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Muñoz-Gómez E, Aguilar-Rodríguez M, Mollà-Casanova S, Sempere-Rubio N, Inglés M, Serra-Añó P. A randomized controlled trial on the effectiveness of mirror therapy in improving strength, range of movement and muscle activity, in people with carpal tunnel syndrome. J Hand Ther 2024:S0894-1130(24)00008-5. [PMID: 38458950 DOI: 10.1016/j.jht.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/07/2024] [Accepted: 02/09/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND There is little information on the potential effects of mirror therapy (MT) on motor recovery in individuals with Carpal Tunnel Syndrome (CTS). PURPOSE To compare the effectiveness of a MT protocol versus a therapeutic exercise (TE) protocol, in improving strength, range of motion (ROM), muscle activity, pain, and functionality in patients with CTS. STUDY DESIGN Randomized clinical trial. METHODS Thirty-nine participants with unilateral CTS were divided into two groups: (i) MT group (n = 20) that followed an exercise protocol applied to the unaffected hand reflected in a mirror, and (ii) TE group (n = 19) that followed the same exercise protocol using the unaffected hand but without a mirror. Strength, wrist ROM, muscle activity, pain and functionality, were assessed at baseline (T0), after treatment (T1) and one month after treatment (T2). RESULTS At T1, the MT group showed significantly higher wrist flexion-extension ROM compared to TE (p = 0.04, d = 0.8), maintained at T2 (p = 0.02, d = 0.8). No significant changes were observed in ulnar-radius deviation, pronosupination, or fatigue following either MT or TE (p > 0.05). MT exhibited enhanced handgrip strength at T1 (p = 0.001, d = 0.7), as well as an increase in the extensor carpi radialis (ECR) and flexor carpi radialis (FCR) maximum muscle activity (p = 0.04, d = 1.0; p = 0.03, d = 0.4). At T1, both groups decreased pain (p = 0.002, d = 1.1; p = 0.02, d = 0.7), and improved functionality (p < 0.001, d = 0.8; p = 0.01, d = 0.5) (MT and TE respectively). DISCUSSION MT led to enhancements in wrist flexion-extension movement, handgrip strength and functionality unlike TE. MT notably increased muscle activity, particularly in the ECR and FCR muscles. CONCLUSIONS MT is a favorable strategy to improve wrist flexion-extension ROM, handgrip strength, ECR and FCR muscle activity, and functionality in people with unilateral CTS.
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Affiliation(s)
- Elena Muñoz-Gómez
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Sara Mollà-Casanova
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Nuria Sempere-Rubio
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Inglés
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Pilar Serra-Añó
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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Sobeeh MG, Benmelouka A, Metwally E, Abuhassira MJ, Abdeljalil AM, Nasr SA, El-Helw GO, Doheim MF. Altered brain function and structure in carpal tunnel syndrome: a systematic review and meta-analysis of structural and functional brain imaging. Brain Struct Funct 2024; 229:257-272. [PMID: 38165482 DOI: 10.1007/s00429-023-02737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
This systematic review with a meta-analysis aimed to identify the altered brain structure and function in carpal tunnel syndrome (CTS) by summarizing the literature about magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and magnetoencephalography (MEG) outcomes compared to healthy controls (HC). CTS is the most common nerve entrapment in the arm associated with altered peripheral and central nociceptive system. PRISMA guidelines were used to report the outcomes. Six databases were searched for relevant literature (Web of Science, Scopus, PubMed, Sage, EBSCO host, and Cochrane). Eligible studies comparing MRI, fMRI, and MEG findings in people with CTS (present for at least 2 months) and HC through the following parameters: (1) interdigit cortical separation distance, (2) white and grey matter changes, (3) peak latency of M20 wave and recovery function of N20 from the somatosensory cortex (SI), and (4) surface area of activated digit cortical representation. The results from different studies were pooled and a meta-analysis was done. From 17 included, there was a significant reduction of interdigit cortical separation distance of index-middle and index-little fingers in the CTS (SMD = - 0.869, 95% CI (- 1.325, - 0.413), p-value = 0.000) and (SMD = - 0.79, 95% CI (- 1.217, - 0.364), p-value = 0.000), respectively. Middle-little fingers interdigit separation showed no difference (SMD = - 0.2, 95% CI (- 0.903, 1.309), p-value = 0.718). There is evidence supporting the altered brain structure and function in CTS as evidenced by reduction of interdigit cortical separation distance, and excessive blurring and disinhibition of SI, with low resting state functional connectivity. Thus, centrally directed therapeutic approaches might complement peripheral treatments.
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Affiliation(s)
- Mohamed Gomaa Sobeeh
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
- Department of Physical Therapy for Orthopedics and Orthopedic Surgery, Faculty of Physical Therapy, Sinai University, Ismailia, Egypt.
