反馈训练可提高功能活动期间对胸骨预防指南的依从性:对优化老年患者正中开胸术后恢复的启示。
Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy.
作者信息
LaPier Ansel, Cleary Kimberly
机构信息
Physical Therapy Department, Eastern Washington University, Spokane, Washington, USA.
出版信息
Appl Bionics Biomech. 2021 Jan 25;2021:8889502. doi: 10.1155/2021/8889502. eCollection 2021.
Patients often need to use their arms to assist with functional activities, but after open heart surgery, pushing with the arms is limited to <10 lb (4.5 kg) to help minimize force across the healing sternum. The main purposes of this study were to determine if older patients (>60 years old) (1) accurately estimated upper extremity (UE) weight bearing force of 10 lb or less and (2) if feedback training improved their ability to limit UE force and pectoralis major muscle contraction during functional activities. An instrumented walker was used to measure UE weight bearing force, and electromyography was used to measure pectoralis major muscle activity simultaneously during 4 functional mobility tasks. After baseline testing, healthy older subjects ( = 30) completed a brief session of visual and auditory concurrent feedback training. Results showed that the self-selected UE force was >10 lb for all tasks (20.0-39.7 lb [9.1-18.0 kg]), but after feedback training, it was significantly reduced (10.6-21.3 lb [4.8-9.7 kg]). During most trials (92%), study participants used >12 lb (5.5 kg) of arm weight bearing force. Pectoralis major muscle peak electromyography activity was <23% of maximal voluntary isometric contraction and was reduced (9.8-14.9%) after feedback training. Older patients may not be able to accurately estimate UE arm force used during weight bearing activities, and visual and auditory feedback improves accuracy and also modulation of pectoralis major muscle activation. Results suggest that an instrumented walker and feedback training could be clinically useful for older patients recovering from open heart surgery.
患者在进行功能活动时通常需要用手臂辅助,但心脏直视手术后,手臂用力需限制在<10磅(4.5千克)以内,以尽量减少作用于愈合胸骨的力量。本研究的主要目的是确定老年患者(>60岁):(1)是否能准确估计10磅及以下的上肢(UE)负重力量;(2)反馈训练是否能提高他们在功能活动中限制UE力量和胸大肌收缩的能力。使用带仪器的步行器测量UE负重力量,并在4项功能性移动任务期间同时使用肌电图测量胸大肌活动。在基线测试后,健康老年受试者(n = 30)完成了简短的视觉和听觉同步反馈训练。结果显示,所有任务的自选中UE力量均>10磅(2…0 - 39.7磅[9.1 - 18.0千克]),但在反馈训练后,力量显著降低(10.6 - 21.3磅[4.8 - 9.7千克])。在大多数试验(92%)中,研究参与者使用的手臂负重力量>12磅(5.5千克)。胸大肌肌电图峰值活动<最大自主等长收缩的23%,反馈训练后降低(9.8 - 14.9%)。老年患者可能无法准确估计负重活动中使用的UE手臂力量,视觉和听觉反馈可提高准确性,并调节胸大肌激活。结果表明,带仪器的步行器和反馈训练对心脏直视手术后康复的老年患者可能具有临床实用性。
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