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Liu C, Peng Y, Yang Y, Li P, Chen D, Nie D, Liu H, Liu P. Structure of brain grey and white matter in infants with spastic cerebral palsy and periventricular white matter injury. Dev Med Child Neurol 2024; 66:514-522. [PMID: 37635344 DOI: 10.1111/dmcn.15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Abstract
AIM To investigate the possible covariation of grey matter volume (GMV) and white matter fractional anisotropy in infants with spastic cerebral palsy (CP) and periventricular white matter injury. METHOD Thirty-nine infants with spastic CP and 25 typically developing controls underwent structural magnetic resonance imaging and diffusion tensor imaging. Multimodal canonical correlation analysis with joint independent component analysis were used to capture differences in GMV and fractional anisotropy between groups. Correlation analysis was performed between imaging findings and clinical features. RESULTS Infants with spastic CP showed one joint group-discriminating component (i.e. GMV-fractional anisotropy) associated with regions in the cortico-basal ganglia-thalamo-cortical loop and in the corpus callosum compared to typically developing controls and one modality-specific group-discriminating component (i.e. GMV). Significant negative correlations were found between loadings in certain regions and the motor function score in spastic CP. INTERPRETATION In infants with spastic CP, covarying GMV-fractional anisotropy and altered GMV in specific regions were implicated in motor dysfunction, which confirmed that simultaneous GMV and fractional anisotropy changes underly motor deficits, but might also extend to sensory, cognitive, or visual dysfunction. These findings also suggest that multimodal fusion analysis allows for a more comprehensive understanding of the relevance between grey and white matter structures and its crucial role in the neuropathological mechanisms of spastic CP.
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Affiliation(s)
- Chengxiang Liu
- Life Science Research Center, School of Life Science and Technology, Xidian University, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, China
- Xi'an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, China
| | - Ying Peng
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Yanli Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Pengyu Li
- Life Science Research Center, School of Life Science and Technology, Xidian University, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, China
- Xi'an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, China
| | - Duoli Chen
- Life Science Research Center, School of Life Science and Technology, Xidian University, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, China
- Xi'an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, China
| | - Dingxin Nie
- Life Science Research Center, School of Life Science and Technology, Xidian University, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, China
- Xi'an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Peng Liu
- Life Science Research Center, School of Life Science and Technology, Xidian University, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, China
- Xi'an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, China
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Tiwari S, Rao PT, Karthikbabu S. Correlations between Trunk Control and Balance in Children with Bilateral Spastic Cerebral Palsy. Percept Mot Skills 2024; 131:432-445. [PMID: 38315610 DOI: 10.1177/00315125231226297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Impairments of postural responses are a salient feature of children with cerebral palsy (CP). While the systems approach describes balance in seven components, the relationship between trunk control and balance in children with CP has not been previously examined with all seven of these components. In this study, we aimed to identify correlations between trunk control and all seven systems approach balance components in children with bilateral spastic CP. Our participants were 30 children (M age = 11.83, SD = 2.32 years) with CP having a Gross Motor Function Classification System level ranging from I to III. We assessed trunk control with the Trunk Control Measurement Scale, including static and dynamic balance (selective voluntary control and reaching). Balance in standing was assessed using Kids-Mini-BESTest involving four domains: anticipatory, reactive, sensory orientation and stability in gait. We used Spearman's rank correlations to correlate trunk control and balance, and we obtained a moderate correlation between the trunk control measurement scale and the Kids-Mini-BESTest in children with both bilateral spastic CP (rs = .618, p < .001) and spastic diplegic CP (rs = .52, p = .02). Analysis of the correlations between separate domains of the Kids-Mini-BESTest and the trunk control measurement scale subscales revealed moderate correlations between the static sitting balance subscale and all four domains of the Kids-Mini-BESTest. The dynamic selective motor control subscale of the trunk control measurement scale moderately correlated with the anticipatory domain of the Kids-Mini-BESTest. The dynamic reaching subscale also correlated moderately with anticipatory and stability in gait domains. This correlation was statistically significant in the 13 to 17-year-old age group and was strong among females, whereas the correlation was moderate in males. Trunk control was moderately associated with balance considering all the systems theory components of balance in children with bilateral spastic cerebral palsy.
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Affiliation(s)
- Sapna Tiwari
- Masters in Physiotherapy in Pediatrics, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bengaluru, India
| | - Pratiksha Tilak Rao
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bengaluru, India
| | - Suruliraj Karthikbabu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bengaluru, India
- Kovai Medical Center Research and Educational Trust, KMCH College of Physiotherapy, Coimbatore, India
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3
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Janzing AM, Eklund E, De Koning TJ, Eggink H. Clinical Characteristics Suggestive of a Genetic Cause in Cerebral Palsy: A Systematic Review. Pediatr Neurol 2024; 153:144-151. [PMID: 38382247 DOI: 10.1016/j.pediatrneurol.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/11/2024] [Accepted: 01/27/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Cerebral palsy (CP) is a clinical diagnosis and was long categorized as an acquired disorder, but more and more genetic etiologies are being identified. This review aims to identify the clinical characteristics that are associated with genetic CP to aid clinicians in selecting candidates for genetic testing. METHODS The PubMed database was systematically searched to identify genes associated with CP. The clinical characteristics accompanying these genetic forms of CP were compared with published data of large CP populations resulting in the identification of potential indicators of genetic CP. RESULLTS Of 1930 articles retrieved, 134 were included. In these, 55 CP genes (described in two or more cases, n = 272) and 79 candidate genes (described in only one case) were reported. The most frequently CP-associated genes were PLP1 (21 cases), ARG1 (17 cases), and CTNNB1 (13 cases). Dyskinesia and the absence of spasticity were identified as strong potential indicators of genetic CP. Presence of intellectual disability, no preterm birth, and no unilateral distribution of symptoms were classified as moderate genetic indicators. CONCLUSIONS Genetic causes of CP are increasingly identified. The clinical characteristics associated with genetic CP can aid clinicians regarding to which individual with CP to offer genetic testing. The identified potential genetic indicators need to be validated in large CP cohorts but can provide the first step toward a diagnostic algorithm for genetic CP.
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Affiliation(s)
- Anna M Janzing
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Eklund
- Faculty of Medicine, Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Tom J De Koning
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands; Faculty of Medicine, Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendriekje Eggink
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Lessard I, Côté I, St-Gelais R, Hébert LJ, Brais B, Mathieu J, Rodrigue X, Gagnon C. Natural History of Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay: a 4-Year Longitudinal Study. Cerebellum 2024; 23:489-501. [PMID: 37101017 DOI: 10.1007/s12311-023-01558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neurologic disorder with generally well-known clinical manifestations. However, few studies assessed their progression rate using a longitudinal design. This study aimed to document the natural history of ARSACS over a 4-year period in terms of upper and lower limb functions, balance, walking capacity, performance in daily living activities, and disease severity. Forty participants were assessed on three occasions over 4 years. Participant performance was reported in raw data as well as in percentage from reference values to consider the normal aging process. Severe balance and walking capacity impairments were found, with a significant performance decrease over the 4 years. Balance reached a floor score of around 6 points on the Berg Balance Scale for participants aged >40 years, while other participants lost about 1.5 points per year. The mean loss in walking speed was 0.044 m/s per year and the mean decrease in the distance walked in 6 min was 20.8 m per year for the whole cohort. Pinch strength, balance, walking speed, and walking distance decreased over time even when reported in percentage from reference values. Major impairments and rapid progression rates were documented in the present study for upper limb coordination, pinch strength, balance, and walking capacity in the ARSACS population. A progression rate beyond the normal aging process was observed. These results provide fundamental insights regarding the disease prognosis that will help to better inform patients, develop specific rehabilitation programs, and improve trial readiness.
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Affiliation(s)
- Isabelle Lessard
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Raphaël St-Gelais
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec, Québec, Canada
- Départements de réadaptation et de radiologie et médecine nucléaire, Faculté de médecine, Université Laval, Québec, Canada
| | - Bernard Brais
- Neurological Institute, McGill University, Quebec, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Xavier Rodrigue
- Institut de réadaptation en déficience physique de Québec, Québec, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada.
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada.
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Biglari S, Vahidnezhad H, Tabatabaiefar MA, Khorram Khorshid HR, Esmaeilzadeh E. RARS1-related hypomyelinating leukodystrophy-9 (HLD-9) in two distinct Iranian families: Case report and literature review. Mol Genet Genomic Med 2024; 12:e2435. [PMID: 38618971 PMCID: PMC11017294 DOI: 10.1002/mgg3.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/04/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Hypomyelinating leukodystrophy-9 (HLD-9) is caused by biallelic pathogenic variants in RARS1, which codes for the cytoplasmic tRNA synthetase for arginine (ArgRS). This study aims to evaluate the clinical, neuroradiological, and genetic characteristics of patients with RARS1-related disease and determine probable genotype-phenotype relationships. METHODS We identified three patients with RARS1 homozygous pathogenic variants. Furthermore, we performed a comprehensive review of the literature. RESULTS Homozygous variants of RARS1 (c.2T>C (p.Met1Thr)) were identified in three patients with HLD-9. Clinical symptoms were severe in all patients. Following the literature review, thirty HLD-9 cases from eight studies were found. The 33 patients' main symptoms were hypomyelination, language delay, and intellectual disability or developmental delay. The mean age of onset for HLD9 in the group of 33 patients with a known age of onset was 5.8 months (SD = 8.1). The interquartile range of age of onset was 0-10 months. Of the 25 variants identified, c.5A>G (p.Asp2Gly) was identified in 11 patients. CONCLUSION Pathogenic variants in RARS1 decrease ArgRS activity and cause a wide range of symptoms, from severe, early onset epileptic encephalopathy with brain atrophy to a mild condition with relatively maintained myelination. These symptoms include the classic hypomyelination presentation with nystagmus and spasticity. Furthermore, the pathogenicity of the variation c.2T>C (p.Met1Thr) has been shown.
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Affiliation(s)
- Sajjad Biglari
- Department of Genetics and Molecular Biology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Hassan Vahidnezhad
- Division of Human GeneticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Center for Applied GenomicsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of Pennsylvania, Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Mohammad Amin Tabatabaiefar
- Department of Genetics and Molecular Biology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
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Nixon M, Zreik N, Bakhit H. Wrist arthrodesis and soft tissue rebalancing in the spastic hand. J Hand Surg Eur Vol 2024; 49:420-427. [PMID: 37879641 DOI: 10.1177/17531934231205548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The aim of the present study was to investigate the outcomes of wrist arthrodesis with simultaneous soft tissue rebalancing of the digits in the spastic wrist. In 43 wrists (40 patients) the surgical goals, patient selection, procedures and outcomes were assessed. Preoperatively, mean passive extension was to 44° below neutral and only two patients had volitional control. Postoperatively, 33 and 10 cases reported excellent and good outcomes, respectively. A mean Goal Attainment Score of 62.4 indicated better than expected outcomes. In total, 37 hands required simultaneous finger rebalancing: 24 underwent tendon transfers and 13 surgical releases. A total of 12 thumbs required tendon transfers, three soft tissue releases and five metacarpophalangeal joint stabilization. Ten patients experienced complications, most commonly wound problems and implant failure, predominantly observed in patients with severe wrist and elbow contractures. In conclusion, wrist arthrodesis with simultaneous soft tissue rebalancing of the digits offers a viable approach in patients with severe spasticity. Cautious patient selection and consideration of potential complications are crucial for good outcomes.Level of evidence: IV.
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Affiliation(s)
- Matthew Nixon
- Countess of Chester Hospital, Chester, UK
- Royal Manchester Royal Children's Hospital, Manchester, UK
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Willaert J, Desloovere K, Van Campenhout A, Ting LH, De Groote F. Identification of Neural and Non-Neural Origins of Joint Hyper-Resistance Based on a Novel Neuromechanical Model. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1435-1444. [PMID: 38526884 PMCID: PMC11032725 DOI: 10.1109/tnsre.2024.3381739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Joint hyper-resistance is a common symptom in neurological disorders. It has both neural and non-neural origins, but it has been challenging to distinguish different origins based on clinical tests alone. Combining instrumented tests with parameter identification based on a neuromechanical model may allow us to dissociate the different origins of joint hyper-resistance in individual patients. However, this requires that the model captures the underlying mechanisms. Here, we propose a neuromechanical model that, in contrast to previously proposed models, accounts for muscle short-range stiffness (SRS) and its interaction with muscle tone and reflex activity. We collected knee angle trajectories during the pendulum test in 15 children with cerebral palsy (CP) and 5 typically developing children. We did the test in two conditions - hold and pre-movement - that have been shown to alter knee movement. We modeled the lower leg as an inverted pendulum actuated by two antagonistic Hill-type muscles extended with SRS. Reflex activity was modeled as delayed, linear feedback from muscle force. We estimated neural and non-neural parameters by optimizing the fit between simulated and measured knee angle trajectories during the hold condition. The model could fit a wide range of knee angle trajectories in the hold condition. The model with personalized parameters predicted the effect of pre-movement demonstrating that the model captured the underlying mechanism and subject-specific deficits. Our model may help with the identification of neural and non-neural origins of joint hyper-resistance and thereby opens perspectives for improved diagnosis and treatment selection in children with spastic CP, but such applications require further studies to establish the method's reliability.
