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Development of motor deficits in a murine model of mucopolysaccharidosis type IIIA (MPS-IIIA).

Mucopolysaccharidosis (MPS) type IIIA or Sanfilippo syndrome is a lysosomal storage disorder characterised by progressive neurological pathology. Patients exhibit aggression, disturbed sleep, hyperactivity and mental decline ultimately resulting in inanition and death. Recently, a mouse model of MPS-IIIA was discovered, and both the clinical signs and neuropathological changes mimic the human disease. This provides us with an opportunity to study the pathological progression of this disorder and to determine the efficacy of novel therapies, for at present all lysosomal storage disorders (LSD) affecting the brain are untreatable. Neuropathological changes have previously been described in areas of the brain involved in regulating motor function, therefore, in the present study we sought to determine whether quantifiable motor abnormalities were present in the MPS-IIIA mouse, and if so, at what age they became detectable. Tests of open-field locomotor activity, hindlimb gait, catalepsy, neuromuscular strength and negative geotaxis were administered to MPS-IIIA and normal male and female mice aged from 3 to 40 weeks of age. Significant changes in open-field activity were observed from 3 weeks in MPS-IIIA mice, whereas abnormalities in tests of gait, grip strength and in the assessment of the negative geotaxis response were observable from approximately 15 weeks of age. Behavioural changes were often detected in male MPS-IIIA mice before they appeared in females. Our observations provide insight into the chronology of pathological changes within the MPS-IIIA brain and this simple series of tests will prove useful in comparing mice following the administration of experimental therapies for this condition.

Aging↗

The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction.

BACKGROUND: Muscle dysfunction is a common finding in malnourished patients and is associated with poor outcome. We investigated whether the Subjective Global Assessment (SGA) is a valuable tool for identifying malnutrition-related muscle dysfunction. METHODS: Two hundred eighty seven consecutive patients were assessed on admission to hospital according to the SGA, anthropometric measurements, and to the results of bioelectrical impedance analysis. The SGA was used as the main criterion for the classification of malnutrition. Muscle function was assessed by handgrip strength. RESULTS: Maximal voluntary handgrip strength was significantly lower in malnourished than in well-nourished male and female patients (45.22 (13.51-67.7)kg versus 30.82(11-48) kg in men; 23.81 (5.60-56.5) kg versus 18.5 (5.90-48.8) kg in women). Handgrip strength tended to decline with age. Handgrip strength was positively correlated to body cell mass (BCM) (r=0.72, P<0.001 in men and: r=0.56, P<0.001 in women) and to body mass index (r=0.271, P=0.03 in men and r=0.183, P=0.02 in women). BCM was identified as a powerful contributor to the variation in handgrip strength (delta r2=0.645, P<0.001). CONCLUSION: The SGA appears to be a reliable bedside assessment tool for malnutrition and malnutrition-related dysfunction. Patients classified malnourished according to the SGA have an impaired functional status. Every effort should be made to provide both nutritional and physical therapy in order to improve the patients' outcome.

Adolescent↗

Food restriction, performance, psychological state and lipid values in judo athletes.

Dietary intake, plasma lipids, lipoprotein and apolipoprotein levels, anthropometric measurements and anaerobic performance were studied in eleven judo athletes during a period of weight maintenance (T1) and after a 7d food restriction (T2). Dietary data were collected using a 7-day diet record. Nutrient analysis indicated that these athletes followed a low carbohydrate diet whatever the period of the investigation. Moreover, mean micronutrient intakes were below the French recommendations. Food restriction resulted in significant decreases in body weight. In addition, it had significant influence on triglyceride and free fatty acid, although glycerol, total cholesterol, LDL-C, HDL-C, apolipoprotein A-1 and B did not alter. Left arm strength and 30 s jumping test decreased significantly. The 7 s jumping test was not affected by the food restriction. Regardless of psychological parameters, tension, anger, fatigue and confusion were significantly elevated from T1 to T2; vigor was significantly lower. The data indicated that a 7-day food restriction adversely affects the physiology and psychology of judo athletes and impairs physical performance, possibly due to inadequate carbohydrate and micronutrients.

Adult↗

Oral administration of creatine monohydrate retards progression of motor neuron disease in the wobbler mouse.

