Search Results (144)

Early rehabilitation is essential for restoring functional recovery in patients with stroke, particularly during the early phase of post-acute care (PAC), or the subacute stage. We aimed to evaluate the effectiveness of a 7-week PAC rehabilitation program in improving muscle strength, physical performance, and functional recovery. A total of 219 inpatients with stroke in the subacute stage were initially recruited from the PAC ward of a regional teaching hospital in Northern Taiwan, with 79 eligible patients—within 1 month of an acute stroke—included in the analysis. The program was delivered 5 days per week, with 3–4 sessions daily (20–30 min each, up to 120 min daily), comprising physical, occupational, and speech–language therapies. Sociodemographic data, muscle strength, physical performance (Berg Balance Scale [BBS], gait speed, and 6-minute walk test [6MWT]), and functional recovery (modified Rankin Scale [mRS], Barthel Index [BI], Instrumental Activities of Daily Living [IADL], and Fugl–Meyer assessment: sensory and upper extremity) were collected at baseline, 3 weeks, and 7 weeks. Generalized estimating equations analyzed program effectiveness. Among the 56 patients (70.9%) who completed the program, significant improvements were observed in the muscle strength of both the affected upper (B = 0.93, p < 0.001) and lower limbs (B = 0.88, p < 0.001), as well as in their corresponding unaffected limbs; in physical performance, including balance (BBS score: B = 9.70, p = 0.003) and gait speed (B = 0.23, p = 0.024); and in functional recovery, including BI (B = 19.5, p < 0.001), IADL (B = 1.48, p < 0.001), and mRS (B = −0.13, p = 0.028). These findings highlight the 7-week PAC rehabilitation program as an effective strategy during the critical recovery phase for patients with stroke. Full article

Objective: The objective of this study was to examine 7 years of clinical physical therapy measures in a child with spastic diplegic cerebral palsy (CP) who received multiple botulinum toxin type A (BoNT-A) injections. Methods: A boy diagnosed with spastic diplegic CP, Gross Motor Function Classification System level II, received four episodes of BoNT-A from ages 4 to 10 years. Serial clinical measures of muscle strength, spasticity, lower extremity passive range of motion, gait kinematics, and gross motor function were collected in the gait analysis lab from age 3 to 10 years. Results: After improvements from ages 3 to 7 years, gait and motor function declined from ages 8 to 10 years with no improvement in spasticity or range of motion measurements. Muscle testing and gait kinematics defined a loss of plantarflexion strength. Conclusions: A decline in gross motor skills and gait is not typical for a child with spastic diplegia at age 8 years and its association with BoNT-A injections needs to be considered. This case demonstrates the importance of evaluating treatment outcomes for youth with spastic CP utilizing a set of reliable, and clinically useful measures of strength, spasticity, contracture, gait, and motor function. Critical examination of impairment and functional level measures defines goals, guides treatment, and evaluates outcomes. With this approach, pediatric therapists can empower families to make well-informed decisions. Full article

Introduction: Spinal and bulbar muscular atrophy (SBMA) is an adult-onset, X-linked, progressive neuromuscular disease caused by abnormal CAG trinucleotide expansion in the androgen receptor gene. Patients with SBMA report difficulty with falls on self-reported activities of daily living scales. To our knowledge, no study has examined the relationship between falls and common clinical measures of strength, balance, mobility, and disease biomarkers. We performed a cross-sectional analysis of an SBMA cohort. Objectives: The objectives of this study are as follows: (1) compare demographics, clinical measures, and biomarkers between patients who did and did not fall; (2) determine which measures best discriminate fallers from non-fallers; and (3) identify cutoff scores to detect patients with a higher fall risk. Design: Cross-sectional analysis was used. Outcome Measures: Disease biomarkers included blood serum creatinine, and clinical measures included the Timed Up and Go (TUG), the Adult Myopathy Assessment Tool (AMAT), and posturography, including the Modified Clinical Test of Sensory Interaction on Balance and the Motor Control Test. The Maximal Voluntary Isometric Contractions (MVICs) of four lower extremity muscles were captured via fixed-frame dynamometry. Results: We identified three clinical measures that help detect fall risk in people with SBMA. A post hoc receiver operating characteristic curve analysis helped identify cut scores for each test. Impairments of mobility (TUG > 8 s), muscle endurance (AMAT endurance subscale < 14), and muscle strength (ankle plantar flexion MVIC < 45% of predicted) were different between fallers and non-fallers, via independent t-tests. Conclusions: These three clinical tests can help detect fall risk that may help clinicians implement gait aid use or other fall prevention strategies before catastrophic falls occur. Full article

