Respiratory abdominal muscle recruitment and chest wall motion in myotonic muscular dystrophy

Abdominal muscles are selectively active in normal subjects during stress and may increase the potential energy for inspiration by reducing the end-expiratory lung volume (EELV). We hypothesized that a similar process would occur in subjects with myotonic muscular dystrophy (MMD), but would be less effective, because of to their weakness and altered chest wall mechanics. Fine-wire electromyography (EMG) of the transversus abdominis (TA), internal oblique (IO), external oblique, and rectus abdominis was recorded in 10 MMD and 10 control subjects. EMG activity, respiratory inductive plethysmography, and gastric pressure were recorded during static pressure measurement and at increasing levels of inspiratory resistance breathing. EELV was reduced and chest wall motion was synchronous only in controls. Although the TA and IO were selectively recruited in both groups, EMG activity of the MMD group was twice that of controls at the same inspiratory pressure. In MMD subjects with mildly reduced forced vital capacity, significant differences can be seen in abdominal muscle recruitment, wall motion, work of breathing, and ventilatory parameters.

Health-related quality of life in peripheral neuropathy

It is now possible for the clinician to use multidimensional measures to assess the quality of life of their patients. Some of the more widely used instruments to measure HRQOL are the Medical Outcomes Study Short Form 36, the Nottingham Health Profile, the Sickness Impact Profile, and the World Health Organization Quality of Life instrument. Potential uses of quality of life assessment tools include: (1) monitoring the health and social status of a given population, (2) evaluating health care policy, (3) conducting clinical trials, (4) assessing the effectiveness of rehabilitation services, (5) justifying the allocation of limited social and health care resources, and (6) tailoring management to the needs of the patient.

Magnetic resonance imaging of denervated muscle: comparison to electromyography

The purpose of the study is to further assess the usefulness of short TI (time to inversion) recovery (STIR) magnetic resonance imaging (MRI) in detecting denervation of skeletal muscle compared to needle electromyography (EMG). Ninety subjects with clinical evidence of peripheral nerve injury or radiculopathy underwent STIR MRI and EMG of the affected limb. In 74 (82%) of these subjects, a positive correlation was found between STIR MRI and EMG (P < 0.009). STIR MRI has a relative sensitivity of 84% and specificity of 100% for detecting denervation. A subset of 28 subjects underwent quantitative assessments of signal intensity ratio (SIR) from the STIR MRI. The rank order correlation coefficient between the SIR and abnormal spontaneous activity on EMG was 0.70 (P < 0.001). Increased signal intensity on STIR MRI corresponds closely with spontaneous activity on EMG in denervated muscle. Although less sensitive than EMG in detecting muscle denervation, STIR MRI may be a useful adjunctive diagnostic tool in this setting.

Pursed lips breathing improves ventilation in myotonic muscular dystrophy

OBJECTIVE

To determine the effects of pursed lips breathing on ventilation, chest wall mechanics, and abdominal muscle recruitment in myotonic muscular dystrophy (MMD).

DESIGN

Before-after trial.

SETTING

University hospital pulmonary function laboratory.

PARTICIPANTS

Eleven subjects with MMD and 13 normal controls.

INTERVENTION

Pursed lips breathing.

OUTCOME MEASURES

Electromyographic (EMG) activity of the transversus abdominis, external oblique, internal oblique, and rectus abdominis was recorded with simultaneous measures of gastric pressure, abdominal plethysmography, and oxygen saturation. Self-reported sensations of dyspnea, respiratory effort, and fatigue were recorded at the end of each trial.

RESULTS

Pursed lips breathing and deep breathing led to increased tidal volume, increased minute ventilation, increased oxygen saturation, reduced respiratory rate, and reduced endexpiratory lung volume. Dyspnea, respiratory effort, and fatigue increased slightly with pursed lips breathing. EMG activity of the transversus abdominis and internal oblique muscles increased in MMD only and was associated with an increase in gastric pressure.

CONCLUSIONS

Pursed lips breathing and deep breathing are effective and easily employed strategies that significantly improve tidal volume and oxygen saturation in subjects with MMD. Abdominal muscle recruitment does not explain the ventilatory improvements, but reduced end-expiratory lung volume may increase the elastic recoil of the chest wall. Further clinical studies are needed to ascertain if the ventilatory improvements with pursed lips breathing and deep breathing improve pulmonary outcomes in MMD.

