The effect of balance training on motor recovery and ambulation after stroke: a randomized controlled trial.

AIM: To investigate the effects of balance training, using force platform biofeedback, on motor recovery, mobility and activity level of hemiparetic patients with stroke. METHODS: In this randomized, controlled, assessor-blinded trial 41 inpatients [mean (+/-SD) age of 60.9 (+/-11.7) years] with hemiparesis after stroke (median time since stroke 6 months) were randomly assigned to an experimental or a control group. The control group (n=19) participated in a conventional stroke inpatient rehabilitation program, whereas the experimental group (n=22) received 15 sessions of balance training (using force platform biofeedback) in addition to the conventional program. Main outcome measures were motor recovery of the lower extremity (Brunnstrom staging), mobility (Rivermead Mobility Index, RMI) and activity level (Functional Independence Measure, FIM) that performed one week before and after the experimental treatment program. RESULTS: Both groups were similar in terms of baseline clinical characteristics. Motor recovery, mobility and activity level improved significantly in both groups (P<0.05). Between-group difference of mean change score was not significant for the Brunnstrom stages (0.23 vs 0.26), RMI (2.9 vs 2.2) and FIM score (10.7 vs 11.5). CONCLUSION: In our group of stroke patients, balance training combined with a conventional rehabilitation program does not provide additional benefit in terms of lower extremity motor recovery, mobility and activity level.

Relation between grip strength and hand bone mineral density in healthy women aged 30-70.

AIM OF STUDY: To determine the site-specific relationship between grip strength and hand bone mineral density (BMD) measured with dual energy x-ray absorptiometry (DXA) in healthy women. The correlation of hand BMD and BMD at axial sites has also been assessed. METHOD: Twenty-nine healthy housewives, aged 30-70, were included in the study. Women were grouped according to their menopausal status (12 premenopausal and 17 postmenopausal). Grip strength of the dominant hand was measured using a Jamar dynamometer. BMD of the antero-posterior spine, femoral neck, trochanter, and Ward's triangle were measured with DXA. For the hand BMD measurements, the analysis software, which was modified from the software of small animals and developed for hand BMD measurements, was used. RESULTS: Hand BMD moderately correlated with grip strength in postmenopausal women. There was no significant correlation between grip strength and hand BMD in premenopausal women. Significant positive correlations were determined between the hand BMD and BMD at axial sites. CONCLUSION: Grip strength may be an independent indicator of hand BMD in postmenopausal women, and also a site-specific relationship. Hand BMD measurements may indirectly reflect the BMD of axial sites especially in postmenopausal women.

Correlation of hand bone mineral density with the metacarpal cortical index and carpo:metacarpal ratio in patients with rheumatoid arthritis.

This study proposed an assessment of the correlation of hand bone mineral density measured by dual energy x-ray absorbtiometry (DXA) with the carpo:metacarpal (C:MC) ratio and metacarpal cortical index (CI) in patients with rheumatoid arthritis (RA). The correlation of total hand BMD, CI and C:MC ratio with BMD at other sites, the Health Assessment Questionnaire (HAQ) and Larsen scores were also examined. The hand and axial BMD of 30 female patients were also compared with 29 age-matched healthy female controls. Total hand BMD values of patients were significantly lower than the control group. There was no significant difference between groups in axial measurements. CI correlated moderately with the second metacap (II.MC) midshaft and total hand BMD. The C:MC ratio correlated with II.MC midshaft and total hand BMD. Total hand BMD correlated moderately with the AP spine (L2-L4) and femoral neck BMD. Larsen scores showed weak negative correlation with II.MC midshaft BMD and CI. Grip strength correlated weakly only with total hand BMD. The results indicated that CI may reflect cortical bone mass of the hand accurately and did not predict bone density of the spine or hip in patients with RA. The C:MC ratio is a useful method for evaluating progression of wrist involvement and may be related to the loss of hand bone mineral density associated with disease process.