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1.
BackgroundAdjunct therapies (ATs) may further improve outcomes after botulinum toxin injections in spastic patients, but evidence was unclear in previous systematic reviews.ObjectiveTo assess the efficacy of non-pharmacological ATs in spastic adults according to the International Classification of Functioning, Disability and Health and build an expert consensus-based on a Delphi process.MethodsFour electronic databases were searched up to May 2020 for reports of comparative trials of non-pharmacologic ATs after botulinum toxin injections in spastic adults. Then, 25 French experts participated in a two-round Delphi process to build recommendations on the use of ATs.ResultsWe included 32 studies (1202 participants, median 32/study) evaluating the effects of physical agents (n = 9), joint posture procedures (JPPs, n = 11), and active ATs (n = 14), mainly after stroke. The average quality of articles was good for randomised controlled trials (median [interquartile range] PEDro score = 7 [6–8]) but moderate (n = 2) or poor (n = 2) for non-randomised controlled trials (Downs & Black checklist). Meta-analysis was precluded owing to the heterogeneity of ATs, control groups and outcome measures. There is evidence for the use of JPPs except low-dose manual stretching and soft posture techniques. Continuous postures (by taping or casting) are recommended; discontinuous postures (by orthosis) may be preferred in patients with active function. Device-free or device-assisted active ATs may be beneficial in the mid-term (> 3 months after botulinum toxin injections), particularly when performed at a high-intensity (> 3 h/week) as in constraint-induced movement therapy. Self-rehabilitation remains understudied after a focal treatment, but its interest is highlighted by the experts. The use of physical agents is not recommended.ConclusionsJPPs and active ATs (device-assisted or device-free) may further improve impairments and activities after botulinum toxin injections. Further studies are needed to better define the best strategies for ATs as a function of the individual treatment goals, participation and quality of life.Review RegistrationPROSPERO (CRD42018105856).  相似文献   
2.
Background and aimsIn this cross-sectional study we investigate the association between handgrip strength (HGS) and muscle function of the lower limbs and the predictors of the appendicular lean mass index (ALMI) in older adults with obesity of both sexes.Methods and resultsEighty-four older (67 ± 5 years) men (N = 44) and women (N = 40) with obesity (body mass index (BMI) 33 ± 4 kg/m2) performed: the HGS, isokinetic knee extensors (KE) and flexors (KF) muscle strength and power and Short Physical Performance Battery (SPPB). The correlation between HGS and lower limbs muscle function was evaluated, and four multiple hierarchical linear models were built to assess the contribution of each ALMI predictor (i.e., HGS, BMI, SPPB, muscle strength and power).In men, HGS was weakly-to-moderately associated (p < 0.05) with KE, KF muscle function and physical performance. In women, HGS showed a weak association (p < 0.05) with KE muscle function. The significant predictors of ALMI were only the BMI in women, whereas in the group of men BMI, KE maximal strength and power better explain the variance in ALMI than HGS alone.ConclusionOur results suggest that HGS should not be used alone as a marker of lower muscle nor physical function. Sex differences exist with the BMI that is a contributor of ALMI both in men and women. However, at least in the group of men, markers related to strength and power of the lower limbs can better describe variations in ALMI compared to HGS in this kind of population.Clinical trial registrationNA.  相似文献   
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BackgroundFalls in older persons are associated with muscle mass and strength alterations, which may also affect balance parameters. However, the most appropriate combined approach to assess muscle and balance components that predict falls in older persons is still lacking.Research questionWe hypothesized that appendicular lean and/or mid-thigh mass and muscle strength and performance are positively associated with balance indices and fall risk in older persons.MethodsCross-sectional analyses of retrospective data from 260 participants with risk and/or history of falls examined at a Falls and Fracture Clinic. Assessments included a comprehensive clinical exam, bone densitometry and body composition by DXA, grip strength, gait speed, posturography, timed up and go (TUG) and four-square step (FSST) tests. Retrospective falls and fracture history was collected. Associations between appendicular and mid-thigh lean mass and muscle strength/performance vs balance indicators were determined before and after adjusting for age and gender.ResultsMean age of participants was 78 ± 6.7 (65−96) years. Both appendicular and mid-thigh lean masses corrected for BMI (but not for height2), and muscle strength and performance measures are associated with better dynamic balance. Conversely, static balance indicators showed less consistent associations with lean mass. Only TUG and sit to stand time consistently showed significant associations with most static balance indicators.SignificanceCombined with strength and performance parameters, ALM and mid-thigh estimates adjusted by BMI strongly correlate with dynamic balance parameters and could become practical elements of falls risk assessment as well as markers of therapeutic response to falls prevention interventions.  相似文献   
5.
