All Articles

Tiffany Hogan ¹, Amy Mancia¹, Kanah Ndiaye¹, Brenda Rodriguez¹, Babak Najand ², Hossein Zare ^3,4, Shervin Assari ^{1 5,6*}

¹Department of Urban Public Health, Charles R. Drew University of Medicine, Los Angeles, California, United States

²Marginalization-related Diminished Returns Center, Los Angeles, California, United States

³Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.

⁴School of Business, University of Maryland Global Campus (UMGC), Adelphi, 20783, USA.

⁵Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States

⁶Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States

Background: Educational attainment has well established and widely recognized the effects on employment conditions and job demands. However, the way in which educational attainment correlates with perceived job demands may be inconsistent across racial groups as suggested by Minorities’ Diminished Returns (MDRs). The aim was to test the moderating effect of race on the association between educational attainment and perceived job demands, particularly for Black and White individuals.

Methods: This study was a cross-sectional analysis of MIDUS Refresher 1, including 1,232 Black and White adults over the age of 25 in the United States. Education attainment was the independent variable and perceived job demands was the dependent variable covariates. Linear regression was used for multivariate models.

Results- We observed positive association between education and perceived job demands, however, statistical interaction between race and education suggested stronger positive associations for Black than White individuals.

Conclusion: Being a highly educated Black professional in the United States equals high demand such increase stress is a risk factor of being a middle class black American. Innovated and bold market policies are required to solve this unfair dilemma.

Song-Young Park^1,2*, Andres Benitez-Albiter^1*, Cody P. Anderson¹, Sungyeon Kim³, Young-hwan An³, Sang-Seo Park^4*, Jung-Hyun Kim⁵

¹School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska

²Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska

³Department of Training Support Center, Korea Paralympic Committee, Republic of Korea

⁴Department of Physiology, KyungHee University, Republic of Korea

⁵Department of Sports Medicine, Kyung-Hee University, Yongin, Korea

Spinal cord injuries (SCI) lead to significant changes in autonomic function, hemodynamics, and body composition. These structural and functional alterations are closely associated with the development of cardiovascular pathologies and other metabolic diseases. Recent clinical studies suggest that passive limb movement (PLM) has beneficial effects on cardiovascular function and skeletal muscle health, which has drawn a growing interest for the use of PLM as a therapeutic option for patients with SCI. However, there is a lack of mechanistic studies that examine the underlying mechanisms of how PLM may ameliorate cardiovascular and skeletal muscle function in patients with SCIs. In this review, we will discuss potential mechanisms of SCI-induced perturbations in autonomic function, hemodynamics, and body composition. Furthermore, we will highlight the therapeutic effects of PLM on autonomic function, vascular structure and function, and skeletal muscle in patients with SCIs. Additionally, we will also introduce the effects of other passive therapeutic interventions such as vibration and massage therapy with potential benefits and concerns for cardiovascular and skeletal muscle adaptations in SCI. Therefore, optimizing the application of PLM in patients with SCIs may be useful to salvage SCI-induced attenuations in vascular function and body composition.

Kenneth Thomas^1*, Jeong Han Kim²

¹University of Wisconsin - Madison

²University of Texas – Rio Grande Valley

This study's goal was to examine, expand upon, and update a chapter that was first printed in a relatively small number of copies of the book titled Essays and Research on Disability¹.  Thomas was the sole author of the original chapter, which discussed how attitudes about disability develop from a psychoanalytic and sociobiological perspective.  Kin, reciprocal, and induced altruism were the first three altruism principles in sociobiology that were covered in this study. Then, Karen Horney's neo-Freudian viewpoint (i.e., less emphasis on sex and focused more on the social environment and culture regarding personality development) and traditional Freudian theories (such as castration anxiety, loss of love, and loss of the object) were tied to sociobiology, and this relationship was further addressed in terms of the evolution of attitude toward handicap. Then, recommendations were offered across a broad range of rehabilitation counseling services and educational practices that might be improved by using these insights, both clinically and politically.  Finally, the present study extends this discussion by addressing similar concerns in the areas of counseling service priorities, multicultural rehabilitation counseling, and identity politics.

Chloé Schorderet^1,2,3*, Roger Hilfiker⁴, Lara Allet^1,2,5

¹School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland

²The Sense Innovation & Research Center, Lausanne and Sion, Switzerland

³Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands

⁴School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Leukerbad, Switzerland

⁵Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland

Background: Long COVID-19 is frequently observed in people who have contracted SARS-COV-2. It is characterized by a set of symptoms that can persist for months after infection and represents a challenge for all health care professionals. Among them, physiotherapists play an essential role thanks to their extensive knowledge in the rehabilitation field. To provide quality treatment, they need recommendations on which to rely. The aim of this study is to gather opinions from therapists working in Europe on the management of long COVID-19 patients in physiotherapy.

Method: A Delphi method was conducted in three rounds. In the first round, participants were asked about the deficits observed in long COVID-19 patients and about tests, monitoring and treatment to be implemented during the treatment of these patients. During the second and third rounds, they were informed about the results already obtained and had to confirm their answers with 6-point Likert scales.

Results: The most frequently observed impairments were pain, reduction in general physical fitness and respiratory problems. For assessment and treatment, the responses are specific to each impairment category. The 6-minute test seems to be particularly relevant for the assessment of several deficits and active approaches seem to have an essential place in the treatment.

