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ESMAC Abstracts 2015 / Gait & Posture 42S (2015) S1–S101
References [1] Schwameder H, Lindenhofer E, Müller E. Effect of walking speed on lower extremity joint loading in graded ramp walking. Sports Biomech 2005;4:227–43. [2] Shultz SP, Anner J, Hills AP. Paediatric obesity, physical activity and the musculoskeletal system. Obes Rev 2009;10:576–82.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.125
Session PS14 Outcome study Physical therapy for infants with postural asymmetry M. Jung Fresenius University of Applied Sciences, Medical School, Idstein, Germany Research question: Is Vojta therapy in infantile postural asymmetry more effective than conventional physical therapy? Introduction: Physical therapy is an acknowledged and frequently applied method for infantile postural asymmetry. However, the scientific evidence for its efficacy in pediatric treatment is low. Materials and methods: In a randomised controlled trial the effect of Vojta-therapy versus conventional physical therapy is assessed in infants with postural asymmetry [1–8]. Using a standardised and blinded video-based assessment, the restriction in head rotation and the convexity of the spine in prone and supine position were documented before and after 8 weeks of therapy. A minimum of 4 point reduction (range of scale 20 points) in postural asymmetry was regarded as a clinical relevant change. 65 infants with postural asymmetry <12 points were recruited. N = 37 infants aged 6–8 weeks (mean 7.38) were found to be eligible and randomly assigned to the intervention groups, 19 receiving Vojta-therapy, 18 conventional physical therapy. As a secondary outcome we look at the parental compliance. Results: The research question was tested using ANOVA. The minimum of 4 points was achieved in both groups. Based on the findings of 3 blinded scorers a mean difference (pre–post) between the groups of −8.87 points (95% CI [−15.03; − 2.72]) in favour of Vojta-therapy was significant (p = 0.006). We had no dropouts and no family has changed the group. Discussion: Both interventions were effective on infantile postural asymmetry and well applied by the parents. The effect of Vojta-therapy was significantly higher. References [1] Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop 1994;14:802–8. [2] Öhman A, Nilsson S, Lagerkvist AL, Beckung E. Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants? Dev Med Child Neurol 2009;7:545–50. [3] Öhmann A, Nilsson S, Beckung E. Stretching treatment for infants with congenital muscular torticollis: physiotherapist or parents? A randomized pilot study. PM&R 2010;2:1073–9. [4] Öhmann AM. The immediate effect of kinesiology taping on muscular imbalance for infants with congenital muscular torticollis. Eur J Phys Rehabil Med 2012;4:504–8. [5] Petronic I, Brdar R, Cirovic D, Nikolic D, Lukac M, Janic D, Pavicevic P, Golubovic Z, Knezevic T. Congenital muscular torticollis in children: distribution, treatment duration and outcome. Eur J Phys Rehabil Med 2010;46:153–8. [6] Philippi H, Faldum A, Jung T, et al. Patterns of postural asymmetry in infants: a standardized video-based analysis. Eur J Pediatr 2006;3:158–64. [7] Philippi H, Faldum A, Schleupen A, et al. Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial. Dev Med Child Neurol 2006;1:5–9. [8] Van Vlimmeren LA, van der Graf Y, Boere-Boonekamp MM, L’Hoir MP, Helders PJ, Engelbert RH. Effect of pediatric physical therapy on deformational plagiocephaly in children with positional preference: a RCT. Arch Pediatr Adolesc Med 2008;8:712–8.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.126
