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Article 22 (NIDRR) Effectiveness of Off-Axis Training on Improving Knee Function in Individuals with Patellofemoral Pain
2012 ACRM–ASNR Annual Conference Abstracts
Other, Including Multiple Diagnostic Groups Article 21 (NIDRR) Development and Evaluation of a Terrain Dependent Electrical Powered Wheelchair Driver Assistance System. Hongwu Wang (University of Pittsburgh, Pittsburgh, PA). Disclosure: None disclosed. Objective: Develop an electrical powered wheelchair (EPW) driver assistance system to improve the performance of EPWs, to decrease the chances of falls and tip over, and to increase the community participation and quality of life of users. Design: Engineer Development and Clinical Validation. Setting: Rehabilitation Engineering Research Center. Main Outcome Measures: EPW performance variables and user rating regarding driving experience. Results: An add-on package to commercial EPWs has been designed and developed where the sensing components can detect different terrains as well as EPW driving parameters, and a tablet computer can record performance variables. Experimental tests with different driving rules on different terrains showed that EPWs require different driving rules on individual terrains to improve their handling performance. A user study with ten able-body subjects confirmed the experimental test results and showed that performance variables agreed with user perceived ratings. Another user study with ten EPW users is planned in May where the system with terrains sensing and automated switching of driving rules will be evaluated. Conclusions: An add-on terrain dependent EPW driver assistance system with developed driving rules will improve the EPW performance and provide better user experience on different terrains. With this system, the challenges related to hazardous terrains for EPW users could be minimized, thus their community participation will be increased. Furthermore, the add-on system could allow clinicians to better understand and evaluate driving performance of EPW users with quantitative data, enhancing the evidence-based practice for EPW prescription and clinical practice. Key Words: Diagnosis-independent; Motor function; Technology; Rehabilitation. Article 22 (NIDRR) Effectiveness of Off-Axis Training on Improving Knee Function in Individuals with Patellofemoral Pain. Liang-Ching Tsai (Northwestern University, Chicago, IL), Song-Joo Lee, Cindy Lin, Aaron Yang, Yupeng Ren, Francois Gaiger, Alison H-I Chang, Joel M. Press, Li-Qun Zhang. Disclosure: Yupeng Ren and Li-Qun Zhang have a personal interest in the device used in the current study. Yupeng Ren is the president of the company Rehabtek LLC, that is developing the device used in the study and has received federal grants to develop and commercialize the device. Li-Qun Zhang has an equity position in the company. Objective: Patellofemoral pain (PFP) is thought to be associated with altered patellofemoral mechanics due to impaired neuromuscular control of the lower extremity, particularly on the frontal and transverse planes (i.e., off-axis motions). The purpose of this study was to examine the effectiveness of an off-axis training program on improving knee pain and function in individuals with PFP. Design: Repeated measures design. Setting: Controlled, laboratory setting. Interventions: Five subjects diagnosed with PFP participated in a six-week exercise program that consisted of a series of lower extremity off-axis neuromuscular training using a custom-made elliptical trainer that allows frontal-plane sliding and transverse-plane pivoting of the two footplates. Main Outcome Measures: Changes in knee pain and function post training were evaluated using Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) scores. Subjects’ lower extremity off-axis neuromuscular control was assessed by calculating the variability (i.e., standard deviation) of the foot rotation angle (FRA) and foot sliding distance (FSD) relative to the initial starting foot positions while performing a stepping task on the elliptical trainer. Results: On average, subjects reported a higher KOOS and IKDC score following the 6-week off-axis training program. Decreased variability of the
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FRA and FSD were also observed post-training. Conclusions: An off-axis training program using a robotic elliptical trainer was effective in enhancing lower extremity neuromuscular control on the frontal and transverse planes. The enhanced off-axis neuromuscular control posttraining was accompanied by a reduction in knee pain and improvement in knee function in persons with PFP. Key Words: Patellofemoral pain; Function and impairment-independent; Technology; Rehabilitation. Article 23 High-Intensity Antigravity Motor Training Improves Clinical Status and Gait Capacity in Parkinson’s Disease. Martin H. Rose (University of Copenhagen, Copenhagen, Denmark), Annemette Løkkegaard, Stig Sonne-Holm, Bente R. Jensen. Disclosure: None disclosed. Background: Patients with Parkinson’s disease (PD) benefit from physical training and the intensity tends to increase the effect. However, their ability to perform physical exercise in a natural environment is compromised due to motor impairment. Objective: To evaluate the effects of high-intensity antigravity motor training on clinical status and gait capacity in PD. Methods: Thirteen patients with idiopathic PD (H&Y 2. 