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Dewald HA, Yao J, Dewald JPA, Nader A, Kirsch RF. Peripheral nerve blocks of wrist and finger flexors can increase hand opening in chronic hemiparetic stroke. Front Neurol 2024; 15:1284780. [PMID: 38456150 PMCID: PMC10919218 DOI: 10.3389/fneur.2024.1284780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Hand opening is reduced by abnormal wrist and finger flexor activity in many individuals with stroke. This flexor activity also limits hand opening produced by functional electrical stimulation (FES) of finger and wrist extensor muscles. Recent advances in electrical nerve block technologies have the potential to mitigate this abnormal flexor behavior, but the actual impact of nerve block on hand opening in stroke has not yet been investigated. Methods In this study, we applied the local anesthetic ropivacaine to the median and ulnar nerve to induce a complete motor block in 9 individuals with stroke and observed the impact of this block on hand opening as measured by hand pentagonal area. Volitional hand opening and FES-driven hand opening were measured, both while the arm was fully supported on a haptic table (Unloaded) and while lifting against gravity (Loaded). Linear mixed effect regression (LMER) modeling was used to determine the effect of Block. Results The ropivacaine block allowed increased hand opening, both volitional and FES-driven, and for both unloaded and loaded conditions. Notably, only the FES-driven and Loaded condition's improvement in hand opening with the block was statistically significant. Hand opening in the FES and Loaded condition improved following nerve block by nearly 20%. Conclusion Our results suggest that many individuals with stroke would see improved hand-opening with wrist and finger flexor activity curtailed by nerve block, especially when FES is used to drive the typically paretic finger and wrist extensor muscles. Such a nerve block (potentially produced by aforementioned emerging electrical nerve block technologies) could thus significantly address prior observed shortcomings of FES interventions for individuals with stroke.
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Affiliation(s)
- Hendrik A. Dewald
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Jun Yao
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Julius P. A. Dewald
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Antoun Nader
- Department of Anesthesiology, Northwestern University, Chicago, IL, United States
| | - Robert F. Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Cleveland FES Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
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Deschrevel J, Andries A, Maes K, De Beukelaer N, Corvelyn M, Staut L, De Houwer H, Costamagna D, Desloovere K, Van Campenhout A, Gayan-Ramirez G. Short-Term Effects of Botulinum Toxin-A Injection on the Medial Gastrocnemius Histological Features in Ambulant Children with Cerebral Palsy: A Longitudinal Pilot Study. Toxins (Basel) 2024; 16:69. [PMID: 38393147 PMCID: PMC10891867 DOI: 10.3390/toxins16020069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Botulinum toxin-A (BoNT-A) injection is known to exert beneficial effects on muscle tone, joint mobility and gait in children with cerebral palsy (CP). However, recent animal and human studies have raised the concern that BoNT-A might be harmful to muscle integrity. In CP-children, the impact of BoNT-A on muscle structure has been poorly studied, and inconsistent results have been reported. This study was aimed at determining the time course effect of a single BoNT-A administration on medial gastrocnemius (MG) morphology in CP-children. MG microbiopsies from 12 ambulant and BoNT-A-naïve CP-children (age, 3.4 (2.3) years, ranging from 2.5 to 7.8 years; seven boys and five girls; GMFCS I = 5, II = 4 and III = 3) were collected before and 3 and 6 months after BoNT-A treatment to analyze the fiber cross-sectional area (fCSA) and proportion; capillarization; and satellite cell (SC) content. Compared with the baseline, the fCSA decreased at 3 months (-14%, NS) and increased at 6 months (+13%, NS). Fiber size variability was significantly higher at 3 months (type I: +56%, p = 0.032; type IIa: +37%, p = 0.032) and 6 months (type I: +69%, p = 0.04; type IIa: +121%, p = 0.032) compared with the baseline. The higher type I proportion seen at 3 months was still present and more pronounced at 6 months (type I: +17%, p = 0.04; type IIx: -65%, p = 0.032). The capillary fiber density was reduced at 3 months (type I: -43%, NS; type II: -44%, p = 0.0320) but normalized at 6 months. There was a non-significant increase in SC/100 fibers at 3 months (+75%, NS) and 6 months (+40%, NS) compared with the baseline. These preliminary data suggest that BoNT-A induced alterations in the MG of children with CP, which were still present 6 months after BoNT-A injection but with signs of muscle recovery.
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Affiliation(s)
- Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, O&N 1bis Box 706, Herestraat 49, 3000 Leuven, Belgium; (J.D.); (A.A.); (K.M.)
| | - Anke Andries
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, O&N 1bis Box 706, Herestraat 49, 3000 Leuven, Belgium; (J.D.); (A.A.); (K.M.)
| | - Karen Maes
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, O&N 1bis Box 706, Herestraat 49, 3000 Leuven, Belgium; (J.D.); (A.A.); (K.M.)
| | - Nathalie De Beukelaer
- Neurorehabilitation Group, Department of Rehabilitation Sciences, Tervuursevest 101 Box 1501, 3000 Leuven, Belgium; (N.D.B.); (L.S.); (D.C.); (K.D.)
| | - Marlies Corvelyn
- Stem Cell and Developmental Biology, Department of Development and Regeneration, O&N4 Box 804, 3000 Leuven, Belgium;
| | - Lauraine Staut
- Neurorehabilitation Group, Department of Rehabilitation Sciences, Tervuursevest 101 Box 1501, 3000 Leuven, Belgium; (N.D.B.); (L.S.); (D.C.); (K.D.)
| | - Hannah De Houwer
- Pediatric Orthopedics, Department of Development and Regeneration, Herestraat 49 Box 7003, 3000 Leuven, Belgium; (H.D.H.); (A.V.C.)
| | - Domiziana Costamagna
- Neurorehabilitation Group, Department of Rehabilitation Sciences, Tervuursevest 101 Box 1501, 3000 Leuven, Belgium; (N.D.B.); (L.S.); (D.C.); (K.D.)
- Stem Cell and Developmental Biology, Department of Development and Regeneration, O&N4 Box 804, 3000 Leuven, Belgium;
- Exercise Physiology Research Group, Department of Movement Sciences, Tervuursevest 101 Box 1500, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation Group, Department of Rehabilitation Sciences, Tervuursevest 101 Box 1501, 3000 Leuven, Belgium; (N.D.B.); (L.S.); (D.C.); (K.D.)
| | - Anja Van Campenhout
- Pediatric Orthopedics, Department of Development and Regeneration, Herestraat 49 Box 7003, 3000 Leuven, Belgium; (H.D.H.); (A.V.C.)
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, O&N 1bis Box 706, Herestraat 49, 3000 Leuven, Belgium; (J.D.); (A.A.); (K.M.)
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Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins (Basel) 2022; 14:toxins14110772. [PMID: 36356022 PMCID: PMC9692445 DOI: 10.3390/toxins14110772] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
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Li Z, Li Z, Li Y, Dong R, Chen C, Huang J, Xia Z, Yu N, Long X. Ultrasonographic observation of the masseter muscle after injection of different botulinum toxin type A. J Cosmet Dermatol 2022; 21:5555-5561. [PMID: 35599608 DOI: 10.1111/jocd.15106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/09/2022] [Accepted: 05/17/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) injection is a popular cosmetic procedure in East Asian countries, and there are multiple types of toxins on the market. Whether different toxin types induce different changes in the masseter has not been studied. OBJECTIVE We aimed to investigate and compare the changes induced by injection of different types of BoNT-A in the masseter. METHODS Upon retrospective review of clinical records and routine ultrasound examination results of patients who underwent BoNT-A injection, four groups were set for comparison: unapproved toxin, OnabotulinumtoxinA, LanbotulinumtoxinA, and non-injected. Clinical records and ultrasound images were collected. Ultrasound images were taken in both horizontal and coronal planes. Elasticity of the masseter muscle was also investigated by measuring the surface wave speed. RESULTS A total of 24 patients were included (six patients per group). All patients were young females. For the non-injected group, the deep inferior tendon was clear and the muscle bundles were arranged, with little fibrous content. Patients who received unapproved toxin injection showed highly disarranged muscle and fiber bundles, with much fiber content present. The changes in OnabotulinumtoxinA and LanbotulinumtoxinA groups were in between those in the non-injected and unapproved toxin groups. Muscle rigidity was the highest in the unapproved toxin group, and generally higher in injected groups compared with the non-injected group. CONCLUSION Different types of BoNT-A may induce different changes in the masseter.