Conclusion: Our study highlighted the diversity of impairments observed by physiotherapists in long COVID-19 patients and allowed to create a consensus on the assessments and treatments to be preferred for each type of impairment. In general, active treatment should be preferred for most of the impairments for which long COVID-19 patients consult a physiotherapist.

Izaya OGON^1*, Hiroyuki TAKASHIMA², Tomonori MORITA¹, Mitsunori YOSHIMOTO¹, Yasushi FUJITA³, Tsuneo TAKEBAYASHI⁴ and Atsushi TERAMOTO¹

¹Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan

²Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

³Department of Orthopaedic Surgery, Nishioka Daiichi Hospital, Sapporo, Japan

⁴Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan

Background and aims: Fat degeneration in the multifidus muscle (Mm) was more common than in other trunk muscles. We hypothesised that the lipid contents of the Mm and patient-reported quality of life (QOL) are related. However, there are no papers examining the association between fatty degeneration of the Mm and patient-reported QOL using magnetic resonance spectroscopy (MRS). This cross-sectional study aimed to investigate the association between patient-reported QOL, evaluated with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and the intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) contents of the Mm and psoas major (PM) by MRS in patients with chronic low back pain (CLBP).

Materials and Methods:

Forty-eight patients (mean age, 64.2 ± 13.2 years; age range, 41–79 years) with nonspecific CLBP underwent MRS for the quantification of IMCL and EMCL of the right Mm and PM in a volume of interest at L4/L5. All subjects underwent MRS and completed the JOABPEQ in the same day. We performed multiple linear regression analysis of the IMCL and EMCL contents of the Mm and PM with the five domains of the JOABPEQ adjusted for age, sex, and body mass index.

Results: The IMCL content of the Mm was correlated with pain-related disorders (standardised partial regression coefficient (β)=−0.59, p<0.01), lumbar spine dysfunction (β=−0.64, p<0.01), and social life dysfunction (β=−0.31, p<0.01) which showed moderate negative correlation, but not with psychological disorders. The EMCL content of the Mm was not correlated with the five domains of the JOABPEQ. The IMCL and EMCL contents of the PM was not correlated with the five domains of the JOABPEQ.

Conclusions: IMCL content of the Mm was significantly correlated with the pain-related disorders, lumbar spine dysfunction, gait disturbance, and social life dysfunction domain scores of the JOABPEQ. Future studies using magnetic resonance spectroscopy of the Mm in patients with CLBP may help optimize exercise strategies using IMCL as an index to enhance patient-reported quality of life.

Richard E. Busch III D. C^1*, Prahlad G Menon², Sergey Leo Sorin, M.D., DABFM³

¹Indiana University, Parker University, Dallas, TX

²Bioengineering, University of Pittsburgh, Pittsburgh, PA

³International Institute of Holistic Medicine, 2840 E. Chestnut Expy, Springfield, MO

Background: Computerized spinal decompression using the intervertebral differential dynamics (IDD) therapy protocol has achieved 86–92% positive results in reducing back pain. There are many causes of back pain, and one of the most common is a degenerative disc. The etiology of a degenerative disc is not completely understood, but it can be related to acute injuries, repetitive stress, nutrition, genetic factors, and oxidative stress¹. Standard of care may include physical therapy or manipulation to introduce movement to the spinal vertebrae. IDD Therapy^® uses a calculated, sinusoidal, logarithmic primary waveform to separate the spinal vertebrae. More recent studies have shown that the addition of a secondary waveform gives a significant increase in efficacy. We observed these effects on the spine during an IDD Therapy^® session.

Methods: Images of the intervertebral space were taken by videofluoroscopy during the IDD Therapy^® session.

Results: The expected separation of L5-S1 was achieved. We also noted the separation profile of the vertebrae was uniquely uniform despite the graduated pressures, particularly when the secondary oscillation waveform was introduced. L5-S1 separation was 1 mm in size, and the anterior–posterior correlation was significant (p<0.05).

Conclusion: Active oscillatory signaling introduced during the high-tension period of treatment may lead to more compliant muscle re-education and thus enhanced uniform separation of the vertebrae. We believe that IDD Therapy^® using Accu-Spina^® may achieve 92% positive results because the secondary oscillatory signal induces mechanotransduction of mechanical stimuli into electrochemical activity at the cellular level. Further research will lead to greater confidence and further exploration of mechanotransduction in intradiscal cellular tissues.

Kenneth R. Thomas. DEd^1*, Kaiqi Zhou,² David A. Rosenthal, PhD³

¹Professor Emeritus, Rehabilitation Psychology, University of Wisconsin-Madison

²Ph.D Candidate, Rehabilitation Psychology, University of Wisconsin-Madison

³Professor, Rehabilitation Psychology, University of Wisconsin-Madison

Object Relations (OR) has been identified as one of the four major schools of psychoanalysis¹. This article provides a comprehensive review of OR practice and theory in the context of rehabilitation psychology. Extensive data are presented on five of the most prominent pioneer object relations theorists, including Melanie Klein, W. R. D. Fairbairn, Michal Balint, Harry Guntrip, and D. W. Winnicott. All of these individuals have contributed significantly to object relations theory. Melanie Klein and W. R. D Fairbairn have been credited with founding the object relations perspective, Michael Balint has been touted as the leading object relations theorist, Harry Guntrip was analyzed by both Fairbairn and Winnicott, and D.W. Winnicott is probably the most creative and respected psychoanalytic theorist since Sigmund Freud. All five of these theorists brought a fresh, new perspective on psychoanalytic theory and practice, and their contributions may be used to better understand the personality development of persons with a disability and to inform the practice of rehabilitation psychology.

