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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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2
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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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Brunner R, De Pieri E, Wyss C, Weidensteiner C, Bracht-Schweizer K, Romkes J, Garcia M, Ma N, Rutz E. The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A. Toxins (Basel) 2023; 15:toxins15040267. [PMID: 37104205 PMCID: PMC10141169 DOI: 10.3390/toxins15040267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/18/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
Local botulinum toxin (BTX-A, Botox®) injection in overactive muscles is a standard treatment in patients with cerebral palsy. The effect is markedly reduced in children above the age of 6 to 7. One possible reason for this is the muscle volume affected by the drug. Nine patients (aged 11.5; 8.7–14.5 years) with cerebral palsy GMFCS I were treated with BTX-A for equinus gait at the gastrocnemii and soleus muscles. BTX-A was administered at one or two injection sites per muscle belly and with a maximum of 50 U per injection site. Physical examination, instrumented gait analysis, and musculoskeletal modelling were used to assess standard muscle parameters, kinematics, and kinetics during gait. Magnetic resonance imaging (MRI) was used to detect the affected muscle volume. All the measurements were carried out pre-, 6 weeks post-, and 12 weeks post-BTX-A. Between 9 and 15% of the muscle volume was affected by BTX-A. There was no effect on gait kinematics and kinetics after BTX-A injection, indicating that the overall kinetic demand placed on the plantar flexor muscles remained unchanged. BTX-A is an effective drug for inducing muscle weakness. However, in our patient cohort, the volume of the affected muscle section was limited, and the remaining non-affected parts were able to compensate for the weakened part of the muscle by taking over the kinetic demands associated with gait, thus not enabling a net functional effect in older children. We recommend distributing the drug over the whole muscle belly through multiple injection sites.
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Affiliation(s)
- Reinald Brunner
- Department of Paediatric Orthopaedics, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Enrico De Pieri
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Christian Wyss
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Claudia Weidensteiner
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Katrin Bracht-Schweizer
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Jacqueline Romkes
- Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Meritxell Garcia
- Department of Neuroradiology, University Hospital Zürich, 8091 Zürich, Switzerland
- Division of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Norine Ma
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne 3052, Australia
| | - Erich Rutz
- Orthopaedic Department, The Royal Children’s Hospital, Melbourne 3052, Australia
- Murdoch Children’s Research Institute—MCRI, Melbourne 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne 3052, Australia
- Medical Faculty, University of Basel, 4000 Basel, Switzerland
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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: 16] [Impact Index Per Article: 8.0] [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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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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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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7
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Baldwin MC, Liu ZJ, Rafferty KL, Keith A, Tamasas B, Kaiyala K, Herring SW. Botulinum toxin in the masseter muscle: Lingering effects of denervation. Anat Rec (Hoboken) 2021; 305:1215-1230. [PMID: 34486243 DOI: 10.1002/ar.24756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/17/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
Botulinum neurotoxins (BoNTs) are paralytic agents used to treat a variety of conditions in jaw muscles. Although their effect is considered temporary, there are reports of persistent functional changes. Using rabbits that received BoNT injection in one masseter muscle, the recovery of neuromuscular connection was investigated using nerve stimulation to evoke an electromyographic (EMG) response, and the recovery of muscle fibers was investigated using histological morphometry and bromodeoxyuridine (BrdU) immunohistochemistry. One month after treatment, evoked EMG was greatly reduced in both amplitude and duration, indicating that little reinnervation had taken place. Muscle fibers were atrophied and collagenous tissue was increased. Three months after treatment, evoked EMG duration was normal, indicating that at least some neuromuscular junctions were functional. Histologically, some muscle fibers were hypertrophied, some were still atrophied, and some appeared to have died. Fibrosis was still apparent amid slight increases in dividing cells and regenerating fibers. The histological effects of BoNT were evident although attenuated at a distance of about 1 cm from the injection level, but no regional differences could be discerned for the evoked EMGs. In conclusion, there were persistent muscular deficits seen 3 months after BoNT treatment that may have been caused by the failure of some affected muscle fibers to become reinnervated.
