AN ELECTROMYOGRAPHIC ANALYSIS OF THE SHOULDER COMPLEX MUSCULATURE WHILE PERFORMING EXERCISES USING THE BODYBLADE? CLASSIC AND BODYBLADE? PRO

Background

In spite of the bodyblade (BB®) being used in clinical settings during shoulder and trunk rehabilitation and training for 24 years, there are only five known scientific papers that have described muscle recruitment patterns using the BB®. Moreover, there are no known studies that have examined muscle activity differences between males and females (who both use the bodyblade in the clinic) or between different BB® devices.

Hypothesis/Purpose

The primary purposes of this investigation were to compare glenohumeral and scapular muscle activity between the Bodyblade® Pro (BB®P) and Bodyblade® Classic (BB®C) devices while performing a variety of exercises, as well as to compare muscle activity between males and females. It was hypothesized that glenohumeral and scapular muscle activity would be significantly greater in females compared to males, significantly greater while performing exercises with the BB®P compared to the BB®C, significantly different among various BB® exercises, and greater with two hand use compared to one hand use for the same exercise.

Study Design

Controlled laboratory study using a repeated-measures, counterbalanced design.

Methods

Twenty young adults, 10 males and 10 females, performed seven BB® exercises using the BB®C and BB®P, which are: 1) BB®1 - one hand, up and down motion, arm at side; 2) BB®2 - one hand, front to back motion, shoulder flexed 90 °; 3) BB®3 - one hand, up and down motion, shoulder abducted 90 °; 4) BB®4 - one hand, side to side motion, shoulder and elbow flexed 45 °; 5) BB®5 - two hands, side to side motion, shoulders and elbows flexed 45 °; 6) BB®6 - two hands, up and down motion, shoulders flexed 90 °; and 7) BB®7 - two hands, front to back motion, shoulders flexed 90 °. EMG data were collected from anterior and posterior deltoids, sternal pectoralis major, latissimus dorsi, infraspinatus, upper and lower trapezius, and serratus anterior during 10 sec of continuous motion for each exercise, and then normalized using maximum voluntary isometric contractions (MVIC). A two-factor repeated measures Analysis of Variance (p < 0.05) was employed to assess differences in EMG activity between BB® devices (BB®C and BB®P) and genders.

Results

As hypothesized, for numerous exercises and muscles glenohumeral and scapular EMG activity was significantly greater in females compared to males and was significantly greater in the BB®P compared to BB®C. There were generally no significant interactions between BB® devices and gender. Overall glenohumeral and scapular muscle activity was significantly greater in BB®3 and BB®6 compared to the remaining exercises, but generally not significantly different between using one hand and using two hands.

Conclusions

It may be appropriate to employ BB® exercises during shoulder rehabilitation earlier for males compared to females and earlier for the BB®C compared to the BB®P given less overall muscle activation in males and BB®C compared to in females and BB®P. There was generally no difference in muscle activity between performing the BB® with one-hand or two-hands. Differences in muscle activity between exercises generally was the similar regardless if the BB®C or the BB®P was employed.

Level of Evidence

Level 2     

WHAT ARE THE EFFECTS OF DIFFERENT MODES OF EXERCISE TRAINING FOR INTERMITTENT CLAUDICATION? - A COCHRANE REVIEW SUMMARY WITH COMMENTARY

The aim of this commentary is to discuss from a rehabilitation perspective the published Cochrane Review “Modes of exercise training for intermittent claudication”(1) by Jansen SCP et al¹, under the direct supervision of Cochrane Vascular. This Cochrane Corner is produced in agreement with the Journal of Rehabilitation Medicine by Cochrane Rehabilitation.Key words: Cochrane Review Summary, exercise training, intermittent claudication, systematic review, walking     

THE HUMAN SPLEEN AS AN H?MATOPLASTIC ORGAN,AS EXEMPLIFIED IN A CASE OF SPLENOMEGALY WITH SCLEROSIS OF THE BONE-MARROW

1. The nodules found in the spleen are islands of active hæmatoplastic tissue. 2. The bone-marrow, at least in the case which has been described, has been the primary focus of disease; some toxin has probably produced a chronic inflammatory change. 3. The bone-marrow, owing to its enormous sclerosis, has lost its hæmopoëtic powers totally or to a marked degree and the spleen has reverted to its fœtal power to form blood.     