Leonard A Jason¹*, Joseph Cotler¹, Mohammed F Islam¹, Jacob Furst², Ben Z Katz³

¹Center for Community Research, DePaul University, Chicago, IL 60614, USA. Emails: Leonard Jason: ljason@depaul.edu; Joseph Cotler: joey.cotler@gmail.com; Mohammed Islam: mfislam87@gmail.com;

²The College of Computing and Digital Media, DePaul University, Chicago, IL 60614, USA. Email: Jacob Furst:   jfurst@cdm.depaul.edu;

³Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, 60611 USA. Email: Ben Z Katz:   bkatz@northwestern.edu;

Background: About 10% of individuals who contract infectious mononucleosis (IM) have symptoms 6 months later that meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).  Our study for the first time examined whether it is possible to predict who will develop ME/CFS following IM.

Methods: We have reported on a prospectively recruited cohort of 4,501 college students, of which 238 (5.3%) developed IM.  Those who developed IM were followed-up at six months to determine whether they recovered or met criteria for ME/CFS. The present study focuses on 48 students who after six months had a diagnosis of ME/CFS, and a matched control group of 58 students who had no further symptoms after their IM. All of these 106 students  had data at baseline (at least 6 weeks prior to the development of IM), when experiencing IM, and 6 months following IM. Of those who did not recover from IM, there were two groups: 30 were classified as ME/CFS and 18 were classified as severe ME/CFS. We measured the results of 7 questionnaires, physical examination findings, the severity of mononucleosis and cytokine analyses at baseline (pre-illness) and at the time of IM.  We examined predictors (e.g., pre-illness variables as well as variables at onset of IM) of  those who developed ME/CFS and severe ME/CFS following IM.

Results: From analyses using receiver operating characteristic statistics, the students who had had severe gastrointestinal symptoms of stomach pain, bloating, and an irritable bowel at baseline  and who also had abnormally low levels of the immune markers IL-13 and/or IL-5 at baseline, as well as severe gastrointestinal symptoms when then contracted IM,  were found to have a nearly 80% chance of having severe ME/CFS persisting six months following IM.

Conclusions: Our findings are consistent with emerging literature that gastrointestinal distress and autonomic symptoms, along with several immune markers, may be implicated in the development of severe ME/CFS.

Connor A. Hernon^1,2, Abduallah Elsayed³, Raphael M. Vicente⁴, Ariane Zamarioli⁴, Melissa A. Kacena^3,5,6, Jonathan W. Lowery^1,2,3,5,6

¹Division of Biomedical Science, Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA

²Bone & Muscle Research Group, Marian University, Indianapolis, Indiana USA

³Department of Orthopaedic Surgery, Indiana University School of Medicine, Indiana, USA

⁴Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, SP, Brazil

⁵Richard L. Roudebush VA Medical Center, IN, USA

⁶Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University, Indianapolis, Indiana, USA

This mini-review summarizes the available information regarding the impact of caloric restriction (CR) and/or intermittent fasting (IF) on bone health. CR and IF are dietary interventions used in rehabilitative healthcare for augmenting weight loss and also proposed for recovery of conditions such as stroke and heart failure. CR restricts the total number of calories rather than different food groups or periods of eating. In contrast, IF severely restricts caloric intake for a period of time followed by a period of ad libitum intake. Here, we discuss the available information regarding the impact of these rehabilitation diets on bone metabolism, highlighting areas of consistency and discrepancy and suggesting future areas of study to advance the understanding of CR and/or IF on bone health.

Kerstin S. Baun¹, Nathan T. Kearns², Jennifer K. Peterson¹, John M. Miguelez¹

¹Clinical Services, Advanced Arm Dynamics, Redondo Beach, CA, USA

²Department of Psychology, University of North Texas, Denton, TX, USA

Purpose: To develop and psychometrically evaluate the Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ), a 28-item, self-report measure of three key facets associated with successful rehabilitation (perceived function, satisfaction, and pain) designed specifically for the adult upper limb loss (ULL) population.

Materials and Methods: Using a national sample of adult ULL patients (N=240), factor structure, internal consistency, convergent/concurrent validity, and known group validity of the total CAPROQ score and three subscale scores were evaluated.

Results: Confirmatory factor analysis indicated adequate-to-strong factor loading on each subscale: satisfaction (.623-.913), perceived function (.572-.860) and pain (.422-.834).  Internal consistencies for the total measure and measure subscales were good-to-excellent (.89-.95) and convergent validity indicated moderate-to-strong statistically significant associations between the CAPROQ subscales and relevant measures. Concurrent validity showed moderate associations between CAPROQ total score, prosthetic wear time, and psychosocial adjustment scores. Known group validity indicated significant differences on CAPROQ total score between initial and definitive fitting stages (p=.012).