BACKGROUND AND AIMS: Creatine has a neuroprotective effect in mutant superoxide dismutase (G93A) transgenic mice, an animal model of motor neuron disease (MND). Treatment with creatine monohydrate enhances muscle strength in patients with neuromuscular disorders. The purpose of our study was to determine whether administration of creatine monohydrate can attenuate progressive disease in wobbler mice. METHODS: After an initial diagnosis of disease at the age of 3-4 weeks, creatine monohydrate (5 or 50 mg/kg, po) or vehicle was given to wobbler mice daily for 4 weeks in a blinded fashion. We compared symptomatic and neuropathological assessments among the three groups. RESULTS: Creatine levels in biceps muscles were increased by approximately 20% following administration of higher-dose creatine monohydrate. In comparison with vehicle, treatment with higher doses of creatine monohydrate potentiated grip strength, attenuated forelimb contracture and increased the weight of biceps muscles. Mice treated with higher doses of creatine monohydrate showed retarded denervation muscle atrophy in the biceps muscles and reduced degeneration of the spinal motor neurons. Thus, oral administration of creatine monohydrate delayed the progression of disease in wobbler mice. CONCLUSION: Our results indicate that this molecule may have therapeutic potential in human motor neuropathy or MND.

Administration, Oral↗

Power output for wheelchair driving on a treadmill compared with arm crank ergometry.

OBJECTIVES: The limiting factors with regard to power output available for wheelchair ambulation have not been identified. The aim of the present study was to correlate power output during wheelchair driving with (i) power output and oxygen uptake during arm crank ergometry and (ii) arm muscle strength. METHODS: Eleven disabled men were examined for maximal power output (POmax) during wheelchair driving on a treadmill and during arm crank ergometry. Oxygen uptake (VO2) was recorded at submaximal and maximal arm crank ergometry in all men and during submaximal wheelchair driving on a treadmill in four men. Power output during wheelchair driving on a treadmill was measured. Static and dynamic elbow muscle strength was measured isokinetically. RESULTS: POmax was significantly lower (P < 0.001) for wheelchair driving (109 (31) W; mean (SD)) than for arm ergometry (163 (49) W). There was a significant correlation between POmax for arm crank ergometry and wheelchair driving (r = 0.73). There was no correlation between POmax and elbow strength. The mechanical efficiency was constant for the different levels on the arm crank ergometry test. The submaximal testing showed a consistently lower mechanical efficiency for wheelchair driving than for arm crank ergometry. CONCLUSIONS: It is suggested that the lower level of power output for wheelchair driving is fully explained by the lower mechanical efficiency. Any improvement in power output available for ambulation must be based on wheelchair ergonomics.

Adult↗

Functional outcomes following surgical repair of wrist extensor tendons.

The long term results following the repair of open injuries to extensors carpi radialis longus and brevis and extensor carpi ulnaris have not previously been reported. A retrospective case note review was performed and patients were called back for assessment following surgical repair. Grip strength and pinch strength were reduced by 9.9% (p=0.017) and 11.5% (p=0.049). Wrist movement was also reduced. This demonstrates that the division of these tendons should not be regarded as trivial as they may have long-term adverse effects on wrist function. Information gained from this study may be beneficial in patient education at the time of injury and may provide useful information when preparing medico legal reports.

Accidents, Home↗

Arthroscopic evaluation of radial osteotomy for Kienböck's disease.

To determine whether osteoarthritic changes of the perilunate articular cartilage improve following radial osteotomy for Kienböck's disease and correlate with clinical results, arthroscopic examination was performed in 18 patients concurrently with radial osteotomy and at the time of removal of implants after an average of 21 months. Clinical results were satisfactory. All patients improved the preoperative level of pain. Wrist function was improved in range of motion and grip strength. Radiographic findings also demonstrated prevention of further collapse of the lunate. However, follow-up arthroscopic examination revealed progression of osteoarthritis in the area of the lunate in two thirds of the cases. There was no correlation between arthroscopic observations and clinical results. A long-term follow-up period is therefore advocated for evaluation of radial osteotomy because of the possibility of additional progression of osteoarthritic changes.

Adolescent↗

Surgical treatment of pediatric scaphoid fracture nonunions.