Introduction: Spinal and bulbar muscular atrophy (SBMA) is an X-linked neuromuscular disorder characterized by progressive muscle weakness, along with muscle cramps, tremors, and sensory neuropathy. Previous research has shown that patients with SBMA have difficulty with dynamic balance and sensory postural control during quiet stance. There have been no reports on automatic postural reactions in SBMA. Objectives: In this study, we aimed (1) to augment previous findings of sensory postural control, (2) to investigate automatic postural reactions in SBMA, and (3) to explore the relationship between strength and balance. Design: A cross-sectional design was used for the analysis. Participants: The participants were fifty male individuals with a confirmed diagnosis of SBMA. Outcome Measures: Balance testing included the NeuroCom modified Clinical Test of Sensory Interaction on Balance (mCTSIB), which measures sway velocity during quiet stance, and the NeuroCom Motor Control Test (MCT), which measures the latency and strength of postural reactions following sudden perturbations. Strength testing included maximal voluntary isometric contractions measured via fixed-frame dynamometry. Results: Forty-seven out of fifty participants were able to complete the mCTSIB test, but only thirty-eight completed the MCT test. Patients who were unable to complete the MCT were significantly weaker in all lower extremity muscles compared to those who were able to complete testing. Compared to normative data, participants showed significantly higher sway velocity during quiet stance across all conditions of the mCTSIB, except when standing on foam with eyes open. They also exhibited significantly slower postural reactions in response to sudden shifts of the force plate on the MCT. Plantarflexor weakness was significantly correlated with poor postural control on the mCTSIB and MCT. Conclusions: This study confirms previously reported abnormalities of sensory postural control in SBMA and highlights patients’ heavy reliance on visual inputs for postural control. Additionally, this study shows that automatic postural corrections are slower than normal in SBMA and provides a unique approach for measuring the combined sensory and motor components of the disease. Both the sensory and automatic balance abnormalities were found to be associated with plantarflexor weakness and may contribute to a higher risk of falls under challenging situations. Therefore, addressing this weakness may be an important step toward fall prevention in this population. Full article

The aim of this research was to investigate the effects of primarily asymmetrical (soccer and volleyball) and symmetrical sport load (sprint and swimming) in the upper and lower limbs on dynamic balance and muscle strength and to compare these values in the dominant and non-dominant limbs. This study employed a cross-sectional design, included 45 adolescent female athletes from four sports, divided into asymmetric (ASYM, n = 25) and symmetric (SYM, n = 20) groups. They were assessed for maximal voluntary isometric muscle contraction (MVIC) relative muscular strength using a handheld dynamometer (HHD) for shoulder external rotation (ER) and internal rotation (IR), as well as hamstring and quadricep strength. Upper and lower limb balance were also assessed using the Upper (YBT-UQ) and Lower Quarter Y Balance Test (YBT-LQ) tests. The results showed significantly greater balance in the upper extremities of swimmers and in the lower extremities of the sprinters in both the dominant (DS) and non-dominant (NDS) sides than in other groups (p < 0.0001). However, no significant difference in internal and external shoulder rotator muscles strength between the groups (p > 0.05). Although significant differences were found in hamstring strength on the dominant side and quadricep strength on both sides (p < 0.05), a notable finding was that sprint athletes consistently demonstrated stronger quadriceps muscles as compared to other groups in both the dominant and non-dominant sides. According to the current findings, there are significant differences in upper and lower body balance, hamstring, and quadricep muscle strength among sports. This suggests that athletes of asymmetrical sports may need to improve non-dominant side knee strength and balance symmetry to prevent the risk of injury. Full article

