There is ample evidence that maintenance of basic physical fitness through exercise training is crucial for patients with chronic renal insufficiency. Rehabilitation based on neuromuscular electrical stimulation (NMES) of thigh muscles has been shown to have many beneficial effects in patients with chronic diseases. It is likely that NMES could have beneficial effects also in patients on chronic ambulatory peritoneal dialysis (CAPD). NMES was applied for 20 weeks to 14 patients on CAPD, mean age 61.9 (8.7) years, using battery-powered stimulators (CEFAR-REHAB X2; Sweden) and self-adhesive electrodes 80 × 130 mm (PALS Platinum; Denmark). Stimulation characteristics: biphasic current, pulse width 400 μs, 8 seconds contraction-12 seconds relaxation, frequency modulation 40-60 Hz, and maximal intensity 60 mA. NMES was home-based and applied simultaneously to quadriceps muscles of both legs (2 × 30 min/day). Functional performance, muscle power (Fmax ), arterial stiffness (assessed by cardio-ankle vascular index-CAVI), and quality of life by KDQOL-SF evaluation was done at baseline and at the end of program. Home NMES improved significantly the main functional parameters: VO2peak /kg increased by +2.2 (1.6) mL O2 /kg/min (P < 0.002), peak workload by +0.1 (0.1) W/kg (P < 0.005), and distance walked in 6 MWT by +44.7 (58.4) m (P < 0.008). Only insignificant changes were observed in CAVI and Fmax . KDQOL-SF analysis showed significant improvement in seven parameters of QoL (P < 0.012-0.049). This pilot study is the first clinical report dealing with the use of NMES in patients on CAPD. The results demonstrate that an improvement of exercise capacity and QoL can be achieved by home-based NMES in CAPD patients.
- MeSH
- chronická renální insuficience patofyziologie terapie MeSH
- čtyřhlavý sval stehenní * patofyziologie MeSH
- elektrostimulační terapie * metody MeSH
- kontinuální ambulantní peritoneální dialýza * MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- senioři MeSH
- svalová síla MeSH
- test chůzí MeSH
- tolerance zátěže MeSH
- tuhost cévní stěny MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Cerebral palsy is a serious world-wide problem; its incidence ranges from one to five per thousand of live-born children and is much influenced by gestation age and birth weight. In orthopaedic treatment of lower extremity motor disorders, one of the options for contracture or deformity elimination and for stiff leg gait improvement is rectus femoris tendon transfer. The aim of this study was to evaluate the results of this surgical technique. MATERIAL AND METHODS In the period from 1993 to 2003, 15 patients of both sexes, aged 5 to 13 years, were treated by the Gage method (22 operations) in our department. The indication for surgery was excessive spasticity of the femoral quadriceps muscle at the beginning of the swing phase of the gait cycle. The spastic syndromes included quadruparesis in seven patients, dipare-sis in seven patients and hemiparesis in one patient. After surgery, a circular plaster cast was applied for 4 weeks. Following immobilization, all patients received a short-term inpatient and long-term outpatient physical therapy. They were followed-up for 1 to 10 years and gait improvement was analyzed on the basis of three criteria in the swing phase: quality of the initial swing, frequency of tripping over the toe and the degree of knee flexion. The results were evaluated on a 1 -to-4 scale (best to worst), categorizing the patients into four groups. RESULTS The first, second and third categories included eight, five and two patients, respectively. None of the patients was placed in the fourth category. Surgery did not increase the initial range of inner hip rotation. Patients with milder forms of cerebral palsy (diparesis and hemiparesis) achieved better results. CONCLUSIONS Our results showed that distal rectus femoris tendon transfer significantly improved knee flexion during the swing phase of the gait cycle. The prerequisite for a good outcome of surgery is a pre-operative potential for passive knee extension and stable function of the other lower extremity joints.
- MeSH
- čtyřhlavý sval stehenní chirurgie patofyziologie patologie MeSH
- dítě MeSH
- elektromyografie metody využití MeSH
- mozková obrna chirurgie komplikace MeSH
- ortopedické výkony metody využití MeSH
- přenos šlachy metody využití MeSH
- svalová kontrakce MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) využití MeSH
- Check Tag
- dítě MeSH
