by ptfadmin | May 29, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Commonly, ataxias are caused by cerebellar disorders of peripheral nerves. People with ataxias are likely to have most difficulty with gait, balance, speech, swallowing, and vision leading to a reduced quality of life. To date, there is no cure for the progressive disease, but some interventions may be helpful in managing the symptoms. This review aims to compile available data on rehabilitation interventions for managing cerebellar ataxia.
Methods
A total of 58 studies collected were published in Portuguese or English between 1990-2020. The review also included articles on the topics of new and emerging interventions.
Results by Category
Physical Therapy
Physical therapy is recommended for all stages of the disease. Coordination training improves motor performance and reduces ataxia symptoms. There is weak evidence for using virtual reality, biofeedback, and bodyweight support treadmill exercises for postural training, however high-intensity motor coordination training proved beneficial for those with degenerative ataxia for stability and motor coordination. Many studies at various levels of evidence conclude that rehab improves mobility, function, ataxia, and balance in adults and children, however, studies lack long-term follow-up and specific training strategies.
Outcome Measures and Clinical Scales
Scale for the Assessment and Rating of Ataxia is commonly used to quantify severity of ataxia with good construct validity. The Neurological Examination Score for Spinocerebellar Ataxias is also commonly used for measuring ataxia severity with good interrater reliability and consistency. The Berg Balance Scale and Timed Up and Go were determined to be the best outcome measures for the population.
Exergames and New Technologies
Incorporating virtual reality into therapy (exergames) can add a motivational aspect to rehab and target coordination, balance, and weight transfer. Some studies found that games such as the Wii can not only improve daily training, but also if used regularly can improve postural sway, balance, gait, and fall frequency.
Speech, Voice, Swallowing Therapy
Early detection and intervention for swallowing and speech impairments for degenerative ataxias is important due to the ultimate progression of the disease. Early intervention can improve swallowing and speech can enhance quality of life.
Occupational Therapy
OT can improve balance, and coordination of patients with degenerative ataxias, however, when combined OT and PT is more effective for long-term benefit. Though it is known that OT should be tailored to patients’ specific needs, specific aspects of treatment and interventions should continue to be studied.
Conclusion
Although there is no cure for cerebellar ataxias, various studies have proven that physical therapy, occupational therapy, speech therapy is essential for patient care and can aid with management of the disease. Some studies suggest they are best used in combination and when implemented early.
Reference
Chien, H.F., Zonta, M.B., Chen, J., Diaferia, G., Viana, C.F., Teive, H.A.G., Pedroso, J.L., &Barsottini, O.G.P. (2022). Rehabilitation in Patients with Cerebellar Ataxias. SciELO Brazil, 80(3), 306-315. https://doi.org/10.1590/0004-282X-ANP-2021-0065
by ptfadmin | May 20, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Low back pain can be a debilitating condition leading to fear and pain with movement leading to reduction in strength, motor control, and coordination. Those with chronic lower back pain often experience diaphragm fatigue. Studies suggest respiratory muscle training could decrease pain, and improve balance, physical function, and overall quality of life, especially in those with subacute and chronic low back pain. This article strives to review a compilation of articles that study the effects of respiratory muscle training on lower back pain symptoms.
Methods
Studies included in the review consisted of patients with LBP for more than 4 weeks. Interventions consisted of inspiratory and expiratory muscle training, combined, and various modalities and devices with a minimum training session of 4 weeks. Outcomes included pain intensity, fear avoidance behaviors, disability, and respiratory muscle function. All studies included were randomized control trials accessed through various databases by two independent reviewers.
Results
The review included 11 studies with over 400 participants and majority of the studies included strength training. Ten studies included an experimental group who performed respiratory muscle training/program. Researchers found low-quality evidence from four studies who concluded that respiratory muscle training increased postural control and a decrease in lumbar disability. They also found that nine studies with low-quality evidence concluded respiratory muscle training decreased lumbar pain intensity, however five studies with moderate quality evidence found no significant difference in reduction in pain related fear avoiding behaviors. Additionally, the review revealed respiratory muscle training significantly increased expiratory muscle strength without effect on inspiratory muscle strength.
Discussion
Findings suggest that there is low quality evidence to support RMT on postural control, lumbar disability, and pain intensity in those with sub-acute or chronic low back pain. However, there is moderate quality evidence to suggest RMT’s improvement of MEP and FVC. The idea of RMT for lower back pain is supported by the fact that the majority of those with lower back pain show some form of fear of movement and increasing abdominal pressure takes stress off the paraspinal muscles. By training the diaphragm and other abdominal muscles, respiratory muscle training could improve recruitment pattern of abdominals and improve lumbar stability. The analysis found that combination of RMT and strength training is more effective at reducing disability and pain intensity of LBP.
Conclusion
More high-quality studies/trials are necessary to determine the effectiveness of RMT on lumbar disability, pain intensity, etc. in sub-acute/chronic LBP population. At best, this analysis concludes that RMT can improve expiratory muscle strength and FVC in those with subacute or chronic LBP.
