Exercise following burn injury.

Fatigue is a major barrier to recovery for burned individuals. Studies indicate that a slow return to normal or near-normal muscle strength is the natural course of recovery. With no special interventions, other than the "usual care" tailored to the needs of the individual, postburn patients will make gradual improvement in strength and aerobic capacity.

A pilot study of functional electrical stimulation cycling in progressive multiple sclerosis.

Background: Functional electrical stimulation (FES) cycling is used by spinal cord injury patients to facilitate neurologic recovery and may also be useful for progressive MS patients.

Objective: To evaluate the safety and preliminary efficacy of home FES cycling in progressive MS and to explore how it changes cerebrospinal fluid (CSF) cytokine levels.

Methods: Five patients with primary or secondary progressive MS were given an FES cycle for six months.

Augmented exercise in the treatment of deconditioning from major burn injury.

Objective: To investigate the efficacy of a 12-week exercise program in producing greater improvement in aerobic capacity in adult burn survivors, relative to usual care.

Design: Randomized, controlled, double-blinded trial.

Setting: Burn center.

Objective assessment of gait in normal-pressure hydrocephalus.

Objectives: Gait abnormalities are an early clinical symptom in normal pressure hydrocephalus (NPH), and subjective improvement in gait after temporary removal of CSF is often used to decide to perform shunt surgery. We investigated objective measures to compare gait before and after CSF drainage and shunt surgery.

Design: Twenty patients and nine controls were studied.

Burden of burn: a norm-based inquiry into the influence of burn size and distress on recovery of physical and psychosocial function.

This prospective, longitudinal study examined the influence of baseline physical and psychological burden on serial assessments of health-related quality of life among adults with major burns from three regional burn centers (n = 162). Physical burden groups were defined by % TBSA burned: <10%, 10% to 30%, or >30%. Psychological burden groups were defined by in-hospital distress using the Brief Symptom Inventory Global Severity Index T-score with scores of < 63 or > or = 63.

Barriers to employment among working-aged patients with major burn injury.

The purpose of this study was to examine the prevalence of preexisting and burn-related impairments and to describe their association with preburn employment status. Data gathered during the acute hospitalization were analyzed on a consecutive series of burn patients aged 16 to 64 years (N = 770) enrolled in a prospective, longitudinal, multicenter study. Patients who were unemployed before the injury were more likely than those who were employed to report being alcohol-dependent (36 vs 18%), abusing other drugs (22 vs 10%), having received psychiatric treatment in the past year (21 vs 6%), and having preexisting physical disability (23 vs 3%); all were significant at P < .

Continuous passive motion for osteoarthritis of the hip: a pilot study.

Objective: To evaluate whether extended use of continuous passive motion (CPM) may allay the pain of walking, diminish disease effect, and increase the usual walking speed in patients with osteoarthritis (OA) of the hip.

Methods: This pilot study comprised 21 patients with Kellgren-Lawrence grade 2-4 OA of the hip who used CPM for periods of 1.2 to 7.

Mass and mass distribution of below-knee prostheses: effect on gait efficacy and self-selected walking speed.

Objective: To study mass and mass distribution effect on function of below-knee prostheses.

Design: Design modifications were done to produce proximal center of mass location versus distal center of mass location variations, and prosthesis weight was modified from 42% to 70% of normal limb weight. Work across joints of affected and unaffected extremities was compared to assess the ability of the prosthesis to substitute for function loss.

The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults.

Background: The study tested the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health services use in older adults.

Methods: The study was a single-blinded, randomized controlled trial with intention-to-treat analysis. Adults (n = 105) age 68-85 with at least mild deficits in strength and balance were selected from a random sample of enrollees in a health maintenance organization.

A comparison of the effects of three types of endurance training on balance and other fall risk factors in older adults.

We hypothesized that short-term endurance training improves balance in older adults, if training involves movements that "stress" balance. We tested the hypothesis by looking for a dose-response relationship between movement during exercise and balance improvement. The study was a single-blinded, randomized controlled trial.

Factors associated with changes in gait speed in older adults.

Background: The study addressed whether changes in gait speed in community-dwelling older adults were associated with changes in fitness (strength and aerobic capacity), physical health status, and/or depressive symptoms.

Methods: The study sample comprised 152 community-dwelling adults aged 68-85 who had participated in an exercise study. Study measures at baseline and 6-month follow-up included gait speed, a leg strength score, maximal aerobic capacity (VO2max), CES-Depression scale, and physical health status (SIP Physical Dimension).

Evidence for a non-linear relationship between leg strength and gait speed.

Although the relationship between strength and physical performance in older adults is probably non-linear, few empirical studies have demonstrated that this is so. In a population-based sample of adults aged 60-96 years (n = 409), leg strength was measured in four muscle groups (knee extensor, knee flexor, ankle plantar flexor, ankle dorsiflexor) of both legs using an isokinetic dynamometer. A leg strength score was calculated as the sum of the four strength measurements in the right leg.

The relationship of joint symptoms with exercise performance in older adults.

Objectives: The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history. In addition, we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise, and report the incidence of musculoskeletal injuries upon initiation of an exercise program.

Design: A population-based, single blinded, randomized controlled trial with three exercise groups and one control group.

Isokinetic testing of ankle strength in older adults: assessment of inter-rater reliability and stability of strength over six months.

The study purposes were (1) to estimate the inter-rater reliability of isokinetic strength tests at the ankle in older adults (test-retest interval of three to 7 days), and to determine whether more experienced examiners were more reliable; and (2) to estimate 6 month stability of strength tests. Inter-rater reliability was high for plantar flexion and dorsiflexion tests where average strength was more than about 10 Newton-meters (Nm) (Pearson R = 0.87-0.