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Affiliation(s)
- Michael C Baldwin
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Zi Jun Liu
- Department of Orthodontics, University of Washington, Seattle, Washington, USA
| | | | - Andrew Keith
- Department of Orthodontics, University of Washington, Seattle, Washington, USA
| | - Basma Tamasas
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA.,Department of Orthodontics, Boston University, Boston, MA, USA
| | - Karl Kaiyala
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Susan W Herring
- Department of Orthodontics, University of Washington, Seattle, Washington, USA
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8
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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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9
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Bilchak JN, Yeakle K, Caron G, Malloy D, Côté MP. Enhancing KCC2 activity decreases hyperreflexia and spasticity after chronic spinal cord injury. Exp Neurol 2021; 338:113605. [PMID: 33453210 PMCID: PMC7904648 DOI: 10.1016/j.expneurol.2021.113605] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 02/03/2023]
Abstract
After spinal cord injury (SCI), the majority of individuals develop spasticity, a debilitating condition involving involuntary movements, co-contraction of antagonistic muscles, and hyperreflexia. By acting on GABAergic and Ca2+-dependent signaling, current anti-spastic medications lead to serious side effects, including a drastic decrease in motoneuronal excitability which impairs motor function and rehabilitation efforts. Exercise, in contrast, decreases spastic symptoms without decreasing motoneuron excitability. These functional improvements coincide with an increase in expression of the chloride co-transporter KCC2 in lumbar motoneurons. Thus, we hypothesized that spastic symptoms can be alleviated directly through restoration of chloride homeostasis and endogenous inhibition by increasing KCC2 activity. Here, we used the recently developed KCC2 enhancer, CLP257, to evaluate the effects of acutely increasing KCC2 extrusion capability on spastic symptoms after chronic SCI. Sprague Dawley rats received a spinal cord transection at T12 and were either bike-trained or remained sedentary for 5 weeks. Increasing KCC2 activity in the lumbar enlargement improved the rate-dependent depression of the H-reflex and reduced both phasic and tonic EMG responses to muscle stretch in sedentary animals after chronic SCI. Furthermore, the improvements due to this pharmacological treatment mirror those of exercise. Together, our results suggest that pharmacologically increasing KCC2 activity is a promising approach to decrease spastic symptoms in individuals with SCI. By acting to directly restore endogenous inhibition, this strategy has potential to avoid severe side effects and improve the quality of life of affected individuals.
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Affiliation(s)
- Jadwiga N Bilchak
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Kyle Yeakle
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Guillaume Caron
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Dillon Malloy
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
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10
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Walhain F, Desloovere K, Declerck M, Van Campenhout A, Bar-On L. Interventions and lower-limb macroscopic muscle morphology in children with spastic cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:274-286. [PMID: 32876960 DOI: 10.1111/dmcn.14652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/24/2022]
Abstract
AIM To identify and map studies that have assessed the effect of interventions on lower-limb macroscopic muscle-tendon morphology in children with spastic cerebral palsy (CP). METHOD We conducted a literature search of studies that included pre- and post-treatment measurements of lower-limb macroscopic muscle-tendon morphology in children with spastic CP. Study quality was evaluated and significant intervention effects and effect sizes were extracted. RESULTS Twenty-eight articles were identified. They covered seven different interventions including stretching, botulinum neurotoxin A (BoNT-A), strengthening, electrical stimulation, whole-body vibration, balance training, and orthopaedic surgery. Study quality ranged from poor (14 out of 28 studies) to good (2 out of 28). Study samples were small (n=4-32) and studies were variable regarding which muscles and macroscopic morphological parameters were assessed. Inconsistent effects after intervention (thickness and cross-sectional area for strengthening, volume for BoNT-A), no effect (belly length for stretching), and small effect sizes were reported. INTERPRETATION Intervention studies reporting macroscopic muscle-tendon remodelling after interventions are limited and heterogeneous, making it difficult to generalize results. Studies that include control groups and standardized assessment protocols are needed to improve study quality and data synthesis. Lack or inconclusive effects at the macroscopic level could indicate that the effects of interventions should also be evaluated at the microscopic level. WHAT THIS PAPER ADDS Muscle-targeted interventions to remodel muscle morphology are not well understood. Studies reporting macroscopic muscle remodelling following interventions are limited and heterogeneous. Passive stretching may preserve but does not increase muscle length. The effects of isolated botulinum neurotoxin A injections on muscle volume are inconsistent. Isolated strengthening shows no consistent increase in muscle volume or thickness.
