Novel Applications of Ultrasound Technology to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue

Sikdar S, Shah JP, Gebreab T, Yen R-H, Gilliams E, Danoff J, Gerber LH. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue.

Objective

To apply ultrasound (US) imaging techniques to better describe the characteristics of myofascial trigger points (MTrPs) and the immediately adjacent soft tissue.

Design

Four sites in each patient were labeled based on physical examination as active myofascial trigger points (A-MTrPs; spontaneously painful), latent myofascial trigger points (L-MTrPs; nonpainful), or normal myofascial tissue. US examination was performed on each subject by a team blinded to the physical findings. A 12∼5MHz US transducer was used. Vibration sonoelastography (VSE) was performed by color Doppler variance imaging while simultaneously inducing vibrations (∼92Hz) with a handheld massage vibrator. Each site was assigned a tissue imaging score as follows: 0, uniform echogenicity and stiffness; 1, focal hypoechoic region with stiff nodule; 2, multiple hypoechoic regions with stiff nodules. Blood flow in the neighborhood of MTrPs was assessed using Doppler imaging. Each site was assigned a blood flow waveform score as follows: 0, normal arterial flow in muscle; 1, elevated diastolic flow; 2, high-resistance flow waveform with retrograde diastolic flow.

Setting

Biomedical research center.

Participants

Subjects (N=9) meeting Travell and Simons' criteria for MTrPs in a taut band in the upper trapezius.

Interventions

Not applicable.

Main Outcome Measures

MTrPs were evaluated by (1) physical examination, (2) pressure algometry, and (3) three types of US imaging including gray-scale (2-dimensional [2D] US), VSE, and Doppler.

Results

MTrPs appeared as focal, hypoechoic regions on 2D US, indicating local changes in tissue echogenicity, and as focal regions of reduced vibration amplitude on VSE, indicating a localized, stiff nodule. MTrPs were elliptical, with a size of .16±.11cm². There were no significant differences in size between A-MTrPs and L-MTrPs. Sites containing MTrPs were more likely to have a higher tissue imaging score compared with normal myofascial tissue (P<.002). Small arteries (or enlarged arterioles) near A-MTrPs showed retrograde flow in diastole, indicating a highly resistive vascular bed. A-MTrP sites were more likely to have a higher blood flow score compared with L-MTrPs (P<.021).

Conclusions

Preliminary findings show that, under the conditions of this investigation, US imaging techniques can be used to distinguish myofascial tissue containing MTrPs from normal myofascial tissue (lacking trigger points). US enables visualization and some characterization of MTrPs and adjacent soft tissue.     

Brain Injury Coping Skills Group: A Preventative Intervention for Patients With Brain Injury and Their Caregivers

Backhaus SL, Ibarra SL, Klyce D, Trexler LE, Malec JF. Brain Injury Coping Skills Group: a preventative intervention for patients with brain injury and their caregivers.

Objective

To determine whether training in coping strategies will improve psychologic functioning and self-efficacy in survivors of brain injury (BI) and caregivers.

Design

Randomized controlled pilot study with measurements at baseline, postintervention, and 3-month follow-up.

Setting

Postacute rehabilitation clinic.

Participants

Survivors of BI (n=20) and caregivers (n=20).

Interventions

The Brain Injury Coping Skills Group is a 12-session, manualized, cognitive-behavioral treatment (CBT) group providing psychoeducation, support, and coping skills training. Effects of this preventative intervention were examined on emotional functioning and perceived self-efficacy (PSE).

Main Outcome Measures

Brief Symptom Inventory-18 (BSI-18) and Brain Injury Coping Skills Questionnaire.

Results

Analyses revealed that the Brain Injury Coping Skills group showed significantly improved PSE compared with the control group immediately posttreatment (F=14.16; P=.001) and maintained this over time. PSE assessed posttreatment predicted global distress at 3-month follow-up across groups (ρ=-.46). No differences between treatment and control groups were apparent on the BSI-18 posttreatment. However, the control group showed increased emotional distress at 3-month follow-up while the Brain Injury Coping Skills group remained stable over time.

Conclusions

Few CBT studies have included survivors of BI and caregivers together in group treatment or included a control group. No prior studies have examined the role of PSE specifically. Prior intervention studies show inconsistent effects on emotional functioning, raising questions regarding the role of intervening variables. This study offers a new conceptualization that PSE may moderate longer-term emotional adjustment after brain injury. Results indicate that PSE is an important and modifiable factor in helping persons better adjust to BI.     

