Activation training facilitates gluteus maximus recruitment during weight-bearing strengthening exercises

Given its tri-planar action at the hip, strengthening of gluteus maximus (GMAX) has been advocated as part of rehabilitation and injury prevention protocols for various musculoskeletal conditions. However, recruitment of GMAX during weight-bearing strengthening exercises can be challenging owing to the muscular redundancy at the hip for a given joint motion. The current study sought to determine if a 1-week activation program could result in greater GMAX recruitment during functional strengthening exercises. Pre- and post-training surface electromyography were collected from 12 healthy participants as they performed double- and single-leg squats. Between testing sessions, participants completed a GMAX activation training program consisting of isometric exercises with band resistance (twice per day for 7 days). Following the 1-week activation program, GMAX recruitment was found to increase by 57% during the double-leg squat (p = 0.005, Cohen’s r = 0.73) and 53% during the single-leg squat (p = 0.006, Cohen’s r = 0.70). Implementation of an initial GMAX activation program should be considered to facilitate neuromuscular adaptations that facilitate utilization of GMAX during hip strengthening exercises.     

A set of rehabilitation measures for compensating emotional stress

The physiological mechanisms of an integrated rehabilitation program and its constituent rehabilitation techniques, namely, local rhythmic thermal impulses; rapid autogenic regulation (RAR); and a session of slow, deep breathing, were studied in apparently healthy subjects who had experienced emotional stress. Mental arithmetic under the conditions of a time deficit with a reprimand was used as a model of emotional stress, which caused a number of rearrangements in the cerebral activity of the subjects, including enhanced β activity in the right frontal area and depression of slow EEG waves in the posterior cerebral areas, and promoted sympathetic influences and hemodynamic impairment. The set of rehabilitation measures, which was designed to affect the body as a whole, promoted the restoration of the initial cortical bioelectrical activity and autonomic status of the subjects. The mechanisms of each rehabilitation technique included in the program were determined.     

Bone mass index analysis in elderly people before and after change prosthesis

Objectives: To evaluate the bone mass index (BMI) of senescent patients before and after prosthetic rehabilitation by complete dentures and evaluating any correlations between prosthetic rehabilitation and changes in BMI. Subjects: Thirty‐two edentulous elder patients who were in need of new complete dentures. Setting: Dental clinic of the Prosthodontics Department (Dental Branch) of the University of São Paulo, Brazil. Materials and methods: The study was performed in three different phases: the first one took place before any procedures relating to the new complete dentures had started and consisted of clinical records and a prosthetic anamnesis. The second and third phases took place after the prosthetic rehabilitation was completed, normally after 3 and 5–6 months respectively. The data collected in the different phases were analysed by using bioestat 3.0; the level of significance was p < 0.05, in a bilateral proof. Results: The non‐parametric statistical analysis of BMI did not show any significant differences when compared with the three phases analysed during the study. Conclusion: There was no evidence that accurate prosthetic rehabilitation could influence BMI.     

Effects of a Brief Intervention on Retention of Patients in a Cardiac Rehabilitation Program

This intervention assessed the effects of a brief intervention on dropout rate in a cardiac rehabilitation program. One hundred thirty five patients were recruited from a cardiac rehabilitation program and randomized to either a control or intervention group. The intervention group participated in four sessions of motivational interviewing and stress management-relaxation in addition to standard cardiac rehabilitation. The control group underwent cardiac rehabilitation alone. Patients who completed the intervention completed an average of 30 sessions while those who dropped out of the intervention completed about six (p < 0.001). Anxiety and depression measured at baseline were the primary predictors of dropout. Patients in both the intervention and controls groups who completed cardiac rehabilitation improved the distance walked, quality of life and decreased anxiety.     

Yoga Ameliorates Performance Anxiety and Mood Disturbance in Young Professional Musicians

Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants later completed a 1-year followup assessment using the same questionnaires. Both yoga groups showed a trend towards less music performance anxiety and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and mood disturbance in young professional musicians.     