Conclusion: Psychometric evaluation indicated that the CAPROQ and CAPROQ subscales were structurally sound, internally consistent, and demonstrated convergent validity with currently used assessments of perceived functioning, satisfaction, and pain.  CAPROQ is needed for guiding individual patient care, improving care models and future prosthesis selection and development.

Aric Anloague^1,4, Devanshi Patel^1,4, Stephanie Henderson^1,4, Hillary Rolfs^1,4, Mackenzie Powell^1,4, Sunny B Patel^2,4, Nicole M LaFave^1,4, Vincent R Marshall^1,4, Bryan G Wacker^1,4, Collin M Young^1,4, Julia M Hum^3,4, Kevin Gries^3,4,5, Jonathan W Lowery^3,4*

¹Marian University College of Osteopathic Medicine, 3200 Cold Spring Road, Indianapolis, Indiana, USA 46222

²William Carey University College of Osteopathic Medicine, 710 William Carey Parkway, Hattiesburg, Mississippi, USA 39401

³Division of Biomedical Science, Marian University College of Osteopathic Medicine, 3200 Cold Spring Road, Indianapolis, Indiana, USA 46222

⁴Bone & Muscle Research Group, Marian University, 3200 Cold Spring Road, Indianapolis, Indiana, USA 46222

⁵Program in Exercise & Sports Science, Marian University, 3200 Cold Spring Road, Indianapolis, Indiana, USA 46222

Individuals with osteoporosis, i.e., low bone mass, are at enhanced risk for fracture, disability, and death. Hospitalizations for osteoporotic fractures exceed those for heart attack, stroke, and breast cancer. Osteoporosis rates are predicted to increase due to an aging global population yet there are limited pharmacological treatment options for osteoporosis, particularly for long-term management of this chronic condition. Moreover, the drug development pipeline is relatively bereft of new strategies and drug candidates, creating an urgent need for developing new therapeutic strategies for treating osteoporosis. In this mini-review, we speculate about the potential for non-invasive soft tissue manipulation (STM) to exert anabolic effects on the skeleton that may provide therapeutic benefit for individuals with low bone mass. Our rationale is premised on work by us and others showing that STM leads to decreased levels of chemokines and pro-inflammatory cytokines (such as Interleukin (IL)-3, IL-6, and IL-8) known to restrict the differentiation and/or activity of bone-forming osteoblasts. However, there are no published studies examining whether STM impacts bone mass, potentially limiting the widespread use of this non-invasive and non-pharmacological intervention in the worldwide treatment of patients with osteoporosis, individuals with low bone mass due to being bed-ridden or otherwise mobility-limited, and persons subjected to spaceflight-related bone loss.

Julia To Dutka¹*, Mark Kovic², Kristen Mauk³, Richard E Oliver⁴

¹CGFNS International, Inc., Pennsylvania, USA

²Midwestern University, Illinois, USA

³Colorado Christian University, Colorado, USA

⁴University of Missouri, Columbia, Missouri, USA

To meet the needs of the 2.41 billion people seeking rehabilitation care, the world’s health workforce must be sustainable and scalable.  In 2021, the WHO launched its Rehabilitation Competency Framework (RCF) to help countries build local rehabilitation ecosystems by focusing on high-level priorities.  A top priority is the development of a health workforce that is sustainable and scalable to meet local needs.  To capitalize on existing health workforce resources, countries need to focus on the specialists and on other members of the rehabilitation team who can assume targeted responsibilities for delivering care. To support these efforts, CGFNS International, Inc., an assessment organization for health professionals worldwide, is developing two exam-based global certifications, one for rehabilitation health workers and one for registered nurses working in rehabilitation settings. These global certifications assess the knowledge and competencies of individual rehabilitation health workers and nurses and certify those who meet the standards.  For consumers, global certification attests to the competence of local service providers and helps ensure quality care.  For health workers and nurses, global certification confers a credential that recognizes their expertise and supports their continuing professional development and career goals.  And for policymakers, global certification provides useful information for managing care delivery.  This article provides the rationale behind global certification, describes the methodology for creating these certifications, and shows how their underlying constructs and those of the WHO’s RCF align.  This alignment helps consumers, health workers and nurses, and local authorities use all available tools to make informed decisions advancing rehabilitation care.

Li Chen¹, Jing Su²*

¹Department of Nursing, Shantou University Medical College, Guangdong, China

²Director of Department of Nursing, Shantou University Medical College, China

Pulmonary rehabilitation (PR) is an important part of the management of COPD, which can reduce symptoms of dyspnea, times of hospitalizations, and improve exercise capacity and health-related quality of patients. As a key element of PR, PR exercise training consists of exercise assessment and training methods. Exercise assessments should include the evaluation of dyspnea, exercise capacity, and health-related quality of life. Following a thorough assessment of patients, individualized exercise training programs, including endurance, resistance, and other exercise training methods, should be developed based on physiologic requirements and individual demands of patients. Although there have been many studies on the types of exercise for patients with COPD, there are still no conclusions about how to develop the best exercise prescription. Choosing the most appropriate methods for patients with COPD to calculate the situation is crucial. Therefore, this review aims to summarize the common methods of exercise assessments and exercise trainings in PR.

Irene J Su*, Yi Li, Li Chen

Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong Province, China

Objectives: The purpose of this study is to identify whether there is an association between sarcopenia and physical function outcomes of patients with stroke.

