Leg muscle function and fatigue during walking in spinal muscular atrophy type 3

Introduction: Spinal muscular atrophy (SMA) causes muscle weakness and fatigue. Better understanding of the relationship between weakness and fatigue may help identify potential targets for rehabilitation. Methods: Gait and surface electromyography (EMG) from 4 muscle groups were measured during the Six‐Minute Walk Test (6MWT) in 10 ambulatory participants, aged 9–49 years. Average root mean square amplitude (RMS) of muscle activity was calculated. Strength was assessed using manual and quantitative methods. Results: RMS, stride length, and velocity decreased during the 6MWT. Knee flexor and hip abductor strength was associated with fatigue‐related changes; overall strength correlated with disease duration; and leg strength was associated with 6MWT distance. Conclusions: Clinical measures are valid in assessing fatigue and function in SMA, and these assessments can be enhanced by use of gait analysis and EMG. Disease duration and strength measures may represent further stratification refinements when enrolling patients in clinical trials. Muscle Nerve 50 : 34–39, 2014     

Muscle–fat MRI: 1.5 tesla and 3.0 tesla versus histology

Introduction: We evaluated muscle/fat fraction (MFF) accuracy and reliability measured with an MR imaging technique at 1.5 Tesla (T) and 3.0T scanner strengths, using biopsy as reference. Methods: MRI was performed on muscle samples from pig and rabbit species (n = 8) at 1.5T and 3.0T. A chemical shift based 2‐point Dixon method was used, collecting in‐phase and out‐of‐phase data for fat/water of muscle samples. Values were compared with MFFs calculated from histology. Results: No significant difference was found between 1.5T and 3.0T (P values = 0.41–0.96), or between histology and imaging (P = 0.83) for any muscle tested. Conclusions: Results suggest that a 2‐point Dixon fat/water separation MRI technique may provide reliable quantification of MFFs at varying field strengths across different animal species, and consistency was established with biopsy. The results set a foundation for larger scale investigation of quantifying muscle fat in neuromuscular disorders. Muscle Nerve 50:170–176, 2014     

Directional Preference Following Epidural Steroid Injection in Three Patients with Acute Cervical Radiculopathy

Cervical radiculopathy is typically characterized by neurologic symptoms that are traced to disturbances of discrete spinal nerve root(s) due to inflammatory or mechanical etiologies. Here we present three patients diagnosed with cervical radiculopathy, whose directional preference only surfaced after either a cervical transforaminal or intralaminar nerve root epidural steroid injection. This retrospective observational case series describes three men who presented with cervical radiculopathy with 7‐9/10 neck pain, neck disability index (NDI) ranging between 44% and 90%, and an irreducible derangement upon McKenzie mechanical diagnosis and therapy (MMDT) evaluation. These patients demonstrated weaknesses, sensory changes, and/or decreased reflexes in the C5, C6, or C7 distributions. They each underwent a cervical transforaminal or intralaminar epidural injections at one or two levels, which uncovered their directional preference and facilitated further conservative treatment. These three patients experienced drastic improvements with each postinjection physical therapy session. They demonstrated decreased pain scores, centralization of pain, and a decreasing NDI trends throughout their treatments. They were all discharged with stable 0‐3/10 pain severity after four physical therapy sessions and NDI scores of 0%. These cases suggest an interplay between inflammatory and mechanical contributors to spine‐mediated pain and the treatment challenge this presents. Dissecting the components of spine pain can be challenging; however, delivery of skilled multidisciplinary care in an algorithmic fashion may be beneficial and provide the future framework for the management of cervical radiculopathy and other spine‐related conditions.     

Exercise Habits and Tobacco Use Among Male Latino Farmworkers

ABSTRACT

Migrant farmworkers risk occupational injury and are at risk for developing chronic health conditions. Exercise may enhance health and help to reduce the risk of occupational injury and/or reduce the risk of developing a chronic health condition. Little is known, however, about the exercise habits of Latino migrant farmworkers. Male Latino migrant farmworkers completed an exercise and health habits questionnaire at health screening clinics. One hundred fifty-three (58.2%) subjects reported exercising during the week. There was no difference in age between those who reported exercising and those who did not (p = .78). Only 42 (16%) of all workers reported exercising for 3 or more hours a week. Seventeen percent of the subjects reported smoking and almost 10% reported chewing tobacco. A majority of subjects do not meet the Centers for Disease Control and Prevention (CDC) exercise guidelines. Tobacco use is highest among individuals who do not exercise. These findings suggest the need for health education interventions for this population. Additional studies are warranted to understand exercise and health habits of this population.     

Lateral and syndesmotic ankle sprain injuries: a narrative literature review

Objective

The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles.

Methods

Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing.

Discussion

Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care.

Conclusion

An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully managed using a nonsurgical approach.