Low back pain relief, causes, measurement & prosthetic fit, production, comfort


Journal of Rehabilitation Research and Development Tipsheet

The current issue of the Journal of Rehabilitation Research and Development (JRRD) includes four articles on measurement, treatment, and causes of low back pain and five articles on prosthetic research, including the affect of practitioner knowledge and technique on prosthetic fit; rapid, low cost prosthetic production; and increase of skin temperature after a prosthetic limb is donned.

Head, body movement may impact gait in patients with inner ear impairment
This study identifies strategies for improving gait in people with inner ear balance organ abnormalities. Head and body movement irregularities were compared in 17 healthy volunteers and 18 volunteers with balance organ dysfunction during a stepping task. Compared to healthy volunteers, volunteers with balance dysfunction displayed more irregular head and body motion. Although neither head nor body motion was relatively more impaired, they appeared to be abnormally coupled to one another. Gait and balance training strategies for this population should consider each patient's potential for restoring a healthy decoupling of head and body movement.

Weak back muscles related to low back pain in people with amputations
This study compares the physical and functional impairments of individuals with lower-limb amputation (LLA) with and without low back pain. Nineteen participants with LLA were placed into two groups based on lower-back pain scores. Functional limitations, iliopsoas length, hamstring length, abdominal strength, back extensor strength, and back extensor endurance were assessed. Investigators found that the incidence of low back pain was related to decreased back extensor muscle strength and back extensor muscle endurance. Individuals reporting more pain had higher levels of disability, greater iliopsoas muscle length, and less low back endurance. Participants with amputation because of trauma had greater abdominal strength than those with amputations because of disease.

Practitioner technique, knowledge affect residual-limb measurement for prosthetics
This study evaluates the accuracy and reliability of seven prosthetic instruments to measure residual-limb characteristics on models of below-knee amputations. Prosthetic-orthotic practitioners and students recorded typical measurements such as residual-limb length and circumference on foam models of below-knee amputated limbs. Investigators identified effective instruments and techniques for measuring the residual limb, which have implications for improving amputee walking through better socket fit. Data also suggested that students were more consistent with linear measurements, while experienced practitioners were more consistent with measuring circumference. This study provides evidence that improper measurement technique or poor understanding of a measurement device can lead to clinically significant errors.

Multiphase cognition rehabilitation effective for people with dual diagnosis
This study evaluates the effectiveness of a multicomponent cognitive rehabilitation program, previously shown to be effective for patients with chronic alcoholism and shown here to be effective for patients with a dual diagnosis of alcoholism and another neuropsychiatric disorder. Forty veterans diagnosed with alcoholism and another neuropsychiatric disorder were administered a battery of neuropsychological tests and then randomly assigned to either a cognitive rehabilitation or attention placebo group. Patients in the cognitive rehabilitation group demonstrated greater improvement than the attention placebo group on attention, conceptual flexibility, and information processing speed. This study shows that cognitive rehabilitation can improve attention and short-term memory for people with a dual diagnosis.

Rapid prototyping technology produces comfortable prosthetic sockets
This study investigates the use of a Rapid Prototyping (RP) technology known as 3-D printing to manufacture prosthetic sockets. RP technology is a relatively new class of manufacturing technologies that creates physical models directly from three-dimensional (3-D) computer data. Study participants reported that the sockets were as comfortable as those made with traditional methods. Investigators urge the use of 3-D printing to produce prosthetic sockets because of low capital and running costs and no special facilities are required. Additionally, RP technology allows prosthetists to take full advantage of computer-aided design and computer-aided manufacture (CAD/CAM) technologies.

Aerobic exercise offers relief from low back pain
This study examines whether individuals with chronic low back pain demonstrate exercise-induced pain reduction. Eight patients with chronic low back pain received a pressure pain stimulus to the nondominant index finger immediately before and after cycling. Pain ratings were assessed at 10-second intervals during the 2-minute pain tests. Compared with preexercise scores, pain ratings were significantly decreased after exercise. Study data demonstrate that pain perception can be reduced for over 30 minutes following aerobic exercise among persons with chronic low back pain.