Methods: A systematic search of Pubmed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang database was conducted to identify studies in Chinese and English from the inception of the database to March 2021. Documents were checked for relevancy. Articles exploring the association between sarcopenia and the physical function of patients with stroke were included. The quality of the literature was evaluated using the Newcastle-Ottawa scale tool. Stata 15.0 software was used to conduct meta-analysis.

Results: Eight studies met the criteria for inclusion. A meta-analysis of four studies showed that sarcopenia was related to an increased risk of poor physical function of patients with stroke (total OR=3.11, 95% CI: 2.22-4.34, P<0.0001). Descriptive analysis was performed in the rest of studies. Overall, a correlation between the two factors was found in patients with stroke. Some studies suggested a difference based on gender and severity of the disease condition. The studies included in this review were of high methodological quality. The Egger's test (P=0.217) showed no publication bias.

Conclusions: This review concludes that sarcopenia is an independent predictive factor of physical function of patients with stroke. Clinicians should pay attention to gender differences and severity of disease condition. Therefore, screening, diagnosis, treatment, and prevention of sarcopenia should be part of the routine clinical practice when providing care to stroke patients.

K.F. Cheng¹, Lee Sze Nga², P. C. Leung^1,3*

¹ Centre for Clinical Trials on Chinese Medicine, Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong

² Grace Rehabilitation Service, Evangelical Lutheran Church Social Service - Hong Kong, Hong Kong

³ State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants (The Chinese University of Hong Kong), Hong Kong

Background: The Community Bone Health Promotion Project offered service to the individual Mentally Retarded person (MR) together with his/ her personal care-givers as a unit.  The MR tends to get old and suffer from chronic diseases much earlier than the general population. The care-giving parent is older by age and yet could serve as a “control” in the assessment exercises.

Methods: The project took a multidisciplinary approach participated by the social workers, medical experts, nurses and therapists to ensure support and compliance. The promotion of bone health was executed through ordinary physical exercises, machine-driven trainings and dietary support. A special dietary supplement with Traditional Chinese Medicine orientation was chosen for the clients who were expected to have extra appreciation because of the cultural heritage.

The project lasted 12 months after which the assessments included objective measurements of Bone Mineral Density (BMD) and subjective evaluation of Quality of Life (QoL).

Results: Of the 136 participants, 55 were patients with MR and 81 were caregivers. The average age of patients with MR was 52.7 years old, and that of caregivers was 62.2 years old. Compliance of the clients and their caregivers had been very good and great appreciations were expressed. The special dietary supplement with medicinal herb extracts was well loved by both MRs and caregivers. BMD, as expected, did not show significant change after 12 months although a trend of improvement was obvious among the more deficient individuals. Caregivers of older ages could be more responsive compared with the younger MRs.

In conclusion, it was a fruitful project endorsing the multidisciplinary approach in the planning, executions, supervision and assessment. The improvements in Physical functioning, Role physical and Role emotional were shown in the Quality of Life evaluation, further supported the enthusiasm and appreciation of the MRs and their caregivers.

Joanne E. Milios*, Timothy R. Ackland, Daniel J. Green

School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, 6009

Peyronie’s Disease (PD) is a connective tissue disorder of the penis affecting 1 in 10 men, resulting in penile deformity and psychological distress in 50% of afflicted men. Therapeutic Ultrasound (TUS) is a non-invasive treatment that uses high frequency sound waves to stimulate tissue repair via thermal effects to increase blood flow, reduce pain and promote a proinflammatory response. TUS has been shown to be effective in case study series however no RCTs currently exist.

Methods & Materials: Forty-six men with PD were recruited into a randomised controlled study that assessed the effectiveness of TUS (n= 23 intervention, n= 20 control).

12 TUS sessions were provided over 4 weeks utilising 1.5-2.5 W/cm², 3 MHz x 10mins/session before and after which all outcome measures were re-assessed. The control group had a 4 -week delayed entry into the intervention. Participants underwent Penile Duplex Doppler Ultrasound (PDDU) to confirm PD. as well as completing the Peyronie’s Disease Questionnaire (PDQ) and IIEF-5.

Results: Forty-three participants (59 y ± 11y, BMI=26.3, duration PD 17 months) completed the trial. PDDU outcomes indicated a Group x Time interaction (F= 4.702, p=0.036) and showed a significant main effect. Average reduction in penile curvature angle was , or 38% of total and ANOVA results show a significant main effect for time and curvature reduction (F=16.762; p < 0.001). For the IIEF-5 outcomes, results show a significant main effect for the Group x Time interaction (F=4.752, p=0.035).

Conclusions: TUS offered an effective first line, non-invasive approach to treatment for PD. Previous studies utilizing TUS on PD have relied on case study reports and this is the first RCT to be undertaken in this field.

