BioMed Research International: Rehabilitation The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Telerehabilitation in Poststroke Anomia Tue, 15 Apr 2014 14:08:58 +0000 Anomia, a word-finding difficulty, is a frequent consequence of poststroke linguistic disturbance, associated with fluent and nonfluent aphasia that needs long-term specific and intensive speech rehabilitation. The present study explored the feasibility of telerehabilitation as compared to a conventional face-to-face treatment of naming, in patients with poststroke anomia. Five aphasic chronic patients participated in this study characterized by: strictly controlled crossover design; well-balanced lists of words in picture-naming tasks where progressive phonological cues were provided; same kind of the treatment in the two ways of administration. ANOVA was used to compare naming accuracy in the two types of treatment, at three time points: baseline, after treatment, and followup. The results revealed no main effect of treatment type () indicating that face-to-face and tele-treatment yielded comparable results. Moreover, there was a significant main effect of time () due to a better performance immediately after treatment and in the followup when comparing them to baseline. These preliminary results show the feasibility of teletreatment applied to lexical deficits in chronic stroke patients, extending previous work on telerehabilitation and opening new vistas for future studies on teletreatment of language functions. Michela Agostini, Martina Garzon, Silvia Benavides-Varela, Serena De Pellegrin, Giulia Bencini, Giulia Rossi, Sara Rosadoni, Mauro Mancuso, Andrea Turolla, Francesca Meneghello, and Paolo Tonin Copyright © 2014 Michela Agostini et al. All rights reserved. Comparing the Activity Profiles of Wheelchair Rugby Using a Miniaturised Data Logger and Radio-Frequency Tracking System Tue, 15 Apr 2014 14:03:43 +0000 The current study assessed the validity and reliability of a miniaturised data logger (MDL) against a radio-frequency-based indoor tracking system (ITS) for quantifying key aspects of mobility performance during wheelchair rugby. Eleven international wheelchair rugby players were monitored by both devices during four wheelchair rugby matches. MDL data were averaged over both 1-second (MDL-1) and 5-second (MDL-5) intervals to calculate distance, mean, and peak speeds. The results revealed no significant differences between devices for the distance covered or mean speeds, although random errors of 10% and 12%, respectively, were identified in relation to the mean values. No significant differences in peak speed were revealed between ITS (ߙm·s−1) and MDL-1 (ߙm·s−1). Whereas peak speeds in MDL-5 (ߙm·s−1) were significantly lower than ITS. Errors in peak speed led to large random errors in time and distance spent in speed zones relative to peak speed, especially in MDL-5. The current study revealed that MDL provide a reasonable representation of the distance and mean speed reported during wheelchair rugby. However, inaccuracy in the detection of peak speeds limits its use for monitoring performance and prescribing wheelchair rugby training programmes. Barry Mason, John Lenton, James Rhodes, Rory Cooper, and Victoria Goosey-Tolfrey Copyright © 2014 Barry Mason et al. All rights reserved. Lateralization of Motor Cortex Excitability in Stroke Patients during Action Observation: A TMS Study Mon, 14 Apr 2014 07:32:30 +0000 Action observation activates the same motor areas as those involved in the performance of the observed actions and promotes functional recovery following stroke. Movement observation is now considered a promising tool for motor rehabilitation, by allowing patients to train their motor functions when voluntary movement is partially impaired. We asked chronic-stroke patients, affected by either left (LHD) or right hemisphere (RHD) lesions, to observe either a left or right hand, while grasping a small target (eliciting a precision grip) or a large target (eliciting a whole hand grasp directed towards a target object). To better understand the effects of action observation on damaged motor circuits, we used transcranial magnetic stimulation (TMS) to induce motor evoked potentials (MEP) from two muscles of the unaffected hand in 10 completely hemiplegic participants. Results revealed that LHD patients showed MEP facilitation on the right (contralesional) M1 during action observation of hand-object interactions. In contrast, results showed no facilitation of the left (contralesional) M1 in RHD patients. Our results confirm that action observation might have a positive influence on the recovery of motor functions after stroke. Activating the motor system by means of action observation might provide a mechanism for improving function, at least in LHD patients. Mattia Marangon, Konstantinos Priftis, Marta Fedeli, Stefano Masiero, Paolo Tonin, and Francesco Piccione Copyright © 2014 Mattia Marangon et al. All rights reserved. High-Intensity Intermittent Swimming Improves Cardiovascular Health Status for Women with Mild Hypertension Thu, 10 Apr 2014 09:08:47 +0000 To test the hypothesis that high-intensity swim training improves cardiovascular health status in sedentary premenopausal women with mild hypertension, sixty-two women were randomized into high-intensity (; HIT), moderate-intensity (; MOD), and control groups (; CON). HIT performed 6–10 × 30 s all-out swimming interspersed by 2 min recovery and MOD swam continuously for 1 h at moderate intensity for a 15-week period completing in total and sessions, respectively. In CON, all measured variables were similar before and after the intervention period. Systolic BP decreased () by and  mmHg in HIT and MOD; respectively. Resting heart rate declined () by bpm both in HIT and MOD, fat mass decreased () by and  kg, respectively, while the blood lipid profile was unaltered. In HIT and MOD, performance improved () for a maximal 10 min swim (% and %), interval swimming (% and %), and Yo-Yo IE1 running performance (% and %). In conclusion, high-intensity intermittent swimming is an effective training strategy to improve cardiovascular health and physical performance in sedentary women with mild hypertension. Adaptations are similar with high- and moderate-intensity training, despite markedly less total time spent and distance covered in the high-intensity group. Magni Mohr, Nikolai Baastrup Nordsborg, Annika Lindenskov, Hildigunn Steinholm, Hans Petur Nielsen, Jann Mortensen, Pal Weihe, and Peter Krustrup Copyright © 2014 Magni Mohr et al. All rights reserved. Angular Velocity Affects Trunk Muscle Strength and EMG Activation during Isokinetic Axial Rotation Tue, 08 Apr 2014 08:49:58 +0000 Objective. To evaluate trunk muscle strength and EMG activation during isokinetic axial rotation at different angular velocities. Method. Twenty-four healthy young men performed isokinetic axial rotation in right and left directions at 30, 60, and 120 degrees per second angular velocity. Simultaneously, surface EMG was recorded on external oblique (EO), internal oblique (IO), and latissimus dorsi (LD) bilaterally. Results. In each direction, with the increase of angular velocity, peak torque decreased, whereas peak power increased. During isokinetic axial rotation, contralateral EO as well as ipsilateral IO and LD acted as primary agonists, whereas, ipsilateral EO as well as contralateral IO and LD acted as primary antagonistic muscles. For each primary agonist, the root mean square values decreased with the increase of angular velocity. Antagonist coactiviation was observed at each velocity; however, it appears to be higher with the increase of angular velocity. Conclusion. Our results suggest that velocity of rotation has great impact on the axial rotation torque and EMG activity. An inverse relationship of angular velocity was suggested with the axial rotation torque as well as root mean square value of individual trunk muscle. In addition, higher velocity is associated with higher coactivation of antagonist, leading to a decrease in torque with the increase of velocity. Jian-Zhong Fan, Xia Liu, and Guo-Xin Ni Copyright © 2014 Jian-Zhong Fan et al. All rights reserved. Resistance Training and Testosterone Levels in Male Patients with Chronic Kidney Disease Undergoing Dialysis Thu, 03 Apr 2014 13:06:57 +0000 Background. We investigated serum testosterone and insulin-like growth factor 1 (IGF-1) levels’ associations with muscle fibre size and resistance training in male dialysis patients. Methods. Male patients were included in a 16-week control period followed by 16 weeks of resistance training thrice weekly. Blood samples were obtained to analyse testosterone, luteinizing hormone (LH), IGF-1, and IGF-binding protein 3. Muscle fibres’ size was analysed in biopsies from m. vastus lateralis. Results. The patients’ testosterone levels were within the normal range at baseline () (19.5 (8.2–52.1) nmol/L versus 17.6 (16.1–18.0), resp.) whereas LH levels were higher (13.0 (5.5–82.8) U/L versus 4.3 (3.3–4.6), , resp.). IGF-1 and IGF-binding protein 3 levels were higher in the patients compared with reference values (203 (59–590) ng/mL versus 151 (128–276), , and 5045 (3370–9370) ng/mL versus 3244 (3020–3983), , resp.). All hormone levels and muscle fibre size () remained stable throughout the study. Age-adjusted IGF-1 was associated with type 1 and 2 fibre sizes (). Conclusion. Patients’ total testosterone values were normal due to markedly increased LH values, which suggest a compensated primary insufficiency of the testosterone producing Leydig cell. Even though testosterone values were normal, resistance training was not associated with muscle hypertrophy. This trial is registered with ISRCTN72099857. Stig Molsted, Jesper L. Andersen, Inge Eidemak, Adrian P. Harrison, and Niels Jørgensen Copyright © 2014 Stig Molsted et al. All rights reserved. Resistance Exercise with Older Fallers: Its Impact on Intermuscular Adipose Tissue Thu, 03 Apr 2014 07:05:51 +0000 Objective. Greater skeletal muscle fat infiltration occurs with age and contributes to numerous negative health outcomes. The primary purpose was to determine whether intermuscular adipose tissue (IMAT) can be influenced by an exercise intervention and if a greater reduction in IMAT occurs with eccentric versus traditional resistance training. Methods. Seventy-seven older adults (age 75.5 ± 6.8) with multiple comorbidities and a history of falling completed a three-month exercise intervention