Wavelet-based spectrum analysis of sacral skin blood flow response to alternating pressure

Jan Y-K, Brienza DM, Geyer MJ, Karg P. Wavelet-based spectrum analysis of sacral skin blood flow response to alternating pressure.

Objectives

To provide insight into the physiologic mechanisms associated with alternating pressure, using wavelet analysis of skin blood flow (SBF) oscillations, and to determine whether the application of alternating pressure induces myogenic responses, thereby enhancing SBF as compared with constant loading.

Design

Repeated-measures design.

Setting

University research laboratory.

Participants

Healthy, young adults (N=10; 5 men, 5 women; mean age ± standard deviation, 30.0±3.1y).

Intervention

Alternating pressure for 20 minutes (four 5-min cycles with either 60mmHg or 3mmHg) and constant loading for 20 minutes at 30mmHg on the skin over the sacrum.

Main Outcome Measures

A laser Doppler flowmeter was used to measure sacral SBF response to both alternating pressure and constant loading. Wavelet-based spectrum analysis of SBF oscillations was used to assess underlying physiologic mechanisms including endothelium-related metabolic (.008-.02Hz), neurogenic (.02-.05Hz), and myogenic (.05-.15Hz) controls.

Results

Alternating pressure stimulated an increase in sacral SBF of compressed soft tissues as compared with constant loading (P<.01). SBF during the high-pressure phase of 4 alternating pressure cycles showed an increasing trend. An increase in power in metabolic frequency range and a decrease in power in the myogenic frequency range during alternating pressure were observed compared with SBF prior to loading. Power increased in the myogenic frequency range during the low-pressure phase of alternating pressure and decreased during the high-pressure phase.

Conclusions

SBF control mechanisms, as assessed by the characteristic frequencies embedded in SBF oscillations, show different responses to 2 loading pressures with the same average pressure but different patterns. Our study suggests that optimization of operating parameters and configurations of alternating pressure support surfaces to compensate for impaired SBF control mechanisms in pathologic populations may be possible using wavelet analysis of blood flow oscillations.     

Design and Evaluation of a New Bladder Volume Monitor

Wang J, Hou C, Zheng X, Zhang W, Chen A, Xu Z. Design and evaluation of a new bladder volume monitor.

Objective

To introduce and evaluate a new implantable bladder volume monitor.

Design

Experimental study.

Setting

Animal laboratory.

Animals

Eight dogs.

Interventions

A coin-shaped permanent magnet was stitched onto the anterior bladder wall and a magnetic field sensor was fixed onto the lower abdominal external wall in 8 male dogs. The bladder was filled with sterile normal saline in consecutive steps of 25mL each from 0 to 200mL by a transurethral catheter.

Main Outcome Measure

Sensor readings were recorded after each step of bladder filling.

Results

The sensor baseline was set at 70° when the bladder was empty. After filling the bladders with 25, 50, 75, 100, 125, 150, 175, and 200mL saline water, the sensor readings were 74.6±0.9°, 79.6±1.2°, 84.5±0.9°, 90.1±0.8°, 95.5±1.1°, 101.8±2.1°, 110.5±2.9°, and 121.9±3.5°, respectively. Sensor readings were positively correlated with bladder volume (r=1; P<.01).

Conclusions

The design of a new bladder volume monitor that is made up of an external magnetic field sensor and an internal permanent magnet is reasonable and feasible. The new bladder volume monitor is simple in structure.     

The effect of blood donation frequency on iron status

Introduction

The effects of blood donation on iron status in donors without iron supplementation were studied. Analysing interactions between donations and iron status markers may predict these effects.

Materials and methods

Haemoglobin (Hb) and serum ferritin were analysed in 893 donors over 1 year. Serum transferrin receptor (sTfR) was measured at the first and last donation.

Results

Prolonged intervals prevented decrease in Hb in women and in ferritin for both genders. In women, a high TfR-F index (sTfR/log ferritin) predicted fall in Hb.

Conclusion

Adjusting the donation intervals is a way to prevent iron deficiency in blood donors.     

Diagnostic Value of History Taking and Physical Examination to Assess Effusion of the Knee in Traumatic Knee Patients in General Practice

Kastelein M, Luijsterburg PA, Wagemakers HP, Bansraj SC, Berger MY, Koes BW, Bierma-Zeinstra SM. Diagnostic value of history taking and physical examination to assess effusion of the knee in traumatic knee patients in general practice.