目的探讨维持性血液透析(MHD)患者血清维生素D水平对下肢肌力减退的预测作用。 方法横断面研究设计,选择2018年9月至10月于战略支援部队特色医学中心血液净化中心的95例MHD患者,检测其血清25-羟维生素D3[25(OH)D3]水平,采用5次站立-坐下实验(5-STS)评价其下肢肌力。根据5-STS完成时间将MHD患者分为下肢肌力正常组(n=85)与减退组(n=10),比较两组患者人口学特征、实验室指标。采用多因素Logistic回归分析下肢肌力减退的影响因素,绘制受试者工作特征(ROC)曲线分析上述因素预测MHD患者发生下肢肌力减退的特异度和敏感度。 结果95例MHD患者血清25(OH)D3水平为11.00~99.50 nmol/L,中位数31.23(19.90~43.30)nmol/L;5-STS完成时间为3.55 s~18.71 s,中位数9.81(7.12,12.43)s,下肢肌力减退者10例(10.53%)。多因素Logistic回归分析显示,血清25(OH)D3是MHD患者下肢肌力减退的保护性因素[OR=0.761,95%CI(0.592~0.978),P=0.033]。进一步ROC曲线分析显示,25(OH)D3对应的ROC曲线下面积为0.815,其预测MHD患者发生下肢肌力减退的敏感度为80.00%,特异度为80.00%。 结论MHD患者血清25(OH)D3水平普遍较低,下肢肌力减退者更为明显;血清维生素D水平对MHD患者是否存在下肢肌力减退具有较好的预测价值。  相似文献   
6.
股四头肌肌力减弱、收缩障碍、伸膝障碍是膝关节术后常见的临床表现,这一现象被称为关节源性肌肉抑制(AMI)。AMI会导致肌力训练无效、肌肉萎缩、运动功能下降,甚至骨关节炎的发生。然而,关于AMI的原理和治疗国内关注和报道较少。本文通过对中国知网、万方、维普、Pubmed、CINAHL、EMBASE、Cochrane Library电子数据进行全面的检索,仅纳入同行评议文章,用描述性系统综述的方法简述膝关节术后股四头肌抑制的原理,总结目前国内外股四头肌抑制的治疗方法,以期为临床工作提供借鉴。  相似文献   
7.
BACKGROUNDThe management of vascular graft infections continues to be a significant challenge in a clinical situation. The aim of this report is to illustrate the novel vacuum sealing drainage (VSD) technique and rectus femoris muscle flap transposition for vascular graft infections, and to evaluate the prospective of future testing of this surgical procedure.CASE SUMMARYWe report the case of a 32-year-old male patient, who presented a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure. Using the VSD and muscle flap trans-position, the groin wound and vascular graft infection were finally treated successfully.CONCLUSIONOur case report highlights that VSD technique and rectus femoris muscle flap transposition could be considered in patients presenting with a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure, especially in consideration of treatable conditions.  相似文献   
8.
《Clinical neurophysiology》2021,132(4):967-974
ObjectiveChronic fatigue syndrome (CFS) and fibromyalgia (FM) are disorders of unknown etiology and unclear pathophysiology, with overlapping symptoms of – especially muscular –fatigue and pain. Studies have shown increased muscle fiber conduction velocity (CV) in the non-painful muscles of FM patients. We investigated whether CFS patients also show CV abnormalities.MethodsFemales with CFS (n = 25), with FM (n = 22), and healthy controls (n = 21) underwent surface electromyography of the biceps brachii, loaded up to 20% of maximum strength, during short static contractions. The mean CV and motor unit potential (MUP) velocities with their statistical distribution were measured.ResultsThe CV changes with force differed between CFS-group and both FM-group and controls (P = 0.01). The CV of the CFS-group increased excessively with force (P < 0.001), whereas that of the controls increased only slightly and non-significantly, and that of the FM-group did not increase at all. In the CFS-group, the number of MUPs conveying very high conduction velocities increased abundantly with force and the MUPs narrowed.ConclusionOur results suggest disturbed muscle membrane function in CFS patients, in their motor units involved in low force generation. Central neural deregulation may contribute to this disturbance.SignificanceThese findings help to detangle the underlying mechanisms of CFS.  相似文献   
9.
BackgroundFalling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role.Research questionDoes walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals?MethodsIn this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0 %, 20 % and 30 % variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection.Results46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2 mm), polio survivors stepped less accurately onto targets (36.4±0.9 mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3 %, ObR: 59±4 %) than healthy individuals (100±0.3 %, p < 0.001 and 94±3 %, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001).SignificancePolio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance, which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.  相似文献   
10.
ObjectivesThe aim of this investigation was to determine if acute or repeated applications of ischemic preconditioning (IPC) could enhance the recovery process, following exercise induced muscle damage (EIMD).DesignRandomized control trial.MethodsTwenty-three healthy males were familiarised with the muscle damaging protocol (five sets of 20 drop jumps from a 0.6 m box) and randomly allocated to one of three groups: SHAM (3 × 5 min at 20 mmHg), Acute IPC (3 × 5 min at 220 mmHg) and Repeated IPC (3 days x 3 × 5 min at 220 mmHg). The indices of muscle damage measured included creatine kinase concentration ([CK]), thigh swelling, delayed onset muscle soreness, counter movement jumps (CMJ) and maximal voluntary isometric contraction (MVIC).ResultsBoth acute and repeated IPC improved recovery in MVIC versus SHAM. Repeated IPC led to a faster MVIC recovery at 48 h (101.5%) relative to acute IPC (92.6%) and SHAM (84.4%) (P < 0.05). Less swelling was found for both acute and repeated IPC vs. SHAM (P < 0.05) but no group effects were found for CMJ, soreness or [CK] responses (P > 0.05).ConclusionTaken together, repeated IPC can enhance recovery time of MVIC more than an acute application, and both reduce swelling following EIMD, relative to a SHAM condition.  相似文献   
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