Effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction.

ABSTRACT. Objective: To examine the effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain for knee surgery patients. Study Design: A randomized controlled clinical trial. Setting: A sports medicine clinic. Participants: Thirty individuals in rehabilitation for anterior cruciate ligament (ACL) reconstruction. Interventions: Ten relaxation and guided imagery sessions for each treatment group participant; attention, encouragement, and support for placebo group participants; no intervention for control group participants. Main Outcome Measures: Knee strength, reinjury anxiety, and pain. Results: Significantly greater knee strength and significantly less reinjury anxiety and pain for treatment group participants at 24 weeks postsurgery than for placebo and control group participants. Conclusions: Relaxation and imagery may be beneficial to ACL rehabilitation, thus warranting further research on mechanisms of obtained effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model to assess the efficacy of moisturizers--the quantification of soap-induced xerosis by image analysis of adhesive-coated discs (D-Squames)

The purposes of this investigation were to examine the effects of unilateral concentric-only leg extension dynamic constant external resistance (DCER) training on: (a) concentric DCER strength in the trained and contralateral (untrained) legs, (b) concentric isokinetic peak torque-velocity curves in the trained and contralateral legs, and (c) retention of concentric DCER strength and concentric isokinetic peak torque in the trained and contralateral legs following detraining. Sixteen adult male (mean age +/- SD = 24.0 +/- 4.0 yr) volunteers comprised training (TR, n = 8) and control (CTL, n = 8) groups. The TR group trained the nondominant limb with concentric-only leg extension DCER exercise (3-5 sets of 6 repetitions at 80% of one-repetition maximum load) for eight weeks followed by eight additional weeks of detraining. The CTL group did not train. All subjects were tested pretraining, posttraining and detraining for unilateral concentric-only leg extension DCER strength as well as concentric isokinetic peak torque at 1.05, 2.09, 3.14, 4.19, and 5.24 rad.s-1 in both legs. Mixed factorial ANOVAs, follow-up, and post-hoc analyses indicated that the training resulted in increased DCER strength in both the trained (42%) and contralateral (15%) legs as well as isokinetic peak torque in the trained leg (7-19%) at velocities ranging from 1.05 to 5.24 rad.s-1. There was no cross-training effect, however, for isokinetic peak torque. Furthermore, the training-induced increases in DCER strength and isokinetic peak torque were retained across eight weeks of detraining.     

Enteral absorption of insulin in rats from mucoadhesive chitosan-coated liposomes

Whole muscle contractile characteristics and fatigue resistance were studied in male patients with chronic heart failure (n = 6) and in healthy control subjects (n = 6). Maximum voluntary isometric strength in the major muscle groups of leg (plantar flexors and knee extensors) and arm (elbow extensors and elbow flexors), was found to be similar for both groups of subjects. However, a faster isometric twitch time course was observed in the plantar flexor and knee extensor muscles of heart failure chronic patients. The poor resistance to fatigue in the knee extensors of chronic heart failure patients was confirmed in the present study, but using twitch interpolation this was shown not to be due to poor activation. The plantar flexors of chronic heart failure patients also showed a tendency to be less resistant to fatigue, even when the muscle was activated by direct electrical stimulation. The present study shows that independent of muscle strength, patients with chronic heart failure may possess muscles that are faster to contract and less resistant to fatigue. However, it seems this increased fatigability is not due to poor muscle activation.     

Rehabilitation following arthroscopic meniscectomy

Meniscal injuries are reported to be the most common injury sustained by athletes, with sports injuries being responsible for over 30% of the total number of lesions. Treatment of meniscal lesions has evolved considerably over the past 20 years and partial meniscectomies, or menisci repairs, are now the treatment of choice for the majority of lesions. Following arthroscopic meniscectomy, patients are routinely able to walk without support within 1 to 3 days, return to work after 1 to 2 weeks, resume athletic training by 2 to 4 weeks and return to competition in 3 to 4 weeks. Physiotherapy has been widely prescribed following arthroscopic meniscectomy and exercise protocols have been described in the literature. However, few studies have actually ascertained whether or not physiotherapy accelerates recovery. From these studies, there is little doubt that some form of rehabilitation, e.g. pain control or exercises, may be effective in accelerating the recovery of muscle strength to preoperative values. Therefore, whether or not physiotherapy is required following arthroscopic meniscectomy may depend on the presence or absence of preoperative strength deficits, and thus, on whether it is the dominant or nondominant leg that is injured. In patients with no preoperative deficits, and a normal post-surgery evolution, full recovery may be expected within 6 weeks if pain and swelling are brought under control. Physiotherapy intervention may not, perhaps, be justified for these patients, except in professional athletes where a faster return to preoperative values may be desired.     

Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction.

Objective: To examine prospectively the relationships among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after knee surgery. Study Design and Participants: Individuals with acute anterior cruciate ligament (ACL) tears (N?=?95) completed measures of self-motivation, social support, athletic identity, and psychological distress before reconstructive surgery. After surgery, 93 participants reported on their completion of home rehabilitation exercises and cryotherapy, and their rehabilitation practitioners indicated the patients' attendance at, and adherence during, rehabilitation sessions. Rehabilitation outcome measures were taken from 69 participants approximately 6 months postsurgery. Main Outcome Measures: Knee laxity, functional ability, and subjective symptoms were the primary outcomes assessed. Results: Self-motivation was significant predictor of home exercise completion; athletic identity and psychological distress were significant predictors of knee laxity; and attendance at rehabilitation sessions and home cryotherapy completion were significant predictors of functional ability. Rehabilitation adherence did not mediate the relationship between psychological factors and rehabilitation outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strength gains without muscle injury after strength training in patients with postpolio muscular atrophy

We evaluated changes in the dynamic and isometric strength in the newly weakened quadriceps muscles and asymptomatic triceps muscles of 6 patients with postpolio muscular atrophy (PPMA) after 10 weeks of progressive resistance strength training. Alterations in muscle size were determined with magnetic resonance imaging. Serum creatine kinase levels were measured throughout training, and histological signs of muscle injury and changes in muscle fiber size and types were assessed with muscle biopsies before and after training. Exercise training led to an increase in dynamic strength of 41% and 61% for the two knee extensor tests, and 54% and 71% for the two elbow extensor tests. Up to 20% of the improvement was maintained 5 months after cessation of training. Isometric strength, whole muscle cross-sectional areas of quadriceps and triceps muscles, and serum muscle enzymes did not change. No destructive histopathological changes were noted in the repeat muscle biopsies, and no consistent changes in muscle fiber size or fiber type percentages were observed. These results demonstrate that a supervised resistance training program can lead to significant gains in dynamic strength of both symptomatic and asymptomatic muscles of PPMA patients without serological or histological evidence of muscular damage.     

Relative importance of aptitude and prior domain knowledge on immediate and delayed posttests.

Two groups of college students were given a pretest covering basketball knowledge and asked to read a passage about basketball history. One group (IDP) took an immediate posttest of 27 items and a delayed posttest 1 wk later of the original items and 27 new items. The 2nd group (DPO) took only the delayed posttest of 54 items. Finally, a control group simply took the pretest and the 54-item posttest and scored at chance level on the posttest. Correlational analyses determined that, for the IDP group, pretest scores were significantly related to the immediate posttest. For the delayed posttest, both Scholastic Aptitude Test—Verbal subtest and pretest scores accounted for significant and unique portions of the variance. The latter results were replicated for the DPO group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Apprentissage de la notion de nombre par une méthode fondée sur le modèle piagétien de la fusion des classes et des relations.

Constructed a series of "operational exercises" to train children on the concept of number. In an experiment with a total of 20 6-7 yr olds, classified as preoperational by a pretest that included 2 experiments on number, the series was given to 3 groups. In accordance with Piaget's theoretical model on the construction of number, the exercises were based on the generalization of class similarities (Group 1), the generalization of relational differences (Group 2), or on both alternately (Group 3). To measure the effect of the learning exercises, the 2 number experiments were readministered in 2 successive posttests with a 1-mo interval. It was found that (a) the performance of all 3 experimental groups was significantly higher than that of the control group; (b) the 2 groups that received only 1 type of exercise (just class or relation) did not differ from each other; and (c) the group subjected to the 2 kinds of exercises was significantly better on the 2nd posttest, although the same as the previous 2 groups on the 1st posttest. The discussion of results focuses on the differential progress of each group and on the child's construction of number. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Morphological and physical characterization of the capsular layer of Vibrio cholerae O139