Objective: This study aimed to establish a dominant and non-dominant limb muscle strength evaluation model to evaluate the asymmetry of lower extremity muscle strength. Methods: The hip, knee, ankle flexors and extensors of 86 runners were evaluated separately in different contraction modes and at different movement speeds. A principal component analysis was used to establish a model for evaluating dominant and non-dominant lower extremity muscle strength and to comprehensively evaluate the asymmetry of lower extremity muscle strength. Results: Six main factors were present in both dominant and non-dominant indicators of lower extremity muscle strength, with dominant indicators of lower extremity muscle strength explaining 80.413% of the total variance and non-dominant indicators explaining 78.607% of the total variance. Conclusions: In a population of healthy male runners, there were differences in the symmetry of lower limbs in the comprehensive assessment model. The main contribution of the non-dominant side was the knee muscles, and the dominant side was the hip and knee muscles, so this difference should be considered in constructing future muscle strength evaluation models. It is critical to understanding the design and function of the human muscle system, and can reduce the number of meaningful tests we perform on diverse populations and help us reduce asymmetry. Full article

This study aimed to investigate the effects of 6-week inspiratory muscle training (IMT) on pain, pulmonary functions, respiratory muscle strength, lower extremity functionality, exercise capacity and quality of life (QoL) in individuals with chronic venous disease (CVD). Individuals were randomly assigned to training (TG) (n = 15, 45.53 ± 8.64 years) and control (CG) (n = 15, 47 ± 9.30 years) groups. While individuals in the TG performed IMT (30 min/everyday), individuals in the CG performed thoracic expansion exercises (TEEs) (10 respiratory cycles/set, four sets/day). Pain, pulmonary function and respiratory muscle strength tests, lower body strength and functional mobility, submaximal exercise capacity and QoL were assessed in all individuals. After 6 weeks, FEV₁/FVC, PEF, FEF_25–75% and MIP significantly increased in the TG compared to the CG (p < 0.05). Within the TG, FEV₁, PEF, FEF_25–75%, MIP, sit-to-stand number and 6-MWT distance significantly increased while resting pain, activity pain and QoL scores significantly decreased after 6 weeks (p < 0.05). Within the CG, FVC and sit-to-stand number significantly increased while activity pain and QoL scores decreased after 6 weeks (p < 0.05). Inspiratory muscle strength and pulmonary functions improved following IMT compared to TEE in individuals with CVD. As pulmonary functions, pain, lower extremity functionality and QoL may improve via IMT or TEE in individuals with CVD, submaximal capacity may improve following IMT. Full article

Background/Objectives: This clinical trial aimed to determine whether perturbation-based gait training (PBGT) on a split-belt treadmill enhances balance and muscle strength in older adults, comparing its effectiveness with walking-only training on a treadmill. Methods: This single-center, prospective, single-blind (assessor), randomized controlled trial included 24 older adults from the Rehabilitation Center of Jeonbuk National University Hospital. Participants were equally divided into the PBGT and control groups. Both groups underwent 12 training sessions, three times a week for 4 weeks, for a total of 43 min per session. The outcomes, including the Five Times Sit-to-Stand Test (FTSST), Falls Efficacy Scale International, timed up-and-go (TUG) test, functional reach test, and lower-extremity manual muscle test scores, were measured at three time points: pre-training, post-training, and four weeks after training. Results: While there were no significant differences between the two groups, the PBGT group demonstrated significant improvements in its FTSST and TUG values. Conclusions: Unpredictable perturbation training on a split-belt treadmill can be safely performed by older adults and may serve as an alternative exercise method to enhance physical performance and balance ability for fall prevention. Full article

