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ObjectiveTo conduct a systematic review of systematic reviews on benefits of health and functioning for children with disabilities in aquatic exercise rehabilitation, in reference to the PRISMA guidelines, based on ICD-11 and ICF. MethodsSystematic reviews about aquatic exercise rehabilitation for children with disabilities were searched in PubMed, Web of Science, Embase and CNKI from January, 2014 to August, 2023. A systematic review was conducted. ResultsSeven English reviews were included from Iran, Brazil, Spain, Australia, USA and Poland, involving 69 randomised controlled trials with a total of 1 825 participants. They were mainly from the journals in the fields of pediatric physics and occupational therapy, physical therapy and rehabilitation, and children with disabilities, and the publication date was mainly from 2014 to 2023. The main types of diseases were intellectual and developmental disability (Down's syndrome, mild or high-functioning autism spectrum disorder, Asperger's syndrome), cerebral palsy (spastic cerebral palsy, spastic quadriplegia), developmental mental coordination disorder, attention deficit hyperactivity disorder, etc. The main impariment of functioning were consciousness function (b110), sleep function (b134), attention function (b140), memory function (b144), psychomotor function (b147), high-level cognitive function (b164), mobility (d4), interpersonal interactions and relationships (d7), community life (d910), recreation and leisure (d920). In the field of physical activity, the main barriers included insufficient participation in physical activity, less participation in aquatic exercise, low overall level of development, physical development as well as motor development and motor ability. The aquatic exercise rehabilitation program mainly included swimming exercises; water resistance and breathing training; water walking, running, jumping; shallow standing exercises; water aerobic activities, strength training and endurance exercises; as well as water games and spa programs. The intervention intensity of aquatic sports rehabilitation was low to moderate, and the frequency was 15 to 100 minutes a time, one to six times a week, lasting six to 40 weeks. The health and functional benefits of aquatic sports rehabilitation for children with disabilities were mainly reflected in improving cardiopulmonary function, enhancing respiratory muscle strength, improving core muscle strength, improving balance and coordination function, improving aerobic endurance, enhancing flexibility, and improving walking speed; reducing body mass, optimizing body mass index, reducing body fat percentage, waist circumference and waist-to-height ratio; improving cognitive and intellectual function, and improving sleep quality. For children with autism spectrum disorder, it could also promote communication activities, reduce repetitive stereotyped behaviors, improve swimming skills and abilities, and increase aquatic physical activity behaviors. ConclusionAquatic exercise rehabilitation can improve the body functions of children with disabilities, promote activity and participation, and enhance their overall health, quality of life and well-being.
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ObjectiveTo explore the neuromuscular control mechanism of training strategies based on mirror neuron system (MNS): action observation (AO), action execution (AE) and action imitation (AO+AE) using functional Near Infrared Spectroscopy (fNIRS) and surface electromyography (sEMG). MethodsFrom July, 2022 to February, 2023, 64 healthy adults were asked to finish four tasks: watching landscape video (control), watching landscape video and acting right wrist and hand extension (AE), watching right wrist and hand extension video (AO), and watching right wrist and hand extension video and acting right wrist and hand extension (AO+AE). A block design was adopted, five times a task in a block, eight cycles, random orders in videos and tasks. The activation of each channel and regions of interest (ROI, namely BA40, BA44, BA45, BA46, BA6 and BA7) in left MNS regions was detected with fNIRS synchronously, as well as the average electromyography (AEMG) of extensor digitorum and extensor carpi radialis with sEMG. ResultsCompared with the control condition, MNS activated in AO, AE and AO+AE conditions, and the intensities mildly increased in turn. Compared with the control condition, 15 channels activated in AO condition, 15 channels activated in AE condition, and all 20 channels activated in AO+AE condition; and the activation intensities of most channels were AO+AE > AE > AO. Four ROI, BA40, BA46, BA6 and BA7, activated in AO condition, all the six ROI activated in AE and AO+AE conditions, and the activation intensities of most ROI were AO+AE > AE > AO. The standardized AEMG of extensor digitorum and extensor carpi radialis were higher in AO+AE condition than in AE condition (|t| > 4.24, P < 0.001). ConclusionMNS has been activated during action observation, execution and imitation, and the ranges and intensities of activation increase in turn. The target muscles activate more during imitation than during execution. Synchronous application of fNIRS and sEMG is feasible in the study of neural mechanism of rehabilitation strategies based on mirror neuron theory.