Weekly changes in basal metabolic rate with eight weeks of overfeeding

Objective : The contribution of basal metabolic rate (BMR) to weight gain susceptibility has long been debated. We wanted to examine whether BMR changes in a linear fashion with overfeeding. Our hypothesis was that BMR does not increase linearly with 1000‐kcal/d overfeeding in lean healthy subjects over 8 weeks. The null hypothesis states that BMR increases linearly with 1000‐kcal/d overfeeding in lean healthy subjects. Research Methods and Procedures : Initially, 16 lean healthy sedentary subjects completed 2 weeks of weight maintenance feeding at the General Clinical Research Center. The subjects were then overfed by 1000 kcal/d over 8 weeks. BMR was measured under standard conditions each week using indirect calorimetry. Results : Baseline BMR was 1693 ± 154.5 kcal/d. BMR increased from 1711 ± 201.3 kcal/d at week 1 of overfeeding to 1781 ± 171.65 kcal/d at the second week of overfeeding (p = 0.05). BMR fell during the third week of overfeeding to 1729 ± 179.5 kcal/d (p = 0.05). After 5 weeks of overfeeding, BMR reached a plateau. Thereafter, there was no further change. Comparison of BMR with weeks of overfeeding was significantly different compared with the linear model (p < 0.05). Discussion : Increases in BMR in lean sedentary healthy subjects with 1000‐kcal/d overfeeding are not linear over 8 weeks. There seems to be a short‐term increase in BMR in the first 2 weeks of overfeeding that is not representative of longer‐term changes.     

Individual differences in the diurnal cortisol response to stress

The objectives of this study were to explore individual differences associated with diverse reactions in cortisol secretion under different stress levels. This study was part of a larger project concerning working hours and health. Thirty-four white-collar workers participated under two different conditions; one work week with a high stress level (H) and one with a lower stress level (L) as measured through self-rated stress during workdays. Based on the morning cortisol concentration during a workday subjects were divided into two groups. One group consisted of subjects whose morning level of cortisol increased in response to the high-stress week, compared to their morning levels in the low-stress condition (Group 1). The other group consisted of subjects whose morning cortisol response was the opposite, with a lower level under the high stress condition (Group 2). Subjects wore actiwatches, completed a sleep diary, and rated their sleepiness and stress for one work week in each condition, i.e., high and low stress. Saliva samples for measures of cortisol were collected on a Wednesday. Group 2 reported higher workload, fatigue, and exhaustion during both weeks. Since there were no differences in perceived stress, neither within nor between groups, the data indicate that there are other factors influencing morning cortisol. The results suggest that one component modulating the cortisol response might be the level of exhaustion, probably related to work overload. Higher levels of stress in exhausted individuals might suppress morning cortisol levels.     

Cerebral complications in juvenile rheumatoid arthritis.

The antecedents of myocardial infarction have been reviewed in 102 patients (117 episodes) undergoing a program of rehabilitation. The year prior to the first attack was characterized by business and social problems, with some weight gain; in the week before the attach there was added tiredness, poor general health and, in some cases, increasing anginal pain. Heavy lifting and/or unusual exercise were common immediately before or during an attack; five attacks were related to the shovelling of wet snow.Both bed and the normal place of work were uncommon sites for an attack. More than 50% of patients had 30 minutes'' warning of infarction. The relevance of these findings to a safe program of therapeutic exercise is discussed.     

A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation

Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.     

Rehabilitation in paraneoplastic stiff-person syndrome – Case Report

We aimed to share our rehabilitation experience in a patient diagnosed with paraneoplastic Stiff-person syndrome(SPS). A 45-year-old female patient was admitted to neurology with the complaint of widespread painful contractions. EMG was evaluated in favor of SPS. Amphiphysin-antibody was +++ in CSF. Patients’ treatment was arranged and transferred to rehabilitation inpatient-clinic.The patient was included in the rehabilitation program of range of motion,stretching,strengthening, posture&walking exercises, balance&coordination exercises, 5 days/week for 3 months. The patient was screened for breast cancer, diagnosed with invasive breast carcinoma and underwent mastectomy. With the rehabilitation, the patient was mobilized first in the parallel-bar then with tripod-cane in the following months. Significant improvements were found in functional status and quality of life with control of spasticity and mobilization. Although the primary treatment of paraneoplastic SPS is cancer treatment, significant gains have been achieved with rehabilitation. It is necessary to raise awareness of the importance of rehabilitation to physicians who diagnose the disease.     