THE MINIMUM CLINICALLY IMPORTANT DIFFERENCE ON THE VISA‐A AND LEFS FOR PATIENTS WITH INSERTIONAL ACHILLES TENDINOPATHY

Study Design

Cohort study of subjects with insertional Achilles tendinopathy (IAT).

Objectives

The purpose of this study was to establish the minimum clinically important difference (MCID) on the Victorian Institute of Sport Assessment ‐ Achilles Questionnaire (VISA‐A) and the Lower Extremity Functional Scale (LEFS) for patients with IAT.

Background

The VISA‐A and LEFS are two measures commonly utilized for patients with IAT. Previous authors have estimated the MCID for the VISA‐A, but a MCID has not been formally established. The MCID for the LEFS has been established for patients with lower extremity conditions in general, but it is not clear if this MCID is applicable to patients with IAT.

Methods

Fifteen subjects participating in a randomized controlled trial studying the effectiveness of intervention for IAT over a 12‐week period were included in this study. Subjects completed the VISA‐A and LEFS forms at baseline and 12 weeks after the initiation of treatment. All subjects also completed a 15‐point global rating of change (GROC) questionnaire at 12 weeks after the initiation of treatment. Subjects were classified as improved or stable based on their GROC scores.

Results

The area under the curve (AUC) for the VISA‐A was 0.97 and a MCID of 6.5 points was identified. The AUC for the LEFS was 0.97 and a MCID of 12 points was identified.

Conclusion

The VISA‐A and LEFS are both useful outcome measures to assess response in patients with IAT.

Level of Evidence

3     

THE RELIABILITY,MINIMAL DETECTABLE CHANGE AND CONSTRUCT VALIDITY OF A CLINICAL MEASUREMENT FOR QUANTIFYING POSTERIOR SHOULDER TIGHTNESS IN THE POST‐OPERATIVE POPULATION

Background:

Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Although reliable and valid measures have been described for the non‐operative population one does not exist for the post‐operative population.

Study Design:

Blinded repeated measures design.

Purpose:

Investigate the intrarater reliability, minimal detectable change at the 90% confidence interval (MDC₉₀) and construct validity of an inclinometric measurement designed to quantify PST in the post‐operative population.

Methods:

One investigator performed PST measurements on the operative shoulder of 23 participants. Passive internal and external rotation measurements were performed for the validity component of the investigation.

Results:

Intrarater reliability using an intraclass correlation coefficient (ICC) model 3,k was good (ICC = 0.79). The MDC₉₀ indicated that a change of greater than or equal to 8 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter‐trial variability or measurement error. Construct validity was supported by a statistically significant relationship between PST and internal rotation r = 0.54 and by a relationship between PST and external rotation r = 0.30 which was not statistically significant.

Conclusion:

The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST in the post‐operative population. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values.

Level of Evidence:

Therapy, level 2b     

WHEN IS AN AORTIC VALVE PROSTHESIS TOO SMALL? THE NEED FOR DOBUTAMINE STRESS ECHOCARDIOGRAPHY

We describe a patient who had undergone aortic valve replacement with a small prosthesis 10 years previously and who presented with exertional breathlessness. The resting transaortic pressure gradient was only 30 mmHg but increased to 165 mmHg on dobutamine stress. Conventional resting echocardiography may fail to demonstrate abnormal prosthetic aortic valve function; in the presence of symptoms, dobutamine stress echocardiography should be considered.     

THE COMPARISON OF THE EMPTY CAN AND FULL CAN TECHNIQUES AND A NEW DIAGONAL HORIZONTAL ADDUCTION TEST FOR SUPRASPINATUS MUSCLE TESTING USING CROSS‐SECTIONAL ANALYSIS THROUGH ULTRASONOGRAPHY

Purpose/Background:

Several examination tests are currently used for diagnosing a supraspinatus lesion. The empty can (EC) test is currently considered the gold standard for testing, but full can (FC) testing is also utilized. Both of these tests do not fully eliminate the deltoid synergistic when resistance is applied. A new diagonal horizontal adduction (DHA) technique has been developed for evaluation of the supraspinatus that has not yet been compared with the existing techniques (EC/FC). Cross‐sectional analysis (CSA) change during contraction as an ultrasonographic means of visualizing and measuring contraction of the supraspinatus has been reported previously.

Objective:

The purpose of this study was to use diagnostic musculoskeletal ultrasound (MSK) to compare CSA of the supraspinatus during the FC, EC, and the DHA tests.

