Effect of exercise therapy combining electrical therapy and balance training on functional instability of ankle sprain

WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721

Research Report Poster Presentation Number: RR-PO-06-11-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 RELATIONSHIP OF PELVIC ANGLE AND HIP JOINT RANGE OF MOTION WITH FACTORS THAT INFLUENCE DUCHENNE PHENOMENON AFTER TOTAL HIP ARTHROPLASTY H. Yoshida, Y. Nakagima, M. Kinnami, K. Tsubouchi, T. Takaoka, S. Sadamatsu Matsuyama Red Cross Hospital, Matsuyama, Japan Background: Duchenne phenomenon commonly causes claudication after total hip arthroplasty (THA). The main characteristic of Duchenne phenomenon after THA is a decrease in the downward lateral tilting of the pelvis on the unoperated side. Furthermore, a decrease in the hip adduction range of motion (ROM) is commonly observed in Duchenne phenomenon, which is mainly due to weakness of the hip joint abductors. Nevertheless, improvement in the pelvic lateral tilting ROM and the hip joint ROM does not only rely on reinforcement of the abductor muscular strength. Purpose: The purpose of this study was to evaluate the hip joint ROM and to identify the factors influencing the hip joint ROM during walking in patients with the Duchenne phenomenon after THA. Methods: Thirty patients (mean age; 67.1 ± 9.4 years) who underwent unilateral THA for osteoarthritis and 10 healthy subjects were recruited. Patients were evaluated before THA and 1 month after THA. The peak value of the hip joint and the pelvic ROM on both sides on the frontal plane during walking were measured using a wireless motion recorder. The maximum hip abduction force was measured with a hand-held dynamometer. The passive ROM of the hip adduction was measured by goniometry. In addition, the change in lower-limb length due to elongation after THA was measured using X-ray images. The Wilcoxon signed-rank and the Mann–Whitney’s U-test were performed to determine differences between groups. Spearman’s rank correlation coefficient was used to examine the correlation between various categories. p values of <0.05 were considered statistically significant. Results: The hip joint ROM and the pelvic lateral tilting ROM were significantly smaller postoperatively than preoperatively on both sides (p < 0.05). Comparison of the hip joint sizes between patients and controls showed that patients had smaller on both sides both preoperatively and postoperatively. Comparison of the pelvic lateral tilting ROM between patients and controls showed that the postoperative ROM in patients was smaller than that of controls on both sides (p < 0.05). The passive hip joint ROM and the maximum hip abduction force on the operated side were smaller postoperatively than preoperatively (p < 0.01), and those were smaller

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than unoperated side both preoperatively and postoperatively (p < 0.05). Significant correlations concerning the hip joint ROM on the operated side were observed among the pelvic ROM on the unoperated side (r = 0.72, p < 0.01), the change in lower-limb length (r = −0.53, p < 0.01), and the maximum hip abduction force (r = 0.40, p = 0.04). Conclusion(s): Patients with Duchenne phenomenon after THA exhibited a decreased the ROM of the pelvis and the hip joint on frontal plane during walking. The pelvic lateral tilting ROM significantly correlated with the hip joint ROM on the frontal plane. Moreover, the hip ROM during walking was influenced by the passive hip joint adduction ROM, change in lower-limb length, and maximum hip abduction force. Implications: This study showed importance of increase of the hip joint ROM on frontal plane during walking and factors for the acquisition during physical therapy for patient with THA. Keywords: Total hip arthroplasty; Motion analysis; Gait Funding acknowledgements: This study was unfunded. Ethics approval: This study was approval of the Ethics Committee of the Matsuyama Red Cross Hospital. http://dx.doi.org/10.1016/j.physio.2015.03.111 Research Report Poster Presentation Number: RR-PO-21-24-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 EFFECT OF EXERCISE THERAPY COMBINING ELECTRICAL THERAPY AND BALANCE TRAINING ON FUNCTIONAL INSTABILITY OF ANKLE SPRAIN T. Yoshida, Y. Tanino, T. Suzuki Kansai University of Health Sciences, Clinical Physical Therapy Laboratory, Osaka, Japan Background: Instability associated with ankle joint sprain is classified into three types: structural, functional, and both structural and functional instability. Functional ankle instability occurs at a rate of 10–30% after acute ankle sprain. Furthermore it was reported that functional instability led to a delay in the muscle reaction time and weakness of the peroneal muscles. In this study, we assessed whether electrical stimulation of the peripheral nerve for a specific period of time increases the excitability of the cerebral cortex. Increases in the pinch force and grip strength were observed by electrical stimulation of the median nerve of healthy subjects. Purpose: The present study examined the effects of transcutaneous electrical nerve stimulation (TENS) during balance exercise on patients with functional instability of the ankles, including the ability to land after jumping at the center of foot pressure (COP).