Renan Fudoli Lins Vieira¹, Rafael Lima Junqueira¹, Rafael C. Gaspar¹, Vitor R. Munoz¹, Jose R. Pauli^1,2*

¹Department of Health Sciences, Laboratory of Molecular Biology of Exercise, School of Applied Sciences, University of Campinas, Sao Paulo, Brazil

²CEPECE-Center of Research in Sport Sciences, School of Applied Sciences, University of Campinas (UNICAMP), Limeira, Sao Paulo, Brazil

Aging is characterized by a decline in metabolism and functional capacities. On the other hand, physical exercise is a well-known strategy that provides metabolic and functional benefits. Since elderly subjects have insulin resistance and issues with carbohydrate metabolism, physical exercise can contribute to glucose homeostasis through its participation in skeletal muscle glucose uptake via insulin-dependent/insulin-independent mechanisms. Therefore, it is important to understand the effects of physical exercise on 5' AMP-activated protein kinase (AMPK) signaling in skeletal muscle and on positive metabolic adaptations and the prevention of age-related diseases. In this mini-review, we will discuss the participation of AMPK in controlling skeletal muscle glucose uptake in response to physical exercise and aging.

Felipe L. Belozo¹, Naely Pivetta², Victor A. R. Fernandes^1,3, Rebeca S.M.N. Belozo¹, Tatiane C. de Paula¹, Carlos K. Katashima⁵, Andre K. Yamada⁴, Carlos Roberto Bueno Jr.⁴, Vagner R. R. Silva⁵*

¹College of Physical Education - Network Faculty, Nova Odessa, SP, Brazil

²State University of Campinas (UNICAMP), Campinas, SP, Brazil

³Laboratory of Tissue Morphology. Jundiai Medical School. Jundiaí, SP, Brazil

⁴School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeiro Preto, Brazil

⁵Postgraduate Program in Nutrition and Sport Sciences and Metabolism. School of Applied Sciences, University of Campinas (UNICAMP), Limeira, SP, Brazil

Background: Falls can lead to several comorbidities and are considered a major cause of mortality in the elderly.

Objective: Herein, we evaluated functional mobility in older practitioners of Liang Gong exercise as a strategy to prevent falls.

Method: We evaluated 90 subjects (10 men and 80 women) using measures of body mass index (BMI), waist circumference (WC), abdominal circumference (AC), calf circumference (CC), 5 times sit to stand test (5TSS), and 4-meter gait speed test (4GST).

Results: Against our expectations, 68.88% of the participants presented low-performance in the 5TSS and 71.11% in the 4GST. In addition, we associated CC (considered a marker of sarcopenia) with the 5TSS using Pearson's correlation analysis but no statistical differences were found between the low-performance group and the high-performance group.

Conclusion: Our results showed that the majority of the older adults who have been practicing Liang Gong exercise for more than 6-months presented unsatisfactory results in the indices of functional mobility and we believe that a combination of resistance, functional and aerobics trainings would be more effective to improve it.

Lidiane Begalli de Souza¹, Mariana Cruz Lazzarin¹, Flavia de Oliveira¹*

¹Departamento de Biociências, Universidade Federal de São Paulo, Campus Baixada Santista, SP, Brazil

Duchenne muscular dystrophy (DMD) is a rare disease caused by mutations or rearrangements in the dystrophin gene, leading to progressive muscle lesion. There is no curative treatment for DMD, however, there is evidence that treatment with LLLT acts to decrease inflammation, oxidative stress, pain and stimulate muscle repair. The aim of this review was to discuss the effects of LLLT as a helpful alternative therapy to be associated with other treatments for DMD. To this end, a systematic research in PubMed database was conducted including the following terms: “Duchenne muscular dystrophy” and “low level laser therapy” or “mdx mice” and “low level laser therapy”. After prospecting scientific articles, 5 were selected. As a result, it was found that there is a lack of information about the use of LLLT on DMD patients because all of the studies were preclinical. The selected articles showed that mdx mice were chosen as the experimental model and although they describe the positive effects of LLLT, the studies were performed with different mice ages, parameters of irradiation, treatment duration and muscle chosen. In conclusion, according to this review both preclinical animal experiments and human clinical studies with LLLT use should be expanded to the benefits of patients in this translational research answer.

Michel Lacour^1,4*, Laurent Tardivet², Alain Thiry³

¹Neurosciences Department, Aix-Marseille University/CNRS, Marseille, France

²Otorhinolaryngology Department, CHU Nice, 30 Voie Romaine, 06000 Nice, France

³Physiotherapist, 29 Bd Dubouchage, 06000 Nice, France

⁴21 Impasse des Vertus - 13710 Fuveau (France)

Purpose: Postural instability is a disabling symptom in patients with acute unilateral vestibular hypofunction (UVH). Vestibular rehabilitation (VR) with the unidirectional rotation paradigm has been shown recently to improve gaze stabilization in UVH patients, particularly when performed early after onset of the vestibular pathology, but its role on posture recovery remains unknown until today.

Methods: Effects on posture and balance recovery of early versus delayed VR with the rotatory chair protocol were analyzed under static and dynamic postural tasks performed in different visual conditions (eye open: EO, eyes closed: EC, optokinetic stimulation). Posture control was investigated through non-linear analyses of the stabilogram in three groups of patients submitted to the same VR program performed at different time periods after onset of the acute vertigo attack (early VR: first two weeks; late 1 VR: third and fourth weeks; late 2 VR: one month and more). The Dizziness Handicap Inventory (DHI) score was evaluated before and after VR.

