Volume 6:1
Comparison of lower extremity anterior compartment muscle EMG when using the Wii Fit™ and BAPS Board™: a repeated measure trial
Shannon R. Ayers, DPT; Karee Davis, DPT; Chad Lairamore, PT, PhD
Study Design: repeated measures design.
Objective: The purpose of this study was to compare electromyographic (EMG) activity of the muscles that prevent inversion and plantarflexion of the ankle while participants performed tasks on a Biomechanical Ankle Platform System (BAPS™) and Nintendo Wii Fit Balance Board™.
Background: The BAPS™ is a common tool used for rehabilitation of ankle injuries. However, use of the BAPS™ is limited during the early phases of rehabilitation after an ankle sprain. The Wii Fit Balance Board™ is a tool that could potentially be used to initiate rehabilitation early after an ankle sprain; little research has been performed on the Wii™ to determine its effectiveness for activating muscles of the anterior compartment of the lower extremity.
Methods and Measures: Ten subjects performed three trials on the BAPS™ and three trials on the Wii Fit Balance Board™ in random order for three minutes each with two minute rests between each trial. EMG data of the activity of bilateral tibialis anterior and peroneus longus muscles were collected during each of these trials using a Biopac Inc. system.
Results: A two-tailed paired t-test with a Bonferroni correction of alpha (0.025) was used to compare means using PASW statistics 17 software. A significant difference existed between the maximum muscle activation of tibialis anterior (TA) muscles with the BAPS™ (left TA: 1.09±0.42, right TA: 0.97±0.3) exhibiting higher levels of EMG compared to the Wii Fit™ (left TA: 0.68±0.39, right TA: 0.62±0.25) p< 0.001 (left) and 0.004 (right). No significant difference existed in maximum muscle activation for the peroneus longus (PL) muscles when comparing the Wii Fit™ (left PL: 0.87±0.8, right PL: 0.88±0.69) and BAPS™ (left PL: 0.98±0.44, right PL: 1.08±0.74) p=0.496 (left) and 0.461(right). A significant difference was found among all mean values when comparing the Wii™ verses BAPS™ with the BAPS™ exhibiting higher mean EMG values (p<0.007 for all comparisons). Mean Wii™ values were: left PL (0.13±0.1), right PL (0.13±0.08), left TA (0.09±0.05), right TA (0.06±0.04). Mean BAPS™ values were: left PL(0.29±0.14), right PL (0.32±0.25), left TA (0.23±0.18), right TA (0.19±0.1).
Conclusions: The BAPS™ generated significantly more muscle activity than the Wii Fit™ and therefore would be a better choice for advanced ankle rehabilitation. However, use of the Wii Fit™ produced muscle activity in the tibialis anterior and peroneus longus muscles. Therefore, the Wii Fit Balance Board™ may be useful for rehabilitation in patient populations with acute ankle sprains who cannot tolerate use of the BAPS™ or for patients that are noncompliant in using the BAPS™ board. Further research should be performed on a population with ankle injury to substantiate these claims.
Preventative Pressure Ulcer Protocols used in Physical Therapy for the Adult Complete Spinal Cord Injury Population: A Systematic Review
Zachary U. Cline, BS, SPT; Sarah E. Dewey, BS, SPT; Emily E. Houchins, BS, SPT; Karen Kott, PhD, PT
Old Dominion University, School of Physical Therapy and Athletic Training
Objective: Examine and assess the current evidence for intervention strategies used by physical therapists for the prevention of pressure ulcers in adults with complete spinal cord injuries.
Background: The most common secondary complication following a complete spinal cord injury is pressure ulcers. Thus far, there is no current evidence on an intervention strategy that clearly states that it effectively provides the best protocol for the prevention of pressure ulcers in selected population.
Methods and Measures: Application of systematic search strategies focused on current evidence of prevention of pressure ulcers in adults with complete spinal cord injuries. Electronic databases were searched using key words. Articles were chosen based upon set inclusion and exclusion criteria established before article search began. Methodological quality assessment was done on chosen articles using two tools: MacDermid’s Evaluation of Quality of an Intervention Study which quantifies twenty-four aspects of a research article (maximum score 48) and Jadad Scoring Scale (maximum score of 5) which quantifies the randomization of a study. After all articles were reviewed, a final grading of recommendations ranking system (A-D) determined the final conclusion.
Results: The initial search found 346 papers. After screening by title and abstracts and for duplications, twenty-four articles were assessed for eligibility. Further eliminations of articles for inclusion of patients with incomplete spinal cord injuries, focus of studies of treatment not prevention and a qualitative study, four articles were assessed each examining a different technique of prevention. The quality of the articles ranged from 25-39/48 on McDermid’s scale and 0-2 on the Jadad scale. Three studies demonstrated positive impact of the prevention technique and one study had no statistically significant changes.
Conclusion: The evidence qualified for a B grade meaning the interventions should be routinely provided to eligible patients because there is fair evidence that benefits outweigh harms. However, the prevention protocols need to be further evaluated to determine the optimal application that will ensure prevention of pressure ulcers in persons with complete spinal cord injuries.
Whole-Body Vibration Improves Functional Mobility, Flexibility, and Relative Risk for Falling in the Assisted Living Elderly: A Case Series
Christina Garrity, DPT1; Harold Merriman, PT, PhD2; C Jayne Brahler, PhD
University of Dayton, School of Education and Allied Professions
Study Design: A randomized double blind repeated measures, case series study of whole body vibration (WBV) in the assisted living elderly.
Background: A single exposure to WBV has been shown to have benefit with respect to muscle activity, strength, balance, and power in some studies while other studies have found no benefit. Its overall effectiveness is unknown due to the conflicting findings reported in the literature.
Case Description: Six subjects (5 female, 1 male; mean age = 85.4) in an assisted living community volunteered to participate. Subjects were exposed to a single bout of WBV at 0, 2, 20, and 26 Hz. Dependent variables including timed get up and go, chair sit and reach, one-legged stance time, and counter-movement jump were collected ten minutes prior, and two, twenty, forty, and sixty minutes after exposure. Published times for predicting falls using the timed up and go test and one-legged stance time were used to determine the number of outcome measures predicting falls prior to WBV. This was then compared to the number of outcome measures that predicted falls after exposure to determine any change.
Outcomes: WBV had no statistically significant effect on mobility in the elderly. However, trends suggest mean timed get up and go may improve after 20 Hz and 26Hz. Mean chair sit and reach showed minimal improvement with time bilaterally following all frequencies of WBV. No trends were found for one-legged stance time and counter-movement jump. The fall risk assessment suggested improvements following 2 Hz of WBV, but findings were not significant.
Conclusion: WBV had no significant effect on mobility in the assisted living elderly. Further research with larger sample size would be beneficial.
