Background
Transcutaneous electrical nerve stimulation (TENS) is a non‐invasive treatment to relieve pain. Contralateral TENS (i.e. TENS administered to the contralateral side of a painful body part) ...is beneficial when TENS cannot be directly applied to pain site, such as in cases of trauma. Although TENS produces segmental analgesia in an ipsilateral limb, it has been unclear whether TENS produces higher analgesic effects in the contralateral segmental area. The aim of the present study was to investigate the analgesic effects of TENS in contralateral segmental or extra‐segmental areas on physiological and subjective pain outcomes, using a nociceptive flexion reflex (NFR) method.
Methods
We randomly allocated 60 healthy participants to three groups: contralateral segmental TENS (CS‐TENS); contralateral extra‐segmental TENS (CE‐TENS); and contralateral placebo TENS (CP‐TENS). CS‐TENS was applied to right superficial sural nerve and CE‐TENS was applied to the right superficial femoral nerve, each for 30 minutes. The magnitude of the NFR elicited by electrical stimulation of the left sural nerve was measured at baseline and at three subsequent 10‐minute intervals. Subjective pain intensity was measured simultaneously with a visual analogue scale (VAS).
Results
At 30 min, the NFR magnitude of CS‐TENS group was significantly lower than that of the CP‐TENS group (p = 0.021). There were no significant differences in VAS scores among the groups at any time point.
Conclusions
Our findings suggest that CS‐TENS inhibited NFR. Although there was no significant between‐group difference in subjective pain intensity, factors such as a placebo effect probably impacted it.
Significance
Our findings provide support for the contralateral approach at stimulation sites when TENS cannot be directly administered to a pain site (e.g. due to disease or trauma).
To compare sensory-level neuromuscular electrical stimulation (NMES) and conventional motor-level NMES in patients after total knee arthroplasty.
Prospective randomized single-blind trial.
Hospital ...total arthroplasty center: inpatients.
Patients with osteoarthritis (N=66; mean age, 73.5±6.3y; 85% women) were randomized to receive either sensory-level NMES applied to the quadriceps (the sensory-level NMES group), motor-level NMES (the motor-level NMES group), or no stimulation (the control group) in addition to a standard rehabilitation program.
Each type of NMES was applied in 45-minute sessions, 5d/wk, for 2 weeks.
Data for the quadriceps maximum voluntary isometric contraction, the leg skeletal muscle mass determined using multiple-frequency bioelectrical impedance analysis, the timed Up and Go test, the 2-minute walk test, the visual analog scale, and the range of motion of the knee were measured preoperatively and at 2 and 4 weeks after total knee arthroplasty.
The motor-level NMES (P=.001) and sensory-level NMES (P=.028) groups achieved better maximum voluntary isometric contraction results than did the control group. The motor-level NMES (P=.003) and sensory-level NMES (P=.046) groups achieved better 2-minute walk test results than did the control group. Some patients in the motor-level NMES group dropped out of the experiment because of discomfort.
Motor-level NMES significantly improved muscle strength and functional performance more than did the standard program alone. Motor-level NMES was uncomfortable for some patients. Sensory-level NMES was comfortable and improved muscle strength and functional performance more than did the standard program alone.
Objective: To investigate the effects of dual task balance training in the elderly on standing postural control while performing a cognitive task.
Design: A randomized two-group parallel controlled ...trial.
Participants: Forty-three subjects (all >65 years old) were enrolled in the study and were assigned randomly to either an experimental group (n = 21) or a control group (n = 22).
Interventions: Subjects in the experimental group were given strength and balance training while performing cognitive tasks simultaneously. Subjects in the control group were given strength and balance training only. The training was administered twice a week for three months.
Measurements: The Chair Stand Test, Functional Reach Test, Timed Up and Go Test and Trail Making Test were measured. The sway length of the centre of gravity was measured during standing while performing the Stroop task. The rate of Stroop task was also measured. All measurements were collected at baseline and after the training period.
Results: There were no significant differences in Functional Reach Test, Timed Up and Go Test and sway length at baseline and after training between the two groups. However, the rate of Stroop task (P < 0.05) was significantly higher after training in the experimental group than in the control group.
Conclusions: These results suggest that dual task balance training in elderly people improves their dual task performance during standing postural control.
