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Use of the dual force system to correct chronic knee deformities due to severe haemophilia.

In this study, the use of the dual force system to correct recent or relatively longstanding knee deformities in ten patients is described. (Nine of the patients had severe haemophilia and one had severe von Willebrand's disease.) The mean duration of deformity in these patients was 10 months. The mean range of movement at the affected knee joints increased from 50 degrees at pre-intervention to 110 degrees following 6 weeks of application of the dual force system. In nine of ten patients (90%) the residual flexion deformity ranged from 0 degrees to 10 degrees. The dual force system offers an easily affordable and effective means of correcting a flexion deformity of the knee joint in severely affected haemophilia and allied disorders. More extensive use of this technique in different centres is required to determine its place in the day-to-day management of such patients.

Adolescent↗

Effects of a manual therapy technique in experimental lateral epicondylalgia.

In patients with lateral epicondylalgia, mobilization-with-movement (MWM) is used as an intervention aimed at achieving analgesia and enhancing grip force, although the mechanisms underlying these effects are unclear. The present study investigated the acute sensory and motor effects of an MWM intervention in healthy controls with experimentally induced lateral epicondylalgia. Twenty-four subjects were randomly allocated to either a MWM or a placebo group (n=12). In both groups, to generate the model of lateral epicondylalgia, delayed onset muscle soreness (DOMS) was provoked in one arm 24h prior (Day 0) to hypertonic saline-induced pain in the extensor carpi radialis brevis muscle (Day 1). Either a MWM or placebo intervention was applied during the saline-induced pain period. Saline-induced pain intensity (visual analogue scale: VAS), pain distribution and pain quality were assessed quantitatively. Pressure pain thresholds (PPTs) were recorded at the common extensor origin and the extensor carpi radialis brevis muscle. Maximal measures of grip and wrist extension force were recorded. In both groups (pooled data), DOMS was efficiently induced as demonstrated by a significant decrease in pre-exercise to pre-injection PPT at the common extensor origin (-45+/-19%) and at the extensor carpi radialis brevis (-61+/-23%; P<0.05), and a significant decrease in maximal grip force (-25+/-6%) and maximal wrist extension force (-40+/-12%; P<0.001). Moreover, both groups experienced a significant increase in muscle soreness (3.9+/-0.2; P<0.0001) at Day 1 compared to pre-exercise. During saline-induced pain and in response to intervention, there were no significant between-group differences in VAS profiles, pain distributions, induced deep tissue hyperalgesia or force attenuation. These data suggest that the lateral glide-MWM does not activate mechanisms associated with analgesia or force augmentation in subjects with experimentally induced features simulating lateral epicondylalgia.

Adult↗

Is the anorectal sphincter damaged during a transanal endorectal pull-through (TERPT) for Hirschsprung's disease? A 3-dimensional, vector manometric investigation.

BACKGROUND/PURPOSE: The transanal endorectal pull-through technique (TERPT) for Hirschsprung's disease (HD) exercises considerable traction on the anorectal tissue during dissection. So the question arises as to whether TERPT impairs the integrity of the anorectal sphincter. Computerised 8-channel vector manometry allows a segmental, 360 degrees analysis of muscular defects along the anal canal. Such data after TERPT are not available yet. METHODS: Between 2002 and 2004, 7 children underwent primary TERPT for HD of the rectosigmoid. All could be recruited for follow-up examinations. Stooling pattern, rectal examination, conventional 4-channel and computerised 8-channel vector manometry were assessed; the anal sphincter pressure at rest (ASPR), rectoanal inhibitory reflex (RIR), anal canal length (ACL), high pressure zone (HPZ), maximal segmental pressure (max SP), segmental/total asymmetric index (SAI/TAI), vector volume at rest (VV) were studied. Mean pre- and postoperative values were compared (pre/post). RESULTS: After a mean of 14 months (range 3-21 months) all children had spontaneous bowel movements, with no complaints of encopresis or constipation. 4-channel manometry revealed an unchanged ASPR (48.1/49.2 mmHg). RIR was present in 1/7. Computerised 8-channel comparison revealed no changes for ACL (15.4/16 mm), HPZ (60/53.19 % of ACL), SAI (17.6/18.63 %) and TAI (35.8/35.63 %). A postoperative increase was noted for max SP squeeze (141.4/178.7 mmHg) and VV (38 161/46 680 mmHg/cm (2)). In conclusion, the TERPT for HD preserves the functional integrity of the anorectal sphincter complex and has a favourable clinical and manometric outcome.