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Affiliation(s)
- Zhujun Li
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China
| | - Zirong Li
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China
| | - Yunzhu Li
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China
| | - Ruijia Dong
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Cheng Chen
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Ultrasound, Beijing, China
| | - Jiuzuo Huang
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China
| | - Zenan Xia
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China
| | - Nanze Yu
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China
| | - Xiao Long
- Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China
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Botox Injections in Paraspinal Muscles Result in Low Maximal Specific Force and Shortening Velocity in Fast but Not Slow Skinned Muscle Fibers. Spine (Phila Pa 1976) 2022; 47:833-840. [PMID: 34265813 DOI: 10.1097/brs.0000000000004162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Basic science, experimental animal study. OBJECTIVE To determine the effects of Botulinum toxin type A (BTX-A) injections on the mechanical properties of skinned muscle fibers (cells) of rabbit paraspinal muscles. SUMMARY OF BACKGROUND DATA BTX-A has been widely used in the treatment of disorders of muscle hyperactivity, such as spasticity, dystonia, and back pain. However, BTX-A injection has been shown to cause muscle atrophy, fat infiltration, and decreased force output in target muscles, but its potential effects on the contractile machinery and force production on the cellular level remain unknown. METHODS Nineteen-month-old, male New Zealand White Rabbits received either saline or BTX-A injections into the paraspinal muscles, equally distributed along the left and right sides of the spine at T12, L1, and L2 at 0, 8, 12, 16, 20, and 24 weeks. Magnetic resonance imaging was used to quantify muscle crosssectional area and structural changes before and at 28 weeks following the initial injection. Skinned fibers isolated from the paraspinal muscles were tested for their active and passive force-length relationships, unloaded shortening velocity, and myosin heavy chain isoforms. RESULTS BTX-A injections led to significant fat infiltration within the injected muscles and a greater proportion of IIa to IIx fibers. Isolated fast fibers from BTX-A injected animals had lower active force and unloaded shortening velocity compared with fibers from saline-injected control animals. Force and velocity properties were not different between groups for the slow fibers. CONCLUSION Injection of BTX-A into the paraspinal rabbit muscles leads to significant alterations in the contractile properties of fast, but not slow, fibers.Level of Evidence: N/A.
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Chandra S, Afsharipour B, Rymer WZ, Suresh NL. Characteristic Variation of Electromechanical Delay After the Botulinum Toxin Injection in Spastic Biceps Brachii Muscles. Front Neurol 2022; 12:789442. [PMID: 35222227 PMCID: PMC8868127 DOI: 10.3389/fneur.2021.789442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to characterize the effects of intramuscular botulinum toxin (BT) injections on the electromechanical delay (EMD) in spastic human biceps muscles. The EMD is calculated as the time lag between the muscle activation onset, as recorded from the surface electromyogram (sEMG), and the onset of recorded force. In a cohort of chronic stroke survivors, we compared the computed EMD derived from the spastic (injected) biceps brachii with that from the contralateral muscle. Eight participants were tested before and up to 3 months after a BT injection. At each session, participants followed an isometric trapezoidal force trajectory at 50 and 30%, respectively, of the tested maximum voluntary contraction (MVC). Joint force and sEMG signals were recorded as well. The number of zero crossings (ZC) of the sEMG during the steady-state portion of the task was also computed. The EMD post-BT was found to increase by 64 ± 10% (at 50% MVC) and 93 ± 18% (at 30% MVC) when compared to pre-BT values, while the number of sEMG-ZC, the mean MVC values, and the force-EMD slope exhibited striking reductions. These parameters, calculated on the contralateral side, remained relatively constant across sessions, with the EMD significantly lower and the MVC values much higher. We discuss potential contributing factors to an increase in EMD values on the affected side, both pre- and post-BT. The observed co-variation across sessions of the increased EMD values with the decreased ZC estimates, a surrogate of motor outflow, and, potentially, more compliant muscle fascicles suggests that the altered motor unit (MU) behavior contributes, at least in part, to the delayed force production.
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Affiliation(s)
- Sourav Chandra
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
- Arms and Hand Laboratory, Shirley Ryan Ability Lab, Chicago, IL, United States
- *Correspondence: Sourav Chandra
| | - Babak Afsharipour
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - William Z. Rymer
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
- Arms and Hand Laboratory, Shirley Ryan Ability Lab, Chicago, IL, United States
| | - Nina L. Suresh
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
- Arms and Hand Laboratory, Shirley Ryan Ability Lab, Chicago, IL, United States
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Chen YT, Liu Y, Zhang C, Magat E, Zhou P, Zhang Y, Li S. Comprehensive Assessment of the Time Course of Biomechanical, Electrophysiological and Neuro-Motor Effects after Botulinum Toxin Injections in Elbow Flexors of Chronic Stroke Survivors with Spastic Hemiplegia: A Cross Sectional Observation Study. Toxins (Basel) 2022; 14:toxins14020104. [PMID: 35202132 PMCID: PMC8875179 DOI: 10.3390/toxins14020104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
Botulinum neurotoxin (BoNT) is commonly used to manage focal spasticity in stroke survivors. This study aimed to a perform comprehensive assessment of the effects of BoNT injection. Twelve stroke subjects with spastic hemiplegia (age: 52.0 ± 10.1 year; 5 females) received 100 units of BoNT to the spastic biceps brachii muscles. Clinical, biomechanical, electrophysiological, and neuro-motor assessments were performed one week (wk) before (pre-injection), 3 weeks (wks) after, and 3 months (mons) after BoNT injection. BoNT injection significantly reduced spasticity, muscle strength, reflex torque, and compound muscle action potential (CMAP) amplitude of spastic elbow flexors (all p < 0.05) during the 3-wks visit, and these values return to the pre-injection level during the 3-mons visit. Furthermore, the degree of reflex torque change was negatively correlated to the amount of non-reflex component of elbow flexor resistance torque. However, voluntary force control and non-reflex resistance torque remained unchanged throughout. Our results revealed parallel changes in clinical, neurophysiological and biomechanical assessment after BoNT injection; BoNT injection would be more effective if hypertonia was mainly mediated by underlying neural mechanisms. BoNT did not affect voluntary force control of spastic muscles.
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Affiliation(s)
- Yen-Ting Chen
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (Y.-T.C.); (E.M.)
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
- Department of Health and Kinesiology, Northeastern State University, Broken Arrow, OK 74014, USA
| | - Yang Liu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA; (Y.L.); (C.Z.); (Y.Z.)
| | - Chuan Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA; (Y.L.); (C.Z.); (Y.Z.)
| | - Elaine Magat
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (Y.-T.C.); (E.M.)
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
| | - Ping Zhou
- Faculty of Biomedical and Rehabilitation Engineering, University of Health and Rehabilitation Sciences, Qingdao 266024, China;
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA; (Y.L.); (C.Z.); (Y.Z.)
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (Y.-T.C.); (E.M.)
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
- Correspondence:
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Fridén J, Stankovic N, Ward SR, Lieber RL. Increased muscle fiber size and pathology with botulinum toxin treatment of upper extremity muscles in cerebral palsy. CURRENT TOPICS IN TOXICOLOGY 2022; 18:167-178. [PMID: 36999118 PMCID: PMC10049878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Intramuscular injections of botulinum toxin A (BTX) are regularly used to treat skeletal muscle spasticity and relieve pain during rehabilitation therapy. However, while numerous preclinical studies have shown dramatic atrophic changes in muscle, little is known about the long-term effect of toxin on human skeletal muscle. In this study, muscle morphology was analyzed in biopsies taken from spastic upper extremity muscles of 8 cerebral palsy patients treated with BTX 5 months to 4 years prior sampling and was compared to muscles from 7 patients who had not ever received BTX treatment (overall 25 muscle biopsies obtained from 6 different muscles.). The most important (and surprising) finding was that BTX-treated muscles contained significantly larger fibers compared to untreated muscles. A strong correlation between fiber size and age was observed but the growth rate in the BTX group was larger. Pathological signs such as central nuclei, neonatal myosin heavy chain expression, angular fibers and hybrid fibers (expressing both slow and fast myosin heavy chain fibers) were significantly greater in BTX-treated muscles compared to untreated muscles. Capillarization was also increased in BTX-treated muscle compared to untreated muscles and was the best predictor of fiber size. We suggest that, in the context of spasticity, BTX may block negative, atrophy-inducing pressure of the central nervous system on skeletal muscle or may allow an altered use pattern that should be considered a positive adjuvant to current rehabilitation therapies.