paired with either eccentric or traditional resistance training. MRI of the mid-thigh was examined at three time points to determine changes in muscle composition after intervention. Results. No differences in IMAT were observed over time, and there were no differences in IMAT response between intervention groups. Participants in the traditional group lost a significant amount of lean tissue () in the nine months after intervention, while participants in the eccentric group did not (). When IMAT levels were partitioned into high and low IMAT groups, there were differential IMAT responses to intervention with the high group lowering thigh IMAT. Conclusions. There is no decrease in thigh IMAT after a three-month exercise intervention in older adults at risk for falling and no benefit to eccentric training over traditional resistance training for reducing IMAT in these individuals. Janelle L. Jacobs, Robin L. Marcus, Glen Morrell, and Paul LaStayo Copyright © 2014 Janelle L. Jacobs et al. All rights reserved. Interleukin-6 and Vitamin D Status during High-Intensity Resistance Training in Patients with Chronic Kidney Disease Wed, 02 Apr 2014 12:45:02 +0000 Background. The aim of this study was to investigate IL-6 and 25-hydroxyvitamin D (25-OH D) associations with muscle size and muscle function in dialysis patients. Methods. Patients were included in a 16-week control period followed by 16 weeks of high-intensity resistance training thrice weekly. IL-6 and 25-OH D were analysed after an over-night fast. Muscle fibre size was analysed in biopsies from m. vastus lateralis. Muscle power was tested using a Leg Extensor Power Rig. Results. Patients () with IL-6 ≥ 6.49 pg/ml (median) were older and had decreased muscle power and a reduced protein intake () compared with patients with IL-6 < 6.49 pg/ml. IL-6 was not associated with muscle fibre size. Vitamin D deficiency (25-OH D < 50 nmol/l) was present in 51% of the patients and not associated with muscle power. IL-6 remained unchanged during the training period, whilst muscle power increased by 20–23% (). Conclusion. Elevated IL-6 values were associated with decreased muscle power but not with decreased muscle fibre size. Half of the patients were suffering from vitamin D deficiency, which was not associated with muscle power. IL-6 was unchanged by high-intensity resistance training in dialysis patients in this study. Stig Molsted, Pia Eiken, Jesper L. Andersen, Inge Eidemak, and Adrian P. Harrison Copyright © 2014 Stig Molsted et al. All rights reserved. Formetric 4D Rasterstereography Mon, 31 Mar 2014 08:02:36 +0000 Johnny Padulo and Luca Paolo Ardigò Copyright © 2014 Johnny Padulo and Luca Paolo Ardigò. All rights reserved. The Long-Term Prognostic Significance of 6-Minute Walk Test Distance in Patients with Chronic Heart Failure Thu, 27 Mar 2014 08:08:24 +0000 Background. The 6-minute walk test (6-MWT) is used to assess patients with chronic heart failure (CHF). The prognostic significance of the 6-MWT distance during long-term followup (>5 years) is unclear. Methods. 1,667 patients (median [inter-quartile range, IQR]) (age 72 [65–77]; 75% males) with heart failure due to left ventricular systolic impairment undertook a 6-MWT as part of their baseline assessment and were followed up for 5 years. Results. At 5 years’ followup, those patients who died (n = 959) were older at baseline and had a higher log NT pro-BNP than those who survived to 5 years (n = 708). 6-MWT distance was lower in those who died [163 (153) m versus 269 (160) m; P < 0.0001]. Median 6-MWT distance was 300 (150–376) m, and quartile ranges were <46 m, 46–240 m, 241–360 m, and >360 m. 6-MWT distance was a predictor of all-cause mortality (HR 0.97; 95% CI 0.96-0.97; Chi-square = 184.1; P < 0.0001). Independent predictors of all-cause mortality were decreasing 6-MWT distance, increasing age, increasing NYHA classification, increasing log NT pro-BNP, decreasing diastolic blood pressure, decreasing sodium, and increasing urea. Conclusion. The 6-MWT is an important independent predictor of all-cause mortality following long-term followup in patients with CHF. Lee Ingle, John G. Cleland, and Andrew L. Clark Copyright © 2014 Lee Ingle et al. All rights reserved. Change of Muscle Architecture following Body Weight Support Treadmill Training for Persons after Subacute Stroke: Evidence from Ultrasonography Mon, 24 Mar 2014 07:40:28 +0000 Although the body weight support treadmill training (BWSTT) in rehabilitation therapy has been appreciated for a long time, the biomechanical effects of this training on muscular system remain unclear. Ultrasonography has been suggested to be a feasible method to measure muscle morphological changes after neurological diseases such as stroke, which may help to enhance the understanding of the mechanism underlying the impaired motor function. This study investigated the muscle architectural changes of tibialis anterior and medial gastrocnemius in patients after subacute stroke by ultrasound. As expected, we found the effect of BWSTT on the muscular system. Specifically, the results showed larger pennation angle and muscle thickness of tibialis anterior and longer fascicle length of medial gastrocnemius after the training. The findings of this study suggest that the early rehabilitation training of BWSTT in subacute stage of stroke provides positive changes of the muscle architecture, leading to the potential improvement of the force generation of the muscle. This may not only help us understand changes of subacute stroke in muscular system but also have clinical implications in the evaluation of rehabilitation training after neurological insults. Peng Liu, Yanjun Wang, Huijing Hu, Yurong Mao, Dongfeng Huang, and Le Li Copyright © 2014 Peng Liu et al. All rights reserved. The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing Sun, 23 Mar 2014 14:55:38 +0000 Hyoid movement in swallowing is biomechanically linked to closure of the laryngeal vestibule for airway protection and to opening of the upper esophageal sphincter. Studies suggest that the range of hyoid movement is highly variable in the healthy population. However, other aspects of hyoid movement such as velocity remain relatively unexplored. In this study, we analyze data from a sample of 20 healthy young participants (10 male) to determine whether hyoid movement distance, duration, velocity, and peak velocity vary systematically with increases in thin liquid bolus volume from 5 to 20 mL. The temporal correspondence between peak hyoid velocity and laryngeal vestibule closure was also examined. The results show that maximum hyoid position and peak velocity increase significantly for 20 mL bolus volumes compared to smaller volumes, and that the timing of peak velocity is closely linked to achieving laryngeal vestibule closure. This suggests that generating hyoid movements with increased power is a strategy for handling larger volumes. Ahmed Nagy, Sonja M. Molfenter, Melanie Péladeau-Pigeon, Shauna Stokely, and Catriona M. Steele Copyright © 2014 Ahmed Nagy et al. All rights reserved. The Role of the Extracellular Matrix Components in Cutaneous Wound Healing Mon, 17 Mar 2014 16:24:52 +0000 Wound healing is the physiologic response to tissue trauma proceeding as a complex pathway of biochemical reactions and cellular events, secreted growth factors, and cytokines. Extracellular matrix constituents are essential components of the wound repair phenomenon. Firstly, they create a provisional matrix, providing a structural integrity of matrix during each stage of healing process. Secondly, matrix molecules regulate cellular functions, mediate the cell-cell and cell-matrix interactions, and serve as a reservoir and modulator of cytokines and growth factors’ action. Currently known mechanisms, by which extracellular matrix components modulate each stage of the process of soft tissue remodeling after injury, have been discussed. Pawel Olczyk, Łukasz Mencner, and Katarzyna Komosinska-Vassev Copyright © 2014 Pawel Olczyk et al. All rights reserved. Physical Performance Is Associated with Working Memory in Older People with Mild to Severe Cognitive Impairment Sun, 16 Mar 2014 12:30:37 +0000 Background. Physical performances and cognition are positively related in cognitively healthy people. The aim of this study was to examine whether physical performances are related to specific cognitive functioning in older people with mild to severe cognitive impairment. Methods. This cross-sectional study included 134 people with a mild to severe cognitive impairment (mean age 82 years). Multiple linear regression was performed, after controlling for covariates and the level of global cognition, with the performances on mobility, strength, aerobic fitness, and balance as predictors and working memory and episodic memory as dependent variables. Results. The full models explain 49–57% of the variance in working memory and 40–43% of episodic memory. Strength, aerobic fitness, and balance are significantly associated with working memory, explaining 3–7% of its variance, irrespective of the severity of the cognitive impairment. Physical performance is not related to episodic memory in older people with mild to severe cognitive impairment. Conclusions. Physical performance is associated with working memory in older people with cognitive impairment. Future studies should investigate whether physical exercise for increased physical performance can improve cognitive functioning. This trial is registered with NTR1482. K. M. Volkers and E. J. A. Scherder Copyright © 2014 K. M. Volkers and E. J. A. Scherder. All rights reserved. Tension-Free Vaginal Tape, Transobturator Tape, and Own Modification of Transobturator Tape in the Treatment of Female Stress Urinary Incontinence: Comparative Analysis Sun, 16 Mar 2014 10:02:20 +0000 Introduction. This study is a comparative evaluation of the TVT, TOT, and our own modification of TOT (mTOT) in the treatment of female stress urinary incontinence from a single center experience. Material and Methods. The study was conducted on 527 patients with SUI diagnosed on the basis of urodynamic studies. They were divided into three groups—TVT: , (TOT): , and mTOT: . All of the patients underwent evaluation at 1, 3, and 6 months after surgery. Results were statistically analysed and compared. Results. Objective and subjective effectiveness after the surgery were not significantly different in the study groups and ranged from 90.1% to 96.4%. Mean surgery time was 32.3, 28.2, and 26.4 in the TVT, TOT, and mTOT, respectively. Mean hospitalization time was 2.51 days. Mean catheter maintenance time was significantly higher in the TVT than in other groups. In the TVT group total incidence of complications was 13.4%, and it was significantly higher than that in TOT and mTOT (9.3% and 8.6%, resp.). Conclusions. TVT, TOT, and mTOT are highly effective and safe methods in the treatment of SUI. There are no differences in the efficacy between the methods with a little higher percentage of complications in the TVT group. Marcin Zyczkowski, Krzysztof Nowakowski, Waclaw Kuczmik, Tomasz Urbanek, Zbiegniew Kaletka, Piotr Bryniarski, Bartosz Muskala, and Andrzej Paradysz Copyright © 2014 Marcin Zyczkowski et al. All rights reserved. Reliability of a Simple Physical Therapist Screening Tool to Assess Errors during Resistance Exercises for Musculoskeletal Pain Thu, 13 Mar 2014 08:32:12 +0000 The main objective was to investigate the intra- and intertester reliability of a simple screening tool assessing errors in exercise execution by visual observation. 