Reference
Fabero-Garrido, R., Rodriguez-Marcos, I., del Corral, T., Plaza-Manzano, G., & Lopez-de-Uralde-Villanueva, I. (2024). Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 13(3053), 1-18. https://doi.org/10.3390/jcm13113053
by ptfadmin | May 15, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
The social determinants of health (SDOH) are factors outside of medical that affect health outcomes. This article evaluates the effects of SDOH on rotator cuff repair with the intention to provide more information to health care providers so they can assist their patients in making more informed decisions.
Methods
Articles for this systematic review were collected by two independent investigators. Articles included randomized and non-randomized studies that focused on rotator cuff repairs, outcomes, and SDOH. Reviewers evaluated articles by evidence level and quality.
Results
Out of 842 articles, 14 were included in the analysis. Seven articles assessed the effects of SDOH on rotator cuff repair and seven evaluated effects of SDOH on outcomes following rotator cuff repair. Based on studies assessing the effect of race/ethnicity on surgical utilization and post-op outcomes, those who were identified as non-white were associated with lower surgical rates and PT treatment. Black patients were also more likely to have worse outcomes using patient reported outcome measures at long-term follow-up. Other studies determined that patients with public insurance, Medicaid, or Medicare were more likely to have a longer wait to first PT follow-up, less PT utilization, and decreased acceptance for post-op PT. Although higher education was related to better post-op satisfaction, there was no difference in Shoulder Pain and Disability Index scores.
Discussion
This systematic review revealed that non-White patients are less likely to receive surgical intervention and less likely to utilize physical therapy. Additionally, those of lower socioeconomic status are more likely to have a longer wait for their first PT appointment due to several factors, including less PT clinics accepting their insurance. It is important to understand SDOH effects on health outcomes because they lead to many disparities within society. Continuing to study these factors can help health care providers determine how to decrease the gap in healthcare disparities.
Conclusion
Race and insurance type can influence patient treatment and outcomes following a rotator cuff repair. It is important that this topic continues to be studied and health care providers, specifically orthopedic surgeons, understand patient external factors.
Paul, R.W., Osman, A., Nigro, A., Muchintala, R., Destine, H., Tjoumakaris, F.P, & Freedman, K.B. (2024). The effects of social determinants of health on rotator cuff repair utilization and outcomes: a systematic review. JSES Reviews, Reports, and Techniques, 4(2024), 346-352. https://doi.org/10.1016/j.xrrt.2024.03.015.
by ptfadmin | May 8, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Surgery for FAIS has increased over the past 10 years. It is important to understand the long term effects of surgery versus nonoperative management to reduce financial impacts on patients and insurance. This study aims to compare the 2-year outcomes of patients who underwent arthroscopic surgery or supervised PT and its implications on disability, costs, and return-to-work status.
Methods
This study consisted of 80 patients seeking care at Madigan Army Medical Center between the ages of 18-60 years. All patients were required to attend informational session about recent evidence of FAIS management prior to randomization. The PT group had 2 sessions per week for 12 weeks, and the surgical group was provided the most appropriate surgery according to the orthopedic surgeon. Data was collected at 6 months, 1 year, and 2 years using the Hip Outcome Score (HOS), the International Hip Outcome Tool (iHOT-33), and the Global Rating of Change (GRC).
Results
Out of 80 patients 66 patients (38 from surgical group, 28 from rehab group) underwent surgery. There was no significant difference between the groups at 2-year follow-up on the HOS or iHOT-33. There was a significant improvement from baseline to 1 and 2 years on the HOS ADL subscale in the PT group. No significant difference was found between the surgery group and nonoperative group at 2 years on the HOS ADL and sport subscales or iHOT-33. Following hip-related care, about half of those on active duty returned to work with no significant difference between the groups.
Discussion
The study found no significant difference in outcomes between the two groups at 2 years and the mean perception of both groups showed no improvement. The results of this study is skewed due to the amount of crossover from the PT group into surgery, making type II errors more likely.
Conclusion
Regardless of treatment randomized or ultimately chosen by the patient, the results were similar within both groups. No meaningful change was perceived but there were patients in each group that showed improvements. Future studies should analyze the factors contributing to cross-over effect and successes between each type of surgery for FAIS.
Reference
Mansell, N.S., Meyer, J., Slevin, J.M., & Marchant, B.G. (2018). Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Control Trial with 2-year Follow-up. The American Journal of Sports Medicine, 46(6), 1306-1314. DOI: 10.1177/0363546517751912
by ptfadmin | May 1, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
In the U.S., the incidence of adhesive capsulitis of the shoulder is estimated to be about 2-5% of the population. Although physical therapy is the most commonly prescribed treatment for non-operative management of frozen shoulder, it lacks high-level evidence to support its use. Treatment for this condition continues to be time consuming and expensive for patients. The goal of this study is to evaluate various treatments for adhesive capsulitis, including high-intensity stretch devices (HIS), and compare the efficacy. Researches hypothesized that high-intensity stretch devices would be just as effective as physical therapy alone.
