Impact of upper-body ergometer rowing exercise on aerobic fitness and cardiometabolic disease risk in individuals with spinal cord injury: A 6-month follow-up study.

OBJECTIVE: We recently demonstrated that upper-body rowing exercise (UBROW) improved aerobic fitness in individuals with spinal cord injury (SCI), with no effect on traditional cardiometabolic risk factors. Here, we tested the hypothesis that the exercise-induced increase in aerobic fitness was maintained at 6-month (6M) follow-up. DESIGN: Six-month follow-up. SETTING: University/hospital. PARTICIPANTS: Seventeen wheelchair-dependent participants with SCI. INTERVENTIONS: 12-week of exercise training (UBROW) or control (CON). OUTCOME MEASURES: Aerobic fitness (POpeak and V̇O2peak), body composition, blood pressure, and blood biomarkers of cardiometabolic risk were assessed at 6M follow-up and compared to baseline (BL) and immediately post-intervention (12-week). Minutes of mild, moderate, and heavy intensity leisure time physical activity (LTPA) were assessed by self-report. RESULTS: Fourteen participants returned at 6M follow-up (CON, n = 6; UBROW, n = 8). In UBROW, POpeak (median (Q1-Q3)) increased from BL (70 W (37-84)) to 12-week (77 W (58-109), P = 0.01) and 6M follow-up (81 W (51-96), P = 0.01), with no difference between 12-week and 6M follow-up (P = 0.21). Similarly, V̇O2peak increased from BL (15.4 ml/kg/min (10.5-19.4)) to 12-week (16.6 ml/kg/min (12.8-21.3), P = 0.01) with no difference between 12-week and 6M follow-up (16.3 ml/kg/min (12.9-19.7), P = 0.74). No differences were found in CON for either POpeak (P = 0.22) or V̇O2peak (P = 0.27). There were no changes over time in traditional cardiometabolic risk factors or for minutes of different LTPA intensities. CONCLUSION: We demonstrate that improvements in aerobic fitness are maintained for at least six months after completion of a 12-week exercise intervention, supporting the use of periodic exercise interventions to boost aerobic fitness level in individuals with SCI.Trial registration: ClinicalTrials.gov identifier: NCT04390087..

Rowing exercise increases cardiorespiratory fitness and brachial artery diameter but not traditional cardiometabolic risk factors in spinal cord-injured humans.

PURPOSE: This study assessed the effects of upper-body rowing exercise on cardiorespiratory fitness, traditional cardiometabolic risk factors, and vascular health in individuals with spinal cord injury (SCI). METHODS: Seventeen male and female adults with chronic (> 1 yr) motor-complete and incomplete SCI (level of injury: C4-L3) were randomized to control (CON, n = 9) or exercise (UBROW, n = 8). Participants in UBROW performed 12-week, 3 weekly sessions of 30-min upper-body ergometer rowing exercise, complying with current exercise guidelines for SCI. Cardiorespiratory fitness ([Formula: see text]O2peak), traditional risk factors (lipid profile, glycemic control) as well as inflammatory and vascular endothelium-derived biomarkers (derived from fasting blood samples) were measured before and after 6 (6W) and 12 weeks (12W). Brachial artery resting diameter and flow-mediated dilation (FMD) were determined by ultrasound as exploratory outcomes. RESULTS: UBROW increased [Formula: see text]O2peak from baseline (15.1 ± 5.1 mL/kg/min; mean ± SD) to 6W (16.5 ± 5.3; P < 0.01) and 12W (17.5 ± 6.1; P < 0.01). UBROW increased resting brachial artery diameter from baseline (4.80 ± 0.72 mm) to 12W (5.08 ± 0.91; P < 0.01), with no changes at 6W (4.96 ± 0.91), and no changes in CON. There were no significant time-by-group interactions in traditional cardiometabolic blood biomarkers, or in unadjusted or baseline diameter corrected FMD. Explorative analyses revealed inverse correlations between changes (∆12W-baseline) in endothelin-1 and changes in resting diameter (r = - 0.56) and FMD% (r = - 0.60), both P < 0.05. CONCLUSION: These results demonstrate that 12 weeks of upper-body rowing complying with current exercise guidelines for SCI improves cardiorespiratory fitness and increases resting brachial artery diameter. In contrast, the exercise intervention had no or only modest effects on traditional cardiometabolic risk factors. The study was registered at Clinicaltrials.gov (N-20190053, May 15, 2020).