The Seattle FICSIT/MoveIt study: the effect of exercise on gait and balance in older adults.

While exercise is generally recommended for older adults, the specific role of exercise in preventing falls and frail health is unclear. The Seattle FICSIT/MoveIt study is a population-based, randomized, controlled trial comparing the effects of three 6-month exercise interventions (endurance training, strength training, or combined endurance and strength training), and three 3-month endurance training interventions (stationary cycle, walking, or aerobic movement). Primary study outcomes are aerobic capacity, strength, gait, balance, and physical functional status.

Footwear and posture. Compensatory strategies for heel height.

The belief that wearing high-heeled shoes increases lumbar lordosis is firmly ingrained in clinical folklore. Proponents of negative heel footwear argue that because high positive heels increase the lumbar lordosis, negative heels will decrease the lumbar lordosis. Quantitative documentation of the assumption regarding high heels is not to be found in the literature, although sporadic attempts to prove this assumption have been made throughout the 20th Century.

Torque development in isokinetic training.

Twenty men were randomized into three groups that performed maximal isokinetic knee extensions five days a week for 12 weeks; a fourth group was a control group. The training protocol was different for the opposite lower extremity of each subject, such that subjects in group I trained at 36 degrees/sec with 20 or 60 repetitions, group II did 20 repetitions at 36 degrees/sec with one limb and 60 repetitions at 108 degrees/sec contralaterally, and group III trained at 108 degrees/sec with 20 or 60 repetitions. Group IV did no training.

Shoulder subluxation in hemiplegia: effects of three different supports.

Shoulder subluxation in hemiplegia is a difficult problem to manage and it may be associated with pain and other complications. Measurements taken from x-rays have been used to obtain objective measures of shoulder subluxation, but have not been used to compare the effects of different shoulder supports. This study used x-ray measurements to evaluate different shoulder supports for subluxation in hemiplegia and to see if there was a significant difference between the Harris hemisling and the Bobath sling.

Heterotopic ossification and peripheral nerve entrapment: early diagnosis and excision.

Heterotopic ossification can occur in neurologic disorders, burns, musculoskeletal trauma, and metabolic disorders. In addition to producing the complications of contracture, skin breakdown, and pain, it can cause peripheral nerve entrapment. Nerve entrapment due to heterotopic ossification may be misdiagnosed, and it is difficult to evaluate and treat without recurrence.

Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement.

This paper presents a hypnotherapeutic intervention for controlling pain in severely burned patients while they go through dressing changes and wound debridement. The technique is based on Barber's (1977) Rapid Induction Analgesia (RIA) and involves hypnotizing patients in their rooms and having their nurses provide posthypnotic cues for analgesia during wound cleaning. Five subjects who underwent hypnotherapy showed reductions on their pain rating scores (Visual Analogue Scale) relative to their own baselines and to the pain curves of a historical control group (N = 8) matched for initial pain rating scores.

Relating mental health and physical function at discharge to rehabilitation status at three months postburn.

Preinjury mental health is said to be a major predictive factor in the rehabilitation progress of burn patients. However, it is unclear which component of rehabilitation (emotional v physical) is predicted by this variable; furthermore, the predictive validity of preinjury mental health has not been compared with physical variables. The present study compared preinjury mental health, physical variables, and length of hospitalization in predicting the rehabilitation progress of 59 major burn patients at three-month follow-up.

The role of the biomechanics laboratory in the analysis of the gait of individuals with arthritis.

The function of a biomechanics laboratory is to measure those aspects of an individual patient's performance that cannot be quantitatively assessed in the clinical setting. Essential equipment provides the ability to measure gait events, ground reactive forces, kinematics (movement of the body and its segments in 3 dimensions), electromyographic activity, and oxygen consumption. A minicomputer with video screen is required to process the data and allow visual checks of the functioning of the system.

Patient self-reports three months after sustaining a major burn.

As survival rates of patients with major burns increase, it is becoming more important to study the course and quality of their recovery. Few studies of the recovery of these patients exist that use a prospective design and standardized measures. This paper describes a preliminary study of the self-reported health of patients three months after sustaining a major burn.

Gait abnormalities in peroneal nerve paralysis and their corrections by orthoses: a biomechanical study.

Stroke, brain injury, incomplete spinal cord injuries, and peripheral neuropathies frequently result in dysfunction of the foot dorsiflexors and evertors. A controlled examination of aspects of these disabilities was conducted with normal volunteers who underwent a temporary peroneal nerve block. The effects of peroneal nerve paralysis were analyzed to quantitatively describe the resulting gait abnormalities and to assess the effectiveness of orthoses in restoring a normal gait pattern.

Ankle-foot orthoses: effect on gait abnormalities in tibial nerve paralysis.

To study the biomechanical effects of gastrocnemius-soleus dysfunction and its potential remediation, the gait patterns of six able-bodied young adults were analyzed before and after induced temporary tibial nerve paralysis. Ambulation with the tibial nerve block was performed with and without the assistance of an ankle-foot orthosis (AFO) with a rigid anterior stop adjusted to either 5 degrees plantarflexion or 5 degrees dorsiflexion. The gait abnormalities resulting from tibial nerve paralysis include delayed advancement of the center of pressure, delayed ipsilateral heeloff and early contralateral heelstrike, decreased steplength, decreased ankle dorsiflexion moment, and increased knee flexion moment.