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Jiménez-García AM, Bonnel G, Álvarez-Mota A, Arias N. Current perspectives on neuromodulation in ALS patients: A systematic review and meta-analysis. PLoS One 2024; 19:e0300671. [PMID: 38551974 PMCID: PMC10980254 DOI: 10.1371/journal.pone.0300671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/01/2024] [Indexed: 04/01/2024] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons, resulting in muscle weakness, paralysis, and eventually patient mortality. In recent years, neuromodulation techniques have emerged as promising potential therapeutic approaches to slow disease progression and improve the quality of life of ALS patients. A systematic review was conducted until August 8, 2023, to evaluate the neuromodulation methods used and their potential in the treatment of ALS. The search strategy was applied in the Cochrane Central database, incorporating results from other databases such as PubMed, Embase, CTgov, CINAHL, and ICTRP. Following the exclusion of papers that did not fulfil the inclusion criteria, a total of 2090 records were found, leaving a total of 10 studies. R software was used to conduct meta-analyses based on the effect sizes between the experimental and control groups. This revealed differences in muscle stretch measures with manual muscle testing (p = 0.012) and resting motor threshold (p = 0.0457), but not with voluntary isometric contraction (p = 0.1883). The functionality of ALS was also different (p = 0.007), but not the quality of life. Although intracortical facilitation was not seen in motor cortex 1 (M1) (p = 0.1338), short-interval intracortical inhibition of M1 was significant (p = 0.0001). BDNF showed no differences that were statistically significant (p = 0.2297). Neuromodulation-based treatments are proposed as a promising therapeutic approach for ALS that can produce effects on muscle function, spasticity, and intracortical connections through electrical, magnetic, and photonic stimulation. Photobiomodulation stands out as an innovative approach that uses specific wavelengths to influence mitochondria, with the aim of improving mitochondrial function and reducing excitotoxicity. The lack of reliable placebo controls and the variation in stimulation frequency are some of the drawbacks of neuromodulation.
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Affiliation(s)
- Ana M. Jiménez-García
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
| | - Gaspard Bonnel
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
| | - Alicia Álvarez-Mota
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
| | - Natalia Arias
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
- Health Research Institute of the Principality of Asturias (Instituto de Investigación Universitaria del Principado de Asturias), Oviedo, Spain
- INEUROPA, Instituto de Neurociencias del Principado de Asturias, Plaza Feijoo, Oviedo, Spain
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Krouma M, Soilhi AA, Desnous B, James S, Boulay C, Scavarda D. Intraventricular baclofen for palliative management of acquired generalized dystonia in pediatric patients: a case series and literature review. Childs Nerv Syst 2024; 40:895-903. [PMID: 37975904 DOI: 10.1007/s00381-023-06217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
Dystonia represents a significant source of disability in children. Generalized dystonia, which involves multiple body regions, leads to impaired mobility and motor function, resulting in substantial challenges in daily activities. Surgical treatments are used when medical treatments fail. Intrathecal baclofen (ITB) or deep brain stimulations (DBS) are the most employed surgical therapies. When these options are not feasible or ineffective, some authors have explored the use of intraventricular baclofen (IVB). In this report, we present four cases of pediatric patients with generalized dystonia who underwent treatment with IVB, resulting in notable improvements. To further explore the potential of this treatment modality, we conducted a comprehensive literature review. The findings from our study provide a comprehensive overview that can guide palliative management in similar cases.
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Affiliation(s)
- M Krouma
- Division of Neurosurgery, Department of Pediatric Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - A Aboudou Soilhi
- Division of Neurosurgery, Department of Pediatric Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - B Desnous
- Department of Pediatric Neurology, La Timone Hospital, Aix Marseille University, Marseille, France
| | - S James
- Department of Pediatric Neurosurgery, Division of Neurosurgery, Necker Hospital, Paris, France
| | - C Boulay
- Department of Pediatric Neurology, La Timone Hospital, Aix Marseille University, Marseille, France
| | - D Scavarda
- Division of Neurosurgery, Department of Pediatric Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France.
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10
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Panahi F, Ebrahimi S, Rojhani-Shirazi Z, Shakibafard A, Hemmati L. Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial. Disabil Rehabil 2024; 46:1092-1102. [PMID: 36970837 DOI: 10.1080/09638288.2023.2190168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. METHODS Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. RESULTS The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). CONCLUSIONS Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.
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Affiliation(s)
- Fatemeh Panahi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Ebrahimi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rojhani-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ladan Hemmati
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Alkhajeh A, Arumugam A, Abd ElKafy E, Hegazy F. The effect of upper limb loading with external weights on gait and trunk control in ambulatory children with spastic hemiplegic cerebral palsy: a randomized controlled trial. Eur Rev Med Pharmacol Sci 2024; 28:2117-2126. [PMID: 38567574 DOI: 10.26355/eurrev_202403_35715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Children with hemiplegic cerebral palsy (CP) are typically ambulant with high motor functioning levels but with gait asymmetry and a greater risk of instability and falling. Physiotherapy is considered the core part of CP rehabilitation due to the risk of neurosurgery and the side effects of drug interventions. Although growing evidence has looked at the effect of upper limb loading during walking in many populations, such interventions in children with CP remain unexplored yet. The purpose of this study was to investigate if loading the upper limbs with external weights could improve walking speed, trunk control, and balance in ambulatory children with hemiplegic CP. PATIENTS AND METHODS The following outcome measures were recorded at baseline and six weeks after the intervention: gait speed [10-Meter Walk Test (10 MWT)], trunk control [Trunk Control Measurement Scale (TCMS)], and balance [Pediatric Balance Scale (PBS)]. Multiple 2 (groups) x 2 (time-points) mixed analysis of variance models (ANOVAs) were used for analysis. RESULTS Both groups showed a significant improvement (p < 0.001) in 10 MWT, TCMS, and PBS scores post-intervention. However, the magnitude of change in the outcome measures was higher in the intervention group (10 MWT = 0.59 m/s, TCMS = 10.41, PBS = 9.35) compared to the control group (10 MWT = 0.37 m/s, TCMS = 6.43, PBS = 4.68). CONCLUSIONS This study demonstrated that although both control and intervention groups showed improvements in terms of gait speed, trunk control, and balance, the intervention group that had upper limb loading showed higher significant improvements. Clinicaltrial.gov ID: NCT05444387.
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Affiliation(s)
- A Alkhajeh
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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Sorek G, Goudriaan M, Schurr I, Schless SH. Influence of musculoskeletal pain during gait on kinematics and selective motor control in individuals with spastic cerebral palsy: A pilot study. Clin Biomech (Bristol, Avon) 2024; 113:106219. [PMID: 38458003 DOI: 10.1016/j.clinbiomech.2024.106219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Individuals with cerebral-palsy commonly present with altered kinematics and selective-motor-control during gait, and may also experience musculoskeletal pain. This pilot study aims to investigate if the immediate experience of musculoskeletal pain during gait influences kinematics and selective-motor-control in individuals with spastic cerebral-palsy. METHODS Retrospective treadmill-based gait-analysis data for 145 individuals with spastic cerebral-palsy were screened. Participants were asked about experiencing lower-extremity musculoskeletal pain immediately during gait, with 26 individuals (18%) reporting this was the case (pain-group; mean 11.55 ± 3.15 years, Gross-Motor-Function-Classification-System levels I/II/III n = 5/13/8, Uni/bilateral involvement n = 11/15). Of the 77 individuals who did not report any pain, a no-pain group (n = 26) was individually matched. Kinematics were evaluated using the Gait-Profile-Score and spatiotemporal parameters (dimensionless-walking-speed, single-leg-support percentage and step-time). Selective-motor-control was assessed using the Walking-Dynamic-Motor-Control index. FINDINGS In the pain-group, 58% reported experiencing pain in their more-involved leg, 8% in the less-involved leg and 34% in both legs. Regarding the pain location, 38% of the pain-group reported experiencing pain in multiple locations. On a more specific level, 35%, 46% and 54% reported pain around the hip/thigh, knee/calf and ankle/ft, respectively. No significant differences were observed between the pain and no-pain groups for any of the outcome measures, in each leg or bilaterally. INTERPRETATION No significant differences in kinematics and selective-motor-control during gait were found between individuals with spastic cerebral-palsy, with and without musculoskeletal pain. This suggests that the individuals in this study may not present with obvious antalgic gait patterns, which may relate to the pre-existing altered kinematics and selective-motor-control.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Pediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Pediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, the Netherlands; University corporate offices, student & academic affairs office, Utrecht university, Utrecht, the Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Pediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Pediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Pediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel; Clinical Motion Analysis Laboratory, ALYN Pediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel.
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Franchino CA, Brughera M, Baderna V, De Ritis D, Rocco A, Seneca S, Regal L, Podini P, D’Antonio M, Toro C, Quattrini A, Scalais E, Maltecca F. Sustained OMA1-mediated integrated stress response is beneficial for spastic ataxia type 5. Brain 2024; 147:1043-1056. [PMID: 37804316 PMCID: PMC10907083 DOI: 10.1093/brain/awad340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023] Open
Abstract
AFG3L2 is a mitochondrial protease exerting protein quality control in the inner mitochondrial membrane. Heterozygous AFG3L2 mutations cause spinocerebellar ataxia type 28 (SCA28) or dominant optic atrophy type 12 (DOA12), while biallelic AFG3L2 mutations result in the rare and severe spastic ataxia type 5 (SPAX5). The clinical spectrum of SPAX5 includes childhood-onset cerebellar ataxia, spasticity, dystonia and myoclonic epilepsy. We previously reported that the absence or mutation of AFG3L2 leads to the accumulation of mitochondria-encoded proteins, causing the overactivation of the stress-sensitive protease OMA1, which over-processes OPA1, leading to mitochondrial fragmentation. Recently, OMA1 has been identified as the pivotal player communicating mitochondrial stress to the cytosol via a pathway involving the inner mitochondrial membrane protein DELE1 and the cytosolic kinase HRI, thus eliciting the integrated stress response. In general, the integrated stress response reduces global protein synthesis and drives the expression of cytoprotective genes that allow cells to endure proteotoxic stress. However, the relevance of the OMA1-DELE1-HRI axis in vivo, and especially in a human CNS disease context, has been poorly documented thus far. In this work, we demonstrated that mitochondrial proteotoxicity in the absence/mutation of AFG3L2 activates the OMA1-DELE1-HRI pathway eliciting the integrated stress response. We found enhanced OMA1-dependent processing of DELE1 upon depletion of AFG3L2. Also, in both skin fibroblasts from SPAX5 patients (including a novel case) and in the cerebellum of Afg3l2-/- mice we detected increased phosphorylation of the α-subunit of the eukaryotic translation initiation factor 2 (eIF2α), increased levels of ATF4 and strong upregulation of its downstream targets (Chop, Chac1, Ppp1r15a and Ffg21). Silencing of DELE1 or HRI in SPAX5 fibroblasts (where OMA1 is overactivated at basal state) reduces eIF2α phosphorylation and affects cell growth. In agreement, pharmacological potentiation of integrated stress response via Sephin-1, a drug that selectively inhibits the stress-induced eIF2alpha phosphatase GADD34 (encoded by Ppp1r15a), improved cell growth of SPAX5 fibroblasts and cell survival and dendritic arborization ex vivo in primary Afg3l2-/- Purkinje neurons. Notably, Sephin-1 treatment in vivo extended the lifespan of Afg3l2-/- mice, improved Purkinje neuron morphology, mitochondrial ultrastructure and respiratory capacity. These data indicate that activation of the OMA1-DELE1-HRI pathway is protective in the context of SPAX5. Pharmacological tuning of the integrated stress response may represent a future therapeutic strategy for SPAX5 and other cerebellar ataxias caused by impaired mitochondrial proteostasis.
