Remote Influences of Acupuncture on the Pain Intensity and the Amplitude Changes of Endplate Noise in the Myofascial Trigger Point of the Upper Trapezius Muscle

Chou L-W, Hsieh Y-L, Kao M-J, Hong C-Z. Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle.

Objective

To investigate the remote effect of acupuncture on the pain intensity and the endplate noise (EPN) recorded from a myofascial trigger point (MTrP) of the upper trapezius muscle.

Design

Randomized controlled trial.

Setting

University hospital.

Participants

Patients (N=20) with active MTrPs in upper trapezius muscles and no experience in acupuncture therapy.

Interventions

Patients were divided into 2 groups. Those in the control group received sham acupuncture, and those in the acupuncture group received modified acupuncture therapy with needle insertion into multiple loci to elicit local twitch responses. The acupuncture points of Wai-guan and Qu-chi were treated.

Main Outcome Measures

Subjective pain intensity (numerical pain rating scale) and mean EPN amplitude in the MTrP of the upper trapezius muscle.

Results

The pain intensity in the MTrP was significantly reduced after remote acupuncture (from 7.4±0.8 to 3.3±1.1; P<.001), but not after sham acupuncture (from 7.4±0.8 to 7.1±0.9; P>.05). The mean EPN amplitude was significantly lower than the pretreatment level after acupuncture treatment (from 21.3±9.5μV to 9.5±3.5μV; P<.01), but not after sham acupuncture treatment (from 19.6±7.6μV to 19.3±7.8μV; P>.05). The change in the pain intensity was significantly correlated with the change of EPN amplitude (r = 0.685).

Conclusions

Both subjective changes in the pain intensity and objective changes of the EPN amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points. This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control.     

Effects of ankle joint mobilizations in adults poststroke: a pilot study

Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.

Objective

To compare the effect of 2 interventions on ankle mobility, ankle kinematics, and weight-bearing symmetry during functional activities in subjects with hemiparesis after a stroke.

Design

Randomized trial.

Setting

Academic medical center.

Participants

A convenience sample of 16 subjects with hemiparesis after stroke (mean age, 55.2y; mean time since stroke, 21.4mo).

Intervention

Subjects received 8 sessions over 4 weeks of either functional task practice combined with ankle joint mobilizations, or functional task practice only.

Main Outcome Measures

Changes in ankle range of motion (ROM) (not blinded), ankle kinematics during sit-to-stand (STS) and gait, and lower-extremity weight-bearing symmetry during STS and static standing.

Results

The combined intervention group gained 5.7°±3.1° in passive ankle ROM compared with 0.2°±2.6° in the functional practice only group (95% confidence interval [CI], 2.5-8.6; P<.01). No significant changes in ankle kinematics or weight bearing during static standing were noted in either group. The functional practice group decreased differences in weight bearing during STS by 9.5%±6.47%, whereas the combined intervention group increased this difference by 3.37%±5.29% (95% CI, 3.26-19.46; P=.01).

Conclusions

The increase in ankle motion did not improve joint kinematics and may have prevented improvement in weight-bearing symmetry.     

Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.

Objectives

To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle.

Design

We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1β (IL-1β), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance.

Setting

A biomedical research facility.

Participants

Nine healthy volunteer subjects.

Interventions

Not applicable.

Main Outcome Measures

Preselected analyte concentrations.

Results

Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).

Conclusions

We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs.     

Accuracy of Manual Needle Placement for Gastrocnemius Muscle in Children With Cerebral Palsy Checked Against Ultrasonography

Yang EJ, Rha D, Yoo JK, Park ES. Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography.

Objective

To investigate the accuracy of manual needle placement into gastrocnemius muscle (GCM) for botulinum toxin type A (BTX-A) injection in children with spastic cerebral palsy (CP).

Design

Prospective clinical study.

Setting

University-affiliated hospital.

Participants

A total of 272 injections in GCMs of 39 children with spastic CP who were scheduled to receive BTX-A injections in GCMs.

Intervention

Not applicable.

Main Outcome Measures

The accuracy of manual needle placement was checked against ultrasonography.

Results

The needle was accurately inserted into GCM muscles in 78.7% of cases. Accuracy was 92.6% into gastrocnemius medialis (GM) and 64.7% into gastrocnemuis lateralis (GL). Muscle thickness at the needle insertion site was significantly thinner in GL than GM. Accuracy of GL in the younger age group (<4y, 57.6%) was lower than in the older age group (≥4y, 78.1%). For GM, accuracy in both younger and older age groups was good (>90%).