38 participants with no previous resistance exercise experience practiced for two weeks four typical upper limb exercises using elastic tubing. At 2-week follow-up, the participants were invited for a test-retest assessment on errors in technical execution. The assessment was based on ordinal deviation of joint position from neutral of the shoulder, elbow, and wrist in a single plane by visual observation. Moderate intratester reliability weighted kappa (w) score ranging from 0.50 (0.21–0.71) to 0.57 (0.24–0.82) for observer 1 and a fair to moderate intratester reliability w score ranging from 0.27 (0.09–0.43) to 0.52 (0.15–0.86) for observer 2 across the four exercises was observed. For intertester reliability moderate to substantial mean w scores were found between the two observers, slightly improving from round one to round two ranging from 0.40 (0.20–0.59) to 0.68 (0.45–0.91) in round one to 0.52 (0.20–0.80) to 0.69 (0.39–0.86) in round two. The exercise error assessment demonstrated fair to substantial intratester and intertester reliability, which is congruent with previously published studies. Hence the simplicity of defining a neutral joint position for each of the involved joints in the exercise and categorizing the deviation in “some deviation” and “substantial deviation” to either side in a single plane is a viable and inexpensive solution when assessing for errors during exercise. Kenneth Jay, Emil Sundstrup, and Lars L. Andersen Copyright © 2014 Kenneth Jay et al. All rights reserved. Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial Thu, 13 Mar 2014 06:39:55 +0000 Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic). Design. Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE () and TR (), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak). Results. The F-M UE (), FIM (), time (), and peak (), were significantly higher in the RFVE group after treatment, but not speed (). The patients affected by hemorrhagic stroke significantly improved FIM (), time (), and peak () after treatment, whereas the patients affected by ischemic stroke improved significantly only speed () when treated by RFVE. Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291. Paweł Kiper, Michela Agostini, Carlos Luque-Moreno, Paolo Tonin, and Andrea Turolla Copyright © 2014 Paweł Kiper et al. All rights reserved. High versus Moderate Intensity Running Exercise to Impact Cardiometabolic Risk Factors: The Randomized Controlled RUSH-Study Tue, 11 Mar 2014 13:07:58 +0000 Aerobic exercise positively impacts cardiometabolic risk factors and diseases; however, the most effective exercise training strategies have yet to be identified. To determine the effect of high intensity (interval) training (HI(I)T) versus moderate intensity continuous exercise (MICE) training on cardiometabolic risk factors and cardiorespiratory fitness we conducted a 16-week crossover RCT with partial blinding. Eighty-one healthy untrained middle-aged males were randomly assigned to two study arms: (1) a HI(I)T-group and (2) a sedentary control/MICE-group that started their MICE protocol after their control status. HI(I)T focused on interval training (90 sec to 12 min >85–97.5% HRmax) intermitted by active recovery (1–3 min at 65–70% HRmax), while MICE consisted of continuous running at 65–75% HRmax. Both exercise groups progressively performed 2–4 running sessions/week of 35 to 90 min/session; however, protocols were adjusted to attain similar total work (i.e., isocaloric conditions). With respect to cardiometabolic risk factors and cardiorespiratory fitness both exercise groups demonstrated similar significant positive effects on MetS-Z-Score (HI(I)T: , versus MICE: , ) and (relative) VO2max (HI(I)T: %, versus MICE: 10.6 ± 9.6%, ) compared with the sedentary control group. In conclusion, both exercise programs were comparably effective for improving cardiometabolic indices and cardiorespiratory fitness in untrained middle-aged males. Wolfgang Kemmler, Michael Scharf, Michael Lell, Carina Petrasek, and Simon von Stengel Copyright © 2014 Wolfgang Kemmler et al. All rights reserved. Propolis Modulates Fibronectin Expression in the Matrix of Thermal Injury Tue, 11 Mar 2014 12:22:52 +0000 The aim of the study was to assess the propolis effect on fibronectin metabolism in the course of burn wounds healing process. A model of burn wound healing of pig skin was applied. The amount of the released glycoprotein was assessed by a surface plasmon resonance. The profile of extracted fibronectin components was also assessed by an electrophoresis in polyacrylamide gel, with a subsequent immunodetection by Western Blotting. Propolis burn treatment decreased the release of fibronectin components from healing wounds in relation to damages treated with silver sulfadiazine. The main reason of decreased extraction of fibronectin components from wounds treated with propolis was a substantial decrease of degradation product release of the mentioned glycoprotein, which was observed particularly from the 3rd to 5th day of the repair. Wounds treatment with propolis demonstrated, especially in relation to damages treated with silver sulfadiazine, the decreased release of synthesized fibronectin molecules. The obtained results suggest that propolis modifies fibronectin metabolism in the course of wound healing process. The influence of propolis is reflected in prevention of fibronectin biosynthesis as well as its degradation in the wound area. The above-mentioned metabolic changes may decrease the risk of complications in the repair wounds process. Pawel Olczyk, Katarzyna Komosinska-Vassev, Grzegorz Wisowski, Lukasz Mencner, Jerzy Stojko, and Ewa M. Kozma Copyright © 2014 Pawel Olczyk et al. All rights reserved. Optogenetic Activation of the Excitatory Neurons Expressing CaMKIIα in the Ventral Tegmental Area Upregulates the Locomotor Activity of Free Behaving Rats Mon, 10 Mar 2014 12:26:40 +0000 The ventral tegmental area (VTA) plays an important role in motivation and motor activity of mammals. Previous studies have reported that electrical stimulations of the VTA’s neuronal projections were able to upregulate the locomotor activity of behaving rats. However, which types of neurons in the VTA that take part in the activation remain elusive. In this paper we employed optogenetic technique to selectively activate the excitatory neurons expressing CaMKIIα in the VTA region and induced a higher locomotor activity for free behaving rats. Further behavioral studies indicated that reward learning mediated in the enhancement of the rat locomotor activity. Finally the immunohistochemistry studies explored that the excitatory neurons under the optogenetic activation in VTA were partly dopaminergic that may participate as a vital role in the optogenetic activation of the locomotor activity. In total, our study provided an optogenetic approach to selectively upregulate the locomotor activity of free behaving rats, thus facilitating both neuroscience researches and neural engineering such as animal robotics in the future. Songchao Guo, Sicong Chen, Qiaosheng Zhang, Yueming Wang, Kedi Xu, and Xiaoxiang Zheng Copyright © 2014 Songchao Guo et al. All rights reserved. Effect of Video-Based versus Personalized Instruction on Errors during Elastic Tubing Exercises for Musculoskeletal Pain: A Randomized Controlled Trial Mon, 10 Mar 2014 10:30:16 +0000 Workplace interventions have shown beneficial results of resistance training for chronic pain in the neck, shoulder, and arm. However, studies have relied on experienced exercise instructors, which may not be an available resource at most workplaces. The objective of this study is to evaluate the technical performance level of upper limb rehabilitation exercises following video-based versus personalized exercise instruction. We recruited 38 laboratory technicians and office workers with neck/shoulder pain for a two-week exercise training period receiving either (1) personal and video or (2) video only instruction in four typical neck/shoulder/arm rehabilitation exercises using elastic tubing. At a 2-week follow-up, the participants’ technical execution was assessed by two blinded physical therapists using a reliable error assessment tool. The error assessment was based on ordinal deviation of joint position from the ideal position of the shoulder, elbow, and wrist in a single plane by visual observation. Of the four exercises only unilateral shoulder external rotation had a higher normalized error score in the V group of 22.19 (9.30) to 12.64 (6.94) in the P group (). For the remaining three exercises the normalized error score did not differ. In conclusion, when instructing simple exercises to reduce musculoskeletal pain the use of video material is a cost-effective solution that can be implemented easily in corporations with challenging work schedules not allowing for a fixed time of day to go see a personal trainer. Kenneth Jay, m. c. schraefel, Mikkel Brandt, and Lars L. Andersen Copyright © 2014 Kenneth Jay et al. All rights reserved. Lasting Effects of Workplace Strength Training for Neck/Shoulder/Arm Pain among Laboratory Technicians: Natural Experiment with 3-Year Follow-Up Mon, 10 Mar 2014 09:16:39 +0000 Objectives. This study investigated long-term effects and implementation processes of workplace strength training for musculoskeletal disorders. Methods. 