Objective

To assess the diagnostic value of history taking and physical examination for knee joint effusion in patients with a knee injury who consult their general practitioner (GP). In addition, to determine the association between effusion seen on magnetic resonance imaging (MRI) and internal derangement of the knee.

Design

Prospective, observational cohort study.

Setting

Primary care.

Participants

Patients (N=134) aged 18 to 65 years with a traumatic knee injury who consulted their GP.

Interventions

Not applicable.

Main Outcome Measures

Patients filled out a questionnaire, underwent a standardized physical examination and underwent an MRI scan to assess the presence of effusion. Multivariate logistic regression analysis was used to determine the diagnostic value of history taking and physical examination (P<0.10) as assessed by sensitivity, specificity, predictive values, and likelihood ratios. The relationship between effusion and internal derangement of the knee was assessed with a chi-square test.

Results

Of the 134 participating patients, 42 had knee joint effusion seen on MRI. Multivariate analysis showed an association with knee joint effusion for the symptom “self-noticed swelling” (history taking) and for the “ballottement test” (physical examination). The likelihood ratio positive (LR+) was 1.5 for self-noticed swelling and 1.6 for the ballottement test. These 2 combined improved the diagnostic value to an LR+ of 3.6. Effusion showed a positive association with internal derangement of the knee (chi-square 9.5); 31 of the 42 patients with knee joint effusion had internal derangement of the knee.

Conclusions

In patients with traumatic knee injury, knee joint effusion is frequently seen on MRI. The combination of self-noticed swelling and the ballottement test was of diagnostic value. Knee joint effusion was associated with internal derangement of the knee.     

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

Objectives

To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.

Design

A parallel randomised single-blind clinical trial.

Participants

Fifty patients aged 65 years or over with knee osteoarthritis.

Interventions

The study group (n = 25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n = 25) were given a brief course in short-wave diathermy treatment.

Main outcome measures

Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.

Results

At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4).

Conclusion

A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.     

Convergent Validation of the Kohlman Evaluation of Living Skills as a Screening Tool of Older Adults' Ability to Live Safely and Independently in the Community

Burnett J, Dyer CB, Naik AD. Convergent validation of the Kohlman Evaluation of Living Skills as a screening tool of older adults' ability to live safely and independently in the community.

Objective

To evaluate the convergent validity of the Kohlman Evaluation of Living Skills (KELS) to screen older adults' ability to live safely and independently.

Design

Cross-sectional study correlating KELS with components of a Comprehensive Geriatric Assessment.

Setting

Participants' homes.

Participants

Community-dwelling older adults (N=200) 65 years and older including 100 persons referred by Adult Protective Services (APS) and 100 ambulatory patients matched on age, race, sex, and socioeconomic status.

Interventions

In-home comprehensive assessment.

Main Outcome Measures

KELS, Geriatric Depression Scale (GDS), modified Physical Performance Test (mPPT), Mini-Mental State Examination (MMSE), Knee Extensor Break Test, Executive Cognitive Test (EXIT25), executive clock-drawing test (CLOX) 1 and 2, and an 8-foot walk test.

Results

Older adults with abnormal KELS scores performed significantly worse on all tests except for the Knee Extensor Break Test. Accordingly, among the entire group, the KELS correlated with measures of executive function (EXIT25, r=.705, P<.001; CLOX 1, r=−.629, P<.001), cognitive function (MMSE, r=−.508, P<.001), affect (GDS, r=.318, P<.001), and physical function (mPPT, r=−.472, P<.001) but did not correlate with the Knee Extensor Break Test (r=−.068, P=.456). Among those referred by APS, the KELS failed to correlate with only the 8-foot walk test (r=.175, P=.153) and GDS (r=.080, P=.450).

Conclusions

This study demonstrated the convergent validity of KELS with a battery of cognitive, affective, executive, and functional measures often used to determine older adults' ability to live safely and independently in the community. KELS may be a valid and pragmatic alternative to screen for the capacity to live safely and independently among older adults.     

Comparative impact of 2 botulinum toxin injection techniques for elbow flexor hypertonia

Mayer NH, Whyte J, Wannstedt G, Ellis CA. Comparative impact of 2 botulinum toxin injection techniques for elbow flexor hypertonia.

