Effects of Electromechanical Exoskeleton-Assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial.
Archives of physical medicine and rehabilitation. 2019;(1):26-31
OBJECTIVE To assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed, and capacity. DESIGN Randomized controlled trial. SETTING University rehabilitation hospital. PARTICIPANTS Individuals (N=40) with stroke who could stand alone. INTERVENTIONS Patients were randomly assigned to control and experimental groups. The control group underwent physical therapist-assisted gait training by conventional method. The experimental group underwent electromechanical gait training assisted by an exoskeleton device. Both types of gait training were performed for 30 minutes each day. The therapeutic interventions were provided for 5 days a week for a period of 4 weeks in both groups. MAIN OUTCOME MEASURES Functional ambulatory category (FAC) before and after gait training. Changes in FAC were the primary outcomes to evaluate the efficacy of electromechanical exoskeleton-assisted gait training. Changes in mobility, walking speed, walking capacity, leg muscle strength, daily activity, and balance were secondary outcomes. RESULTS FAC in the control group was 2.44±1.55 in the pretraining and 2.75±1.53 in the post-training. FAC in the experimental group was 3.22±1.31 in the pretraining and 3.78±1.44 in the post-training. Although FAC between pre- and post-training sessions improved in both groups, the changes in FAC were statistically significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the 2 groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events were noticed during gait training in either group. CONCLUSIONS Electromechanical exoskeleton-assisted gait training is as effective as conventional gait training by a physical therapist when administered by a gait trainer. As an overground walking system without harness, electromechanical exoskeleton replaced a physical therapist in assisted gait training for patients who stand alone. Because the ambulatory function of stroke patients was affected negatively by stroke duration, the effect of electromechanical-assisted gait training might decline with increased stroke duration.
The Effect of a Multidisciplinary Lifestyle Intervention on Obesity Status, Body Composition, Physical Fitness, and Cardiometabolic Risk Markers in Children and Adolescents with Obesity.
Plain language summary
Children and adolescents with obesity are at a high risk of being obese in adulthood. The aim of this study was to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity. The study is based on the Intervention for Childhood and Adolescents Obesity via Activity and Nutrition (ICAAN) – quasi-experimental intervention trial - which recruited 103 participants aged between 6 and sixteen years (63 were boys and 40 girls). The study was based on 2 active treatment groups (usual care group vs exercise group) receiving a 16-week intervention program. Results indicate that children and adolescents with obesity can achieve positive effects on body composition, physical fitness, and cardiometabolic markers, particularly with the exercise intervention. Authors conclude that the moderate-intensity multidisciplinary lifestyle intervention program they developed, can be sustained in the real-world setting and it is applicable to both moderate and severe obesity.
undefined: This study aimed to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity, and assess the additional effects of exercise intervention when compared to usual care. Overall, the 103 enrolled participants were ≥85th percentile of age and sex-specific body mass index (BMI). Participants were divided into groups that received 16 weeks of either usual care or exercise intervention. The BMI -score of the overall completers decreased by about 0.05 after the 16-week intervention ( = 0.02). After the intervention, only the exercise group had a significantly lower BMI -score than the baseline score by about 0.1 ( = 0.03), but no significant group by time interaction effects were observed. At the 16-week follow-up, significant group by time interaction effects were observed in percentage body fat (%BF) (β = -1.52, 95%CI = -2.58⁻-0.45), lean body mass (LM) (β = 1.20, 95%CI = 0.12⁻2.29), diastolic blood pressure (β = -5.24, 95%CI = -9.66⁻-0.83), high-sensitivity C-reactive protein (β = -1.67, 95%CI = -2.77⁻-1.01), and wall sit test score (β = 50.74, 95%CI = 32.30⁻69.18). We developed a moderate-intensity intervention program that can be sustained in the real-world setting and is practically applicable to both moderate and severe obesity. After interventions, the exercise group had lower %BF and cardiometabolic risk markers, and higher LM and leg muscle strength compared to the usual care group.
Effective Timing of Curcumin Ingestion to Attenuate Eccentric Exercise-Induced Muscle Soreness in Men.