Session PS14 Outcome study Effects of neurodynamic mobilization versus foam rolling treatment after delayed-onset muscle soreness b , S. ˜ B. Romero-Moraleda a,∗ , D. Munoz-García c d e ˜ , V. Paredes , A.B. Lerma Lara , R. Ferrer Pena Peinado f a
CSEU La Salle-UAM, Health Sciences Faculty, Camilo José Cela University, Madrid, Spain b CSEU La Salle-UAM, Group on Movement-Behavioral Science and Study of Pain, Madrid, Spain c CSEU La Salle-UAM, Hospital Infantil Universitario Ni˜ no Jesús, Madrid, Spain d CSEU La Salle-UAM, Centro de Atención Primaria, Entrevías, Madrid, Spain e Health Sciences Faculty, Camilo José Cela University, Rayo Vallecano S.A.D., Villanueva de la Ca˜ nada, Madrid, Spain f School of Physical Activity and Sport Sciences, LFE Research Group, Technical University of Madrid, Madrid, Spain Research question: Is neurodynamic mobilization better than a foam rolling treatment for treating muscle induced pain? Introduction: Delayed-onset muscle soreness (DOMS) refers to the skeletal muscle pain that is experienced following eccentric exercise [1]. Exercise-induced muscle damage is known to be manifested as increased serum concentrations of creatine kinase (CK), ultrastructural disruption, inflammation and strength deficits [2]. Numerous recovery strategies have been used in an attempt to minimize the symptoms of DOMS [3]. The purpose of this study was to asses the acute effects of a single session of NM treatment and to compare with foam roller application after exercise-induced muscle damage [4]. Materials and methods: Thirty-two healthy subjects (21 males and 11 females, mean age: 22.6 ± 2.2 years) were randomly assigned into neurodynamic group (ND, n = 16) and foam roller group (FR, n = 16). Drop jumps were used to induce muscle damage (5 set × 20 rep/2 min. recovery). Maximum voluntary contraction (MIVC), muscle activation in landing jump (MALJ), 0–10 pain scale, pressure pain thresholds, hip and knee ROM and knee bend neural test were measured baseline, post 48 h preview treatment and immediately post treatment. A PhysioPlux® system was used for sEMG data collection. Electrode placement was done following the SENIAM recommendations. A band-pass filter was performed to the raw signals and RMS was calculated. A digital algometer (Wagner Pain Test® ) was used for PPT and an universal goniometer for ROM measurements. Results: MIVC, MALJ and hip and knee ROM were decreased and DOMS measured through pain increased in both groups (p < 0.05). After treatment, both groups showed improvements for strength and pain. Pain scale decreased significantly without differences between groups (Pain FR: −2.38 ± 1.41%; Pain ND: −2.53 ± 0.92%, p = 0.71). For strength measures, the FR achieved greatest changes than ND (MIVC FR: 10.8 ± 4.65%; MIVC ND: 4.80 ± 4.33%; p = 0.03). Discussion: The data indicated that the both treatments were effectives to improve pain and strength, showing EMG measures greater change with FR treatment. References [1] Kanda K, Sugama K, Hayashida H, Sakuma J, Kawakami Y, Miura S, et al. Eccentric exercise-induced delayed-onset muscle soreness and changes in markers of muscle damage and inflammation. Exerc Immunol Rev 2013;19:72–85. [2] Miyama M, Nosaka K. Influence of surface on muscle damage and soreness induced by consecutive drop jumps. J Strength Cond Res 2004;18(2):206–11.
ESMAC Abstracts 2015 / Gait & Posture 42S (2015) S1–S101 [3] Torres R, Ribeiro F, Akberto Duarte J, Cabri JM. Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis. Phys Ther Sport 2012;13(2):101–14. [4] Howatson G, Goodall S, Van Someren K. The influence of cold water immersions on adaptation following a single bout of damaging exercise. Eur J Appl Physiol 2009;105(4):615–21.