Scaphoid fractures in the pediatric population are uncommon but can usually be successfully managed with standard immobilization techniques. However, nonunions of pediatric scaphoid wrist fractures have been reported. We present the treatment and outcome of 13 pediatric scaphoid fracture nonunions in 12 children treated over an 18-year period. The average time elapsed between time of fracture and time of surgery was 16.7 months. Four of the nonunions were treated by using the Matti-Russe procedure, and nine were treated with Herbert screw fixation and iliac crest bone grafting. The average time of follow-up was 6.9 years (range, 2-19 years). All cases went on to clinical and radiographic union. There was no statistically significant difference in range of motion or strength between the operative and nonoperative wrist. Eleven of 12 patients demonstrated an excellent rating based on the Mayo Modified Wrist score. The length of time for postoperative immobilization in the Herbert screw group was significantly less than that in the Matti-Russe group. Currently our standard approach to the treatment of scaphoid fracture nonunions in the skeletally immature patient is the use of the Herbert screw and iliac crest bone graft.

Adolescent↗

Parallel comparison of grip strength measures obtained with a MicroFET 4 and a Jamar dynamometer.

Repeated measures of grip strength obtained bilaterally with a Jamar and a MicroFET 4 dynamometer were compared. Measurements obtained with the MicroFET 4 tended to be slightly (2.2-3.1 lb.) higher but were highly correlated (r > or = .96) with those obtained with the Jamar. Parallel reliability for the two devices was excellent (intraclass correlation coefficient > or = .96). Although clinicians should be cautious about using the devices interchangeably, the MicroFET 4 appears to be a legitimate alternative to the Jamar dynamometer.

Adult↗

Reliability of hand-held dynamometry in assessment of knee extensor strength after hip fracture.

OBJECTIVES: To examine the reliability of hand-held dynamometry in assessing knee extensor strength in inpatients undergoing rehabilitation after hip fracture and to examine the discriminant validity of this measure. DESIGN: A total of 16 subjects (14 women; mean +/- SD, 79 +/- 7 yrs) undergoing inpatient rehabilitation after hip fracture volunteered to participate. Isometric knee extensor strength of the fractured and unfractured sides was determined with a hand-held dynamometer. Subjects were retested 1-2 days after the initial testing session. RESULTS: Test-retest intraclass correlation coefficients were high for both the fractured (0.91) and unfractured legs (0.90). A low coefficient of variation was observed for both the fractured (15.3%) and unfractured (14.7%) sides. The maximal knee extensor strength was significantly different when comparing the fractured (7.9 +/- 3 kg) and unfractured (15.6 +/- 4 kg) legs. When comparing test 1 and test 2 mean values for the fractured leg, the scores significantly differed (t = 3.14, P < 0.01), with 13 of 16 subjects scoring higher on test 2. CONCLUSIONS: Hand-held dynamometry is a reliable and valid tool for assessment of knee extensor strength after hip fracture. Reduced knee extensor strength in the fractured leg may be an important component limiting rehabilitation progress in these patients.

Aged↗

Comparative study of functional limitation and disability in old age: Delhi and New York city.

Cross-national variation in elder health is well established, with older adults in developing countries reporting poorer health than elders in developed countries. However, cross-national research using performance-based assessment is rare. We examined grip strength in American and Indian elders using a common methodology and found that older adults in India had significantly poorer strength than the US sample even when matched for age, gender, medical conditions, and self-rated disability. The difference in performance is likely explained by life-long differences in nutrition, occupational demands, and access to medical care. These differences in health among people who have survived to old age may also explain differences in life expectancy in later life.

Activities of Daily Living↗

Arthrodesis of ring finger and little finger metacarpal bases for little finger carpometacarpal joint arthritis.

Five patients with localized little finger carpometacarpal arthritis were treated by excision of the little finger metacarpal base and arthrodesis of the little and ring metacarpals. A dorsal periosteal/capsular flap was used as an interposition graft. All patients achieved significant pain relief, good cosmesis and satisfactory grip strength. All returned to activities of daily living. This procedure, the Dubert procedure, is indicated for localized pathology of the hamate-little finger metacarpal joint. It has theoretical advantages over arthrodesis and resection or interposition arthroplasty as it preserves little finger length, rotation and alignment and maintains some mobility of the transverse carpal arch and the little finger ray.

