This study examined the benefits and possible risks of immediate continuous passive motion after autogenous patellar tendon reconstruction of the anterior cruciate ligament. Thirty patients scheduled to undergo ACL reconstruction were prospectively randomized into two groups, CPM and non-CPM. Postoperatively, those in the non-CPM group wore a hinged knee brace. Those in the CPM group were kept on a CPM machine 16 hrs a day while in the hospital and they used it 6 hrs a day for the first 2 weeks postoperatively. After surgery the patients were assessed for hemovac drainage, range of motion, swelling, effusion, subjective pain, and use of pain medication. The CPM group had significantly less swelling and effusion, required less pain medication, and had greater knee flexion. No differences were found in hemovac drainage, passive knee extension, or subjective pain reports despite a significantly greater use of pain medication in the non-CPM group. The results suggest that immediate CPM after ACL reconstruction is safe and facilitates early range of motion by decreasing the amount of pain medication, effusion, and soft tissue swelling.
Carlan K. Yates, Michael R. McCarthy, Howard S. Hirsch and Mark S. Pascale
Kelli F. Koltyn
Chronic pain is a significant problem for many older adults. Strategies for pain management appear to be limited, with the prescription of analgesic medication used most often to treat pain. Older adults, however, are often sensitive to adverse side effects from analgesic medications, so nonpharmacological strategies for treating pain are receiving increased attention. This review article summarizes results from studies that have examined whether improvements in pain occur after an exercise intervention. Limited research has been conducted, and it can be characterized as both experimental and quasi-experimental. In addition, pain has usually been a secondary variable assessed in conjunction with a number of other variables. Results from most studies indicate that improvement in pain can occur after exercise training, but several investigators did not find changes in pain after an exercise-training program. Even less research has been conducted with older adults residing in assisted-care facilities, and this research is limited by small sample sizes.
Jessie M. Huisinga, Iraklis I. Pipinos, Nicholas Stergiou and Jason M. Johanning
Pharmacological treatment has been used to alleviate the claudication symptoms and improve walking performance in peripheral arterial disease (PAD) patients. However, the effects of claudication treatments on gait mechanics have not been objectively indentified with biomechanical techniques. For this study, 20 PAD patients were assigned to take either pentoxifylline (n = 11) or cilostazol (n = 9), the two FDA-approved pharmacological therapies used to treat intermittent claudication symptoms. All patients completed a gait evaluation protocol that involved the acquisition of kinematic and kinetic gait data before use of the medication and after 12 weeks of treatment. Results showed that treatment with either pentoxifylline or cilostazol resulted in limited overall improvement in gait parameters including joint angles and joint moments. Walking speed was unchanged, in either treatment group, as a result of the medication. These results suggest that to improve biomechanical walking parameters of PAD patients, clinicians cannot rely on drug therapies alone.
Michelle A. Sandrey
Tendons have biomechanical properties based on collaborative remodeling of all their cells through normal lysis and synthesis. This review assesses factors that affect the healing response and presents solutions for rehabilitating acute and chronic tendon injuries.
MEDLINE (1970–2002) and SPORTDiscus (1970–2002). Key words searched were tendon, tendinitis, tendinosis, tendinopathy, rehabilitation, ultrasound, NSAIDs, exercise, mobilization, aging, immobilization, and healing.
The biomechanical roles tendons play change throughout one’s lifetime and are influenced by maturation and aging, injury and healing, immobilization, exercise, medications, and therapeutic modalities. Suggestions from animal, case, and clinical studies are varied but provide solutions in the treatment of acute and chronic tendon injuries.
Conclusions and Recommendations:
All factors that affect the tendon structure should be considered in a rehabilitation program. Therapeutic exercise, medications, or therapeutic modalities should never be used as a stand-alone therapy.
Edward M. Phillips, Jeffrey Katula, Michael E. Miller, Michael P. Walkup, Jennifer S. Brach, Abby C. King, W. Jack Rejeski, Tim Church and Roger A. Fielding
To examine baseline characteristics and change in gait speed and Short Physical Performance Battery (SPPB) scores in participants medically suspended (MS) from a physical activity intervention (PA).
Randomized controlled trial.
University and community centers.
Sedentary older adults (N = 213) randomized to PA in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P).
MS was defined as missing 3 consecutive PA sessions in adoption and transition phases or 2 wk in maintenance phase because of a health event.
In all, 122 participants completed PA without MS (NMS subgroup), 48 participants underwent MS and resumed PA (SR subgroup), and 43 participants underwent MS and did not complete PA (SNR subgroup). At baseline, SNR walked slower (p = .03), took more prescribed medications (p = .02), and had lower SPPB scores than NMS and SR (p = .02). Changes from baseline to Month 12 SPPB scores were affected by suspension status, adjusted mean (SE) SPPB change: SNR 0.0957 (0.3184), SR 0.9413 (0.3063), NMS 1.0720 (0.1871); p = .03.