Implementation of a municipality-based rehabilitation program for patients with neuritis vestibularis: lessons learned and derived snowball effects.

BACKGROUND: Patients with dizziness are severely affected in their daily life. The dizziness may be caused by vestibular neuritis and this condition may be severe and result in hospitalization. Qualified municipal rehabilitation services are warranted for these patients after edischarge from the hospital. However, very few specialized municipal initiatives in Denmark are targeting this patient group. METHODS: This paper reports on the development of a clinically applicable municipality-based vestibular neuritis rehabilitation program and evaluates the acceptability of this initiative. RESULTS: The study recognized the need for a rehabilitation program after hospital discharge. However, the program was not evaluated as acceptable for multiple reasons. The exercise program was applicable and feasible but was experienced as a limitation for the practitioner, when addressing other balance issues was needed. It proved challenging to inform both the administrative staff and the clinicians about the new rehabilitation service to allow for sufficient implementation. CONCLUSION: Although the rehabilitation program was not considered an unequivocal success, there were several derived valuable snowball effects of the program. This paper advocates that focus should not only lie on the success of a single program, but also explore the derived benefits for patients and organizations, as well as the practice-oriented knowledge these programs generate.

Wheelchair-modified ergometer rowing exercise in individuals with spinal cord injury: a feasibility, acceptability, and preliminary efficacy study.

STUDY DESIGN: Exploratory clinical investigation. OBJECTIVES: To assess the feasibility, acceptability, and preliminary efficacy of upper-body rowing exercise adapted to wheelchair users with spinal cord injury (SCI). SETTING: University exercise laboratory. METHODS: Eight individuals with SCI exercised on a rowing ergometer modified for wheelchair users (REMW), three times weekly, for up to 30 min per session. Participants completed feasibility and acceptability questionnaire (1-5 Likert scale), and the Wheelchair Users Shoulder Pain Index (WUSPI) before and after six weeks of exercise. Average power output (POAVG), distance rowed, percent peak heart rate (%HRpeak), and rating of perceived exertion (RPE) (6-20 scale) were monitored throughout the 18 exercise sessions and analyzed to evaluate preliminary efficacy of the exercise modality. RESULTS: All eight participants completed the study (97% adherence). Participants rated the exercise high on the feasibility and acceptability scale; median (interquartile range) = 5.0 (4.0-5.0), where higher numbers indicated greater feasibility. Shoulder pain was reduced by 21% yet not significantly different from baseline (p = 0.899). Physiological measures (%HRpeak = 80-83%; RPE = 15.0-16.0) indicated a high cardiovascular training load. From week 1 to week 6, POAVG and distance rowed increased by 37 and 36%, respectively (both p ≤ 0.001). CONCLUSIONS: Data from six weeks of exercise on the REMW suggests that upper-body rowing is a feasible and acceptable exercise modality for wheelchair users with SCI. Session data on %HRpeak, RPE, and shoulder pain indicate that REMW evoked moderate to vigorous intensity exercise without exacerbation of shoulder pain. Future research is required to quantify potential training-induced changes in cardiorespiratory fitness.

Lifestyle physical activity in manual wheelchair users - an overlooked public health opportunity.