Anal Canal↗

Nighttime insomnia treatment and education for Alzheimer's disease: a randomized, controlled trial.

OBJECTIVES: To evaluate whether a comprehensive sleep education program (Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE-AD)) could improve sleep in dementia patients living at home with their family caregivers. DESIGN: A randomized, controlled trial. PARTICIPANTS: Thirty-six community-dwelling patients with Alzheimer's disease (AD) and their family caregivers. INTERVENTION: All participants received written materials describing age- and dementia-related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n=17) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills. Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box. Control subjects (n=19) received general dementia education and caregiver support. MEASUREMENTS: Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep-wake activity measured at baseline, posttest (2 months), and 6-month follow-up using an Actillume wrist-movement recorder. Secondary patient outcomes included the Epworth Sleepiness Scale, the Cornell Depression Scale, and the Revised Memory and Behavior Problem Checklist. Caregiver self-reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale. RESULTS: Patients participating in NITE-AD showed significantly greater (P<.05) posttest reductions in number of nighttime awakenings, total time awake at night, and depression, and increases in weekly exercise days than control subjects. At 6-month follow-up, treatment gains were maintained, and additional significant improvements in duration of night awakenings emerged. When cognitive level was controlled, NITE-AD patients had lower longitudinal ratings of daytime sleepiness than controls. There was a trend for control subjects to spend more time in bed at 6 months than NITE-AD patients. CONCLUSION: This study provides the first evidence that patients with AD who are experiencing sleep problems can benefit from behavioral techniques (specifically, sleep hygiene education, daily walking, and increased light exposure) that are known to improve sleep in nondemented, institutionalized older adults.

Adult↗

Controlled mobilization after flexor tendon repair in zone II: a prospective comparison of three methods.

A new controlled-motion program that incorporates dynamic flexion traction to all four digits, a short splint leaving the interphalangeal joints free, and a nighttime extension splint was prospectively compared with a modification of the Kleinert technique and a combination of the modified Kleinert technique and passive movements. Each program was applied to approximately one third of 178 consecutively treated digits with tendon injuries in zone II. The mean total active interphalangeal joint range of motion 6 weeks and 1 year postoperatively was significantly better and extension deficits were significantly less frequent in the digits mobilized with the new program. The postoperative treatment input, in terms of frequency of reviews and time spent in therapy sessions, is not greater than with more traditional controlled-motion programs. Our results indicate that the new program is a safe, reliable, and cost-effective method that produces very good results in a general population.

Exercise Therapy↗

Music education and performing arts medicine: the state of the alliance.

As a group, musicians tend to be somewhat disembodied; their awareness of their whole selves extends almost exclusively to the parts involved directly with musical technique. Even though many consider musicians to be small muscle athletes, it is unusual to see a group of beginning musicians working out or warming up on their practice field, or having a trainer present to supervise their movements or their mental performance orientation, as one would in sports. Several questions come to mind. How has this state of things come about? What do musicians know about the mental, spiritual, and physical attributes they bring to music making? What do music teachers teach students about wellness? How can a collaboration of the fields of music education and rehabilitation medicine approach these issues? This article addresses these questions.

Humanities↗

Acute and chronic adaptations of muscle proprioceptors in response to increased use.

Acute adaptations to use have been shown to occur in both the muscle spindle and Golgi tendon organ pathways. This short term activation adaptation increases the excitability of the motoneuron pool, thereby potentially providing a nonvoluntary increase in the excitation of subsequent contractions. It is thought that the intrafusal muscle fibres reset to a higher gain after contraction and that the tendon organ pathway undergoes a brief desensitisation. These phenomena could be important clinically when trying to stretch muscles, i.e. a contraction before a stretch should make the stretch more difficult. Also, this could affect the amount of muscle force generated, thereby altering motor behaviours requiring fine accuracy. Research on the adaptations of proprioceptors during free movement, using locomotion as a model, has found that the hypothesis of consistent alpha-gamma coactivation during motor behaviours is much more complicated and adaptable, depending on the environmental circumstance and the specific motor task. These research findings support the use of selective training, i.e. training to the task, for optimal motor learning. The results of the relatively limited research on chronic adaptations of proprioceptors due to exercise has shown that on a microlevel, the intrafusal muscle fibres may show some metabolic changes but do not show any hypertrophy. However, on a more macro level, with extended training, the latency of the stretch reflex response is found to be decreased and the amplitude is found to be increased in both animals and humans. Through classical conditioning research, proprioceptors may also be necessary for motor learning. Lastly, both primates and humans have been shown to be able to up- or down-grade their stretch reflex responses using operant conditioning techniques and many practice sessions. These findings have important implications both for rehabilitation of persons with abnormal reflex activity and in the training of athletes. This review provides some consolidation of the recent research findings, but much more research needs to be done in order to fully understand the purpose and importance of the proprioceptive sensory system.