1) completed eight weeks (3x1hour/week) of progressive high-intensity motor training on an antigravity treadmill (lower-body-positive-pressure). Patients were evaluated using the Movement-Disorders-Society-Unified-Parkinson’s-Disease-Rating-Scale (MDS-UPDRS), Parkinson’s-Disease-Questionnaire-39 (PDQ39) and six-minutes walking test, eight weeks prior to, pre- and post-training. Data obtained between the first and second measurement served as paired control data. The training was performed in a one-patient to one-coach setup. Motor control was challenged during (1) running and walking using sudden changes in artificial body weight and speed, (2) different types of locomotion (e.g. chasse, skipping and jumps) and (3) intervals with high speed sprints in fractional gravity. Results: At the end of training, statistical significant improvements were found in all outcome measures compared to the control period. Total MDS-UPDRS changed from (mean⫾1SD) 58⫾18 to 47⫾18, MDS-UPDRS motor part from 35⫾10 to 29⫾12, total summary score of PDQ39 from 22⫾13 to 13⫾12 and 6-minute walking distance from 576⫾93m to 637⫾90m. No changes were observed during the control period. Conclusions: Patients with Parkinson’s disease were able to complete eight weeks of high-intensity antigravity motor training. The training improved clinical status and gait capacity significantly. Key Words: Neurodegenerative disorder; Motor function; Clinical practice; Rehabilitation. Article 24 An Experimental Study of the Impacts of Assistive Technology on Users and Their Informal Caregivers. Ben Mortenson (Simon Fraser University, Burnaby, BC, Canada). Disclosure: None disclosed. Objectives: To determine if an inclusive approach to assistive technology provision (AT) is effective in 1) improving AT users’ activity performance, and 2) decreasing their caregivers’ sense of burden. Design: Delayed-intervention, randomized control trial. Setting: The homes of community-dwelling participants. Participants: Baseline data were collected on 88 participants (44 dyads). The mean ages of assistance users and their informal caregivers were 83 and 71 years respectively. Interventions: The intervention involved: (1) a detailed in-home assessment by an experienced occupational therapist, (2) identification of a problematic activity according to both the caregiver and AT user, (3) negotiation of an AT focused intervention plan, and (4) implementation of this plan, including device provision and training and home modifications. Main Outcome Measures: The primary outcome measure for AT users was the Assessment of Life Habits and the primary outcome measure for caregivers was the Caregiver Assistive Technology Outcome Measure. Results: Compared to the delayed intervention group, assistance users in the immediate intervention group experienced significantly increased satisfacArch Phys Med Rehabil Vol 93, October 2012
Other, Including Multiple Diagnostic Groups Article 21 (NIDRR) Development and Evaluation of a Terrain Dependent Electrical Powered Wheelchair Driver Assistance System. Hongwu Wang (University of Pittsburgh, Pittsburgh, PA). Disclosure: None disclosed. Objective: Develop an electrical powered wheelchair (EPW) driver assistance system to improve the performance of EPWs, to decrease the chances of falls and tip over, and to increase the community participation and quality of life of users. Design: Engineer Development and Clinical Validation. Setting: Rehabilitation Engineering Research Center. Main Outcome Measures: EPW performance variables and user rating regarding driving experience. Results: An add-on package to commercial EPWs has been designed and developed where the sensing components can detect different terrains as well as EPW driving parameters, and a tablet computer can record performance variables. Experimental tests with different driving rules on different terrains showed that EPWs require different driving rules on individual terrains to improve their handling performance. A user study with ten able-body subjects confirmed the experimental test results and showed that performance variables agreed with user perceived ratings. Another user study with ten EPW users is planned in May where the system with terrains sensing and automated switching of driving rules will be evaluated. Conclusions: An add-on terrain dependent EPW driver assistance system with developed driving rules will improve the EPW performance and provide better user experience on different terrains. With this system, the challenges related to hazardous terrains for EPW users could be minimized, thus their community participation will be increased. Furthermore, the add-on system could allow clinicians to better understand and evaluate driving performance of EPW users with quantitative data, enhancing the evidence-based practice for EPW prescription and clinical practice. Key Words: Diagnosis-independent; Motor function; Technology; Rehabilitation. Article 22 (NIDRR) Effectiveness of Off-Axis Training on Improving Knee Function in Individuals with Patellofemoral Pain. Liang-Ching Tsai (Northwestern University, Chicago, IL), Song-Joo Lee, Cindy Lin, Aaron Yang, Yupeng Ren, Francois Gaiger, Alison H-I Chang, Joel M. Press, Li-Qun Zhang. Disclosure: Yupeng Ren and Li-Qun Zhang have a personal interest in the device used in the current study. Yupeng Ren is the president of the company Rehabtek LLC, that is developing the device used in the study and has received federal grants to develop and commercialize the device. Li-Qun Zhang has