Public health guidelines and health promotion efforts have traditionally focused on weekly accumulation of moderate to vigorous physical activity (MVPA) via structured exercise. There has been a recent paradigm shift towards the organic incorporation of MVPA in daily leisure and non-leisure time, termed "Lifestyle Physical Activity" (LPA). However, this paradigm shift and the underlying research has neglected manual wheelchair users (MWCUs) with spinal cord injury (SCI), who could benefit from LPA. This article argues for expanding the LPA paradigm shift into research and health promotion efforts involving MWCUs with SCI. We suggest a working definition of LPA for MWCUs and candidate metrics for quantifying LPA. This is followed by brief overviews of LPA correlates, outcomes/consequences, and interventions and the need for theory based approaches to study these domains. We lastly suggest an approach for mitigating potential negative outcomes of increased LPA in MWCUs and suggest a research agenda.

Attentional Capacity during Dual-task Balance Performance Deteriorates with Age before the Sixties.

Postural control may be automated and leave residual attentional capacity for concurrent cognitive challenges - i.e. dual-task capacity. In old people and impaired individuals, the automatization is lost but dual-task performance may deteriorate even earlier in life.A convenience sample of 112 healthy individuals represented three subgroups: <30 years, 30-60 years and >60 years. They were challenged in a novel dual-task test on postural control and attentional capacity, which allowed participants to improve the performance time compared with their baseline provided they had residual attentional capacity to utilize leading cues in their movement strategies.Performance time in the baseline motor task (single task) increased with age, and relative improvement with cue (attentional capacity during dual task) decreased with age: correlation coefficients: 0.32 and -0.41. There were differences between the age groups in the improvement with cues: young 26.6% (6.6), middle aged 19.1% (12.2) and elderly 10.1% (11.6).In general, all age groups performed the task faster with cues, but individual differences were large. The middle-aged group as well as the elderly group had a poorer dual-task performance than the young group. This suggests that attentional capacity during dual-task balance may be affected even before the sixties.

Sociodemographic characteristics associated with physical activity barrier perception among manual wheelchair users.

BACKGROUND: Individuals with disabilities are sub-optimally active and at increased risk for chronic diseases. Limited knowledge exists about how differences among wheelchair-dependent individuals may affect their perception of physical activity barriers. OBJECTIVE: We examined whether the perception of physical activity barriers are associated with wheelchair user sociodemographic characteristics. METHODS: Danish manual wheelchair users (MWCUs) (N = 181; 52.5% females, mean ± SD: age 48 ± 14 yrs) completed the 'Barriers to Physical Activity Questionnaire for People with Mobility Impairments' (BPAQ-MI) online. The BPAQ-MI queries physical activity barriers in four domains (intrapersonal, interpersonal, organizational, and community) and eight subdomains. Participant characteristics evaluated as potentially associated with physical activity barriers included age, sex, years in chair, body mass index (BMI), spinal cord injury (SCI) (if any), education, employment, and resident city size. Simple linear regression (step 1) and multiple regression models (step 2) were created to assess associations between MWCU characteristics and barriers. RESULTS: Multiple regression models revealed that MWCUs who were obese, who did not complete high school, or were unemployed rated physical activity barriers higher across several subdomains (all r2≤0.226, p<0.05). Resident city size was associated with safety subdomain barrier impact (r2=0.039, p<0.05). Sex, age, years in chair and SCI were not associated with any barrier domains (all p ≥ 0.064). CONCLUSIONS: Our results provide new evidence that MWCUs with BMI ≥30; who are not employed; or who only have completed high school, may need special consideration and resources to overcome distinct physical activity barriers. Behavioral strategies and interventions focusing on reducing physical activity barriers should be tailored to the individuals above.

Physical Activity Barriers in Danish Manual Wheelchair Users: A Cross-sectional Study.

