Hong Kong Physiotherapy Journal

Editorial

Gladys L.Y. Cheing, Joseph K.-F. Ng

New Approaches to Enhance Motor Function of the Upper Limb in Patients with Hemiparesis

Mindy F. Levin, Nadine K. Musampa, Amy K. Henderson, Luiz A. Knaut

Abstract: A common finding in patients with hemiparesis due to stroke is that they may use altered movement strategies to perform functional arm and hand movements. Altered movement strategies may be considered compensatory if they substitute the movements that are impaired at the behavioural level and yet lead to the accomplishment of the task at the functional level. Motor compensation may be maladaptive in that it may limit recovery of pre-morbid movement patterns. Studies in patients with stroke suggest that, given optimal training strategies and environments, behavioural recovery (re-appearance of pre-morbid movement patterns) may occur even in patients with chronic hemiparesis. On the other hand, it has also been shown that non-guided therapy may lead to the reinforcement of compensatory movements. The challenge facing rehabilitation professionals is to create optimal training environments based on current notions of plasticity and re-organisation in the central nervous system to maximise behavioural and functional recovery.

Reference Values for 6-Minute Walk Test and Hand-Grip Strength in Healthy Hong Kong Chinese Adults

Raymond C.C. Tsang

Abstract: This study aimed to establish reference values for the 6-minute walk test (6MWT) and hand-grip strength (HGS) in healthy Hong Kong Chinese adults and to examine their test-retest reliability. There were 548 subjects in five age strata between 21 and 70 years old. The 6MWT was administered and isometric HGS was measured following standard protocols on two occasions separated by 3 days. The 6-minute walk distance (6MWD) was measured once on each day. HGS was measured three successive times for both the dominant and non-dominant hands on each occasion. Both the mean values (mean method) and the maximum values (maximum method) of the three successive measurements were recorded for data analysis. Test-retest reliability was calculated in terms of intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC) and 95% limits of agreement (LoA). In the first test, mean ± standard deviation (SD) of 6MWD for males and females were 635 ± 97 m and 573 ± 91 m, respectively; mean ± SD HGS (mean values) for dominant and non-dominant hands were 43.8 ± 8.0 kgf and 40.8 ± 7.8 kgf for males, and 28.5 ± 5.7 kgf and 26.2 ± 5.5 kgf for females, respectively, while mean ± SD HGS (maximum values) were 45.5 ± 8.1 kgf and 42.6 ± 8.1 kgf for males, and 29.8 ± 5.8 kgf and 27.6 ± 5.6 kgf for females, respectively. There was a mean increase of 10.8 ± 50.0 m in 6MWD in the second test. The test-retest reliabilities of 6MWD were satisfactory (ICC[2,1], 0.87; 95% confidence interval, CI, 0.84–0.89; SEM, 35.3 m; MDC, 97.8 m; 95% LoA, −87.9 to 108.6 m). The lower limit of the 95% CI for the ICC of HGS measurements was 0.94. The SEM and MDC for HGS measurements ranged from 2.0–2.2 kgf and from 5.5–6.2 kgf, respectively. The 95% LoA ranged from −6.7–5.6 kgf. This study established a set of reference values for the 6MWT and HGS in a group of healthy Hong Kong Chinese subjects. Although the test-retest reliabilities in terms of ICC for 6MWT and HGS measurement were satisfactory to high, the associated random variations were large on repeated measurements. Physiotherapists should be aware of these random errors in the evaluation of change in 6MWT and HGS. In the future, the normative values for 6MWT and HGS in Hong Kong Chinese adults should be established with random sampling of subjects from the community.

Transcutaneous Electrical Nerve Stimulation and Interferential Current Combined with Exercise for the Treatment of Knee Osteoarthritis: A Randomised Controlled Trial

Rufus A. Adedoyin, Matthew O.B. Olaogun, Adewale L. Oyeyemi

Abstract: Interferential current (IFC) and transcutaneous electrical nerve stimulation (TENS) are forms of electrical stimulation frequently used to treat knee osteoarthritis (OA). The relative effectiveness of these two modalities is currently unknown. The purpose of this study was to evaluate the effects of IFC and TENS, when used in conjunction with exercise, on pain and function in patients with knee OA. Forty-six subjects with radiographically confirmed OA were randomly assigned to one of three groups: TENS and standardised exercises, IFC and exercises or exercises alone. An electrical stimulator was used to apply IFC or TENS at 80 Hz for 20 minutes. All groups had a standardised exercise programme. Treatment was applied twice per week for 4 weeks. Outcomes included a 10-point pain rating scale for pain intensity and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). A two-way repeated measures ANOVA performed on the pain assessment score showed a statistically significant effect of time (p < 0.001), but not of experimental group (p = 0.813) or interaction (p = 0.067). A similar result was obtained for WOMAC score (p < 0.001, p = 0.241 and p = 0.130 for time, group and interaction effects, respectively). All treatment protocols led to significant improvements in pain and function over time. Neither IFC nor TENS displayed significant additional effects over exercise alone.