Results: All the postural parameters (Postural Instability Index: PII, Spectral Power Density: SPD, Critical Point amplitude: CP amp, and Hausdorff Frequency: HF) were significantly modified in the UVH patients tested before VR compared to the controls. Greater instability (increased PII) associated with higher energy to control posture (enhanced SPD), higher CoP displacements without feedback corrections (increased CP amp), and lower time of automatic control of posture (decreased HF) was the typical pattern of the UVH patients. After rehabilitation and in static posturography conditions, all the postural parameters were improved in the three groups of patients, whatever the visual condition, without significant differences between the groups. By contrast, recovery of balance in the dynamic postural conditions was better only when rehabilitation was performed early. A lower percentage of fallers was observed in the early and late 1 group in the most challenging conditions with EC and optokinetic stimulation. In addition, the early group was the only one to show significant improvement of the postural parameters (PII, SPD, CP amp and HF), and the late 2 group the only one to show no significant changes. The late 1 group exhibited an intermediate recovery pattern. The DHI scores were significantly reduced in the early and late 1 groups only.

Conclusions: Posture control is strongly impaired in the UVH patients who display greater instability, higher body sway without feedback correction, and spend much more energy to keep balance. Postural recovery after VR does not depend on the time period between onset of pathology and beginning of VR when patients were tested in the easy postural tasks on a stable support. However, in the most challenging conditions on unstable support, without vision or moving visual environment, earlier the rehabilitation with the rotatory chair protocol, better the recovery. This latter result suggests a critical period to recover optimally the dynamic vestibulo-spinal function, similar to the early opportunity time window we have highlighted for the recovery of the dynamic vestibulo-ocular reflex.

Vagner R. R. Silva^1#, Felipe L. Belozo^1#, Rodrigo M. Pereira¹, Carlos K. Katashima¹, Andre V. Cordeiro¹, Jean F. Alves², Jose R. Pauli¹, Adelino Silva^3,4, Eduardo R. Ropelle¹, Leandro P. De Moura¹*

¹Department of Sport Sciences, School of Applied Science, University of Campinas (UNICAMP), Limeira, Sao Paulo, Brazil

²Department of Biochemistry, Faculty of Biology, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil

³Postgraduate Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, USP, Ribeirao Preto, SP, Brazil

⁴School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil

⁵School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo (USP), Ribeirao Preto, SP, Brazil

Sedentary lifestyle is one of the main factors that contribute to the development of diabetes. The amount recommended, in order to achieve an improved overall metabolic health, is at least 150 minutes of moderate-intensity exercise weekly. However, due to the high volume prescribed, the adherence to this practice is not as good as expected, thereby increasing the incidence of sedentary lifestyle and diabetes. Here, we show the impact of reducing the recommended amount of exercise by 40% (90 minutes/week) on cholesterolemia and glycemia among diabetic individuals. 13 diabetics (men and women), divided into two groups: untrained (n=6) and trained (n=7) (mean age 45.3±3.9). The trained group was submitted to the practice of aerobic exercise on a treadmill, three times a week (70–80% MHR), for 30 min/day, for 8 weeks. Subsequently, were analysed glucose levels, glycated hemoglobin A1C (HbA1c), total cholesterol and its fraction (LDL-c, VLDL-c, HDL-c) and total triglycerides (TG). Ninety minutes per week of moderate-intensity exercise was effective in controlling blood cholesterol by reducing the total cholesterol and LDL-c fraction. Furthermore, it was observed that this amount of exercise promoted a reduction in hyperglycemia from the first session until the end of the experiment. Fasting glycemia was reduced after the fourth week of training, even without changes in the adiposity. In conclusion, 90 minutes of moderate intensity exercise a week, spread over 3 nonconsecutive days of 30 minutes of exercise, can improve the lipid profile and glucose homeostasis in diabetic patients, even without a reduction of adiposity.

This study was registered under ClinicalTrials.gov with the identifier code number: RBR-8mwkyq

Michel Lacour¹*, Laurent Tardivet², Alain Thiry³

¹Neurosciences Department, Aix-Marseille University/CNRS, Marseille, France

²Otorhinolaryngology Department, CHU Nice, 30 Voie Romaine, 06000 Nice, France

³Physiotherapist, 29 Bd Dubouchage, 06000 Nice, France

Unilateral vestibular hypofunction (UVH) patients were submitted to a vestibular rehabilitation (VR) program with two different protocols based on the unidirectional rotation paradigm. One group (N=28) was submitted to active gaze stabilization exercises with the head impulse test (HIT), and a second group (N=31) with the passive whole-body rotation on a rotatory chair. Head or body rotations were always performed to the hypofunction side and a similar number of training sessions were used in each group (2 times a week for four weeks). Patients in each group were subdivided into three subgroups based on the time delay between onset of the disease and beginning of VR (early VR: the first two weeks after onset; late 1 VR: third and fourth weeks after onset; late 2 VR: one month and more after onset). The angular vestibulo-ocular reflex (aVOR) and the directional preponderance (DP) regarding the horizontal canals were the main outcomes. The results pointed to similar findings with the two protocols, characterized by a significant improvement of the aVOR gain on the hypofunction side, responsible for the significant decrease of the DP in the horizontal canals. These powerful changes were observed in the early subgroups only. No significant modifications were found in the late 1 and late 2 subgroups. The data clearly attest to the effectiveness of the unidirectional rotation paradigm when performed in the acute phase of the disease, thus extending to UVH patients the concept of critical period for VR already demonstrated in animal models.