Low-speed isokinetic exercise has been recommended to exert a maximal contraction and produce greater muscle torque than high-speed exercise in young adults. The purpose of this study was to compare the effectiveness of low- and high-speed isokinetic exercise programs for increasing muscle torque in young and elderly people. Twenty healthy elderly and 20 young subjects participated. The elderly subjects were divided into two groups. One group performed high-speed (300 degrees/s) isokinetic exercise training three times a week for the dominant-side knee extensor and low-speed (60 degrees/s) exercise for the non-dominant side for 6 weeks. The other group was trained using the reverse exercise regime. The training program for the young subjects was the same as that for the elderly groups. All subjects had their knee extensor torque evaluated with an isokinetic test before and at 2-week intervals during the training program. For young and elderly groups, both high- and low-speed isokinetic exercise training increased extensor torque in low- and high-speed tests. For the young group, low-speed exercise effectively improved muscle torque at low and high speeds. The improvement in slow muscle torque was significantly greater than that in fast muscle torque. For the elderly subjects, high-speed isokinetic exercise produced the greatest muscle torque at high speed in the first 2 weeks of training, and demonstrated a sharp increase in muscle torque in the final 2 weeks. Low-speed exercise frequently caused knee stress and the inability of some elder subjects to continue the exercises with maximal effort. Our findings indicate that high-speed exercise may be more appropriate for the elderly, and low-speed exercise may be more appropriate for younger people.     

The effect of a 12-week dynamic resistance strength training program on gait velocity and balance of older adults

This study tested whether a 12-week dynamic resistance strength training program can change gait velocity and improve measures of balance among adults age 65 and older. Fifty-five community-dwelling adults (mean age = 71.1) were randomized into an exercise (n = 25) or control (n = 30) group. The exercisers were requested to complete three bouts of strength training per week for 12 weeks using elastic tubing. At posttest the exercisers demonstrated slower gait velocity, enhanced balance, and an improved ability to walk backward, although none of these posttest measures was significantly different from the control group.     

Modification of concept identification performance in older adults.

A sequential training procedure combining operant and cumulative learning hierarchy principles was found effective in reducing the decrement in concept identification performance typically observed in older adults. 20 male and 20 female Ss aged 63-83 yrs were given a pretest and posttest, each involving a 3-category unidimensional concept identification problem. The training and reinforced-training Ss were given 3 training sessions between pretest and posttest. Training involved a programmed learning sequence designed to facilitate the development of an effective solution strategy. Control Ss were given only the pretest and posttest, while practice Ss were given 3 additional practice sessions. Substantial improvement was found in both the training and reinforced training groups, but only slight improvement obtained in the practice and control groups. Results are consistent with recent conceptions of cognitive and intellectual development in the older adults in which performance deficits are largely attributed to experiential factors. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive-social learning approach to social skill training with low-status preschool children.

Changes in the behavior and peer acceptance of low-status preschool children as a result of social skill training were examined. Children who had low sociometric status and were also low in classroom use of social skills were randomly assigned to a skill training group (n?=?18) or to an attention control group (n?=?15). Children in the training group were coached in 4 skills: leading peers, asking questions of peers, making comments to peers, and supporting peers. Trained children showed a significant increase in their use of the trained skills comments and leads from pretest to posttest, whereas control-group children showed no change. Neither control nor skill-trained children changed significantly on sociometric measures from pretest to posttest. Increases in skill use in the classroom with peers was correlated with improvements in children's knowledge of friendly social strategies from pre- to posttest. Results are interpreted as evidence of a social skill basis for peer acceptance and of the need to develop procedures to assess the mechanisms of change during social skills training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relevance of Helicobacter pylori infection in the development of gastric tumors

The efficacy of a 6-week rehabilitation program was evaluated in 100 consecutive patients, age 15-42 years, with acute anterior cruciate ligament (ACL) injury. Arthroscopy revealed associated lesions in 82% of the patients. Except for resections on menisci with large and unstable lesions, no surgery was performed. The patients were randomly assigned to supervised training or self-monitored training after instruction. RESULTS: At the 6-week follow-up there was no difference between the groups with regard to pain at rest, pain during walking, or experience of giving-way episodes, Tegner activity level of Lysholm knee score. Only 2 of the 100 patients were observed without joint mobility restriction. The only significant difference between the groups was the improvement of muscle function in men in the supervised training group. Conclusion: Six weeks' rehabilitation is too short a time period from original injury to obtain normal mobility and restored knee function.     