A Pilot Falls-prevention Programme for Older People with Dementia from A Predominantly Italian Background

Shylie F. Mackintosh, Lorraine A. Sheppard

Abstract: This pilot study aimed to assess the feasibility and effectiveness of a falls-prevention programme for older people with dementia from predominantly an Italian background. The study had a single group pretest- posttest design and enrolled 64 community-dwelling older people with dementia; 6-month follow-up data were available for 32 participants. The falls-prevention programme was embedded in a healthy lifestyle dementia respite programme, which combined day respite with preventative health programmes. A comprehensive falls risk assessment was conducted for each client to develop an individualised falls and injury management plan that included a tailored exercise programme to improve strength and balance. Outcome measurements were fall status, cognitive function (Mini Mental State Examination, MMSE), balance (Berg Balance Scale, BBS) and aerobic capacity (6-minute walk test). There were no significant differences between baseline and 6-month measures for the number of fallers, BBS, MMSE or 6-minute walk test (n = 32; p > 0.05), indicating that participants neither improved nor declined significantly. A feasible method of delivering falls prevention services to older people with dementia has been developed. There is a need for further investigation to establish the effectiveness of this method.

The Effect of Depression on Balance Decline in Mature Women

Jennifer C Nitz, Nancy Low Choy, Meredith Ogilvie

Abstract: Depression has been identified as a risk factor for falls, and a change in balance ability over time has yet to be investigated. This study aimed to identify if, over a 3-year period, balance ability changed in 26 women who were on medication for depression, compared to 26 non-depressed women. The two groups were matched for age, number of co-morbidities, activity level, medications, and height. All participants were simultaneously enrolled in a larger, longitudinal study of ageing. Balance measures included the Functional Reach (FR) test, Lateral Reach (LR) test, Step Test (ST), Timed Up and Go, and the Modified Clinical Test of Sensory Integration and Balance, Unilateral Stance (ULS) and Limit of Stability (LOS) laboratory tests. Results showed a significant difference between the groups on ST, right ULS (eyes closed) and forward end point excursion of the LOS. There was no difference in the number of falls between groups. Analysis of the depressed group alone showed that right FR declined significantly and left and right LR tended towards decline, but not differently between groups. There was no between-group differences for these measures. There was no significant decline in non-depressed women for any measurement. Depressed women have less ability to maintain their balance than non-depressed women, and should be encouraged to participate in appropriate activities known to improve or maintain balance.

A Comparison of Analogue and Digital Video for Analysing the Temporal Phases of the Gait Cycle

James C. Wall, Saud Al-Obaidi

Abstract: The duration of the temporal phases of the gait cycle can be determined from a slow motion video by timing the intervals between each make and break of foot-floor contact using a multi-memory stopwatch. This technique has been shown to be valid and reliable when using an analogue VHS video. The new MiniDV digital video format has excellent image quality, but runs in slow motion at about twice the speed of the analogue system. This study compared these formats with one another for measuring temporal phases of the gait cycle. Twenty-one healthy young adults were included, and each subject walked a distance of 7 m at self-selected slow, medium and fast walking speeds. A digital camcorder was used to videotape the subjects. A copy of this recording was placed on an analogue VHS system. Each recording was played in slow motion and the temporal phases were measured using the stopwatch. This process was repeated 1 month later by the same investigator. Reliability and validity were tested through analysis of mean differences and 95% CI. Both the systems showed high intra-rater reliability. Mean difference between the two systems was 1.429% stride time for double support phases and −1.410% stride time for single support/swing phases.

Performance on the NSMDA During the First and Second Year of Life to Predict Functional Ability at the Age Of 4 in Children with Cerebral Palsy

Julie MacDonald, Yvonne Burns

Abstract: Cerebral palsy (CP) is a common cause of motor deficiency in children born prematurely. The present study explored the effect of biographical factors on study measures; determined whether performance on neuro-sensory motor developmental assessment (NSMDA) at 8, 12 and 24 months in prematurely born children with CP predicted performance at the age of 4 years; and investigated the percentage of children within each NSMDA classification at each test age who were walking independently at the age of 4 years. Forty-three children born prematurely and diagnosed with CP by the age of 4 years were assessed on NSMDA. Regression analyses showed that NSMDA at 8 months was predictive of classification at 12 months (x2(1) = 10.3, p = 0.001, OR = 2.6, 95% CI = 1.45, 4.66); at 12 months predicted classification at 2 years (x2(1) = 12.2, p = 0.000, OR = 4.15, 95% CI = 1.86, 9.2); and at 2 years predicted classification at 4 years (x2(1) = 8.2, p = 0.004, OR = 4.7, 95% CI = 1.63, 13.87). All children with normal, minimal and mild NSMDA classifications at 12 months were independently walking at 4 years. NSMDA provides useful information regarding the outcome of children with CP from 8 months.