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Affiliation(s)
- Jan Fridén
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Tetrahand Surgery and Hand Surgery, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Nenad Stankovic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Samuel R. Ward
- Department of Radiology, University of California and Veterans Affairs Medical Centers, San Diego, California, USA
- Departments of Orthopaedic Surgery and Bioengineering, University of California and Veterans Affairs Medical Centers, San Diego, California, USA
| | - Richard L. Lieber
- Departments of Physical Medicine and Rehabilitation, Physiology and Biomedical Engineering, Northwestern University, Chicago IL, USA
- Shirley Ryan AbilityLab, Chicago IL, USA
- Hines Veterans Affairs Medical Center, Maywood IL, USA
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Binder-Markey BI, Murray WM, Dewald JPA. Passive Properties of the Wrist and Fingers Following Chronic Hemiparetic Stroke: Interlimb Comparisons in Persons With and Without a Clinical Treatment History That Includes Botulinum Neurotoxin. Front Neurol 2021; 12:687624. [PMID: 34447346 PMCID: PMC8383209 DOI: 10.3389/fneur.2021.687624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neural impairments that follow hemiparetic stroke may negatively affect passive muscle properties, further limiting recovery. However, factors such as hypertonia, spasticity, and botulinum neurotoxin (BoNT), a common clinical intervention, confound our understanding of muscle properties in chronic stroke. Objective: To determine if muscle passive biomechanical properties are different following prolonged, stroke-induced, altered muscle activation and disuse. Methods: Torques about the metacarpophalangeal and wrist joints were measured in different joint postures in both limbs of participants with hemiparetic stroke. First, we evaluated 27 participants with no history of BoNT; hand impairments ranged from mild to severe. Subsequently, seven participants with a history of BoNT injections were evaluated. To mitigate muscle hypertonia, torques were quantified after an extensive stretching protocol and under conditions that encouraged participants to sleep. EMGs were monitored throughout data collection. Results: Among participants who never received BoNT, no significant differences in passive torques between limbs were observed. Among participants who previously received BoNT injections, passive flexion torques about their paretic wrist and finger joints were larger than their non-paretic limb (average interlimb differences = +42.0 ± 7.6SEM Ncm, +26.9 ± 3.9SEM Ncm, respectively), and the range of motion for passive finger extension was significantly smaller (average interlimb difference = -36.3° ± 4.5°SEM; degrees). Conclusion: Our results suggest that neural impairments that follow chronic, hemiparetic stroke do not lead to passive mechanical changes within the wrist and finger muscles. Rather, consistent with animal studies, the data points to potential adverse effects of BoNT on passive muscle properties post-stroke, which warrant further consideration.
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Affiliation(s)
- Benjamin I Binder-Markey
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, United States.,School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia, PA, United States.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation Science, Northwestern University, Chicago, IL, United States.,Shirley Ryan Ability Lab, Chicago, IL, United States
| | - Wendy M Murray
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation Science, Northwestern University, Chicago, IL, United States.,Shirley Ryan Ability Lab, Chicago, IL, United States.,Research Service, Edward Hines Jr., VA Hospital, Hines, IL, United States
| | - Julius P A Dewald
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation Science, Northwestern University, Chicago, IL, United States
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10
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Lieber RL, Binder-Markey B. Biochemical and structural basis of the passive mechanical properties of whole skeletal muscle. J Physiol 2021; 599:3809-3823. [PMID: 34101193 PMCID: PMC8364503 DOI: 10.1113/jp280867] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/06/2021] [Indexed: 01/18/2023] Open
Abstract
Passive mechanical properties of whole skeletal muscle are not as well understood as active mechanical properties. Both the structural basis for passive mechanical properties and the properties themselves are challenging to determine because it is not clear which structures within skeletal muscle actually bear passive loads and there are not established standards by which to make mechanical measurements. Evidence suggests that titin bears the majority of the passive load within the single muscle cell. However, at larger scales, such as fascicles and muscles, there is emerging evidence that the extracellular matrix bears the major part of the load. Complicating the ability to quantify and compare across size scales, muscles and species, definitions of muscle passive properties such as stress, strain, modulus and stiffness can be made relative to many reference parameters. These uncertainties make a full understanding of whole muscle passive mechanical properties and modelling these properties very difficult. Future studies defining the specific load bearing structures and their composition and organization are required to fully understand passive mechanics of the whole muscle and develop therapies to treat disorders in which passive muscle properties are altered such as muscular dystrophy, traumatic laceration, and contracture due to upper motor neuron lesion as seen in spinal cord injury, stroke and cerebral palsy.
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Affiliation(s)
- Richard L. Lieber
- Shirley Ryan AbilityLab
- Departments of Physical Medicine and Rehabilitation and
Biomedical Engineering, Northwestern University, Chicago, IL, USA
- Edward Hines V.A. Medical Center, Hines, IL USA
| | - Ben Binder-Markey
- Department of Physical Therapy and Rehabilitation Sciences
and School of Biomedical Engineering, Sciences and Health Systems, Drexel
University, Philadelphia, PA USA
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11
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Long-term BTX-A effects on bi-articular muscle: Higher passive force, limited length range of active force production and unchanged intermuscular interactions. J Biomech 2021; 126:110627. [PMID: 34293603 DOI: 10.1016/j.jbiomech.2021.110627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022]
Abstract
Botulinum toxin type-A (BTX-A) is commonly used for spasticity management aiming at reducing joint stiffness and increasing joint range of motion in CP patients. However, previous animal studies showed acutely increased passive forces and a narrowerlength range of active force exertion (lrange) for muscles exposed. BTX-A can spread affecting mechanics of several muscles in a compartment, but it was shown acutely to diminishepimuscular myofascial force transmission (EMFT). Yet, our understanding of these effects in the long-term is limited and they need to be tested in a bi-articular muscle. The goal was to test the following hypotheses in a long-term rat model: exposure to BTX-A (i) has no effects onlrangeand passive forces of bi-articular extensor digitorum longus (EDL) muscle and (ii) diminishes EMFT. Male Wistar rats were divided into two groups: BTX-A and control (0.1 units of BTX-A or only saline was injected into the tibialis anterior). Isometric proximal and distal EDL forces were measured simultaneously, one-month post-injection. Proximally and distally lengthening the muscle showed that BTX-A causes a significantly narrowerlrange(by 14.7% distally and 32.2% proximally) and significantly increased passive muscle forces (over 2-fold both distally and proximally). Altering muscle position at constant length showed that BTX-A does not change EMFT. The findings reject both hypotheses showing that long-term exposure to BTX-A compromises bi-articular muscle's contribution to motion for both joints and the muscle's mechanical interaction with the surroundings remains unaffected. These effects which may compromise long-term spasticity management should be studied in CP patients.
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Goo M, Johnston LM, Hug F, Tucker K. Systematic Review of Instrumented Measures of Skeletal Muscle Mechanical Properties: Evidence for the Application of Shear Wave Elastography with Children. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1831-1840. [PMID: 32423570 DOI: 10.1016/j.ultrasmedbio.2020.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/16/2020] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
The aim of this review was to identify instrumented devices that quantify skeletal muscle mechanical properties and to evaluate their potential clinical utility and clinimetric evidence with respect to children. Four databases were searched to identify articles reporting original clinimetric data for devices measuring muscle stiffness or elastic modulus, along a muscle's main fibre direction. Clinimetric evidence was rated using the Consensus-Based Standard for the Selection of Measurement Instruments (COSMIN) checklist. Sixty-five articles provided clinimetric data for two devices meeting our criteria: the Aixplorer and the Acuson. Both are shear wave elastography devices that determine the shear modulus of muscle tissue. The Aixplorer had strong construct validity and reliability, and the Acuson, moderate construct validity and reliability. Both devices have sound clinical utility with non-invasive application at various joint positions and data acquisition in real time, minimizing fatigue. Further research is warranted to evaluate utility for children with specific disorders of abnormal muscle structure or function.
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Affiliation(s)
- Miran Goo
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Francois Hug
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia; Laboratory "Movement, Interactions, Performance", Nantes, France; Institut Universitaire de France, Faculty of Sport Sciences, University of Nantes, Paris, France
| | - Kylie Tucker
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia.
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Chandra S, Afsharipour B, Rymer WZ, Suresh NL. Precise quantification of the time course of voluntary activation capacity following Botulinum toxin injections in the biceps brachii muscles of chronic stroke survivors. J Neuroeng Rehabil 2020; 17:102. [PMID: 32703213 PMCID: PMC7376714 DOI: 10.1186/s12984-020-00716-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Spasticity is a key motor impairment that affects many hemispheric stroke survivors. Intramuscular botulinum toxin (BT) injections are used widely to clinically manage spasticity-related symptoms in stroke survivors by chemically denervating muscle fibers from their associated motor neurons. In this study, we sought to understand how BT affects muscle activation, motor unit composition and voluntary force generating capacity over a time period of 3 months. Our purpose was to characterize the time course of functional changes in voluntary muscle activity in stroke survivors who are undergoing BT therapy as part of their physician-prescribed clinical plan. Method Our assessment of the effects of BT was based on the quantification of surface electromyogram (sEMG) recordings in the biceps brachii (BB), an upper arm muscle and of voluntary contraction force. We report here on voluntary force and sEMG responses during isometric elbow contractions across consecutive recording sessions, spread over 12 weeks in three segments, starting with a preliminary session performed just prior to the BT injection. At predetermined time points, we conducted additional clinical assessments and we also recorded from the contralateral limbs of our stroke cohort. Eight subjects were studied for approximately 86 experimental recording sessions on both stroke-affected and contralateral sides. Results We recorded an initial reduction in force and sEMG in all subjects, followed by a trajectory with a progressive return to baseline over a maximum of 12 weeks, although the minimum sEMG and minimum force were not always recorded at the same time point. Three participants were able to complete only one to two segments. Slope values of the sEMG-force relations were also found to vary across the different time segments. While sEMG-force slopes provide assessments of force generation capacity of the BT injected muscle, amplitude histograms from novel sEMG recordings during the voluntary tasks provide additional insights about differential actions of BT on the overall motor unit (MU) population over time. Conclusions The results of our study indicate that there are potential short term as well as long term decrements in muscle control and activation properties after BT administration on the affected side of chronic stroke survivors. Muscle activation levels as recorded using sEMG, did not routinely return to baseline even at three months’ post injection. The concurrent clinical measures also did not follow the same time course, nor did they provide the same resolution as our experimental measures. It follows that even 12 weeks after intramuscular BT injections muscle recovery may not be complete, and may thereby contribute to pre-existing paresis.
