1
|
Bieniaszewska A, Sobieska M, Steinborn B, Gajewska E. Examination of Upper Limb Function and the Relationship with Gross Motor Functional and Structural Parameters in Patients with Spinal Muscular Atrophy. Biomedicines 2023; 11:biomedicines11041005. [PMID: 37189623 DOI: 10.3390/biomedicines11041005] [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: 02/15/2023] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by the deletion or/and mutation in the survival motor neuron 1 (SMN1) gene on chromosome 5. Until now, only a few articles investigating the relationship between upper limb function and the gross motor function in untreated SMA patients have been published. However, there is still a lack of publications including the relationship between structural changes such as cervical rotation, trunk rotation and side trunk shortening, and upper limb function. The aim of the study was to examine the upper limb function in patients with spinal muscular atrophy and the relationship between the upper limb function, gross motor function, and structural parameters. We present an analysis of 25 SMA patients, divided into sitter and walker groups, undergoing pharmacological treatment (nusinersen or risdiplam), examined twice between the initial examination and evaluation after a 12-month period. The participants were tested using validated scales such as the Revised Upper Limb Module (RULM), the Hammersmith Functional Motor Scale-Extended (HFMSE), and the structural parameters. Our results showed that patients demonstrated greater improvement on the RULM scale than on the HFMSE scale. Moreover, persistent structural changes negatively affected both the upper limb function and gross motor skills.
Collapse
Affiliation(s)
- Aleksandra Bieniaszewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Bukowska 70, 60-812 Poznan, Poland
| | - Magdalena Sobieska
- Department of Rehabilitation and Physiotherapy, Poznan University of Medical Sciences, 61-545 Poznan, Poland
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Ewa Gajewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| |
Collapse
|
2
|
Prospective Analysis of Functional and Structural Changes in Patients with Spinal Muscular Atrophy-A Pilot Study. Biomedicines 2022; 10:biomedicines10123187. [PMID: 36551943 PMCID: PMC9776007 DOI: 10.3390/biomedicines10123187] [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: 10/27/2022] [Revised: 11/24/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Spinal muscular atrophy (SMA) is a rare, autosomal recessive neuromuscular disease. Recent years have seen a significant development of therapeutic options for SMA patients. With the development of treatment methods, it has become necessary to adapt a physiotherapeutic approach to the evolving clinical picture of SMA patients. We presented an analysis of 40 SMA patients undergoing pharmacological treatment, examined twice in an average interval of 5 months. Twelve patients (non-sitters) were evaluated using CHOP-INTEND, while 28 (sitters) were tested using the Hammersmith scale. The research protocol consisted of measurements of upper and lower limb ranges of motion, and four tests for early detection of musculoskeletal changes. Both non-sitters and sitters patients showed motor improvement between the first and second examinations. Favorable changes in range of motion parameters were noted in most children, except for hip extension (HE) range, which deteriorated. An association was also observed between scale scores and the presence of contractures in the hip and knee joints depending on the group studied. Our findings showed that the presence of contractures at the hip and knee joint negatively affected functional improvement as measured by the scale scores.
Collapse
|
3
|
Indrayani NLD, Wang JJ, Chang JH, Permatasari H, Wang CJ. Development of an educational protocol for ergonomic risk assessment of working postures to enhance the competence of occupational health nurses. Int J Nurs Pract 2022; 28:e13052. [PMID: 35315175 DOI: 10.1111/ijn.13052] [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: 08/17/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/27/2022]
Abstract
AIM To develop a protocol and provide a valid, evidence-based procedure for identifying the ergonomic risk of working postures by occupational health nurses. BACKGROUND Although ergonomic risk assessment tools have been used for the early detection of risky working postures, their operational procedures and validations do not target the competence of occupational nursing personnel. DESIGN This study developed and validated an educational protocol, comprised of 13 procedures in five stages. First, the number of work tasks in the workplace is determined. Second, the working postures are confirmed. Third, the raters are trained to use the assessment tools. Fourth, high-risk postures are identified and categorized. Fifth, the inter-rater reliability of the tool is reported. The content of the protocol is validated by experts, with a validity value of 0.87. DATA SOURCES The protocol was created through review of literature published from 1991 to 2021, protocol development (between 2018 to 2020) and expert validation (2020). CONCLUSION The protocol can be applied to educate occupational health nurses and increase their competence in detecting workers' ergonomic risks. It can be used as a reference in occupational health nursing education to evaluate work tasks and detect risky postures.
