Aims: This article describes a home-based study evaluating the effectiveness of modified constraint induced movement therapy (CIMT) in improving upper limb function in stroke survivors, and compares it with the clinical-based Neurodevelopmental Treatment (NDT) approach. Methods: In this pretest-post-test randomized study, 10 stroke survivors received home-based modified CIMT and eight stroke survivors received conventional NDT rehabilitation. The focus of the CIMT was on the hemiplegic hand, by which the less affected hand was restrained, with structured training for the more affected arm and hand. The intervention was executed two hours a day, seven days a week for two months, in the patients' normal day-care environment. Arm motor function outcomes were evaluated using the Wolf Motor Function Test as a primary outcome measure. The motor activity log, and the Fugl-Meyer Assessment were used as secondary outcome measures. Findings: Stroke survivors in the CIMT group showed a statistically significant improvement in all arm motor function outcomes. However, while numerically the improvement was better in the CIMT group, it failed to be significantly better than that seen in the NDT group. Conclusions: Home based CIMT conducted by caregivers with therapists' support is a promising approach for improving affected upper limb in stroke survivors. However, additional studies are needed to confirm these findings.
BackgroundThe aim of this study was to compare the effects of 10 weeks of resistance or treadmill exercises on glycemic indices levels prior to and immediately following exercise in adults with type 2 diabetes.Research Design and MethodTwenty inactive subjects (mean age 53.5 years) with type 2 diabetes enrolled in the study. Baseline HbA1c, blood glucose levels, heart rate, and blood pressure were measured for each subject prior to the initiation of the exercise program. Subsequently, subjects were matched to age, waist circumference and sex and assigned to either isocaloric resistance or treadmill exercise groups, which met 3 times per week for 10 weeks.ResultsBoth groups showed a reduction in pre and post-exercise blood glucose and HbA1c values. There was no change in resting blood pressure or heart rate in either group during the course of the 10 week intervention. The group receiving resistance exercises showed significant differences in the daily pre-exercise plasma glucose readings between the beginning and end of the exercise protocol (p < 0.001). There were significant improvements in the mean HbA1c reading pre and post training in both groups (p < 0.001). However, the greater reduction was noted in the resistance exercise group, and at 10 weeks their HbA1c levels were significantly lower than the group that received treadmill exercises (p < 0.006).ConclusionTen weeks of resistance exercises were associated with a significantly better glycemic control in adults with type 2 diabetes compared to treadmill exercise.
Carbonized rubber electrodes were tested extensively when they were first developed 30 years ago, but modern carbonized rubber electrodes have not received the type of scrutiny that the first electrodes received. Modern electrodes differ from the original electrodes in that they come with a self-adhesive electrode gel called hydrogel as part of their composition. The present study was undertaken to examine the current distribution and impedance characteristics of five brands of carbonized rubber electrodes and to examine the current distribution between electrodes during electrical stimulation in six subjects. Several different electrode sizes were tested between 3 and 10 cm. The current flow between the electrodes was determined by measuring the voltage across the skin on human subjects in 15 discrete locations between the electrodes. Blood flow was also measured between the electrodes with a laser Doppler flow meter to assess the physiological effect of current distribution on the skin at several skin temperatures. The results of these studies showed that at low currents, such as is used in TENS, very little current is actually applied through the skin due to the high impedance of the electrodes. At current levels normally used for electrical stimulation for functional movement, while current flow is better in most electrodes, it is very uneven, resulting in high current density in the centre of the electrodes and a fall off of at least 50% in current intensity at the edges of the electrode. There was very little difference in current density between small and large electrodes due to the high current density in the centre. Skin blood flow altered the movement of current between the electrodes and also may contribute to electrode performance. The implication of these studies is that electrode design needs to be altered for better current distribution, especially at low stimulation currents.
Electrical stimulation (ES) is a modality used to increase skin blood flow (SBF) and to aid in wound healing. A greater SBF in non wounded skin is induced if ES is used in a warm environment compared to a thermoneutral environment, where ES is usually applied. Therefore, in this paper, a method to investigate the effect of local heating and ES on the SBF is developed. A total of 33 males (18-40 years) were divided into group G (n = 15) who received the ES during a global heating protocol and group L (n = 18) who received ES during a local heating protocol. In the global heating protocol, ES (30 Hz, 250 micros) was applied for 15 min on the subject's thigh in thermoneutral (25 +/- 0.5 degrees C) and warm (35 +/- 0.5 degrees C) environments. In the local heating protocol, ES was applied for 15 minutes at 25 degrees C, 35 degrees C and 40 degrees C local skin temperatures. A laser Doppler imager measured the SBF in both protocols pre, during, and post ES. The results of the experiment showed the significant differences in the SBFs were found at pre, during, and post ES in a thermoneutral environment or when the skin was locally cooled to 25 degrees C. The SBFs were significantly increased during and post ES after global heating or during local heating at 35 degrees C and 40 degrees C. There were no significant differences in SBFs between the warm environment and at 35 degrees C of local heating. However, the SBF response to ES was the highest at 40 degrees C of local heating. Thus, ES during local heating of the skin, as well as during global heating is an effective method to increase SBF.
Electrical stimulation caused temporary increase in TEWL with no effects on other skin properties.
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