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Affiliation(s)
- S Chandra
- Shirley Ryan Ability Lab, 355 East Erie St., 21st floor, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, IL, USA.
| | - B Afsharipour
- Department of Biomedical Engineering, University of Alberta, Edmonton, CA, Canada
| | - W Z Rymer
- Shirley Ryan Ability Lab, 355 East Erie St., 21st floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, IL, USA
| | - N L Suresh
- Shirley Ryan Ability Lab, 355 East Erie St., 21st floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, IL, USA
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Sätilä H. Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections? Toxins (Basel) 2020; 12:toxins12070440. [PMID: 32640636 PMCID: PMC7404978 DOI: 10.3390/toxins12070440] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/20/2022] Open
Abstract
Botulinum toxin type A (BTXA) has been used for over 25 years in the management of pediatric lower and upper limb hypertonia, with the first reports in 1993. The most common indication is the injection of the triceps surae muscle for the correction of spastic equinus gait in children with cerebral palsy. The upper limb injection goals include improvements in function, better positioning of the arm, and facilitating the ease of care. Neurotoxin type A is the most widely used serotype in the pediatric population. After being injected into muscle, the release of acetylcholine at cholinergic nerve endings is blocked, and a temporary denervation and atrophy ensues. Targeting the correct muscle close to the neuromuscular junctions is considered essential and localization techniques have developed over time. However, each technique has its own limitations. The role of BTXA is flexible, but limited by the temporary mode of action as a focal spasticity treatment and the restrictions on the total dose deliverable per visit. As a mode of treatment, repeated BTXA injections are needed. This literature reviewed BTXA injection techniques, doses and dilutions, the recovery of muscles and the impact of repeated injections, with a focus on the pediatric population. Suggestions for future studies are also discussed.
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Affiliation(s)
- Heli Sätilä
- Department of Neuropediatrics, Päijät-Häme Central Hospital, Lahti, Finland, Keskussairaalankatu 7, 15850 Lahti, Finland
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15
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Kaya CS, Yılmaz EO, Akdeniz-Doğan ZD, Yucesoy CA. Long-Term Effects With Potential Clinical Importance of Botulinum Toxin Type-A on Mechanics of Muscles Exposed. Front Bioeng Biotechnol 2020; 8:738. [PMID: 32695774 PMCID: PMC7338794 DOI: 10.3389/fbioe.2020.00738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Botulinum toxin type-A (BTX-A) is widely used for spasticity management and mechanically aims at reducing passive resistance at the joint and widening joint range of movement. However, recent experiments on acute BTX-A effects showed that the injected rat tibialis anterior (TA) muscle’s passive forces increased, and the length range of active force exertion (lrange) did not change. Additionally, BTX-A was shown to spread into non-injected muscles in the compartment and affect their mechanics. Whether those effects persist in the long term is highly important, but unknown. The aim was to test the following hypotheses with experiments conducted in the anterior crural compartment of the rat: In the long term, BTX-A (1) maintains lrange, (2) increases passive forces of the injected TA muscle, and (3) spreads into non-injected extensor digitorum longus (EDL) and the extensor hallucis longus (EHL) muscles, also affecting their active and passive forces. Male Wistar rats were divided into two groups: BTX-A and Control (0.1 units of BTX-A or only saline was injected into the TA). Isometric forces of the muscles were measured simultaneously 1-month post-injection. The targeted TA was lengthened, whereas the non-targeted EDL and EHL were kept at constant length. Hydroxyproline analysis was done to quantify changes in the collagen content of studied muscles. Two-way ANOVA test (for muscle forces, factors: TA length and animal group) and unpaired t or Mann-Whitney U test (for lrange and collagen content, where appropriate) were used for statistical analyses (P < 0.05). BTX-A caused significant effects. TA: active forces decreased (maximally by 75.2% at short and minimally by 48.3%, at long muscle lengths), lrange decreased (by 22.9%), passive forces increased (by 12.3%), and collagen content increased (approximately threefold). EDL and EHL: active forces decreased (up to 66.8%), passive force increased (minimally by 62.5%), and collagen content increased (approximately twofold). Therefore, hypothesis 1 was rejected and 2 and 3 were confirmed indicating that previously reported acute BTX-A effects persist and advance in the long term. A narrower lrange and an elevated passive resistance of the targeted muscle are unintended mechanical effects, whereas spread of BTX-A into other compartmental muscles indicates the presence of uncontrolled mechanical effects.
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Affiliation(s)
- Cemre S Kaya
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Evrim O Yılmaz
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Zeynep D Akdeniz-Doğan
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University, Istanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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16
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Ward SR, Winters TM, O'Connor SM, Lieber RL. Non-linear Scaling of Passive Mechanical Properties in Fibers, Bundles, Fascicles and Whole Rabbit Muscles. Front Physiol 2020; 11:211. [PMID: 32265730 PMCID: PMC7098999 DOI: 10.3389/fphys.2020.00211] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/24/2020] [Indexed: 01/26/2023] Open
Abstract
Defining variations in skeletal muscle passive mechanical properties at different size scales ranging from single muscle fibers to whole muscles is required in order to understand passive muscle function. It is also of interest from a muscle structural point-of-view to identify the source(s) of passive tension that function at each scale. Thus, we measured passive mechanical properties of single fibers, fiber bundles, fascicles, and whole muscles in three architecturally diverse muscles from New Zealand White rabbits (n = 6) subjected to linear deformation. Passive modulus was quantified at sarcomere lengths across the muscle’s anatomical range. Titin molecular mass and collagen content were also quantified at each size scale, and whole muscle architectural properties were measured. Passive modulus increased non-linearly from fiber to whole muscle for all three muscles emphasizing extracellular sources of passive tension (p < 0.001), and was different among muscles (p < 0.001), with significant muscle by size-scale interaction, indicating quantitatively different scaling for each muscle (p < 0.001). These findings provide insight into the structural basis of passive tension and suggest that the extracellular matrix (ECM) is the dominant contributor to whole muscle and fascicle passive tension. They also demonstrate that caution should be used when inferring whole muscle properties from reduced muscle size preparations such as muscle biopsies.
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Affiliation(s)
- Samuel R Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Taylor M Winters
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Shawn M O'Connor
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Richard L Lieber
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Veteran's Administration San Diego Healthcare System, San Diego, CA, United States.,Shirley Ryan AbilityLab, Northwestern University, Chicago, IL, United States
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17
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Hong SW, Kang JH. Decreased mandibular cortical bone quality after botulinum toxin injections in masticatory muscles in female adults. Sci Rep 2020; 10:3623. [PMID: 32107437 PMCID: PMC7046747 DOI: 10.1038/s41598-020-60554-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
This study aimed to clarify how masticatory muscle atrophy induced by botulinum toxin (BTX) injection affects cortical bone quality of the mandible using 3D modeling technology. A total of 39 young (26.9 ± 6.0 years) and 38 post-menopausal (55.3 ± 6.3 years) females were included. Computed tomography (CT) images were obtained before and after 12 months of treatment. Predictor variables were application of a stabilization splint, and/or two times of BTX injection in the bilateral temporalis and masseter muscles within a six-month interval. Outcome variables were changes in average Hounsfield units (HU) and cortical thickness of region of interest (ROI). 3D mandibular models were reconstructed using CT images, and models were used to calculate average HU and cortical thickness of ROIs, including inferior half of the lateral surface of ascending ramus, coronoid process, and temporomandibular joint condyle. Cortical bone quality at muscle insertion site was influenced by decreased muscle thickness but seemed not to be affected by decreased functional loading. Reduced functional loading seemed to influence cortical bone quality of the condyles. These effects were more remarkable in post-menopausal females. Hence, decreased masticatory muscle thickness may lead to alterations of the mandibular cortical structures, especially in post-menopausal females.
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Affiliation(s)
- Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181, Korea
| | - Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea.