Expanding the role of hospice care in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive, ultimately fatal, motor neuron disease that poses a myriad of clinical and end-of-life problems. The needs of advanced ALS patients are well suited to the interdisciplinary, multi-modality setting of hospice, where comprehensive palliative strategies may ease suffering and allow the patient to die with dignity in the home. Unfortunately, hospice services are far underutilized in this setting. There is a great need to increase awareness of both patients and clinicians regarding the effectiveness of hospice in the care of advanced ALS patients.

Neuropathic pain in Charcot-Marie-Tooth disease

OBJECTIVES

To determine the frequency and extent to which subjects with Charcot-Marie-Tooth (CMT) disease report pain and to compare qualities of pain in CMT to other painful neuropathic conditions.

STUDY DESIGN

Descriptive, nonexperimental survey, using a previously validated measurement tool, the Neuropathic Pain Scale (NPS).

PARTICIPANTS

Participants were recruited from the membership roster of a worldwide CMT support organization.

MAIN OUTCOME MEASURES

NPS pain descriptors reported in CMT were compared with those reported by subjects with postherpetic neuralgia (PHN), complex regional pain syndrome, type 1 (CRPS-1), also known as reflex sympathetic dystrophy, diabetic neuropathy (DN), and peripheral nerve injury (PNI).

RESULTS

Of 617 CMT subjects (40% response rate), 440 (71%) reported pain. with the most severe pain sites noted as low back (70%), knees (53%), ankles (50%), toes (46%), and feet (44%). Of this group, 171 (39%) reported interruption of activities of daily living by pain; 168 (38%) used non-narcotic pain medication and 113 (23%) used narcotics and/or benzodiazepines for pain. The use of pain description was similar for CMT, PHN, CRPS-1, DN, and PNI in terms of intensity and the descriptors hot, dull, and deep.

CONCLUSIONS

Neuropathic pain is a significant problem for many people with CMT. The frequency and intensity of pain reported in CMT is comparable in many ways to PHN, CRPS-1, DN. and PNI. Further studies are needed to examine possible pain generators and pharmacologic and rehabilitative modalities to treat pain in CMT.

The effect of age and temperature on mdx muscle fatigue

We have studied the in vitro contractile and fatigue characteristics of extensor digitorum longus (EDL) muscles from 8- and 62-week-old dystrophin-deficient (mdx) and control mice at 20 degrees C and 35 degrees C. There were no differences in fatigability at 20 degrees C, but at 35 degrees C the dystrophin-deficient muscles demonstrated increased fatigability compared to controls, with the older mice exhibiting the greatest fatigue. These results suggest a temperature-related mechanism of myofibrillar fatigue in dystrophin-deficient EDL muscles.

Quality of life. Issues for persons with neuromuscular diseases

Improving quality of life has always been a goal of rehabilitation medicine. However, health care providers often do not know much about the quality of life of individuals with neuromuscular diseases, nor what factors are critical to achieving a good quality of life. Lack of knowledge about subjective quality of life factors can negatively influence expectations and selection of treatments. In the most glaring cases, a physician's subjective but incorrect assessment of a disabled individuals' quality of life may prevent life-sustaining interventions. As a group, the quality of life of individuals with NMD is not much different than nondisabled controls and is substantially better than presumed by the general public and, often times, by health care workers. Nevertheless, their quality of life is reduced in certain areas. Surprisingly, level of disability is not a critical factor that significantly alters life satisfaction. Presumably, this is because physical functioning has been adequately managed. The greatest problems that individuals with neuromuscular disease identified were: lack of information about the disease and services; poor coordination of services; negative attitudes; and a diminished expectation of their potential. In addition, people with severe disabilities had significant problems obtaining, financing, and managing personal care attendants. Factors related to a good quality of life were related to perceived control, perceived health status, but not disability. The more that people could do for themselves, either on their own or with personal care assistants, assistive devices, and use of technology, the better their quality of life.

Animal models of neuromuscular diseases: pathophysiology and implications for rehabilitation

This article explains how animal models can be utilized to develop rehabilitation approaches to minimize the pathophysiology of neuromuscular diseases (NMD). Homologous animal models can be used to understand the pathogenesis of each NMD and the effect of physical interventions. Much of the current work using animals has been conducted to show how gene therapy could be used to ameliorate these diseases. Although we applaud this work, animal models should also be used to determine how the phenotypic expression of the disease can be modified by such physical interventions as exercise, stretching, and immobilization. Methods that can be experimentally applied to animals but not to humans can be used to determine the underlying causes of the pathologic process and to identify potential therapies for NMD.

