Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy

摘要

Patients often need to use their arms to assist with functional activities, but after open heart surgery, pushing with the arms is limited to 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 ( ) 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.