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Affiliation(s)
- Camilla Aurora Franchino
- Mitochondrial Dysfunctions in Neurodegeneration Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Martina Brughera
- Mitochondrial Dysfunctions in Neurodegeneration Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Valentina Baderna
- Mitochondrial Dysfunctions in Neurodegeneration Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Daniele De Ritis
- Mitochondrial Dysfunctions in Neurodegeneration Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Alessandra Rocco
- Mitochondrial Dysfunctions in Neurodegeneration Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Sara Seneca
- Medical Center of Genetic, UZ-VUB, Vrije Universiteit Brussels, 1090 Brussels Jette, Belgium
| | - Luc Regal
- Pediatric Neurology and Metabolism, UZ-VUB, Vrije Universiteit Brussels, 1090 Brussels Jette, Belgium
| | - Paola Podini
- Experimental Neuropathology Unit, Division of Neuroscience and Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Maurizio D’Antonio
- Biology of Myelin Unit, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Camilo Toro
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Division of Neuroscience and Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Emmanuel Scalais
- Department of Pediatric, Division of Pediatric Neurology, Centre Hospitalier de Luxembourg, L1210 Luxembourg, Luxembourg
| | - Francesca Maltecca
- Mitochondrial Dysfunctions in Neurodegeneration Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Università Vita-Salute San Raffaele, 20132 Milan, Italy
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Mizuta N, Hasui N, Kai T, Inui Y, Sato M, Ohnishi S, Taguchi J, Nakatani T. Characteristics of limb kinematics in the gait disorders of post-stroke patients. Sci Rep 2024; 14:3082. [PMID: 38321081 PMCID: PMC10847092 DOI: 10.1038/s41598-024-53616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/02/2024] [Indexed: 02/08/2024] Open
Abstract
Post-stroke gait disorders involve altered lower limb kinematics. Recently, the endpoint of the lower limb has been used as a control variable to understand gait kinematics better. In a cross-sectional study of sixty-seven post-stroke patients, the limb extension angle and effective limb length during gait were used as input variables with a mixed Gaussian model-based probabilistic clustering approach to identify five distinct clusters. Each cluster had unique characteristics related to motor paralysis, spasticity, balance ability, and gait strategy. Cluster 1 exhibited high limb extension angle and length values, indicating increased spasticity. Cluster 2 had moderate extension angles and high limb lengths, indicating increased spasticity and reduced balance ability. Cluster 3 had low limb extension angles and high limb length, indicating reduced balance ability, more severe motor paralysis, and increased spasticity. Cluster 4 demonstrated high extension angles and short limb lengths, with a gait strategy that prioritized stride length in the component of gait speed. Cluster 5 had moderate extension angles and short limb lengths, with a gait strategy that prioritized cadence in the component of gait speed. These findings provide valuable insights into post-stroke gait impairment and can guide the development of personalized and effective rehabilitation strategies.
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Affiliation(s)
- Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemi-cho, Handa-shi, Aichi, 475-0012, Japan.
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan.
| | - Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Takumi Kai
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Rehabilitation Medicine, Hatsudai Rehabilitation Hospital, 3-53-3 Honmachi, Shibuya-ku, Tokyo, 151-0071, Japan
| | - Yasuhiro Inui
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, 722 Oo, Tawaramoto, Shiki-gun, Nara, 636-0393, Japan
| | - Masahiro Sato
- Department of Rehabilitation, Nakazuyagi Hospital, 1-31, Nakazu, Tokushima-shi, Tokushima, 770-0856, Japan
| | - Sora Ohnishi
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Junji Taguchi
- Department of Medical, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
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Ravera EP, Rozumalski A. Selective dorsal rhizotomy and its effect on muscle force during walking: A comprehensive study. J Biomech 2024; 164:111968. [PMID: 38325195 DOI: 10.1016/j.jbiomech.2024.111968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/03/2024] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
Selective dorsal rhizotomy (SDR) is commonly used to permanently reduce spasticity in children with cerebral palsy (CP). However, studies have yielded varying results regarding muscle strength and activity after SDR. Some studies indicate weakness or no changes, while a recent study using NMSK simulations demonstrates improvements in muscle forces during walking. These findings suggest that SDR may alleviate spasticity, reducing dynamic muscle constraints and enhancing muscle force without altering muscle activity during walking in children with CP. In this study, we combined NMSK simulations with physical examinations to assess children with CP who underwent SDR, comparing them to well-matched peers who did not undergo the procedure. Each group (SDR and No-SDR) included 81 children, with pre- and post-SDR assessments. Both groups were well-matched in terms of demographics, clinical characteristics, and gait parameters. The results of the physical examination indicate that SDR significantly reduces spasticity without impacting muscle strength. Furthermore, our findings show no significant differences in gait deviation index improvements and walking speed between the two groups. Additionally, there were no statistically significant changes in muscle activity during walking before and after SDR for both groups. NMSK results demonstrate a significant increase in muscle force in the semimembranosus and calf muscles during walking, compared to children with CP who received other clinical treatments. Our findings confirm that although SDR does not significantly impact muscle strength compared to other treatments, it creates a more favorable dynamic environment for suboptimal muscle force production, which is essential for walking.
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Affiliation(s)
- Emiliano Pablo Ravera
- Group of Analysis, Modeling, Processing and Clinician Implementation of Biomechanical Signals and Systems, Bioengineering and Bioinformatics Institute, CONICET-UNER, Oro Verde, Argentina; Human Movement Research Laboratory, School of Engineering, National University of Entre Ríos (UNER), Oro Verde, Argentina.
| | - Adam Rozumalski
- The James R. Gage Center for Gait & Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, MN, United States of America.
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Fitoussi F, Lallemant-Dudek P. The upper limb in children with cerebral palsy. Evaluation and treatment. Orthop Traumatol Surg Res 2024; 110:103763. [PMID: 37992866 DOI: 10.1016/j.otsr.2023.103763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 11/24/2023]
Abstract
Management of the upper limb in children with cerebral palsy is often complex and must be carried out by a team experienced in this field. Several clinical parameters must be taken into consideration, such as higher functions, visual problems, overall upper limb function, motor control, sensitivity, presence of hemineglect or synkinesis, limb position at rest and during walking. And last but not least, a complete analysis of the upper limb is required. It is only after this exhaustive assessment - which often includes occupational therapy, physiotherapy and in some cases, video and electromyography evaluations - that a treatment indication can be discussed with the patient's family. Other than baseline treatment consisting of rehabilitation, occupational therapy and bracing, botulinum toxin injections could be an option, targeting specific muscle groups. Surgical treatments, which are often indicated in severe forms with contractures, are proposed after the patient's case is presented at a multidisciplinary meeting. These include selective neurotomy, muscle-tendon release, transfer or lengthening, and procedures on bone and joints (osteotomy, arthrodesis). LEVEL OF EVIDENCE: Expert opinion.
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Affiliation(s)
- Frank Fitoussi
- Armand Trousseau Hospital - Sorbonne Medical University, Paris, France.
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Vahedi F, Low EE, Kaizer AM, Fehmi SA, Hasan A, Chang MA, Kwong W, Krinsky ML, Anand G, Greytak M, Yadlapati R. Esophageal anatomy and physiology vary across spastic and non-spastic phenotypes of disorders of esophagogastric junction outflow. Neurogastroenterol Motil 2024; 36:e14709. [PMID: 38009826 PMCID: PMC10843578 DOI: 10.1111/nmo.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Pathophysiologic mechanisms of disorders of esophagogastric junction (EGJ) outflow are poorly understood. We aimed to compare anatomic and physiologic characteristics among patients with disorders of EGJ outflow and normal motility. METHODS We retrospectively evaluated adult patients with achalasia types 1, 2, 3, EGJ outflow obstruction (EGJOO) or normal motility on high-resolution manometry who underwent endoscopic ultrasound (EUS) from January 2019 to August 2022. Thickened circular muscle was defined as ≥1.6 mm. Characteristics from barium esophagram (BE) and functional lumen imaging probe (FLIP) were additionally assessed. KEY RESULTS Of 71 patients (mean age 56.2 years; 49% male), there were 8 (11%) normal motility, 58 (82%) had achalasia (5 (7%) type 1, 32 (45%) classic type 2, 21 (30%) type 3 [including 12 type 2 with FEPs]), and 7 (7%) had EGJOO. A significantly greater proportion of type 3 achalasia had thickened distal circular muscle (76.2%) versus normal motility (0%; p < 0.001) or type 2 achalasia (25%; p < 0.001). Type 1 achalasia had significantly wider mean maximum esophageal diameter on BE (57.8 mm) compared to type 2 achalasia (32.8 mm), type 3 achalasia (23.4 mm), EGJOO (15.9 mm), and normal motility (13.5 mm). 100% type 3 achalasia versus 0% type 1 achalasia/normal motility had tertiary contractions on BE. Mean EGJ distensibility index on FLIP was lower for type 3 achalasia (1.2 mmHg/mm2 ) and EGJOO (1.2 mmHg/mm2 ) versus type 2 (2.3 mmHg/mm2 ) and type 1 achalasia (2.9 mmHg/mm2 ). CONCLUSIONS Our findings suggest distinct pathologic pathways may exist: type 3 achalasia and EGJOO may represent a spastic outflow phenotype consisting of a thickened, spastic circular muscle, which is distinct from type 1 and 2 achalasia consisting of a thin caliber circular muscle layer with more prominent esophageal dilation.
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Affiliation(s)
- Farnoosh Vahedi
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Eric E Low
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Alexander M Kaizer
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Colorado School of Public Health, Aurora, Colorado, USA
| | - Syed Abbas Fehmi
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Aws Hasan
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Michael A Chang
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Wilson Kwong
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Mary L Krinsky
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Gobind Anand
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Madeline Greytak
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
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Lee JI, Günther A, Paus S, Royl G, Weyen U, Wissel J, Zeuner KE, Klebe S. [Improvement of the treatment of patients with spastic movement disorder after stroke]. Nervenarzt 2024; 95:133-140. [PMID: 37987799 PMCID: PMC10850175 DOI: 10.1007/s00115-023-01571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Spastic movement disorder (SMD) develops in up to 43% of cases as a sequela of stroke. In the event of a functionally relevant or daily life impairing SMD or to avoid an impending complication, the medicinal treatment of a focal, multifocal and segmental increase in muscle tone with botulinum neurotoxin A (BoNT-A) is recommended; however, treatment data reveal a lack of guideline-conform treatment with BoNT‑A in Germany. OBJECTIVE The aim of the reported expert meeting was to discuss solutions to the incorrect treatment and undertreatment of patients with SMD and to formulate consensus recommendations to improve the care situation. METHODS At a consensus meeting held in April 2022, eight experts from the fields of neurology, physical medicine and rehabilitation discussed the causes for the incorrect treatment and undertreatment and formulated consensus solution approaches. RESULTS Possible reasons for the current incorrect treatment and undertreatment in SMD management in Germany include insufficient awareness of SMD among physicians, a lack of treatment capacities, a lack of information transfer in discharge management as well as staff shortages in the specialized inpatient and outpatient SMD treatment centers. The committee therefore recommended a patient pathway in which affected patients with SMD are provided with correctly implemented BoNT‑A treatment in combination with physical measures. CONCLUSION The recommended treatment pathway for use in stroke patients is intended to close gaps in care and thus ensure guideline-conform treatment of post-stroke SMD.