The human vestibulospinal tract has important roles in postural control, but it has been unknown whether vestibulospinal tract excitability is influenced by the body's postures. We investigated ...whether postures influence the vestibulospinal tract excitability by a neurophysiological method, i.e., applying galvanic vestibular stimulation (GVS) 100 ms before tibial nerve stimulation evoking the soleus H-reflex. GVS is a percutaneous stimulation, and it has not been clarified how the cutaneous input from GVS influences the facilitation effect of cathodal GVS on the soleus H-reflex amplitude. In Experiment 1, we evaluated the effects of GVS on the soleus H-reflex amplitude of subjects in the prone, supine, and sitting positions in random order to clarify the differences in the GVS effects among these postures. In Experiment 2, to determine whether the effects of GVS in the supine and sitting positions are due solely to cutaneous input from GVS, we provided GVS and cutaneous stimulations as conditioning stimuli and compared the effects in both postures. Interaction effects between postures and stimulus conditions were observed in both experiments. The facilitation rate of the maximum H-reflex amplitude by GVS in the sitting position was significantly higher than those in the prone and supine positions (Experiment 1). The facilitation rate of GVS was significantly larger than the cutaneous stimulation only in the sitting position (Experiment 2). These results indicate that vestibulospinal tract excitability may be higher in the sitting position than in either lying position (prone and supine), due mainly to the increased need for postural control.
The body's subjective postural vertical (SPV) has been thought to be affected by somatosensory information. How the SPV is perceived based on what types of somatosensory information has not been ...determined experimentally by manipulating somatosensory conditions. We investigated the effects of disturbing the somatosensory information from a seat pad and/or vestibular sensory information on the SPV in 15 healthy adults. Their SPV values were measured under four conditions (control, somatosensory, vestibular, and somatosensory + vestibular) in random order. The average and absolute SPV values were measured. In the somatosensory condition, a foam rubber pad was placed on the seating surface and the subject's SPV was measured. In the vestibular condition, the SPV was measured during galvanic vestibular stimulation (GVS). The somatosensory + vestibular condition was used to measure the SPV during combined somatosensory and vestibular stimulation. The mean SPV value was significantly increased in the somatosensory + vestibular condition compared to the other three conditions. The absolute value of SPV was significantly increased in the somatosensory and somatosensory + vestibular conditions compared to the control and vestibular conditions. There was no significant difference in the average or absolute SPV values in the vestibular condition compared to the other conditions. There was no significant difference between SPV errors when somatosensory information was disturbed or when somatosensory + vestibular information was disturbed. When the somatosensory information from the seat was disturbed, the SPV error increased, and it also shifted under the influence of the vestibular sensory information modulation. These results indicate that somatosensory information from the seat plays an important role in SPV in healthy adults.
•When somatosensory information from the seat was disturbed, SPV error increased.•SPV did not change by the disturbance of only vestibular sensory information.•SPV shifted by the somatosensory + vestibular sensory information was disturbed.•Somatosensory information from the seat plays an important role in SPV.
•A laser system can easily assess footsteps and walking trajectories in TUG.•People with PD regardless of FOG turned close to the TUG marker.•Turning close to the marker in PD was related to short ...step length when turning.•Healthy older people turned using the large depth of space behind the marker.
Footsteps and walking trajectories during the Timed Up and Go test (TUG), and their relationships with spatiotemporal gait parameters during turning in people with Parkinson’s disease (PD) and older people have not been clarified.
We investigated the footsteps, walking trajectories, and spatiotemporal parameters during the TUG in PD, healthy older (HO), and healthy young (HY) subjects and the associations between the parameters of footsteps or walking trajectories and the spatiotemporal parameters during turning.
Twenty-six PD, 20 HO, and 20 HY subjects participated. They performed the TUG at self-selected speed and underwent evaluations of spatiotemporal parameters in the forward, turning, and return phases and parameters of footsteps and walking trajectories by a system using laser range sensors to measure the two-dimensional distance data of the legs. Foot placement for each foot was measured as the estimated position when the leg speed of movement reached the minimum between foot-contact and foot-off. We calculated the minimum distance from a TUG marker to footsteps and the maximum anterior distance from the start to the footsteps. Step length was calculated using a method for non-linear walking.
The PD subjects showed significantly smaller step lengths in all phases. The minimum distance from the marker to the footsteps in PD subjects was significantly smaller than in HO subjects and was significantly positively correlated only with the turning-phase step length. The maximum anterior distance from the start to footsteps in HO subjects was significantly larger than in PD and HY subjects and was not correlated with any spatiotemporal parameters.
This study demonstrated that people with PD turn close to the TUG marker, and this turning strategy may be associated with the decreased step length when turning. These findings could help in providing instructions which prevent the exaggeration of step-length reduction when turning.