Collapse
Affiliation(s)
- Ni Luh Dwi Indrayani
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jer-Hao Chang
- Department of Occupational Therapy and Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Henny Permatasari
- Department of Community Health Nursing, Faculty of Nursing, University of Indonesia, Indonesia
| | - Chi-Jane Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
4
|
Neurodynamic Functions and Their Correlations with Postural Parameters in Adolescents with Idiopathic Scoliosis. J Clin Med 2022; 11:jcm11041115. [PMID: 35207387 PMCID: PMC8880101 DOI: 10.3390/jcm11041115] [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: 11/24/2021] [Revised: 01/10/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
Knowledge about neurodynamic functions of the nervous system (NS) in patients with idiopathic scoliosis (IS) is limited. This study aimed to assess the mechanosensitivity of the NS structures (MNS) in adolescents with IS. The study included 69 adolescents with IS and 57 healthy peers aged 10–15 years. The Upper Limb Neurodynamic Test 1 (ULNT1), straight leg raise (SLR) test, and slump test (SLUMP) were used to assess MNS. The spinal curvatures in the sagittal plane and selected ranges of motion were measured. The data were analysed using the Mann–Whitney U test and Spearman’s rank correlation. Increased MNS assessed by ULNT1 and SLUMP tests was observed in participants with IS. Values of the neurodynamic tests correlated significantly with the sagittal profile of the spine and the mobility of the spine and lower limbs in both groups. In conclusion, increased MNS occurs in adolescents with IS. Therefore, the examination of adolescents with IS should include an assessment of MNS with the neurodynamic tests. Future studies should investigate this issue to better understand the mechanisms that coexist with IS.
Collapse
|
5
|
Stępień A, Gajewska E, Rekowski W. Motor Function of Children with SMA1 and SMA2 Depends on the Neck and Trunk Muscle Strength, Deformation of the Spine, and the Range of Motion in the Limb Joints. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179134. [PMID: 34501722 PMCID: PMC8430973 DOI: 10.3390/ijerph18179134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 01/12/2023]
Abstract
The purpose of this study was to investigate the functional relationships between selected ranges of motion of the neck, upper and lower limbs, the strength of the neck and trunk muscles, postural parameters, and the motor function of children with SMA1 and SMA2—27 children, aged 6 months-15 years, with genetically confirmed spinal muscular atrophy type 1 (19 children) and 2 (8 children) undergoing pharmacological treatment. All children were examined, according to the methodology, including the motor function evaluation, measurement of selected ranges of motion, assessment of postural parameters, and measurement of neck and trunk muscle strength. The functional status of 15 children was assessed with the CHOP INTEND (CHOP group) scale and of 12 children with the HFMSE (HFMSE group). The results obtained showed that, in children examined with the CHOP scale, greater limitation of flexion in the shoulder joints was observed. As the deformation of the chest increased, the functional abilities of children deteriorated. In participants examined with the CHOP group, the ranges of neck rotation decreased with the increase of the chest deformity. In the HFMSE group, the ranges of head rotation showed a strong relationship with some parameters of muscle strength and the sum of the R coefficients. Participants showed many significant relationships between the range of motion in the neck and joints of the limbs, with more significant relationships in the CHOP group. The following conclusions were made: motor skills of children with SMA depend on muscle strength, range of motion, and deformities of the spine and chest; the development of scoliosis adversely affects the motor function, ranges of motion, and muscle strength; and movement ranges are related to motor skills and strength values.
Collapse
Affiliation(s)
- Agnieszka Stępień
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka Str., 00-968 Warszawa, Poland; (A.S.); (W.R.)
| | - Ewa Gajewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Str, 60-355 Poznan, Poland
- Correspondence:
| | - Witold Rekowski
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka Str., 00-968 Warszawa, Poland; (A.S.); (W.R.)