333 and 140 laboratory technicians from private and public sector companies, respectively, replied to a 3-year follow-up questionnaire subsequent to a 1-year randomized controlled trial (RCT) with high-intensity strength training for prevention and treatment of neck, shoulder, and arm pain. Being a natural experiment, the two participating companies implemented and modified the initial training program in different ways during the subsequent 2 years after the RCT. Results. At 3-year follow-up the pain reduction in neck, shoulder, elbow, and wrist achieved during the first year was largely maintained at both companies. However, the private sector company was rated significantly better than the public sector company in (1) training adherence, (2) training culture, that is, relatively more employees trained at the workplace and with colleagues, (3) self-reported health changes, and (4) prevention of neck and wrist pain development among initially pain-free employees. Conclusions. This natural experiment shows that strength training can be implemented successfully at different companies during working hours on a long-term basis with lasting effects on pain in neck, shoulder, and arm. Peter Mortensen, Anders I. Larsen, Mette K. Zebis, Mogens T. Pedersen, Gisela Sjøgaard, and Lars L. Andersen Copyright © 2014 Peter Mortensen et al. All rights reserved. High-Intensity Interval Training in Patients with Substance Use Disorder Sun, 02 Mar 2014 13:37:01 +0000 Patients with substance use disorder (SUD) suffer a higher risk of cardiovascular disease and other lifestyle diseases compared to the general population. High intensity training has been shown to effectively reduce this risk, and therefore we aimed to examine the feasibility and effect of such training in SUD patients in clinical treatment in the present study. 17 males and 7 females (32 ± 8 yr) in treatment were randomized to either a training group (TG), treadmill interval training in 4 × 4 minutes at 90–95% of maximal heart rate, 3 days a week for 8 weeks, or a conventional rehabilitation control group (CG). Baseline values for both groups combined at inclusion were 44 ± 8 (males) and 34 ± 9 (females) mL · min−1 · kg−1, respectively. 9/12 and 7/12 patients completed the TG and CG, respectively. Only the TG significantly improved (15 ± 7%) their maximal oxygen consumption (V), from 42.3 ± 7.2 mL · min−1 · kg−1 at pretest to 48.7 ± 9.2 mL · min−1 · kg−1 at posttest. No between-group differences were observed in work economy, and level of insomnia (ISI) or anxiety and depression (HAD), but a significant within-group improvement in depression was apparent for the TG. High intensity training was feasible for SUD patients in treatment. This training form should be implemented as a part of the rehabilitation since it, in contrast to the conventional treatment, represents a risk reduction for cardiovascular disease and premature death. Grete Flemmen, Runar Unhjem, and Eivind Wang Copyright © 2014 Grete Flemmen et al. All rights reserved. The Effect of a Short-Term High-Intensity Circuit Training Program on Work Capacity, Body Composition, and Blood Profiles in Sedentary Obese Men: A Pilot Study Sun, 23 Feb 2014 13:57:07 +0000 The objective of this study was to determine how a high-intensity circuit-training (HICT) program affects key physiological health markers in sedentary obese men. Eight obese (body fat percentage %) males completed a four-week HICT program, consisting of three 30-minute exercise sessions per week, for a total of 6 hours of exercise. Participants’ heart rate (HR), blood pressure (BP), rating of perceived exertion, total work (TW), and time to completion were measured each exercise session, body composition was measured before and after HICT, and fasting blood samples were measured before throughout, and after HICT program. Blood sample measurements included total cholesterol, triacylglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glucose, and insulin. Data were analyzed by paired t-tests and one-way ANOVA with repeated measures. Statistical significance was set to . Data analyses revealed significant () improvements in resting HR (16% decrease), systolic BP (5.5% decrease), TW (50.7%), fat tissue percentage (3.6%), lean muscle tissue percentage (2%), cholesterol (13%), triacylglycerol (37%), and insulin (18%) levels from before to after HICT program. Overall, sedentary obese males experienced a significant improvement in biochemical, physical, and body composition characteristics from a HICT program that was only 6 hours of the total exercise. Matthew B. Miller, Gregory E. P. Pearcey, Farrell Cahill, Heather McCarthy, Shane B. D. Stratton, Jennifer C. Noftall, Steven Buckle, Fabien A. Basset, Guang Sun, and Duane C. Button Copyright © 2014 Matthew B. Miller et al. All rights reserved. High-Intensity Strength Training Improves Function of Chronically Painful Muscles: Case-Control and RCT Studies Sun, 23 Feb 2014 07:51:34 +0000 Aim. This study investigates consequences of chronic neck pain on muscle function and the rehabilitating effects of contrasting interventions. Methods. Women with trapezius myalgia (MYA, ) and healthy controls (CON, ) participated in a case-control study. Subsequently MYA were randomized to 10 weeks of specific strength training (SST, ), general fitness training (GFT, ), or a reference group without physical training (REF, ). Participants performed tests of 100 consecutive cycles of 2 s isometric maximal voluntary contractions (MVC) of shoulder elevation followed by 2 s relaxation at baseline and 10-week follow-up. Results. In the case-control study, peak force, rate of force development, and rate of force relaxation as well as EMG amplitude were lower in MYA than CON throughout all 100 MVC. Muscle fiber capillarization was not significantly different between MYA and CON. In the intervention study, SST improved all force parameters significantly more than the two other groups, to levels comparable to that of CON. This was seen along with muscle fiber hypertrophy and increased capillarization. Conclusion. Women with trapezius myalgia have lower strength capacity during repetitive MVC of the trapezius muscle than healthy controls. High-intensity strength training effectively improves strength capacity during repetitive MVC of the painful trapezius muscle. Lars L. Andersen, Christoffer H. Andersen, Jørgen H. Skotte, Charlotte Suetta, Karen Søgaard, Bengt Saltin, and Gisela Sjøgaard Copyright © 2014 Lars L. Andersen et al. All rights reserved. Evaluation of Bioelectrical Activity of Pelvic Floor Muscles and Synergistic Muscles Depending on Orientation of Pelvis in Menopausal Women with Symptoms of Stress Urinary Incontinence: A Preliminary Observational Study Wed, 19 Feb 2014 10:00:53 +0000 Objectives. Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt. Design. Preliminary, prospective observational study. Setting. Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Participants. Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study. Primary Outcome Measures. Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe. Secondary Outcome Measures. Evaluation of activity of the synergistic muscles by sEMG and surface electrodes. Results. No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles. Conclusions. This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM. Tomasz Halski, Lucyna Słupska, Robert Dymarek, Janusz Bartnicki, Urszula Halska, Agata Król, Małgorzata Paprocka-Borowicz, Janusz Dembowski, Romuald Zdrojowy, and Kuba Ptaszkowski Copyright © 2014 Tomasz Halski et al. All rights reserved. A Pilot Study of Partial Unweighted Treadmill Training in Mobility-Impaired Older Adults Wed, 19 Feb 2014 07:31:25 +0000 Background. Partial unweighted treadmill training is a potentially effective modality for improving fitness and function in frail elders. We tested the feasibility of partial unweighted treadmill training in older, mobility-impaired veterans. Methods. Eight mobility-impaired elders participated in partial unweighted treadmill training three times/week for twelve weeks. Outcome measures included gait speed, performance-oriented mobility assessment (POMA), eight foot up and go, and the SF-36 physical functioning short form. Results. There was significant improvement in treadmill walking time (+8.5 minutes; ), treadmill walking speed (+0.14 meters/second; ), and percent of body weight support (−2.2%; ). Changes in physical performance included usual gait speed (+0.12 meters/second; ), rapid gait speed (+0.13 meters/second; ), POMA (+2.4 summary score; ), and eight foot up and go (−1.2 seconds; ). Conclusions. Partial unweighted treadmill training is feasible in mobility-impaired elders. Improvements in treadmill training capacity resulted in clinically meaningful improvements in fitness levels and improved mobility. Matthew J. Peterson, Nanyamka Williams, Kevin Caves, and Miriam C. Morey Copyright © 2014 Matthew J. Peterson et al. All rights reserved. Effect of Training Supervision on Effectiveness of Strength Training for Reducing Neck/Shoulder Pain and Headache in Office Workers: Cluster Randomized Controlled Trial Wed, 19 Feb 2014 07:06:31 +0000 Objective. To investigate the effect of workplace neck/shoulder strength training with and without regular supervision on neck/shoulder pain and headache among office workers. Method. A 20-week cluster randomized controlled trial among 351 office workers was randomized into three groups: two training groups with the same total amount of planned exercises three times per week (1) with supervision (3WS) throughout the intervention period, (2) with minimal supervision (3MS) only initially, and (3) a reference group (REF). Main outcome is self-reported pain intensity in neck and shoulder (scale 0–9) and headache (scale 0–10). Results. Intention-to-treat analyses showed a significant decrease in neck pain intensity the last 7 days in 3MS compared with REF: −0.5 ± 0.2 and a tendency for 3WS versus REF: −0.4 ± 0.2 (). Intensity of headache the last month decreased in both training groups: 3WS versus REF: −1.1 ± 0.2 () and 3MS versus REF: −1.1 ± 0.2 (). Additionally, days of headache decreased 1.0 ± 0.5 in 3WS and 1.3 ± 0.5 in 3MS versus REF. There were no differences between the two training groups for any of the variables. Conclusion. Neck/shoulder training at the workplace reduced neck pain and headache among office workers independently of the extent of supervision. This finding has important practical implications for future workplace interventions. Bibi Gram, Christoffer