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Objective:To evaluate the intervention effects of aquatic therapeutic exercise on functioning and quality of life for children and youth with cerebral palsy within framework of World Health Organization Family International Classifications using systematic review. Methods:Literatures were retrieved and reviewed from the databases of Cochrane Library, PEDro, PubMed, EMBASE, Web of Knowledge, Web of Science, OVID, EBSCO, CMCI, CNKI, Wangfang and VIP until May, 2020. The randomized controlled trials (RCTs) about aquatic therapeutic exercise for children and youth with cerebral palsy for functioning were systematically reviewed. The data were analyzed with RevMan 5.3. Results:Nine RCTs were selected, including 162 children and youth. The score of Gross Motor Function Measure improved significantly after aquatic exercise (WMD = 6.31, 95 %CI 2.57 to 10.06, P < 0.001), as well as daily activities and quality of life. Conclusion:Aquatic therapeutic exercise can help improve the gross motor function of children and youth with cerebral palsy, and has positive effects on function of activity and quality of life.
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Objective:To observe the effect of microelectronic EMG bridge (EMGB) training on the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury. Methods:From March, 2016 to March, 2017, 20 patients with complete cervical 5 spinal cord injury were randomly divided into control group (n = 10) and experimental group (n = 10). The control group received routine wrist extensor muscle training, and the experimental group received EMGB training in addition, for 180 days. The motor function of the affected limb was evaluated by sEMG of extensor carpi radialis longus, Manual Muscle Test (MMT), Wolf Motor Function Test (WMFT) and Spinal Cord Lesion Independence Measure (SCIM). Results:After treatment, the peak value and average value of sEMG of extensor carpi longus of both sides increased in both groups (t > 2.510, P < 0.05), the peak value and average value of the left side were higher (t > 2.759, P < 0.05), and the peak value of the right side was higher (t = 2.691, P < 0.05) in the experiment group than in the control group, however, there was no significant difference in average value of the right side between two groups (t = 2.063, P = 0.054). The scores of MMT increased in both groups (t > 2.569, P < 0.05), and were higher in the experimental group than in the control group (t > 2.278, P < 0.05). The scores of WMFT and SCIM increased in both groups (t > 3.839, P < 0.05), however, there was no significant difference between two groups (t < 1.498, P > 0.05). Conclusion:EMGB training could improve the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury.
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Objective:To evaluate the effects of aquatic exercise on lower-limb motor function and activities of daily living for patients with stroke. Methods:The randomized controlled trials (RCTs) about effects of aquatic therapeutic exercise on stroke patients were recalled from the databases of Cochrane Library, PEDro, PubMed, EMBASE, Web of Knowledge, Web of Science, OVID, EBSCO, CMCI, CNKI, Wanfang and VIP. The methodological quality of the included RCTs was evaluated. The data were extracted, and analysed with RevMan 5.3. Results:A total of 23 RCTs that represented 861 participants were evaluated. Compared with the control group, aquatic exercise significantly improved the performance of Berg Balance Scale (WMD = 2.69, 95%CI 1.21 to 4.16,P < 0.001), Timed Up and Go Test (WMD = -1.56, 95%CI -3.07 to -0.05,P < 0.05), Functional Reach Test (WMD = 2.69, 95%CI 1.21 to 4.16,P < 0.001), sway velocity of center of pressure (SVCOP) (left/right) (WMD = -1.38, 95%CI -2.72 to -0.05,P < 0.05), SVCOP (anteroposterior) (WMD = -1.64, 95%CI -3.10 to -0.18,P < 0.05), walking speed (SMD = 0.33, 95%CI 0.07 to 0.58,P < 0.05), Two Minute Walk Test (WMD = 12.75, 95%CI 4.17 to 21.34,P < 0.01), Functional Ambulation Category (WMD = 0.94, 95%CI 0.67 to 1.20,P < 0.001), muscle strength of knee extensor (WMD = 4.30, 95%CI 1.53 to 7.07,P < 0.01), muscle strength of knee flexor (WMD = 4.80, 95%CI 0.29 to 9.32,P < 0.05), and Functional Independence Measurement (WMD = 6.12, 95%CI 3.98 to 8.27,P < 0.001), but not significantly in the score of modified Barthel Index (WMD = 2.92, 95%CI -6.74 to 12.58,P = 0.55). Conclusion:Aquatic exercise can improve balance, walking and muscle strength of lower extremities of stroke patients, but do not for activities of daily living.
