Rehabilitative Sciences

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    Tai Chi and Diabetic Peripheral Neuropathies
    (2021) Janssen, Allison; Kolenovic, Mersida; Logsdon, Liana; Liu, Howe; Salem, Yasser
    Background: Every year about 1.5 million Americans are diagnosed with diabetes. A common and major complication these individuals face is the development of peripheral neuropathies, typically due to uncontrolled glucose levels. The purpose of this systematic review is to identify the benefits of Tai Chi as an exercise intervention to alter peripheral sensation and balance related to neuropathy in diabetic patients. Tai Chi is an ancient Chinese martial art that incorporates elements of balance, strength, postural control, and concentration. Methods: This systematic review examines the effects of a Tai Chi program based on studies from PubMed database within the past 20 years. Each intervention program had varying parameters like numbers of forms, session durations and session frequencies. Results: Six studies show improvement in ankle proprioception, quality of life, glucose control, nerve conduction velocities in legs and arms, vascular reactivity index, plantar sensation, and locomotor stability. Each study had less than 60 participants and a Tai Chi program of at least 8 weeks of Yang, Sun, or Cheng style with progressions at the instructor's discretion. Conclusion: Tai Chi is a beneficial intervention for people with peripheral neuropathy. The six studies showed improvement in glucose control, quality of life, sensation and standing balance components. After thorough analysis, this review exposes several deficits in the existing research. Further studies could control for more balance variables, include larger sample sizes, and investigate the efficacy of specific Tai Chi program parameters.
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    Finding the PIN in the Haystack: Case report on the localization of a Posterior Interosseous Nerve lesion
    (2021) Colucci, Patricia; Mirochnitchenko, Alissa; Ooi, Preston
    Background: Posterior interosseous nerve (PIN) lesions are uncommon, with an incidence of 0.003%. This case report investigates a PIN lesion distal to the Arcade of Frohse with an unknown etiology. Case Information: A 45 year old male with a history of multilevel anterior cervical spine discectomy and fusion (ACDF) and right cubital tunnel release presented to clinic with persistent right hand weakness. Although his numbness had improved in the fourth and fifth digits, he still experienced dorsal forearm fatigue and thumb extension weakness on the right side. He denied recent trauma or any other comorbid chronic conditions. Physical exam revealed 5/5 strength in bilateral upper extremities, 1/5 strength in first digit extension and abduction, 2/5 strength in second digit extension, and 4/5 strength in third through fifth digits. A nerve conduction study (NCS) was conducted and revealed appropriate amplitudes, latencies and conduction velocities in the median and ulnar sensory and motor nerves, and radial sensory nerves bilaterally. Electromyography (EMG) revealed residual abnormalities attributed to recent ulnar nerve impingement and chronic findings due to C5-6 ACDF. EMG was further suggestive of a radial neuropathy between the takeoff of the nerve to abductor pollicis longus (APL) and extensor pollicis brevis (EPB). The patient was referred to surgery for further management. Conclusions: This case demonstrates the importance of the investigation of new pathology when multiple, chronic pathologies exist. Furthermore, this case highlights that EMG, NCS, and anatomical knowledge play crucial roles in uncovering complex pathology.