Andersen, Mette K. Zebis, Thomas Bredahl, Mogens T. Pedersen, Ole S. Mortensen, Rigmor H. Jensen, Lars L. Andersen, and Gisela Sjøgaard Copyright © 2014 Bibi Gram et al. All rights reserved. The Application of Negative Pressure Wound Therapy in the Treatment of Chronic Venous Leg Ulceration: Authors Experience Tue, 18 Feb 2014 15:50:30 +0000 The aim of the study was to use negative pressure wound therapy (NPWT) in patients with chronic venous leg ulceration. The authors present their experience in treatment of 15 patients whose average ulceration surface area was 62.6 cm2. In 10 patients, the ulcers healed within 6 weeks and in the remaining patients within 20 weeks. Based on the results obtained, the authors imply that NPWT is an effective method in the treatment of chronic venous leg. Marek Kucharzewski, Paweł Mieszczański, Katarzyna Wilemska-Kucharzewska, Jakub Taradaj, Andrzej Kuropatnicki, and Zbigniew Śliwiński Copyright © 2014 Marek Kucharzewski et al. All rights reserved. Medium-/Long-Term Effects of a Specific Exercise Protocol Combined with Patient Education on Spine Mobility, Chronic Fatigue, Pain, Aerobic Fitness and Level of Disability in Fibromyalgia Wed, 29 Jan 2014 07:36:06 +0000 Objective. To propose a rehabilitation protocol able to produce immediate and long-term beneficial effects on level of disability and overall performance in ADLs. Materials and Methods. Forty-one FM patients were randomized to an exercise and educational-behavioral programme group (experimental group, EG = 21) or to a control group (CG = 20). Each subject was evaluated before, at the end (T1), and after 6 months (T6) from the conclusion of the rehabilitation treatment using the Fibromyalgia Impact Questionnaire (FIQ), the visual analogue scale (VAS), the Health Assessment Questionnaire (HAQ), the fatigue severity scale (FSS), the 6-minute walking test (6MWT), tender points count (TPC), and spinal active range of motion. The exercise protocol included 20 sessions consisting in self-awareness, stretching, strengthening, spine flexibility, and aerobic exercises, which patients were subsequently educated to perform at home. Results. The two groups were comparable at baseline. At T1, the EG showed a positive trend in FIQ, VAS, HAQ, and FSS scales and significant improvement in 6MWT and in most spinal active range of motion measurements (P between 0.001 and 0.04). The positive results were maintained at the follow-up. Conclusion. The proposed programme was well tolerated and produced immediate and medium-term beneficial effects improving function and strain endurance. This trial is registered with DRKS00005071 on DRKS. Erika Giannotti, Konstantinos Koutsikos, Maurizia Pigatto, Maria Elisa Rampudda, Andrea Doria, and Stefano Masiero Copyright © 2014 Erika Giannotti et al. All rights reserved. High Intensity Physical Exercise and Pain in the Neck and Upper Limb among Slaughterhouse Workers: Cross-Sectional Study Thu, 09 Jan 2014 10:03:51 +0000 Slaughterhouse work involves a high degree of repetitive and forceful upper limb movements and thus implies an elevated risk of work-related musculoskeletal disorders. High intensity strength training effectively rehabilitates musculoskeletal disorders among sedentary employees, but less is known about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise and musculoskeletal pain. We investigated the association between high intensity physical exercise and pain among 595 slaughterhouse workers in Denmark, Europe. Using logistic regression analyses, odds ratios for pain and work disability as a function of physical exercise, gender, age, BMI, smoking, and job position were estimated. The prevalence of pain in the neck, shoulder, elbow, and hand/wrist was 48%, 60%, 40%, and 52%, respectively. The odds for experiencing neck pain were significantly lower among slaughterhouse workers performing physical exercise (OR = 0.70, CI: 0.49–0.997), whereas the odds for pain in the shoulders, elbow, or hand/wrist were not associated with exercise. The present study can be used as general reference of pain in the neck and upper extremity among slaughterhouse workers. Future studies should investigate the effect of high intensity physical exercise on neck and upper limb pain in slaughterhouse workers. Emil Sundstrup, Markus D. Jakobsen, Kenneth Jay, Mikkel Brandt, and Lars L. Andersen Copyright © 2014 Emil Sundstrup et al. All rights reserved. Walking Recovery after a Hip Fracture: A Prospective Follow-Up Study among Community-Dwelling over 60-Year Old Men and Women Mon, 06 Jan 2014 12:27:40 +0000 Purpose. Recovery of walking outdoors after hip fracture is important for equal participation in the community. The causes of poor recovery are not fully understood. This study investigates recovery of walking outdoors and associated determinants after hip fracture. Methods. A prospective follow-up study, among clinical sample of 81 community-dwelling hip fracture patients over 60 years. Perceived difficulty in walking outdoors and 500 meters was assessed before fracture, at discharge to home (3.2 ± 2.2 weeks after surgery), and on average 6.0 ± 3.3 weeks after discharge. Potential determinants for walking recovery were assessed. Linear latent trajectory model was used to analyse changes during follow-up. Association between walking trajectories and potential determinants was analysed with a logistic regression model. Results. Two trajectories, No-to-minor-difficulty and Catastrophic, were found. Thirty-eight percent of the participants ended up in the Catastrophic trajectory for walking outdoors and 67% for 500 meters. Multivariate logistic regression analysis revealed that use of walking aid and indoor falls before fracture and prolonged pain were independently associated with catastrophic decline in both primary outcomes: difficulty in walking outdoors and 500 meters. Conclusions. A large proportion of community-dwelling older people recovering from hip fracture experienced catastrophic decline in outdoor walking. Acknowledging recovery prognoses at early stage enables individualized rehabilitation. Anu Salpakoski, Timo Törmäkangas, Johanna Edgren, Sanna Sihvonen, Mika Pekkonen, Ari Heinonen, Maija Pesola, Mauri Kallinen, Taina Rantanen, and Sarianna Sipilä Copyright © 2014 Anu Salpakoski et al. All rights reserved. Effect of Brief Daily Resistance Training on Occupational Neck/Shoulder Muscle Activity in Office Workers with Chronic Pain: Randomized Controlled Trial Tue, 31 Dec 2013 17:56:52 +0000 Purpose. This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain. Methods. 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day () or in control receiving weekly email-based information on general health (). Electromyography (EMG) from the splenius and upper trapezius was recorded during a normal workday. Results. Adherence to training and control interventions were 86% and 89%, respectively. Compared with control, training increased isometric muscle strength 6% () and decreased neck/shoulder pain intensity by 40% (). The frequency of periods with complete motor unit relaxation (EMG gaps) decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius. Conclusion. While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain. Mark Lidegaard, Rene B. Jensen, Christoffer H. Andersen, Mette K. Zebis, Juan C. Colado, Yuling Wang, Thomas Heilskov-Hansen, and Lars L. Andersen Copyright © 2013 Mark Lidegaard et al. All rights reserved. The Evaluation of Bioelectrical Activity of Pelvic Floor Muscles Depending on Probe Location: A Pilot Study Wed, 11 Dec 2013 08:53:16 +0000 Objectives. The main objective was to determine how the depth of probe placement affects functional and resting bioelectrical activity of the PFM and whether the recorded signal might be dependent on the direction in which the probe is rotated. Participants. The study comprised of healthy, nulliparous women between the ages of 21 and 25. Outcome Measures. Bioelectric activity of the PFM was recorded from four locations of the vagina by surface EMG and vaginal probe. Results. There were no statistically significant differences between the results during functional sEMG activity. During resting sEMG activity, the highest bioelectrical activity of the PFM was observed in the L1 and the lowest in the L4 and a statistically significant difference between the highest and the lowest results of resting sEMG activity was observed (). Conclusion. Different electrodes placement during functional contraction of PFM does not affect the obtained results in sEMG evaluation. In order to diagnose the highest resting activity of PFM the recording plates should be placed toward the anterior vaginal wall and distally from the introitus. However, all of the PFM have similar bioelectrical activity and it seems that these muscles could be treated as a single muscle. Tomasz Halski, Kuba Ptaszkowski, Lucyna Słupska, and Robert Dymarek Copyright © 2013 Tomasz Halski et al. All rights reserved. The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction Thu, 05 Dec 2013 09:22:05 +0000 The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741. J. Taradaj, T. Halski, M. Kucharzewski, K. Walewicz, A. Smykla, M. Ozon, L. Slupska, R. Dymarek, K. Ptaszkowski, J. Rajfur, and M. Pasternok Copyright © 2013 J. Taradaj et al. All rights reserved. Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Randomized Single-Blind Controlled Pilot Study Wed, 27 Nov 2013 09:34:54 +0000 The aim of the study was to assess the efficacy of Kinesiology Taping (KT) for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, ), the Quasi KT group (quasi K-tapes, ), or the MCT group (multilayered compression therapy group, ). Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stretch bandages were given every treatment session, 3 times per week for 1 month. Patient evaluation items included limb size and percentage edema. Comparing the changes in K-tapes with quasi K-tapes changes, there were no significant differences (). The edema reduction of multilayered bandages was much better than in results observed in taping groups. The KT appeared to be ineffective at secondary lymphedema after breast cancer treatment. The single-blind, controlled pilot study results suggest that K-tape could not replace the bandage, and at this moment it must not be an alternative choice for the breast cancer-related lymphedema patient. The trial is registered with ACTRN12613001173785. A. Smykla, K. Walewicz, R. Trybulski, T. Halski, M. Kucharzewski, C. Kucio, W. Mikusek, K. Klakla, and J. Taradaj Copyright © 2013 A. Smykla et al. All rights reserved. Robotic Technologies and Rehabilitation: New Tools for Stroke Patients’ Therapy Wed, 20 Nov 2013 17:07:29 +0000 Introduction. The role of robotics in poststroke patients’ rehabilitation has been investigated intensively. This paper presents the state-of-the-art and the possible future role of robotics in poststroke rehabilitation, for both upper and lower limbs. Materials and Methods. We performed a comprehensive search of PubMed, Cochrane, and PeDRO databases using as keywords “robot AND stroke AND rehabilitation.” Results and Discussion. In upper limb robotic rehabilitation, training seems to improve arm function in activities of daily living. In addition, electromechanical gait training after stroke seems to be effective. It is still unclear whether robot-assisted arm training may improve muscle strength, and which electromechanical gait-training device may be the most effective for walking training implementation. Conclusions. In the field of robotic technologies for stroke patients’ rehabilitation we identified currently relevant growing points and areas timely for developing research. Among the growing points there is the development of new easily transportable, wearable devices that could improve rehabilitation also after discharge, in an outpatient or home-based setting. For developing research, efforts are being made to establish the ideal type of treatment, the length and amount of training protocol, and the patient’s characteristics to be successfully enrolled to this treatment. Patrizia Poli, Giovanni Morone, Giulio Rosati, and Stefano Masiero Copyright © 2013 Patrizia Poli et al. All rights reserved. Measuring Activity Levels at an Acute Stroke Ward: Comparing Observations to a Device Sun, 27 Oct 2013 08:09:43 +0000 Background. If a simple system of instrumented monitoring was possible early after stroke, therapists may be able to more readily gather information about activity and monitor progress over time. Our aim was to establish whether a device containing a dual-axis accelerometer provides similar information to behavioural mapping on physical activity patterns early after stroke. Methods. Twenty participants with recent stroke ≤2 weeks and aged >18 were recruited and monitored at an acute stroke ward. The monitoring device (attached to the unaffected leg) and behavioural mapping (observation) were simultaneously applied from 8 a.m. to 5 p.m. Both methods recorded the time participants spent lying, sitting, and upright. Results. The median percentage and interquartile range (IQR) of time spent lying, sitting, and upright recorded by the device were 36% (15–68), 51% (28–72), and 2% (1–5), respectively. Agreement between the methods was substantial: Intraclass Correlation Coefficient (95% CI): lying 0.74 (0.46–0.89), sitting 0.68 (0.36–0.86), and upright 0.72 (0.43–0.88). Conclusion. Patients are inactive in an acute stroke setting. In acute stroke, estimates of time spent lying, sitting, and upright measured by a device are valid. Sharon F. Kramer, Toby Cumming, Leonid Churilov, and Julie Bernhardt Copyright © 2013 Sharon F. Kramer et al. All rights reserved. The Value of Pain Coping Constructs in Subcategorising Back Pain Patients according to Risk of Poor Outcome Thu, 24 Oct 2013 13:50:05 +0000 Background. Subcategorising patients with chronic low back pain (CLBP) could improve patient outcomes and facilitate prioritisation of treatment resources. Objective. This study aimed to develop a subcategorising method for individuals with CLBP using the Coping Strategies Questionnaire 24 (CSQ24) and to investigate the methods potential validity. Methods. 196 patients were recruited from a physiotherapy outpatients department. All participants completed a battery of questionnaires before and after treatment including the CSQ24 and a measure of pain, disability, and mood. At discharge participants also completed a global subjective outcomes scale consisting of a 6-point Likert scale. All participants received usual physiotherapy. Results. Cut-off values for the CSQ24 were calculated using triangulation of the findings from three different statistical methods. Cut-off values were identified for the Catastrophising and Cognitive Coping subscales of the CSQ24. Participants were categorised into low, medium, and high risk of a poor outcome. The cut-off values for these were ≥21 on Cognitive Coping and ≤9 on Catastrophising for low risk and ≤15 on Cognitive Coping for high risk, with all other patients being classified as being at moderate risk. Conclusion. Further validation is required before this approach can be recommended for clinical practice. Nicholas Harland and Cormac Gerard Ryan Copyright © 2013 Nicholas Harland and Cormac Gerard Ryan. All rights reserved. Body Posture Asymmetry Differences between Children with Mild Scoliosis and Children with Unilateral Cerebral Palsy Wed, 09 Oct 2013 14:05:52 +0000 Patients with unilateral cerebral palsy (CP) often have impaired movement coordination, reduced between-limb synchronization, and less weight bearing on the affected side, which can affect the maintenance of an upright weight-bearing position and gait. This study evaluated whether the different postural patterns of children with unilateral CP could be statistically recognized using cluster analysis. Forty-five outpatients with unilateral CP (mean age, 9 years and 5 months) and 51 able-bodied children with mild scoliosis (mean age, 9 years and 2 months) were included. One observer performed moiré topography (MT) examinations using a CQ Electronic System (Poland) device. A weight distribution analysis on the base of support (BOS) between the body sides was performed simultaneously. A force plate dynamographic platform (PDM), ZEBRIS (Germany), with FootPrint software was used for these measurements. Cluster analysis revealed three groups: Cluster 1 (, 73.96%), Cluster 2 (, 8.33%), and Cluster 3 (, 17.71%). Based on the MT parameters (extracted using a data reduction technique), three typical asymmetrical postural patterns were described: (1) the postural pattern of children with mild scoliosis (SCOL), (2) the progravitational postural pattern (PGPP), and (3) the antigravitational pattern. Patterns two and three were identified in children with unilateral CP. Małgorzata Domagalska-Szopa and Andrzej Szopa Copyright © 2013 Małgorzata Domagalska-Szopa and Andrzej Szopa. All rights reserved. Differences in Muscle Activation Patterns during Sit to Stand Task among Subjects with and without Intellectual Disability Mon, 07 Oct 2013 14:48:18 +0000 The aim of this study is to analyse the differences in muscle activity between subjects who have intellectual disability and healthy subjects when they make the transition from sitting to standing positions. A cross-sectional study. A group of adults was divided into two subgroups: with and without intellectual disability (ID). The means of the basic features in both groups were 22.13 and 22.83 for age, 66.38 and 67.67 for weight, and 173.38 and 174.33 for height, for the ID () and without ID () groups, respectively. Each subject performed three sets of five repetitions during which, starting from sitting, they had to get up and sit on the chair. The recording of muscle activity was performed using surface electromyography taking the measures of muscle activity of different muscles of the lower limbs. The results showed differences in the pattern of muscle activity between groups during sitting to standing movement. Antonio I. Cuesta-Vargas and Manuel González-Sánchez Copyright © 2013 Antonio I. Cuesta-Vargas and Manuel González-Sánchez. All rights reserved. Modeling the Prospective Relationships of Impairment, Injury Severity, and Participation to Quality of Life Following Traumatic Brain Injury Wed, 02 Oct 2013 14:59:06 +0000 Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation—mobility and occupational activities—mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustmentafter TBI are discussed. Ryan J. Kalpinski, Meredith L. C. Williamson, Timothy R. Elliott, Jack W. Berry, Andrea T. Underhill, and Philip R. Fine Copyright © 2013 Ryan J. Kalpinski et al. All rights reserved. Rehabilitation of Children with Hemiparesis: A Pilot Study on the Use of Virtual Reality Wed, 02 Oct 2013 09:00:10 +0000 Background. A wide range of treatments have been used to improve upper arm motor performances in children with congenital hemiplegia. Recent findings are suggesting that virtual reality based intervention could be a promising tool also in pediatric rehabilitation. Methods. Six patients with congenital hemiplegia (age: 4–16 years) were recruited among those treated in the Child Neuropsychiatry and Rehabilitation Unit of the IRCCS “Santa Maria Nascente” (Milan, Italy), for a preliminary investigation about using nonimmersive virtual reality for upper limb rehabilitation. Ten sessions using VRRS system (Khymeia, Padova, Italy) were weekly administered as a part of the rehabilitative treatment. Melbourne Assessment of Unilateral Limb Movement, Ashworth Scale, and Arm’s PROM were selected as main outcome measures. At the end of treatment, participants filled in an ad hoc satisfaction questionnaire. Results. All subjects completed the proposed treatment, and they also gave a positive judgment regarding this rehabilitative method. Melbourne score increased in all patients. Conclusion. Our findings seem to support the evidence that VR treatment could be a promising and engaging tool for pediatric rehabilitation. However, the limited size of the population and the small number of sessions require further investigations and RCTs to confirm our positive results. Ivana Olivieri, Matteo Chiappedi, Paolo Meriggi, Marcella Mazzola, Attilia Grandi, and Lucia Angelini Copyright © 2013 Ivana Olivieri et al. All rights reserved. Exercise Trajectories of Women from Entry to a 6-Month Cardiac Rehabilitation Program to One Year after Discharge Thu, 12 Sep 2013 12:16:16 +0000 Background. Physical activity is associated with reduced mortality and morbidity. Cardiac rehabilitation (CR) is an effective intervention for patients with cardiovascular disease (CVD). Unfortunately, women are less likely to engage in, or sustain, regular physical activity. Objectives were to (1) describe women’s guidelines-based levels of physical activity during and after CR and (2) determine the physical activity trajectories of women from entry to CR to one year after