Bala S. Rajaratnam

Objective: To identify factors within the hospital environment that can facilitate maximal motor recovery after stroke. Comments: A challenging and movement oriented hospital environment can stimulate early, active and intensive patient participation in functional activities of daily living always including during non-therapy times. Regular participation in activities also prevents secondary complications such as muscle contractures. Rearranging the ward routine reduces the inactive times during hospital stay, redesigning physical structures within the ward encourages weight bearing, adopting constraint induced therapy concepts will facilitate upper limb recovery for performance of activities of daily living and embracing technological devices motivates patient to move regularly. Better utilization of family visitation times to use satellite rehabilitation locations may enhance the importance of self-practice. Hospital staff and rehabilitation therapists should review the practice of no rehabilitation during weekends and public holidays as it may facilitate early discharge. Physiotherapists should regularly lead a creative team of health care professionals to redesign the hospital environment to be challenging and motivating for maximal motor recovery after stroke.

[Purpose] This study aimed to investigate the perceived discomfort and trunk muscle activity in three different 1-hour sitting postures. [Subjects] A repeated-measures design study was conducted on 10 healthy subjects. [Methods] Each subject sat for an hour in three sitting postures (i.e., upright, slumped, and forward leaning sitting postures). Subjects rated perceived body discomfort using Borg's CR-10 scale at the beginning and after 1 hour sitting. The electromyographic activity of the trunk muscle activity was recorded during the 1-hour period of sitting. [Results] The forward leaning sitting posture led to higher Borg scores in the low back than those in the upright (p = 0.002) and slumped sitting postures (p < 0.001). The forward leaning posture was significantly associated with increased iliocostalis lumborum pars thoracis (ICL) and superficial lumbar multifidus (MF) muscle activity compared with the upright and slumped sitting postures. The upright sitting posture was significantly associated with increased internal oblique (IO)/transversus abdominis (TrA) and ICL muscle activity compared with the slumped sitting posture. [Conclusion] The sitting posture with the highest low back discomfort after prolonged sitting was the forward leaning posture. Sitting in an upright posture is recommended because it increases IO/TrA muscle activation and induces only relatively moderate ICL and MF muscle activation.

Muscles are important “sensors of the joint instability”. The aim of this study was to identify the neuro-motor control strategies adopted by patients with anterior shoulder instability during overhead shoulder elevation in two planes.

This randomised controlled and double-blinded pilot study evaluated if interactive virtual reality balance related games integrated within conventional rehabilitation sessions resulted in more superior retraining of dynamic balance compared to CR after stroke. 19 subjects diagnosed with a recent episode of stroke were recruited from a local rehabilitation hospital and randomly assigned to either a control or an experimental group. Subjects in the control groups underwent 60 minutes of conventional rehabilitation while those in the experimental groups underwent 40 minutes of convention rehabilitation and 20 minutes of self-directed virtual reality balanced rehabilitation. Functional Reach Test, Timed Up and Go, Modified Barthel Index, Berg Balance Scale, and Centre of Pressure of subjects in both groups were evaluated before and on completion of the rehabilitation sessions. Results indicate that the inclusion of interactive virtual reality balance related games within conventional rehabilitation can lead to improved functional mobility and balance after a recent episode of stroke without increasing treatment time that requires more health professional manpower.

Objective The prospective pre–post control study was designed to evaluate the effect of introducing balance-focused interactive virtual-reality games to community-dwelling older women to improve their agility, balance and functional mobility. Method The study was set in a senior citizens’ club in Cheras, Kuala Lumpur, Malaysia. The participants were 36 community-dwelling older women. Participants were randomly divided into either a group undertaking balance-focused virtual-reality games or a group doing therapeutic balance exercises. The program lasted 6 weeks and was conducted twice a week for 40 min during each session. As the main outcome measures, the results of the Ten Step Test (TST), postural sway (overall performance index, OPI) and the Timed Up and Go test (TUG) were measured pre- and post-intervention to evaluate agility, balance and functional mobility, respectively. Results Although both groups improved in OPI (F = 4.63, p < 0.001), TST (F = 46.15, p < 0.001) and TUG (F = 52.57, p = 0.03), combined time and group interaction only improved in the TUG (F = 4.54, p < 0.05). No significant differences between the two groups were found in terms of TST (F = 0.02, p = 0.86), OPI (F = 0.66, p = 0.42), and TUG (F = 0.11, p = 0.74). Conclusion Older people could improve their agility, balance and functional mobility by complementing therapeutic balance exercises with active participation in interactive virtual-reality games at home or in the community.