Rehabilitative Sciences

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    Effects of Tai Chi programs on acute and chronic pulmonary conditions
    (2020) Kolenovic, Mersida; Traina, Allison; Liu, Howe; Salem, Yasser; Logsdon, Liana
    Introduction: The health benefits of Tai Chi has been found to have numerous health benefits throughout all systems of the body. Due to Tai Chi's focus on controlled breath and diaphragmatic breathing, Tai Chi has been shown to improve pulmonary functions in chronic and acute pulmonary disease such as chronic obstructive pulmonary disease (COPD), asthma, lung cancer, and cystic fibrosis. The purpose of this systematic review is to analyze studies related to Tai Chi intervention for subjects with pulmonary disease in order to compare Tai Chi program parameters. Methods: This systematic review examines how a Tai Chi program can improve lung function, forced expiratory volume of 1 second (FEV1), 6 minute walk distance (6MWD) test results, dyspnea scale measures, and overall sense of well-being. This review utilized random control trials from PubMed database within the past 15 years. Key words used were "Tai Chi," "intervention," "cystic fibrosis," "asthma," "COPD," "lung cancer". Results: Individuals with COPD benefitted most from a Tai Chi program with sessions twice per week for 12 weeks. Two studies showed sustained physiological and subject perceived improvements 12 weeks after completion of Tai Chi program for individuals with COPD. Conclusion: Tai Chi is a beneficial intervention for individuals with pulmonary disease in improving lung function, endurance, and overall sense of well-being. This systematic review revealed that further studies are needed to uncover sustained effects of Tai Chi programs and regarding pulmonary conditions such as adult and pediatric asthma, lung cancer, and cystic fibrosis.
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    A Systematic Review of the Effectiveness Aquatic Exercises has for Individuals with Parkinson's Disease
    (2020) Salem, Yasser; Liu, Howe; Quiben, Myla; Holmes, Clayton; Aggarwal, Sonali
    Purpose: The aim of this systematic review was to examine the evidence regarding benefits of aquatic exercise for patients with Parkinson's disease. Methods: Electronic databases used were PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two individuals independently searched for relevant literature & sorted based on the inclusion criteria. Studies were included if they met the diagnosis criteria (Hoehn & Yagr scale or physician diagnosed) and aquatic exercise was the main intervention. Articles were excluded if they were not available in English. Results: Of 19 articles, there were eleven randomized controlled trials, one nonrandomized controlled trial, one case control study, five cohort studies, and one case study. Participant age ranged from 60 to 76 and overall inclusion criteria was 19-95 or older. Sample sizes ranged from 1 to 46 participants and 437 individuals were analyzed. Treatment duration was 3-4 up to 16 weeks with session frequency being 1-2 sessions up to 5 per week. Session length ranged from 35 to 60 minutes. A range of aquatic exercises and techniques were used to address multiple impairment areas. Various outcome measures were used to assess effectiveness of treatment. Conclusions: The evidence suggests an aquatic exercise program may effectively address deficits in quality of life, functional mobility, balance, posture, pain, and mood. Studies reported that aquatic activities are safe, enjoyable, & feasible interventions without adverse events or exacerbation of symptoms. Variability between studies was found with randomization, intervention parameters, population, and outcome measures for documenting changes.
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    Evaluation of an Enhanced Peer Mentor Program for Individuals with Spinal Cord Injury
    (2020) Callender, Librada; Ochoa, Christa; Froehlich-Grobe, Katherine; Holden, Alexandria
    Purpose: People with new spinal cord injuries (SCIs) encounter challenges in making lifestyle adjustments. Peer interventions have been effective in helping individuals with SCI. The peer mentor program at Baylor Scott and White Institute for Rehabilitation offers a structured support relationship extending beyond inpatient rehabilitation stay. Patient and clinical perspectives inform efforts for improvement and sustainability. Methods: The evaluation includes questionnaires completed by mentees and inpatient rehabilitation staff. Measured outcomes of the impact and quality of peer intervention for mentees include satisfaction of program before and after discharge (Peer Mentor Assessment), perceived self-efficacy (General Self Efficacy Scale), perceived resilience (Spinal Cord Injury - Quality of Life Resilience), environmental barriers (Craig Hospital Inventory of Environmental Factors), social participation (Craig Handicap Assessment and Reporting Technique), and health care service use (Cornell Service Index). Staff evaluations are categorized into four domains: patient knowledge, patient psychosocial factors, patient compliance, satisfaction and integration of peer intervention into treatment. Results: Evaluation of peer intervention is ongoing. Key findings for interim results are available. A total of 61 mentees completed pre-discharge assessments and 26 mentees completed three-month post-discharge assessments. Overall, mentees reported satisfaction with regular meetings, discussion topics, and match with peer mentors. All mentees identified at least one perceived problem in measured outcomes. Staff reported satisfaction across all domains. However, some staff members raised concerns about scheduling conflicts and misinformation. Conclusions: Using peer mentors as role models for patients with SCIs may help with social participation, general self-efficacy, and adjustment to disability.