Conclusions

Injection of the toxin into GCMs through the use of anatomic landmark was acceptable in GM, but not acceptable in GL, especially in young children.     

Effect of botulinum toxin injection in the rectus femoris on stiff-knee gait in people with stroke: a prospective observational study

Stoquart GG, Detrembleur C, Palumbo S, Deltombe T, Lejeune TM. Effect of botulinum toxin injection in the rectus femoris on stiff-knee gait in people with stroke: a prospective observational study.

Objective

To study the effect of botulinum toxin type A (BTX-A) injection in the rectus femoris on the decreased knee flexion during the swing phase of gait (stiff-knee gait) in people with stroke.

Design

Intervention study (before-after trial) with an observational design.

Setting

Outpatient rehabilitation clinic and gait laboratory.

Participants

Nineteen chronic hemiparetic adults presenting with stiff-knee gait.

Intervention

Injection of 200U of BTX-A (Botox) into the rectus femoris.

Main Outcome Measures

Before and 2 months after BTX-A rectus femoris injection: Stroke Impairment Assessment Set (SIAS), Duncan-Ely test, and an instrumented gait analysis.

Results

Median SIAS score improved from 53 (range, 36−65) to 57 (range, 42−70) (signed-rank test, P=.005) and the Duncan-Ely score from 3 (range, 1−3) to 1 (range, 0−3) (P<.001). In gait analysis, mean (± standard deviation) maximum knee flexion improved from 26°±13° to 31°±14° during the swing phase (paired t test, P<.001), knee flexion speed at toe-off improved from 82°±63° to 112°±75°/s (P=.009), and knee negative joint power (eccentric muscular contraction) improved from −.27±.23 to −.37±.26W/kg (P<.001). The 4 patients who almost did not flex the knee (<10°) before the BTX-A rectus femoris injection did not improve after the injection. The other 14 patients who flexed the knee more than 10° before the BTX-A rectus femoris injection decreased the walking energy cost from 5.4±1.6 to 4.6±1.3J·kg⁻¹·m⁻¹ (P=.006).

Conclusions

BTX-A rectus femoris injection may be beneficial in patients with a stiff-knee gait after stroke, particularly in patients with some knee flexion (>10°).     

Test position and hip strength in healthy adults and people with chronic stroke

Barbic S, Brouwer B. Test position and hip strength in healthy adults and people with chronic stroke.

Objective

To determine if peak torques generated by the hip flexors and extensors are dependent on test position in healthy adults and in people with chronic stroke.

Design

Cross-sectional study.

Setting

Motor performance laboratory.

Participants

Volunteers were 10 young (20.7±1.5y), 10 older adults (62.1±7y), and 10 stroke survivors (60.6±10y) who were an average of 5 years poststroke.

Interventions

Not applicable.

Main Outcome Measures

Isokinetic (60°/s) peak concentric hip flexor and extensor torques (in Nm/kg) generated in supine and standing positions.

Results

Peak flexor torques measured in standing were generally higher than in supine (P=.018); a pattern evident in all groups, but significant only in stroke. An interaction between test position and group for hip extensor strength (P=.016) reflected 2 distinct patterns in which torques were highest in standing among the young subjects and highest in supine after stroke.

Conclusions

Isokinetic hip flexor and extensor strength measured in standing and supine are comparable in young and older healthy people. In chronic stroke, the test position may over or underestimate maximum peak torque depending on the muscle group tested, particularly on the side ipsilateral to the lesion. These findings may have implications for predicting functional ability from strength measurements.     

5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity.

Objectives

To examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

A convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.

Interventions

Not applicable.

Main Outcome Measures

5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.

Results

Excellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (ρ=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.

Conclusions

The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke.     

Isometric Muscle Function of Knee Extensors and the Relation With Functional Performance in Patients With Stroke

Gerrits KH, Beltman MJ, Koppe PA, Konijnenbelt H, Elich PD, de Haan A, Janssen TW. Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke.

Objective

(1) To examine the isometric strength, speed, and fatigue resistance of the knee extensors of the paretic limb and nonparetic limb in patients with stroke and compare these with able-bodied subjects. (2) To relate the contractile properties with different indices of functional performance.