Background and Objectives: Recreational football (RF) as a community activity can provide a positive transformative effect on the musculoskeletal systems necessary for the self-care and independent life demands of older adults when designed with a geriatric approach, in addition to its psycho-social benefits. However, studies investigating the potential value of these practices in older adults living in different ecosystems are needed. The aim of this study was to investigate the effects of RF on bone mineral density (BMD) and knee isokinetic muscle strength (KIMS) at angular velocities of 60°/s⁻¹ and 120°/s⁻¹ in older adult men. Material and Methods: A total of 57 elderly men (65.5 ± 2.7 years) were randomly divided into a football group (FG; n = 28) and a control group (CG; n = 29). The FG participated in 28 sessions of training, twice a week. Participants were evaluated using the DEXA and IsoMed 2000. The groups, their pre-test–post-test time differences, and group*time interactions were analyzed by mixed design ANOVA. Results: The results were analyzed considering a p < 0.05 significance level. There was no observed statistically significant difference between the groups for bone mineral density values (p > 0.078), but there was an observed statistically significant difference in the FG group*time interaction (F = 7.009, p < 0.009, η²p = 0.060). There was a statistically significant difference between the groups in the peak torque flexion and peak torque extension values at 60°/s⁻¹ angular velocity, respectively (p < 0.002, p < 0.011). At 120°/s⁻¹ angular velocity, peak torque flexion and extension, total work flexion and extension, and peak power flexion and extension showed statistically significant differences between the groups, respectively (p < 0.001, p < 0.0027; p < 0.003, p < 0.025; p < 0.001, p < 0.009). Conclusions: These results suggest that RF interventions provide positive biochemical and morphological adaptations in bone mineral density and lower extremity muscle groups, making older adults both more resistant to potential risks and encouraging exercise as a way of life with its autotelic flow structure. Full article

Background: Although a cross-legged sitting (CLS) posture has been commonly practiced as a daily activity, particularly in Arabic, Middle Eastern, and Asian societies, there is no medical study focusing on the effects of cross-legged sitting on body balance and muscular strength. Therefore, this study aimed to investigate the effect of CLS on lower extremity muscular strength, muscular electrical activity, and body balance. Methods: Thirty healthy volunteers participated in this research study by performing CLS for a 20 min duration. The balance tests included a static test, i.e., a single-leg-standing posture with eyes closed, to assess if the centre of the pelvis and centre of the shoulders (CoS) moved, and a dynamic test, i.e., four-square-returning, to assess if the moving speed changed. Regarding the muscular assessment, the electrical activity was assessed depending on the maximal value of activation and rooted mean of squared values, while the muscular strength was assessed according to the maximum force by the lower limbs using a force sensor. The balance and muscular results were statistically compared before and after CLS. Results: The duration of the static balance after CLS decreased by an average of 2.5 s, or approximately 15.64%, compared to before CLS (p < 0.05 *). Further, the Centre of Pelvis moved greater distances in the medial–lateral direction after CLS compared to before, but CoS was not significantly changed in the static balance test. However, in the dynamic balance test, the duration significantly decreased by 0.2 s, or approximately 8.5%, after CLS compared to before, meaning that dynamic balance ability improved. Considering the muscle results, only the lateral gastrocnemius muscle was noticeably electrically activated after CLS, while the hip extensor and knee flexor muscles became significantly stronger after CLS compared to before, roughly by about 14%, and the ankle plantar flexor maximum force increased noticeably, by about 4%, after CLS. Conclusions: CLS had a positive impact on the dynamic balance; the strength of the hip extensor, knee flexor, and ankle plantar flexion; and all lower limb muscles, in terms of electrical stimulation, except for the lateral gastrocnemius post-CLS compared to pre-CLS. Therefore, CLS can be safely included in one’s daily routine and in any rehabilitation programme, except for patients who are suffering from static balance disturbance. Although this posture is commonly used in many societies, because this is the first study focused on the impact of CLS on body balance and muscular status, the results would supply knowledge and new understanding, as well as provide clear insight for sitting posture research. Full article