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Objective:To explore the related factors affecting the functional outcome of adult spinal cord injury and to establish a predictive model. Methods:A retrospective analysis was made on the medical records of 110 adult spinal cord injured patients with paraplegia from September, 2016 to December, 2018. Quantitative indicators that affected functional outcome were systematically collected, including age, length of stay, number of other diagnostic, number of complications, number of comorbidities, number of operations, days from onset to rehabilitation intervention, and the total scores of Lower Extremity Motor Subscore (LEMS), light touch (LT), pin prick (PP) and modified Barthel Index (MBI) at admission (MBIa) and discharge (MBId), the change values and change rates of MBI were calculated. The correlation coefficients among variables were analyzed. Multivariate linear regression models were established for the MBI total score at discharge and change of MBI score from admission to discharge (MBIc). Results:MBId was significantly correlated with MBIa, the total score of LEMS at admission (LEMSa), the total score of PP at admission, the total score of LT at admission, the number of days from onset to rehabilitation intervention, the number of operations and the number of comorbidities. The fitted regression equation was: MBId = 28.24 + 0.52 × MBIa + 0.24 × LEMSa - 1.23 × number of comorbidities (R2 = 0.64, P < 0.001). The MBIc was significantly correlated with MBIa, the days from onset to rehabilitation intervention and the length of stay. The fitted regression equation was: MBIc = 18.44 - 0.29 × MBIa + 0.06 × length of stay (R2 = 0.29, P < 0.001). Conclusion:The spinal cord injured patients with better functional status, higher motor score and less comorbidity at admission, and longer hospitalization have better functional recovery.
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Objective:To explore the application of mobile medical technology in aquatic rehabilitation assessment for patients with spinal cord injury. Methods:From November, 2017 to April, 2018, 72 patients with spinal cord injury accepted aquatic exercise were randomly divided into control group (n = 36) and experimental group (n = 36). All the patients were assessed with Water Orientation Assessment of Alyn (WOTA), using paper scale for the control group, mobile scale for the experimental group, twice. The time for assessment and for recall was recorded. The accuracy of results and variety between assessment was compared. Results:The time for assessment and for recall was less in the experimental group than in the control group (t > 10.492, P < 0.001), with more accuracy of standard total score, the variety of total score and standard total score (χ2 > 4.545, P < 0.05). Conclusion:Compared with the paper-based assessment, the assessment based on mobile technology may improve work efficiency.
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@#Objective To translate the Water Orientation Test of Alyn 2 (WOTA2) into Chinese, and to study its reliability and validity for patients with spinal cord injury. Methods After authorizing, the English version WOTA2 scale and its training package were translated into Chinese. From January to September, 2018, 137 patients with spinal cord injury were evaluated with the Chinese version WOTA2 by two evaluators independently, and evaluated again three days later by one of the evaluators. The Cronbach's α, Spearman-Brown coefficient, intra-group correlation coefficient (ICC) and Kappa coefficient were calculated to evaluate the reliability. Content Validity Index (CVI) of items (I-CVI) and scale (S-CVI) were used to evaluate the content validity, and factors analysis was used to evaluate the structure validity. Results The Cronbach's α was 0.947 in all items of the scale, 0.890 in mental adjustment items and 0.954 in aquatic skills items. Pearson correlation coefficient of the half scales separated by odd and even items was 0.948, and the Spearman-Brown coefficient was 0.973. The ICC of test-retest was 0.965 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The ICC of inter-testers was 0.964 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The Kappa coefficient was 0.528 to 0.927 in test-retest and 0.528 to 0.927 in inter-testers. The I-CVI was 0.8 to 1.0 and S-CVI was 0.63. Factors analysis extracted four factors, which met the theory, and contributed 67% of cumulative variance. Conclusion The Chinese version WOTA2 is good in reliability and validity for patients with spinal cord injury, and can be used in the clinical practice of aquatic therapeutic exercise in China.
