Increased Lower Limb Loading During Sit-to-Stand is Important for the Potential for Walking Progression in Ambulatory Individuals with Spinal Cord Injury

@#Background: Decreased rehabilitation time may increase the need for walking devices at the time of discharge to promote levels of independence among ambulatory individuals with spinal cord injury (SCI). However, using walking devices could create adverse effects on patients. This study explores the proportion of walking devices used, potential for walking progression, and associated factors among ambulatory individuals with SCI. Methods: Fifty-seven participants were assessed for their demographics and functional ability relating to the requirement for walking devices, including the Timed Up and Go Test (TUGT) and lower limb loading during sit-to-stand (LLL-STS). Results: Thirty-five participants (61%) used a walking device, particularly a standard walker, for daily walking. More than half of them (n = 23, 66%) had potential of walking progression (i.e., safely walk with a less-support device than the usual one). The ability of walking progression was significantly associated with a mild severity of injury, increased lower-limb muscle strength, decreased time to complete the TUGT, and, in particular, increased LLL-STS. Conclusion: A large proportion of ambulatory individuals with SCI have the potential for walking progression, which may increase their level of independence and minimise the appearance of disability. Strategies to promote LLL-STS are important for this progression.

Levels of Community Ambulation Ability in Patients with Stroke Who Live in a Rural Area

Background: Community ambulation is essential for patients with stroke. Apart from treatments, an assessment with a quantitative target criterion is also important for patients to clearly demonstrate their functional alteration and determine how close they are to their goal, as well as for therapists to assess the effectiveness of the treatments. The existing quantitative target criteria for community ambulation were all derived from participants in a developed country and ability was assessed using a single-task test. To explore cutoff scores of the single-task and dual-task 10-meter walk test (10MWT) in ambulatory patients with stroke from rural areas of a developing country. Methods: Ninety-five participants with chronic stroke were interviewed concerning their community ambulation ability, and assessed for their walking ability using the single- and dual-task 10MWT. Results: A walking speed of at least 0.47 m/s assessed using the single-task 10MWT, and at least 0.30 m/s assessed using the dual-task 10MWT, could determine the community ambulation ability of the participants. Conclusion: Distinct contexts and anthropometric characteristics required different target criteria for community walking. Thus, when establishing a target value for community ambulation, it needs to be specific to the demographics and geographical locations of the patients.

Walking Devices Used by the Elderly Living in Rural Areas of Thailand

Background: The use of all types of external devices was previously investigated for elderly with and without orthopaedic problems of a developed country. This study describes the proportion, types and the reasons of using a walking device in elderly who live in many rural areas of Thailand. Methods: Participants (n = 390) were interviewed using a questionnaire to ascertain their demographics, health status and types of walking device required for daily activities. Results: Forty-one participants (11%) used a walking device, particularly when walking long distances due to a fear of falling, musculoskeletal pain, and impaired walking ability. The proportion of walking devices used dramatically increased in participants aged 75 years and over (six times of those aged 60–74 years). Most of the participants used a modified walking stick by their own determination (81%), while only 7% used one according to medical prescription. A significant increase in the need of a walking device was seen in participants aged 75 years and over (OR = 13.9; 95% CI 5.9–32.7; P < 0.001), with a medical problem (OR = 45.9; 95% CI 6.7–73.4; P < 0.001) and who required regular medication (OR = 12.7; 95% CI 5.0–33.6; P = 0.001). Conclusion: The findings emphasise the importance of a community health service to promote health status, particularly before 75 years of age.

Effects of sit to stand training on functional balance of children with cerebral palsy

This quasi-experimental study aimed to investigate the effects of task-specific training: sit to stand on functional balance in children with cerebral palsy. The study recruited 10 school children, aged between 6 to 15 years, with a Gross Motor Function Classification System-Expanded and revised version (GMFCS-E\&R) level I to III. Subjects were evaluated their abilities of sit to stand using the Motor Assessment Scale (MAS: sit to stand item). Their functional balance was assessed using Pediatric Balance Scale (PBS), Functional Reach Test (FRT) in sitting posture and Five Times Sit to Stand (FTSST). The subjects attended 20-minute task specific training program of sit to stand 3 times a week for 6 weeks.   Wilcoxon Signed Rank test (P \< 0.05) was used to analyze the outcome differences between pre-training and post-training, and those between post-training and the follow-up periods. Results were found that the median (range) score of sit to stand item in MAS was significantly improved from 2 (2-6) at pre-training to 4 (2-6) at post-training (P = 0.03). Median reaching distance during sitting was significantly increased from 25.5(3-34) at pre-training to 29(10-50) cm. at post-training (P = 0.02). Total balance scores were significantly increased from 40.5 (7-55) at pre-training to 44.5 (8-55) at post-training (P = 0.04). The median of time spent for five times sit to stand in children with GMFCS-E\&R level I-II was significantly decreased from 21.8 (13.31-48.34) at pre-training to 14 (10.47-32.31) seconds at post-training (P = 0.03). The effects of training remained after 6 weeks post training. Results of this study implied that specific sit to stand training improved an ability of sit to stand and functional balance in subjects with cerebral palsy.