Expiratory muscle strength training may improve swallowing, breathing, speech deficits in elderly
This study discusses the affect of expiratory muscle strength training (EMST) on lung and chest wall decline in the elderly. EMST, a technique of respiratory muscle strengthening, may improve breathing, coughing, swallowing, and speech. As people age, skeletal muscle strength is reduced, which is caused in part by muscle mass loss and neuromuscular changes. Strength training of limb muscles has been shown effective for increasing muscle hypertrophy, suggesting that strength training of respiratory muscles may induce the same effect as strength training of limb muscles. Investigators recommend that the elderly maintain their skeletal muscle functions to prevent age-related regression.

Back muscle activation imbalances difficult to assess in low back pain patients
This study tests the use of electromyographic (EMG) contralateral imbalances (differences in left and right back muscle use) to measure back muscle impairment. EMG activation of four pairs of back muscles was measured in healthy and chronic low back pain volunteers during static extension exercises. The results showed that EMG contralateral imbalances were generally not affected by a lack of asymmetric body control, but this does not apply for all low back pain volunteers. Investigators state that it is imperative to control factors that could be related to pain behaviors or lower-limb impairments that may cause asymmetric postures and efforts.

New method evaluates bending stiffness during treatment for low back pain
This study develops a method of measuring the bending stiffness of the spine when subjected to posteroanterior mobilization force, a popular treatment for low back pain. Mobilization force was applied to the lumbar spines of 20 healthy participants while they were lying prone. Mobilization force and the corresponding changes in spinal curvature were measured. The change in spinal curvature was related to the mobilized load applied. Investigators suggest measuring the bending stiffness of the spine, an indicator of its health and mobility, for the evaluation of rehabilitation and guide a treatment plan.

3-D scan reliably measures functional shoulder movements, monitors pathology progress
This study tests the reliability of three-dimensional (3-D) shoulder movements during four functional tasks, characterizes four functional tasks in terms of shoulder movements, and examines the relationships between age and shoulder movements. Twenty-five healthy volunteers performed four functional tasks with their right arms. The tasks were assessed with a 3-D electromagnetic movement-tracking system. The 3-D shoulder kinematics reliably quantified and distinguished functional tasks with a motion analysis system. Data increase understanding of shoulder movement pathology and offers a means to monitor patients' recovery.

Study may lead to improved gait training for patients with neurological disorders or limb loss
This study discusses the timing of gait initiation and termination. Ten healthy participants and ten participants with below-knee limb loss performed starting, stopping, and steady-state walking. The time needed to reach steady-state speeds during gait initiation and the time needed to rapidly terminate gait do not depend on the steady-state walking speed. No differences existed in these durations when the participants with below-knee amputations initiated or terminated gait with either their prosthetic sides or their nonamputated sides. A greater understanding of the timing characteristics of gait initiation and termination may aid in the design of better training methods for patients with neurological disorders or limb loss.

Donning prosthesis increases skin temperature of residual limb
This study quantifies skin temperature of the residual limb in lower-limb amputees while resting and walking. Sensors were placed inside the prostheses of five below-knee amputees, and skin temperatures were measured while the amputees rested for 15 minutes and then walked on a treadmill for 10 minutes. Donning a prosthesis and resting for 15 minutes caused the amputee's residual limb skin temperature to increase by 0.8 C. After amputees completed a 10-minute walk, the skin temperature increased by a total of 1.7 C. This information may help aid in understanding where and why residual limb skin problems develop and provide design requirements for new prosthetic socket systems.

Microstimulators effective in generating bladder contractions in animal model
This study investigates the potential of model microstimulators (m-micro) to stimulate bladder contractions and urination. Investigators applied pelvic-plexis stimulation to four female cats with and without anesthesia at the bladder neck and the bladder wall. In both studies, bilateral stimulation was more effective than unilateral stimulation, and the location at the bladder neck was advantageous in several examples compared with a higher location on the bladder wall. Side effects of stimulation were a limitation in some cases. Investigators suggest that microstimulators should be further investigated as a treatment of severe urinary retention.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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