Background: The forward lunge is a closed-chain weight-bearing multi-joint exercise simulating the activities of daily living, such as walking or stair climbing, which mainly activates hip, knee, and ankle musculature and is also used by athletes and other individuals to train lower-extremity musculature. Objectives: The purpose of this study is to compare lower-extremity muscle recruitment patterns between stride and step length variations in forward lunges. Methods: Twenty participants had a mean (±SD) age, mass, and height of 26 ± 6 y, 79 ± 8 kg, and 176 ± 7 cm, respectively, for males, and 27 ± 4 y, 62 ± 6 kg, and 161 ± 7 cm, respectively, for females. All participants used their 12-repetition maximum weight while performing a short step and long step forward lunge with a stride (striding forward and pushing back to the starting position) and without a stride (lunging up and down with feet stationary). During each lunge variation, surface electromyography (EMG) data were collected from the quadriceps, hamstrings, gastrocnemius, hip adductors, gluteus maximus, and gluteus medius muscles, and then normalized as a percent of each muscle’s maximum voluntary isometric contraction. A repeated measures two-way analysis of variance was employed (p < 0.01), with step length and stride comprising the two factors. Results: The following had no significant interactions: (1) quadriceps, hamstrings, gastrocnemius, hip adductor, and gluteus maximus EMG activities were significantly greater in lunges with a long step compared to lunges with a short step; and (2) gluteus maximus and gluteus medius EMG activities were significantly greater in lunges with a stride compared to lunges without a stride. The following had significant interactions: (1) gluteus medius EMG activities were significantly greater in lunges with a long step with and without a stride compared to lunges with a short step with and without a stride; (2) quadriceps EMG activities were generally significantly greater in lunges with long and short steps with a stride compared to lunges with long and short steps without a stride, in lunges with a long step with a stride compared to lunges with a short step with a stride, and in lunges with a short step without a stride compared to lunges with a long step without a stride; (3) hamstring and hip adductor EMG activities were significantly greater in lunges with a long step with a stride compared to lunges with a long step without a stride, and in lunges with a long step with and without a stride compared to lunges with a short step with and without a stride; and (4) gastrocnemius EMG activities were significantly greater in lunges with a long step with and without a stride compared to lunges with a short step with and without a stride. Conclusions: Lower-extremity muscle activity is generally greater in forward lunges with a long step compared to a short step, and greater in lunges with a stride compared to without a stride. During the externally loaded forward lunge, high to very high muscle activity occurs in the quadriceps, gluteus maximus, and gluteus medius, thus enhancing muscle hypertrophy and strength in these muscles, while moderate muscle activity occurs in the hamstrings, gastrocnemius, and adductor longus. Full article

Background/Objectives: The aim of the present study was to investigate the effect of two long-term reduced concurrent training frequencies (incorporating power training for the upper and high-intensity interval aerobic training for the lower extremities), in which participants performed one training session every either 7 or 14 days, after 12 weeks of systematic concurrent training on upper extremities’ muscle strength, power, and morphology in young females. Methods: After a 12-week concurrent resistance and aerobic training period, participants were assigned into three groups and performed either one training session every 7 days (G7), or once every 14 days (G14), or detraining (GD) for 12 weeks, followed by 12 additional weeks of detraining. Results: Performance and muscle mass increased after the initial 12-week training period. After the reduced training frequency period, bench press 1-RM and aerobic power remained unchanged in G7 and decreased significantly in G14 (−5.9 ± 4.9%; −1.4 ± 4.5%). Muscle power and muscle thickness of the triceps branchii long head decreased significantly in G7 (−9.8 ± 7.7%; −0.9 ± 0.6%; respectively, p < 0.05) and G14 (−10.9 ± 7.6%; −2.8 ± 2.7%, respectively, p < 0.05), without significant differences between groups (p > 0.05). Conclusions: In conclusion, 12 weeks of systematic concurrent resistance (upper extremities) and aerobic training (lower extremities) induced significant improvements in upper extremities muscle power/strength and muscle architecture characteristics. Both reduced training frequencies led to significant reductions in power performance. Thus, performing one training session every 2 weeks for 3 months may preserve 90 to 95% of the muscle power/strength, aerobic power and 72% of muscle mass adaptations achieved with systematic concurrent training. However, greater preservations in the above parameters could be observed if the training frequency is one training session per week. Full article