•Degree of H-reflex facilitation by GVS had adequate inter-session reliability.•H-reflex facilitation by GVS was not significantly different between left and right.•H-reflex facilitation by GVS was ...related to lateral deviation of COP when standing.
The vestibulospinal tract (VST) plays an important role in the control of the ipsilateral antigravity muscles, and the balance of left and right VST excitability is important in human postural control. A method for measuring VST excitability is the application of galvanic vestibular stimulation (GVS) before tibial nerve stimulation that evokes the soleus H-reflex; the change rate of the H-reflex amplitude is then evaluated. Assessments of VST excitability and the left and right balance could be useful when determining the pathology for interventions in postural control impairments. However, the reliability and laterality of this assessment have not been clarified, nor has its relationship to postural control. We investigated the reliability, laterality and standing postural control in relation to the degree of facilitation of the H-reflex following GVS in 15 healthy adults. The assessments were performed in two sessions, one each for the left- and right-sides, in random order. The inter-session reliability of the short-interval assessments of an increase in the H-reflex following GVS on both sides were sufficient. The degree of H-reflex facilitation by GVS showed no significant difference between the left- and right-sides in any session. There was a moderate positive correlation between the mediolateral position of the center of pressure in the eyes-closed standing on foam condition and the left/right ratio of the degree of increased H-reflex in the first-session. We concluded that this method for evaluating the increase in the soleus H-reflex following GVS has high inter-session reliability in the short-interval that did not differ between sides.
Long-term physiotherapy is acknowledged to be crucial to manage motor symptoms for Parkinson's disease (PD) patients, but its effectiveness is not well understood.
This systematic review and ...meta-analysis aimed to assess the evidence regarding the effectiveness of long-term physiotherapy to improve motor symptoms and reduce antiparkinsonian medication dose in PD patients.
Pubmed, Cochrane, PEDro, and CINAHL were searched for randomized controlled trials before August 31, 2020 that investigated the effectiveness of physiotherapy for 6 months or longer on motor symptoms and levodopa-equivalent dose (LED) in PD patients with Hoehn and Yahr stage 1- 3. We performed random effects meta-analyses for long-term physiotherapy versus no/control intervention and estimated standard mean differences with 95% confidence intervals (CIs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation approach.
From 2,940 studies, 10 studies involving 663 PD patients were assessed. Long-term physiotherapy had favorable effects on motor symptoms in off medication state - 0.65, 95% CI - 1.04 to - 0.26, p = 0.001 and LED - 0.49, 95% CI - 0.89to - 0.09, p = 0.02. Subgroup analyses demonstrated favorable effects on motor symptoms in off medication state by aerobic exercise - 0.42, 95% CI - 0.64 to - 0.20, p < 0.001 and LED by multidisciplinary rehabilitation of primarily physiotherapy - 1.00, 95% CI - 1.44 to - 0.56, p < 0.001. Quality of evidence for aerobic exercise and multidisciplinary rehabilitation were low and very low.
This review provided evidence that long-term physiotherapy has beneficial impact on motor symptoms and antiparkinsonian medication dose in PD patients and could motivate implementation of long-term physiotherapy.
Postural imbalance, abnormal axial posture, and axial rigidity are the characteristic features of Parkinson’s disease (PD), and they are referred to as axial symptoms. The symptoms are difficult to ...manage since they are often resistant to both L-DOPA and deep brain stimulation. Hence, other treatments that can improve Parkinsonian axial symptoms without adverse effects are required. Vestibular dysfunction occurs in PD since neuropathological changes and reflex abnormalities are involved in the vestibular nucleus complex. Galvanic vestibular stimulation (GVS), which activates the vestibular system, is a noninvasive method. This review aimed to assess the clinical effect of GVS on axial symptoms in PD. To date, studies on the effects of GVS on postural instability, anterior bending posture, lateral bending posture, and trunk rigidity and akinesia in PD had yielded interesting data, and none of the patients presented with severe adverse events, and the others had mild reactions. GVS indicated a possible novel therapy. However, most included a small number of patients, and the sample sizes were not similar in some studies that included controls. In addition, there was only one randomized controlled clinical trial, and it did not perform an objective evaluation of axial symptoms. In this type of research, vestibular contributions to balance should be distinguished from others such as proprioceptive inputs or nonmotor symptoms of PD.
This study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire.
This cross-sectional observational study assessed ...appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment - Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes.
Among the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13-16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R
= 0.662).
This study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.
PDF