OBJECTIVE: To identify physical activity barrier prevalence and severity among manual wheelchair users (MWCUs) and test whether barrier impact is associated with self-reported physical activity level (PAL). DESIGN: Cross-sectional survey. The Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) was translated from English to Danish and administered online. The BPAQ-MI includes barriers within 4 domains and 8 subdomains and queries if an item hindered physical activity participation in the last 3 months (yes/no). If "yes," participants graded barrier severity from very small (1) to very big (5). Barrier impact scores were summed within and across domains. SETTING: General community. PARTICIPANTS: Danish MWCUs (N=181; 52.5% female, mean age, 48±14y.). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PAL was rated from not active (1) to extremely active (10). Individual barrier prevalence (frequency, %) and severity (median [interquartile range]) was computed. Unadjusted (Spearman rank correlations, domains, subdomains) and adjusted (multivariate linear regression, subdomains) associations between PAL and barrier impact were computed. RESULTS: The 5 most prevalent barriers were reported by ≥49.6% of participants (2 intrapersonal and 3 community). The 5 most severe barriers all had a median of 5 (1 organizational and 4 community). Unadjusted analysis showed that PAL was inversely associated with total intrapersonal (r=-0.487, P<.01) and overall (r=-0.241, P<.01) impact and the intrapersonal "health" (r=-0.477, P<.01) and "beliefs/attitudes"(r=-0.307, P<.01) subdomains. Adjustment for shared variance revealed only the "health" subdomain impact score was independently associated with PAL (P<.001). CONCLUSIONS: Intrapersonal barriers were highly prevalent. Health-related barriers were inversely related to PAL. When organizational and community barriers were present, they were rated as particularly severe. These results provide novel information that can guide the design of future interventions aiming to increase MWCUs PALs.

Effect of wheelchair-modified rowing exercise on cardiometabolic risk factors in spinal cord injured wheelchair users: protocol for a randomised controlled trial.

INTRODUCTION: Cardiovascular and metabolic diseases are a growing concern for individuals with spinal cord injury (SCI). Physical inactivity contributes to cardiometabolic morbidity and mortality in the SCI population. However, previous studies have shown mixed results regarding the effects of exercise on cardiometabolic risk factors in individuals with SCI. This discrepancy could be influenced by insufficient exercise stimuli. Recent guidelines recommend 30 min of moderate-to-vigorous intensity aerobic exercise, three times per week, for improvement in cardiometabolic health in individuals with SCI. However, to date, no studies have implemented an exercise intervention matching the new recommendations to examine the effects on cardiometabolic risk factors. Therefore, the primary objective of this study is to determine the effects of 12 weeks of wheelchair user-modified upper-body rowing exercise on both traditional (constituents of the metabolic syndrome) and novel (eg, vascular structure and function) cardiometabolic risk factors in manual wheelchair users with SCI. METHODS AND ANALYSIS: A randomised controlled trial will compare 12 weeks of upper-body rowing exercise, 30 min three times per week, with a control group continuing their normal lifestyle. Outcome measurements will be performed immediately before (baseline), after 6 weeks (halfway), 12 weeks of training (post) and 6 months after the termination of the intervention period (follow-up). Outcomes will include inflammatory (eg, C reactive protein) and metabolic biomarkers determined from venous blood (with serum fasting insulin as primary outcome), body composition, arterial blood pressure, cardiorespiratory fitness level, brachial artery vascular structure and function and autonomic nervous system function. ETHICS AND DISSEMINATION: This trial is reported to the Danish Data Protection Agency (J.nr. 2019-899/10-0406) and approved by the Committees on Health Research Ethics in The North Denmark Region on 12 December 2019 (J.nr. N-20190053). The principal investigator will collect written informed consent from all participants prior to inclusion. Irrespective of study outcomes, the results will be submitted to peer-reviewed scientific journals for publication. TRIAL REGISTRATION NUMBER: NCT04390087.

Age related differences in balance approached by a novel dual-task test of anticipatory postural control strategies.