CR. Methods and Results. A prospective, longitudinal study of 203 women with CVD enrolled in a 6-month CR program. Physical activity was measured using the Godin Leisure Time Exercise Questionnaire (LSI), focusing on moderate-strenuous activity. Data were analyzed using latent class growth analysis (LCGA) and logistic regression. Mean scores on the LSI showed women to be “active” at all follow-up points. LCGA revealed a two-class model, respectively, called “inactive relapsers” and “moderately active relapsers.” Predictors of the “moderately active relapsers” class were employment status and diagnosis of myocardial infarction. Conclusions. Women achieved the recommended physical activity levels by the end of CR and sustained them until one year after CR. LCGA allowed us to determine the class trajectories associated with moderate-strenuous activity and, from these, to identify implications for targeted intervention. Heather M. Arthur, Chris Blanchard, Elizabeth Gunn, Jennifer Kodis, Steven Walker, and Brenda Toner Copyright © 2013 Heather M. Arthur et al. All rights reserved. Association of Seat Height and Arm Position on the Five Times Sit-to-Stand Test Times of Stroke Survivors Wed, 11 Sep 2013 09:20:07 +0000 Objectives. To investigate (1) the association of seat height and (2) the association of arm position on the five times sit-to-stand test (FTSTS) times of individuals with stroke. Design. A cross-sectional study. Setting. University-based rehabilitation centre. Subjects. Patients () with chronic stroke. Methods. The times in completing the FTSTS with different seat height (85%, 100%, and 115% knee height) and arm positions (arms across chest, hands on thighs). Results. FTSTS times were significantly different between 85% and 100% seat heights, and between the 85% and 115% seat heights in both arm positions. However, there was no significant difference between the FTSTS times with the two arm positions at any seat height tested. Conclusion. Seat heights lower than the knee height result in longer FTSTS times, whereas arms positions did not significantly affect the FTSTS times. Shamay S. M. Ng, Susanna Y. Cheung, Lauren S. W. Lai, Ann S. L. Liu, Selena H. I. Ieong, and Shirley S. M. Fong Copyright © 2013 Shamay S. M. Ng et al. All rights reserved. Chair-Based Exercises for Frail Older People: A Systematic Review Mon, 09 Sep 2013 08:45:26 +0000 Introduction. Frail older people are often unable to undertake high-intensity exercise programmes. Chair-based exercises (CBEs) are used as an alternative, for which health benefits are uncertain. Objective. To examine the effects of CBE programmes for frail older people through a systematic review of existing literature. Method. A systematic search was performed for CBE-controlled trials in frail populations aged ≥65 years published between 1990 and February 2011 in electronic databases. Quality was assessed using the Jadad method. Results. The search identified 164 references: with 42 duplicates removed, 122 reviewed, 116 excluded, and 6 analysed. 26 outcome measures were reported measuring 3 domains: mobility and function, cardiorespiratory fitness, mental health. All studies were of low methodological quality (Jadad score ≤2; possible range 0–5). Two studies showed no benefit, and four reported some evidence of benefit in all three domains. No harmful effects were reported; compliance was generally good. Conclusion. The quality of the evidence base for CBEs is low with inconclusive findings to clearly inform practice. A consensus is required on the definition and purpose of CBEs. Large well-designed randomised controlled trials to test the effectiveness of CBE are justified. Kevin Anthony, Katie Robinson, Philippa Logan, Adam L. Gordon, Rowan H. Harwood, and Tahir Masud Copyright © 2013 Kevin Anthony et al. All rights reserved. Neurocognitive Functioning in Schizophrenia and during the Early Phases of Psychosis: Targeting Cognitive Remediation Interventions Thu, 05 Sep 2013 14:31:46 +0000 Recent interest in the early course of schizophrenia accentuated altered cognition prior to the onset. Ultrahigh risk (UHR) individuals with attenuated positive symptoms and transient psychotic episodes demonstrate neurocognitive deficits across multiple domains such as memory, executive functioning, and processing speed which are consistent with similar disturbances identified in patients with a first episode of schizophrenia. Cognitive remediation (CR) approaches representing a broad set of activities are aimed to restore or improve cognitive functioning. CR proved to be effective in modulating the cognitive dysfunction in schizophrenia but is rarely used in ultrahigh risk individuals. From the clinical prospective, a better understanding of cognitive functioning in at-risk states is essential for the development of optimal early intervention models. In the review, we highlight the intervention targets, notably the specific cognitive deficits in at risk individuals which preceed the transition to psychosis and emphasize the need of the additional studies using CR approaches in UHR group aiming to enhance cognition and therefore mediate functional improvement. Yulia Zaytseva, Natalya Korsakova, Mark Agius, and Isaac Gurovich Copyright © 2013 Yulia Zaytseva et al. All rights reserved. The Usefulness of Impedance Cardiography for Predicting Beneficial Effects of Cardiac Rehabilitation in Patients with Heart Failure Mon, 26 Aug 2013 17:30:35 +0000 Aim. Cardiac rehabilitation (CR) is an important part of heart failure (HF) treatment. The aim of this paper was to evaluate if thoracic fluid content (TFC) measured by impedance cardiography (ICG) is a useful parameter for predicting the outcome of CR. Methods. Fifty HF patients underwent clinical and noninvasive haemodynamic (TFC) assessments before and after 8-week CR. Results. As a result of CR, the patients’ exercise tolerance improved, especially in terms of peak VO2 (18.7 versus 20.8 mL × kg−1 × min−1; ). TFC was found to identify patients with significantly improved peak VO2 after CR. “High TFC” patients (TFC > 27.0 kOhm−1), compared to those of “low TFC” (TFC < 27.0 kOhm−1), were found to have more pronounced increase in peak VO2 (1.3 versus 3.1 mL × kg−1 × min−1; ) and decrease in TFC (4.0 versus 0.7 kOhm−1; ). On the other hand, the patients with improved peak VO2 () differed from those with no peak VO2 improvement in terms of higher baseline TFC values (28.4 versus 25.3 kOhm−1; ) and its significant decrease after CR (2.7 versus 0.2 kOhm−1; ). Conclusions. TFC can be a useful parameter for predicting beneficial effects of CR worth including in the process of patients’ qualification for CR. Grzegorz Gielerak, Paweł Krzesiński, Ewa Piotrowicz, and Ryszard Piotrowicz Copyright © 2013 Grzegorz Gielerak et al. All rights reserved. Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics Mon, 26 Aug 2013 15:07:25 +0000 A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° () and 15° (). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise. Sadegh Norouzi, Fateme Esfandiarpour, Ali Shakourirad, Reza Salehi, Mohammad Akbar, and Farzam Farahmand Copyright © 2013 Sadegh Norouzi et al. All rights reserved. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit Mon, 19 Aug 2013 10:07:20 +0000 Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25) of the day in some form of physical activity and received 58 (SD 34) minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32) hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care. Tanya West and Julie Bernhardt Copyright © 2013 Tanya West and Julie Bernhardt. All rights reserved. High-Frequency Transcutaneous Peripheral Nerve Stimulation Induces a Higher Increase of Heat Pain Threshold in the Cutaneous Area of the Stimulated Nerve When Confronted to the Neighbouring Areas Tue, 06 Aug 2013 11:20:36 +0000 Background. TENS (transcutaneous electrical nerve stimulation) is probably the most diffused physical therapy used for antalgic purposes. Although it continues to be used by trial and error, correct targeting of paresthesias evoked by the electrical stimulation on the painful area is diffusely considered very important for pain relief. Aim. To investigate if TENS antalgic effect is higher in the cutaneous area of the stimulated nerve when confronted to neighbouring areas. Methods. 10 volunteers (4 males, 6 females) underwent three different sessions: in two, heat pain thresholds (HPTs) were measured on the dorsal hand skin before, during and after electrical stimulation (100 Hz, 0.1 msec) of superficial radial nerve; in the third session HPTs, were measured without any stimulation. Results. Radial nerve stimulation induced an increase of HPT significantly higher in its cutaneous territory when confronted to the neighbouring ulnar nerve territory, and antalgic effect persisted beyond the stimulation time. Conclusions. The location of TENS electrodes is crucial for obtaining the strongest pain relief, and peripheral nerve trunk stimulation is advised whenever possible. Moreover, the present study indicates that continuous stimulation could be unnecessary, suggesting a strategy for avoiding the well-known tolerance-like effect of prolonged TENS application. M. Buonocore, N. Camuzzini, M. Cecini, and E. Dalla Toffola Copyright © 2013 M. Buonocore et al. All rights reserved. Effects of a Rehabilitation Program on Perceived Environmental Barriers in Older Patients Recovering from Hip Fracture: A Randomized Controlled Trial Tue, 06 Aug 2013 09:06:24 +0000 Objectives. To study effects of a one-year multicomponent intervention on perceived environmental barriers in hip fracture patients. Design. Randomized controlled trial of a 12-month home-based rehabilitation aiming to improve mobility and function (ISRCTN53680197); secondary analyses. Subjects. Community-dwelling hip fracture patients on average 70 days after trauma (). Methods. Assessments at baseline, 3, 6, and 12 months later included perceived entrance-related barriers (e.g., indoor/outdoor stairs, lighting, floor surfaces, and storage for mobility devices) and perceived barriers in the outdoor environment (poor street condition, hilly terrain, long-distances, and lack of resting places). Sum scores for entrance-related and outdoor barriers were analyzed using general estimating equation models. Results. At baseline, 48% and 37% of the patients perceived at least one entrance-related barrier, and 62% and 60% perceived at least one outdoor barrier in the intervention and control