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Affiliation(s)
- John-Ih Lee
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
| | - Albrecht Günther
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Sebastian Paus
- Fachabteilung Neurologie, GFO Kliniken Troisdorf, Troisdorf, Deutschland
| | - Georg Royl
- Klinik für Neurologie, Neurovaskuläres Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Ute Weyen
- BG Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland
| | - Jörg Wissel
- Neurorehabilitation, Vivantes Klinikum Spandau, Berlin, Deutschland
| | - Kirsten E Zeuner
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Stephan Klebe
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland
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19
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Wang X, Teh SH, Wang XH. Knowledge mapping of spastic cerebral palsy. A bibliometric analysis of global research (2000-2022). Ital J Pediatr 2024; 50:9. [PMID: 38238820 PMCID: PMC10797869 DOI: 10.1186/s13052-024-01577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Cerebral palsy (CP) is characterized by abnormal pronunciation, posture, and movement. Spastic CP accounts for more than 70% of all CP. To date, there has been no bibliometric analysis to summarize study on spastic CP. Here, we aim to conduct a bibliometric analysis of spastic CP to summarize this field's knowledge structure, research hotspots, and frontiers. METHOD Publications about spastic CP were searched utilizing the Web of Science Core Collection (WoSCC) database from 1 January 2000 to 30 November 2022, the WoSCC literature analysis wire, VOSviewer 1.6.18, CiteSpace 6.1.R4 and Online analysis platform for bibliometrics were used to conduct the analysis. RESULTS A total of 3988 publications, consisting of 3699 articles and 289 reviews, were included in our study. The United States emerged as the most productive country, while Kathleen Univ Leuven was the most productive institution. The leading author was Desloovere K. A total of 238 journals contributed to this field, with Developmental medicine and child neurology being the leading journal. Important keywords and keyword clusters included Spastic cerebral palsy, Reliability, and Gross motor function. Keywords identified through burst detection indicated that hotspots in this field were management, randomized controlled trials, and definition. CONCLUSION Based on the analysis of bibliometric on spastic CP over the past 20 years, the trends and the knowledge graph of the countries, institutions, authors, references, and the keywords have been identified, providing accurate and expedited insights into critical information and potentially new directions in the study of spastic CP.
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Affiliation(s)
- Xing Wang
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
- Famous TCM Expert Heritage Studio, Xi'an Encephalopathy Hospital Affiliated to Shaanxi University of Chinese Medicine, Xi'an, Shaanxi, China
| | - Siew Hoon Teh
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Xing-Hua Wang
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia.
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Barmouz M, Uribe LV, Ai Q, Azarhoushang B. Design and fabrication of a novel 4D-printed customized hand orthosis to treat cerebral palsy. Med Eng Phys 2024; 123:104087. [PMID: 38365340 DOI: 10.1016/j.medengphy.2023.104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 02/18/2024]
Abstract
This research study is dedicated to additive manufacturing of the shape memory polymer hand orthosis to treat patients with cerebral palsy. The treatment process for cerebral palsy is a step-by-step process that needs different adjustments for the spastic hand to stretch it towards a normal posture, whereas meeting these requirements using conventional methods or complicated mechanisms is expensive, less flexible, time-consuming, and less practical. A comprehensive investigation was conducted to design and fabricate novel thermally actuated customized hand orthosis via digital light processing (DLP). The highly precise scanning device was used to derive the hand model, and subsequently, the Blender software was used to design the customized orthosis. The results showed that fabricated orthosis could represent a strong potential to become an alternative treatment for cerebral palsy. The shape memory actuation of the orthosis indicated that 100 % shape recovery is achievable in different actuating conditions with recovery temperatures higher than 55°C. Besides, it was found that the response time and shape recovery percentage could be tailored in the range of 5 to 40 s and 45 to 100%, respectively, by adjusting programming and actuation temperatures. Further, the repeatability of the shape memory effects in the printed orthosis was investigated as well, which proved that until 17 repetitions, 100 % shape recovery was achievable.
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Affiliation(s)
- Mohsen Barmouz
- Institute of Precision Machining (KSF), Furtwangen University, Germany.
| | | | - Qingfeng Ai
- Institute of Precision Machining (KSF), Furtwangen University, Germany
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Bjornson KF, Fatone S, Orendurff M, Zhou C, Hurvitz PM, Shippen G. Individualized orthotic alignment and footwear for balance and mobility in children with bilateral spastic cerebral palsy: A randomized trial. Dev Med Child Neurol 2024; 66:52-60. [PMID: 37340674 PMCID: PMC10730764 DOI: 10.1111/dmcn.15675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023]
Abstract
AIM To examine whether designed-to-be-rigid ankle-foot orthoses and footwear combinations with individualized alignment and footwear designs (AFO-FC/IAFD) would be more effective than designed-to-be-rigid AFO with non-individualized alignment and footwear designs (AFO-FC/NAFD) in children with cerebral palsy (CP). METHOD Nineteen children with bilateral spastic CP were randomized to AFO-FC/NAFD (n = 10) or AFO-FC/IAFD (n = 9) groups. Fifteen were male, average age 6 years 11 months (range 4 years 2 months-9 years 11 months), classified in Gross Motor Function Classification System levels II (n = 15) and III (n = 4). The Pediatric Balance Scale (PBS), Gait Outcomes Assessment List (GOAL), Patient-Reported Outcomes Measurement Information System (PROMIS), and Orthotic and Prosthetic Users' Survey (OPUS) measures of satisfaction were collected at baseline and after 3 months' wear. RESULTS Compared with the AFO-FC/NAFD group, those with AFO-FC/IAFD demonstrated greater change in PBS total scores (mean 12.8 [standard deviation 10.5] vs 3.5 [5.8]; p = 0.03) and GOAL total scores (3.5 [5.8] vs -0.44 [5.5]; p = 0.03). There were no significant changes in OPUS or PROMIS scores. INTERPRETATION After 3 months, individualized orthosis alignment and footwear designs had a greater positive effect on balance and parent-reported mobility than a non-individualized approach. No effect was documented for the PROMIS and OPUS. Results may inform orthotic management for ambulatory children with bilateral spastic CP. WHAT THIS PAPER ADDS Balance and parent-reported mobility increased more over time for the ankle-foot orthoses and footwear combinations with individualized alignment and footwear designs (AFO-FC/IAFD) group. Changes in balance over time suggest a therapeutic effect of the AFO-FC/IAFD approach.
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Affiliation(s)
- Kristie F Bjornson
- Pediatrics, Seattle Children’s Research Institute, University of Washington, Seattle, WA, USA
| | - Stefania Fatone
- Northwestern University, Chicago, IL, USA
- University of Washington, Seattle, WA, USA
| | | | - Chuan Zhou
- Pediatrics, Seattle Children’s Research Institute, University of Washington, Seattle, WA, USA
| | - Philip M Hurvitz
- Center for Studies in Demography and Ecology; Urban Form Lab, University of Washington, Seattle, WA, USA
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Vallinoja J, Nurmi T, Jaatela J, Wens V, Bourguignon M, Mäenpää H, Piitulainen H. Functional connectivity of sensorimotor network is enhanced in spastic diplegic cerebral palsy: A multimodal study using fMRI and MEG. Clin Neurophysiol 2024; 157:4-14. [PMID: 38006621 DOI: 10.1016/j.clinph.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/02/2023] [Accepted: 10/15/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To assess the effects to functional connectivity (FC) caused by lesions related to spastic diplegic cerebral palsy (CP) in children and adolescents using multiple imaging modalities. METHODS We used resting state magnetoencephalography (MEG) envelope signals in alpha, beta and gamma ranges and resting state functional magnetic resonance imaging (fMRI) signals to quantify FC between selected sensorimotor regions of interest (ROIs) in 11 adolescents with spastic diplegic cerebral palsy and 24 typically developing controls. Motor performance of the hands was quantified with gross motor, fine motor and kinesthesia tests. RESULTS In fMRI, participants with CP showed enhanced FC within posterior parietal regions; in MEG, they showed enhanced interhemispheric FC between sensorimotor regions and posterior parietal regions both in alpha and lower beta bands. There was a correlation between the kinesthesia score and fronto-parietal connectivity in the control population. CONCLUSIONS CP is associated with enhanced FC in sensorimotor network. This difference is not correlated with hand coordination performance. The effect of the lesion is likely not fully captured by temporal correlation of ROI signals. SIGNIFICANCE Brain lesions can show as increased temporal correlation of activity between remote brain areas. We suggest this effect is likely separate from typical physiological correlates of functional connectivity.
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Affiliation(s)
- Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O. BOX 12200, 00076 AALTO Espoo, Finland.
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O. BOX 12200, 00076 AALTO Espoo, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. BOX 35, FI-40014 Jyväskylä, Finland
| | - Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O. BOX 12200, 00076 AALTO Espoo, Finland
| | - Vincent Wens
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN(2)T), UNI - ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Translational Neuroimaging, HUB - Hôpital Erasme, Brussels, Belgium
| | - Mathieu Bourguignon
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN(2)T), UNI - ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Neurophysiology and Movement Biomechanics, UNI - ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; BCBL, Basque Center on Cognition, Brain and Language, 20009 San Sebastian, Spain
| | - Helena Mäenpää
- Department of Child Neurology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Harri Piitulainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O. BOX 12200, 00076 AALTO Espoo, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. BOX 35, FI-40014 Jyväskylä, Finland; Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland
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23
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Hajiyeva IE. [Morbidity rate of children's cerebral palsy in Baku city]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:143-146. [PMID: 38261297 DOI: 10.17116/jnevro2024124011143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To study the morbidity rate of children's cerebral palsy (CP) in Baku in children born in 2006-2016. MATERIAL AND METHODS During 2006-2016, 35 891, 37 130, 37 459, 40 050, 34 726, 34 192, 33 258, 30 373, 29 722, 29 654 and 29 564 children were born in Baku. CP was diagnosed in 1162 of these children. Newborns and children with CP were divided into 3 groups by body mass (<1500; 1500- 2500; 2500 and more) and into 4 groups by the gestational age (<28, 28-32; 32-36, 36 and more weeks). The morbidity rates were detected in these groups. The statistical significance of morbidity rates was assessed by χ2 criteria. RESULTS The morbidity rate of CP changed within the interval 0.27% (95% CI 0.22-0.33%) in 2006 to 0.37% (95% CI 0.30-0.44%) in 2016. The difference between the minimum and maximum morbidity rates was not statistically significant (p>0.05). The morbidity rate of CP in newborns with body mass <1500 grams was 10.35% (95% CI 0-21.65%) and was 6.1 times higher than in the group of newborns weighing 1500-2500 grams at birth (1.72%; 95% CI 0.20-3.25%) and 30.4 times higher than in the group of newborns with body mass ≥2500 grams (0.34%; 95% CI 0.27-0.41%). The difference between morbidity rates of CP in groups depending on birth body mass was significant (p<0.0001). CONCLUSION The incidence rate of CP in a cohort of newborns during the first 60 months after birth in 2006-2016 fluctuated in the range of 0.27-0.37% and had a weak growth trend. The morbidity rate of children's CP is significantly higher in children with body mass at birth <1500 (10.34%) and 1500-2500 grams (1.72%) than in children with body mass at birth 2500 and more grams (0.34%). The gestational age of newborns affects the morbidity rate of CP, which is 5.48; 1.78 and 0.34% at gestational age <32, 32-36 and ≥36 weeks. The structure of subtypes of this pathology is close to that in other populations against the background of the comparative morbidity rate of CP in Baku, the proportion of spastic unilateral, spastic bilateral, dyskinetic and atonic CP is 35.2; 58.0; 3.9 and 1.4%, respectively.
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Mohammed SS, Abdelwahab MS, Zaky NA, Abdelazeim FH. Impact of mother's care burden, fatigue and child's functional level on quality of life in spastic cerebral palsy. Physiother Res Int 2024; 29:e2067. [PMID: 38126239 DOI: 10.1002/pri.2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral palsy (CP) may be considered one of the most common motor disabilities that require a lot of caregiving from mothers or caregivers; therefore, the mothers of children with CP face a lot of difficulties in their caregiving, which in turn may affect the child's quality of life (QOL). This work was conducted to evaluate the impact of the children's functional level in different types of spastic CP, mothers' care burden (CB), and fatigue on the child's QOL. METHODS One hundred thirty-eight children with different types of spastic CP (unilateral and bilateral) with different levels of the gross motor function classification system (GMFCS), with an age range of 6-12 years, and their mothers with ages ranged from 25 to 45 years, participated in this study. Mother CB, fatigue, and child QOL were measured and compared between different groups by using the Zarit burden Interview (ZBI), Chalder Fatigue Questionnaire (CFQ), and Pediatric Quality of Life Inventory (PedsQL) CP Module, respectively. RESULTS There were significant differences in all measured variables (ZBI, CFQ, GMFCS, and PedsQL) with p-value <0.001 among the different spastic groups (unilateral and bilateral CP). However, the results revealed a positive impact of the child's GMFCS, mother's CB, and fatigue level on the quality of the child's life, with a greater effect on those with quadriplegic type. CONCLUSION The mother's CB and fatigue should be considered in the rehabilitation of spastic CP children based on their GMFCS, as they have a negative impact on child QOL; therefore, helping the mother with her needs should not be ignored, especially in families with severely spastic CP children and low financial income.
