clinical tests more appropriately. The main purpose of this study was to compare the mechanical and material properties of the Achilles tendon in children with cerebral palsy to those of typically developing children. Methods: Using a combination of ultrasonography and motion analysis, we determined tendon mechanical properties in ten children with spastic cerebral palsy and ten aged-matched typically developing children. Specifically, we quantified muscle and tendon stiffness, tendon slack length, tendon strain, cross-sectional area, Young׳s Modulus and the strain rate dependence of tendon stiffness. Findings: Children with CP had a greater muscle to tendon stiffness ratio compared to typically developing children. Despite a smaller tendon cross-sectional area and greater tendon slack length, no group differences were observed in tendon stiffness or Young׳s Modulus. The slope describing the stiffness strain-rate response was steeper in children with cerebral palsy. Interpretation: These results provide us with a more differentiated understanding of the muscle and tendon mechanical properties, which would be relevant for future research and paediatric clinicians

Effects of an acute bout of dynamic stretching on biomechanical properties of the gastrocnemius muscle determined by shear wave elastography

Aims The aim of this study was to examine the acute effects of dynamic stretching (DS) exercise on passive ankle range of motion (RoM), resting localized muscle stiffness, as measured by shear wave speed (SWS) of medial gastrocnemius muscle, fascicle strain, and thickness. Methods/Results Twenty-three participants performed a DS protocol. Before and after stretching, SWS was measured in the belly of the resting medial gastrocnemius muscle (MGM) using shear wave elastography. DS produced small improvements in maximum dorsiflexion (+1.5 ±1.5; mean difference ±90% confidence limits) and maximum plantarflexion (+2.3 ±1.8), a small decrease in fascicle strain (-2.6% ±4.4) and a small increase in SWS at neutral resting angle (+11.4% ±1.5). There was also a small increase in muscle thickness (+4.1mm ±2.0). Conclusions Through the use of elastography, this is the first study to suggest that DS increases muscle stiffness, decreases fascicle strain and increases muscle thickness as a result of improved RoM. These results can be beneficial to coaches, exercise and clinical scientists when choosing DS as a muscle conditioning or rehabilitation intervention

Influence of dynamic stretching on ankle joint stiffness, vertical stiffness and running economy during treadmill running

Data availability statement: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Copyright © 2022 Pamboris, Noorkoiv, Baltzopoulos, Powell, Howes and Mohagheghi. The purpose of the present study was to investigate whether and how dynamic stretching of the plantarflexors may influence running economy. A crossover design with a minimum of 48 h between experimental (dynamic stretching) and control conditions was used. Twelve recreational runners performed a step-wise incremental protocol to the limit of tolerance on a motorised instrumented treadmill. The initial speed was 2.3 m/s, followed by increments of 0.2 m/s every 3 min. Dynamic joint stiffness, vertical stiffness and running kinematics during the initial stage of the protocol were calculated. Running economy was evaluated using online gas-analysis. For each participant, the minimum number of stages completed before peak O2 uptake (V̇O2peak) common to the two testing conditions was used to calculate the gradient of a linear regression line between V̇O2 (y-axis) and speed (x-axis). The number of stages, which ranged between 4 and 8, was used to construct individual subject regression equations. Non-clinical forms of magnitude-based decision method were used to assess outcomes. The dynamic stretching protocol resulted in a possible decrease in dynamic ankle joint stiffness (−10.7%; 90% confidence limits ±16.1%), a possible decrease in vertical stiffness (−2.3%, ±4.3%), a possibly beneficial effect on running economy (−4.0%, ±8.3%), and very likely decrease in gastrocnemius medialis muscle activation (−27.1%, ±39.2%). The results indicate that dynamic stretching improves running economy, possibly via decreases in dynamic joint and vertical stiffness and muscle activation. Together, these results imply that dynamic stretching should be recommended as part of the warm-up for running training in recreational athletes examined in this study

Dynamic stretching is not detrimental to neuromechanical and sensorimotor performance of ankle plantarflexors