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was focused on the upper limb, it was able to lead an improvement of gait performance. Interestingly the instrumental evaluation was more sensitive than clinical scale to assess such improvements in terms of walking stability and lower limb motility. Reference [1] Cimolin V, et al. J Head Trauma Rehabil 2012;27:177–87.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.127 http://dx.doi.org/10.1016/j.gaitpost.2015.06.128
Session PS14 Outcome study Quantitative evaluation of gait kinematics in post-stroke patients: The effects of a specific integrated upper limb rehabilitation L. Pianta a,∗ , V. Cimolin b , M. Bigoni a , M. Galli b , A. Scirè a , A. Mauro c a
Istituto Auxologico Italiano, Oggebbio, Italy b Politecnico di Milano, Milano, Italy c Università degli Studi di Torino, Torino, Italy
Research question: The aims of the present study are: analyse the effects of an innovative integrated upper limb rehabilitative treatment in a post-stroke patient and assess gait kinematics changes using instrumental evaluation. Introduction: In post-stroke patients, the affected upper limb is a stumbling block to the achievement of autonomy during the Activities of Daily Living and also affect gait performance. Movements’ incoordination, during walking, emerges from disorganized postural muscle synergies and excessive muscle co-contraction. Load shifting toward the unaffected side and compensatory movements such as excessive hip and knee flexion/extension often occur during gait. Following these suggestions was purposed to treat upper limb to achieve gait improvement [1]. Materials and methods: The patient (R.D., age 46) suffered a post-stroke left hemiparesis with severe upper limb impairment, trunk troubles but an autonomous walking. The proposed rehabilitative approach was based on the integration of different rehabilitative techniques focused on upper limb treatment: exercises aimed to reach a better trunk control and shoulder stabilisation, followed by functional activities for upper limb muscles coordination. No specific gait training was carried out. Rehabilitation treatment included ten sessions lasting one hour a day. The patient was evaluated using optoelectronic system with passive markers (Vicon, UK), two force plates (Kistler, CH) and a synchronic Video system. As concerns Gait Analysis the markers were placed according to Davis’ protocol and five trials were considered for each session. Some parameters obtained by Gait Analysis data were identified and calculated in order to quantify gait strategies before and after the treatment. Clinical evaluation included scales for: upper limb, trunk and balance. The patient was assessed in two sessions: PRE and POST treatment. The comparison between the two sessions was done using non-parametric tests (p < 0.05). Results: The gait evaluation after the treatment showed improvements in terms of spatio-temporal parameters mainly in step length which increased bilaterally (left: 0.29 vs. 0.37 m; right: 0.45 vs. 0.53 m; normality: 0.62 m) and stance phase which reduced their values (left: 65 vs. 63% gait cycle; right: 83 vs. 80% gait cycle; normality: 60% gait cycle). As concerns kinematics, the affected side improved its range of motion at all lower limb joints (hip, knee and ankle joint) and at knee in non-affected side. On the contrary, the clinical scale showed no changes. Discussion: Our preliminary data about quantitative movement analysis showed a surprising effect of the proposed rehabilitative treatment in a post-stroke patient. In fact, even if rehabilitation
Session PS14 Outcome study Gait rehabilitation of post-stroke patients by treadmill gait training with visual feedback Z. Pavare ∗ , I. Garuta, T. Ananjeva, A. Smolovs National Rehabilitation Centre, Vaivari, Jurmala, Latvia Research question: To study gait training on treadmills with visual feedback and the effect thereof on the quantitative and qualitative gait parameters in stroke patients during their in-hospital rehabilitation. Introduction: Post-stroke patients tend to develop functional outcomes impacting their mobility and resulting in deficits in daily activities and performance of basic daily functions. Consequently, the recovery of normal motor patterns in the body, hip and lower limbs for improved gait, improvement of symmetry and loading patterns in the paretic side, and energy efficient walking represent the key objectives of gait training in patients with stroke. Gait training on a treadmill with visual feedback is one of the methods to facilitate gait rehabilitation in post-stroke individuals. Visual feedback has a potential to provide additional sensory stimuli during gait training and facilitate the re-establishment of normalised gait patterns. Materials and methods: 20 non-recurrent stroke patients (13 men and 7 women, age 58.7 ± 7 years) with left-sided or right-sided hemiparesis who are capable of walking at least 10 meters without assistance. The subjects/patients of the study were randomly distributed in two groups. One of the groups underwent a conventional physical therapy with 5 weekly sessions, 60 minutes each, complemented with gait training on a treadmill with visual feedback (mirror) with 30- minute sessions daily. The second group underwent a conventional physical therapy with 5 weekly sessions, 60 minutes each, complemented with gait training on a treadmill with no visual feedback, in the same pattern of 30-minute sessions daily [1–3]. Study tools: Hauser Ambulation Index, instrumental gait analysis (6 Qualisys ProReflex cameras (240 Hz)) for the evaluation of time and distance parameters of gait, as well as kinematic parameters of gait. Results: The study demonstrated considerable improvement in time and distance parameters of gait (gait speed, support and swing phases of gait cycle, step length and step width) in patients undergoing training on a treadmill with visual feedback compared to the group of patients conducting treadmill training without visual feedback (p < 0.05). The assessment of the kinematic parameters of gait did not produce a statistically significant motion improvement (p > 0.05) in the sagittal plane of knee and ankle joints. Discussion: Treadmill gait training with visual feedback for stroke patients has a potential of considerably improving time and distance parameters of gait during in-hospital rehabilitation, however they fail to produce statistically significant changes in the amount of movement in the joints of lower limbs in sagittal plane.