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Objective To investigate the effects of aquatic Taiji Quan on balance function of patients with incomplete spinal cord injury. Methods From March to December, 2015, 30 patients with incomplete spinal cord injury received aquatic Taiji Quan exercise based on rou-tine rehabilitation, 30 minutes every day, five times a week for five weeks. They were assessed with Berg Balance Scale (BBS) before and after exercise. Dynamic balance function and static balance function were also assessed with Active Balancer assessment. Results The BBS score significantly improved after exercise (t=-9.652, P3.528, Z>-2.590, P0.05). The dynamic stability limit range enlarged (t=-4.516, P<0.01), and the time to target significantly shortened (t=4.530, P<0.001). Conclusion Aquatic Taiji Quan can improve the balance function of patients with incomplete spinal cord injury.
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Objective To explore the characteristics of gait and surface electromyography (sEMG) of underwater treadmill training (UWTT). Methods From January to September, 2015, gait and sEMG parameters of ten healthy adults were synchronously collected using three-dimensional gait analysis system and sEMG systems on land and UWTT. Results When walking in self comfortable speed, compared with walk on land, there was significant increase in gait cycle (t=-11.411, P0.05). The integral electromyography of biceps femoris, gastrocnemius, tibialis anterior muscle were significant less than iEMG on land (t>3.984, P0.05). Conclusion There are signifi-cant differences in gait and muscle contraction intensity between land walking and UWTT. The dynamic physiology and neural control of UWTT need further study.
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Objective To investigate the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on non-fluent aphasia in patients after stroke.Methods Forty stroke patients displaying non-fluent aphasia were randomly assigned to an rTMS group and a control group using a random number table.Both groups were treated with conventional language therapy,while the rTMS group was additionally given 0.5 Hz rTMS over the Broca's homologues of the unaffected hemisphere 5 days a week for 3 weeks.The patients were stimulated at 90％ of the motor threshold (MT),with 16 second trains and intervals of 3 seconds 48 times (384 pulses) in a session.Before and after the 3 weeks of treatment,the Western Aphasia Battery (WAB) and the Communicative Abilities in Daily Living (CADL) test were conducted in both groups to evaluate their language function and communication ability.Results Only spontaneous speech improved significantly (P＜0.05) in the control group after 3 weeks of treatment.In the rTMS group,the spontaneous speech,auditory comprehension,repetition,naming and aphasia quotient (AQ) had all improved significantly (P＜0.05).Moreover,after the treatment,the average score of the auditory comprehension (153.90± 31.79),repetition (82.65± 15.14),naming(81.28±22.12) and AQ (63.66± 13.64) of the rTMS group were significantly higher than those of the control group (P＜0.05).Conclusion rTMS applied to the Broca's homologues of the unaffected hemisphere can significantly improve language function in those exhibiting non-fluent aphasia after stroke.
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@#Objective To translate the Water Orientation Test of Alyn 1 (WOTA1) into Chinese and investigate the test-retest reliability, inter-rater reliability and validity of this Chinese Version. Methods The Water Orientation Test of Alyn 1 was translated from English into Chinese. 25 children with cerebral palsy were tested with Chinese Version of WOTA1 by 2 raters. One of the raters accessed the same children again after 2 days. While the children were assessed with Brief Assessment of Motor Function (BAMF). The scores from both raters, twice of one rater, and of WOTA1 and of BAMF were analyzed with Pearson correlation coefficient. Results The correlation coefficient of test-retest of WOTA1 total score is 0.992 (95% CI: 0.982-0.996), and it was 0.887 to 1.000 of the scores of items. The correlation coefficient of inter-rater of total score is 0.992 (95% CI: 0.980-0.998), and it was 0.748 to 1.000 of the scores of items. The correlation coefficient between scores of WOTA1 and BAMF was 0.926 (P<0.01). Conclusion The Chinese Version of WOTA1 is good reliable and valid to assess the motor function in hydrotherapy pool.