| | | | | | | | | | - Sara Amr Nasr
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Li LL, Wu JJ, Ma J, Li YL, Xue X, Li KP, Jin J, Hua XY, Zheng MX, Xu JG. White matter fiber integrity and structural brain network topology: implications for balance function in postischemic stroke patients. Cereb Cortex 2024; 34:bhad452. [PMID: 38037387 DOI: 10.1093/cercor/bhad452] [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: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Previous studies have suggested that ischemic stroke can result in white matter fiber injury and modifications in the structural brain network. However, the relationship with balance function scores remains insufficiently explored. Therefore, this study aims to explore the alterations in the microstructural properties of brain white matter and the topological characteristics of the structural brain network in postischemic stroke patients and their potential correlations with balance function. We enrolled 21 postischemic stroke patients and 21 age, sex, and education-matched healthy controls (HC). All participants underwent balance function assessment and brain diffusion tensor imaging. Tract-based spatial statistics (TBSS) were used to compare the fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of white matter fibers between the two groups. The white matter structural brain network was constructed based on the automated anatomical labeling atlas, and we conducted a graph theory-based analysis of its topological properties, including global network properties and local node properties. Additionally, the correlation between the significant structural differences and balance function score was analyzed. The TBSS results showed that in comparison to the HC, postischemic stroke patients exhibited extensive damage to their whole-brain white matter fiber tracts (P < 0.05). Graph theory analysis showed that in comparison to the HC, postischemic stroke patients exhibited statistically significant reductions in the values of global efficiency, local efficiency, and clustering coefficient, as well as an increase in characteristic path length (P < 0.05). In addition, the degree centrality and nodal efficiency of some nodes in postischemic stroke patients were significantly reduced (P < 0.05). The white matter fibers of the entire brain in postischemic stroke patients are extensively damaged, and the topological properties of the structural brain network are altered, which are closely related to balance function. This study is helpful in further understanding the neural mechanism of balance function after ischemic stroke from the white matter fiber and structural brain network topological properties.
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Affiliation(s)
- Ling-Ling Li
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yu-Lin Li
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xin Xue
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Kun-Peng Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jing Jin
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai 201203, China
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Macionis V. Neurovascular Compression-Induced Intracranial Allodynia May Be the True Nature of Migraine Headache: an Interpretative Review. Curr Pain Headache Rep 2023; 27:775-791. [PMID: 37837483 DOI: 10.1007/s11916-023-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW Surgical deactivation of migraine trigger sites by extracranial neurovascular decompression has produced encouraging results and challenged previous understanding of primary headaches. However, there is a lack of in-depth discussions on the pathophysiological basis of migraine surgery. This narrative review provides interpretation of relevant literature from the perspective of compressive neuropathic etiology, pathogenesis, and pathophysiology of migraine. RECENT FINDINGS Vasodilation, which can be asymptomatic in healthy subjects, may produce compression of cranial nerves in migraineurs at both extracranial and intracranial entrapment-prone sites. This may be predetermined by inherited and acquired anatomical factors and may include double crush-type lesions. Neurovascular compression can lead to sensitization of the trigeminal pathways and resultant cephalic hypersensitivity. While descending (central) trigeminal activation is possible, symptomatic intracranial sensitization can probably only occur in subjects who develop neurovascular entrapment of cranial nerves, which can explain why migraine does not invariably afflict everyone. Nerve compression-induced focal neuroinflammation and sensitization of any cranial nerve may neurogenically spread to other cranial nerves, which can explain the clinical complexity of migraine. Trigger dose-dependent alternating intensity of sensitization and its synchrony with cyclic central neural activities, including asymmetric nasal vasomotor oscillations, may explain the laterality and phasic nature of migraine pain. Intracranial allodynia, i.e., pain sensation upon non-painful stimulation, may better explain migraine pain than merely nociceptive mechanisms, because migraine cannot be associated with considerable intracranial structural changes and consequent painful stimuli. Understanding migraine as an intracranial allodynia could stimulate research aimed at elucidating the possible neuropathic compressive etiology of migraine and other primary headaches.
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Cheng S, Dong X, Zhou J, Tang C, He W, Chen Y, Zhang X, Ma P, Yin T, Hu Y, Zeng F, Li Z, Liang F. Alterations of the White Matter in Patients With Knee Osteoarthritis: A Diffusion Tensor Imaging Study With Tract-Based Spatial Statistics. Front Neurol 2022; 13:835050. [PMID: 35370891 PMCID: PMC8968011 DOI: 10.3389/fneur.2022.835050] [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: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Functional and structural alterations in the gray matter have been observed in patients with knee osteoarthritis (KOA). However, little is known about white matter changes in KOA. Here, we evaluated fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) to investigate potential alterations in the white matter of patients with KOA. Methods A total of 166 patients with KOA, along with 88 age- and sex-matched healthy controls were recruited and underwent brain magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) data were collected and analyzed using tract-based spatial statistics (TBSS). Statistical significances were determined at p < 0.05 and were corrected by the threshold-free cluster enhancement (TFCE) method. Then, we evaluated potential correlations between FA, MD, AD, RD values and disease duration, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and visual analog scale (VAS) scores. Results FA values for the body of corpus callosum, splenium of corpus callosum, bilateral superior longitudinal fasciculus, cingulum, bilateral superior corona radiata, and right posterior corona radiata were significantly higher in patients with KOA than in healthy controls (p < 0.05, TFCE corrected). Compared with healthy controls, patients with KOA also had significantly lower MD, AD, and RD values of the genu of corpus callosum, body of corpus callosum, splenium of corpus callosum, corona radiata, right posterior thalamic radiation, superior longitudinal fasciculus, and middle cerebellar peduncle (p < 0.05, TFCE corrected). Negative correlations were detected between WOMAC scores and AD values for the body of the corpus callosum and the splenium of the corpus callosum (p < 0.05, FDR corrected). Conclusion Patients with KOA exhibited extensive white matter alterations in sensorimotor and pain-related regions. Longitudinal observation studies on the causation between abnormalities in the white matter tracts and KOA is needed in the future.
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Affiliation(s)
- Shirui Cheng
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohui Dong
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Zhou
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chenjian Tang
- The First Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenhua He
- The Second Affiliated Hospital of Shanxi, University of Traditional Chinese Medicine, Taiyuan, China
| | - Yang Chen
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinyue Zhang
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peihong Ma
- Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China
| | - Tao Yin
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yimei Hu
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhengjie Li
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Zhengjie Li
| | - Fanrong Liang
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Fanrong Liang
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