© 2018 The Authors. The acute effects of two dynamic stretching (DS) protocols on changes in the ankle range of motion (RoM), neuromechanical, and sensorimotor properties of the plantarflexor muscle group were examined. Eighteen participants received slow (SDS) or fast dynamic stretching (FDS) on two separate days. Outcome measures were assessed pre‐ and 2 minutes post‐interventions, and included maximum dorsiflexion angle, maximum isometric torque at neutral ankle position, maximum concentric and eccentric torques, force matching capacity, joint position sense and medial gastrocnemius muscle and tendon strain. Possibly and likely small increases in dorsiflexion RoM were observed after SDS (mean ± 90% confidence intervals; 1.8 ± 1.2°) and FDS (2.1 ± 1.2°), respectively. Very likely moderate decreases in muscle strain after SDS (−38.0 ± 20.6%) and possibly small decrease after FDS (−13.6 ± 21.2%) were observed. SDS resulted in a likely beneficial small increase in tendon strain (25.3 ± 29.7%) and a likely beneficial moderate increase after FDS (41.4 ± 44.9%). Effects on strength were inconsistent. Possibly small effect on positional error after SDS (−27.1 ± 37.5%), but no clear effect after FDS was observed. Both DS protocols increased RoM, and this was more due to an increase in tendon elongation rather than the muscle. However, SDS showed greater improvement than FDS in both neuromechanical and sensorimotor performance, and hence, SDS can be recommended as part of warm‐up in sporting contexts

A systematic review with meta-analysis of the StartReact effect on motor responses in stroke survivors and healthy individuals

Control of limb movements may be impaired after stroke due to the loss of connectivity between the cerebral cortex and spinal cord. A notion to improve motor function in stroke survivors is to use alternate motor fibers, such as the reticulospinal tract (RST), which originate from the brainstem and terminate at different levels of spinal cord. One way of targeting the RST is to use a “StartReact” protocol to foster premature release of a preplanned movement in response to a startling stimulus. Our aim was to find support for the preservation of such StartReact effect in stroke survivors. We conducted a systematic review with meta-analysis of literature published in English up to September 2020, to explore differences in motor responses to startling stimuli in StartReact effects. Protocol of the study was registered (PROSPERO Registration No. CRD42020191581). PubMed, Google Scholar, Web of Science, PsycINFO, and Science Direct were searched for relevant literature. The meta-analysis contained six studies involving a total of 151 stroke and healthy participants. Muscle onset latency data were extracted from the qualifying studies and compared using RevMan. StartReact effect was present in both stroke and healthy groups, represented by shortened muscle onset latency when startling stimulus was present. There was considerable heterogeneity of the outcome measures, which was attributed to the range of motor impairments among stroke survivors and methodologies used. Our findings support the notion of preservation of preprogramming ability and suitability of RST and StartReact effect for motor rehabilitation following stroke

Influence of dynamic stretching on ankle joint stiffness, vertical stiffness and running economy during treadmill running

The purpose of the present study was to investigate whether and how dynamic stretching of the plantarflexors may influence running economy. A crossover design with a minimum of 48 h between experimental (dynamic stretching) and control conditions was used. Twelve recreational runners performed a step-wise incremental protocol to the limit of tolerance on a motorised instrumented treadmill. The initial speed was 2.3 m/s, followed by increments of 0.2 m/s every 3 min. Dynamic joint stiffness, vertical stiffness and running kinematics during the initial stage of the protocol were calculated. Running economy was evaluated using online gas-analysis. For each participant, the minimum number of stages completed before peak O2 uptake (V̇O2peak) common to the two testing conditions was used to calculate the gradient of a linear regression line between V̇O2 (y-axis) and speed (x-axis). The number of stages, which ranged between 4 and 8, was used to construct individual subject regression equations. Non-clinical forms of magnitude-based decision method were used to assess outcomes. The dynamic stretching protocol resulted in a possible decrease in dynamic ankle joint stiffness (−10.7%; 90% confidence limits ±16.1%), a possible decrease in vertical stiffness (−2.3%, ±4.3%), a possibly beneficial effect on running economy (−4.0%, ±8.3%), and very likely decrease in gastrocnemius medialis muscle activation (−27.1%, ±39.2%). The results indicate that dynamic stretching improves running economy, possibly via decreases in dynamic joint and vertical stiffness and muscle activation. Together, these results imply that dynamic stretching should be recommended as part of the warm-up for running training in recreational athletes examined in this study