Objective

To compare 2 techniques of botulinum toxin injection for elbow flexor hypertonia.

Design

Parallel-group, randomized, controlled trial with blinded outcome assessment.

Setting

Laboratory, tertiary rehabilitation hospital.

Participants

Adults (N=31) with acquired brain injury (21 with traumatic brain injury, 8 with stroke, 2 with hypoxic encephalopathy) provided 36 sets of elbow flexors with Ashworth Scale scores equal to 3.

Intervention

Botulinum toxin type A (BTX-A) was injected with a motor point or a multisite injection technique after obtaining 2 baseline evaluations of the main outcome measures. Motor point technique involved decremental electric stimulation with delivery of 60U of BTX-A (Botox) in 2.4mL or 30U BTX-A in 1.2mL of preservative-free saline at single biceps and brachioradialis motor points, respectively. Distributed injection was performed using electromyographic feedback. Fifteen units in 0.6mL were delivered to each of 4 biceps sites and 2 brachioradialis sites. Total dose (90U) and total injection volume (3.6mL) were identical across groups. Only sites and injection techniques varied. The brachialis was not injected in either group.

Main Outcome Measures

Ashworth Scale, Tardieu catch angle, and root mean square surface electromyographic activity of the biceps, brachialis, and brachioradialis.

Results

Postintervention testing at 3 weeks showed no significant differences between groups (P range, .31-.82 across 3 outcome measures). However, within each group, significant treatment effects were observed on all outcome measures (all P<.01). For the uninjected brachialis muscle, electromyographic reduction was greater for the distributed group.

Conclusions

In 31 adults with acquired brain injury, single motor point and multisite distributed injections of low-dose, high-volume BTX-A had similar impact. Findings suggest that low-dose, high-volume strategies may have a potential role in reducing drug cost and helping clinicians stay within accepted limits for total body dose in patients with upper motoneuron syndrome requiring many injections.     

Efficacy of Partial Body Weight-Supported Treadmill Training Compared With Overground Walking Practice for Children With Cerebral Palsy: A Randomized Controlled Trial

Willoughby KL, Dodd KJ, Shields N, Foley S. Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial.

Objective

To evaluate the efficacy of 9 weeks of twice-weekly partial body weight-supported treadmill training (PBWSTT) for children with cerebral palsy (CP) and moderate to severe walking difficulty compared with overground walking.

Design

Randomized controlled trial.

Setting

Metropolitan Specialist School for children with moderate to severe physical and/or intellectual disabilities.

Participants

Thirty-four children classified level III or IV by the Gross Motor Function Classification System were recruited and randomly allocated to experimental or control groups. Of these, 26 (15 girls, 11 boys; mean age 10y, 10mo ± 3y, 11mo [range, 5-18y]) completed training and testing.

Interventions

Both groups completed 9 weeks of twice-weekly walking training. The experimental group completed PBWSTT, and the control group completed overground walking practice.

Main Outcome Measures

Ten-meter walk test (self-selected walking speed), 10-minute walk (walking endurance), School Function Assessment.

Results

The overground walking group showed a trend for an increase in the distance walked over 10 minutes (F=3.004, P=.097). There was no statistically significant difference in self-selected walking speed over 10 meters or in walking function in the school environment as measured by the School Function Assessment.

Conclusions

PBWSTT is safe and feasible to implement in a special school setting; however, it may be no more effective than overground walking for improving walking speed and endurance for children with CP. Continued emphasis on progressive reduction of body weight support along with adding concurrent overground walking practice to a treadmill training protocol may increase the intensity of training and assist with carryover of improvements to overground walking. Treadmill training programs that include concurrent overground walking as an additional key feature of the training protocol need to be rigorously evaluated for children with CP.     

One-leg cycling versus arm cranking: which is most appropriate for physical conditioning after knee surgery?

Olivier N, Legrand R, Rogez J, Berthoin S, Prieur F, Weissland T. One-leg cycling versus arm cranking: which is most appropriate for physical conditioning after knee surgery?

Objective

To compare the cardiorespiratory responses, blood lactate concentration and perceived exertion between 1-leg cycling and arm cranking.

Design

Comparison of exercise modalities.

Setting

Hospital.

Participants

Fourteen men who had undergone knee surgery were evaluated during rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Each patient performed 2 maximal graded tests: 1-leg cycling and arm cranking exercise, with a 7-day interval. Respiratory gas exchange, heart rate, blood lactate concentration, and the ratings of perceived exertion (RPE) were measured.