Activities of Daily Living↗

NeuFlex compared with Sutter prostheses: a blind, prospective, randomised comparison of Silastic metacarpophalangeal joint prostheses.

Forty patients (156 metacarpophalangeal joints) with mutilating rheumatoid arthritis were randomly allocated in a blinded manner to have either NeuFlex or Sutter implants. Indications for operation were pain and severe deformity. Thirty-nine patients were followed up postoperatively for one year. An independent physiotherapist and occupational therapist examined each one. Grip strength, range of motion, and pain during activity and at rest were measured. The Canadian Occupational Performance Measure (COPM) assessed the patients' evaluation of their occupational performance. Both groups had overall good results, but it seems that though patients' mobility and grip strength improve considerably, pain seems to do so only relatively. Most patients seem to be satisfied with the operation and their functional gain. Five out of 78 Sutter and two out of 78 NeuFlex implants broke. We found no major differences between the two designs, but the patients in the NeuFlex group seemed to be more satisfied with their occupational performance (COPM performance) (p=0.05).

Adult↗

Deterioration of muscle function after 21-day forearm immobilization.

PURPOSE: Although it is well known that immobilization causes muscle atrophy, most immobilization models have examined lower limbs, and little is known about the forearm. The purpose of this study was to determine whether forearm immobilization produces changes in muscle morphology and function. METHODS: Six healthy males (age: 21.5 +/- 1.4, mean +/- SD) participated in this study. The nondominant arm was immobilized with a cast (CAST) for 21 d, and the dominant arm was measured as the control (CONT). The forearm cross-sectional area (CSA) and circumference were measured as muscle morphology. Maximum grip strength, forearm muscle oxidative capacity, and dynamic grip endurance were measured as muscle function. Magnetic resonance (MR) imaging was used to measure CSA, and 31phosphorus MR spectroscopy was used to measure time constant (Tc) for phosphocreatine (PCr) recovery after submaximal exercise (PCr-Tc). Grip endurance was expressed by the number of handgrip contractions at 30% maximum grip strength load. All measurements were taken before and after the immobilization. RESULTS: After the 21-d forearm immobilization, no changes were seen for each measurement in CONT. CSA and the circumference showed no significant changes in CAST. However, maximum grip strength decreased by 18% (P < 0.05), PCr-Tc was prolonged by 45% (P < 0.05), and the grip endurance at the absolute load was reduced by 19% (P < 0.05) for CAST. CONCLUSION: In this model, 21-d forearm immobilization caused no significant changes in forearm muscle morphology, but the muscle function showed remarkable deterioration ranging from 18 to 45%.

Adult↗

Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial.

We carried out a randomised, prospective, multicentre clinical trial of the treatment of Colles' fractures. A total of 339 patients was placed into two groups, those with minimally displaced fractures not requiring manipulation (151 patients) and those with displaced fractures which needed manipulation (188 patients). Treatment was by either a conventional Colles' plaster cast (a control group) or with a prefabricated functional brace (the Aberdeen Colles' fracture brace). Similar results were obtained in both groups with regard to the reduction and to pain scores but the brace provided better grip strength in the early stages of treatment. This was statistically significant after five weeks for both manipulated and non-manipulated fractures. At the tenth day the results were statistically significant only in manipulated fractures. There was no significant difference in the functional outcome between the two treatment groups. However, younger patients and those with less initial displacement had better functional results.

Adult↗

Adiposity does not hinder the fitness response to exercise training in obese women.

BACKGROUND: This study examined how sedentary obese (OB) and normal weight (NW) women respond to exercise training; and if fitness levels of the OB and NW are comparable, in spite of differences in adiposity. METHODS: Sedentary OB (n=46, 48.5+/-1.5 yrs, BMI=35.9+/-0.8; mean+/-SEM) and NW (n=43, 48.3+/-1.7 yrs, BMI=21.7+/-0.2) women participated in a 14-week fitness program. RESULTS: There were no group differences in exercise adherence. No changes for either group were found for body weight or composition. Both groups improved similarly in aerobic fitness (VO2max), muscular strength (grip strength), muscular endurance (modified push-up), and flexibility (sit and reach). However, since norms for fitness are generally expressed relative to body weight (e.g. VO2max, ml x kg(-1) x min(-1); grip strength ratios), the OB women continued to be classified as unfit after exercise training, and categorized below the NW women in spite of having absolute scores for VO2max (OB=2.1+/-0.1, NW=1.8+/-0.1 l x min(-1)) and grip strength (OB=65.1+/-1.5, NW= 58.6+/-1.5 kg) that were higher than the NW women. CONCLUSIONS: The data suggest that OB women respond in a similar manner as NW women to exercise; that weight loss is not necessary for improved fitness; and that the OB are not less fit than the NW, but that low fitness scores for the OB are simply a reflection of the absolute scores being deflated because they are proportioned to body weight.