Quality of life in patients with advanced gastric cancer: a randomized trial comparing docetaxel, cisplatin, 5-FU (TCF) with epirubicin, cisplatin, 5-FU (ECF)

BACKGROUND: Health related quality of life (HRQOL) is an important outcome after treatment for upper gastrointestinal carcinoma. This study aimed to compare HRQOL in patients with advanced gastric cancer (GC) receiving either a standard or an experimental treatment. METHODS: Seventy-one patients have been treated in Cancer Institute (Tehran, Iran) with docetaxel, cisplatin, 5 FU (TCF) or epirubicin, cisplatin, 5-FU (ECF) and were followed from Jan 2002 to Jan 2005. End points were response rate, HRQOL and survival. HRQOL was assessed using the EORCT QLQ-C30 at baseline and after the third cycle of chemotherapy. RESULTS: The baseline HRQOL scores were comparable between two groups. After treatment improvement was seen in a number of items and domains except for cognitive functioning, and diarrhoea. Pain decreased and physical functioning improved in both groups. However, only the TCF group showed statistically and clinically meaningful improvement in global QOL (P = 0.001). Surgical and pathologic response was better with TCF but there was no difference in survival rate between two groups. CONCLUSION: Docetaxel based treatment (TCF) showed better palliation and improvement of global QOL as compared with epirubicin based treatment (ECF). However, it seems that regardless of treatment offered, effective chemotherapy was the most important factor affecting QOL in these patients

Quality of life in patients with gastric cancer: translation and psychometric evaluation of the Iranian version of EORTC QLQ-STO22

<p>Abstract</p> <p>Background</p> <p>Disease and treatment related events, can adversely affect the quality of life of patients with cancer. The purpose of this study was to translate and validate a gastric cancer specific health related quality of life questionnaire (EORTC QLQ-STO22) for Iranian patients suffering from gastric cancer.</p> <p>Methods</p> <p>Forward-backward procedure was applied to translate the English language version of the EORTC QLQ-STO22 into Persian (Iranian language). Then, the questionnaire and the EORTC core quality of life instrument (QLQ-C30) were administered to a sample of patients with confirmed diagnosis of gastric cancer. All patients filled in questionnaires before and after one month of treatment. Patients were divided into two groups based on intension of treatment (curative vs. palliative). Reliability and validity of the module was tested by internal consistency and known group comparisons, respectively.</p> <p>Results</p> <p>In all, 105 patients were entered into the study. Cronbach's alpha for multi-item scales (to test reliability) ranged from 0.54 to 0.87. The questionnaire discriminated well between clinically distinct subgroups of patients both before and after treatment lending support to its convergent and clinical validity.</p> <p>Conclusion</p> <p>Overall, the Iranian version of the EORTC QLQ-STO22 demonstrated a good reliability and clinical validity to support its use in combination with core questionnaire in outcome studies of gastric cancer in Iran. However, using the QLQ-STO22 in a wide range of Iranian patients with gastric cancer should allow further confirmation for its psychometric properties.</p

Locomotor Adaptation versus Perceptual Adaptation when Stepping Over an Obstacle with a Height Illusion

Background During locomotion, vision is used to perceive environmental obstacles that could potentially threaten stability; locomotor action is then modified to avoid these obstacles. Various factors such as lighting and texture can make these environmental obstacles appear larger or smaller than their actual size. It is unclear if gait is adapted based on the actual or perceived height of these environmental obstacles. The purposes of this study were to determine if visually guided action is scaled to visual perception, and to determine if task experience influenced how action is scaled to perception. Methodology/Principal Findings Participants judged the height of two obstacles before and after stepping over each of them 50 times. An illusion made obstacle one appear larger than obstacle two, even though they were identical in size. The influence of task experience was examined by comparing the perception-action relationship during the first five obstacle crossings (1–5) with the last five obstacle crossings (46–50). In the first set of trials, obstacle one was perceived to be 2.0 cm larger than obstacle two and subjects stepped 2.7 cm higher over obstacle one. After walking over the obstacle 50 times, the toe elevation was not different between obstacles, but obstacle one was still perceived as 2.4 cm larger. Conclusions/Significance There was evidence of locomotor adaptation, but no evidence of perceptual adaptation with experience. These findings add to research that demonstrates that while the motor system can be influenced by perception, it can also operate independent of perception