This study investigates the effects of low-intensity high-repetition (LI-HR) and high-intensity low-repetition (HI-LR) resistance training (RT) on functional fitness and myokines in older adults. A total of 30 participants (mean age ~76 years) were randomized into control (n = 10), LI-HR (n = 10), or HI-LR (n = 10) groups. Participants in LI-HR and HI-LR groups performed elastic band-based RT three times per week for 12 weeks. Pre- and post-intervention assessments included functional fitness (relative grip strength, sit-to-stand, 4 m walk, timed up-and-go (TUG)), ankle muscle strength, lower extremity power, and myokine levels (IL-6, IGF-1, SPARC, BDNF). Both experimental groups showed significant IL-6 reduction (LI-HR: p = 0.033; HI-LR: p = 0.015) and IGF-1 increase (LI-HR: p = 0.003; HI-LR: p < 0.001). SPARC increased significantly only in the HI-LR group (p = 0.021). Functional improvements were noted in TUG for both groups, while the 4 m walk improved significantly in the HI-LR group (p < 0.001). Body fat percentage increased in both LI-HR (p = 0.003) and HI-LR (p = 0.047). In conclusion, both LI-HR and HI-LR RT effectively enhance functional fitness and key myokines, with LI-HR emerging as a promising, accessible option for older adults. Full article

Background/Objectives: To determine whether epidural electrical stimulation (EES) improves sensory recovery and walking function in patients with chronic spinal cord injury (SCI) with a grade on the American Spinal Cord Injury Association impairment scale (AIS) of C or D at the cervical level. Methods: Three individuals with cervical-level chronic AIS D SCI were enrolled in the study. The mean injury duration and age were 4.8 ± 4.5 (range: 1.5–10) and 56.7 ± 9 years, respectively. The participants received personalized electrical stimulation for 36 weeks and were evaluated for their SCI characteristics, the result of an AIS assessment according to the lower extremity sensorimotor scale, their muscle activity, and preoperative walking ability parameters, initially as well as at weeks 8 and 36 of the EES intervention. Results: Participants receiving EES significantly increased the muscle activity in most lower limb muscles. Regarding the AIS assessment of the lower extremities, one participant fully regained a light touch sensation, while two fully recovered their pinprick sensation (AIS sensory scores increased from 14 to 28). One participant achieved a full motor score, whereas the others’ scores increased by 19 and 7 points. Compared with preoperative gait parameters, two participants showed improvements in their walking speed and cadence. Walking symmetry, an important parameter for assessing walking function, improved by 68.7%, 88%, and 77% in the three participants, significantly improving the symmetry index (p = 0.003). Conclusions: Thus, EES may be an effective strategy for sensory impairment recovery, as well as muscular activity and strength improvement. These findings may facilitate stable walking in subjects with chronic incomplete SCI, but larger clinical trials are warranted. Clinical trial: NCT05433064. Full article

Background and Objectives: Long COVID-19 syndrome may cause difficulties in functionality during daily life in young people. Our objective was to investigate the respiratory and functional sequelae in young adults with asymptomatic or mild COVID-19 compared with healthy peers 3–6 months and 6–12 months after COVID-19 infection. Materials and Methods: Participants aged 18–25 who had COVID-19 within the last 3–6 months (Post-COVID Group 1, n = 25) and 6–12 months (Post-COVID Group 2, n = 25) and age–gender-matched healthy controls (n = 25) were included in this study. Respiratory functions and muscle strength were measured. Physical function was assessed with 6 min walking test (6MWT) and an Incremental Shuttle Walk Test (ISWT). The 1 min sit-to-stand test (1-MSTST) and hand grip strength (HGS) were used to assess muscle performance. Fatigue and dyspnea severity were questioned. Results: The FVC%pred (p = 0.023) and MEP (p = 0.034) were higher, and 1-MSTST repetitions were lower in Post-COVID Group-1 compared to Post-COVID Group-2 (p = 0.029). The PEF%pred (p = 0.025), MEP (p = 0.001), and ISWT distance were lower in Post-COVID Group-2 compared to healthy controls. The number of 1-MSTST repetitions and 6MWT distance were lower in Post-COVID Group-1 (p = 0.003, p = 0.001) and Post-COVID Group-2 (p = 0.003, p = 0.017) than in healthy controls. Exercise-induced blood lactate change during the ISWT, HGS, fatigue, and dyspnea were not significantly different between post-COVID groups and healthy controls. Conclusions: Young adults who pass asymptomatic or mild SARS-CoV-2 infection exhibit a decline in FVC%pred, PEF%pred, lower extremity muscle performance, and physical function within 3–6 months. In addition, the deterioration in respiratory and physical functions becomes apparent within 6–12 months. Full article