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Nancy Margaret Salbach, Jo-Anne Howe, Karen Brunton, Kathryn Salisbury, and Lorene Bodiam

Background:

The purpose of this article is to describe the development and evaluation of a task-oriented group exercise program, delivered through a municipal recreation program, for community-dwelling people with neurological conditions.

Methods:

Physical therapists (PTs) at a rehabilitation hospital partnered with a municipal recreation provider to develop and evaluate a 12-week exercise program for people with stroke, acquired brain injury, and multiple sclerosis at 2 community centers. Fitness instructors who were trained and supported by PTs taught 1-hour exercise classes twice a week. In a program evaluation of the safety, feasibility and effects of the program, standardized measures of physical function were administered before and after the program.

Results:

Fourteen individuals (mean age: 63 years) participated and attended 92% of exercise classes, on average. Two minor adverse events occurred during 293 attendances. Improvement in mean score on all measures was observed. In people with stroke, a statistically significant improvement in mean Berg Balance Scale (mean ± SD change = 3 ± 2 points, P = .016, n = 7) and 6-minute walk test scores (change = 26 ± 26 m, P = .017, n = 9) was observed.

Conclusions:

This model of exercise delivery provides people with neurological conditions with access to a safe, feasible and potentially beneficial exercise program in the community.

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Kenneth G. Holt and Suh Fang Jeng

This paper presents some of the ways we are attempting to understand why physically challenged children adopt the movement patterns they do. It focuses on the skill of walking and compares non-neurologically disabled persons with children with cerebral palsy. A multidisciplinary approach is advocated in which the tools of biomechanics, physiology, and dynamical systems theory are explored. Traditional biomechanics of children with cerebral palsy tend to be descriptive in nature. More recent methods include both traditional biomechanical and dynamical systems approaches to understand why physically challenged children adopt the gait patterns they do. The concept of self-optimization is introduced as a way to motivate the investigations. Mechanical energy conservation, minimal metabolic cost, normality, and stability are discussed as some of the potential optimality criteria. Optimality criteria measurement including several methods of analysis of stability are discussed, and preliminary results of findings in the three groups are reported.

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Bryan L. Riemann and Kevin M. Guskiewicz

Mild head injury (MHI) represents one of the most challenging neurological pathologies occurring during athletic participation. Athletic trainers and sports medicine personnel are often faced with decisions about the severity of head injury and the timing of an athlete's return to play following MHI. Returning an athlete to competition following MHI too early can be a catastrophic mistake. This case study involves a 20-year-old collegiate football player who sustained three mild head injuries during one season. The case study demonstrates how objective measures of balance and cognition can be used when making decisions about returning an athlete to play following MHI. These measures can be used to supplement the subjective guidelines proposed by many physicians.

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Cecilia Persson, Jon Summers, and Richard M. Hall

A spinal cord injury may lead to loss of motor and sensory function and even death. The biomechanics of the injury process have been found to be important to the neurological damage pattern, and some studies have found a protective effect of the cerebrospinal fluid (CSF). However, the effect of the CSF thickness on the cord deformation and, hence, the resulting injury has not been previously investigated. In this study, the effects of natural variability (in bovine) as well as the difference between bovine and human spinal canal dimensions on spinal cord deformation were studied using a previously validated computational model. Owing to the pronounced effect that the CSF thickness was found to have on the biomechanics of the cord deformation, it can be concluded that results from animal models may be affected by the disparities in the CSF layer thickness as well as by any difference in the biological responses they may have compared with those of humans.

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Jin H. Yan and John H. Downing

Tai Chi, an ancieni form of Chinese fitness exercise, affords its participants a variety of physical and psychological benefits. Research has suggested that individuals engaging in Tai Chi exercises improve cardiovascular fitness and motor control while reducing stress, anxiety and depression. Tai Chi is particularly suitable for seniors, who are often at risk for a variety of problems associated with aging (e.g.. arthritis, neurological dysfunction, and general decline of balance, coordination, and locomotor function). Because of its self-paced. nonstressful, and noncompetitive nature, and its ability to afford economy of lime, space, and equipment, Tai Chi presents an effective, functional alternative exercise form for the senior adult population. This article presents the background of Tai Chi practice and introduces several key elements and suggestions for teaching Tai Chi to senior participants. Finally, some selected resources for Tai Chi practice are listed.

