Efficacy of proprioceptive neuromuscular facilitation techniques versus traditional prosthetic training for improving ambulatory function in transtibial amputees

The objective of this randomized controlled trial was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) techniques in comparison to traditional prosthetic training (TPT) in improving ambulatory function in transtibial amputees. Thirty study participants (19 men and 11 women) with unilateral transtibial amputation participated in the study. They were randomly allocated to either the traditional training group (i.e., TPT) (n = 15) or the PNF training group (n = 15). The treatment in the TPT group consisted of weight-bearing, weight-shifting, balance, and gait exercises for 30 minutes daily for 10 treatment sessions. In the PNF group, the same activities were performed by employing PNF principles and techniques. The outcome measures were gait parameters (e.g., stride width, step length, and stride length) and the Locomotor Capabilities Index (LCI). The between-group comparisons at the end of the trial showed that the PNF group showed significant improvement in gait parameters and in the LCI, compared to the TPT group (p < 0.05). The results of the study suggested that prosthetic training based on proprioceptive feedback is more effective than the traditional prosthetic programme in improving ambulatory function.     

Near-fiber electromyography

ObjectiveDescribe and evaluate the concepts of near fiber electromyography (NFEMG), the features used, including near fiber motor unit potential (NFMUP) duration and dispersion, which relate to motor unit distal axonal branch and muscle fiber conduction time dispersion, and NFMUP segment jitter, a new measure of the temporal variability of neuromuscular junction transmission (NMJ), and axonal branch and muscle fibre conduction for the near fibres (i.e. NF jitter), and the methods for obtaining their values.MethodsTrains of high-pass filtered motor unit potentials (MUPs) (i.e. NFMUP trains) were extracted from needle-detected EMG signals to assess changes in motor unit (MU) morphology and electrophysiology caused by neuromuscular disorders or ageing. Evaluations using simulated needle-detected EMG data were completed and example human data are presented.ResultsNFEMG feature values can be used to detect axonal sprouting, conduction slowing and NMJ transmission delay as well as changes in MU fiber diameter variability, and NF jitter. These changes can be detected prior to alterations of MU size or numbers.ConclusionsThe evaluations clearly demonstrate and the example data support that NFMUP duration and dispersion reflect MU distal axonal branching, conduction slowing and NMJ transmission delay and/or MU fiber diameter variability and that NFMUP jiggle and segment jitter reflect NF jitter.SignificanceNFEMG can detect early changes in MU morphology and/or electrophysiology and has the potential to augment clinical diagnosis and tracking of neuromuscular disorders.     

Developments in the discovery of drugs for spinal muscular atrophy: successful beginnings and future prospects

Introduction: Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by mutations in a gene that produces a protein called survival motor neuron (SMN). SMN has an important role in snRNP assembly in all cells but that may not be its only role; the reasons for SMN deficiency resulting in neuromuscular dysfunction and motor neuron degeneration remain active areas of research. Besides increasing SMN, compensating for SMN deficiencies or neuroprotection may be therapeutic options for SMA. Age of onset and the rate of disease progression are variable and therapeutic strategies should be appropriate to subtypes of SMA patients.

Areas covered: The article discusses SMA, their targets and where these targets can be found. Additionally, the article reviews small molecules identified as disease modifiers and how these small molecules were discovered. The article also describes and discusses emerging concepts regarding the disease mechanisms. The author compiled this review using scientific literature, patent databases, company and patient association and government websites.

Expert opinion: Small molecules targeting various processes implicated in SMA are reaching the clinic. These molecules and targets, although not yet validated, are providing insight into the complexity of a ‘simple’ genetic disease such as SMA. SMA is not a single disease and so various therapeutic strategies are needed. Biomarkers and regulatory guidelines are required to select patients for clinical trials, decide when to initiate treatment and how to develop combinations of investigational drugs.     

Stochastically-modulated stimulation to slow down muscle fatigue at stimulated sites in paraplegics using functional electrical stimulation for leg extension

Abstract

This short communication is a preliminary report on a study concerning slowing down the rate of muscle fatigue when FES (Functional Electrical Stimulation) is applied for standing and walking by complete (traumatic) thoracic-level paraplegics. It is shown that randomly modulating the inter-pulse interval between FES pulses (which serve to trigger action potentials in the peripheral nerves concerned) re~lJlts in a significantly lower rate ofmuscle fatigue, as tested in a series ofleg extensions, when FES was applied at the quadriceps. Specifically, we report that the best results (longest durations of leg extension prior to onset of muscle-fatigue) were achieved with a ± 5 msec uniformly-distributed (pseudo-) white-noise modulation at a 42 msec inter-pulse interval (24 pulses per sec). These resulted in an average increase in duration of leg extension ofapproximately 37% in this pilot study, as compared with unmodulated (fixed-rate) trains ofFES pulses. This significant increase, even in a very preliminary study appears to merit careful further examination, since it may allow a possibly significant increase in standing duration and in walking range of paraplegics using FES for ambulation. [Neural Res 2000; 22: 703-704]     

Making space: Integrating meaningful interprofessional experiences into an existing curriculum

Many health professional education programs have instituted, or are in the process of developing, structures for implementing interprofessional education (IPE). Professional organizations are also adopting IP competencies for their respective memberships and accreditations. Our IPE design and educational framework was informed by evidence gathered from professional organizations; the students' lived experience with traditional approaches and evolving IPE designs and data from our school's longitudinal curriculum evaluation study. This paper briefly describes the evolution and design of an embedded IPE program within an existing master's level curriculum – which meets not only curriculum competencies but also nationally recognizes IPE competencies. In addition, the embedded program articulates with a mandatory faculty-wide IPE initiative. The creation of embedded IPE within existing courses allowed for enriched learning opportunities for both discipline-specific and IPE knowledge without changing the overall curriculum structure.     

Exercise in neuromuscular disease

In this review, we present an overview of the role of exercise in neuromuscular disease (NMD). We demonstrate that despite the different pathologies in NMDs, exercise is beneficial, whether aerobic/endurance or strength/resistive training, and we explore whether this benefit has a similar mechanism to that of healthy subjects. We discuss further areas for study, incorporating imaginative and novel approaches to training and its assessment in NMD. We conclude by suggesting ways to improve future trials by avoiding previous methodological flaws and drawbacks in this field. Muscle Nerve, 2013