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Affiliation(s)
- Sara S Mohammed
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, October 6 University, Giza, Egypt
| | - Manal S Abdelwahab
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University and 6 October University, Giza, Egypt
| | - Naglaa A Zaky
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Faten H Abdelazeim
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University and 6 October University, Giza, Egypt
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Larkin T, Martinez V, Scully T, Martinez D, Hayes C, Verduzco-Gutierrez M. Upper Limb Spasticity: The Quality of Online Patient Resources. Am J Phys Med Rehabil 2024; 103:18-23. [PMID: 37256662 DOI: 10.1097/phm.0000000000002297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the study is to assess the quality, readability, content, accessibility, and structure of online resources for patients with upper limb spasticity. DESIGN This was a cross sectional study examined Internet searches across three search engines related to patient resources for upper limb spasticity. Search phrases for either hand or upper limb spasticity were used. The top 20 Websites from each search were evaluated using the four readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software. RESULTS Thirty-six Websites and 33 videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the Websites was 11.7 ± 3.1, showing low Website readability. According to this index, only two Websites were written at the suggested sixth-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both Websites and videos scored in the "good" range (53.5 ± 8 and 50.5 ± 6.6), respectively. CONCLUSIONS Current online resources for upper limb spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand.
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Affiliation(s)
- Tyler Larkin
- From the University of the Incarnate Word, School of Osteopathic Medicine, San Antonio, Texas (TL, VM, TS); University of Houston, Fertitta Family College of Medicine, Houston, Texas (DM); and UT Health San Antonio, Department of Rehabilitation Medicine, San Antonio, Texas (CH, MV-G)
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Amini E, Rohani M, Lang AE, Azad Z, Habibi SAH, Alavi A, Shahidi G, Emamikhah M, Chitsaz A. Estimation of Ambulation and Survival in Neurodegeneration with Brain Iron Accumulation Disorders. Mov Disord Clin Pract 2024; 11:53-62. [PMID: 38291840 PMCID: PMC10828622 DOI: 10.1002/mdc3.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/29/2023] [Accepted: 11/04/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Neurodegeneration with Brain Iron Accumulation (NBIA) disorder is a group of ultra-orphan hereditary diseases with very limited data on its course. OBJECTIVES To estimate the probability of preserving ambulatory ability and survival in NBIA. METHODS In this study, the electronic records of the demographic data and clinical assessments of NBIA patients from 2012 to 2023 were reviewed. The objectives of the study and factors impacting them were investigated by Kaplan-Meier and Cox regression methods. RESULTS One hundred and twenty-two genetically-confirmed NBIA patients consisting of nine subtypes were enrolled. Twenty-four and twenty-five cases were deceased and wheelchair-bound, with a mean disease duration of 11 ± 6.65 and 9.32 ± 5 years. The probability of preserving ambulation and survival was 42.9% in 9 years and 28.2% in 15 years for classical Pantothenate Kinase-Associated Neurodegeneration (PKAN, n = 18), 89.4% in 7 years and 84.7% in 9 years for atypical PKAN (n = 39), 23% in 18 years and 67.8% in 14 years for Mitochondrial Membrane Protein-Associated Neurodegeneration (MPAN, n = 23), 75% in 20 years and 36.5% in 33 years for Kufor Rakeb Syndrome (KRS, n = 17), respectively. The frequencies of rigidity, spasticity, and female gender were significantly higher in deceased cases compared to surviving patients. Spasticity was the only factor associated with death (P value = 0.03). CONCLUSIONS KRS had the best survival with the most extended ambulation period. The classical PKAN and MPAN cases had similar progression patterns to loss of ambulation ability, while MPAN patients had a slower progression to death. Spasticity was revealed to be the most determining factor for death.
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Affiliation(s)
- Elahe Amini
- Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
- Department of Neurology, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
| | - Mohammad Rohani
- Department of Neurology, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
- ENT and Head and Neck Research Center and DepartmentThe Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
| | - Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and Edmond J. Safra Program in Parkinson DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Zahra Azad
- Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
| | | | - Afagh Alavi
- Genetics Research CenterThe University of Social Welfare and Rehabilitation SciencesTehranIran
| | - Gholamali Shahidi
- Department of Neurology, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
| | - Maziar Emamikhah
- Department of Neurology, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
| | - Ahmad Chitsaz
- Department of NeurologyIsfahan University of Medical SciencesIsfahanIran
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Mahmood Q, Habibullah S, Aurakzai HU. Effectiveness of simple and basic home-based exercise programs including pediatric massage executed by caregivers at their homes in the management of children with spastic cerebral palsy: A randomized controlled trial. J Pediatr Rehabil Med 2024; 17:97-106. [PMID: 38427509 PMCID: PMC10977413 DOI: 10.3233/prm-220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/27/2023] [Indexed: 03/03/2024] Open
Abstract
PURPOSE This study aimed to assess the effectiveness of simple and basic home-based exercise programs (HEPs), including pediatric massage (PM), executed by caregivers at their homes in the management of children with spastic cerebral palsy (CP). METHODS Sixty-eight children with spastic CP (diplegia) aged 4-12 years were randomly assigned to PM and HEP groups for a randomized controlled trial continuing from November 01, 2021 to June 2022. Parents provided home-based exercises to both groups, five times a week for 12 weeks. However, the PM group was additionally provided with PM. Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM-88) and Gross Motor Function Classification System (GMFCS) were used for evaluation of spasticity and gross motor activity at baseline as well as after six and 12 weeks of intervention. Comparative analysis of data was carried out with SPSS-20. RESULTS Mean age in HEP and PM groups was 6.65±2.12 and 7.09±2.22 years respectively. Data revealed homogeneity of both groups at the beginning of study. The PM group showed a statistically significant decrease in MAS scores after six and 12 weeks of intervention (p < 0.05) when compared with the HEP group, but similar changes did not happen in GMFM scores and GMFCS levels. However, comparative analysis revealed statistically significant change in GMFM scores and GMFCS levels (p < 0.05) when compared from baseline to 12 weeks of intervention in both groups. CONCLUSION PM along with HEPs can be used effectively to reduce spasticity and to improve gross motor ability if performed for a period of at least six and 12 weeks respectively. In conjunction with HEPs, PM has better outcomes in the management of tone and movement disorders of spastic CP than HEPs alone.
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Affiliation(s)
- Qamar Mahmood
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
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Mirbagheri SS, Bahramizadeh M, Aminian G, Dalvand H, Farahmand F, Vahedi M. A case series on the effect of dynamic neoprene orthosis on lower limb kinematic variables in children with cerebral palsy. J Pediatr Rehabil Med 2024; 17:131-138. [PMID: 37694316 PMCID: PMC10977358 DOI: 10.3233/prm-200806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/27/2023] [Indexed: 09/12/2023] Open
Abstract
PURPOSE This study examined the effects of a dynamic neoprene orthosis on kinematic variables of gait in children with spastic bilateral cerebral palsy (CP). METHODS Five children (whose median age was 9.6 years and who ranged in age from six to 12) with spastic bilateral CP and flexed knee at levels I-III of the Gross Motor Function Classification System were examined using kinematic gait analysis in three different conditions: 1) with dynamic neoprene orthosis; 2) without dynamic neoprene orthosis (immediate effect); and 3) without orthosis after six weeks of intervention. RESULTS The comparison between condition one (with dynamic neoprene orthosis) and condition two (without dynamic neoprene orthosis) demonstrated the existence of improvements in minimum hip and knee flexion variables. Moreover, the results indicated that the improvements remained constant in several key gait variables after six weeks. CONCLUSION The results varied from subject to subject, and there were signs of improvement in some of the subjects. Therefore, it was not possible to draw conclusions at a group level. Nonetheless, a number of individuals may benefit from this type of orthosis.
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Affiliation(s)
- Sedigheh Sadat Mirbagheri
- Department of Orthotic and Prosthetic, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotic and Prosthetic, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Aminian
- Department of Orthotic and Prosthetic, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Dalvand
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Miura M, Nishijima H, Suzuki C, Tomiyama M. Late-onset 5,10-methylenetetrahydrofolate reductase deficiency with subacute disturbance of consciousness. Pediatr Int 2024; 66:e15720. [PMID: 38217098 DOI: 10.1111/ped.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Maki Miura
- Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Haruo Nishijima
- Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Chieko Suzuki
- Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Masahiko Tomiyama
- Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Aomori, Japan
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Hjalmarsson E, Lidbeck C, Barrero Santiago L, Pingel J, Norrbom J, Sanz G, Palmcrantz A, Pontén E, von Walden F, Fernandez-Gonzalo R. Determinants of Frame Running Capacity in Athletes With Cerebral Palsy to Improve Training Routines and Classification Strategies: A Cross-sectional Observational Study. Am J Phys Med Rehabil 2024; 103:79-86. [PMID: 36897812 DOI: 10.1097/phm.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES The aim of the study were to (1) investigate what physical and physiological parameters are most important for Frame Running capacity, a parasport for individuals with ambulatory difficulties, and (2) determine whether Frame Running capacity can be predicted in athletes with cerebral palsy. DESIGN Athletes with cerebral palsy ( N = 62, Gross Motor Classification System I-V; 2/26/11/21/2) completed a 6-min Frame Running test. Before the 6-min Frame Running test, muscle thickness, passive range of motion (hip, knee, ankle), selective motor control, and spasticity (hip, knee, ankle) were measured in both legs. In total, 54 variables per individual were included. Data were analyzed using correlations, principal component analysis, orthogonal partial least square regression, and variable importance in projection analysis. RESULTS The mean 6-min Frame Running test distance was 789 ± 335 m and decreased with motor function severity. The orthogonal partial least square analysis revealed a modest degree of covariance in the variables analyzed and that the variance in the 6-min Frame Running test distance could be predicted with 75% accuracy based on all the variables measured. Variable importance in projection analysis indicated hip and knee extensor spasticity (negative effect), and muscle thickness (positive effect) arose as the most important factors contributing to Frame Running capacity. CONCLUSIONS These results are an important resource to enable optimization of training regimes to improve Frame Running capacity and contribute to evidence-based and fair classification for this parasport.
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Affiliation(s)
- Emma Hjalmarsson
- From the Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden (EH, AP, EP, FvW); Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden (EH, AP); Department of Pediatric Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden (CL); Department of Molecular Biology, Histology, and Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain (LBS); Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (JP); Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (JN); Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden (GS); Department of Pediatric Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden (EP); Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden (RF-G); and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden (RF-G)
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Adar S, Demircan A, Akçin Aİ, Dündar Ü, Toktaş H, Yeşil H, Eroğlu S, Eyvaz N, Beştaş E, Köseoğlu Toksoy C. Evaluation of finger strength and spasticity in hemiplegic patients using hand-finger robotic device: A validity and reliability study. Medicine (Baltimore) 2023; 102:e36479. [PMID: 38065919 PMCID: PMC10713106 DOI: 10.1097/md.0000000000036479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
We aimed to investigate the validity, reliability, and clinical relevance of Amadeo hand-finger robotic rehabilitation system measurements for evaluating spasticity and strength in hemiplegic patients. In total, 161 participants (107 hemiplegic patients and 54 sex- and age-matched healthy controls) were included in this study. Spasticity was evaluated using the Modified Ashworth Scale, hand motor functions were evaluated using the Fugl-Meyer Assessment Hand Subscale, and hand grip and pinch strength were evaluated using the Jamar hand grip and pinch dynamometer. The Amadeo (Tyromotion) hand-finger robotic rehabilitation system was used to evaluate finger spasticity and strength of the participants. A statistically significant difference was found between the median values of the Modified Ashworth Scale (both clinical and robotic evaluation results) and the mean values of hand flexor and extensor strength measured with the robotic device in patients compared to healthy subjects (P < .01). Statistically, excellent agreement was obtained between the clinical and robotic test-retest results of the scale (P < .01) (intra-class correlation coefficient, ICC = .98-.99; ICC = .98-.99, respectively). There was a statistically significant positive correlation between the clinical and robotic device results of the Modified Ashworth Scale (r = .72; P < .01). There was a statistically significant positive correlation between the hand strength values measured with the robotic device, Jamar grip, pinch, and Fugl-Meyer Assessment Hand Subscale scores (P < .01) in the patient group. Hand finger spasticity and strength measurements of the Amadeo hand-finger robotic rehabilitation system were valid, reliable, and clinically correlated in stroke patients.