Balance, fall and quality of life in active and inactive elderly

This study aimed to assess the ability of balance control, fall, and quality of life in active and inactive elderly. In active elderly, the study also compared the information in elderly who regularly participated in exercise programs (exercise subjects) and routinely conducted physical activities (lifestyle active subjects). One hundred-and-fifty subjects from several communities in Khon Kaen province, Thailand, aged between 65 to 80 years with a BMI of 20-30 kg/m2 Participated in the study. They were subdivided into 3 groups (50 subjects/group). Each of them was tested on balance ability by using the timed up and go test (TUGT) and berg balance scale (BBS). They were also interviewed regarding their fall history during the past 6 months by using a questionnaire and quality of life by using a self-administered WHOQOL-BREF-THAI questionnaire. There were no significant differences on age, BMI and genders of subjects among the groups. Both exercise and lifestyle active subjects reported a higher rate perceived exertion score (Borg score) of their daily physical or exercise activity than that of inactive subjects (P \< 0.001). Lifestyle active subjects also had the longest duration of their routine physical activities. The results of balance performance showed that exercise subjects achieved the best balance control, followed by lifestyle active and inactive subjects respectively. Inactive subjects required the time to complete TUGT longer than 12 seconds (normative cut-off point for elderly between 65 and 85 years of age). Furthermore, inactive and lifestyle active subjects required the time to complete TUGT longer than exercise subject which was clinically significant from that of the exercise subjects. In addition, the number of inactive subjects who experienced falls during the past 6 months was about 2 times greater than that of active subjects. However, there were no significant differences in quality of life of subjects among the groups (P \> 0.05). Findings of this study confirm that the regular exercise is the best for balance control and fall prevention. However, participation in regular physical activity also benefits for those abilities. Thus the program for balance improvement and fall prevention in elderly should emphasize on regular exercise or physical activity.

Physical abilities, quality of life, incidences of complications and falls in patients with chronic spinal cord injury after discharge

Patients with spinal cord injury (SCI) are likely to loss ability to control functions of body systems that lead the patients unable to control their movements. After discharge, unsuitable environmental conditions may significantly affect their ability and increase risks of complications and falls of the patients. This study evaluated the changes of physical abilities and quality of life (QOL), and incidences of complications and falls of 10 patients with chronic complete SCI at 6 months after discharge. Physical abilities and QOL of the patients were measured by using the Spinal cord independence measure (SCIM) and the WHOQOL-BREF-THAI consecutively. Incidence of complications and falls were monthly assessed by using a questionnaire. An average age and post-injury time of the patients were 42.9 ± 14.0 years and 5.6 ± 4.8 years respectively. After 6 months, physical abilities and QOL of the patients were reduced (median physical ability scores reduced from 55 to 54 scores, and median QOL decreased from 93 to 87 scores). All of them reported the incidences of medical complications from 1 – 2 types where 4 of them required rehospitalization for 3 – 30 days. Five patients experienced 1 – 5 occasions of falls. The findings of this study indicated that subjects with chronic SCI showed minimal changes of their physical ability, and faced with a high risk of complications and falls that might affect their ability and QOL. Further study regarding causes and strategies of prevention and health promotion is important for minimizing the consequences of SCI.