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    The Effect of Tai Chi on Sleep Quality and Sleep Disorders: A Systematic Review
    (2021) Baker, Joshua; Liu, Howe; Salem, Yasser
    Purpose: To identify the effects of Tai Chi (TC) on sleep quality in older adults with or without a medical condition. Methods: Tai Chi, Tai Ji, insomnia, sleep disorder, and sleep problem were used to search for articles in peer-reviewed, English journals from the last 15 within the following databases: PubMed, Medline, and Scopus. Studies that met the initial criteria included subjects older than 18 with a sleeping disorder and included Tai Chi as one of the interventions. Two hundred and ten articles met the initial selection criteria and were further scanned and discussed as needed by 3 reviewers. Following review, 16 studies were qualified. Results: Sleep quality was improved as measured by the Pittsburg Sleep Quality Index (PSQI) in 14 studies and by the Spiegel Sleep Questionnaire (SSQ) in 1 study in adults without medical conditions, or for those with cancer, sleep apnea, depression, or insomnia. Also, fatigue and quality of life were found to be improved in 4 studies as evaluated by the Brief Fatigue Inventory (BFI) and SF-12 or SF-26. Further, one study investigated the effect of Tai Chi on inflammatory biomarkers in patients with insomnia due to breast cancer and revealed significant inhibition of pro-inflammatory cytokines. The most commonly used TC parameters were 60 minutes per session, 2-7 times per week, with a duration between 3-6 months. Conclusions: TC is an effective program for improving sleep quality in individuals with or without a medical condition.
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    Postural stability as a predictor for reactive response to perturbations
    (2021) Yasuda, Tai; Moudy, Sarah; Patterson, Rita; Hensel, Kendi
    Purpose: The major cause of accidental death for people above 65 is fall-related injuries. Fall risk can be assessed through postural stability or gait analysis following a trip-like perturbation. Easy clinical assessment is a major advantage of using postural stability, but it is unclear if it represents the ability to recover from a trip. The purpose of this study is to investigate if postural stability can be used to predict reactive response to perturbations. Methods: Postural stability was examined by participants standing still for 30 seconds. Corresponding measures were extracted from center of pressure (COP) including: mean velocity of COP (mvN), distances from COP (net_area), base of support (net_bos), and ratio of change in net_area to net_bos support (net_ratio). Reactive recovery was assessed by COP-Center of Mass (COM) distance and step length after perturbations were elicited by accelerating the treadmill at 5 meters/sec2 while walking. To determine if postural stability is associated with reactive recovery, linear regressions and correlations were performed. Waveform analysis was applied for COP-COM distances. Results: Weak correlations (r= 0-01-0.31, p=0.002-0.05) were found between step length and postural stability measures. COP-COM distance found one significant relationship with mvN after perturbation (p= 0.022, r=0.29). No other significant relationships were found. Conclusions: Data points selected for quiet standing, or inherent differences between postural and dynamic components of gait, may explain these results. Additional research in understanding if postural stability can predict reactive response is recommended for future assessment of fall risk.
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    Exoskeleton & Gait Speed in Patients with Spinal Cord Injury
    (2021) Walls, Paige; Diu, Pam; Salem, Yasser; Liu, Howe
    Purpose: Robot assisted gait training (RAGT) is an intervention used to improve gait in individuals with lower extremity motor dysfunction. The purpose of this review is to evaluate both prior and recent literature on the effectiveness of exoskeleton use as an intervention for gait speed in individuals with spinal cord injury. Methods: Electronic databases used in the search included PubMed, CINAHL, PEDro, & Scopus. Two reviewers searched all results from the databases and categorically organized relevant articles based on inclusion & exclusion criteria. Studies were included if they involved exoskeleton as an intervention for gait speed and were conducted on adults diagnosed with spinal cord injury. Results: 37 final articles were reviewed. The sample sizes ranged from 1 to 170 participants. Participant ages ranged from 18 to 81 years old. Duration of treatment ranged from a single session to 16 weeks, frequency ranging from 1-2 sessions to 5 per week. Length of sessions ranged from 20 to 90 minutes. The primary outcome measure for gait speed used in most studies was the 10MWT. Others included the 6MWT, 2MWT, TUG, treadmill speed, and motion capture analysis. Conclusion: The evidence suggests that the use of robotic assistance may effectively improve gait speed in individuals with spinal cord injury. However, evidence is inconclusive as to whether RAGT is more effective in improving gait speed when compared to other interventions. Studies report that robotic assisted interventions are safe & feasible interventions without adverse events or exacerbation of symptoms for patients of this population.