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    Virtual Reality Intervention for Parkinson's Disease: A Systematic Review.
    (2020) Liu, Howe; Salem, Yasser; Henry, Zach; Tran, Kelly
    Purpose: With growing evidence supporting the use of Virtual Reality (VR) for people with Parkinson's Disease (PD) as an effective treatment technique to improve functional mobility. The purpose of this systematic review was to examine the evidence with regard to the effectiveness of VR for improving mobility function in individuals with PD. Number of subjects: A systematic review of literature including 22 studies with a total of 569. Methods: Literature search included the following databases: PubMed, Scopus, PEDro, and CINAHL using the following terms: virtual reality, games, and gaming with PD. There were two reviewers that independently reviewed, extracted data, and assessed quality of articles. A third reviewer was utilized when there was a disagreement between the two reviewers. Results: Analysis of the included studies indicated that 19 out of 22 studies demonstrated a statistically significant improvement of their outcome measures following the use of VR intervention. Out of the 22 studies, 10 studies conducted a follow-up to evaluate the long-term effects of VR. Eight out of the ten studies that conducted a follow-up showed lasting effects of VR intervention. Conclusions: The mobility decline associated with PD has been shown to contribute to a decrease in daily living activities, decreased community participation, and depression. Virtual reality and gaming may have the potential to combat the mobility deficits associated with PD more effectively to improve the functional mobility and quality of life of patients. Future studies should investigate long term retention and patient compliance to home-based VR.
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    Effects of Robotic Use on Gait in People with Spinal Cord Injuries: A Systematic Review
    (2020) Salem, Yasser; Butzer, Madison; Byrd, Kari
    Purpose: The purpose of this study was to describe and analyze current literature over the effects of robotic use on gait in people with SCI. Methods: Fifty-four studies with 988 participants with SCI were included. Electronic databases used were PubMed/MEDLINE, the Physiotherapy Evidence Database (PEDro), Scopus, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Key terms used were "Spinal Cord Injury AND Robotic/Exoskeleton AND Gait/Ambulation." Data search included published works to date (March 2019). Altogether, 1659 articles were extracted, 595 articles advanced to title review, 184 articles advanced to abstract review, 109 articles advanced to full article review, and 54 articles met the inclusion criteria. Studies were included if they met the criteria of diagnosis (any type of SCI), population (13-years-old and above), published in peer-reviewed journal, intervention (RGT), time since injury (acute and chronic injuries), and exoskeleton used (all types). Results: Of the 54 articles, ten studies were randomized control trials, five were quasi-experimental, twenty-four were single group design, seven were case series, and eight were case reports. Common outcome measures were 10-meter walk test (10MWT), 6-minute walk test (6MWT), Timed-Up-and-Go (TUG), Walking Index for Spinal Cord Injury - II (WISCI-II), and more. Conclusions: Most studies showed significant improvement in all outcome measures. According to the results of this study, it would be beneficial to incorporate RGT into the rehabilitation of patients with SCI to improve overall gait.