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Affiliation(s)
- Fenna Walhain
- Department of Anatomy, Anton de Kom University of Suriname, Paramaribo, Suriname.,Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | - Marlies Declerck
- Department of Physical Therapy, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Anja Van Campenhout
- Department of Development and Regeneration, University Hospital Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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11
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Pingel J, Pacolet A, Elfving B, Ledri LN. Intramuscular BoNT/A injections cause an inflammatory response in the muscle tissue of rats. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211039942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The purpose of the present study was to investigate whether intramuscular BoNT/A injections cause an systemic inflammatory response and a local inflammatory response in the muscle tissue. Methods Thirty-two male Sprague Dawley rats treated with BoNT/A (i.m., 1IU) were divided in four groups, depending on the time of BoNT/A injection (2 days before, 1, 2, and 4 weeks before the experiment). Bio-Plex Pro Rat Cytokine 23-plex Multiplex Assay (Bio-Rad, USA). Results Systemic inflammation: 17 cytokines (IL1-α ( p = 0.005), IL-1β ( p = 0.01), IL-2 ( p = 0.04), IL-4 ( p = 0.03), IL-6 ( p = 0.03), IL-10 ( p = 0.02), IL12(p70) ( p = 0.03), IL-13 ( p = 0.04), IL-17 ( p = 0.03), GM-CSF ( p = 0.03), INF-γ ( p = 0.03), MIP-1α ( p = 0.03), MIP-3α ( p = 0.04), RANTES ( p = 0.001), TNF-α ( p = 0.04), vascular endothelial growth factor ( p = 0.03), and MCP-1 ( p = 0.02)) showed significantly higher expression levels 2 days after intramuscular BoNT/A injections compared to other time points (1, 2, and 4 weeks). Local inflammation: 12 cytokines (IL-1β ( p = 0.02), IL-6 ( p = 0.002), IL-10 ( p = 0.02), IL-13 ( p = 0.04), IL-17 ( p = 0.02), TNF-α ( p = 0.001), GM-CSF ( p = 0.01), M-CSF ( p = 0.04), MIP-1α ( p = 0.04), MIP-3α ( p = 0.002), RANTES ( p = 0.02), and MCP-1( p = 0.004)) showed higher expression levels 2 and/or 4 weeks after intramuscular BoNT/A injections compared to the other time points (2 days and 1 week). Conclusion Intramuscular BoNT/A injections result in a rapid systemic inflammatory response that only lasts a couple of days. At the same time, intramuscular BoNT/A injections cause an inflammatory response locally in the muscle with significantly higher cytokine levels 2 and/or 4 weeks after injections.
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Affiliation(s)
- Jessica Pingel
- Department of Neuroscience, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Pacolet
- Department of Neuroscience, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Betina Elfving
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Litsa N Ledri
- Department of Neuroscience, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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Ledri LN, Pingel J, Hultborn H, Therkildsen ER, Wienecke J, Nielsen JB. Immobilization leads to reduced stretch reflexes but increased central reflex gain in the rat. J Neurophysiol 2020; 124:985-993. [PMID: 32783594 DOI: 10.1152/jn.00748.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Plastic adaptations are known to take place in muscles, tendons, joints, and the nervous system in response to changes in muscle activity. However, few studies have addressed how these plastic adaptations are related. Thus this study focuses on changes in the mechanical properties of the ankle plantarflexor muscle-tendon unit, stretch reflex activity, and spinal neuronal pathways in relation to cast immobilization. The left rat hindlimb from toes to hip was immobilized with a plaster cast for 1, 2, 4, or 8 wk followed by acute electrophysiological recordings to investigate muscle stiffness and stretch reflex torque. Moreover, additional acute experiments were performed after 4 wk of immobilization to investigate changes in the central gain of the stretch reflex. Monosynaptic reflexes (MSR) were recorded from the L4 and L5 ventral roots following stimulation of the corresponding dorsal roots. Rats developed reduced range of movement in the ankle joint 2 wk after immobilization. This was accompanied by significant increases in the stiffness of the muscle-tendon complex as well as an arthrosis at the ankle joint at 4 and 8 wk following immobilization. Stretch reflexes were significantly reduced at 4-8 wk following immobilization. This was associated with increased central gain of the stretch reflex. These data show that numerous interrelated plastic changes occur in muscles, connective tissue, and the central nervous system in response to changes in muscle use. The findings provide an understanding of coordinated adaptations in multiple tissues and have important implications for prevention and treatment of the negative consequences of immobilization following injuries of the nervous and musculoskeletal systems.NEW & NOTEWORTHY Immobilization leads to multiple simultaneous adaptive changes in muscle, connective tissue, and central nervous system.