Journal of nutritional science and vitaminology. 2019;(1):82-89
Curcumin is known to have potent anti-inflammatory effects. We have reported that acute curcumin ingestion attenuates eccentric exercise-induced muscle damage. This study aimed to examine the effect of curcumin ingestion timing (before or after exercise) on the changes in muscle damage markers after eccentric exercise. In this randomized, single-blind, parallel design study, 24 healthy young men performed 30 maximal isokinetic (120º/s) eccentric contractions of the elbow flexors using an isokinetic dynamometer. Subjects were randomly assigned to ingest 180 mg/d of oral curcumin either 7 d before (PRE) or 4 d after exercise (POST) or 180 mg/d of oral placebo 4 d after exercise (CON). The maximal voluntary contraction (MVC) torque of the elbow flexors, elbow joint range of motion (ROM), muscle soreness, and serum creatine kinase (CK) activity were measured before, immediately after, and 1-4 d after exercise. Changes in these variables were compared over time. In the POST group, ROM were higher at 3-4 d and muscle soreness was lower at 3 d after exercise compared with the CON group (p<0.05). However, in the PRE group, there were no significant differences compared with the CON group in changes in ROM and muscle soreness. Meanwhile, there were no significant differences among the groups in terms of changes in MVC torque and serum CK activity. Our results suggest that curcumin ingestion after exercise had a more beneficial effect in attenuating muscle soreness.
Land-based and aquatic trunk exercise program improve trunk control, balance and activities of daily living ability in stroke: a randomized clinical trial.
European journal of physical and rehabilitation medicine. 2019;(6):687-694
BACKGROUND There are many land-based or aquatic exercise programs for improving trunk control, balance, and activities of daily living in stroke patients. However, no study has reported the effects of an exercise program that combines land-based and aquatic trunk exercises in stroke patients. AIM: To investigate the effects of a land-based and aquatic trunk exercise (LATE) program on trunk control, balance, and activities of daily living in chronic stroke patients. DESIGN This study was designed as a single-blind randomized controlled trial. SETTING Inpatient rehabilitation ward, Goyang, Republic of Korea. POPULATION Twenty-nine patients participated in this study. METHODS Participants were randomly allocated to the LATE group (N.=14) and control group (N.=15). The LATE program consisted of land-based and aquatic trunk exercises, performed for 30 minutes per day, 5 days per week, for 4 weeks as an adjunct to 30 minutes of conventional physical therapy. The control group underwent only conventional physical therapy for 30 minutes each time, twice per day, 5 days per week, for 4 weeks. The participants were tested before and after the intervention using the Korean Trunk Impairment Scale (K-TIS) and the 5-item, 3-level Postural Assessment Scale for Stroke (PASS-3L) to assess trunk control; the 7-item, 3-level Berg Balance Scale (BBS-3L) and the Functional Reach Test (FRT) to evaluate balance; and the Modified Barthel Index (MBI) to assess activities of daily living. RESULTS The LATE group exhibited improvements in K-TIS, PASS-3L, BBS-3L, and MBI scores and FRT distance compared with the control group (P<0.05). CONCLUSIONS The results of this study suggest that the LATE program can help improve trunk control, balance, and activities of daily living in chronic stroke patients and may be used as a practical adjunct to conventional physical therapy. CLINICAL REHABILITATION IMPACT The LATE program can improve postural control in stroke patients and improve independence in daily activities.
Is there a dose-dependent effect of modified constraint-induced movement therapy in patients with hemiplegia?
BACKGROUND Impairment of upper extremity function is a common sequelae of stroke. It has been reported that modified constraint-induced movement therapy (mCIMT) could prove to be effective. OBJECTIVE To investigate the relationship between the intensity of rehabilitation such as treatment and constraining time, and the functional outcome for the paretic upper extremity in stroke patients through mCIMT. METHODS We conducted an observational prospective study of 31 patients with hemiplegia and subacute or chronic stroke. The mCIMT was performed for two weeks. Rehabilitation time and constraining time were variable among patients. The rehabilitation time included an individualized task-oriented program and conventional occupation treatment with an individualized therapist. The constraining time, with mit or splint, was also asked to self-record individually. The outcome was evaluated on the more affected side by the Wolf Motor Function Test, Fugl-Meyer Assessment, Motor Activity Log 14, and Functional Independence Measure for self-care tasks after the therapy. RESULTS All participants after the modified constraint-induced movement therapy program for two weeks improved on the evaluated outcome measures (P < 0.05). No significant correlation was found between the dose-dependent treatment or constraining time and outcomes. Comparisons improvement with subgroups based on the duration from onset, constraining component, dominant hand consistent with lesion side of stroke, and initial medical research council score for muscle strength, also showed no significant differences. CONCLUSIONS This is the first study on the effects of intensity of mCIMT with respect to time-dosage. Although all patients in this study showed improved functional status, no significant correlation between dose-dependent rehabilitation or constraining time and outcomes was seen.