Long-term recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM

Hypoglycaemia unawareness, is a major risk factor for severe hypoglycaemia and a contraindication to the therapeutic goal of near-normoglycaemia in IDDM. We tested two hypotheses, first, that hypoglycaemia unawareness is reversible as long as hypoglycaemia is meticulously prevented by careful intensive insulin therapy in patients with short and long IDDM duration, and that such a result can be maintained long-term. Second, that intensive insulin therapy which strictly prevents hypoglycaemia, can maintain long-term near-normoglycaemia. We studied 21 IDDM patients with hypoglycaemia unawareness and frequent mild/severe hypoglycaemia episodes while on "conventional" insulin therapy, and 20 nondiabetic control subjects. Neuroendocrine and symptom responses, and deterioration in cognitive function were assessed in a stepped hypoglycaemia clamp before, and again after 2 weeks, 3 months and 1 year of either intensive insulin therapy which meticulously prevented hypoglycaemia (based on physiologic insulin replacement and continuous education, experimental group, EXP, n = 16), or maintenance of the original "conventional" therapy (control group, CON, n = 5). At entry to the study, all 21 IDDM-patients had subnormal neuroendocrine and symptom responses, and less deterioration of cognitive function during hypoglycaemia. After intensive insulin therapy in EXP, the frequency of hypoglycaemia decreased from 0.5 +/- 0.05 to 0.045 +/- 0.02 episodes/patient-day; HbA1c increased from 5.83 +/- 0.18 to 6.94 +/- 0.13% (range in non-diabetic subjects 3.8-5.5%) over a 1-year period; all counterregulatory hormone and symptom responses to hypoglycaemia improved between 2 weeks and 3 months with the exception of glucagon which improved at 1 year; and cognitive function deteriorated further as early as 2 weeks (p < 0.05). The improvement in responses was maintained at 1 year. The improvement in plasma adrenaline and symptom responses inversely correlated with IDDM duration. In contrast, in CON, neither frequency of hypoglycaemia, nor neuroendocrine responses to hypoglycaemia improved. Thus, meticulous prevention of hypoglycaemia by intensive insulin therapy reverses hypoglycaemia unawareness even in patients with long-term IDDM, and is compatible with long-term near-normoglycaemia. Because carefully conducted intensive insulin therapy reduces, not increases the frequency of moderate/severe hypoglycaemia, intensive insulin therapy should be extended to the majority of IDDM patients in whom it is desirable to prevent/delay the onset/progression of microvascular complications.     

A school-based group activity therapy intervention with at-risk high school students as it relates to their moral reasoning.

The main goal of this study was to examine whether group therapy is useful for developing moral reasoning in at-risk youth. This research compared the impact of 10 weeks of group activity therapy (n = 27) and group talk therapy (n = 34) on the moral reasoning of at-risk ninth grade students. Group activity therapy is the developmentally appropriate extension of child centered play therapy for adolescents. Using pretest and posttest scores on the Maintaining Norms Schema subscale of the Defining Issues Test 2 (DIT-2; Rest, Narvaez, Thoma, & Bebeau, 1999), an analysis of covariance indicated significant difference between groups. Implications for counselors who work with this population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acetic acid iontophoresis and ultrasound for the treatment of calcifying tendinitis of the shoulder: a randomized control trial

