The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

This study expands upon the Hastings et al (2018) study on the use of heel lifts to change static postural alignment in persons with Parkinson's Disease (PD) and further explores whether the use of heel lifts provide improvements in dynamic gait parameters, Timed Up and Go (TUG) scores, and balance confidence. Outcome measures were taken with and without the heel lifts in place, at two data collection dates. Photographs were analyzed for postural alignment measures using ImageJ software and video was analyzed for gait and turning parameters utilizing the Dite and Temple scale. The Activities-specific Balance Confidence (ABC) scale was collected at baseline and after two weeks of heel lift use, otherwise outcome measures were performed in the reverse order on the first and second session to account for ordering, practice, and fatigue effects. Statistical analysis included paired t-tests for outcome measures and Pearson product correlation between the degree of plantarflexion contracture and ABC scale and overall balance confidence and fall history. We found that head tilt angle and turn time significantly improved (p = .037) (p = .002) with use of heel lifts. Turn time correlated to overall balance confidence (r = -.802, p = .000) and overall balance confidence correlated to fall history (r = -.501, p = .041). This study showed that accommodating a lack of ankle dorsiflexion range of motion with heel lifts significantly improves head tilt angle and decreases turn time as compared to without heel lifts, but has no significant effect on step length, gait speed, or overall TUG score in individuals with PD. Because our work shows that limited range of motion at the ankle contributes to real and perceived balance difficulties healthcare providers working with any population of patients exhibiting balance problems should include this measurement in their assessment and consider intervention with a heel lift when limitations are found.

Observations of Thoracic Neuromuscular Oscillation Subsequent to Thoracic Pathology

In this paper we propose that a tremor occurring over a thoracic myotomal region as representative of a motor manifestation of thoracic radicular injury. We term this process thoracic neuromuscular oscillation. It is characterized by synchronous firing of the unilateral oblique muscles at one or more adjacent thoracic myotomal distributions at a frequency of 8 to 10 Hz. Six cases of observed regular continuous abdominal wall muscular tremor occurring after traumatic thoracic spine pathology are presented. These cases were drawn retrospectively from patient files obtained over 20 years. We refer to this tremor, measured to be 8–10 Hz, as thoracic neuromuscular oscillation. The neuromuscular oscillation was influenced by mechanical forces, specifically spine loading in either a bending or compressive mode. In some cases, cervical position modulated the tremor. Other examples of thoracic spine pathology that occurred comorbid to thoracic neuromuscular oscillation are noted.

Comprehensive Preoperative Pulmonary Rehabilitation Including Intensive Nutritional Support Reduces the Postoperative Morbidity Rate of Sarcopenia-Related Patients with Lung Cancer

Since surgical resection is the treatment of choice for localized lung cancer, it is important to develop an effective strategy to reduce the risk of postoperative complications caused by poor preoperative conditions. We prospectively implemented a comprehensive preoperative pulmonary rehabilitation (CHPPR) program that includes intensive nutritional support with branched-chain amino acids and herbal medicine supplementation concomitant with potential high-intensity physical therapy through an interdisciplinary team approach. This study aimed to evaluate whether CHPPR is beneficial for elderly, low body weight (percentage ideal body weight <90%) patients scheduled to undergo lung surgery. Between 2006 and 2015, 171 patients aged >70 years underwent standard lobectomy for lung cancers. Of these, 12 patients with a low body weight (sarcopenia-related, Group A) and 62 patients without a low body weight (sarcopenia-unrelated, Group B) underwent surgery after CHPPR. Twenty-four patients with a low body weight (sarcopenia-related, Group C) and 73 patients without a low body weight (sarcopenia-unrelated, Group D) refused CHPPR. The postoperative morbidity rates of patients in Groups A, B, C, and D were 17%, 16%, 63%, and 21%, respectively. Of the patients in the sarcopenia-related groups (Groups A and C), those who participated in the CHPPR program (Group A) had a significantly lower morbidity rate than those who did not participate in the CHPPR program (Group C) (P = 0.014). The CHPPR program is beneficial in reducing the postoperative morbidity rate of sarcopenia-related patients scheduled to undergo pulmonary resection.