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    The effectiveness of piano therapy as a means of upper extremity rehabilitation for cerebral palsy
    (2020) Newey, Carter; Bansal, Vishal; Schulze, David; Fraser, Kristina; Meiling, James
    Purpose: Music-supported therapy, particularly piano therapy, is an effective form of neurorehabilitation. The process of rehabilitation in piano therapy is largely due to neuroplasticity, which enables the participant to improve motor cortex excitability, cortical connectivity and motor deficits in their paretic hands. Cerebral palsy that affects the upper extremities, particularly the hands and fingers, may see benefits from utilizing a more specific type of therapy: practicing and playing the piano. This comprehensive review of the current literature will summarize all of the pertinent studies that have been published regarding the effectiveness of piano therapy as a means of upper extremity rehabilitation for individuals with cerebral palsy. Methods: A comprehensive review. Results: The authors found (3) studies that fit the inclusion criteria - (2) small-scale clinical trials and (1) case-control study. Conclusions: Piano therapy shows great promise as a therapeutic medium in upper extremity rehabilitation in patients with CP. Although the complexity of CP varied from case to case, a positive association in at least one of the associated outcome measures was noted in each study. Patients showed significant improvements in reductions of finger mean stroke intervals. fMRI assessments showed improvements in endogenous connectivity from primary motor cortex contralateral to the dominant hand and the cerebellum ipsilateral to the same hand. We recommend that continued research regarding benefits of CP and piano therapy with children, adults, and inclusion of mildly to severely symptomatic cases of CP be carried out to make definitive recommendations on its role in rehabilitation.
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    Cerebral Palsy REHAB Glove and Muscle Car
    (2020) Patterson, Rita; Haghshenas-Jaryani, Mahdi; Mirochnitchenko, Alissa; Schnell, Brittany; Baset, Neshat; Thomas, Andrew
    Purpose: To develop and evaluate the REHAB Glove, a wearable hand rehabilitation system to aid in functional recovery of hands for patients with Cerebral Palsy (CP). We used a sensorized glove capable of monitoring and assisting CP patients' hand and finger motion for optimal rehabilitation and obtain quantifiable data to correlate to rehabilitation progression. We also tested a device called the Muscle Car which was designed to measure the resting hand tension of patients with CP. Occasional resting hand tension measurements for patients could be used to quantitatively show improvement through their rehabilitation regime. Methods: The REHAB Glove was tested on a typically developing child. The glove was run through a wide range of movements to test its functionality and practicality. The glove was also evaluated on ease of use and comfort to the patient. The Muscle Car was tested to prove proof of concept with volunteers from the lab. Resting hand tension data was recorded from each volunteer in a repeatable and standardized procedure. Results: We found that the REHAB Glove works as intended and is able to produce the needed force and movements to one day become a fully working rehabilitation device. Data collected from the Muscle Car was found to show a range of resting hand tension values that were consistent across our volunteers. Conclusion: The REHAB Glove is being continually tested and refined to one day be used to help treat kids with CP. The Muscle Car was proven to work and record its intended data.
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    Effectiveness of Proprioceptive Neuromuscular Facilitation in the Stroke Population: A Systematic Review
    (2020) Salem, Yasser; Quiben, Myla; Mendez, Ana; Aggarwal, Sonali
    Purpose: The purpose of this systematic review was to evaluate the effectiveness of proprioceptive neuromuscular facilitation (PNF) for treatment of patients post stroke. Methods: A search of electronic databases (Pubmed, CINHAL, PeDRO, and Scopus) was conducted with the keywords "proprioceptive neuromuscular facilitation" and "stroke". This yielded 172 articles and 89 remained after screening for duplicates. Thirty articles were included for final review based on exclusion criteria. Studies included adults 18 years and older after a cerebrovascular accident (CVA), PNF as the main intervention, and availability in English. Results: Thirty articles met the criteria: 16 randomized control trials, 7 quasi-experimental, 3 case controls, and 4 case reports. Sample size ranged from 1 to 131 participants and 802 subjects were analyzed. Age ranged from 32 to 82. Session duration ranged from 10 to 60 minutes and intervention length ranged from 1 to 12 weeks. Frequency ranged from 1 to 6 sessions per week. Many outcome measures were used, and improvements were found in the following domains: functional outcome measures, gait/mobility, tone/spasticity, stroke specific assessment, balance, strength, range of motion, sensation, and dysphagia. Conclusion: Based on this review, PNF is effective for addressing the dysfunctions commonly seen after a stroke. No adverse outcomes were reported. Variability existed in study design concerning population, frequency, duration, PNF techniques, and outcome measures. The majority of studies had small sample sizes & the overall number of studies were low. Additional research is needed to further support the effectiveness of PNF with patients after CVA.
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    Tai Chi and Diabetic Peripheral Neuropathies
    (2020) Kolenovic, Mersida; Logsdon, Liana; Salem, Yasser; Liu, Howe; Traina,Allison
    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.