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18
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Age-associated changes in the mechanical properties of human cadaveric pelvic floor muscles. J Biomech 2019; 98:109436. [PMID: 31708240 DOI: 10.1016/j.jbiomech.2019.109436] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/12/2022]
Abstract
Proper function of the female pelvic floor requires intact pelvic floor muscles (PFMs). The prevalence of pelvic floor disorders (PFDs) increases substantially with age, in part due to clinically identified deterioration of PFM function with age. However, the etiology of this decline remains largely unknown. We previously demonstrated that PFMs undergo age-related fibrotic changes. This study sought to determine whether aging also impacts PFMs' passive mechanical properties that are largely determined by the intramuscular extracellular matrix. Biopsies from younger (≤52y) and older (>52y) female cadaveric donors were procured from PFMs, specifically coccygeus (C) and two portions of the levator ani - iliococcygeus (IC) and pubovisceralis (PV), and the appendicular muscles - obturator internus (OI) and vastus lateralis (VL). Muscle bundles were subjected to a passive loading protocol, and stress-sarcomere length (Ls) relationships calculated. Muscle stiffness was compared between groups using 2-way ANOVA and Sidak pairwise comparisons, α < 0.05. The mean age was 43.4 ± 11.6y and 74.9 ± 11.9y in younger (N = 5) and older (N = 10) donors, respectively. In all PFMs, the quadratic coefficient of parabolic regression of the stress-Ls curve, a measure of stiffness, was lower in the younger versus older group: C: 33.7 ± 13.9 vs 87.2 ± 10.7, P = 0.02; IC: 38.3 ± 12.7 vs 84.5 ± 13.9, P = 0.04; PV: 24.7 ± 8.8 vs 74.6 ± 9.6, P = 0.04. In contrast, non-PFM stiffness was not affected by aging: OI: 14.5 ± 4.7 vs 32.9 ± 6.2, P = 0.8 and VL: 13.6 ± 5.7 vs 30.1 ± 5.3, P = 0.9. Age-associated increase in PFM stiffness is predicted to negatively impact PFM function by diminishing muscle load-bearing, excursional, contractile, and regenerative capacity, thus predisposing older women to PFDs.
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19
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Bleiler C, Ponte Castañeda P, Röhrle O. A microstructurally-based, multi-scale, continuum-mechanical model for the passive behaviour of skeletal muscle tissue. J Mech Behav Biomed Mater 2019; 97:171-186. [DOI: 10.1016/j.jmbbm.2019.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 12/30/2022]
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20
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Moriyama H, Ozawa J, Yakuwa T, Inoue S, Wakigawa T, Kito N, Sakai Y, Akisue T. Effects of hypertonia on contracture development in rat spinal cord injury. Spinal Cord 2019; 57:850-857. [PMID: 31201373 DOI: 10.1038/s41393-019-0312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Experimental animal study. OBJECTIVES Spastic hypertonia is originally believed to cause contractures from clinical observations. Botulinum toxin is effective for the treatment of spasticity and is widely used in patients who have joints with contractures. Using an established rat model with knee contractures after spinal cord injuries, we aimed to verify whether hypertonia contributes to contracture development, and the botulinum toxin improves structural changes in muscles and joint components responsible for contractures. SETTING University laboratory in Japan. METHODS To evaluate the effect of hypertonia on contracture development, the rats received botulinum toxin injections after spinal cord injuries. Knee extension motion was measured with a goniometer applying a standardized torque under anesthesia, and the contribution by muscle or non-muscle structures to contractures were calculated by measuring joint motion before and after the myotomies. We quantitatively measured the muscle atrophy, muscle fibrosis, and synovial intima length. RESULTS Botulinum toxin injections significantly improved contractures, whereas did not completely prevent contracture development. Botulinum toxin was effective in improving the muscular factor, but little difference in the articular factor. Spinal cord injuries induced muscle atrophy, and botulinum toxin significantly accelerated muscle atrophy and fibrosis. The synovial intima length decreased significantly after spinal cord injuries, and botulinum toxin did not improve this shortening. CONCLUSIONS This animal study provides new evidence that hypertonia is not the sole cause rather is the partial contributor of contractures after spinal cord injuries. Furthermore, botulinum toxin has adverse effects in the muscle.
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Affiliation(s)
- Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Japan.
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
| | - Takumi Yakuwa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Shota Inoue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Taisei Wakigawa
- Faculty of Health Sciences, School of Medicine, Kobe University, Kobe, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Akisue
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Japan
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21
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Spyrou L, Brisard S, Danas K. Multiscale modeling of skeletal muscle tissues based on analytical and numerical homogenization. J Mech Behav Biomed Mater 2019; 92:97-117. [DOI: 10.1016/j.jmbbm.2018.12.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/17/2018] [Accepted: 12/21/2018] [Indexed: 02/03/2023]
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22
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Ursu D, Cederna PS. Discussion: Contralateral Botulinum Toxin Improved Functional Recovery after Tibial Nerve Repair in Rats. Plast Reconstr Surg 2018; 142:1520-1522. [PMID: 30489525 DOI: 10.1097/prs.0000000000005075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel Ursu
- From the Section of Plastic Surgery and the Department of Biomedical Engineering, University of Michigan
| | - Paul S Cederna
- From the Section of Plastic Surgery and the Department of Biomedical Engineering, University of Michigan
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23
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Worton LE, Gardiner EM, Kwon RY, Downey LM, Ausk BJ, Bain SD, Gross TS. Botulinum toxin A-induced muscle paralysis stimulates Hdac4 and differential miRNA expression. PLoS One 2018; 13:e0207354. [PMID: 30427927 PMCID: PMC6235354 DOI: 10.1371/journal.pone.0207354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022] Open
Abstract
At sufficient dose, intramuscular injection of Botulinum toxin A causes muscle wasting that is physiologically consistent with surgical denervation and other types of neuromuscular dysfunction. The aim of this study was to clarify early molecular and micro-RNA alterations in skeletal muscle following Botulinum toxin A-induced muscle paralysis. Quadriceps were analyzed for changes in expression of micro- and messenger RNA and protein levels after a single injection of 0.4, 2 or 4U Botulinum toxin A (/100g body weight). After injection with 2.0U Botulinum toxin A, quadriceps exhibited significant reduction in muscle weight and increased levels of ubiquitin ligase proteins at 7, 14 and 28 days. Muscle miR-1 and miR-133a/b levels were decreased at these time points, whereas a dose-responsive increase in miR-206 expression at day 14 was observed. Expression of the miR-133a/b target genes RhoA, Tgfb1 and Ctfg, and the miR-1/206 target genes Igf-1 and Hdac4, were upregulated at 28 days after Botulinum toxin A injection. Increased levels of Hdac4 protein were observed after injection, consistent with anticipated expression changes in direct and indirect Hdac4 target genes, such as Myog. Our results suggest Botulinum toxin A-induced denervation of muscle shares molecular characteristics with surgical denervation and other types of neuromuscular dysfunction, and implicates miR-133/Tgf-β1/Ctfg and miR-1/Hdac4/Myog signaling during the resultant muscle atrophy.
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Affiliation(s)
- Leah E. Worton
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
- * E-mail:
| | - Edith M. Gardiner
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Ronald Y. Kwon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Leah M. Downey
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Brandon J. Ausk
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Steven D. Bain
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Ted S. Gross
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
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Goo M, Tucker K, Johnston LM. Muscle tone assessments for children aged 0 to 12 years: a systematic review. Dev Med Child Neurol 2018; 60:660-671. [PMID: 29405265 DOI: 10.1111/dmcn.13668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 01/10/2023]
Abstract
AIM The aim of this study was to identify and examine the psychometric properties of muscle tone assessments for children aged 0 to 12 years. METHOD Four electronic databases were searched to identify studies that included assessments of resting and/or active muscle tone. Methodological quality and overall psychometric evidence of studies were rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. RESULTS Twenty-one assessments were identified from 97 included studies. All assessments were broad developmental assessments that included muscle tone items or subscales. Most assessments (16/21) were designed for young children (<2y). Four assessments measured resting and active tone and demonstrated at least moderate validity or reliability: the Amiel-Tison Neurological Assessment (ATNA) at term, Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS), Premie-Neuro for newborn infants, and the Hammersmith Infant Neurological Examination (HINE) for infants aged 2 months to 2 years. For children over 2 years, the Neurological Sensory Motor Developmental Assessment (NSMDA) assesses resting and active tone but has limited validity. INTERPRETATION The ATNA at term, NNNS, Premie-Neuro, HINE, and NSMDA can assess resting and active tone in infants and/or children. Further psychometric research is required to extend reliability, validity, and responsiveness data, particularly for older children. WHAT THIS PAPER ADDS This is the first review of muscle tone assessments for children aged 0 to 12 years. Twenty-one assessments contain muscle tone items and 16 are for children under 2 years. Four assessments are reliable or valid to measure both resting and active tone.