Methods:

The supraspinatus muscle of 37 healthy, uninjured volunteers (21 males and 16 females, mean age of 26.9) were visualized and CSA was captured during 4 randomly assigned test positions (including control) using MSK.

Results:

A one‐way Analysis of Variance with repeated measures of the mean CSA obtained in the testing positions was performed followed by least significant difference (LSD) for post‐hoc analysis. Significant differences (p < 0.05) were found between the mean CSA of the controls and the CSA of each of the three testing procedures analyzed using the MSK. There were no significant differences (p < 0.05) in CSA between any of the three testing procedures.

Conclusions:

In this study, MSK visualized and objectified activity of the supraspinatus muscle as evidenced through increased mean CSA when resisted. All the testing positions (FC, EC, and DHA) demonstrated significantly increased mean CSA of the muscle when isometrically contracted when compared to the resting control. The DHA procedure also elicited significant increase in CSA of the supraspinatus. However, no significant difference was found between the CSA of the DHA when compared to the FC and EC tests.

Level of Evidence:

Level 2     

A SECOND CASE OF GONORRH?AL SEPTIC?MIA AND ULCERATIVE ENDOCARDITIS WITH OBSERVATIONS UPON THE CARDIAC COMPLICATIONS OF GONORRH?A

(1) An acute gonorrhœal urethritis may be the starting point for a grave general septicæmia with all its possible complications. (2) These infections may be mixed or secondary, due to the entrance into the circulation of organisms other than the gonococcus, or they may be purely gonococcal in nature. (3) Endocarditis is an occasional complication of gonorrhœa. (4) This endocarditis may be transient, disappearing with but few apparent results, or it may leave the patient with a chronic valvular lesion, or it may pursue a rapidly fatal course with the symptoms of acute ulcerative endocarditis. (5) The endocarditis associated with gonorrhœa is commonly due to the direct action of the gonococcus, hut may be the result of a secondary or mixed infection. (6) Pericarditis may also occur as a complication of gonorrhœa, but it is less frequent than endocarditis. It may, as in the case of the latter, be the result either of a pure gonococcal or of a mixed infection. (7) Grave myocardial changes, necroses, purulent infiltration, embolic abscesses are common in the severe gonococcal septicæmias. (8) In instances of gonococcal septicæmia the diagnosis may, in some cases, be made during life by cultures taken from the circulating blood according to proper methods.     

THE SERUM SAMPLE CAN BE DIRECTLY ADDED INTO REAL- TIME PCR TUBE WITH MNIR： A NEW NUCLEIC ACID ISOLATION TECHNOLOGY

The real -time PCR technique for detection and quantification of hepatitis B virus DNA has been used broadly in clinic diagnosis in the world , especially in china. But the HBV DNA used in amplification must be extracted by many steps of tube to tube, repeating washes centrifugations and other operations, such as Phenol - chloroform, Guanidinium thiocyanate （GuSCN） - silica and QIAamp,     

'FRET NO MORE MY CHILD… FOR I'M ALL OVER HEAVEN ALL DAY': RELIGIOUS BELIEFS IN THE BEREAVEMENT OF AFRICAN AMERICAN,MIDDLE-AGED DAUGHTERS COPING WITH THE DEATH OF AN ELDERLY MOTHER

This article examines the ways in which religious beliefs of 30 African American, middle-aged daughters help them cope with the death of their elderly mothers. This qualitative, exploratory study found that daughters use their beliefs to move through states of grief that allow them to prepare, relinquish control, accept death, and maintain a connection to their mothers beyond death. Important themes identified in this study include the belief in an afterlife and the reunification of family members there. Findings suggest that religious beliefs provide a means for adult daughters to cope with the tasks of living in the present yet maintain a tie with their deceased mothers that serves to enhance their religious beliefs and fortitude in daily living.     

DOES THE ERADICATION OF HELICOBACTER PYLORI CURE DUODENAL ULCER DISEASE IN COMMUNITIES WITH A HIGH PREVALENCE RATE? COMPARISON WITH LONG-TERM ACID SUPPRESSION