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Affiliation(s)
| | - Jessica Pingel
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Hans Hultborn
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | | | - Jacob Wienecke
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Holmegårdsvej, Charlottenlund, Denmark
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13
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Afsharipour B, Chandra S, Li G, Rymer WZ, Suresh NL. Characterization of Differences in the Time Course of Reflex and Voluntary Responses Following Botulinum Toxin Injections in Chronic Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1642-1650. [PMID: 32634101 DOI: 10.1109/tnsre.2020.2997213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spasticity is a major impairment that can occur following a hemispheric stroke and is often treated with injections of botulinum toxin, a neurotoxin that impairs transmission at the neuromuscular junction. Hyperreflexia is a defining feature of spasticity. Our main objective here was to quantify the time course of changes in the deep tendon reflex (DTR) responses and voluntary activation capacity following BT injection as well as to track changes in a clinical assessment of spasticity. Four chronic stroke survivors, scheduled to receive BT in their Biceps Brachii(BB) as part of their clinical care plan, were recruited for repeated testing sessions over the course of 4 months post injection. Both surface BB EMG reflex response to bicipital tendon taps as well as signals of applied tendon tap forces were recorded before and up to 18 weeks post-BT. Voluntary force and biceps EMG signals were also recorded during maximum voluntary (isometric) contractions (MVC) at each testing session. Our results show major reductions (up to 75%) in voluntary sEMG and force arising between 11 to 35 days post-BT-injection. The stretch reflex gain declined two weeks after the maximal reductions in voluntary EMG and force. Paradoxically, there was a short-term increase in stretch reflex gain, in three out of four participants, approximately 11-35 days post BT. The time course of recovery of voluntary MVC and reflex responses varied considerably with a longer recovery time for the reflex responses.
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14
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Kalkman BM, Bar-On L, O'Brien TD, Maganaris CN. Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? Front Physiol 2020; 11:131. [PMID: 32153428 PMCID: PMC7047287 DOI: 10.3389/fphys.2020.00131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/06/2020] [Indexed: 12/27/2022] Open
Abstract
Hyper-resistance at the joint is one of the most common symptoms in children with cerebral palsy (CP). Alterations to the structure and mechanical properties of the musculoskeletal system, such as a decreased muscle length and an increased joint stiffness are typically managed conservatively, by means of physiotherapy involving stretching exercises. However, the effectiveness of stretching-based interventions for improving function is poor. This may be due to the behavior of a spastic muscle during stretch, which is poorly understood. The main aim of this paper is to provide a mechanistic explanation as to why the effectiveness of stretching is limited in children with CP and consider clinically relevant means by which this shortcoming can be tackled. To do this, we review the current literature regarding muscle and tendon plasticity in response to stretching in children with CP. First, we discuss how muscle and tendon interact based on their morphology and mechanical properties to provide a certain range of motion at the joint. We then consider the effect of traditional stretching exercises on these muscle and tendon properties. Finally, we examine possible strategies to increase the effectiveness of stretching therapies and we highlight areas of further research that have the potential to improve the outcome of non-invasive interventions in children with cerebral palsy.
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Affiliation(s)
- Barbara M Kalkman
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, VC University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Thomas D O'Brien
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Constantinos N Maganaris
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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15
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Jensen DB, Klingenberg S, Dimintiyanova KP, Wienecke J, Meehan CF. Intramuscular Botulinum toxin A injections induce central changes to axon initial segments and cholinergic boutons on spinal motoneurones in rats. Sci Rep 2020; 10:893. [PMID: 31964988 PMCID: PMC6972769 DOI: 10.1038/s41598-020-57699-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/30/2019] [Indexed: 01/29/2023] Open
Abstract
Intramuscular injections of botulinum toxin block pre-synaptic cholinergic release at neuromuscular junctions producing a temporary paralysis of affected motor units. There is increasing evidence, however, that the effects are not restricted to the periphery and can alter the central excitability of the motoneurones at the spinal level. This includes increases in input resistance, decreases in rheobase currents for action potentials and prolongations of the post-spike after-hyperpolarization. The aim of our experiments was to investigate possible anatomical explanations for these changes. Unilateral injections of Botulinum toxin A mixed with a tracer were made into the gastrocnemius muscle of adult rats and contralateral tracer only injections provided controls. Immunohistochemistry for Ankyrin G and the vesicular acetylcholine transporter labelled axon initial segments and cholinergic C-boutons on traced motoneurones at 2 weeks post-injection. Soma size was not affected by the toxin; however, axon initial segments were 5.1% longer and 13.6% further from the soma which could explain reductions in rheobase. Finally, there was a reduction in surface area (18.6%) and volume (12.8%) but not frequency of C-boutons on treated motoneurones potentially explaining prolongations of the after-hyperpolarization. Botulinum Toxin A therefore affects central anatomical structures controlling or modulating motoneurone excitability explaining previously observed excitability changes.
