Vol 3 No 4 December 2000
Dodd KJ, Morris ME, Wrigley TV, Goldie PA.
Accurate assessment of walking is essential for the effective treatment of gait disorders following stroke. Although sophisticated measurement tools are now available for quantifying gait disorders, the expense, time and expertise required has restricted their use to specialist gait laboratories. In everyday clinical practice, visual analysis of patients’ walking patterns remains the most common method of assessing gait disorders. The accuracy of visual analysis can be optimised by using an observational strategy which directs the physiotherapist’s attention to critical features of a particular movement disorder. One movement disorder commonly observed following stroke is atypical lateral pelvic displacement (LPD). Patients with hemiparesis typically fail to transfer their body centre of mass (COM) normally from side-to-side during walking, leading to asymmetry and atypical amplitude of LPD in the frontal plane. Due to the anatomical proximity of the COM to the pelvis, observation of LPD provides a clinically useful indication of the normality of frontal plane COM motion. This paper outlines the basis for an observational strategy to assist physiotherapists to more accurately identify and assess disorders of LPD. Based on assessment findings using this strategy, a movement rehabilitation program can be devised with the overall aim of improving walking function and independence..
Pulmonary
Rehabilitation
Jenkins
S
Pulmonary
rehabilitation is defined by the American Thoracic Society as “a multidisciplinary
program of care for patients with chronic respiratory impairment that
is individually tailored and designed to optimize physical and social
performance, and autonomy” (1 p. 1666). It is now widely accepted that
pulmonary rehabilitation is an established treatment for the management
of patients with chronic obstructive pulmonary disease (COPD) with benefit
also demonstrated in patients with other chronic respiratory diseases
(1-3). The processes involved in a comprehensive pulmonary rehabilitation
program consist of exercise training, patient and family education, and
psychosocial and behavioural interventions. In addition, outcome assessment
is important to reinforce to the patient the gains from the program (1).
Respiratory
Muscle Training in People with
Chronic Obstructive Pulmonary Disease
W.
Darlene Reid 1 and Anju Sharma 2
Chronic obstructive
pulmonary disease results in increased work of breathing due to changes
in the lungs which can increase the work of breathing and place the inspiratory
muscles in
a less advantageous position. These increased loads may lead to fatigue
and over-use injury.
Similar to limb muscles, respiratory muscle performance will improve in
response to exercise
training. The respiratory muscles undergo cellular changes indicative
of training but also
show signs of injury similar to limb muscles after sustained increased
loading. Strength of
the respiratory muscles can be estimated by measuring maximal inspiratory
and expiratory
mouth pressures, transdiaphragmatic pressure, and maximal sniff inspiratory
pressures.
Measurements of strength can show respiratory muscle weakness, however,
inspiratory
muscle endurance should be measured as a baseline before training. Inspiratory
muscle
endurance can be assessed by determining: the maximal sustainable ventilatory
capacity,
the maximal sustainable inspiratory mouth pressure that can be sustained
for a specific
endurance time and the maximal inspiratory threshold load that can be
achieved during an
incremental loading test. Inspiratory muscle training improves inspiratory
muscle strength
and endurance, and exercise tolerance. The most effective training methods
appear to be
threshold training or inspiratory resistive breathing accompanied by a
targeting device.
Higher intensity loads produce greater improvements but may also be less
comfortable for patients and have a greater risk of inducing excessive
fatigue or exertion-induced respiratory
muscle injury. Future work should be directed towards examining the optimal
training
protocol and the impact of inspiratory muscle training on functional status
and health related
quality of life.
All Rights Reserved.