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Affiliation(s)
- Sevda Adar
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ali Demircan
- Ataturk Vocational School of Health Services, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ali İzzet Akçin
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ümit Dündar
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Hasan Toktaş
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Hilal Yeşil
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Selma Eroğlu
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Nuran Eyvaz
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ersin Beştaş
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Cansu Köseoğlu Toksoy
- Department of Neurology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Low EE, Hasan A, Fehmi SA, Chang MA, Kwong W, Krinsky ML, Anand G, Greytak M, Kaizer A, Yadlapati R. Diagnostic methods to measure spastic segment and guide tailored myotomy length in type 3 achalasia. Neurogastroenterol Motil 2023; 35:e14625. [PMID: 37288617 PMCID: PMC10726676 DOI: 10.1111/nmo.14625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Myotomy length in type 3 achalasia is generally tailored based on segment of spasticity on high-resolution manometry (HRM). Potential of length of tertiary contractions on barium esophagram (BE) or length of thickened circular muscle on endoscopic ultrasound (EUS) to guide tailored myotomy is less understood. This study aimed to assess agreement between spastic segments lengths on HRM, BE, and EUS among patients with type 3 achalasia. METHODS This retrospective study included adults with type 3 achalasia on HRM between November 2019 and August 2022 who underwent evaluation with EUS and/or BE. Spastic segments were defined as HRM-distance between proximal borders of lower esophageal sphincter and high-pressure area (isobaric contour ≥70 mmHg); EUS-length of thickened circular muscle (≥1.2 mm) from proximal border of esophagogastric junction (EGJ) to the transition to a non-thickened circular muscle; BE-distance between EGJ to proximal border of tertiary contractions. Pairwise comparisons assessed for correlation (Pearson's) and intraclass correlation classification (ICC) agreement. KEY RESULTS Twenty-six patients were included: mean age 66.9 years (SD 13.8), 15 (57.7%) male. Spastic segments were positively correlated on HRM and BE with good agreement (ICC 0.751, [95% CI 0.51, 0.88]). Spastic segments were negatively correlated with poor agreement on HRM and EUS (ICC -0.04, [-0.45, 0.39]) as well as BE and EUS (ICC -0.03, [-0.47, 0.42]). CONCLUSIONS & INFERENCES Length of spastic segment was positively correlated on HRM and BE while negatively correlated when compared to EUS, supporting the common use of HRM and highlighting the uncertain role for EUS in tailoring myotomy length for type 3 achalasia.
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Affiliation(s)
- Eric E. Low
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Aws Hasan
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Syed Abbas Fehmi
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Michael A. Chang
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Wilson Kwong
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Mary L. Krinsky
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Gobind Anand
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Madeline Greytak
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
| | - Alexander Kaizer
- Department of Biostatistics and Informatics, University of Colorado, Denver, Colorado, USA
| | - Rena Yadlapati
- Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
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Vinti M, Saikia MJ, Donoghue J, Mandigout S, Compagnat M, Kerman KL. Broader Estimates of Gastrocnemius Activity Generated a More Representative Cocontraction Index: A Study in Pediatric Population. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4382-4389. [PMID: 37910411 DOI: 10.1109/tnsre.2023.3329057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
The electromyography (EMG) cocontraction index (CCI) given by the antagonistic/agonistic Root Mean Square (RMS) amplitude ratio of the same muscle is a qualified biomarker used for spastic cocontraction quantification and management in cerebral palsy children. However, this normative EMG ratio is likely subject to a potential source of errors with biased estimates when measuring the gastrocnemius plantar flexors activity. Due to the uneven distribution of electrical activity within the muscle volume, cocontraction levels can be misestimated, if EMGs are obtained from the sole traditional bipolar sensor location recommended by SENIAM. This preliminary study, on 10 healthy children (mean age 10 yr), investigated whether surface EMG detected proximally and distally via two pairs of bipolar electrodes, within the medial gastrocnemius (MG), provides a significant difference in CCI estimates during non-dynamic (isometric dorsiflexion) and dynamic (swing phases of gait) conditions. Gait cycles were extracted from Inertial Measurement Unit sensors. Medial gastrocnemius activity was greater distally than proximally during plantar flexion when it acts as an agonist (~24±18%) and it was greater proximally during dorsiflexion (~23±9%) when it is acting as an antagonist. As a direct consequence, CCI estimates from the conventional sensor location were significantly different (~36%) from the CCIs computed by considering broader MG regions. This difference arose in all subjects during isometric efforts and in two of 10 healthy children during the swing phase of gait who presented cocontraction patterns ( [Formula: see text]). EMG bipolar sampling encompassing proximal and distal gastrocnemius muscle regions may reduce bias in CCI computation and provide a more representative and accurate cocontraction index that is especially important for comparisons to the diseased state.
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Hokimoto S, Kaikita K, Yasuda S, Tsujita K, Ishihara M, Matoba T, Matsuzawa Y, Mitsutake Y, Mitani Y, Murohara T, Noda T, Node K, Noguchi T, Suzuki H, Takahashi J, Tanabe Y, Tanaka A, Tanaka N, Teragawa H, Yasu T, Yoshimura M, Asaumi Y, Godo S, Ikenaga H, Imanaka T, Ishibashi K, Ishii M, Ishihara T, Matsuura Y, Miura H, Nakano Y, Ogawa T, Shiroto T, Soejima H, Takagi R, Tanaka A, Tanaka A, Taruya A, Tsuda E, Wakabayashi K, Yokoi K, Minamino T, Nakagawa Y, Sueda S, Shimokawa H, Ogawa H. JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction. J Cardiol 2023; 82:293-341. [PMID: 37597878 DOI: 10.1016/j.jjcc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Affiliation(s)
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, Japan
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Yoshiaki Mitsutake
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Yasuhiko Tanabe
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Nobuhiro Tanaka
- Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Japan
| | - Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Takahiro Imanaka
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan
| | | | - Yunosuke Matsuura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yasuhiro Nakano
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Japan
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | | | - Ryu Takagi
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Japan
| | - Kohei Wakabayashi
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital, Japan
| | - Kensuke Yokoi
- Department of Cardiovascular Medicine, Saga University, Japan
| | - Toru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Shozo Sueda
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Hiroaki Shimokawa
- Graduate School, International University of Health and Welfare, Japan
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Soares EG, Gusmão CHV, Souto DO. Efficacy of aerobic exercise on the functioning and quality of life of children and adolescents with cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol 2023; 65:1292-1307. [PMID: 36895173 DOI: 10.1111/dmcn.15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/11/2023]
Abstract
AIM To investigate the efficacy of aerobic exercise on the functioning (participation, activities, and body functions and structures) and quality of life (QoL) of children and adolescents with cerebral palsy (CP). METHOD A systematic review with meta-analysis was performed. A comprehensive search of articles was performed using the electronic databases Embase, PubMed, PEDro, and CINAHL. Methodological quality and certainty of evidence were evaluated with the PEDro and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scales respectively. The effects of aerobic exercise on functioning were assessed using meta-analytic techniques. However, given the broad nature of outcomes related to functioning and QoL, different instruments can be used to measure them; this made it impossible to synthesize results in a meta-analysis for some of the outcomes. RESULTS Fifteen randomized controlled trials with 414 participants with CP were included. Analysis of the methodological quality of the studies revealed a low risk of bias. The effect of aerobic exercise compared to usual care or other interventions was significant for aerobic capacity (standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.16-1.47; p < 0.002; I2 = 68%), gross motor function (SMD = 0.70; 95% = CI 0.21-1.19; p = 0.005; I2 = 49%), mobility (SMD = 0.53; 95% CI = 0.05-1.05; p = 0.03; I2 = 27%), balance, and participation (SMD = 0.74; 95% CI = 0.10-1.39; p = 0.02; I2 = 0%). Aerobic exercise was not effective for muscle strength, spasticity, gait parameters, and QoL (p > 0.05). The certainty of evidence for most comparisons was moderate to low. INTERPRETATION This review provides the most up-to-date evidence on the efficacy of aerobic exercise on the functioning and QoL of children and adolescents with CP. WHAT THIS PAPER ADDS Aerobic exercise improves gross motor function but not gait parameters in cerebral palsy (CP). It improves participation but not quality of life in children and adolescents with CP. It is more effective than usual care or other interventions in improving mobility, aerobic capacity, and balance in CP. It is no more effective than usual care or other interventions in improving muscle strength and spasticity.
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Affiliation(s)
- Esther G Soares
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
| | - Cláudio H V Gusmão
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
| | - Deisiane O Souto
- Department of Physiotherapy, College of Santa Luzia, Santa Luzia, Brazil
- Graduate Program in Rehabilitation Sciences, Physical Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Wang M, Yang H, Lin Z, Li X, Liu L, Huang S, Zhao H, Zhu X, Xiao Q, Duan R, Wang J, Zuchner S, Tang B, Zhang R. The genetic and clinical spectrum in a cohort of 39 families with complex inherited peripheral neuropathies. J Neurol 2023; 270:4959-4967. [PMID: 37365282 DOI: 10.1007/s00415-023-11821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
With complicated conditions and a large number of potentially causative genes, the diagnosis of a patient with complex inherited peripheral neuropathies (IPNs) is challenging. To provide an overview of the genetic and clinical features of 39 families with complex IPNs from central south China and to optimize the molecular diagnosis approach to this group of heterogeneous diseases, a total of 39 index patients from unrelated families were enrolled, and detailed clinical data were collected. TTR Sanger sequencing, hereditary spastic paraplegia (HSP) gene panel, and dynamic mutation detection in spinocerebellar ataxia (SCAs) were performed according to the respective additional clinical features. Whole-exome sequencing (WES) was used in patients with negative or unclear results. Dynamic mutation detection in NOTCH2NLC and RCF1 was applied as a supplement to WES. As a result, an overall molecular diagnosis rate of 89.7% was achieved. All 21 patients with predominant autonomic dysfunction and multiple organ system involvement carried pathogenic variants in TTR, among which nine had c.349G > T (p.A97S) hotspot variants. Five out of 7 patients (71.4%) with muscle involvement harbored biallelic pathogenic variants in GNE. Five out of 6 patients (83.3%) with spasticity reached definite genetic causes in SACS, KIF5A, BSCL2, and KIAA0196, respectively. NOTCH2NLC GGC repeat expansions were identified in all three cases accompanied by chronic coughing and in one patient accompanied by cognitive impairment. The pathogenic variants, p.F284S and p.G111R in GNE, and p.K4326E in SACS, were first reported. In conclusion, transthyretin amyloidosis with polyneuropathy (ATTR-PN), GNE myopathy, and neuronal intranuclear inclusion disease (NIID) were the most common genotypes in this cohort of complex IPNs. NOTCH2NLC dynamic mutation testing should be added to the molecular diagnostic workflow. We expanded the genetic and related clinical spectrum of GNE myopathy and ARSACS by reporting novel variants.
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Affiliation(s)
- Mengli Wang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Honglan Yang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhiqiang Lin
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaobo Li
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lei Liu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shunxiang Huang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Huadong Zhao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiying Zhu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiao Xiao
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Stephan Zuchner
- Dr John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ruxu Zhang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China.