Effect of functional electrical stimulation on the effort and walking speed,surface electromyography activity,and metabolic responses in stroke subjects

ObjectiveTo investigate the effects of functional electrical stimulation (FES) combined with conventional rehabilitation program on the effort and speed of walking, the surface electromyographic (sEMG) activity and metabolic responses in the management of drop foot in stroke subjects.MethodsFifteen patients with a drop foot resulting from stroke at least 3 months prior to the start of the trial took part in this study. All subjects were treated 1 h a day, 5 days a week, for 12 weeks, including conventional stroke rehabilitation program and received 30 min of FES to the tibialis anterior (TA) muscle of the paretic leg in clinical settings. Baseline and post-treatment measurements were made for temporal and spectral EMG parameters of TA muscle, walking speed, the effort of walking as measured by physiological cost index (PCI) and metabolic responses.ResultsThe experimental results showed a significant improvement in mean-absolute-value (21.7%), root-mean-square (66.3%) and median frequency (10.6%) of TA muscle EMG signal, which reflects increased muscle strength. Mean increase in walking speed was 38.7%, and a reduction in PCI of 34.6% between the beginning and at end of the trial. Improvements were also found in cardiorespiratory responses with reduction in oxygen consumption (24.3%), carbon dioxide production (19.9%), heart rate (7.8%) and energy cost (22.5%) while walking with FES device.ConclusionsThe results indicate that the FES may be a useful therapeutic tool combined with conventional rehabilitation program to improve the muscle strength, walking ability and metabolic responses in the management of drop foot with stroke patients.     

A review of musculoskeletal adaptations in individuals following major lower-limb amputation

Structural musculoskeletal adaptations following amputation, such as bone mineral density (BMD) or muscle architecture, are often overlooked despite their established contributions to gait rehabilitation and the development of adverse secondary physical conditions. The purpose of this review is to provide a summary of the existing literature investigating musculoskeletal adaptations in individuals with major lower-limb amputations to inform clinical practice and provide directions for future research. Google Scholar, PubMed, and Scopus were searched for original peer-reviewed studies that included individuals with transtibial or transfemoral amputations. Summary data of twenty-seven articles indicated reduced BMD and increased muscle atrophy in amputees compared to controls, and in the amputated limb compared to intact and control limbs. Specifically, BMD was reduced in T-scores and Z-scores, femoral neck, and proximal tibia. Muscle atrophy was evidenced by decreased thigh cross-sectional area, decreased quadriceps thickness, and increased amounts of thigh fat. Overall, amputees have impaired musculoskeletal health. Future studies should include dysvascular etiologies to address their effects on musculoskeletal health and functional mobility. Moreover, clinicians can use these findings to screen increased risks of adverse sequelae such as fractures, osteopenia/porosis, and muscular atrophy, as well as target specific rehabilitation exercises to reduce these risks.     

Rehabilitation of patellar tendinopathy

Patellar tendinopathy is a common musculoskeletal disorder characterized by progressive activity-related anterior knee pain and patellar tendon dysfunction. It is highly prevalent in sports which involve running and jumping. Various treatment methods are used in the management of PT including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery. Even though various treatment options are available for patellar tendinopathy, no single method has proven to result in a consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment. This study presents an overview of the current practice about the management of patellar tendinopathy with an emphasis on rehabilitation. This review can act as a guide to sports medicine and rehabilitation professionals’ decision making in the management of this disorder.     

Effects of balance training using wobble boards in the elderly

Few studies have examined balance training of elderly people using wobble boards. This study assessed the effects of wobble board balance training on physical function in institutionalized elderly people. This study examined 23 subjects (age 84.2 ± 5.9 years) who lived in a nursing home. The exercise program for the training group comprised balance training standing on a wobble board for 9 weeks, twice a week. In all, 11 training group subjects and 11 control group subjects completed this study. After 9 weeks, standing time on a wobble board, standing time on a balance mat, and maximum displacement distance of anterior-posterior center of pressure in the training group were significantly greater than those of the control group. Frequency analysis revealed that the power spectrum in 0.1-0.2 Hz significantly increased in the training group. These results suggest that wobble board training is effective for elderly people to improve their standing balance, by which they frequently control their center of gravity and maintain a standing posture on unstable surface conditions.     

Community Rehabilitation Program

A broad outline of a community program has been given, with particular stress on in-sanatorium facilities.It is reasonable to conclude that rehabilitation is feasible, desirable and economically sound.The object of the program is complete rehabilitation in all categories of the greatest possible number of persons incapacitated by tuberculosis.     