Exercise↗

Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons.

OBJECTIVE: This study examined whether three aspects of functioning (i.e., functional limitations, physical performance, and physical activity) were associated with fractures in older men and women. DESIGN: A 3-year prospective cohort study. PARTICIPANTS AND SETTING: A total of 715 men and 762 women, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam. MEASUREMENTS: During an interview at home, three aspects of functioning were assessed: functional limitations (what people say they can do), physical performance, i.e., three performance tests and handgrip strength (what people are able to do), and physical activity (what people actually do). Afterward, a follow-up on fractures was conducted for 3 years. RESULTS: 77 patients (5.2%) suffered a fracture during 3-year follow-up. Most patients suffered a hip fracture (1.6%) or a wrist fracture (1.4%). The fracture rate per 1,000 person-years was 20.1. During 3-year follow-up, a fracture was reported by 12%, 10%, 12%, and 6% of the respondents with functional limitations, low performance test score, poor handgrip strength, and low physical activity, respectively. Using Cox proportional hazard analysis, functional limitations (RR = 3.5; 95% CI, 2.1 to 6.0), low performance test score (RR = 1.9; 95% CI, 1.1 to 3.3), low handgrip strength (RR = 2.5; 95% CI, 1.5 to 4.1), and low physical activity (RR = 1.9; 95% CI, 1.1 to 3.5) were significantly associated with fractures after adjustment for age and sex. Functional limitations (RR = 3.2; 95% CI, 1.8 to 5.5), low performance test score (RR = 1.8; 95% CI, 1.0 to 3.3) and low handgrip strength (RR = 2.0; 95% CI, 1.1 to 3.6) remained significantly associated with fractures after additional adjustment for body composition, chronic diseases, psychosocial factors, life style factors, and the other levels of functioning. No significant interaction terms were found. CONCLUSIONS: Functional limitations and poor physical performance were independent risk factors for fractures.

Activities of Daily Living↗

Capsulodesis for the treatment of chronic scapholunate instability.

PURPOSE: Scapholunate (SL) instability is the most common form of carpal instability. The treatment of this disorder is challenging and varying treatment options have been described. The purpose of this study was to examine the intermediate-term results of dorsal capsulodesis for cases of chronic SL dissociation. METHODS: A retrospective analysis was conducted that examined all dorsal capsulodesis procedures performed for chronic SL dissociation between January of 1990 and February of 2000. Wrist pain had to be present for greater than 3 months. Patients had to have a minimum follow-up period of 2 years for inclusion in the study. Thirty-one patients were identified with isolated chronic SL dissociation. Of the 31 patients 18 had dynamic carpal instability and 13 had static carpal instability. The time from injury to surgery averaged 20 months. The follow-up period averaged 54 months (range, 24-96 mo). All patients had a dorsal capsulodesis procedure using either a Blatt or Mayo technique. Results were reviewed clinically and radiologically. Static and dynamic groups were compared with a Student t test. RESULTS: There was a 20% decrease in wrist motion after capsulodesis. There was no improvement in grip strength after surgery. Most patients had improvement in pain but only 2 patients were completely pain free. Radiographically the SL gap increased over time from 2.7 mm before surgery to 3.9 mm at the final follow-up evaluation. The SL angle also increased from 56 degrees before surgery to 62 degrees on final follow-up evaluation. There was no statistical difference in overall wrist motion, grip strength, or wrist score between the dynamic and static groups. The time to surgery and age had no significant effect on overall outcome. CONCLUSIONS: Dorsal capsulodesis provided pain relief for patients with both dynamic and static SL instability. Although pain was improved it was not completely resolved in the majority of cases. From a radiographic perspective dorsal capsulodesis did not provide maintenance of carpal alignment in cases of chronic SL dissociation.

Adolescent↗