All Articles

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.

Giovanni Scibilia¹, Serena V. Capobianco¹*, Adriana Bonifacino², Valter Santilli¹, Teresa Paolucci¹

¹Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, “Sapienza” University of Rome, Rome (Italy)

²Department of Medical-Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Sant'Andrea University Hospital, Rome, Italy

³Unit of Physical Medicine and Rehabilitation, Department of Medical and Oral Sciences and Biotechnologies, DSMOB, University G. d’Annunzio of Chieti-Pescara,Italy

Breast cancer is the most common cancer affecting women over 35 years. The primary adverse consequences after surgical treatment and often after chemotherapy or radiotherapy, are pain, upper limb impairment, postural imbalances, lymphedema, fatigue, and depression. The aim of this study is to review rehabilitative Clinical Practice Guidelines in breast cancer patients after surgical treatment and to analyze recommendations and their level of evidence.

Materials and Methods: The articles were searched for the MeSH terms “breast cancer,” “guidelines,” “rehabilitation,” “lymphedema,”, “survivor,” “survivorship,” “therapy,” “exercise,” “complementary,” “cognitive,” “integrative,” “body image,” “physical therapy,” “treatment,” and “quality of life” in Cochrane Database of Systematic Reviews, PubMed, Science Direct. We restricted our search to full-text English language publications published between July 2006 and June 2017 and we considered only international practice guidelines that focus on rehabilitation after breast cancer surgery.

Results: We selected four guidelines focusing on primary care, rehabilitative approaches and integrative approaches. They recommend the early taking charge of the patient and to manage upper limb dysfunctions, lymphedema, pain, fatigue, peripheral neuropathy, body imagine concerns and lifestyle recommendations.

Conclusions: The current model of care for women with breast cancer focuses mostly on treatment of disease; this approach too often lacks attention to patients’ physical and functional well-being. Many criticisms emerge from this review.

We suggest that there is a need to strengthen the level of evidence for many commonly used clinical practices and to better describe innovative rehabilitative approaches.

Highlights

• Breast cancer is the most common cancer affecting women over 35 years;

• There is an increasing of survivor patients;

• The latest guidelines on breast cancer are not exhaustive about rehabilitation and complications after surgery;

• There is the need to strengthen the level of evidence of many commonly used clinical rehabilitation practices and to better describe rehabilitative approaches for breast cancer survivors.

• Only 4 breast cancer guidelines were interested in rehabilitation for survivor patients in the latest 10 years.

Jousielle Márcia dos Santos¹, Vanessa Amaral Mendonça^1,2,3, Vanessa Gonçalves Cesar Ribeiro³, Vinicius Cunha Oliveira², Sueli Ferreira da Fonseca³, Hércules Ribeiro Leite^1,2,3, Ana Carolina Coelho de Oliveira¹, Pedro Henrique Scheidt Figueiredo^1,2,3, Mario Bernardo-Filho⁴, Vanessa Pereira Lima^1,2, Ana Cristina Rodrigues Lacerda^1,2,3*

¹Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil

²Physiotherapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerias, Brazil

³Multicenter Postgraduate Program in Physiological Sciences, Sociedade Brasileira de Fisiologia (SBFis), Diamantina, Brazil

⁴Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil

Introduction: Whole Body Vibration (WBV) exercise has been widely applied in the clinical practice. Thus, the present review aims to provide an updated review of current literature on the effects and efficacy of WBV alone or combined with exercise in patients with fibromyalgia (FM).

Methods: The works were identified and selected from the PubMed, Cochrane-Central-Register-of-Controlled-Trials and Physiotherapy Evidence-Database (PEDro) databases. Randomized controlled trials (RCTs) and case-control studies were selected without language restrictions. Articles including single or multiple WBV sessions have been identified.

Results: Nine works were included in the review (1 case-control study and 8 RCTs). The average PEDRro score was 7.44 ± 0.95. The sample size varied from 20 to 46 participants, involving only women diagnosed with FM. The outcomes identified were pain, balance, quality of life, fatigue and disability. Only one study investigated FM-related inflammatory biomarkers.

Conclusions: Although WBV treatment appears to be safe and feasible, there is limited evidence to support WBV application in clinical practice in patients with FM.