Balance, Fall and Quality of Life of Regular and Non-regular Exercise Elderly

Objectives: To compare balance performance, incidences of fall and quality of life of regular and non-regular exercise elderlyMethods: The study cross-sectionally recruited 300 well-functioning older adults, aged 60 – 80 years both males and females. The eligible subjects were assigned into the regular and non-regular exercise groups by using a questionnaire. Balance performances were investigated by using the Berg Balance Scale (BBS) and Timed Up and Go Test (TUGT). Incidences of fall and quality of life were assessed by using questionnaires.Results: Subjects were mostly females which the mean ages of subjects in non-regular exercise group were 69.65 + 5.09 years and regular exercise group were 68.12 + 4.88 years. There were no significant differences of baseline demographics of subjects in both groups. The findings demonstrated that regular exercise subjects had better balance performances and quality of life with a lower incidence of fall than non-regular exercise subjects. Balance performance of subjects in both groups were significant differences (p

Obstacle crossing in patients with incomplete spinal cord injury: A preliminary study

An important goal of physical therapy treatments for patients with incomplete spinal cord injury (iSCI) is to improve gait performance in order to maximize their capacities in the homes and community. However, gait rehabilitation nowadays are mainly done in a smooth and empty room which is different from what patients have to encounter after being discharged from the hospital. It is crucial to know the ability of patients when they walk across an obstacle. Thus, this study aimed to evaluate ability to walk over obstacles at the sizes that commonly found in the homes and community. Participants were 8 patients with iSCI who were able to walk independently with or without walking devices (FIM walking score = 5-7). The results demonstrated that 6 participants (75 %) failed when walked over the obstacles at least once. The fails were mostly due to foot or walking devices contact an obstacle. The finding indicated that participants who walked independently faced with a risk of fall when they had to walk over an obstacle. The information may have an important contribution for the modification of physical therapy programs for patients with iSCI.

Gait Rehabilitation for Patients with Incomplete Spinal Cord Injury (iSCI): Conventional and Treadmill Training

Walking is an important goal that patients with incomplete spinal cord injury (iSCI) want to achieve. Physiotherapy approaches to improve this ability can be divided into 2 main types: conventional and treadmill training. Conventional walking training for patients with iSCI is not unique and likely to employ the techniques used for patients with similar conditions from other pathologies. The methods are based mainly on either individual components necessary for walking or the whole task of walking. However, training on the whole task of walking requires patients to have enough strength and balance to perform both the stance and swing phases of the gait. Treadmill training is an alternative form of whole task walking training that can be started immediately when the patient has stable medical conditions with assistance from therapists and a harness. There are vast variations of the setting methods for treadmill therapy. This article reports information of these training methods which may benefit physiotherapists to choose the treatment for their patients.

Balance and obstacle crossing ability in independent ambulatory spinal cord injury patients

Patients with spinal cord injury (SCI) are frequently having impairment of movement control particularly a complex task such as walking and balance control. This study investigated ability of 18 independent ambulatory SCI patients to control their balance by using Berg Balance Scale (BBS), Timed Up and Go Test (TUGT) and to walk over small obstacles (wide or high obstacles at the size 1, 4 and 8 cm., 6 conditions totally), which are the sizes that commonly found at home and in the community. Each obstacle was placed at the middle of the 10-meter walkway. Results demonstrated that most of independent ambulatory subjects still had problem in balance control that resulting in exposing to a high risk of fall (BBS = 32.83 + 13.66 scores and TUGT = 45.57 + 18.83 seconds). In addition, 39 % of subjects were unable to successfully walk over obstacle(s).  There were clinical significance of balance control (BBS) between subjects who were able and unable to successfully walk over an obstacle (\> 6 scores). The results may indicate that the development of balance control and obstacle crossing in patients with SCI who are able to walk independently is important to decrease risk of accident after discharge.

Prevalence of musculoskeletal disorders in patients who received treatments from the Office of Medical Technology and Physical Therapy Health Service, Faculty of Associated Medical Sciences, Khon Kaen University

Nowadays, the number of patients with musculoskeletal disorders has been increasing both in public and private hospitals. A study regarding prevalence of these conditions is vital for health promotion and prevention for people in the community. This study aimed to report the prevalence of musculoskeletal disorders in patients who received treatments from The Office for Medical Technology and Physical Therapy Health Service, Faculty of Associated Medical Sciences, Khon Kaen University during October 2006 – September 2007. The results showed that there were 688 new cases who were treated during official time (Sixty percent were female). Most of these patients were middle-aged (forty-five percents of aged between 45-64 years old). Forty-one percents of the patients were employed by the university whereas the rest worked outsides. There were 905 lesion sites. The three most frequent areas of disorders were lower back, neck and upper back respectively. Most of these patients worked in the Faculty of Associated Medical Sciences, Faculty of Nursing, and Faculty of Dentistry respectively.  The most frequently found of the disorders was neck problem. The findings may contribute to further study for development of appropriate health promotion and prevention programs for patients with musculoskeletal disorders.