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Piscitelli D, Pellicciari L, Vidmar T, Kregar NG, Puh U. Is It Time to Go Beyond the Modified Ashworth Scale? Letter to the Editor on "Reliability of the Modified Ashworth Scale After Stroke for 13 Muscle Groups". Arch Phys Med Rehabil 2023; 104:1735-1736. [PMID: 37479163 DOI: 10.1016/j.apmr.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/03/2023] [Indexed: 07/23/2023]
Affiliation(s)
| | | | - Tjaša Vidmar
- Department of Rehabilitation of Patients After Stroke, University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia.
| | - Nika Goljar Kregar
- Department of Rehabilitation of Patients After Stroke, University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia
| | - Urška Puh
- Research and Development Unit, University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia
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Li X, Huang Z, Lu T, Liang J, Guo H, Wang L, Chen Z, Zhou X, Du Q. Effect of virtual reality combined with repetitive transcranial magnetic stimulation on musculoskeletal pain and motor development in children with spastic cerebral palsy: a protocol for a randomized controlled clinical trial. BMC Neurol 2023; 23:339. [PMID: 37752420 PMCID: PMC10521467 DOI: 10.1186/s12883-023-03359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE This trial aims to investigate the efficacy and safety of virtual reality (VR) combined with repetitive transcranial magnetic stimulation (rTMS) for improving musculoskeletal pain and motor development in children with unilateral spastic cerebral palsy (CP). METHODS This study protocol is for a randomized controlled trial consisting of 2 treatment sessions (3 days/week for 4 weeks in each session, with a 1-week interval between sessions). We will recruit children aged 3-10 years with unilateral spastic CP (Gross Motor Function Classification System level I or II). Participants will be randomly divided into 3 groups: the VR + rTMS group (immersive VR intervention, rTMS and routine rehabilitation therapy), rTMS group (rTMS and routine rehabilitation therapy), and control group (sham rTMS and routine rehabilitation therapy). VR therapy will involve a daily 40-minute movement training session in a fully immersive environment. rTMS will be applied at 1 Hz over the primary motor cortex for 20 min on the contralateral side. The stimulation intensity will be set at 90% of the resting motor threshold, with 1200 pulses applied. A daily 60-minute routine rehabilitation therapy session including motor training and training in activities of daily living will be administered to all participants. The primary outcome will be pain intensity, assessed by the Revised Face, Legs, Activity, Cry, and Consolability Scale (R-FLACC). The secondary outcomes will include motor development, evaluated by the 66-item version of the Gross Motor Function Measure (GMFM-66) and Fine Motor Function Measure (FMFM); balance capacity, measured by the interactive balance system; activities of daily living; and quality of life, measured by the Barthel index and the Chinese version of the Cerebral Palsy Quality of Life scale for Children (C-CP QOL-Child). Safety will be monitored, and adverse events will be recorded during and after treatment. DISCUSSION Combined application of VR therapy and rTMS may reveal additive effects on pain management and motor development in children with spastic CP, but further high-quality research is needed. The results of this trial may indicate whether VR therapy combined with rTMS achieves a better analgesic effect and improves the motor development of children with spastic CP. TRIAL REGISTRATION Registration number: ChiCTR230069853. Trial registration date: 28 March 2023. Prospectively registered.
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Affiliation(s)
- Xin Li
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zefan Huang
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tijiang Lu
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Juping Liang
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Haibin Guo
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lixia Wang
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Zhengquan Chen
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Xuan Zhou
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Qing Du
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China.
- Chongming Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China.
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Castro A, Tun K, Petzey L, Soorneela S, Bainbridge R, Pollack R. Spastic Paralysis in a Full-Term Newborn. Neoreviews 2023; 24:e587-e590. [PMID: 37653084 DOI: 10.1542/neo.24-9-e587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Alejandro Castro
- Department of Pediatrics, Department of Neonatology, NYC Health and Hospitals/Lincoln Medical Center, New York, NY
| | - Khin Tun
- Department of Pediatrics, Department of Neonatology, NYC Health and Hospitals/Lincoln Medical Center, New York, NY
| | - Larissa Petzey
- Department of Pediatrics, Department of Neonatology, NYC Health and Hospitals/Lincoln Medical Center, New York, NY
| | - Shrawani Soorneela
- Department of Pediatrics, Department of Neonatology, NYC Health and Hospitals/Lincoln Medical Center, New York, NY
| | - Ronald Bainbridge
- Department of Pediatrics, Department of Neonatology, NYC Health and Hospitals/Lincoln Medical Center, New York, NY
| | - Rebecca Pollack
- Department of Pediatrics, Department of Neonatology, NYC Health and Hospitals/Lincoln Medical Center, New York, NY
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Gómez-Pérez C, Vidal Samsó J, Puig Diví A, Medina Casanovas J, Font-Llagunes JM, Martori JC. Relationship between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy: Clinical interpretation proposal. J Orthop Sci 2023; 28:1136-1142. [PMID: 36216726 DOI: 10.1016/j.jos.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Understanding the links between gait disorders, impairments, and activity limitations is essential for correctly interpreting the instrumented gait analysis. We aimed to evaluate the relationships between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy, and find out whether spatiotemporal parameters provide clinical information regarding gait pattern and walking. METHODS Data from 19 children with bilateral spastic cerebral palsy (nine males, ten females, 9.6 ± 2.8 years old) were collected retrospectively. All children underwent an instrumented gait analysis and a standardized clinical assessment. Seven spatiotemporal parameters were calculated: non-dimensional cadence, stride length, step width, gait speed, first double support, single support, and time of toe off. Clinical outcomes included measures of two different components of the International Classification of Functioning, Disability and Health - Children and Youth version: body functions and structures (spasticity, contractures and range of motion, and deformities), and activities and participation (gross motor function, and walking capacity). Pearson correlation, ANOVA, Student's t, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze relationships. Spatiotemporal parameters related to clinical outcomes of body functions and structures were interpreted as outcome measures of gait pattern, while those related to clinical outcomes of activities and participation were interpreted as outcome measures of walking. RESULTS Non-dimensional cadence, stride length, and gait speed showed relationships (p < 0.05) with hip flexors spasticity and hindfoot deformity, ankle plantar flexors spasticity, and hindfoot deformity, respectively. All spatiotemporal parameters except non-dimensional cadence showed correlation (p < 0.05) with gross motor function and walking capacity. CONCLUSIONS Spatiotemporal parameters provide clinical information regarding both gait pattern and walking.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.
| | - Joan Vidal Samsó
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Albert Puig Diví
- Blanquerna School of Health Sciences - Ramon Llull University, Barcelona, Spain
| | - Josep Medina Casanovas
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Takigawa Y, Fujiwara K, Tabuchi I, Kudo K, Hayashi K, Matsumoto S, Omori H, Matsuoka S, Mitsumune S, Watanabe H, Sato A, Sato K, Shibayama T. Successful Treatment with Mepolizumab for Coronary Spastic Angina Associated with Eosinophilic Granulomatosis with Polyangiitis. Intern Med 2023; 62:2389-2393. [PMID: 37587056 PMCID: PMC10484760 DOI: 10.2169/internalmedicine.0930-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/02/2022] [Indexed: 08/18/2023] Open
Abstract
A 46-year-old man with a history of bronchial asthma and chronic sinusitis presented to our hospital with chest pain. We suspected angina evoked by epicardial coronary spasm and performed an ergonovine provocation test to diagnose coronary spastic angina (CSA). The patient also met the diagnostic criteria for eosinophilic granulomatosis with polyangiitis (EGPA) and was treated with 60 mg prednisolone (PSL) for EGPA-associated CSA. After PSL administration, eosinophils decreased, and angina attacks disappeared. However, when PSL was tapered to 12.5 mg, chest pain recurred. We administered mepolizumab subcutaneously and chest pain disappeared. Additional mepolizumab may be effective for EGPA with CSA.
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Affiliation(s)
- Yuki Takigawa
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Isao Tabuchi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Kenichiro Kudo
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Kazuna Hayashi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Shoichiro Matsumoto
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Hiroki Omori
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Suzuka Matsuoka
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Sho Mitsumune
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Hiromi Watanabe
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Akiko Sato
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Ken Sato
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Takuo Shibayama
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
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Wang ZLA, Tang HT, Xiong Y, Ma WW, Luo AQ. [Core in jingjin diagnosis and treatment: yizhi weishu]. Zhongguo Zhen Jiu 2023; 43:876-80. [PMID: 37577881 DOI: 10.13703/j.0255-2930.20221208-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Jingjin (muscle region of meridian) is a distal diagnosis and treatment system of the sinew/fascia disorders on the base of the concept of jin in TCM. Jin should be a particular palpable structure rather than a single anatomic structure with a specific distributing course. Yizhi weishu refers to a idea running through the whole process of diagnosis and treatment of sinew/fascia disorders, in which, the results, obtained by the overall observation and palpation of patient's sinew/fascia structure, are taken as the criteria of treatment. Yitong weishu (taking the sites of sensitivity or tenderness as the points) verifies this idea in practice. Under the guidance of yizhi weishu, through identifying the primary from the secondary, and regulating yin and yang, the spasticity and flaccidity of sinews/fascia can be cured and the induced diseases treated. The diagnosis and treatment system of jingjin, based on yizhi weishu, develops the original jingjin theory with vague concept involved, formulates a systematic thinking of treatment for sinew/fascia disorders and provides a new approach to clinical treatment.
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Affiliation(s)
- Zhi-Liu-An Wang
- College of Acupuncture-Moxibustion and Orthopedics, Hubei University of CM, Wuhan 430061, China
| | - Hong-Tu Tang
- College of Acupuncture-Moxibustion and Orthopedics, Hubei University of CM, Wuhan 430061, China
| | - Yong Xiong
- College of Acupuncture-Moxibustion and Orthopedics, Hubei University of CM, Wuhan 430061, China
| | - Wei-Wei Ma
- College of Acupuncture-Moxibustion and Orthopedics, Hubei University of CM, Wuhan 430061, China
| | - An-Qi Luo
- College of Acupuncture-Moxibustion and Orthopedics, Hubei University of CM, Wuhan 430061, China
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Draganov PV. Peroral endoscopic myotomy: A lifelong solution or another temporizing measure for achalasia and nonachalasia spastic esophageal motility disorders? Gastrointest Endosc 2023; 98:249-251. [PMID: 37004814 DOI: 10.1016/j.gie.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
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Chen Z, Liu Y, Yan J, Wang J, Oetomo D, Tan Y, Niu CM. Differentiation in additive and multiplicative inputs to motoneuron pool as origins of spasticity - a neuromorphic modeling study . Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083678 DOI: 10.1109/embc40787.2023.10340479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Spasticity is characterized by a velocity-dependent increase in the tonic stretch reflex. Evidence suggests that spasticity originates from hyperactivity in the descending tract or reflex loop. To pinpoint the source of hyperactivity, however, is difficult due to lack of human data in-vivo. Thus, we implemented a neuromorphic model to revive the neurodynamics with spiking neuronal activity. Two types of input were modeled: (1) the additive condition (ADD) to apply tonic synaptic inputs directly into the reflex loop; (2) the multiplicative (MUL) condition to adjust the loop gains within the reflex loop. Results show that both conditions produced antagonist EMG responses resembling patient data. The timing of spasticity is more sensitive to the ADD condition, whereas the amplitude of spastic EMG is more sensitive to the MUL condition. In conclusion, our model shows that both additive and multiplicative hyperactivities suffice to elicit velocity-dependent spastic electromyographic signals (EMG), but with different sensitivities. This simulation study suggests that spasticity caused by different origins may be discernable by the progression of severity, which may help individualized goalsetting and parameter-selection in rehabilitation.Clinical Relevance-Potential application of neuromorphic modeling on spasticity includes selection of parameters for therapeutic plans, such as movement range, repetition, and load.
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Vuong A, Joshi SH, Staudt LA, Matsumoto JH, Fowler EG. Improved Myelination following Camp Leg Power, a Selective Motor Control Intervention for Children with Spastic Bilateral Cerebral Palsy: A Diffusion Tensor MRI Study. AJNR Am J Neuroradiol 2023; 44:700-706. [PMID: 37142433 PMCID: PMC10249693 DOI: 10.3174/ajnr.a7860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE Children with spastic cerebral palsy have motor deficits associated with periventricular leukomalacia indicating WM damage to the corticospinal tracts. We investigated whether practice of skilled lower extremity selective motor control movements would elicit neuroplasticity. MATERIALS AND METHODS Twelve children with spastic bilateral cerebral palsy and periventricular leukomalacia born preterm (mean age, 11.5 years; age range, 7.3-16.6 years) participated in a lower extremity selective motor control intervention, Camp Leg Power. Activities promoted isolated joint movement including isokinetic knee exercises, ankle-controlled gaming, gait training, and sensorimotor activities (3 hours/day, 15 sessions, 1 month). DWI scans were collected pre- and postintervention. Tract-Based Spatial Statistics was used to analyze changes in fractional anisotropy, radial diffusivity, axial diffusivity, and mean diffusivity. RESULTS Significantly reduced radial diffusivity (P < . 05) was found within corticospinal tract ROIs, including 28.4% of the left and 3.6% of the right posterior limb of the internal capsule and 14.1% of the left superior corona radiata. Reduced mean diffusivity was found within the same ROIs (13.3%, 11.6%, and 6.6%, respectively). Additionally, decreased radial diffusivity was observed in the left primary motor cortex. Additional WM tracts had decreased radial diffusivity and mean diffusivity, including the anterior limb of the internal capsule, external capsule, anterior corona radiata, and corpus callosum body and genu. CONCLUSIONS Myelination of the corticospinal tracts improved following Camp Leg Power. Neighboring WM changes suggest recruitment of additional tracts involved in regulating neuroplasticity of the motor regions. Intensive practice of skilled lower extremity selective motor control movements promotes neuroplasticity in children with spastic bilateral cerebral palsy.