MS participants unable to return to complete the PA in a trial of mobility-limited sedentary older adults had slower walking speeds, lower SPPB scores, and a higher number of prescribed medications at baseline. Change in SPPB scores at 12 months was related to suspension status.
Katja Borodulin, Anja Kärki, Tiina Laatikainen, Markku Peltonen and Riitta Luoto
Daily sitting time may be a risk factor for incident cardiovascular disease (CVD); however, this has not yet been extensively studied. Our aim was to study the association of total sitting time with the risk of CVD.
Participants (n = 4516, free of CVD at baseline) from the National FINRISK 2002 Study were followed for fatal and nonfatal CVD using national registers. Participants underwent a health examination and completed questionnaires, including total daily sitting time.
During a mean follow-up of 8.6 years, 183 incident CVD cases occurred. Sitting on a typical weekday, at baseline, was statistically significantly associated with fatal and nonfatal incident CVD. The hazard ratios (with 95% confidence intervals, CI) for the total amount of sitting were 1.05 (95% CI, 1.00–1.10) in the age and gender adjusted model and 1.06 (95% CI, 1.01–1.11) in the fully adjusted model, including age, gender, employment status, education, BMI, smoking status, leisure time physical activity, use of vegetables and fruit, alcohol use, blood pressure or its medication, and cholesterol or its medication.
Our findings suggest that total amount of daily sitting is a risk factor for incident CVD. More research is needed to understand the etiology of sedentary behavior and CVD.
Laura S. Ho, Harriet G. Williams and Emily A.W. Hardwick
The study’s objective was to examine the health status, physical activity behaviors, and performance-based functional abilities of individuals classified as being at high or low risk for frailty and to determine which of these characteristics discriminates between the 2 groups. Participants were 78 community-dwelling individuals with an average age of 74 years; 37 were categorized as being at high risk and 42 at low risk for frailty. Logistic-regression analysis indicated that individuals classified as being at high risk for frailty were more likely to have visited the doctor more than 3 times in the past year, experienced a cardiac event, taken more than 4 medications a day, and participated in little or no physical activity. High-risk individuals were more likely to have poor balance, difficulty with mobility, decreased range of motion, poor unimanual dexterity, and difficulty performing activities of daily living than were those classified as being at low risk for frailty.
Jay L. Alberts, Christopher M. Elder, Michael S. Okun and Jerrold L. Vitek
The aim of this study was to determine the effects of unilateral deep brain stimulation (DBS) on the control and coordination of grasping forces produced by Parkinson's disease (PD) patients. Ten advanced PD patients with unilateral DBS in the globus pallidus (GPi) or the subthalamic nucleus (STN) (5 patients in each group) performed a functional bimanual dexterous manipulation task. Experiments were performed in the “Off” medication state with DBS “On” and “Off.” DBS resulted in (a) significant clinical improvements, (b) greater maximum grip force for both limbs, (c) reduced movement time, and (d) bilateral coupling of grasping forces. There were no significant differences between the GPi and STN groups for any clinical or kinematic measures. DBS of the GPi and STN leads to an improvement in the motor functioning of advanced PD patients. Improvement in force-timing specification during DBS might allow PD patients to employ a feedforward method of force control.
Ai-Wen Hwang, Chiao-Nan Chen, I-Chin Wu, Hsin-Yi Kathy Cheng and Chia-Ling Chen
This cross-sectional study investigated the correlates of body mass index (BMI) and risk factors for overweight among 91 children with motor delay (MD) aged 9–73 months. Anthropometric measurements and questionnaires regarding multiple risk factors were obtained. Simple correlations between BMI percentile classifications and potential predictors were examined using Spearman’s rank/Pearson’s correlations and χ2 analysis. Multiple predictors of overweight were analyzed using logistic regression. BMI was correlated positively with higher caloric intake (rs = .21, p < .05) and negatively with passive activity (rs = -.21, p < .05). When multiple predictors were considered, more severe dysphagia (odds ratio [OR], 2.81, p = .027, 95% confidence interval [CI], 1.13–7.04) and antiepileptic drug use (OR, 19.12, p = .008, 95% CI, 2.14–170.81) had significant partial effects on overweight status. Agencies supporting early development should consider caregiver education regarding the potential implication of feeding style and medication on BMI.
The motor proficiency of 56 boys with attention deficit hyperactivity disorder (ADHD) was compared with that of 56 boys with learning disabilities (LD); both groups were divided into two age groups, 7 to 8 years and 9 to 12 years. Boys with ADHD were taking Ritalin and attending public schools. Boys with LD were medication-free and attending private schools for LD. The Bruininks-Oseretsky Test of Motor Proficiency–Long Form (BOTMP–LF) was used to measure balance, bilateral coordination, strength, upper limb coordination, response speed, visual-motor coordination, and upper limb speed and dexterity. MANOVA revealed significant main effects for condition and age. Subsequent univariate ANOVAs revealed (a) expected age differences on all but one item and (b) significantly poorer performance for boys with ADHD than boys with LD on all variables except balance, upper limb coordination, and response speed.