Effects of exercise detraining and deacclimation to the heat on plasma volume dynamics

The effects of the discontinuation (DET) of an endurance training/heat acclimation (T/A) program on vascular volumes were studied in 16 adult males. Resting and exercise blood volume dynamics were examined prior to and during an exercise task performed after completion of T/A (CT1) and again at the end of DET (CT2). T/A consisted of cycling at 60% of peak VO2 for 90 min per day, 6 days per week, for 4 weeks. Ambient temperature was 20 degrees C for the first 3 weeks and 40 degrees C for the last week (rh = 30-35%). Subjects were randomly assigned to one of the following DET conditions: 1) cycling one day per week at 40 degrees C, 2) cycling one day per week at 20 degrees C, 3) resting one day per week at 40 degrees C, 4) control. The exercise tasks consisted of 60 min of continuous cycle ergometer exercise at 50% of peak VO2 (Ta = 30 degrees C, rh = 35%). Although significant differences were found between CT1 and CT2, there were no interactions between the various DET conditions. Resting red cell volume decreased 98 ml and plasma volume decreased 248 ml following DET. A reduction in plasma protein content accounted for 97% of the decrease in plasma volume. Hemoconcentration occurred during exercise in both CT1 and CT2, while there were slight increases in plasma [Na+] and [Cl-] and a rapid rise in [K+]. It appears that a single exercise and/or heat exposure per week was not different from complete cessation of endurance exercise in the heat with regard to maintenance of the various vascular volumes.     

Knee stability and muscle coordination in patients with anterior cruciate ligament injuries: An electromyographic approach

We present findings on the way in which to use electromyographic (EMG) measurements from muscles acting on the knee in planning rehabilitation of subjects after rupture of anterior cruciate ligament (ACL). ACL subjects demonstrated an earlier recruitment and a tendency to prolonged activity in muscles around the deficient knee as compared with a control group. Especially the hamstring lateralis and the gastrocnemius medialis (GM) muscles showed an earlier EMG onset and a longer EMG burst duration. The clinical relevance of the EMG findings was assessed by comparing the muscle coordination and relative levels of activity between a functionally excellent/good and a functionally poor ACL patient group. Significant differences between the two groups were noted in EMG onset and burst duration of the GM muscle. A rehabilitation program based on the EMG findings from the GM muscle was designed. In this program, the ACL subjects with poor stability were trained to change the EMG activity of the gastrocnemius muscles according to the recruitment pattern of the good/excellent ACL-group. We were able to train the subjects to change their muscle recruitment and to improve their knee stability. The stability of the knee joint depends on the stiffness of the muscles and ligaments around and within the knee. We discuss the importance of the gastrocnemius muscles with regard to knee joint stiffness.     

Reliability of spectral EMG parameters of healthy back extensors during submaximum isometric fatiguing contractions and recovery

Spectral EMG parameters are being used as an objective evaluation of low back rehabilitation programs. The reliability of these spectral parameters is important in determining the validity of this evaluation tool. Two groups of eight subjects, with no history of back pain, were measured: the first group every day for one week; the second group one day per week for four weeks. During each session, subjects performed a 30-second isometric fatiguing contraction of the back extensors at 60% MVC followed by a 60-second rest and a 10-second repeat contraction. The intraclass correlation coefficient (ICC) did not demonstrate high reliability (ICC<0.6) for the rate of median power frequency (MedPF) change (Hz/s), the magnitude of the recovery (Hz) and differences between the dominant and the non-dominant sides within a subject. However, the initial MedPF (Hz) of the fatigue and repeat contractions demonstrated excellent reliability (ICC>0.8) with five or more repeated measures. The practical implication of this work is that the experimental condition must have sufficiently large changes in MedPF (signal)—at least larger than the variability inherent in the MedPF (noise)—to constitute a valid measure.     

A real-time database/models base/expert system in predictive microbiology

Summary This paper describes the development and operation of a database/models base/expert system funded by the Ministry of Agriculture, Fisheries and Food in the UK. As part of an on-going coordinated program on predictive microbiology, the system being established involves storage of data and models relevant to changes in populations of food-borne pathogens under given conditions. The system is due to be completed by March 1994.