Design

Case-control study.

Setting

Rehabilitation center research laboratory.

Participants

Eighteen stroke patients and 10 able-bodied controls.

Interventions

Not applicable.

Main Outcome Measures

Maximal voluntary torque (MVT), maximal rate of torque development, time to maximal rate of torque development, half relaxation time (½RT), and fatigue index. Scores on the Functional Ambulation Category scale, Berg Balance Scale, and Rivermead Mobility Index as well as distance walked during the six-minute walk test were obtained.

Results

MVT of the paretic leg was lower than of the nonparetic leg (P<.05), and both limbs had lower MVT than controls (P<.05). Both the paretic and the nonparetic leg showed longer ½RT compared with controls (P<.05). The fatigue index was reduced in the paretic leg (P<.05) but not in the nonparetic leg compared with controls. MVT and fatigue index of the paretic leg were related to indices of functional performance (r=0.49-0.64; P<.05).

Conclusions

Apart from bilateral weakness, knee extensors in patients with stroke showed a lower rate of torque development and relaxation (both paretic and nonparetic leg) and lower fatigue resistance (paretic leg only) than controls, which in part may be a consequence of changes within the muscles. Strength and fatigue resistance relate to functional performance, indicating that these muscle properties should be addressed during rehabilitation. However, future research is needed to elucidate the efficacy of exercise programs.     

Intrinsic Properties of the Knee Extensor Muscles After Subacute Stroke

Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke.

Objective

To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke.

Design

Case-control study.

Setting

Rehabilitation center research laboratory.

Participants

Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12).

Interventions

Not applicable.

Main Outcome Measures

Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery.

Results

No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001).

Conclusions

The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation.     

Validity of the Community Balance and Mobility Scale in Community-Dwelling Persons After Stroke

Knorr S, Brouwer B, Garland SJ. Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke.

Objectives

To examine the convergent validity, sensitivity to change, floor and ceiling effects of the Community Balance and Mobility Scale (CB&M) in community-dwelling stroke survivors. The secondary objective was to determine the correlations between the CB&M and lower-limb motor recovery and strength.

Design

Validity study.

Setting

Two university-based research centers.

Participants

Community-dwelling persons after stroke (N=44; 24 men, 20 women; mean age, 62.6±12.6y). Baseline measures were taken 3 months after the onset of stroke (98.6±52.6d); participants were reassessed 8 months poststroke (246.8±57.2d).

Interventions

Not applicable.

Main Outcome Measures

CB&M, Berg Balance Scale (BBS), Timed Up & Go (TUG), Chedoke McMaster Stroke Assessment (CMSA) Impairment Inventory for leg and foot, concentric bilateral isokinetic strength of the lower-limb flexor and extensor muscle groups using a dynamometer. The magnitude of the associations and the standardized response means (SRMs) among the CB&M, BBS, and TUG were used to examine the convergent validity and sensitivity to change, respectively.

Results

Moderate to high convergent validities (ρ=.70 to .83, P<.001) were observed among the CB&M, BBS, and TUG. The CB&M was moderately correlated with the CMSA leg and foot scores (ρ=.61 and .63, respectively, P<.001) and the paretic limb strength (ρ=.67, P<.001). The CB&M demonstrated the greatest ability to detect change between the baseline and follow-up assessments (SRM=.83).

Conclusions

The CB&M is valid and sensitive to change in assessing functional balance and mobility in ambulatory stroke survivors with moderate to mild neurologic impairments.     

Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement

Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.

Objective

To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.

Design

Case control.

Setting

Sports medicine research laboratory.

Participants

Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.

Interventions

Not applicable.

Main Outcome Measures

Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.

Results

The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).

Conclusions

The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat.     

Proprioception of the shoulder after stroke

Niessen MH, Veeger DH, Koppe PA, Konijnenbelt MH, van Dieën J, Janssen TW. Proprioception of the shoulder after stroke.

Objective

To investigate position sense and kinesthesia of the shoulders of stroke patients.

Design

Case-control study.

Setting

A rehabilitation center.

Participants

A total of 22 inpatients with stroke and 10 healthy control subjects.

Interventions

Not applicable.

Main Outcome Measures

Angular displacement (in degrees) for threshold to detection of passive motion (TDPM) tests and absolute error (in degrees) for passive reproduction of joint position tests.