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Affiliation(s)
- A Vuong
- From the Departments of Bioengineering (A.V., S.H.J.)
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
| | - S H Joshi
- From the Departments of Bioengineering (A.V., S.H.J.)
- Neurology (S.H.J.), Ahmanson Lovelace Brain Mapping Center
| | - L A Staudt
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
| | - J H Matsumoto
- Pediatrics (J.H.M.), University of California Los Angeles, Los Angeles, California
| | - E G Fowler
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
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Meireles ALF, Menegol NA, Perin GA, Sanada LS. Randomized clinical trials of physical therapy for cerebral palsy: a review of study outcomes, methodological quality, and publication merits. Int J Rehabil Res 2023; 46:126-132. [PMID: 37042180 DOI: 10.1097/mrr.0000000000000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The study aimed to examine the main characteristics of clinical trials of motor interventions in physical therapy in children with cerebral palsy (CP). The Physiotherapy Evidence Database (PEDro) was used to collect information on clinical trials regarding motor outcomes in physical therapy in children with CP. Two reviewers independently screened, selected the studies, and extracted data. The characteristics extracted were CP subtype; age group; gross motor function and manual motor ability; methodological quality; open access status; 2020 journal impact factor, Consolidated Standards of Reporting Trials (CONSORT) endorsement; primary outcome; intervention adopted, and assessment instruments. The search strategy resulted in 313 articles from 120 different journals. Most of the clinical trials included participants with spastic bilateral subtype, aged between 6 and 12 years old, and with fewer limitations in gross and manual motor abilities. The most used primary outcomes covering the International Classification of Functioning, Disability and Health (ICF) domain of activity were gross motor function (18.8%) and upper limb and hand function (16.3%), with the Gross Motor Function Measurement being the most frequently used instrument (19.8%). Articles with better scores on the PEDro scale were published in journals with a higher impact factor, and higher rates of CONSORT endorsement, and most were not open access. Clinical trials investigating motor interventions used in physical therapy for children with CP tend to focus on patients with milder gross and manual motor function impairments and often explore the body function domain of the ICF. Furthermore, these studies have moderate methodological quality, and a substantial proportion of them fail to follow adequate reporting and methodological recommendations.
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Affiliation(s)
- André L F Meireles
- Universidade do Estado de Santa Catarina
- Universidade do Sul de Santa Catarina - Campus Ilha, Florianópolis-SC, Brazil
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Selves C, Lejeune T, Detrembleur C, Haustrate MA, Stoquart G. Validity and reliability of the assessment of hand flexors stiffness using a new electromechanical oscillatory device in people with stroke. Int J Rehabil Res 2023; 46:170-177. [PMID: 36916037 DOI: 10.1097/mrr.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Hyper-resistance after a central nervous system injury has been largely referred to as spasticity, which is but one of its neural components. Assessment largely relies on clinical scales (Modified Ashworth scale - MAS and Modified Tardieu scale, MTS) which are unable to distinguish between the non-neural (tissue-related) and the neural (central nervous system-related) components. This study assessed criterion validity and reliability (reproducibility) of muscle stiffness measures, namely, maximum elastic stiffness (ELmax), viscous stiffness (VI), and path length (L-path) in the hand flexor muscles among people with stroke. Measurements were obtained with a wrist-electromechanical oscillatory device (w-EOD). Twenty-four people with arm impairment after stroke were evaluated with the w-EOD and clinical assessment (MAS and MTS), twice on the same day (short-term reliability) and once 10 days later (long-term reliability). For criterion validity, a Spearman coefficient ( r ) was calculated between stiffness values and the clinical scales. For reliability, intraclass correlation coefficients (ICCs), SEM, and MDC95 were calculated. Moderate correlations were observed between EL max and MAS ( r = 0.49) and MTS (V2, r = 0.43; V3, r = 0.49) of the wrist flexors, and finger flexors (MAS, r = 0.60; MTS V2, r = 0.56; MTS V3, r = 0.55). There was a poor correlation between the clinical scales and VI and L-path. Reliability was excellent for all stiffness measurements at short term (EL max : 0.95, VI: 0.94, L-path: 0.92) and good at long term (EL max : 0.87, VI: 0.76, L-path: 0.82). In conclusion, stiffness measurements are valid and reliable to evaluate hyper-resistance in people with stroke.
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Affiliation(s)
- Clara Selves
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
| | - Thierry Lejeune
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
| | - Christine Detrembleur
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
| | - Marie-Adeline Haustrate
- Department of Physical Medicine and Rehabilitation, Cliniques Saint Pierre, Avenue Reine Fabiola, Ottignies, Belgium
| | - Gaëtant Stoquart
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
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Caron G, Bilchak J, Marie-Pascale Côté. Bumetanide increases postsynaptic inhibition after chronic SCI and decreases presynaptic inhibition with step-training. J Physiol 2023; 601:1425-1447. [PMID: 36847245 PMCID: PMC10106440 DOI: 10.1113/jp283753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
Current anti-spastic medication significantly compromises motor recovery after spinal cord injury (SCI), indicating a critical need for alternative interventions. Because a shift in chloride homeostasis decreases spinal inhibition and contributes to hyperreflexia after SCI, we investigated the effect of bumetanide, an FDA-approved sodium-potassium-chloride intruder (NKCC1) antagonist, on presynaptic and postsynaptic inhibition. We compared its effect with step-training as it is known to improve spinal inhibition by restoring chloride homeostasis. In SCI rats, a prolonged bumetanide treatment increased postynaptic inhibition but not presynaptic inhibition of the plantar H-reflex evoked by posterior biceps and semitendinosus (PBSt) group I afferents. By using in vivo intracellular recordings of motoneurons, we further show that a prolonged bumetanide increased postsynaptic inhibition by hyperpolarizing the reversal potential for inhibitory postsynaptic potentials (IPSPs) after SCI. However, in step-trained SCI rats an acute delivery of bumetanide decreased presynaptic inhibition of the H-reflex, but not postsynaptic inhibition. These results suggest that bumetanide might be a viable option to improve postsynaptic inhibition after SCI, but it also decreases the recovery of presynaptic inhibition with step-training. We discuss whether the effects of bumetanide are mediated by NKCC1 or by off-target effects. KEY POINTS: After spinal cord injury (SCI), chloride homeostasis is dysregulated over time in parallel with the decrease in presynaptic inhibition of Ia afferents and postsynaptic inhibition of motoneurons, and the development of spasticity. While step-training counteracts these effects, it cannot always be implemented in the clinic because of comorbidities. An alternative intervention is to use pharmacological strategies to decrease spasticity without hindering the recovery of motor function with step-training. Here we found that, after SCI, a prolonged bumetanide (an FDA-approved antagonist of the sodium-potassium-chloride intruder, NKCC1) treatment increases postsynaptic inhibition of the H-reflex, and it hyperpolarizes the reversal potential for inhibitory postsynaptic potentials in motoneurons. However, in step-trained SCI, an acute delivery of bumetanide decreases presynaptic inhibition of the H-reflex, but not postsynaptic inhibition. Our results suggest that bumetanide has the potential to decrease spastic symptoms related to a decrease in postsynaptic but not presynaptic inhibition after SCI.
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Affiliation(s)
- Guillaume Caron
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University, Philadelphia, PA 19129
| | - Jadwiga Bilchak
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University, Philadelphia, PA 19129
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University, Philadelphia, PA 19129
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Kim JA, Chun MH, Lee A, Ji Y, Jang H, Han C. The effect of training using an upper limb rehabilitation robot (HEXO-UR30A) in chronic stroke patients: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33246. [PMID: 36961152 PMCID: PMC10036062 DOI: 10.1097/md.0000000000033246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Upper limb robotic rehabilitation can be beneficial to the patients when applied appropriately. HEXO-UR30A is a novel exoskeletal type upper limb rehabilitation robot that provides continuous passive motion to the shoulder joint. OBJECTIVE The purpose of this study is to evaluate the effectiveness of HEXO-UR30A on the patient's functional change, spasticity, and range of motion (ROM). METHODS We included stroke patients with upper limb hemiparesis of age > 19 years with spasticity grading of modified Ashworth scale < 3 and Brunnstrom recovery stage ≥ 4. The efficacy of the robot was investigated based on a rehabilitation program for 3 weeks. Patient's functions were compared before vs after treatment and between the HEXO group vs control. We conducted the Fugl-Meyer Assessment of the Upper Extremity, modified Barthel index, modified Ashworth scale, ROM, and Motricity Index upper limb. Patients' satisfaction was evaluated using a questionnaire after every 10 sessions of training. RESULTS In the HEXO group, the Fugl-Meyer assessment for shoulder improved significantly (P value = .006*) compared with the control group (P value = .075). Both groups showed significant improvement (P value < .05) in Motricity Index upper limb after treatment. There were some improvements in the passive and active ROM. Patients in the HEXO group reported high satisfaction with upper limb rehabilitation. CONCLUSION These results show that HEXO-UR30A can improve functional ability in chronic stroke patients. Moreover, the high satisfaction in patients might promote active involvement in upper limb rehabilitation.
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Affiliation(s)
- Ji Ae Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Anna Lee
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
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Gorgey AS, Goldsmith JA, Khalil RE, Liu XH, Pan J, Cardozo C, Adler RA. Predictors of muscle hypertrophy responsiveness to electrically evoked resistance training after spinal cord injury. Eur J Appl Physiol 2023; 123:479-493. [PMID: 36305973 DOI: 10.1007/s00421-022-05069-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
The purpose of the study was to identify potential predictors of muscle hypertrophy responsiveness following neuromuscular electrical stimulation resistance training (NMES-RT) in persons with chronic spinal cord injury (SCI). Data for twenty individuals with motor complete SCI who completed twice weekly NMES-RT lasting 12-16 weeks as part of their participation in one of two separate clinical trials were pooled and retrospectively analyzed. Magnetic resonance imaging (MRI) was used to measure muscle cross-sectional area (CSA) of the whole thigh and knee extensor muscle before and after NMES-RT. Muscle biopsies and fasting biomarkers were also measured. Following the completion of the respective NMES-RT trials, participants were classified into either high-responders (n = 8; muscle CSA > 20%) or low-responders (n = 12; muscle CSA < 20%) based on whole thigh muscle CSA hypertrophy. Whole thigh muscle and knee extensors CSAs were significantly greater (P < 0.0001) in high-responders (29 ± 7% and 47 ± 15%, respectively) compared to low-responders (12 ± 3% and 19 ± 6%, respectively). There were no differences in total caloric intake or macronutrient intake between groups. Extensor spasticity was lower in the high-responders compared to the low-responders as was the dosage of baclofen. Prior to the intervention, the high-responders had greater body mass compared to the low-responders with SCI (87.8 ± 13.7 vs. 70.4 ± 15.8 kg; P = 0.012), body mass index (BMI: 27.6 ± 2.7 vs. 22.9 ± 6.0 kg/m2; P = 0.04), as well as greater percentage in whole body and regional fat mass (P < 0.05). Furthermore, high-responders had a 69% greater increase (P = 0.086) in total Akt protein expression than low-responders. High-responders also exhibited reduced circulating IGF-1 with a concomitant increase in IGFBP-3. Exploratory analyses revealed upregulation of mRNAs for muscle hypertrophy markers [IRS-1, Akt, mTOR] and downregulation of protein degradation markers [myostatin, MurF-1, and PDK4] in the high-responders compared to low-responders. The findings indicate that body composition, spasticity, baclofen usage, and multiple signaling pathways (anabolic and catabolic) are involved in the differential muscle hypertrophy response to NMES-RT in persons with chronic SCI.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Central Virginia VA Health Care System, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jacob A Goldsmith
- Spinal Cord Injury and Disorders Service, Central Virginia VA Health Care System, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Refka E Khalil
- Spinal Cord Injury and Disorders Service, Central Virginia VA Health Care System, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Xin-Hua Liu
- National Center for the Medical Consequences of Spinal Cord Injury and Medical and Surgical Service, James J Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | - Jiangping Pan
- National Center for the Medical Consequences of Spinal Cord Injury and Medical and Surgical Service, James J Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | - Christopher Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury and Medical and Surgical Service, James J Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | - Robert A Adler
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Endocrine Division, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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