INTRODUCTION: Assessment of balance is key to identifying individuals with postural control deficits and an increased fall risk. Subjects may compensate for their deficits by utilizing other strategies; to avoid this, it is recommended to assess postural control using a dual-task test. In most dual-task tests, it is difficult to monitor the performance in the secondary task and the individual's task prioritisation. This study evaluated a new dual-task testing approach. MATERIALS AND METHODS: A convenience sample of 54 community-dwelling elderly (age 65+ years) and a reference group of 20 young participants were included in the study. They performed a test in which they could utilize cues to improve their baseline performance, provided their level of postural control allowed them residual attention capacity for this cognitive task. RESULTS: Significant performance differences were seen between the young and the elderly. The young group improved their performance time by 23.9% (10.7) and 7.1% (14.2) with a cue and a reverse cue, respectively, whereas the elderly failed to improve their performance time. The test was unable to distinguish between individuals within the elderly group due to a floor effect. DISCUSSION: The test reveals an individual's capacity to use cues for anticipatory postural control strategies in a dual-task setting and thereby estimates automatization of postural control. While the young subjects were capable of improving their performance during dual-task conditions, the elderly subjects apparently had no residual attentional capacity allowing them to utilize the facilitating cues. Within the elderly group, the dual-task aspects of the test added no value with respect to differentiation in the level of postural control.

Evaluation of functional ankle instability assessed by an instrumented wobble board.

OBJECTIVES: Ankle sprains often lead to a history of recurrent injuries and functional joint instability. This study evaluated a new method for assessing functional impairment in patients with chronic ankle instability. DESIGN: Case-control study for construct validation purpose. SETTING: The participants were tested during one-leg standing for 20 s on an instrumented wobble board and on a balance platform. PARTICIPANTS: Twenty-five young people with previous ankle sprain and an instability score >11 in the "Identification of Functional Ankle Instability questionnaire" and an age-matched control group of 25 healthy individuals. MAIN OUTCOME MEASURES: Wobble board variation of tilt angle measured by two accelerometers placed horizontally in the board. RESULTS: The variation in angular tilt of the wobble board in the medio-lateral direction (standard deviation of tilt angle) was higher in the group with perceived ankle instability than in the control group: 1.5 (0.7) versus 1.1 (0.3). ICC for intra-tester reliability: 0.87 and correlation with COP area measures from the stable balance platform: 0.64. CONCLUSIONS: People with functional ankle instability display poorer postural stability in the medio-lateral direction when challenged on an unstable surface. The instrumented wobble board may serve as a relevant tool in the clinical evaluation of functional ankle stability.

Manipulation of the body schema - Unilateral manual stimulation of lower extremity influences weight distribution in standing position.

Clinical experience advocates sensory stimulation to increase the body sensation and adjust the body schema, which may be disturbed in some patients. Unilateral massage may affect the body midline orientation, but little evidence is available to support the effect of this practice. Twenty-one healthy young people participated in this experimental study. Two force plates measured weight distribution between the legs in standing position before and after unilateral manual stimulation of the lower extremities. Stimulation of the leg with initial least weight-bearing increased the load on this leg significantly from 48.2% to 49.0% and a similar but reverse effect was seen when stimulating the contra-lateral leg. When analysing the data with respect to stimulation of the non-dominant leg, the stimulation increased the weight-bearing on this leg from 49.6% to 51.3%. These findings indicate that external afferent stimuli may enhance the body perception and influence the body schema and midline orientation.

Medial shoe-ground pressure and specific running injuries: A 1-year prospective cohort study.