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Affiliation(s)
- D B Jensen
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark
| | - S Klingenberg
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark
| | - K P Dimintiyanova
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark
| | - J Wienecke
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, DK-2200, Copenhagen, Denmark
| | - C F Meehan
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark.
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16
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Luchi KCG, Cardozo LT, Marcondes FK. Increased learning by using board game on muscular system physiology compared with guided study. ADVANCES IN PHYSIOLOGY EDUCATION 2019; 43:149-154. [PMID: 30933536 DOI: 10.1152/advan.00165.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of this work is to describe the "Muscular System Game," created to assist in the teaching-learning process concerning the physiology of the muscular system, and to evaluate its effect on the learning of university students. Participating in this study were first-year undergraduate students of the pharmacy course (game group, n = 21, 5 men and 16 women, age 23.57 ± 4.92 yr) and the nursing course (control group, n = 22, 2 men and 20 women, age 22.90 ± 4.93 yr), who had the same level of preparation. After theoretical classes concerning the physiology of the muscular system, all students were instructed to study the topic. In the next week, the students of the game group performed the activity with the board game, and the students of the control group undertook a guided study activity, which contained a list of exercises with the same questions used in the game, to be answered by groups. In the week following these activities, all of the students answered evaluation questions about the topic. The scores obtained for the two groups in the evaluation were compared using Student's t-test for unpaired samples, considering a significance level of 0.05. The score obtained for the control group (5.78 ± 0.38) was significantly lower than the score for the game group (7.50 ± 0.47; P < 0.05). The results obtained indicating that the use of an educational board game about the physiology of muscle contraction resulted in significantly improved learning, compared with the use of guided study.
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Affiliation(s)
- Kelly Cristina Gavião Luchi
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas-UNICAMP , Piracicaba, São Paulo , Brazil
| | - Lais Tono Cardozo
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas-UNICAMP , Piracicaba, São Paulo , Brazil
| | - Fernanda Klein Marcondes
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas-UNICAMP , Piracicaba, São Paulo , Brazil
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17
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Ateş F, Yucesoy CA. Botulinum toxin type-A affects mechanics of non-injected antagonistic rat muscles. J Mech Behav Biomed Mater 2018; 84:208-216. [DOI: 10.1016/j.jmbbm.2018.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
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18
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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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19
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Delcour M, Massicotte VS, Russier M, Bras H, Peyronnet J, Canu MH, Cayetanot F, Barbe MF, Coq JO. Early movement restriction leads to enduring disorders in muscle and locomotion. Brain Pathol 2018; 28:889-901. [PMID: 29437246 DOI: 10.1111/bpa.12594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/21/2017] [Accepted: 02/09/2018] [Indexed: 01/01/2023] Open
Abstract
Motor control and body representation in the central nervous system (CNS) as well as musculoskeletal architecture and physiology are shaped during development by sensorimotor experience and feedback, but the emergence of locomotor disorders during maturation and their persistence over time remain a matter of debate in the absence of brain damage. By using transient immobilization of the hind limbs, we investigated the enduring impact of postnatal sensorimotor restriction (SMR) on gait and posture on treadmill, age-related changes in locomotion, musculoskeletal histopathology and Hoffmann reflex in adult rats without brain damage. SMR degrades most gait parameters and induces overextended knees and ankles, leading to digitigrade locomotion that resembles equinus. Based on variations in gait parameters, SMR appears to alter age-dependent plasticity of treadmill locomotion. SMR also leads to small but significantly decreased tibial bone length, chondromalacia, degenerative changes in the knee joint, gastrocnemius myofiber atrophy and muscle hyperreflexia, suggestive of spasticity. We showed that reduced and atypical patterns of motor outputs, and somatosensory inputs and feedback to the immature CNS, even in the absence of perinatal brain damage, play a pivotal role in the emergence of movement disorders and musculoskeletal pathologies, and in their persistence over time. Understanding how atypical sensorimotor development likely contributes to these degradations may guide effective rehabilitation treatments in children with either acquired (ie, with brain damage) or developmental (ie, without brain injury) motor disabilities.