Feedback Facility-Assisted Balance Training in a Patient With Multiple System Atrophy: A Case Presentation.
PM & R : the journal of injury, function, and rehabilitation. 2018;(5):555-559
Multiple system atrophy is a rare neurodegenerative disease with a poor prognosis. Furthermore, there are no pharmacological or notable rehabilitation strategies available to prevent the worsening of the disease. This case presentation assessed the outcome of feedback facility-assisted balance training in combination with physical therapy in a 61-year-old man. The patient participated in 30 training sessions over 6 weeks for 30 minutes each that involved balance training. His static and dynamic balance abilities were improved on the Berg Balance Scale, Trunk Impairment Scale, Functional Independence Measure, and Functional Reach. Although this patient's gait speed and muscle strength did not show improvement after training, feedback facility-assisted balance training might be a potential strategy to help reduce the rate of symptom deterioration in patients with multiple system atrophy. LEVEL OF EVIDENCE V.
The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial.
Topics in stroke rehabilitation. 2018;(1):37-43
BACKGROUND The changes effected by the inspiratory muscle training (IMT) on the structure of inspiratory muscles such as on the diaphragm, in patients with stroke, is unclear. OBJECTIVE To investigate the effect of IMT on inspiratory function, diaphragm thickness, walking endurance, and fatigue in patients with stroke. METHODS A total of 30 patients with stroke were randomized to either the experimental group or the control group. The experimental group (n = 15) underwent inspiratory muscle training with resistance adjusted to 30% of maximal inspiratory pressure, 90 breaths a day, 5 times a week for 6 weeks. Both groups received regular physical therapy for the same amount of time. The primary outcome measure was the diaphragm thickness ratio. The secondary outcomes were inspiratory function; maximal inspiratory pressure and inspiratory muscle endurance; and gait endurance and fatigue. RESULTS There were significant differences between the two groups in the thickness ratio on the affected diaphragm thickness (medium effect size), maximal inspiratory pressure (medium effect size), and inspiratory muscle endurance (large effect size; Bonferroni correction p < 0.005). The gait endurance (medium effect size) and fatigue (small effect size) showed no significant differences in the between group comparison. CONCLUSION Inspiratory muscle training was effective in improving respiratory function and inducing structural changes, especially in the affected diaphragm.
Observational Study of Clinical and Functional Progression Based on Initial Brain MRI Characteristics in Patients with Alzheimer's Disease.
Journal of Alzheimer's disease : JAD. 2018;(4):1721-1730
BACKGROUND Magnetic resonance imaging (MRI) is a useful tool to predict the diagnosis and progression of Alzheimer's disease (AD), especially for primary physicians. However, the correlation between baseline MRI findings and AD progression has not been fully established. OBJECTIVE To investigate the correlation between hippocampal atrophy (HA) and white matter hyperintensities (WMH) on initial brain MRI images and the degree of cognitive decline and functional changes over 1 year. METHODS In this prospective, 12-month observational study, dementia outpatients were recruited from 29 centers across South Korea. Baseline assessments of HA and WMH on baseline brain MRI were derived as well as cognitive function, dementia severity, activities of daily living, and acetylcholinesterase inhibitor (AChEI) use. Follow-up assessments were conducted at 6 and 12 months. RESULTS Among 899 enrolled dementia patients, 748 were diagnosed with AD of whom 654 (87%) were taking AChEIs. Baseline WMH showed significant correlations with age, current alcohol consumption, and Clinical Dementia Rating score; baseline HA was correlated with age, family history, physical exercise, and the results of cognitive assessments. Among the AChEI group, changes in the Korean version of the Instrumental Activities of Daily Living (K-IADL) were correlated with the severity of HA on baseline brain MRI, but not with the baseline severity of WMH. In the no AChEI group, changes in K-IADL were correlated with the severity of WMH and HA at baseline. CONCLUSION Baseline MRI findings could be a useful tool for predicting future clinical outcomes by primary physicians, especially in relation to patients' functional status.
