Objective: To determine the feasibility and efficacy of using a structured Nintendo Wii protocol to improve range of motion, strength, and quality of life in patients with shoulder impingement syndrome. Methods: A total of 14 patients with shoulder pain were randomized to perform a structured Wii protocol (n = 8) or conventional therapy (n = 6). Pain-free shoulder range of motion, strength, shoulder pain and disability, and quality of life were assessed pre- and post-treatment. Results: All 8 patients completed the Wii protocol, and 3 completed conventional therapy. The Wii protocol conferred significant improvements in shoulder range of motion, pain and disability, and quality of life but not strength, whereas conventional therapy conferred a significant improvement in strength. Conclusions: As compared to conventional treatment, the structured Wii protocol implemented in this pilot study was a viable adjunct to therapy for shoulder impingement syndrome. Gaming may have a supplemental benefit by increasing motivation, pleasure, and/or adherence. Further investigation in larger cohorts is warranted.
Objective: To investigate the effectiveness of a novel locomotor treadmill training protocol applied in the acute stage of recovery from stroke to produce symmetrical gait. Design: Case series. Setting: Inpatient rehabilitation center. Participants: 18 adults with first-time cortical and/or subcortical ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit. Interventions: Thirty minutes of locomotor treadmill training with partial body weight support, initiated prior to formal over ground gait training, once daily each weekday during the inpatient rehabilitation stay. Main Outcome Measures: 3-dimensional gait analysis (symmetry and kinematics) at 6 months post insult and falls history by patient report. Results: 3-dimensional gait analysis data revealed better symmetry profiles at the hip, knee and ankle than have been documented after stroke. Of the 18 participants, 15 walked without the use of an assistive device and 11 walked without an ankle foot orthosis at 6 months. In addition, a total of 5 of 18 participants reported falls in the first 6 months after onset, representing an incidence of 28%. Conclusions: Application of locomotor treadmill training with partial BWS before over ground gait training was effective in producing more symmetrical gait than is typically observed post stroke. In addition, the participants required less upper extremity support to walk independently as well as fewer ankle foot orthoses than published reports of persons after stroke. Another positive finding was the reduced incidence of falls for the population compared to documented statistics. These positive outcomes were achieved by application of a feasible clinical intervention in the acute rehabilitation setting.
Case Description: A patient with stage IV prostate cancer in remission for 10 years presented with several years of progressive, severe right buttock and sacroiliac joint (SIJ) pain necessitating multiple ER visits per month. He was maintained on leuprolide, and his prostate specific antigen (PSA) remained low at 0.7. Serial contrast MRIs showed pelvic scar tissue, SIJ arthropathy, and gluteal tendinopathy but did not demonstrate metastases. Initial evaluation by a physiatrist noted gluteal and pelvic floor muscle spasm with SIJ dysfunction. Comprehensive treatment with pelvic floor physical therapy, coccygeus trigger point injection, and SIJ prolotherapy significantly decreased his pain for eight months. His pain ultimately returned and was accompanied by right-sided perianal numbness, prompting referral for magnetic resonance neurography (MRN) of the lumbosacral plexus. Setting: Tertiary referral hospital. Results or Clinical Course: MRN findings were consistent with prostate carcinoma metastases within the right S2, S3, and S4 nerves. His PSA level doubled to 1.4. After radiation therapy and chemotherapy, his PSA fell to 0.6 and he achieved good pain control. Discussion: It is well known that prostate cancer metastasizes to the spine via the lymphatic system or hematogenously. Neuronal spread is an alternate, but less described pathway. Furthermore, the clinical manifestations of perineural prostate cancer invasion are not well characterized. Our patient presented with muscle and joint pain that responded well to musculoskeletal interventions. It is possible that many patients with metastatic disease involving the plexus are under-diagnosed, as traditional MRI with contrast was unable to detect the neural metastases that were visualized on MRN. Conclusions: Men with a history of prostate cancer presenting with new hip, buttock or pelvic musculoskeletal symptoms need to be evaluated for possible perineural neoplastic invasion. MRN is a powerful new tool which can help in such cases.
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