Results

For patients, the TDPM for internal and external rotation was significantly higher for both the contralateral (paretic) side (internal, 7.92°±7.19°; external, 8.46°±8.87°) and the ipsilateral (nonparetic) side (internal, 4.86°±5.03°; external, 6.09°±9.15°) compared with the control group (internal, 1.83°±1.09°; external, 1.71°±.85°). Also, for internal rotation, TDPM was significantly higher for patients on the contralateral side compared with the ipsilateral side. For passive reproduction of joint position tests, no differences were found.

Conclusions

Both the contralateral and ipsilateral shoulders of stroke patients showed impaired TDPM. Passive reproduction of joint position does not seem to be affected as a result of a stroke. The control of the muscle spindles and central integration or processing problems of the afferent signals provided by muscle spindles might cause these effects.     

Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors

Background

The objective of this study was to investigate changes in active and passive biomechanical properties of the calf muscle–tendon unit induced by controlled ankle stretching in stroke survivors.

Methods

Ten stroke survivors with ankle spasticity/contracture and ten healthy control subjects received intervention of 60-min ankle stretching. Joint biomechanical properties including resistance torque, stiffness and index of hysteresis were evaluated pre- and post-intervention. Achilles tendon length was measured using ultrasonography. The force output of the triceps surae muscles was characterized via the torque–angle relationship, by stimulating the calf muscles at a controlled intensity across different ankle positions.

Findings

Compared to healthy controls, the ankle position corresponding to the peak torque of the stroke survivors was shifted towards plantar flexion (P < 0.001). Stroke survivors showed significantly higher resistance torques and joint stiffness (P < 0.05), and these higher resistances were reduced significantly after the stretching intervention, especially in dorsiflexion (P = 0.013). Stretching significantly improved the force output of the impaired calf muscles in stroke survivors under matched stimulations (P < 0.05). Ankle range of motion was also increased by stretching (P < 0.001).

Interpretation

At the joint level, repeated stretching loosened the ankle joint with increased passive joint range of motion and decreased joint stiffness. At the muscle–tendon level, repeated stretching improved calf muscle force output, which might be associated with decreased muscle fascicle stiffness, increased fascicle length and shortening of the Achilles tendon. The study provided evidence of improvement in muscle tendon properties through stretching intervention.     

Speed of Voluntary Stepping in Chronic Stroke Survivors Under Single- and Dual-Task Conditions: A Case-Control Study

Melzer I, Tzedek I, Or M, Shvarth G, Nizri O, Ben-Shitrit K, Oddsson LE. Speed of voluntary stepping in chronic stroke survivors under single- and dual-task conditions: a case-control study.

Objective

To investigate voluntary step behavior of chronic stroke survivors during single- and dual-task conditions and compare the results to healthy age- and sex-matched controls.

Design

Case-control.

Setting

Laboratory-based study.

Participants

Chronic stroke survivors (n=16) and healthy controls (n=16).

Interventions

Not applicable.

Main Outcome Measures

Forward and backward rapid voluntary stepping were performed as a reaction time task under 2 conditions: (1) awaiting a cutaneous cue (single task), and (2) awaiting a cutaneous cue while performing an attention-demanding task. Step initiation, preparatory and swing phases, foot-off time, and foot-contact time were extracted from center of pressure and ground reaction forceplate data.

Results

Chronic stroke survivors were significantly slower than healthy controls in all step parameters under single- and dual-task conditions. For dual compared with single task, the foot-contact time increased from 1295ms to 1445ms (12%) in chronic stroke survivors and from 876ms to 1006ms (15%) in controls.

Conclusions

The significant increase in step phase's duration during single- and dual-task conditions may be a factor contributing to the large number of falls seen in stroke patients. The interference effects of attention-demanding task were similar between groups, suggesting that both groups used similar strategies. Future research should determine whether step training can improve step decrements in chronic stroke survivors.     

Stroke prevention care delivery: Predictors of risk factor management outcomes

Background

Internationally, the development and implementation of stroke care guidelines have resulted in the evolution of stroke prevention outpatient clinics designed to accelerate patient access to treatment and behavioral risk reduction following transient ischemic attack or stroke.

Objectives

To examine the extent to which selected demographic, social-psychological, physiological, and adherence characteristics predicted achievement of blood pressure and glucose targets in a group of patients referred to a Canadian stroke prevention clinic with confirmed transient ischemic attack (TIA) or stroke and hypertension and/or diabetes.