Results

Peak power output, peak minute ventilation, peak oxygen uptake (Vo₂peak), and peak heart rate did not differ significantly between 1-leg cycling and arm cranking. The first and second ventilatory thresholds occurred at above 40% and 72% of Vo₂peak, respectively, in both tests. The maximal lactate concentrations and the RPE values were significantly higher during arm cranking (+10%, +12%, respectively, P<.05) compared with corresponding 1-leg cycling values.

Conclusions

The maximal cardiorespiratory values were not different between arm cranking and 1-leg cycling. However, the RPE and blood lactate concentration were lower when the exercise was performed with the lower limb. Thus 1-leg cycling may be more easily tolerated than arm cranking by patients participating in aerobic conditioning after knee surgery.     

Effects of Walking With a Shopping Trolley on Spinal Posture and Loading in Subjects With Neurogenic Claudication

Comer CM, White D, Conaghan PG, Bird HA, Redmond AC. Effects of walking with a shopping trolley on spinal posture and loading in subjects with neurogenic claudication.

Objectives

To explore possible mechanisms underpinning symptom relief and improved walking tolerance in patients with neurogenic claudication (NC) when pushing a shopping trolley by evaluating the effects of a shopping trolley on spinal posture and loading patterns.

Design

An exploratory study of kinematic and kinetic changes in walking with and without pushing a shopping trolley in persons with NC symptoms and a comparison with asymptomatic control subjects.

Setting

A primary care-based musculoskeletal service.

Participants

Participants (n=8) with NC symptoms who have anecdotally reported symptomatic improvement when walking with a shopping trolley and a control group of asymptomatic persons (n=8).

Interventions

Shopping trolley.

Main Outcome Measures

Changes in lumbar spinal sagittal posture and ground reaction force.

Results

Subjects with NC and asymptomatic controls walked with significantly more flexed spinal posture (increase in flexion, 3.40°; z=3.516; P<.001) and reduced mean ground reaction forces (−6.9% of body weight; z=−3.46; P=.001) when walking with a shopping trolley. However, at the midstance point of the gait cycle, controls showed minimal reliance on the trolley, whereas, people with NC showed continued offloading.

Conclusions

Both posture and loading are affected by pushing a shopping trolley; however, patients with NC were found to offload the spine throughout the stance phase of gait, whereas asymptomatic controls did not.     

Mechanical and Sensorimotor Implications With Ankle Osteoarthritis

Hubbard TJ, Hicks-Little C, Cordova M. Mechanical and sensorimotor implications with ankle osteoarthritis.

Objective

To understand the mechanical and sensorimotor adaptations that may occur with ankle osteoarthritis (OA).

Design

Case-control.

Setting

Biodynamics research laboratory.

Participants

Subjects with ankle OA (n=8; 4 males, 4 females) were matched to healthy controls (n=8; 4 males, 4 females).

Interventions

Not applicable.

Main Outcome Measures

Mechanical joint stability was assessed with an instrumented ankle arthrometer. Static balance was measured using a force platform during a double-legged stance. Isometric ankle/foot complex strength in the sagittal and frontal plane was assessed with a handheld dynamometer. Last, subjective level of function was assessed using the foot and ankle disability index.

Results

There were significant group × side interactions for anterior displacement, inversion rotation, eversion rotation, ankle isometric strength, and the foot and ankle disability index (P<.05). The affected ankle of the OA group demonstrated significantly more mechanical stiffness, more impairments in ankle/foot isometric strength, and less subjective level of function than the matched controls. Additionally, the ankle OA group exhibited significantly more center of pressure displacement, total velocity, and medial-lateral velocity (P<.05).

Conclusions

These limitations observed in joint laxity, postural control, muscle strength, and perceived function provide evidence that patients with ankle OA display a number of characteristics that affect joint stability and overall function. These identified impairments necessitate the need for rehabilitation and exercise programs to be developed to help improve joint stability and function in patients with ankle OA.     

Peripheral vascular changes after home-based passive leg cycle exercise training in people with paraplegia: a pilot study

Ballaz L, Fusco N, Crétual A, Langella B, Brissot R. Peripheral vascular changes after home-based passive leg cycle exercise training in people with paraplegia: a pilot study.

Objective

To determine the hemodynamic adaptations after home-based passive leg cycle exercise training in person with paraplegia.