Korean OBEsity Surgical Treatment Study (KOBESS): protocol of a prospective multicentre cohort study on obese patients undergoing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.
BMJ open. 2017;(10):e018044
INTRODUCTION Bariatric surgery effectively induces long-term weight loss in Western populations. However, its effectiveness in Asians remains to be confirmed objectively. The Korean Society for Metabolic and Bariatric Surgery proposes the first prospective cohort study on Koreans undergoing bariatric surgery. METHODS AND ANALYSIS The Korean OBEsity Surgical treatment Study (KOBESS) is a prospective, multicentre, single-arm, observational, cohort study on morbidly obese patients who undergo primary sleeve gastrectomy or Roux-en-Y gastric bypass in Korea. In total, 100 consecutive obese Asian patients who will undergo bariatric surgery will be recruited in 2016-2017; follow-up will be for 1 year. Primary outcomes are change in body weight and waist circumference at 1 year. All patients will undergo anthropometry, laboratory tests, bioelectrical impedance analysis, gastrofibroscopy, polysomnography and fat-measuring CT before and after surgery. Patients with diabetes will also undergo perioperative oral glucose tolerance and endocrinological hormone tests. Hypertensive patients will also undergo perioperative echocardiography and carotid Doppler ultrasonography. Female patients suspected of having polycystic ovarian syndrome will also undergo perioperative hormone tests and abdominal ultrasonography. Visceral and subcutaneous fat will be harvested during surgery. Blood, stool and urine samples will be taken at various perioperative time points. Although the cohort is small and the follow-up duration is relatively short, this study will determine whether bariatric surgery induces satisfactory weight loss in obese Koreans. Significantly, the tissue samples will also facilitate many studies examining the effects of bariatric surgery and their mechanisms. ETHICS AND DISSEMINATION Ethics approval was obtained from the institutional review board of each participating hospital. All findings arising from this cohort study will be published in open-access peer-reviewed journals and will be presented at national and international meetings. All KOBESS investigators will be able to propose research studies and potential publications based on KOBESS data and tissue samples. TRIAL REGISTRATION NUMBER NCT03100292; Pre-results.
[Effectiveness of Self-efficacy Promoting Vestibular Rehabilitation Program for Patients with Vestibular Hypofunction].
Journal of Korean Academy of Nursing. 2016;(5):710-719
PURPOSE In this study an examination was done of the effect of self-efficacy promoting vestibular rehabilitation (S-VR) on dizziness, exercise selfefficacy, adherence to vestibular rehabilitation (VR), subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness in patients with vestibular hypofunction. METHODS This was a randomized controlled study. Data were collected 3 times at baseline, 4 and 8 weeks after beginning the intervention. Outcome measures were level of dizziness, exercise self-efficacy, and level of adherence to VR. Subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness were also obtained. Data were analyzed using Windows SPSS 21.0 program. RESULTS After 4 weeks of S-VR, there was no difference between the groups for dizziness, subjective and objective vestibular functions. However, exercise self-efficacy and adherence to VR were higher in the experimental group than in the control group. After 8 weeks of S-VR, dizziness (p=.018) exercise self-efficacy (p<.001), adherence to VR (p<.001), total-dizziness handicap inventory (DHI) (p=.012), vision analysis ratio (p=.046) in the experimental group differ significantly from that of the control group. The number of patients with recurring dizziness were higher in the control group than in the experimental group (p<.001). CONCLUSION The results indicate that continuous 8 weeks of S-VR is effective in reducing dizziness, and improving exercise self-efficacy, subjective vestibular function and adherence to VR. Objective vestibular function and vestibular compensation were also improved in the experimental group at the end of 8 weeks of S-VR.