Shallon Atuhaire¹*, Akin-Tunde A. Odukogbe², John F. Mugisha³, Oladosu A. Ojengbede

¹Pan African University of Life and Earth Sciences Institute, University of Ibadan, Nigeria

²Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan / University College Hospital, Ibadan, Nigeria

³Cavendish University, Kampala, Uganda

Introduction: Obstetric fistula is highly debilitating with effects acknowledged as beyond treatment thus, it requires physical and social rehabilitation. The study described the extent to which obstetric fistula patients have been involved in social rehabilitation services at Kitovu Hospital in Uganda.

Methods: A cross-sectional survey that used mixed methods was done among 390 obstetric fistula patients and 12 key informants at Kitovu Hospital in Uganda. The 390 patients responded to a semi-structured questionnaire, and 10 of them were involved in in-depth interviews. The 12 key informants were hospital staffs actively involved in the management of obstetric fistula, and patients’ partners who were involved in care giving. The variables under investigation included: socio-demographic and obstetric factors alongside whether the patients had been empowered, earned daily, had received aid to startup an income generating activity, had skills training, counseling, physiotherapy, health education, needs assessment and whether their needs had been addressed.

Results: Among the 390 participants, 192 (49.2%) had had fistula repair, 198 (50.8%) had not had repair, 215 participants felt they had not been empowered at all, 215 did not earn daily. Again, 211 indicated that they had not received aid to startup an income generating activity, 235 had not received skills training, 195 had not received counseling, and 299 had not had physiotherapy. A significant difference was noted across all the variables (empowerment, daily earning, having received aid to startup an income generating activity, skills training, counseling, physiotherapy, health education, needs assessment and having their needs addressed) and their repair category with a P-value of <0.001. Qualitative findings also indicated that patients received inadequate social rehabilitation due to inadequate resources. Patients preferred fistula repair before they could be socially rehabilitated as they still felt incapacitated.

Conclusions: A larger proportion of patients with unrepaired fistula had not been involved in social rehabilitation compared to those whose fistula had been repaired. More repair and rehabilitation centers ought to be constructed and adequately facilitated for the patients to receive the services they desire for effective social rehabilitation.

Edwards David*, Brickner Joseph, Hadadzedeh Mohammad, Molek Joseph, Shapiro Elina

Wheeling Jesuit University, United States

Background: Often clinicians attempt to correct the longitudinal arch of the foot in those with pes planus to improve physical performance, this theory has not been studied extensively. The purpose of this study was to determine the correlation between increased navicular drop/low arched feet and explosive jump performance in young adults.

Methods: A correlational design was used to carry out this study. The study took place at four centers and a convenience sample was selected from these locations. One-hundred and five healthy adults between the ages of 18 and 35, with a mean age of 23.23 (+/- 2.62) participated. The participant’s measurement of hyper pronation was quantified through navicular drop test. Explosive performance was then measured through vertical and broad jump. A Pearson correlation and follow-up Spearman correlations were then performed to analyze the relationship between navicular drop and vertical and broad jump while keeping level of significance at alpha= .05.

Findings: There was no signifigant correlation between an individual’s navicular drop and their vertical jump measurement (r=-0.077, p=.268; r_s=.-.059, p=.550). or broad jump (r= 0.012, p=.382; r_s= .007, p= .945).

Interpretation: There was no correlation between navicular drop and vertical and broad jump measurements in young adults. A low arched foot did not predispose an individual to decreased explosive performance in the form of vertical and broad jump measurements. This could have implications on the decision to attempt to correct pes planus with measures such as orthotics or taping to improve performance.

Gabrielly Marques Moreira¹, Elis Marina Romão de Lima², Ingrid Thaíse Machado², Ana Paula Cunha Loureiro³, Elisangela Ferretti Manffra¹*

¹Health Technology Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil

²Physical Therapy Undergraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil

³Department of Physical Therapy, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil

Background: Stroke causes somatosensory and motor deficits that compromise the static and dynamic balance. The recovery of these skills is an essential goal in the rehabilitation process and physiotherapy treatments have employed video games (VG) for therapeutic purposes.

Objective: To investigate the effects of employing VG in static and dynamic balance of individuals after stroke.

Design: Quasi-experimental study.

Method: The sample consisted of 28 individuals with hemiparesis, divided into experimental (EG) and control groups (CG), with 14 participants in each. The EG underwent conventional physiotherapy and commercial video games training. The interventions were individualized, with duration of 30 minutes, twice a week, for 10 sessions. The CG received only conventional physiotherapy. The groups were evaluated before and immediately after completion of the study. Individuals were assessed with Berg Balance Scale, MiniBESTest, Postural Assessment Scale for Stroke, Functional Reach Test and 1-minute sit-to-stand test.

Results: Both groups increased their scores on the scales. However, this increase was significant only for the EG in the Berg Balance Scale (p = 0.001), MiniBESTest (p = 0.001) and Functional Reach Test (p = 0.041). Correlation analysis indicated that the increase in functional scales was related to progress in the Tightrope game.

Conclusion: These results suggest that VG can be a valuable tool for physiotherapy practice, bringing potential benefits to improve static and dynamic balance in stroke individuals.