Participants

A total of 313, English speaking, adult patients who were referred from family or emergency department physicians to a stroke prevention clinic provided demographic data and received social-psychological screening testing at intake. Of these, 93 participants who met criteria of confirmed TIA or stroke plus hypertension and/or diabetes were identified as the study group. Seventy-seven of study group participants completed a 6-month follow-up.

Methods

Admission screening tests included the Modified and Mini-Mental State Examinations, Trail Making Test, Clock Drawing Test, a medication self-efficacy scale, the Lubben Social Network Scale and the Geriatric Depression Scale. Family physician follow-up was ascertained 4-8 weeks after intake. At approximately 6 months after the initial screening measures, 77 study group participants completed additional measures of adherence, blood pressure and/or glycated hemoglobin.

Results

Transient ischemic attack was confirmed in 58% and stroke in 42% of the study group. Mean age was 69 years (SD = 11); 53% were male; 97% had hypertension; and 25% were diabetic; some had both. Twenty-three percent were not followed-up by family practitioners. At 6-month follow-up, 97% reported ≥80% adherence to medication; only 57% met treatment targets. A logistic regression analysis identified three independent predictors of achieving blood pressure and/or glucose targets: self-efficacy expectations (OR, 1.61; 95% CI, 1.03-2.54; p = 0.04), Mini-Mental State (OR, 1.28; 95% CI, 1.06-1.54; p = 0.009); and self-reported adherence (OR, 1.14; 95% CI, 1.01-1.29; p = 0.03).

Conclusions

Three simple screening measures identified patients at increased risk of not achieving clinical risk factor management targets.     

Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients

Treger I, Aidinof L, Lutsky L, Kalichman L. Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients.

Objective

To evaluate the association between mean flow velocity (MFV) in the middle cerebral artery (MCA) measured by using transcranial Doppler (TCD) and functional and neurologic impairment change during rehabilitation after acute stroke.

Design

Cross-sectional observational study.

Setting

Acute neurologic rehabilitation department.

Participants

Consecutive patients (N=67; 53 men, 14 women; mean ± SD age, 61.54±8.92y) referred to the rehabilitation center during the first 6 months of 2006 for a first ischemic stroke in the MCA area.

Interventions

Not applicable.

Main Outcome Measures

All subjects were evaluated on admission and at discharge by using the National Institutes of Health Stroke Scale (NIHSS) and the FIM. TCD measurements of MFV of the ipsilateral and contralateral MCA were performed on admission (during the first 20 days after stroke) and a few days before discharge.

Results

Contralateral MFV at admission was associated significantly with all indexes of functional rehabilitation success (FIM score at discharge [β=.169; P=.010], change in FIM score [β=.554; P=.010], relative improvement in FIM score [β=.783; P=.003]). No significant association was found between indexes of NIHSS change and ipsilateral or contralateral MFV.

Conclusions

Ipsilateral or contralateral MFV measured at admission did not change during the 2-month rehabilitation period. Our data showed a significant association between blood flow velocity in the contralateral MCA and functional rehabilitation parameters of patients after first ischemic stroke in the MCA area.     

Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control

Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.

Objectives

To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.

Design

Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.

Setting

Biomechanics laboratory.

Participants

Healthy novice wheelchair users (N=13; 6 men) from a university student population.

Interventions

Not applicable.

Main Outcome Measures

Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.

Results

Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.

Conclusions

Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition.     

Cervical erector spinae and upper trapezius muscle activity in children using different information technologies

Objectives

Researchers investigating the effects of computer use and the development of musculoskeletal disorders have mainly focused on the effects of prolonged muscle loading associated with postures assumed during computer use in the adult population. The objective of this study was to investigate the effects of different forms of old and new information technology (IT) on muscle activity levels in a paediatric population.

Design

A 3 × 3 × 2 mixed model design was used for this study.

Participants

Thirty-two schoolchildren aged 4-17 years participated in this study.

Outcome measures

Surface electromyography (EMG) data were collected from the left and right cervical erector spinae and upper trapezius muscles. Participants performed a 5-minutes reading task using the three IT types (book, laptop and desktop computer).

