The effects of electromyographic-triggered neuromuscular electrical muscle stimulation on the functional hand recovery among stroke survivors.

Restoration of functional hand following stroke still presents formidable challenges to physiotherapists. The study evaluated the effectiveness of EMG-triggered NMES on the functional hand recovery of stroke survivors. Nineteen stroke survivors referred for physiotherapy at Korle-Bu Teaching Hospital, Accra Ghana, were consecutively assigned into an Intervention (IV) and the usual care (UC) groups. The outcome measures included box and block timed manipulation test, action research arm test (ARAT) and an adapted hand dynamometry. Measurements were recorded at baseline, at 4 and 8 weeks of the treatment by an independent assessor. The intervention group received EMG-triggered NMES in addition to the usual care during the evaluation period. Statistical analysis involved Freidman Two way ANOVA by ranks to evaluate the statistical significant changes within each group whilst Mann-Whitney U test compared the differences in the post treatment variables between the two groups. Alpha level was set at P < 0.05. The mean periods of onset of stroke were 3.63 +/- 2.13 and 5.50 +/- 2.16 months for UC and IV groups respectively. There was no significant difference (P > 0.05) in the periods of onset of stroke and ages between the two groups. Within group comparison showed significant performance (P < 0.05) on the outcome measures post baseline. No significant difference occurred between both groups except in ARAT where intervention group performed significantly better (P < 0.05) at the 8th week of the evaluation. It was concluded that inclusion of EMG-triggered NMES could contribute to a better functional hand recovery among stroke survivors during recovery stage.

Assessment of limited joint mobility of the hand in Black Africans with diabetes mellitus and in non-diabetics.

OBJECTIVE: This study is designed to further characterize Limited Joint Mobility (LJM) of the hand using quantitative goniometric measurements among Black Africans with Type 2 diabetes mellitus and non-diabetes. METHODS: Seventy-six patients with Type 2 diabetes and 63 normal controls matched for age and gender were purposively selected. Visual clinical examination and quantitative goniometric assessment of patients with DM and non-DM controls were done. The LJM was graded using the criteria of Silverstein et al. Glycaemic control and proteinuria were also assessed. RESULTS: Prevalence of LJM among Type 2 DM patients was 26.3% compared with 4.8% in normal controls. Subjects with LJM within the control group were significantly older than those with LJM within the DM group (p < 0.05). Prayer sign was 11.8% in DM patients compared with 4.8% of control. The flattening sign demonstrated by the inability to flatten their hands on a flat surface was more in patients with DM (10.5%) compared with 4.8% in the control group. Stage II LJM with 18.4% prevalence was the commonest followed by Stage III (7.9%) among patients with DM. Poor glycaemic control was found in 85%, using fasting plasma glucose and 70%, using 2-hour postprandial blood glucose (2 hpp). CONCLUSION: We conclude that Black Africans with Type 2 DM only have moderately severe cases of LJM.

Balance, gait and fear of falling in the elderly--a pilot study in community-based rehabilitation homes.

BACKGROUND: Falls represent a major threat to health status and independence in the elderly, causing pain and cessation of physical activities, whether due to fear of falling, declining mobility or balance. OBJECTIVE: To evaluate falls, vis-à-vis balance, gait and fear of falling, in the elderly living in Community-Based Rehabilitation Homes. METHODS: Two Community-Based Rehabilitation Homes were randomly picked and 85 apparently healthy elderly (Males 44, Females 41), aged between 65 and 90 years, volunteered to participate in this study. The level of gait and balance of the participants was assessed using Tinetti Performance Oriented Mobility Assessment (TPOMA) scale while the fear of falling was assessed using the Activities Specific Balance Confidence (ABC) scale. The occurrence of falls in the elderly was also recorded. Data were analyzed using descriptive statistics and inferential statistic of chi-square to see the effect of gender. RESULTS: There was a significant difference between the physical characteristics of the male and female participants. Falls and fears of falls were prevalent. The frequency of falls increased with age. Chi-square test showed that the frequency of falls was significantly (p<0.05) higher in the females than males. CONCLUSION: Falls are significant causative factors of pain and avoidable disability. Their prevention in the elderly should be a major concern in our environment.

The effect of histamine iontophoresis on the heart rate and blood pressure of female subjects.

The main purpose of this study was to determine the effect of histamine iontophoresis on the Blood Pressure (BP), and heart rate (HR) of female subjects. Twenty apparently healthy female undergraduates of Obafemi Awolowo University, Ile-Ife (average age 24.2 +/- 2.9) participated in the study. An automated electronic sphygmo-manometer that monitors both BP and HR was used to measure the Systolic Blood Pressure(SBP) and diastolic Blood Pressure (DBP) over the left brachial artery. The histamine gel used in this study contained 1 percent histamine dihydro-chloride. The gel was applied to the right biceps brachii and active was applied below the cubital fossa. The current intensity Interrupted Direct Current (IDC) was gradually increased and subjects were instructed to indicate immediately they experienced tingling sensation under the electrode. The same procedure was carried out the second time on the subjects with the same intensity of IDC current but without histamine for each subject. The treatments were administered on different days but within a two-week interval. The cardiovascular response was monitored five minutes before the administration, twenty minutes during the administration and five minutes after the termination of each treatment. Blood Pressure and heart rate did not change significantly from the baseline during the histamine iontophoresis and direct currents treatments (P > 0.05). The findings suggest that the subjects' BP and HR were not affected by histamine iontophoresis during the twenty minutes treatment. It was concluded that local administration of 1 percent histamine dihydrochloride into the subcutaneous tissue of females' right upper arm with the aid of direct current did not appreciably affect the blood pressure and heart rate after 20 minutes of treatment.

The effect of abnormal foot wear on postural stability

A brief review of the result of studies on the wearing of high heel shoes was presented. The primary objective of determining in a quantifiable manner; the effect of such shoes on the stability of the body during standing and walking was defined. With the use of a gravity reference goniometer values; in degrees; of the stability range of movement (SROM) were obtained from 23 undergraduate female students; in standing positions; under 2 conditions of experiment viz:- (i) wearing of low heel shoes and (ii) wearing of high heel shoes. Inferential statistics were invoked to compare the scores of the SROM under these two conditions. Regression analysis was also used to determine the effect of anthropometric variables - of weight and height - on these scores. The results were discussed and the limitation of the study was spelt out. Proposals for public englightenment were suggested

The step height and the stepping distance as important predictors of the maximal knee joint angle in stepping movements - A proposal for the reconditioning of the injured knee@

The strategies of steps negotiation by individuals were investigated with the aim of relating anthropometric variable; step height; and stepping distance to the joint movements at the knee. Measurements of statures and lengths of limb; leg and foot were taken from 30 subjects. Absolute maximal knee angles were obtained separately for each of the subjects - for different step heights and for different stepping distances. Correlation coefficients of anthropometric variables with the knee angle were compared in cases in which the step height was normalised with respect to each of the anthropometric variables. Stature was eventually used to normalize both step height and stepping distance. A regression equation was developed to predict the absolute maximal knee angle for a given relative step height and at a given relative distance