group, respectively. Over time, () the number of entrance-related barriers decreased in both groups (group ; interaction ). For outdoor barriers, time (), group (), and interaction effect () were not significant. Conclusion. Our intervention had no additional benefit over standard care in hip fracture patients. Further study is warranted to determine whether perceived environmental barriers can be reduced by interventions targeted at the older individual. This trial is registered with ISRCTN53680197. Erja Portegijs, Merja Rantakokko, Johanna Edgren, Anu Salpakoski, Ari Heinonen, Marja Arkela, Mauri Kallinen, Taina Rantanen, and Sarianna Sipilä Copyright © 2013 Erja Portegijs et al. All rights reserved. Variables Associated with Performance of an Active Limb Movement following Within-Session Instruction in People with and People without Low Back Pain Thu, 01 Aug 2013 10:56:45 +0000 Modification of a movement pattern can be beneficial in decreasing low back pain (LBP) symptoms. There is variability, however, in how well people are able to modify performance of a movement. What has not been identified is the factors that may affect a person’s ability to modify performance of a movement. We examined factors related to performance of active hip lateral rotation (HLR) following standardized instructions in people with and people without LBP. Data were collected during performance of HLR under 3 conditions: passive, active, and active instructed. In people with LBP, motion demonstrated during the passive condition (, ), motion demonstrated during the active condition (, ), and gender (, ) were related to motion demonstrated during the active-instructed condition. Motion demonstrated during the passive condition explained 76% of the variance in motion demonstrated during the active-instructed condition. A similar relationship did not exist in people without LBP. The findings of the study suggest that it may be important to assess motion demonstrated during passive HLR to determine how difficult it will be for someone with LBP to modify the performance of HLR. Prognosis should be worst for those who display similar movement patterns during passive HLR and active-instructed HLR. Sara A. Scholtes, Barbara J. Norton, Sara P. Gombatto, and Linda R. Van Dillen Copyright © 2013 Sara A. Scholtes et al. All rights reserved. Respiratory Muscle Training in Patients Recovering Recent Open Cardiothoracic Surgery: A Randomized-Controlled Trial Tue, 30 Jul 2013 12:27:49 +0000 Objectives. To evaluate the clinical efficacy and feasibility of an expiratory muscle training (EMT) device (Respilift) applied to patients recovering from recent open cardiothoracic surgery (CTS). Design. Prospective, double-blind, 14-day randomised-controlled trial. Participants and Setting. A total of 60 inpatients recovering from recent CTS and early admitted to a pulmonary rehabilitation program. Interventions. Chest physiotherapy plus EMT with a resistive load of 30 cm H2O for active group and chest physiotherapy plus EMT with a sham load for control group. Measures. Changes in maximal expiratory pressure (MEP) were considered as primary outcome, while maximal inspiratory pressures (MIP), dynamic and static lung volumes, oxygenation, perceived symptoms of dyspnoea, thoracic pain, and well being (evaluated by visual analogic scale—VAS) and general health status were considered secondary outcomes. Results. All outcomes recorded showed significant improvements in both groups; however, the change of MEP (+34.2 mmHg, and +26.1%, for absolute and % of predicted, resp.) was significantly higher in active group. Also VAS dyspnoea improved faster and more significantly () at day 12, and 14 in active group when compared with control. The drop-out rate was 6%, without differences between groups. Conclusions. In patients recovering from recent CTS, specific EMT by Respilift is feasible and effective. This trial is registered with NCT01510275. Ernesto Crisafulli, Elena Venturelli, Gherardo Siscaro, Fabio Florini, Alessandra Papetti, Daniela Lugli, Massimo Cerulli, and Enrico Clini Copyright © 2013 Ernesto Crisafulli et al. All rights reserved. Sustainability of Tailored Goal Oriented Community Brief Intervention Model among Risky Drinkers in Community in Thailand Wed, 17 Jul 2013 09:30:19 +0000 Tailored Goal Oriented Community Brief Intervention Model (TGCBI), first implemented as culturally secure and acceptable to communities in Thailand, is designed in 2 stages or levels: community level, a culturally secure approach to motivate participants to reconsider their drinking behavior; individual level, involved in the key messages received from the community level together with additional input focused towards individuals. TGCBI’s effectiveness was measured by the number of abstinent drinkers and number of alcohol-free months among those who continued to drink at followup in two communities that originally had high prevalence of risky drinking. Multivariate Poisson regression was used to investigate the intervention effect. Results indicated that the number of participants who stopped drinking 6 months later and the number of alcohol-free months during followup were significantly greater () for 47 participants in the intervention group compared to the control group (). TGCBI results in sustainable drinking cessation. Chitlada Areesantichai, Usaneya Perngparn, and Catherine Pilley Copyright © 2013 Chitlada Areesantichai et al. All rights reserved. Addressing the Question of Disorder-Specific Risk Factors of Internet Addiction: A Comparison of Personality Traits in Patients with Addictive Behaviors and Comorbid Internet Addiction Tue, 25 Jun 2013 14:53:37 +0000 Uncontrolled use of the internet has been reported to affect the lives of some users in a negative way. According to epidemiological studies, about 1% of the general population is showing signs of internet addiction. Since internet addiction is becoming a growing health concern, research on potential risk factors is becoming more important in order to develop strategies for prevention and to adopt therapeutic treatment. Although there are some studies investigating personality traits in internet addiction, most of these studies are based on samples of healthy subjects. In this research project, we compared personality profiles of a sample of patients in different rehabilitation centers. 70 patients with an addiction disorder that additionally met the criteria for internet addiction were compared to 48 patients suffering from alcohol dependence. Besides Big Five personality traits, we also assessed depressive symptoms. It was shown that patients with comorbid internet addiction can be discriminated from other patients by higher neuroticism and lower extraversion as well as lower conscientiousness. After controlling for depressive symptoms, lower conscientiousness especially turned out to be a disorder-specific risk factor. As internet addiction is related to unique patterns of personality traits and can be discriminated from alcohol dependence, treatment approaches are needed that meet the specific requirements of patients with internet addiction. K. W. Müller, A. Koch, U. Dickenhorst, M. E. Beutel, E. Duven, and K. Wölfling Copyright © 2013 K. W. Müller et al. All rights reserved. Comparison of Breast Cancer-Related Lymphedema (Upper Limb Swelling) Prevalence Estimated Using Objective and Subjective Criteria and Relationship with Quality of Life Tue, 18 Jun 2013 14:17:30 +0000 This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95–10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema. Catherine Bulley, Susanne Gaal, Fiona Coutts, Christine Blyth, Wilma Jack, Udi Chetty, Matthew Barber, and Chee-Wee Tan Copyright © 2013 Catherine Bulley et al. All rights reserved. Effect of Therapy Ball Seating on Learning and Sitting Discomforts among Saudi Female Students Mon, 10 Jun 2013 09:25:43 +0000 The aim of the study was to evaluate the effect of therapy ball seating as an alternative for typical chair seating in a classroom. We evaluated the effect of ball seating on the student's sitting discomfort and academic performance using Cornell Musculoskeletal Discomfort Questionnaire and problem-based learning scales, respectively. A sample of convenience was taken. Data was collected and analyzed using t-test. Subjects experienced a major discomfort at neck and a minor discomfort at knee joint. Results showed that there was a significant improvement () in sitting discomfort and student's performance when seated on therapy balls compared to typical classroom chairs. This study provides evidence for the effectiveness of therapy balls as a classroom seating for students who exhibit sitting discomfort and problem-based learning. Einas Al-Eisa, Syamala Buragadda, and Ganeswara Rao Melam Copyright © 2013 Einas Al-Eisa et al. All rights reserved. Intra- and Interday Reliability of Spine Rasterstereography Sun, 02 Jun 2013 18:44:22 +0000 To determine intra- and interday reliability of spine rasterstereographic system Formetric 4D with and without reflective markers. Twenty-six healthy volunteers (M group) had two markers placed in correspondence of vertebra prominens and intergluteal cleft, and 24 volunteers (NM group) were assessed without markers. All participants were analyzed two times in the same day and one time on a separate day. Trunk length, kyphotic angle, lordotic angle, pelvic inclination, kyphotic and lordotic apex, right and left lateral deviation, flèche cervicale and lombaire, trunk imbalance, pelvic tilt, inflection point, rotation correction, right and left surface rotation, pelvic torsion, and trunk torsion were measured. Intraclass correlation coefficient (ICC) and Cronbach Alpha (Cα) were calculated. In M group, for intra-, interday, and overall evaluations, the higher reliability coefficients were 0.971, 0.963, and 0.958 (ICC) and 0.987, 0.983, and 0.985 (Cα) for trunk length, kyphotic angle, and lordotic apex, respectively; while in NM group, they were 0.978, 0.982, and 0.972 and 0.989, 0.991, and 0.991 for trunk length. In M group, the lower values were 0.598, 0.515, and 0.534 (ICC) and 0.742, 0.682, and 0.784 (Cα) for trunk and pelvic torsion and in NM group 0.561, 0.537, and 0.461 and 0.731, 0.695, and 0.729 for left lateral deviation. The reliability of most parameters was excellent. Laura Guidetti, Valerio Bonavolontà, Alessandro Tito, Victor M. Reis, Maria Chiara Gallotta, and Carlo Baldari Copyright © 2013 Laura Guidetti et al. All rights reserved.