OBJECTIVE: To assess the effects of acetic acid iontophoresis (AAI) and ultrasound on calcifying tendinitis of the shoulder, and to determine the relation between changes in the radiological measures of calcium deposit (CD) and shoulder function. DESIGN: Randomized control trial. SETTING: General community, private practice. PATIENTS: Twenty-two adults (7 men, 15 women) with a calcifying tendinitis of the shoulder, without associated conditions, stratified according to the type of lesions (X-ray: type I, fleecy appearance: type II, homogeneous), were randomly allocated to an experimental (EXP, n = 11) or to a control (CTL, n = 10) group. INTERVENTIONS: CTL group, no treatment; EXP group, nine treatments including AAI (5% acetic acid solution via the negative electrode, 5mA galvanic current, 20 minutes) followed by continuous ultrasound (0.8w/cm2, 1MHz, 5 minutes). MAIN OUTCOME MEASURES: Area and density of the CD, passive shoulder abduction (range of motion [ROM]), pain intensity. RESULTS: Significant reduction in the area and density of CD (ANCOVA, p = .01 and .03) over time in the EXP and CTL groups, but no significant difference between groups for any of the variables measured. The decrease in the area of CD in type I lesions (n = 5) was larger (Mann-Whitney U test, p < .01) than in type II (n = 16) lesions. The relation was stronger (rs = .90) between changes in area and density of CD than between ROM and pain (rs = -.67). Correlations were weak (rs = .21 to .41) between radiological and functional changes. CONCLUSION: The reduction in CD area and density likely results from a natural process rather than treatment (AAI and ultrasound); type I lesions (resorptive phase) are more likely to display resorption of the CD than type II lesions (formative phase). Reduction of the CD area does not necessary result in a functional improvement.     

Prediction of postoperative knee flexion in Insall-Burstein II total knee arthroplasty

Postoperative knee flexion in patients undergoing Insall-Burstein-II total knee arthroplasty at 2 years was evaluated regarding two basic questions: what groups of patients gain or lose the most flexion and what groups of patients have the best or worst postoperative flexion. Thirteen preoperative variables (maximum flexion, flexion arc, tibiofemoral angle, quadriceps strength, extensor lag, Knee Society score, Knee Society patient assessment, gender, age, height, weight, diagnosis, and surgeon) and four postoperative variable (leg length change, tibiofemoral angle, distance from patella to the joint line, and the tibial prosthesis anteroposterior translation on a lateral radiograph) were used in an attempt to explain postoperative flexion. The analysis was performed on 164 consecutive Insall-Burstein-II total knees in which the data were gathered prospectively on a time oriented medical record database. A regression tree analysis was used to identify several groups of patients, characterized by preoperative factor values, who had markedly above average performance on postoperative flexion. The preoperative factors identified include preoperative flexion, flexion arc, tibiofemoral angle, extensor lag, diagnosis, and age. The only postoperative variable of significance was tibiofemoral angle. Among the potential determinants of postoperative flexion that failed to appear predictive were the Knee Society scores and surgeon. Preoperative flexion is known to be a critical determinant of postoperative flexion in total knee replacement. However, in the current study, preoperative flexion accounted for only half of the difference between the best (122 degrees) and the worst (88 degrees) group, as determined with regression tree analysis.     

Improvements in horizontality performance as a function of type of training

90 undergraduates with low spatial perceptual ability were assigned to one of three groups of control, learner-guided instructions, and tutor-guided instructions. The groups differed in amount and type of spatial training administered in a laboratory setting. Participants completed horizontality and vertically spatial perceptual tasks immediately after pretesting and again one month later. Both groups given training showed more accurate performance at posttest than at pretest. In addition, the learner-guided instruction group outperformed the tutor-guided instruction group and control group at posttest and on novel but related tasks. Gender differences in posttest performance favoring males (n = 35) were obtained in the tutor-guided performance group and control group but not in the learner-guided instruction group. The number of hints the latter needed during training was predictive of posttest performance. Implications for assessment and remediation of undergraduates' spatial perceptual abilities are discussed.     

Gait adaptations before and after anterior cruciate ligament reconstruction surgery

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.     

Quetiapine produces a prolonged reversal of the sensorimotor gating-disruptive effects of basolateral amygdala lesions in rats.

Prepulse inhibition (PPI) of startle is impaired in schizophrenia and in rats after manipulations of limbic cortical and subcortical regions. The atypical antipsychotic quetiapine was used to reverse PPI deficits after basolateral amygdala (BLA) lesions in rats. BLA quinolinic acid lesions significantly disrupted PPI 1 week postsurgery. Tests with quetiapine (0 vs 7.5 mg/kg) in a within-subject design 2-3 weeks postsurgery revealed a normalization of PPI. Carry-over effects lasted up to 3 weeks, with a return of lesion-induced deficits by Week 5 postsurgery. This dose of quetiapine also blocked the PPI-disruptive effects of phencyclidine. PPI deficits after BLA lesions are reversed by quetiapine, in a manner that is sustained beyond its acute pharmacological effects and which may be mediated downstream from the BLA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)