OBJECTIVES: Achilles tendinitis, plantar fasciopathy and medial tibial stress syndrome injuries (APM-injuries) account for approximately 25% of the total number of running injuries amongst recreational runners. Reports on the association between static foot pronation and APM-injuries are contradictory. Possibly, dynamic measures of pronation may display a stronger relationship with the risk of APM-injuries. Therefore, the purpose of the present study was to investigate if running distance until the first APM-injury was dependent on the foot balance during stance phase in recreational male runners. DESIGN: Prospective cohort study. METHODS: Foot balance for both feet was measured during treadmill running at the fastest possible 5000-m running pace in 79 healthy recreational male runners. Foot balance was calculated by dividing the average of medial pressure with the average of lateral pressure. Foot balance was categorized into those which presented a higher lateral shod pressure (LP) than medial pressure, and those which presented a higher medial shod pressure (MP) than lateral pressure during the stance phase. A time-to-event model was used to compare differences in incidence between foot balance groups. RESULTS: Compared with the LP-group (n=59), the proportion of APM-injuries was greater in the MP-group (n=99) after 1500km of running, resulting in a cumulative risk difference of 16%-points (95% CI=3%-point; 28%-point, p=0.011). CONCLUSIONS: Runners displaying a more medial pressure during stance phase at baseline sustained a greater amount of APM-injuries compared to those displaying a lateral shod pressure during stance phase. Prospective studies including a greater amount of runners are needed to confirm this relationship.

Asymmetry in gait pattern following tibial shaft fractures - a prospective one-year follow-up study of 49 patients.

INTRODUCTION: Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12 months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. PATIENTS AND METHODS: The study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post-operatively measured with a 6-metre-long pressure-sensitive mat. The mat registers footprints and present gait speed, cadence as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. RESULTS: 49 patients were included with a mean age of 43.1 years (18-79 years). Forty-three patients completed the 12-month follow-up (88%). Gait speed and cadence were significantly increased between the 6- and 12-month follow-up (P<0.001). At 6-month follow-up, patients showed considerable asymmetry in the injured leg compared with the non-injured leg: single-support time 12.8% shorter, swing-time 12.8% longer, step-length 11.9% shorter, and rotation of the foot increased by 32.3%. At the 12-month follow-up, gait asymmetry become almost normalized compared to a healthy reference group. CONCLUSION: In patients treated by intramedullary nailing following a tibial shaft fracture, gait asymmetry accompanied with slower speed and cadence are common during the first 6 months and become normalized compared with a healthy reference population between 6 and 12 months post-operatively.

Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture: a prospective 1-year follow-up cohort study.

INTRODUCTION: To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture. MATERIALS AND METHODS: The design was a prospective, follow-up cohort study. QOL was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs were recorded at 6 and 12 months. RESULTS: Forty-nine patients were included. The mean age at the time of fracture was 43.1 years (18-79 years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95 % CI 0.747-0.837). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P < 0.001). Twelve months postoperatively, increasing relative difference in muscle strength during knee extension show a fair correlation to worse QOL (R = 0.541, P < 0.001). CONCLUSIONS: Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Muscle strength in the non-injured leg improved over time and was higher after 6 and 12 months compared with the injured leg.

The Use of Cognitive Cues for Anticipatory Strategies in a Dynamic Postural Control Task - Validation of a Novel Approach to Dual-Task Testing.

INTRODUCTION: Dual-task testing is relevant in the assessment of postural control. A combination of a primary (motor) and a secondary (distracting cognitive) tasks is most often used. It remains a challenge however, to standardize and monitor the cognitive task. In this study a new dual-task testing approach with a facilitating, rather than distracting, cognitive component was evaluated. METHODS: Thirty-one community-dwelling elderly and fifteen young people were tested with respect to their ability to use anticipatory postural control strategies. The motor task consisted of twenty-five repetitive tasks in which the participants needed to exceed their limit of stability in order to touch one out of eight lights. The participants performed three tests. In two of the tests the color cues of the lights allowed the participants to utilize cognitive strategies to plan their next movement and improve their performance time. RESULTS: The young performed the baseline motor task test in an average of 29 seconds, while the average time for the elderly was 44 seconds. When comparing the performance time with a leading cue to the time with no cue, the young group improved their performance time significantly better than the elderly did: young: 17% (5), elderly: 5% (8); p<0.001. Similar differences were seen with a more complicated leading cue: young: 12% (5), elderly: 4% (9); p<0.01. The reliability of the test showed moderate to substantial agreement (ICC = 0.74), with a small learning effect between two sessions. CONCLUSION: The dual-task test was sensitive enough to discriminate between elderly and young people. It revealed that the elderly did not utilize cognitive cues for their anticipatory postural control strategies as well as the young were able to. The test procedure was feasible and comprehensible for the participants, and it may be relevant to standardize a similar test for an alternative dual-task approach in the clinical setting.