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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721

Methods: Subjects who provided informed consent were seven males with a history of ankle joint sprain and a sprained ankle score ≤80 points on Karlson’s functional instability test. They were asked to jump over a 20-cmhigh platform sideways for 10 consecutive seconds and on a force plate with one leg. The length of COP was measured for comparison of balance exercise (CON condition) and the CON condition plus TENS therapy during balance exercise (TENS condition). The stimulation intensity was maintained for 40 minutes: intensity of sensation threshold level: 4.8 ± 1.5 mA, single-phase square wave, pulse width: 1 ms, burst frequency: 1 bp, pulse frequency: 10 Hz to common peroneal nerve. Results: The length of COP on the sprain side was significantly larger than on the non-sprain side under both conditions. Under the CON condition, the length of COP on the sprain side showed no significant change 609.4 ± 177.4 and 618.4 ± 217.6 mm before and after challenge, respectively. Under the TENS condition, the length of COP on the sprain side was significantly reduced 578.2 ± 114.5.2 and 479.4 ± 94 mm before and after challenge, respectively. Conclusion(s): Jump-landing on the sprain side was significantly reduced in the challenges before and after the TENS condition. Electrical stimulation of the common peroneal nerve in the dorsal motor area facilitated increased activity of the primary motor cortex. Also, leg peroneal muscles showed increased activity by common peroneal innervation. Implications: TENS has effects on functional instability after ankle sprain that lead to improvement of stability of jump-landing. Keywords: Ankle sprain; Jump-landing; Electrical therapy Funding acknowledgements: There was no significant financial support for this study. Ethics approval: This study was approved by the institutional research ethics committee of Kansai University of Health Sciences. http://dx.doi.org/10.1016/j.physio.2015.03.112

Research Report Poster Presentation Number: RR-PO-13-13-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 RELATIONSHIP BETWEEN WEIGHT LOSS, AND BODY COMPOSITION AND HEMATOLOGIC VALUES IN JAPANESE COMMUNITY-DWELLING FRAIL OLDER ADULTS T. Yoshimatsu 1 , H. Shimada 2 , H. Makizako 2 , T. Doi 2 , K. Uemura 2 , K. Tsutsumimoto 2 , T. Suzuki 3 1 Tokyo

University of Technology, School of Health Sciences, Department of Physical Therapy, Tokyo, Japan; 2 National Center for Geriatrics and Gerontology, Section for Health Promotion, Department for Research and Development to Support Independent Life of Elderly, Aichi, Japan; 3 National Center for Geriatrics and Gerontology, Aichi, Japan Background: Frailty has been increasingly recognized as a relevant health measure in older populations and is associated with an increased risk of adverse health outcomes and care dependency. Among the 5 factors of the frailty phenotype, weight loss is an index that reflects nutritional status. However, the relationship between weight loss and nutritional status, such as body composition and hematologic values, on frailty is unclear. Purpose: The aim of this study was to investigate the weight loss status in Japanese community-dwelling frail older adults from the perspective of the relationship between weight loss, and body composition and hematologic values. Methods: We selected 4,654 older adults (aged 3 65 years; mean age, 72 years) from the Obu Study of Health Promotion for the Elderly (OSPHE). Each participant underwent detailed physical testing and answered a series of questionnaires to assess frailty. Frailty was defined as a condition characterized by limitations by 3 or more of the following 5 variables: slow gait speed (<1.0 m/s), decreased grip strength, self-reported exhaustion, decreased physical activity, and self-reported weight loss (5% or more in the last 2 years). Actual body weight and height were measured, and body fat mass (BFM) and appendicular skeletal muscle mass (ASMM), as body composition, were estimated from bioimpedance analysis. Serum albumin (Alb) and triglyceride (TG) concentrations were used as nutritional biomarkers. Results: The participants were classified as controls (n = 3,862), not frailty but with weight loss (WL, n = 369), frailty but no weight loss (FR, n = 236), and FR with WL (n = 187). Actual body weight, body mass index (BMI), BFM, Alb, and TG were significantly affected by the WL factor (all P < .001). Furthermore, BMI and BFM were not significantly affected by the FR factor. Among the 5 factors of frailty, gait speed, grip strength, and exhaustion were