Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series

STUDY DESIGN: A case series of consecutive patients with cervical radiculopathy. BACKGROUND: A multitude of physical therapy interventions have been proposed to be effective in the management of cervical radiculopathy. However, outcome studies using consistent treatment approaches on a well-defined sample of patients are lacking. The purpose of this case series is to describe the outcomes of a consecutive series of patients presenting to physical therapy with cervical radiculopathy and managed with the use of manual physical therapy, cervical traction, and strengthening exercises. CASE DESCRIPTION: Eleven consecutive patients (mean age, 51.7 years; SD, 8.2) who presented with cervical radiculopathy on the initial examination were treated with a standardized approach, including manual physical therapy, cervical traction, and strengthening exercises of the deep neck flexors and scapulothoracic muscles. At the initial evaluation all patients completed self-report measures of pain and function, including a numeric pain rating scale (NPRS), the Neck Disability Index (NDI), and the Patient-Specific Functional Scale (PSFS). All patients again completed the outcome measures, in addition to the global rating of change (GROC), at the time of discharge from therapy and at a 6-month follow-up session OUTCOMES: Ten of the 11 patients (91%) demonstrated a clinically meaningful improvement in pain and function following a mean of 7.1 (SD, 1.5) physical therapy visits and at the 6-month follow-up. DISCUSSION: Ninety-one percent (10 of 11) of patients with cervical radiculopathy in this case series improved, as defined by the patients classifying their level of improvement as at least "quite a bit better" on the GROC. However, because a cause-and-effect relationship cannot be inferred from a case series, follow-up randomized clinical trials should be performed to further investigate the effectiveness of manual physical therapy, cervical traction, and strengthening exercises in a homogeneous group of patients with cervical radiculopathy.     

A home-based program for a preschool behaviorally disturbed child with parents as therapists

The effects of a set of reinforcement procedures upon the “autistic” behaviors of a four-year-old girl were evaluated. The study was carried out entirely in a home setting with the mother and father as change agents. The parents were trained to use, in a semi-structured play setting, through written and verbal instructions, a treatment program consisting of positive attention and timeout. Each parent independently applied the training procedures to the child's compliance, inappropriate vocalization and noncompliance behaviors. Both multiple baseline and reversal procedures were employed to assess treatment effects. Results indicated that the parents' use of the positive attention and timeout procedures was responsible for a substantial improvement in their daughter's compliance with instructions and a marked decrease in the two inappropriate responses. Comparisons across parents indicated no marked differences in the procedures' effects on the child's behaviors.     

A unique subpopulation of Tbr1-expressing deep layer neurons in the developing cerebral cortex

Cells of the subplate (SP) and deep cortical plate (CP) are among the pioneer neurons of the developing cerebral cortex, an important group of early-born cells that impact cortical organization and function. Similarities between pioneer neurons in different cortical positions and heterogeneities in pioneer cells in the same cortical location, however, have made it difficult to appreciate the characteristics and functions of particular sets of these cells. Here, we provide a tool to illuminate a unique subset of SP and deep CP neurons: expression of a Tbrain-1 (Tbr1)-driven transgene. Transgene-expressing cells were consistently positive for neuronal but not glial markers, were born early in corticogenesis, representing just a subset of SP and deep CP neurons, were morphologically complex during the formation of the cortex, and were maintained into maturity. This analysis reveals a novel group of pioneer neurons and demonstrates unrecognized diversity within this cortical population. In the future, this information will help to uncover the roles of discrete pioneer populations in cortical development.     

A randomized clinical trial of valacyclovir in multiple sclerosis

OBJECTIVE: The human Herpesvirus type-6 (HHV-6) has been implicated in multiple sclerosis (MS). Valacyclovir is an antiviral agent with an excellent safety profile. A two-year placebo-controlled, double-blind study was conducted to (1) ascertain if high-dose, prolonged treatment with valacyclovir would be safe and (2) observe if valacyclovir would delay the progression of MS clinically or by magnetic resonance imaging (MRI). DESIGN/METHODS: Fifty-eight patients were stratified as to severity and randomly assigned to receive valacyclovir (3000 mg/day) or placebo for a period of two years. Patients were followed clinically over the two-year period by means of the Expanded Disability Status Scale (EDSS), the Ambulation Index (AI) and brain MRI scans. Patients underwent routine lab studies every three months. Patients continued on the medication for two years unless they had a sustained progression or repeated exacerbations. RESULTS: No patient discontinued the study due to side effects or toxicity. In Relative Ranking of Progression, time to first attack, attack rate, and time to withdrawal there were trends (but not statistically significant) toward drug effect over placebo in the Severe clinical category. MRI evaluation showed no significant drug effect. CONCLUSIONS: Although not statistically significant, positive trends were detected for acyclovir by clinical measures, but not by MRI.     

Hydroxyurea exerts a cytostatic but not immunosuppressive effect on T lymphocytes

OBJECTIVE: To demonstrate that, despite a dose-dependent cytostatic effect, hydroxyurea (HU) does not have immunosuppressive effects. METHODS: The effects of HU on T lymphocyte proliferation parameters, activation phenotype and cytokine production were examined in vitro after exposure to clinically relevant concentrations of HU (10, 50, and 100 micromol/l). The effects of HU in vivo on CD4 T cell counts, viral load, activation phenotype and virus-specific response were examined in 17 Rhesus macaques infected with SIV(mac251) and randomized into three groups: untreated controls; treated with (R)-9-(2-phosphonylmethoxypropyl)adenine (PMPA) and didanosine (ddI) only; and treated with PMPA, didanosine, and HU. RESULTS: The in vitro inhibition of T lymphocyte proliferation confirmed the cytostatic effect of HU, with a linear dose-dependent effect; however, no relevant differences were found in the expression of activation markers between treated and untreated controls. Both T helper type 1 and type 2 cytokine production were enhanced by HU. Consistent with the in vitro results, a blunted increase of peripheral CD4 T cells was observed in vivo in the HU group, without relevant effects on the expression of activation markers, and SIV-specific T cell responses were not affected by HU. CONCLUSIONS: Hyper-proliferation of T-lymphocytes is a major factor contributing to HIV pathogenesis. HU exerts a cytostatic effect on T lymphocytes, without altering their activation and apparently without having an immunosuppressive effect. The increase in cytokine production at the single cell level might compensate for the decrease in the percentage of activated CD4 T lymphocytes, without overall impairment of HIV-specific immune responses.     

Reliability and validity of the mother-child neglect scale

The current study offers a new way to ascertain information about child neglect by evaluating a self-report measure of neglectful behaviors, the Mother-Child Neglect Scale (MCNS). The scale was modified from an existing self-report measure, the Neglect Scale (NS), which was originally designed to measure personal histories of neglect. One hundred adolescent mothers were administered the MCNS and NS in two occasions via phone interviews. In addition, maternal abuse potential and the quality of mother-child interactions were assessed when children were age 3 and 5 years. The MCNS had high internal consistency and moderate test-retest reliability. Convergent validity was found between the MCNS and maternal histories of neglect as well as observed parenting behaviors and child abuse potential; those relationships remained after social desirability was controlled. This research tool may prove useful, in conjunction with existing assessment instruments, in determining the type and severity of past neglectful behaviors.