The long-term effect of Helicobacter pylori eradication on the natural history of duodenal ulcer has been investigated and compared with long-term acid suppression treatment in an endemic community for infection. Seventy-three patients with endoscopically verified H. pylori positive active duodenal ulcer disease were included in this prospective study. Patients were divided into two groups. Group A patients (n = 39) were given an omeprazole-based triple eradication regimen, while group B patients (n = 34) were given omeprazole alone followed by long-term famotidine 20 mg daily as maintenance treatment. A control endoscopy was performed at the third month of treatment. The bacterium was eradicated in 32 (82%) of group A patients. All patients were followed up for two years and an endoscopy performed at the end of each year. H. pylori recurred in 13 patients and the reinfection rate was 44.8% over two years. Duodenal ulcer recurred in seven of these patients at two years (24.1%). There was a close association between H. pylori reinfection and ulcer relapse. Group B patients remained H. pylori positive during the study and the ulcer recurred in five of these patients (6.6%) despite continuous famotidine treatment. There was no statistically significant difference in ulcer relapse rate between the groups. These results suggested that H. pylori eradication is not an absolute solution for duodenal ulcer disease in high endemic regions and continuous maintenance treatment with H2-receptor antagonists is still an alternative approach in some chronic recurrent cases.     

EXPERIMENTS ON THE PRODUCTION OF SPECIFIC ANTISERA FOR INFECTIONS OF UNKNOWN CAUSE : I. TYPE EXPERIMENTS WITH KNOWN ANTIGENS—A BACTERIAL HEMOTOXIN (MEGATHERIOLYSIN), THE PNEUMOCOCCUS,AND POLIOMYELITIC VIRUS.

Attempts to produce antisera in animals to combat specific infections are usually deferred until the cause of the infection has been isolated and grown in pure culture to furnish antigen. It has seemed to us that the fulfillment of these conditions might in some cases be rendered unnecessary through the use of infected tissue itself as an antigen, combined with selective absorption of the antiserum to rid it of elements injurious to the species furnishing the tissue. In order to test this possibility type experiments have been carried out with immune sera effective against known antigens of three different sorts: 1. Sera resulting from the injection of rabbits and a goat with normal guinea pig tissues and a bacterial hemotoxin, the megatheriolysin described by Todd, which hemolyzes guinea pig cells. The sera possessed strong antitoxins for the megatheriolysin but were fatal to guinea pigs. By the method of selective absorption they were rendered innocuous to these animals and were successfully used to protect them from lethal doses of the megatheriolysin. 2. Anti-rabbit dog sera containing antibodies protective against pneumococcus infection. Such sera, subjected to repeated absorption with rabbit red cells, proved capable of protecting mice from pneumococcus infection in exactly the same degree as the unexhausted serum; that is to say, they protected against 100 times the dose of pneurnococci that was fatal with normal dog serum. 3. The serum of a monkey recovered from poliomyelitis and repeatedly injected with human red cells and extract of placental tissue. This serum, after selective absorption with human red cells, protected a monkey against an intracerebral dose of poliomyelitic virus fatal to eight other monkeys given it with normal monkey or human serum. The results in these instances, purposely chosen for their simplicity, would seem to indicate for the absorption method some usefulness in the study of immunity to infections of unknown cause. In Part II of our paper the method is applied to one such infection; namely, a sarcoma of the fowl engendered by a filterable agent. A general discussion will be found in connection with this portion of the work.     

I S T HERE G ENDER B IAS IN THE P REHOSPITAL M ANAGEMENT OF P ATIENTS WITH A CUTE C HEST P AIN ?

Objective. Prior emergency department (ED) and inpatient studies have found that women with coronary artery disease are more frequently misdiagnosed and undertreated compared with men. This study was performed to determine whether there is a gender bias in the prehospital management of patients with acute chest pain. Methods. This study was performed in a large urban county emergency medical services (EMS) agency with approximately 40,000 patient contacts/year. The study population comprised consecutive patients ≥45 years old with a chief complaint of atraumatic chest pain. Using χ² analysis and the unpaired Student's t-test, male and female patient encounters were compared. This study had >80% power (alpha 0.05) to detect a 3% difference between populations. Results. Data from 2,858 consecutive patient encounters were analyzed, with females comprising 1,508 (53%). Females were significantly older than males (67 ± 13.1 vs. 62.7 ± 12.3 years, p < 0.001). Male patients were more likely to receive aspirin (42.3% vs. 35.4%, p < 0.001) and 12-lead electrocardiograms (ECGs) (46.8% vs. 39.3%, p < 0.001) compared with female patients. The rates of transport refusal, oxygen, nitroglycerin, and narcotic administration did not differ between populations. Conclusion. Although females presenting to this urban EMS system with acute chest pain were older, they received significantly less aspirin and fewer 12-lead ECGs in the field. These results suggest strategies must be developed to ensure that appropriate therapy is provided to women presenting to EMS systems with acute cardiac ischemia.