Humans↗

Sieving of electrolytes at capillary wall of cat skeletal muscle by osmotic water flow.

To test the hypothesis that a significant proportion of transcapillary water flow occurs through solute-restricting channels, we investigated the effects of transcapillary water movement on plasma electrolytes in isolated perfused cat skeletal muscle. The lower hindlimbs of anesthetized cats were perfused with a plasma-albumin solution and were weighed to determine transcapillary water movement. Osmolality was increased 60-70 mosmol/kgH2O with sucrose, creating water fluxes of 8-10 ml.min-1.100 g-1, and the changes in the venous concentrations of sodium, potassium, and chloride were determined. The ion concentrations were all reduced by 6-7% with no significant difference between them. The amount of reduction was quantitatively explained by the flow of ion-free water from the interstitial space into plasma and the diffusion of electrolyte in the same direction. These findings support the hypothesis that important water-only transcapillary channels exist in mammalian skeletal muscle. The observations may also explain some of the electrolyte changes seen in intense exercise.

Animals↗

A critical assessment of pulmonary function testing in exercising ponies.

Pulmonary function measurements during exercise were tested for accuracy and reproducibility in 5 saddle ponies weighing 267 +/- 9 Kg. Airflow (V) and tidal volume (VT) were measured with a Fleisch pneumotachograph mounted on a face mask. The linearity of the response and the symmetry of this device were carefully checked. Pleural pressure changes were measured by pleural puncture (Ppl) and with an esophageal balloon catheter (Pes). The elastance of the esophageal wall and the effect of the position of the esophageal catheter tip on Pes were also investigated. Airflow, VT, Ppl, Pes, mask pressure, an electrocardiogram and limb movements were simultaneously recorded before, during and after exercise. These recordings were used to assess the validity of some pulmonary function measurements and to evaluate the influence of the breathing apparatus on the respiratory pattern. Maximal intrathoracic pressure changes and total pulmonary resistance values did not differ significantly when calculated on the basis of the Ppl and the Pes curves respectively. Although the absolute Ppl values were significantly different from the absolute Pes values, both pressures recorded at different workloads were closely correlated (R = 0.99). The mean specific elastance of the esophagus was 1.56 +/- 0.24 kPa.cm.ml.-1. Changes in the position of the esophageal catheter tip induced significant differences in the recorded Pes values. The pressure/flow relationship of the pneumotachograph pressure transducer system was linear within the range of the V measured during exercise. The mask had a significant influence on respiratory frequency and maximum difference in Pes, but did not modify the exercise-induced changes in these parameters. It was concluded that the technique and methods used in this study can allow accurate pulmonary function measurements in exercising ponies.

Animals↗

Assessment of dynamic finger forces in pianists: effects of training and expertise.

Playing a musical instrument requires complex sensorimotor programming of hand and finger movements. During musical training motor programs are optimized to achieve highest accuracy with a minimum of effort. In the lack of handy measurement tools these rational assumptions of piano theorists did not undergo an experimental evaluation up to now. In the present pilot study we used a dynamic pressure measurement system with the pianoforte. Three finger exercises with increasing degrees of difficulty had to be performed by a group of musical amateurs and a group of expert players. From the dynamic force measurements we calculated (a) the mean pulse per touch and (b) the mean touch-duration for each exercise and each subject. To achieve the same tempo and the same loudness, amateurs applied significantly more and longer force to the keys, leading to higher mean pulses per touch. Pulse and duration values increased with higher demands on finger coordination in both, expert pianists and amateurs. The results show that dynamic force measurement systems can support music learners and teachers in training a relaxed piano technique and preventing musicians from overuse injuries.

Adolescent↗

Cardiovascular tolerance of healthy elderly subjects to weight-lifting exercises.