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Affiliation(s)
- Miran Goo
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Kylie Tucker
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Wang R, Gäverth J, Herman PA. Changes in the Neural and Non-neural Related Properties of the Spastic Wrist Flexors After Treatment With Botulinum Toxin A in Post-stroke Subjects: An Optimization Study. Front Bioeng Biotechnol 2018; 6:73. [PMID: 29963551 PMCID: PMC6013585 DOI: 10.3389/fbioe.2018.00073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
Quantifying neural and non-neural contributions to the joint resistance in spasticity is essential for a better evaluation of different intervention strategies such as botulinum toxin A (BoTN-A). However, direct measurement of muscle mechanical properties and spasticity-related parameters in humans is extremely challenging. The aim of this study was to use a previously developed musculoskeletal model and optimization scheme to evaluate the changes of neural and non-neural related properties of the spastic wrist flexors during passive wrist extension after BoTN-A injection. Data of joint angle and resistant torque were collected from 21 chronic stroke patients before, and 4 and 12 weeks post BoTN-A injection using NeuroFlexor, which is a motorized force measurement device to passively stretch wrist flexors. The model was optimized by tuning the passive and stretch-related parameters to fit the measured torque in each participant. It was found that stroke survivors exhibited decreased neural components at 4 weeks post BoNT-A injection, which returned to baseline levels after 12 weeks. The decreased neural component was mainly due to the increased motoneuron pool threshold, which is interpreted as a net excitatory and inhibitory inputs to the motoneuron pool. Though the linear stiffness and viscosity properties of wrist flexors were similar before and after treatment, increased exponential stiffness was observed over time which may indicate a decreased range of motion of the wrist joint. Using a combination of modeling and experimental measurement, valuable insights into the treatment responses, i.e., transmission of motoneurons, are provided by investigating potential parameter changes along the stretch reflex pathway in persons with chronic stroke.
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Affiliation(s)
- Ruoli Wang
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Mechanics, Royal Institute of Technology, Stockholm, Sweden.,KTH Biomex Center, Royal Institute of Technology, Stockholm, Sweden
| | - Johan Gäverth
- Functional Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Pawel A Herman
- Department of Computational Science and Technology, Royal Institute of Technology, Stockholm, Sweden
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Yucesoy CA, Ateş F. BTX-A has notable effects contradicting some treatment aims in the rat triceps surae compartment, which are not confined to the muscles injected. J Biomech 2018; 66:78-85. [DOI: 10.1016/j.jbiomech.2017.10.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/19/2017] [Accepted: 10/28/2017] [Indexed: 11/27/2022]
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Pingel J, Nielsen MS, Lauridsen T, Rix K, Bech M, Alkjaer T, Andersen IT, Nielsen JB, Feidenhansl R. Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures. Sci Rep 2017; 7:14746. [PMID: 29116170 PMCID: PMC5677119 DOI: 10.1038/s41598-017-14997-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/20/2017] [Indexed: 12/30/2022] Open
Abstract
Botulinum-toxin A (BoNT/A) is used for a wide range of conditions. Intramuscular administration of BoNT/A inhibits the release of acetylcholine at the neuromuscular junction from presynaptic motor neurons causing muscle-paralysis. The aim of the present study was to investigate the effect of high dose intramuscular BoNT/A injections (6 UI = 60 pg) on muscle tissue. The gait pattern of the rats was significantly affected 3 weeks after BoNT/A injection. The ankle joint rotated externally, the rats became flat footed, and the stride length decreased after BoNT/A injection. Additionally, there was clear evidence of microstructural changes on the tissue level by as evidenced by 3D imaging of the muscles by Synchrotron Radiation X-ray Tomographic Microscopy (SRXTM). Both the fibrillar and the non-fibrillar tissues were affected. The volume fraction of fibrillary tissue was reduced significantly and the non-fibrillar tissue increased. This was accompanied by a loss of the linear structure of the muscle tissue. Furthermore, gene expression analysis showed a significant upregulation of COL1A1, MMP-2, TGF-b1, IL-6, MHCIIA and MHCIIx in the BoNT/A injected leg, while MHVIIB was significantly downregulated. IN CONCLUSION The present study reveals that high dose intramuscular BoNT/A injections cause microstructural damage of the muscle tissue, which contributes to impaired gait.
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Affiliation(s)
- Jessica Pingel
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark.
| | | | | | - Kristian Rix
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - Martin Bech
- Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Tine Alkjaer
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Ida Torp Andersen
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - R Feidenhansl
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
- European XFEL, Hamburg, Germany
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Ward SR, Minamoto VB, Suzuki KP, Hulst JB, Bremner SN, Lieber RL. Recovery of rat muscle size but not function more than 1 year after a single botulinum toxin injection. Muscle Nerve 2017; 57:435-441. [PMID: 28556093 DOI: 10.1002/mus.25707] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Neurotoxin injection is used to treat a wide variety of neuromuscular disorders. The purpose of this study was to measure the functional and structural properties of botulinum toxin-injected adult rat skeletal muscle over nearly the entire lifespan. METHODS Ten groups of animals were subjected to either neurotoxin injection [Botox, Type A (BT-A); Allergan, Irvine, California] or saline solution injection. Neurotoxin-injected animals (n = 90) were analyzed at different time-points: 1 week; 1 month; 3 months; 6 months; 12 months; or 18 months. RESULTS In spite of the recovery of structural features, such as muscle mass and fiber area, dorsiflexion torque production remained significantly depressed by 25%, even at 12 months after neurotoxin injection. DISCUSSION The data demonstrate that, after a single BT-A injection, although gross muscle morphology recovered over a 12-month time period, loss of contractile function did not recover. Muscle Nerve 57: 435-441, 2018.
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Affiliation(s)
- Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA.,Department of Bioengineering, University of California, San Diego, La Jolla, California, USA.,Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Viviane B Minamoto
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Kentaro P Suzuki
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Jonah B Hulst
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Shannon N Bremner
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Richard L Lieber
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA.,Department of Bioengineering, University of California, San Diego, La Jolla, California, USA.,Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois, 60611, USA
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29
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Shehata AS, Al-Ghonemy NM, Ahmed SM, Mohamed SR. Effect of mesenchymal stem cells on induced skeletal muscle chemodenervation atrophy in adult male albino rats. Int J Biochem Cell Biol 2017; 85:135-148. [PMID: 28232107 DOI: 10.1016/j.biocel.2017.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/25/2017] [Accepted: 01/29/2017] [Indexed: 12/11/2022]
Abstract
The present research was conducted to evaluate the effect of bone marrow derived mesenchymal stem cells (BM-MSCs) as a potential therapeutic tool for improvement of skeletal muscle recovery after induced chemodenervation atrophy by repeated local injection of botulinum toxin-A in the right tibialis anterior muscle of adult male albino rats. Forty five adult Wistar male albino rats were classified into control and experimental groups. Experimental group was further subdivided into 3 equal subgroups; induced atrophy, BM-MSCs treated and recovery groups. Biochemical analysis of serum LDH, CK and Real-time PCR for Bcl-2, caspase 3 and caspase 9 was measured. Skeletal muscle sections were stained with H and E, Mallory trichrome, and Immunohistochemical reaction for Bax and CD34. Improvement in the skeletal muscle histological structure was noticed in BM-MSCs treated group, however, in the recovery group, some sections showed apparent transverse striations and others still affected. Immunohistochemical reaction of Bax protein showed strong positive immunoreaction in the cytoplasm of muscle fibers in the induced atrophy group. BM-MSCs treated group showed weak positive reaction while the recovery group showed moderate reaction in the cytoplasm of muscle fibers. Immunohistochemical reaction for CD34 revealed occasional positive CD34 stained cells in the induced atrophy group. In BM-MSCs treated group, multiple positive CD34 stained cells were detected. However, recovery group showed some positive CD34 stained cells at the periphery of the muscle fibers. Marked improvement in the regenerative capacity of skeletal muscles after BM-MSCs therapy. Hence, stem cell therapy provides a new hope for patients suffering from myopathies and severe injuries.
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Affiliation(s)
| | | | - Samah M Ahmed
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Li X, Shin H, Li L, Magat E, Li S, Zhou P. Assessing the immediate impact of botulinum toxin injection on impedance of spastic muscle. Med Eng Phys 2017; 43:97-102. [PMID: 28169197 DOI: 10.1016/j.medengphy.2017.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 01/03/2017] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Abstract
This study aimed to investigate the immediate impacts of Botulinum Toxin A (BoNT-A) injections on the inherent electrical properties of spastic muscles using a newly developed electrical impedance myography (EIM) technique. Impedance measures were performed before and after a BoNT-A injection in biceps brachii muscles of 14 subjects with spasticity. Three major impedance variables, resistance (R), reactance (X) and phase angle (θ) were obtained from three different configurations, and were evaluated using the conventional EIM frequency at 50kHz as well as multiple frequency analysis. Statistical analysis demonstrated a significant decrease of resistance in the injected muscles (Multiple-frequency: Rpre=25.17±1.94Ohm, Rpost=23.65±1.63Ohm, p<0.05; 50kHz: Rpre=29.06±2.16Ohm, Rpost=27.7±1.89Ohm, p<0.05). Despite this decrease, there were no substantial changes in the reactance, phase angle, or anisotropy features after a BoNT-A injection. The significant changes of muscle resistance were most likely associated with the liquid injection of the BoNT-A-saline solution rather than the immediate toxin effects on the muscle. This study demonstrated high sensitivity of the EIM technique in the detection of alterations to muscle composition.