an equity position in the company. Objective: Patellofemoral pain (PFP) is thought to be associated with altered patellofemoral mechanics due to impaired neuromuscular control of the lower extremity, particularly on the frontal and transverse planes (i.e., off-axis motions). The purpose of this study was to examine the effectiveness of an off-axis training program on improving knee pain and function in individuals with PFP. Design: Repeated measures design. Setting: Controlled, laboratory setting. Interventions: Five subjects diagnosed with PFP participated in a six-week exercise program that consisted of a series of lower extremity off-axis neuromuscular training using a custom-made elliptical trainer that allows frontal-plane sliding and transverse-plane pivoting of the two footplates. Main Outcome Measures: Changes in knee pain and function post training were evaluated using Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) scores. Subjects’ lower extremity off-axis neuromuscular control was assessed by calculating the variability (i.e., standard deviation) of the foot rotation angle (FRA) and foot sliding distance (FSD) relative to the initial starting foot positions while performing a stepping task on the elliptical trainer. Results: On average, subjects reported a higher KOOS and IKDC score following the 6-week off-axis training program. Decreased variability of the
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FRA and FSD were also observed post-training. Conclusions: An off-axis training program using a robotic elliptical trainer was effective in enhancing lower extremity neuromuscular control on the frontal and transverse planes. The enhanced off-axis neuromuscular control posttraining was accompanied by a reduction in knee pain and improvement in knee function in persons with PFP. Key Words: Patellofemoral pain; Function and impairment-independent; Technology; Rehabilitation. Article 23 High-Intensity Antigravity Motor Training Improves Clinical Status and Gait Capacity in Parkinson’s Disease. Martin H. Rose (University of Copenhagen, Copenhagen, Denmark), Annemette Løkkegaard, Stig Sonne-Holm, Bente R. Jensen. Disclosure: None disclosed. Background: Patients with Parkinson’s disease (PD) benefit from physical training and the intensity tends to increase the effect. However, their ability to perform physical exercise in a natural environment is compromised due to motor impairment. Objective: To evaluate the effects of high-intensity antigravity motor training on clinical status and gait capacity in PD. Methods: Thirteen patients with idiopathic PD (H&Y 2. 1) completed eight weeks (3x1hour/week) of progressive high-intensity motor training on an antigravity treadmill (lower-body-positive-pressure). Patients were evaluated using the Movement-Disorders-Society-Unified-Parkinson’s-Disease-Rating-Scale (MDS-UPDRS), Parkinson’s-Disease-Questionnaire-39 (PDQ39) and six-minutes walking test, eight weeks prior to, pre- and post-training. Data obtained between the first and second measurement served as paired control data. The training was performed in a one-patient to one-coach setup. Motor control was challenged during (1) running and walking using sudden changes in artificial body weight and speed, (2) different types of locomotion (e.g. chasse, skipping and jumps) and (3) intervals with high speed sprints in fractional gravity. Results: At the end of training, statistical significant improvements were found in all outcome measures compared to the control period. Total MDS-UPDRS changed from (mean⫾1SD) 58⫾18 to 47⫾18, MDS-UPDRS motor part from 35⫾10 to 29⫾12, total summary score of PDQ39 from 22⫾13 to 13⫾12 and 6-minute walking distance from 576⫾93m to 637⫾90m. No changes were observed during the control period. Conclusions: Patients with Parkinson’s disease were able to complete eight weeks of high-intensity antigravity motor training. The training improved clinical status and gait capacity significantly. Key Words: Neurodegenerative disorder; Motor function; Clinical practice; Rehabilitation. Article 24 An Experimental Study of the Impacts of Assistive Technology on Users and Their Informal Caregivers. Ben Mortenson (Simon Fraser University, Burnaby, BC, Canada). Disclosure: None disclosed. Objectives: To determine if an inclusive approach to assistive technology provision (AT) is effective in 1) improving AT users’ activity performance, and 2) decreasing their caregivers’ sense of burden. Design: Delayed-intervention, randomized control trial. Setting: The homes of community-dwelling participants. Participants: Baseline data were collected on 88 participants (44 dyads). The mean ages of assistance users and their informal caregivers were 83 and 71 years respectively. Interventions: The intervention involved: (1) a detailed in-home assessment by an experienced occupational therapist, (2) identification of a problematic activity according to both the caregiver and AT user, (3) negotiation of an AT focused intervention plan, and (4) implementation of this plan, including device provision and training and home modifications. Main Outcome Measures: The primary outcome measure for AT users was the Assessment of Life Habits and the primary outcome measure for caregivers was the Caregiver Assistive Technology Outcome Measure. Results: Compared to the delayed intervention group, assistance users in the immediate intervention group experienced significantly increased satisfacArch Phys Med Rehabil Vol 93, October 2012