OBJECTIVE: To evaluate the hemodynamic strain and the myocardial tolerance of weight-lifting exercises in healthy elderly subjects. METHODS: Sixty-five healthy elderly subjects (32 men/33 women) aged 65-80, were studied. Weight-lifting exercises consisted of two sets of 12 repetitions at 12-repetition maximum (RM) and four sets of five repetitions at 5-RM for, horizontal leg press, seated chest press, and bilateral leg extension movements. Cardiovascular tolerance to weight-lifting exercises was evaluated both physiologically and biologically by measuring heart rate (HR) and blood pressures continuously during exercise, and cardiac troponin I (cTnI) blood concentration before and 6 h postexercise. Comparisons between resting and exercise or postexercise values were performed by a bilateral-paired t-test. A value of P < 0.05 was considered statistically significant. RESULTS: No significant increase in cTnI circulating concentration was observed secondary to exercise (16.56+/-2.23 vs 14.40+/-1.96 ng x L(-1); mean +/- SEM). This was observed despite a significant (P < 0.001) exercise-induced increase in systolic (SAP) and diastolic arterial pressures (DAP) and HR. Highest values of SAP, DAP, and HR (223.6+/-3.1 mm Hg, 139.6+/-1.9 mm Hg, and 108+/-2 min(-1), respectively) were measured during the horizontal leg press exercise. CONCLUSION: These data suggest that weight-lifting exercises can be conducted in healthy elderly subjects without clinical, electrical, and biological sign of myocardial ischemia, if appropriate selection criteria, and proper respiratory techniques during exercise are applied.

Aged↗

Ideokinetic imagery as a postural development technique.

In two experiments we examined the effectiveness of ideokinetic imagery and flexibility combined with abdominal strength training as methods for improving the spinal angles of lordosis and kyphosis and reducing low back pain. Ideokinetic imagery is a postural development technique that involves using movement images to gain subcortical control over the spinal musculature. Experiment 1 investigated the effectiveness of these treatments for males with a previous history of low back pain. Findings indicated that only ideokinetic imagery had a positive effect on the spinal column and low back pain. Experiment 2 extended these findings by investigating males and females using a noninvasive video analysis technique to record changes in spinal angles. This study further supports the effectiveness of ideokinetic imagery as a postural development technique in males with acute spinal angles. In these subjects spinal angles improved significantly, and the subjects reported complete cessation of low back pain. This research supports the use of ideokinetic imagery as an inexpensive and noninvasive technique to improve poor posture and reduce low back pain.

Abdominal Muscles↗

Pectoral stretching program for women undergoing radiotherapy for breast cancer.

Surgery and radiotherapy commonly cause adverse musculoskeletal problems, particularly loss of strength and range of motion, in the upper quadrant of breast cancer patients. Few well-designed studies have investigated whether these impairments can be prevented. Stretching is an effective technique for increasing range of motion, hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer. Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery. Participants were randomised to either a control or stretch group. Participants in both groups were reviewed by the physical therapist on a weekly basis for approximately 6 weeks, and were given general information about skin care and lymphedema. The control group received no advice about exercise. The stretch group received instruction on low-load, prolonged pectoral stretches, which were to be performed daily and were checked at weekly visits. Shoulder range of motion, strength, arm circumference, and quality of life measurements were taken prior to, and at completion of radiotherapy, and at 7 months after radiotherapy. There was no difference in any outcome between groups. Breast symptoms increased for both groups during radiotherapy, without loss of strength or range of movement. The incidence of lymphedema during the study was low for both groups and did not differ between groups. The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture.

Breast Neoplasms↗

Three-dimensional kinematics of the taped ankle before and after exercise.

The practice of prophylactic ankle taping or wrapping to reduce the incidence of inversion ankle sprains in athletes has come under attack. The purpose of this study was to measure objectively one ankle taping technique's ability to withstand the stresses placed upon it by a standardized exercise routine. Electrogoniometers were used to measure the three-dimensional ankle motion of 20 subjects walking on a level surface and a 10 degrees sideslope. The evaluations were carried out under these three conditions: (1) both ankles untaped, (2) both ankles taped before exercises, and (3) both ankles taped after exercise. The results from this study indicate that the tape does indeed restrict those motions associated with inversion ankle sprain. Methods similar to those described in this study could be used in the evaluation of many current training room practices and thereby provide an objective rationale for their application.

Adult↗

Changes in force-velocity and power output of upper and lower extremity musculature in young subjects following 20 days bed rest.