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Affiliation(s)
- Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA .
| | - Henry Shin
- Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Le Li
- Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Elaine Magat
- Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA ; Guangdong Work Injury Rehabilitation Center, Guangzhou, Guangdong Province, China
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Spyrou LA, Agoras M, Danas K. A homogenization model of the Voigt type for skeletal muscle. J Theor Biol 2016; 414:50-61. [PMID: 27884495 DOI: 10.1016/j.jtbi.2016.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/12/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
A three-dimensional constitutive model for skeletal muscle incorporating microstructural characteristics is developed and numerically implemented in a general purpose finite element program. The proposed model takes into account explicitly the volume fractions of muscle fibers and connective tissue by using the Voigt homogenization approach to bridge the different length scales of the muscle structure. The model is used to estimate the active and passive homogenized muscle response. Next, the model is validated by experimental data and periodic three-dimensional unit cell calculations comprising various fiber volume fractions and mechanical properties of the constituents. The model is found to be in very good agreement with both the experimental data and the finite element results for all the examined cases. The influence of fiber volume fraction and material properties of constituents on effective muscle response under several loading conditions is examined.
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Affiliation(s)
- L A Spyrou
- Institute for Research & Technology - Thessaly, Centre for Research & Technology Hellas (CERTH), 38333 Volos, Greece.
| | - M Agoras
- Department of Mechanical Engineering, University of Thessaly, 38334 Volos, Greece.
| | - K Danas
- LMS, CNRS, École Polytechnique, Université Paris-Saclay, 91128 Palaiseau, France.
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32
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Pingel J, Wienecke J, Lorentzen J, Nielsen JB. Botulinum toxin injection causes hyper-reflexia and increased muscle stiffness of the triceps surae muscle in the rat. J Neurophysiol 2016; 116:2615-2623. [PMID: 27628204 DOI: 10.1152/jn.00452.2016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022] Open
Abstract
Botulinum toxin is used with the intention of diminishing spasticity and reducing the risk of development of contractures. Here, we investigated changes in muscle stiffness caused by reflex activity or elastic muscle properties following botulinum toxin injection in the triceps surae muscle in rats. Forty-four rats received injection of botulinum toxin in the left triceps surae muscle. Control measurements were performed on the noninjected contralateral side in all rats. Acute experiments were performed, 1, 2, 4, and 8 wk following injection. The triceps surae muscle was dissected free, and the Achilles tendon was cut and attached to a muscle puller. The resistance of the muscle to stretches of different amplitudes and velocities was systematically investigated. Reflex-mediated torque was normalized to the maximal muscle force evoked by supramaximal stimulation of the tibial nerve. Botulinum toxin injection caused severe atrophy of the triceps surae muscle at all time points. The force generated by stretch reflex activity was also strongly diminished but not to the same extent as the maximal muscle force at 2 and 4 wk, signifying a relative reflex hyperexcitability. Passive muscle stiffness was unaltered at 1 wk but increased at 2, 4, and 8 wk (P < 0.01). These data demonstrate that botulinum toxin causes a relative increase in reflex stiffness, which is likely caused by compensatory neuroplastic changes. The stiffness of elastic elements in the muscles also increased. The data are not consistent with the ideas that botulinum toxin is an efficient antispastic medication or that it may prevent development of contractures.
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Affiliation(s)
- Jessica Pingel
- Neural Control of Movement Research Group, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Wienecke
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark; and
| | - Jakob Lorentzen
- Neural Control of Movement Research Group, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Neural Control of Movement Research Group, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark; .,Elsass Institute, Charlottenlund, Denmark
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Drewes E, Driscoll M, Blyum L, Vincentz D. The Effects of a Home-Based Connective Tissue Targeting Therapy on Hip Development in Children With Cerebral Palsy: Six Case Reports. Explore (NY) 2016; 12:268-76. [PMID: 27198038 DOI: 10.1016/j.explore.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Indexed: 10/21/2022]
Abstract
Hip subluxation in children with Cerebral Palsy (CP) has an incidence of 10-30 %, and children with severe CP having the highest incidence. The condition deteriorates if left untreated. Surgery is the most common method used in managing hip subluxation because standard conservative therapies do not improve it. Surgery may have to be repeated and comes at a biological cost to the child. A new home-based CAM, Advanced Biomechanical Rehabilitation (ABR), has shown encouraging results leading to improved spinal stability and stability in sitting in children with severe CP. This case report examines hip development over time in six children with severe CP in the ABR Program. Changes in their clinical picture and pelvic X-Rays are reported. ABR appeared to help stabilize and improve hip subluxation, resulting in these children not requiring further surgical intervention. These findings warrant further investigation of ABR as a noninvasive therapy for hip subluxation.
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Affiliation(s)
- Erika Drewes
- Integrative Family Physician (Private Practice), 15 Budock Road, Claremont, Cape Town 7708.
| | - Mark Driscoll
- Advanced Biomechanical Rehabilitation, Montreal, Pierre-Baillargeons, Canada 11991; Biomedical Research Group, 5135 Bessborough St, Montreal, Canada H4V2S5
| | - Leonid Blyum
- Biomedical Research Group, 5135 Bessborough St, Montreal, Canada H4V2S5
| | - Diane Vincentz
- Advanced Biomechanical Rehabilitation, Horndrupvej 36, Skanderborg 8660, Denmark
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Mathevon L, Michel F, Decavel P, Fernandez B, Parratte B, Calmels P. Muscle structure and stiffness assessment after botulinum toxin type A injection. A systematic review. Ann Phys Rehabil Med 2015; 58:343-50. [DOI: 10.1016/j.rehab.2015.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 11/27/2022]
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The Effect of Botulinum Toxin A Injections in the Spine Muscles for Cerebral Palsy Scoliosis, Examined in a Prospective, Randomized Triple-blinded Study. Spine (Phila Pa 1976) 2015; 40:E1205-11. [PMID: 26165216 DOI: 10.1097/brs.0000000000001049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, randomized triple-blinded cross-over design treating with either botulinum toxin A (BXT) or saline (NaCl). OBJECTIVE To examine the efficacy of BTX treatment in cerebral palsy scoliosis (CPS). SUMMARY OF BACKGROUND DATA Intramuscular injections with BTX have been used off label in treating CPS. 1 prospective study has been conducted, demonstrating in both radiological and clinical improvement, whereas showing no side effects or complications. METHODS Subjects (brace-treated CPS between 2 and 18 yr) were injected using ultrasonic-guidance with either NaCl or BTX in selected spine muscles with 6 mo intervals (block randomization, sealed envelope). Radiographs of the spine and clinical follow-up were captured before and 6 weeks after each injection. Primary outcome parameter was radiological change in Cobb angle, where a 7° change was regarded as an effect (1 SD). Radiological parameters were measured before and 6 weeks after treatment by 3 experienced doctors separately. Moreover, clinical results were evaluated by the pediatric quality of life score and systematic open questioning of the parents about the child's wellbeing. Subjects, researchers, and monitors were blinded during the trial. Appropriate permissions (2008-004584-19) and no funding were obtained. RESULTS 16 cerebral palsy patients (GFMCS III-V) with CPS were consecutively included, whereas 6 patients were excluded. There were no drop-outs to follow-up, but 1 possible serious adverse event of pneumonia resulting in death was recorded and the study was terminated. No significant radiological or clinical changes were detected when compared with NaCl injections using Wilcoxon matched pair signed-rank test. CONCLUSION No positive radiological or clinical effects were demonstrated by this treatment, except for the parent's initial subjective but positive appraisal of the effect. However, the study was terminated due to 1 possible severe adverse event and scheduled numbers needed to treat (hence power) were not reached. LEVEL OF EVIDENCE 1.
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36
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García Salazar LF, dos Santos GL, Pavão SL, Rocha NACF, de Russo TL. Intrinsic properties and functional changes in spastic muscle after application of BTX-A in children with cerebral palsy: systematic review. Dev Neurorehabil 2015; 18:1-14. [PMID: 25180438 DOI: 10.3109/17518423.2014.948640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This article aimed to review the literature to verify the effect of botulinum toxin type A (BTX-A) on the intrinsic properties of spastic muscles and functionality in children with cerebral palsy (CP). METHODS A literature search was conducted in the following databases: CINAHL, SCOPUS, Web of Science and PubMed. Database searches were limited to the period from January 1993 to March 2014. RESULTS A total of 2182 papers were identified, and 17 met the inclusion criteria. Only one study analyzed the effect of the toxin on muscle intrinsic properties and others analyzed the effect on functionality. CONCLUSION BTX-A application demonstrated no changes in the passive stiffness of spastic muscle. In relation to functional level, the evidence of BTX-A effect was controversial. These studies showed methodological quality limitations that restrict the interpretation of the results for the entire CP population, which justifies the need for further randomized controlled trials.