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Michael Maliszewski

Combat oriented sports and activities have come under increasing scrutiny by the media and professional groups. In particular, within the last 5 years boxing has been a primary topic of concern. A variety of medical groups—neurological, pediatric, and general practice—have conducted extensive surveys and provided position policy statements regarding dangers associated with involvement in such an activity. Although the American Psychological Association recently endorsed a position advocating close scrutiny and eventual banning of amateur and professional boxing in 1987, surprisingly no serious review of the literature or empirical studies have been conducted with respect to a psychological evaluation of this sport. This article briefly reviews the evidence supporting the APA position on boxing.

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Pei-Chun Kao and Daniel P. Ferris

During passive lower limb movement, active use of the upper limbs increases unintentional lower limb muscle activation. We hypothesized that faster movement frequencies would amplify lower limb muscle activation during upper limb exertion but would not affect lower limb muscle activation when the upper limbs were relaxed. We studied 10 healthy participants exercising on a recumbent stepping machine that mechanically coupled the four limbs via handles and pedals. Participants exercised at four frequencies (30, 60, 90, 120 steps/min) under four conditions of active and passive movement. Self-driven lower limb motion resulted in greater muscle activation compared to externally driven lower limb motion. Muscle activation amplitude increased with frequency for all conditions except for externally driven stepping. These results indicate that fast upper limb movement facilitates neuromuscular recruitment of lower limb muscles during stepping tasks. If a similar effect occurs in neurologically impaired individuals during active stepping, self-assisted exercise might enhance neuromuscular recruitment during rehabilitation.

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Rachele E. Vogelpohl, Rachel A. Lindsey, Christopher D. Stickley, Ronald K. Hetzler, Whitney Williams, and Iris F. Kimura

Subconcussive head impacts do not result in outward signs of neurological dysfunction, however they may have an effect on neurocognitive function. Limited research has indicated that negative changes in neurocognitive function occurs in high school football athletes as a result of one season of football. The purpose of this study was to prospectively evaluate the effects of one season of high school football on neurocognitive test scores. Results revealed a significant group and time interaction effect (p < .001) for the Verbal Memory composite score of the ImPACT test. Further analysis revealed a significant difference in the Verbal Memory score between groups at postseason (p < .01), with the football group scoring lower than the low contact group. It appears that one season of high school football may have a negative effect on the Verbal Memory composite score of the ImPACT test in high school football athletes.

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Denis H. Stott, Sheila E. Henderson, and Fred A. Moyes

The lack of a system for the analysis and diagnosis of handwriting incompetence has led to the neglect of this area of learning failure. This article describes a new instrument, the Diagnosis and Remediation of Handwriting Problems (DRHP) (Stott, Moyes, & Henderson, 1984b), that has been designed to fill this hiatus. Handwriting problems are divided into (a) faults of concept and style, which reflect failures of learning or teaching, and (b) faults of motor control, which suggest fine-motor or perceptual dysfunction and may have a neurological origin. Specimens of children’s handwriting illustrate this categorization. The methodology of the remedial programs proposed by the DRHP is based on empirical findings about the nature of handwriting movements. These programs are briefly described. There is a need for handwriting specialists to advise teachers and help in the diagnosis of problems. It is suggested that physical education teachers be trained to develop these skills.

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Rebekah L. Scott and J. Gregory Anson

Conversion Disorder affects voluntary motor and sensory function and involves unexplained neurological symptoms without an organic cause. Many researchers have attempted to explain how these symptoms arise but the neural correlates associated with Conversion Disorder remain largely unknown to clinicians and neuroscientists alike. This review focuses on investigations of Conversion Disorder (with motor symptoms) when deficits in voluntary movement occur. No single consistent hypothesis has emerged regarding the underlying cortical mechanisms associated with motor Conversion Disorder. However, findings from electrophysiology, neuroimaging, and behavioral research implicate the involvement of prefrontal networks. With further research using measurement techniques precise in spatial as well as temporal resolution, the conflict associated with two views of the neural correlates of motor Conversion Disorder may be resolved. This will provide a better understanding of the impairment associated with the preparation, generation, and execution of intentional movement in Conversion Disorder.