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@#Objective To compare the effect of underwater treadmill training (UWTT), body weight support treadmill training (BWSTT) and conventional gait training (CGT) for walking ability and balance function in hemiplegic patients after stroke. Methods 43 patients were divided into CGT group (n=14), BWSTT group (n=13) and UWTT group (n=16). Based on conventional gait training, the UWTT group and BWSTT group respectively accepted UWTT and BWSTT for 4 weeks. They were assessed with Functional Ambulation Category (FAC), maximum walking speed (MWS), 6 Minute Walk Test (6MWT), and dynamic balance function and static balance function with Active Balancer before and after training. Results All the patients improved in all items after training (P<0.05), while the UWTT group improved more in the 6MWT and balance function items than the BWSTT group (P<0.05). Conclusion UWTT is more effective for hemiplegic patients after stroke in walking ability and balance function than BWSTT.
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@#Objective To develop a comprehensive rehabilitation information system based on browser/server (B/S) structure, to implement entry, retrieval, statistics, analysis, browsing and exhibition of electronic data in rehabilitation medicine. Methods Based on the systematic analysis of the rehabilitation work flow and the data need to be disposed, a distributed database system was established, and some modules of applications were developed, such as treatment planning, efficacy evaluation, outcome prediction and performance appraisal. Results The simplified version of Hydrotherapy Comprehensive Rehabilitation Information System was initially developed based on Ruby on Ralis framework and PostgreSQL database, and tested in the local area network of China Rehabilitation Research Center. Conclusion The comprehensive rehabilitation information system based on B/S structure is feasible, and shows the potentialities to improve the team work in rehabilitation based on internet.
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Objective To compare the effect of underwater treadmill training (UWTT), body weight support treadmill training (BW-STT) and conventional gait training (CGT) for walking ability and balance function in hemiplegic patients after stroke. Methods 43 patients were divided into CGT group (n=14), BWSTT group (n=13) and UWTT group (n=16). Based on conventional gait training, the UWTT group and BWSTT group respectively accepted UWTT and BWSTT for 4 weeks. They were assessed with Functional Ambulation Category (FAC), maximum walking speed (MWS), 6 Minute Walk Test (6MWT), and dynamic balance function and static balance function with Ac-tive Balancer before and after training. Results All the patients improved in all items after training (P<0.05), while the UWTT group im-proved more in the 6MWT and balance function items than the BWSTT group (P<0.05). Conclusion UWTT is more effective for hemiple-gic patients after stroke in walking ability and balance function than BWSTT.
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Objective To translate the Water Orientation Test of Alyn 1 (WOTA1) into Chinese and investigate the test-retest reliability, inter-rater reliability and validity of this Chinese Version. Methods The Water Orientation Test of Alyn 1 was translated from English into Chinese. 25 children with cerebral palsy were tested with Chinese Version of WOTA1 by 2 raters. One of the raters accessed the same chil-dren again after 2 days. While the children were assessed with Brief Assessment of Motor Function (BAMF). The scores from both raters, twice of one rater, and of WOTA1 and of BAMF were analyzed with Pearson correlation coefficient. Results The correlation coefficient of test-retest of WOTA1 total score is 0.992 (95%CI:0.982-0.996), and it was 0.887 to 1.000 of the scores of items. The correlation coefficient of inter-rater of total score is 0.992 (95%CI:0.980-0.998), and it was 0.748 to 1.000 of the scores of items. The correlation coefficient be-tween scores of WOTA1 and BAMF was 0.926 (P<0.01). Conclusion The Chinese Version of WOTA1 is good reliable and valid to assess the motor function in hydrotherapy pool.