The Use of Computer-Assisted Home Exercises to Preserve Physical Function after a Vestibular Rehabilitation Program: A Randomized Controlled Study.

Objective. The purpose of this study was to evaluate whether elderly patients with vestibular dysfunction are able to preserve physical functional level, reduction in dizziness, and the patient's quality of life when assistive computer technology is used in comparison with printed instructions. Materials and Methods. Single-blind, randomized, controlled follow-up study. Fifty-seven elderly patients with chronic dizziness were randomly assigned to a computer-assisted home exercise program or to home exercises as described in printed instructions and followed for tree month after discharge from an outpatient clinic. Results. Both groups had maintained their high functional levels three months after finishing the outpatient rehabilitation. No statistically significant difference was found in outcome scores between the two groups. In spite of moderate compliance levels, the patients maintained their high functional level indicating that the elderly should not necessarily exercise for the first three months after termination of the training in the outpatient clinic. Conclusion. Elderly vestibular dysfunction patients exercising at home seem to maintain their functional level, level of dizziness, and quality of life three months following discharge from hospital. In this specific setup, no greater effect was found by introducing a computer-assisted training program, when compared to standard home training guided by printed instructions. This trial is registered with NCT01344408.

Strategies for equilibrium maintenance during single leg standing on a wobble board.

The aim of this study was to identify and compare movement strategies used to maintain balance while single leg standing on either a firm surface (FS) or on a wobble board (WB). In 17 healthy men, retroreflective markers were positioned on the xiphoid process and nondominant lateral malleolus to calculate trunk and contralateral-leg excursion (EXC) and velocity (VEL), and center of pressure (CoP) EXC and VEL during FS on a force platform. From the WB test, standing time (WBTIME) was determined and the board's angular EXC and VEL were calculated from four markers on the WB as surrogate measures for CoP dynamics. Electromyographic average rectified values (ARV) from eight leg and thigh muscles of the supporting limb were calculated for both tasks. WB ARV amplitudes were normalized with respect to the value of FS ARV and presented significantly higher peroneus longus and biceps femoris activity (p<0.05). WB standing time was correlated to trunk sagittal plane velocity (r=-0.73 at p=0.016) and excursion (r=-0.67 at p=0.03). CoP and WB angular movement measures were weakly and not significantly correlated between tasks. This lack of correlation indicates that WB balance maintenance requires movement beyond the ankle strategy as described for the FS task. WB standing likely demands different biomechanical and neuromuscular control strategies, which has immediate implications for the significance of WB tests in contrast to FS balance tests. Differences in control strategies will also have implications for the understanding of mechanisms for rehabilitation training using such devices.

Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing.

OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postoperatively after intramedullary nailing of tibial shaft fracture. METHODS: A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed bilaterally by pain pressure thresholds (PPTs). RESULTS: The mean age at the time of fracture was 42.9 years. Twelve months after surgery, the pain intensity for worst pain during the last 24 hours was 1.8 ± 2.7 cm. The PPTs progressively increased from 6 weeks after surgery to 12 months postoperatively for all PPT sites except for the forearm (P < 0.012). Moreover, the PPTs on the leg were generally reduced on the injured side compared with the non-injured side (P < 0.04). CONCLUSIONS: This study suggests that localized, distal, and bilateral hyperalgesia are common following an isolated tibial shaft fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.