Results

Cervical erector spinae and upper trapezius muscle activity levels were significantly higher when children used the laptop set-up (P < 0.001). The lowest muscle activity levels were found when children used the desktop set-up. Cervical erector spinae and upper trapezius muscle activities were found to be higher on the left side in the book set-up compared with higher right muscle activity levels in the computer set-ups (P = 0.047 and <0.001, respectively).

Conclusions

The three IT types had different effects on cervical erector spinae and upper trapezius muscle activity, suggesting varying risks associated with different IT types. Activity levels were often above 5% maximum EMG (MEMG). As adult studies have linked activity levels greater than 5%MEMG with the development of musculoskeletal disorders, it seems that children are potentially at risk of replicating these adverse health reactions associated with adult IT use.     

Changes in interleukin-10 mRNA expression are predictive for 9-day survival of pigs in an emergency preservation and resuscitation model

Aim of the study

This study aimed at evaluating (I) the impact of different intra-arrest hypothermia levels on the expression of selected cytokines and (II) their prognostic value for 9-day survival.

Methods

Female Large White pigs (n = 21, 31-38 kg) were subjected to 15 min of ventricular fibrillation, followed by intra-arrest cardiopulmonary bypass cooling for 1, 3, or 5 min achieving brain temperatures (Tbr) of 30.4 ± 1.6, 24.2 ± 4.6 and 18.8 ± 4.0 °C. After 40 min of controlled rewarming, pigs were defibrillated and kept at Tbr of 34.5 °C for 20 h, survival was for 9 days. Plasma samples were analysed for interleukin (IL)-6, tumor necrosis factor-α (TNF-α), and IL-10 levels by ELISA. Total RNA out of peripheral blood mononuclear cells was analysed by real-time PCR for IL-1, IL-2, IL-4, IL-10, TNF-α, interferon-γ, inducible NO synthase, and heme oxygenase-1 gene expressions.

Results

Plasma IL-6 and TNF-α levels significantly (p = 0.0001 and 0.0003) increased in all animals within 1 h after resuscitation with no significant differences between groups. Pigs surviving exhibited a decrease in IL-10 expression between baseline and intra-arrest values as compared to non-surviving animals, which showed a slight increase (p = 0.0078). ROC curve analysis revealed that changes in IL-10 expression had a good prognostic power for survival to day 9 (area under the curve = 0.882).

Conclusion

The systemic inflammatory response syndrome after cardiac arrest was reflected by a remarkable increase of plasma IL-6 and TNF-α levels. Intra-arrest hypothermia levels did not influence the expression of selected cytokines. As prognostic marker for survival IL-10 was identified with decreasing mRNA levels during cardiac arrest in survivors.     

Accelerometer monitoring of home- and community-based ambulatory activity after stroke

Haeuber E, Shaughnessy M, Forrester LW, Coleman KL, Macko RF. Accelerometer monitoring of home- and community-based ambulatory activity after stroke. Arch Phys Med Rehabil 2004;85:1997-2001.

Objectives

To investigate the utility of a novel microprocessor-linked Step Watch Activity Monitor (SAM) to quantify ambulatory activity after stroke and to evaluate the validity and reliability of conventional accelerometers to measure free-living physical activity in this population.

Design

Cross-sectional with repeated measures of 2 separate 48-hour recordings in 17 persons wearing an ankle-mounted SAM and Caltrac, a hip-mounted mechanical accelerometer.

Setting

Home and community.

Participants

Seventeen subjects with chronic hemiparetic gait after stroke.

Interventions

Not applicable.

Main outcome measures

The SAM derived stride counts per day and Caltrac estimated the daily caloric expenditure of physical activity.

Results

SAM data revealed that stroke patients had a mean strides per day ± standard deviation of 3035±1944 and demonstrated a broad range of daily activity profiles (400-6472 strides). SAM test-retest reliability was high across separate monitoring periods (r=.96, P<.001). Although Caltrac also revealed a broad range of daily activity calories (346±217kcal/d; range, 83-1222kcal/d), reliability was poor (r=.044, P=not significant) and Caltrac accounted for only 64% of the ambulatory activity quantified by the SAM.

Conclusions

Microprocessor-linked accelerometer monitoring, but not conventional accelerometers, are accurate and highly reliable for quantifying ambulatory activity levels in stroke patients. These findings support the utility of personal status monitoring of ambulatory activity as an outcomes instrument and metric in programs to increase physical activity and cardiovascular health after stroke.