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Affiliation(s)
- Luisa Fernanda García Salazar
- Department of Physical Therapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar) , São Carlos, SP , Brazil and
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37
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Howren AM, Jamieson DH, Alvarez CM. Early ultrasonographic evaluation of idiopathic clubfeet treated with manipulations, casts, and Botox(®): a double-blind randomized control trial. J Child Orthop 2015; 9:85-91. [PMID: 25609054 PMCID: PMC4340848 DOI: 10.1007/s11832-015-0633-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 01/08/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The manipulations, casts, and Botox(®) method for treating idiopathic clubfoot is an alternative non-surgical treatment method. Botox(®)-induced reversible muscle paralysis of the gastrocsoleus enables a physician to manipulate and cast the clubfoot in greater dorsiflexion. Ultrasound is incorporated during the early treatment stages to monitor the underlying physiology of the muscle-tendon unit following Botox(®). METHODS Ultrasonographic evaluation was performed parallel to a double-blind randomized control trial administering Botox(®) or placebo to correct clubfoot. Patients underwent two-dimensional ultrasound to monitor the length changes to the gastrocsoleus and Achilles tendon unit at two time points: pre-injection (baseline) and 6 weeks post-blinded injection. Gastrocsoleus and Achilles tendon length measurements were analyzed among placebo, Botox(®) and contralateral controls using repeated measures ANOVA. RESULTS The baseline gastrocsoleus length of the clubfoot (322.4 pixels) before blinded injection appears shorter than controls (337.5 pixels), but fails to reach significance (p = 0.05). The complex length within each of the three treatment groups displayed no significant change between baseline and 6 weeks. The complex-tendon ratio and muscle-tendon ratio of the Botox(®) treatment group was significantly decreased compared to controls (p = 0.049 and 0.042, respectively). Briefly, when expressed as a proportion, an increase in Achilles tendon length and decrease in gastrocsoleus is observed when clubfeet are treated with Botox(®). CONCLUSIONS Only in the Botox(®) treatment cohort did the muscle shrink to uncover tendon (seen as a decreased complex-tendon ratio and muscle-tendon ratio) over the 6-week interval to effectively increase tendon length with respect to the unit as a whole.
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Affiliation(s)
- Alyssa M Howren
- Department of Orthopaedics, British Columbia's Children's Hospital, 1D18-4480 Oak Street, Vancouver, BC V6H 3V4, Canada,
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Sato EJ, Killian ML, Choi AJ, Lin E, Esparza MC, Galatz LM, Thomopoulos S, Ward SR. Skeletal muscle fibrosis and stiffness increase after rotator cuff tendon injury and neuromuscular compromise in a rat model. J Orthop Res 2014; 32:1111-6. [PMID: 24838823 PMCID: PMC4415493 DOI: 10.1002/jor.22646] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/24/2014] [Indexed: 02/04/2023]
Abstract
Rotator cuff tears can cause irreversible changes (e.g., fibrosis) to the structure and function of the injured muscle(s). Fibrosis leads to increased muscle stiffness resulting in increased tension at the rotator cuff repair site. This tension influences repairability and healing potential in the clinical setting. However, the micro- and meso-scale structural and molecular sources of these whole-muscle mechanical changes are poorly understood. Here, single muscle fiber and fiber bundle passive mechanical testing was performed on rat supraspinatus and infraspinatus muscles with experimentally induced massive rotator cuff tears (Tenotomy) as well as massive tears with chemical denervation (Tenotomy + BTX) at 8 and 16 weeks post-injury. Titin molecular weight, collagen content, and myosin heavy chain profiles were measured and correlated with mechanical variables. Single fiber stiffness was not different between controls and experimental groups. However, fiber bundle stiffness was significantly increased at 8 weeks in the Tenotomy + BTX group compared to Tenotomy or control groups. Many of the changes were resolved by 16 weeks. Only fiber bundle passive mechanics was weakly correlated with collagen content. These data suggest that tendon injury with concomitant neuromuscular compromise results in extra-cellular matrix production and increases in stiffness of the muscle, potentially complicating subsequent attempts for surgical repair.
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Affiliation(s)
- Eugene J. Sato
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093
| | - Megan L. Killian
- Department of Orthopaedic Surgery, Washington University, St. Louis, Saint Louis, MO 63110
| | - Anthony J. Choi
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA 92093
| | - Evie Lin
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA 92093
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA 92093
| | - Leesa M. Galatz
- Department of Orthopaedic Surgery, Washington University, St. Louis, Saint Louis, MO 63110
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Washington University, St. Louis, Saint Louis, MO 63110,Animal model and surgery-Stavros Thomopoulos, PhD, Departments of Orthopaedic Surgery, Biomedical Engineering, Mechanical & Materials Science, Washington University in St Louis, BJC-Institute of Health, 11 Floor-ROM 11616, Phone: (314) 362-8597,
| | - Samuel R. Ward
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093,Department of Radiology, University of California San Diego, La Jolla, CA 92093,Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA 92093,Addresses for correspondence: Muscle-Samuel R. Ward, PT, PhD Departments of Radiology, Orthopaedic Surgery, and Bioengineering, University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093, Phone: (858) 534-4918,
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Effects of botulinum toxin type A on non-injected bi-articular muscle include a narrower length range of force exertion and increased passive force. Muscle Nerve 2014; 49:866-78. [DOI: 10.1002/mus.23993] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 01/09/2023]
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Lieber RL, Ward SR. Cellular mechanisms of tissue fibrosis. 4. Structural and functional consequences of skeletal muscle fibrosis. Am J Physiol Cell Physiol 2013; 305:C241-52. [PMID: 23761627 DOI: 10.1152/ajpcell.00173.2013] [Citation(s) in RCA: 214] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skeletal muscle fibrosis can be a devastating clinical problem that arises from many causes, including primary skeletal muscle tissue diseases, as seen in the muscular dystrophies, or it can be secondary to events that include trauma to muscle or brain injury. The cellular source of activated fibroblasts (myofibroblasts) may include resident fibroblasts, adult muscle stem cells, or inflammatory or perivascular cells, depending on the model studied. Even though it is likely that there is no single source for all myofibroblasts, a common mechanism for the production of fibrosis is via the transforming growth factor-β/phosphorylated Smad3 pathway. This pathway and its downstream targets thus provide loci for antifibrotic therapies, as do methods for blocking the transdifferentiation of progenitors into activated fibroblasts. A structural model for the extracellular collagen network of skeletal muscle is needed so that measurements of collagen content, morphology, and gene expression can be related to mechanical properties. Approaches used to study fibrosis in tissues, such as lung, kidney, and liver, need to be applied to studies of skeletal muscle to identify ways to prevent or even cure the devastating maladies of skeletal muscle.
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Affiliation(s)
- Richard L Lieber
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California 92093-0863, USA.
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Haubruck P, Mannava S, Plate JF, Callahan MF, Wiggins WF, Schmidmaier G, Tuohy CJ, Saul KR, Smith TL. Botulinum Neurotoxin A injections influence stretching of the gastrocnemius muscle-tendon unit in an animal model. Toxins (Basel) 2012; 4:605-19. [PMID: 23012650 PMCID: PMC3446746 DOI: 10.3390/toxins4080605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 12/13/2022] Open
Abstract
Botulinum Neurotoxin A (BoNT-A) injections have been used for the treatment of muscle contractures and spasticity. This study assessed the influence of (BoNT-A) injections on passive biomechanical properties of the muscle-tendon unit. Mousegastrocnemius muscle (GC) was injected with BoNT-A (n = 18) or normal saline (n = 18) and passive, non-destructive, in vivo load relaxation experimentation was performed to examine how the muscle-tendon unit behaves after chemical denervation with BoNT-A. Injection of BoNT-A impaired passive muscle recovery (15% vs. 35% recovery to pre-stretching baseline, p < 0.05) and decreased GC stiffness (0.531 ± 0.061 N/mm vs. 0.780 ± 0.037 N/mm, p < 0.05) compared to saline controls. The successful use of BoNT-A injections as an adjunct to physical therapy may be in part attributed to the disruption of the stretch reflex; thereby modulating in vivo passive muscle properties. However, it is also possible that BoNT-A injection may alter the structure of skeletal muscle; thus modulating the in vivo passive biomechanical properties of the muscle-tendon unit.
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Affiliation(s)
- Patrick Haubruck
- UniversitätsKlinikum Heidelberg, Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany;
- Authors to whom correspondence should be addressed; (P.H.); (J.F.P.); Tel.: +1-336-713-4025; Fax: +1-336-713-7310
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Johannes F. Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
- Authors to whom correspondence should be addressed; (P.H.); (J.F.P.); Tel.: +1-336-713-4025; Fax: +1-336-713-7310
| | - Michael F. Callahan
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
| | - Walter F. Wiggins
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Gerhard Schmidmaier
- UniversitätsKlinikum Heidelberg, Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany;
| | - Christopher J. Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
| | - Katherine R. Saul
- Department of Biomedical Engineering, Wake Forest School of Medicine and VT-WFU School of Biomedical Engineering and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA;
| | - Thomas L. Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
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