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Affiliation(s)
- Maxime Delcour
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, Marseille, France
| | - Vicky S Massicotte
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Michaël Russier
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, Marseille, France
| | - Hélène Bras
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
| | - Julie Peyronnet
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
| | - Marie-Hélène Canu
- Université de Lille, EA 7369 « Activité Physique, Muscle et Santé » - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000 Lille, France
| | - Florence Cayetanot
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Jacques-Olivier Coq
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
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20
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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: 49] [Impact Index Per Article: 7.0] [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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21
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Pingel J, Hultborn H, Näslund-Koch L, Jensen DB, Wienecke J, Nielsen JB. Muscle disuse caused by botulinum toxin injection leads to increased central gain of the stretch reflex in the rat. J Neurophysiol 2017; 118:1962-1969. [PMID: 28724781 DOI: 10.1152/jn.00276.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 12/26/2022] Open
Abstract
Botulinum toxin (Btx) is used in children with cerebral palsy and in other neurological patients to diminish spasticity and reduce the risk of development of contractures. We investigated changes in the central gain of the stretch reflex circuitry in response to Btx injection in the triceps surae muscle in rats. Experiments were performed in 21 rats. Eight rats were a control group, and 13 rats were injected with 6 IU of Btx in the left triceps surae muscle. Two weeks after Btx injection, larger monosynaptic reflexes (MSR) were recorded from the left (injected) than the right (noninjected) L4 + L5 ventral roots following stimulation of the corresponding dorsal roots. A similar increase on the left side was observed in response to stimulation of descending motor tracts, suggesting that increased excitability of spinal motor neurons may at least partly explain the increased reflexes. However, significant changes were also observed in postactivation depression of the MSR, suggesting that plastic changes in transmission from Ia afferent to the motor neurons also may be involved. The data demonstrate that muscle paralysis induced by Btx injection is accompanied by plastic adaptations in the central stretch reflex circuitry, which counteract the antispastic effect of Btx.NEW & NOTEWORTHY Injection of botulinum toxin into ankle muscles causes increased gain of stretch reflex. This is caused by adaptive changes in regulation of transmitter release from Ia afferents and increased excitability of spinal motor neurons.
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Affiliation(s)
- Jessica Pingel
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Hans Hultborn
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Lui Näslund-Koch
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Dennis B Jensen
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Jacob Wienecke
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Jens Bo Nielsen
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark; .,Elsass Institute, Charlottenlund, Denmark; and
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22
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Pingel J, Bartels EM, Nielsen JB. New perspectives on the development of muscle contractures following central motor lesions. J Physiol 2017; 595:1027-1038. [PMID: 27779750 PMCID: PMC5309377 DOI: 10.1113/jp272767] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/18/2016] [Indexed: 01/03/2023] Open
Abstract
Muscle contractures are common in patients with central motor lesions, but the mechanisms responsible for the development of contractures are still unclear. Increased or decreased neural activation, protracted placement of a joint with the muscle in a short position and muscle atrophy have been suggested to be involved, but none of these mechanisms are sufficient to explain the development of muscle contractures alone. Here we propose that changes in tissue homeostasis in the neuromuscular-tendon-connective tissue complex is at the heart of the development of contractures, and that an integrated physiological understanding of the interaction between neural, mechanical and metabolic factors, as well as genetic and epigenetic factors, is necessary in order to unravel the mechanisms that result in muscle contractures. We hope thereby to contribute to a reconsideration of how and why muscle contractures develop in a way which will open a window towards new insight in this area in the future.
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Affiliation(s)
- J. Pingel
- Department of ExerciseNutrition and SportsUniversity of CopenhagenDenmark
| | - E. M. Bartels
- The Biochemistry and Physiology LaboratoryThe Parker InstituteCopenhagen University HospitalBispebjerg and FrederiksbergDenmark
| | - J. B. Nielsen
- Department of ExerciseNutrition and SportsUniversity of CopenhagenDenmark
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