Ten healthy sedentary students were exposed to 20 days bed rest (BR) to study the effect of simulated weightlessness on force(F)-velocity(V) characteristics and power(P) output of upper and lower limb movements. F, V and P were measured using a special dynamometer applicable to single joint movements [elbow flexion(EF) and extension(EE), knee flexion(KF) and extension(KE), and hip flexion] or multi-joint movements (squatting). Physiological cross-sectional areas(PCSA) of KF and KE muscles were measured by a magnetic resonance imaging technique. After BR, attenuation in P were observed in lower limb movements (decreased by 19.8-43.6% for squatting, KF and KE), in upper limb movements on the other hand, the decreases in P were not significant (approximately -5% for EF and EE). Decrease in P in lower limb were more pronounced in heavier loaded conditions which were characterized by decreases in both F and V. For KF and KE, decreases in maximal static F (-18.9 to approximately -26.8%) were more pronounced than the decreases observed in the PCSA (approximately -7%), resulting in decreases in specific tension (-12.3 to approximately -22.1%). Neural excitation potentials to generate maximal muscle tension or P might also be influenced by weightlessness.

Adult↗

Constraint-induced movement therapy: bridging from the primate laboratory to the stroke rehabilitation laboratory.

In this laboratory we have developed a set of techniques that randomized controlled studies indicate can substantially reduce the motor deficit of patients with mild to moderately severe chronic strokes. The techniques, termed Constraint-Induced Movement therapy (CI therapy), involve motor restriction of the less-affected arm while at the same time intensively training the more-affected arm. The intervention was derived directly from basic research with monkeys. The primary difference between CI therapy and conventional physical therapy is in the duration and intensity of the treatment. The greatly improved extremity function produced in the laboratory transfers to the activities of daily living outside the clinic. Treatment gains persisted for the two years tested. Converging data from seven experiments has shown that CI therapy produces massive alterations in brain organization and function correlated with the large improvements in motor ability that it produces.

Animals↗

Perceived effort in force production as reflected in motor-related cortical potentials.

OBJECTIVE: The perceived effort in force production was investigated in a series of experiments where subjects performed isometric force tasks with the index finger while the nominal force, the rate of force development and signal gain were controlled and rating of effort for each task was obtained. The hypotheses tested were that: (1) force-related perceived effort may selectively influence the amplitude of motor-related cortical potentials (MRCP); and (2) the MRCP may directly reflect the intensity of perceived effort associated with force production. METHODS: The force trace was displayed on a computer monitor using various control-gains so that the perceived effort matched or was at odds with actual muscular effort applied to the load cell to accomplish the task. The MRCP were extracted from continuous EEG records using averaging techniques. RESULTS: The findings showed that: (1) perceived effort proportionally increased with the increment of rate of force development and force error, but not with the actual force level; (2) the amplitude of the MRCP increased when a large amount of force was accompanied by an increased rate of force development; (3) the amplitude of early components of MRCP preceding the force initiation (MP-100 to 0) increased as a function of anticipated effort, whereas, the amplitude movement-monitoring potentials (MMP) accompanying the force production increased as a function of actual force level. CONCLUSIONS: The findings from this study provide additional insight clarifying the distinct patterns of EEG activity exhibited under various degrees of perceived effort associated with force output. The findings support the hypothesis that the early components of MRCP may reflect the perceived effort associated with achieving the required force level. SIGNIFICANCE: The results from this study may be considered in the larger context of physical activity in terms of importance of perceived effort during prescribed exercise in rehabilitation programs.

Adult↗

Functional radiographic diagnosis of the lumbar spine. Flexion-extension and lateral bending.

Several attempts have been made to measure the segmental range of motion in the lumbar spine during flexion-extension with the purpose of gathering additional data for the diagnosis of instability. The previous studies were performed in vitro or in vivo during active motion. The aim of this study was to obtain normal values of passively performed segmental motions. Forty-one healthy adults were examined by means of functional radiographs during flexion-extension and lateral bending. A graphic construction method and a computer-assisted method were used to measure rotations. Comparing with recent in vivo studies, the values obtained for normal angles of rotation were predominately larger. This might be due to the passive examination used in the study. The graphic construction method and computer-assisted method techniques are equally reliable, but the computer-assisted method method yields other important kinematic data, such as translations. It is proposed that passive motion be applied during functional examination of patients with suspected instabilities. However, the large variation of rotational values between individuals in the normal population may limit the clinical usefulness of functional lumbar analysis using this parameter. Future studies should explore the clinical relevance of determining altered segmental mobility in low-back pain patients.

Adult↗