Design

A randomized controlled trial (small cohort).

Setting

University department of physical medicine and rehabilitation.

Participants

A volunteer sample of people with paraplegia (N=17).

Intervention

Subjects within the experimental group performed 36 passive cycling sessions at home.

Main Outcome Measures

Before and after training, we measured heart rate and maximal and minimal femoral artery blood flow velocity at rest and immediately after a 10-minute session of passive cycling by using a quantitative duplex Doppler ultrasound. For each condition, we calculated the mean blood flow velocity and velocity index (VI), used as an indicator of peripheral resistance.

Results

At rest, after training, mean blood flow velocity (P=.08) and VI did not differ significantly in the experimental group compared with the pretraining values (nonparametric analysis). However, in this group, the postexercise mean blood flow velocity and VI are respectively increased and decreased after training (P<.05) compared with the pretraining values. No changes were noted in the control group.

Conclusions

Six weeks of home-based passive cycling training have no significant effect on the rest hemodynamic values but increase the hemodynamic response to acute passive cycling exercise.     

The Effects of Scapulothoracic Bursa Injections in Patients With Scapular Pain: A Pilot Study

Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.

Objective

To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.

Design

Prospective open-label unicenter trial with a 3-month follow-up.

Setting

University rehabilitation hospital.

Participants

Twenty-two cases of suspected scapulothoracic bursitis.

Intervention

Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.

Main Outcome Measures

Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.

Results

Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.

Conclusions

Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis.     

Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial

Yang YR, Wang RY, Chen YC, Kao MJ. Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial.

Objective

To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke.

Design

Single-blind randomized controlled trial.

Setting

General community.

Participants

Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects (a minimum gait velocity, 58cm/s).

Interventions

Participants were randomized into a control group (n=12) or experimental group (n=13). Subjects in the control group did not receive any rehabilitation training. Subjects in the experimental group underwent a 4-week ball exercise program.

Main Outcome Measures

Gait performance was measured under single task (preferred walking) and tray-carrying task. Gait parameters of interest were walking speed, cadence, stride time, stride length, and temporal symmetry index.

Results

The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions. In the control group, there were no significant changes over the 4-week period for all selected measures. There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions.

Conclusions

The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke.     

Predictors of Cardiopulmonary Hospitalization in Chronic Spinal Cord Injury

Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury.

Objective

To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized.

Design

Prospective cohort study.

Setting

Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts.

Participants/Data Sources

Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database.

Interventions

Not applicable.

Main Outcome Measures

Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression.

Results

Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4kg/m²). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors.

Conclusions

Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations.     

Effects of Midodrine Hydrochloride on Blood Pressure and Cerebral Blood Flow During Orthostasis in Persons With Chronic Tetraplegia

Wecht JM, Rosado-Rivera D, Handrakis JP, Radulovic M, Bauman WA. Effects of midodrine hydrochloride on blood pressure and cerebral blood flow during orthostasis in persons with chronic tetraplegia.

Objective

To determine the mean arterial pressure (MAP) and middle cerebral artery mean blood flow velocity (MFV) responses to 5 and 10mg midodrine during head-up tilt (HUT) in persons with tetraplegia.

Design

Prospective dose-response trial.

Setting

James J. Peters Veterans Administration Medical Center.

Participants

Persons (N=10) with chronic tetraplegia (duration of injury=23±11y).

Intervention

A dose titration study was performed over 3 testing days: control (no drug), 5mg midodrine (5mg), or 10mg midodrine (10mg) during 30 minutes of baseline (predrug/no drug), 30 minutes of supine rest postdrug/no drug, 15 minutes of progressive HUT (5 minutes at 15°, 25°, 35°), and 45 minutes of 45° HUT.

Main Outcome Measures

MAP and MFV response to midodrine supine and during HUT.

Results

Ten milligrams of midodrine significantly increased MAP while supine and during the HUT maneuver. Of note, the mean increase in MAP during HUT with 10mg was a result of a robust effect in 2 persons, with minimal change in the remaining 8 study subjects. The reduction in cerebral MFV during HUT was attenuated with 10mg.

Conclusions

These findings suggest that midodrine 10mg may be efficacious for treatment of hypotension and orthostatic hypotension in select persons with tetraplegia. Although midodrine is routinely prescribed to treat orthostatic hypotension, the results of our work suggests limited efficacy of this agent, but additional studies in a larger sample of subjects with spinal cord injury should be performed.