| |
Collapse
|
6
|
Stępień A, Mazurkiewicz Ł, Maślanko K, Rekowski W, Jędrzejowska M. Cervical rotation, chest deformity and pelvic obliquity in patients with spinal muscular atrophy. BMC Musculoskelet Disord 2020; 21:726. [PMID: 33160358 PMCID: PMC7648994 DOI: 10.1186/s12891-020-03710-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/12/2020] [Indexed: 01/02/2023] Open
Abstract
Background Musculoskeletal disorders are often observed in patients with spinal muscular atrophy (SMA). The aim of the study was to assess passive ranges of rotation in the cervical spine, chest deformity and pelvic obliquity in SMA patients, and to compare these results to the norms obtained in the group of healthy individuals. The second aim was to review these measurements and Cobb angle values for correlations in SMA patients. Methods The study included 74 patients with SMA and 89 healthy individuals aged 2 to 18 years. Cervical Rotation (CR), Supine Angle of Trunk Rotation (SATR) and Pelvic Obliquity (PO) tests were carried out. Results Cervical rotation ranges were significantly higher in the control group than in SMA patients (p < 0.05). Differences between cervical rotation ranges to the left and to the right were significantly larger in SMA I and SMA II groups than in healthy individuals (p = 0.000). Chest asymmetry and pelvic obliquity were bigger in SMA groups than in the control (p < 0.05). Significant correlations between cervical rotation measurements, chest deformity, pelvic obliquity and Cobb angle were found in SMA individuals, depending on the type. Conclusions The results of the study suggest that CR, SATR and PO tests may assist in the assessment of SMA patients in addition to the radiographic evaluation of the spine. Biomechanical relationships between disorders located in various skeletal structures should be taken into account in the treatment of SMA patients. Special attention should be given to assessing postural parameters in non- sitters and sitters. Treatment of patients with SMA and associated musculoskeletal disorders requires a multi-specialist approach.
Collapse
Affiliation(s)
- Agnieszka Stępień
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland.
| | - Łucja Mazurkiewicz
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Witold Rekowski
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Maria Jędrzejowska
- Rare Diseases Research Platform, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego 5, 02-106, Warsaw, Poland
| |
Collapse
|
7
|
Kobylińska M, Malak R, Majewska K, Kędzia A, Samborski W. Assessment of anterior-posterior spinal curvatures in children suffering from hypopituitarism. BMC Endocr Disord 2019; 19:137. [PMID: 31829163 PMCID: PMC6907119 DOI: 10.1186/s12902-019-0462-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Body posture may be disordered by vestibular dysfunction, neurological disorders, problems with the distribution of muscle tone, brain injuries, and other dysfunctions. Growth hormone deficiency (GHD) can lead to many disorders, particularly of the musculoskeletal system. During treatment with recombinant human growth hormone (rhGH), an increase in muscle mass and an improvement in bone structure can be observed in children suffering from hypopituitarism from GHD. METHODS The study involved 33 children suffering from hypopituitarism with GHD (9 girls and 24 boys), aged 10-14 years old. Measurements of the magnitude of their anterior-posterior spinal curvatures were made using an inclinometer. The children were examined at the medianus of the sacrum bone, the Th12-L1 intervertebral area, and the C7-Th1 intervertebral area. In order to characterize the anterior-posterior curvature of the spine, the results were compared with the general norms reported by Saunders. Statistical calculations were carried out using the statistical package Statistica 10 PL. RESULTS Lumbar lordosis angles were higher in the patients currently receiving growth hormone (GH) treatment than in those who had yet to receive it. There is a statistically significant positive correlation between the length of growth hormone treatment and the alpha angle. There are also statistically significant correlations between age at the beginning of growth hormone therapy and the angle of lordosis. Statistically significant correlations were also seen between age at the beginning of growth hormone therapy and the alpha angle. CONCLUSIONS Although there may be changes in posture at the beginning of rhGH treatment, the sooner growth hormone therapy begins, the better the body posture. The longer the growth hormone treatment, the better the posture, as expressed by the alpha angle in the sagittal plane.
Collapse
Affiliation(s)
- Magdalena Kobylińska
- Department of Clinical Auxology and Pediatrics Nursing Faculty of Health Sciences, Poznań University of Medical Sciences, Szpitalna 27/33, 60-572 Poznań, Poland
| | - Roksana Malak
- Department and Clinic of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, 28 Czerwca 1956 nr 135/147, 61-545 Poznań, Poland
| | - Katarzyna Majewska
- Department of Clinical Auxology and Pediatrics Nursing Faculty of Health Sciences, Poznań University of Medical Sciences, Szpitalna 27/33, 60-572 Poznań, Poland
| | - Andrzej Kędzia
- Department of Clinical Auxology and Pediatrics Nursing Faculty of Health Sciences, Poznań University of Medical Sciences, Szpitalna 27/33, 60-572 Poznań, Poland
| | - Włodzimierz Samborski
- Department and Clinic of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, 28 Czerwca 1956 nr 135/147, 61-545 Poznań, Poland
| |
Collapse
|