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Objective To develop a comprehensive rehabilitation information system based on browser/server (B/S) structure, to imple-ment entry, retrieval, statistics, analysis, browsing and exhibition of electronic data in rehabilitation medicine. Methods Based on the system-atic analysis of the rehabilitation work flow and the data need to be disposed, a distributed database system was established, and some mod-ules of applications were developed, such as treatment planning, efficacy evaluation, outcome prediction and performance appraisal. Results The simplified version of Hydrotherapy Comprehensive Rehabilitation Information System was initially developed based on Ruby on Ralis framework and PostgreSQL database, and tested in the local area network of China Rehabilitation Research Center. Conclusion The compre-hensive rehabilitation information system based on B/S structure is feasible, and shows the potentialities to improve the team work in reha-bilitation based on internet.
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@#Objective To compare the effect of underwater treadmill training (UWTT), body weight support treadmill training (BWSTT) and conventional gait training (CGT) for walking ability and balance function in hemiplegic patients after stroke. Methods 43 patients were divided into CGT group (n=14), BWSTT group (n=13) and UWTT group (n=16). Based on conventional gait training, the UWTT group and BWSTT group respectively accepted UWTT and BWSTT for 4 weeks. They were assessed with Functional Ambulation Category (FAC), maximum walking speed (MWS), 6 Minute Walk Test (6MWT), and dynamic balance function and static balance function with Active Balancer before and after training. Results All the patients improved in all items after training (P<0.05), while the UWTT group improved more in the 6MWT and balance function items than the BWSTT group (P<0.05). Conclusion UWTT is more effective for hemiplegic patients after stroke in walking ability and balance function than BWSTT.
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@#Objective To observe the effects of Traditional Chinese Medicine bubble bath on the children with spastic diplegia cerebral palsy. Methods 13 children with spastic diplegia cerebral palsy received routine rehabilitation and bubble bath (control group), while 14 children received routine rehabilitation and Traditional Chinese Medicine bubble bath (experimental group). All the children were assessed with Gross Motor Function Measure (GMFM-66) and Modified Ashworth Scale (MAS) of triceps surae muscle before and 10 weeks after treatment.Results The total score of GMFM-66 increased (P<0.001) and the MAS score decreased in both groups (P<0.01) after treatment. The dimensions B, D, and E of GMFM-66 only increased in the experimental group (P<0.05). The MAS score decreased more in the experimental group than in the control group after treatment (P<0.05). Conclusion Traditional Chinese Medicine bubble bath can improve gross motor function and reduce triceps surae muscle tension of the children with spastic diplegia cerebral palsy.
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Objective To observe the therapeutic effects of oral placement therapy (OPT) on managing sialorrhea after stroke.Methods A total of 37 stroke inpatients with sialorrhea were enrolled from January 2011 to September 2013 in the authors' department for the study and divided into 2 group on the basis of the time of enrollment.The control group (n =18) received 30min of routine treatment (including such neuromuscular facilitation techniques as Bobath and Rood techniques,motor relearning program,neuromuscular electrical stimulation and ice stimulation),twice daily,and the treatment group (n =19) received 15 min of routine treatment plus 15 min of OPT,twice daily.Frenchay Dysarthria Assessment was used to evaluate the sialorrhea severity and clinical efficacy before and 1,2 and 4 weeks after initiation of treatment.Results Sialorrhea symptom was significantly improved in treatment group after 1 week (P ＜ 0.05),while no significant improvement was observed in control group (P ＞ 0.05).After 2 and 4 weeks of treatments,significant improvements of sialorrhea were noted in both groups.After 1,2 and 4weeks of treatment,the total effective rate were 63.16％,94.74％ and 94.74％,respectively,in the treatment group,versus 5.88％,61.11％ and 61.11％,respectively,in the control group.The total effective rate of the treatment group were significantly higher in the above three time-points than the control group (P ＜ 0.05).Conclusions Oral placement therapy can improve sialorrhea symptom after stroke more effectively than routine treatment.