Methods
The data was collected between 2019 and 2022 and included 34 patients with an average age of 56 years old, diagnosed with adhesive capsulitis at first incidence. These participants were randomized into 3 groups (high-intensity stretch device, PT + HIS, and PT alone). The exclusion criteria consisted of several factors that could interfere with the patients’ progress such as ipsilateral shoulder infection or full-thickness rotator cuff tears. Flexion, abduction, and external rotation measurements were recorded prior to initiation of treatment. PT used in this study consisted of the following, shoulder ROM exercises, joint mobilization, and scapular stabilization. There were three 60-minute PT sessions per week until affected shoulder had regained at least 90% ROM of shoulder external rotation and flexion. The high-intensity stretching was performed every day for 3 sessions per day for a total of 60 minutes/day. Outcome measures = American Shoulder and Elbow Surgeons standardized shoulder assessment form (ASES), Simple shoulder test (SST), and a 5-point Likert scale for satisfaction and convenience of the intervention. ASES and SST scores were collected at baseline, 6 weeks, 3 months, 6 months, and last available follow-up.
Results
Within each of the groups (HIS only, PT only, HIS + PT), there were significant improvements in all motions and improvements in patient reported outcome measures. The HIS group regained most motion at 95% contralateral shoulder ROM, followed by combination therapy (92%), followed by PT only (82%). Participants believed HIS device was more convenient and they were more satisfied with its use when compared to the other two groups.
Discussion
The treatment of adhesive capsulitis to improve shoulder range of motion, reduce pain, and return to work, can be a burdensome process, therefore, finding a cost-effective and time-saving intervention is imperative. This study presents evidence that HIS devices used alone can address patients’ concerns, returning them to work much faster. However, it is important to note that the COVID-19 epidemic may have been a factor in the results.
Conclusion
This randomized control trial concluded the HIS device was just as good if not better than PT alone or combination therapy at improving ROM deficits, outcome measures, and patient satisfaction.
Reference
Teytelbaum, D.E., Kumar, N.S., Dent, C.S. Neaville, S., Warren, D.H., Simon, P., & Baker, C.E. (2024). Efficacy of a high-intensity home stretching device and traditional physical therapy in non-operative management of adhesive capsulitis – a prospective, randomized control trial. BMC Musculoskeletal Disorders, 25(305), 1-9. https://doi.org/10.1186/s12891-024-07448-4
by ptfadmin | Apr 24, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Joint hypermobility disorders affect a smaller portion of the population, but when symptomatic they can have a major effect on quality of life. More severe hypermobility disorders, such as Hypermobile Ehlers-Danlos Syndrome (EDS) can be difficult to diagnose and distinguish from newly named disorders such as Hypermobility Spectrum Disorder (HSD). Due to their perceived similarities, this article strives to compare the two disorders (EDS and HSD) to determine if they present similarly and therefore can be treated similarly.
Methods
The study included 97 adult patients with symptomatic generalized hypermobility syndrome recruited by physiotherapists, physiatrists, rheumatologists, and other health care professions. Variable used in the study included the 2017 diagnostic criteria for hypermobile EDS (hEDS), symptom severity (using quantitative and qualitative measures), and extra-articular manifestations. Those that did not fit the 3 criteria for hEDS were classified as having HSD. Patients were assessed at three times: baseline, 6 months, and more than 12 months. Following a PT eval, each patient was provided with a POC with a focus on body awareness or proprioception, low resistance exercises to strengthen deep and stabilizer muscles in closed or semi-closed chain.
Results
Out of 97 patients, 61 were classified as having hEDS, and the others (36) classified as having HSD. The median age of participants was 41 years old and overwhelmingly female (93%). Those classified as having hEDS had a higher Beighton score, more family history of the condition, and more musculoskeletal pain, more occurrence of chronic or recurrent dislocations than those classified with HSD. At 6 months, 37% of 76 patients not lost to follow up considered improvement in their condition. After 12 months, 54% of 59 patients not lost to follow up considered improvement in their condition. Improvement at 12 months were associated with the following factors: initial pain intensity, sleep disturbance, family history of hypermobility.
Discussion
According to this study, physical therapy is beneficial in patient symptoms for about half of those with hEDS and HSD. It remains difficult to determine significant difference in symptoms between the two groups: hEDS and HSD. Within both groups, a similar amount (about 50%) reported similarities of chronic pain symptom/problem, and neuropathic pain. This study suggests that the diagnosis (hEDS vs. HSD) does not predict outcomes following participation in physical therapy. Limitations of this study include, French/English speaking participants within a specific area of Switzerland, disproportionate ratio of females to males, and subjective data sets.
Conclusion
Using the 2017 criteria for diagnosing hEDS and HSD, this study found that the two groups presented similarly in symptom severity and limitations. About 50% of all participants believed they experienced some improvement in symptoms with PT. In conclusion, these groups can be treated similarly in the PT setting.
Reference
Aubry-Rozier, B., Schwitzguebel, A., Valerio, F., Tanniger, J., Paquier, C., Berna, C., Hugle, T., & Benaim, C. (2021). Are patients with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder so different? Rheumatology International, 2021(41), 1785-1794. https://doi.org/10.1007/s00296-021-04968-3
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