Effects of aging and voluntary exercise on the function of dystrophic muscle from mdx mice

To understand how exercise affects the contractile function of dystrophic muscle, we examined the effect of long-term voluntary exercise on mdx mice and related these effects to our findings in sedentary aging mice. Although the mdx mouse is the genetic homolog for Duchenne muscular dystrophy, it does not demonstrate the same progression in limb muscle dysfunction as Duchenne muscular dystrophy as it ages. We postulated that the sedentary lifestyle of this animal plays an important role in its minimal phenotypic expression. To examine the effect of exercise, eight C57BL/10 (C57) and eight mdx mice were allowed to run ad libitum for one year. Forty sedentary mdx mice and 40 sedentary C57 from one month to 18 months of age were used as controls. Contractile characteristics of the extensor digitorum longus and soleus muscles and morphometric characteristics of the mice were examined. The mdx mice ran approximately 45% fewer kilometers per day than C57 mice. Long-term voluntary running had beneficial training effects on both the old mdx mice and their C57 controls. The exercise ameliorated the age-associated loss in tension production that was observed in the soleus of sedentary mdx and sedentary C57 mice. There was a 9% reduction in the fatigability of the extensor digitorum longus muscle of the old mdx mice after the exercise. Despite these improvements, the old mdx mice exhibited significant functional deficits compared with their C57 controls. Our hypothesis, that long-term voluntary exercise would have a beneficial training effect on control mice and a deleterious effect on mdx mice as they aged, was not supported by this study. This study shows that dystrophin-less muscles from sedentary mice display significant signs of muscle damage, yet can respond beneficially to low-level voluntary running in a manner similar to that of the C57 control.

Employment profiles in neuromuscular diseases

Consumer and rehabilitation provider factors that might limit employment opportunities for 154 individuals with six slowly progressive neuromuscular diseases (NMD) were investigated. The NMDs were spinal muscular atrophy (SMA), hereditary motor sensory neuropathy (HMSN), Becker's muscular dystrophy (BMD), facioscapulohumeral muscular dystrophy (FSHD), myotonic muscular dystrophy (MMD), and limb-girdle syndrome (LGS). Forty percent were employed in the competitive labor market at the time of the study, 50% had been employed in the past, and 10% had never been employed. The major consumer barrier to employment was education. Other important factors were type of occupation, intellectual capacity, psychosocial adjustment, and the belief by most individuals that their physical disability was the only or major barrier to obtaining a job. Psychological characteristics were associated with level of unemployment. However, physical impairment and disability were not associated with level of unemployment. There also were differences among the types of NMDs. Compared with the SMA, HMSN, BMD, and FSHD groups, the MMD and LGS groups had significantly higher levels of unemployment, lower educational levels, and fewer employed professional, management, and technical workers. Nonphysical impairment factors such as a low percentage of college graduates, impaired intellectual function in some individuals, and poor psychological adjustment were correlated with higher unemployment levels in the MMD group. Unemployment in the LGS group was correlated with a failure to complete high school. Major provider barriers to employment were the low level of referrals to Department of Rehabilitation by physicians and the low percentage of acceptance into the State Department of Rehabilitation. The low rate of acceptance was primarily attributable to the low number of referrals compounded by a lack of counselor experience with individuals with NMD. Both consumer and provider barriers may contribute to the lack of interest in obtaining a job.

Profiles of neuromuscular diseases. Myotonic dystrophy

Ninety-two individuals with myotonic dystrophy (MD) were evaluated prospectively over a 10-yr period and separated into two types, 75 noncongenital (NC-MD) and 17 congenital (C-MD) MD. Muscle weakness was relatively mild and similar in both types, 4.0 +/- 0.7 manual muscle test (MMT) scores for NC-MD and 3.8 +/- 0.7 in C-MD. However, weakness was progressive in the former, -0.36 MMT units per decade, and nonprogressive in C-MD. Weakness was usually generalized in both types, with no significant differences between upper and lower extremities or the proximal and distal muscles. Flexor and extensor differences were variable. Quantitative strength measurements showed a similar pattern but were more sensitive showing marked strength losses of 40-50% in muscle groups with MMT scores of four or more. There was a high frequency (47%) of relatively mild, nonprogressive scoliosis in C-MD, whereas spine deformity was unusual in NC-MD. Contractures, usually at the ankles, were also more common in C-MD. In NC-MD and C-MD, respectively, there was a low frequency of severe restrictive lung disease (14 and 20%) but a high percentage of significant electrocardiographic (ECG) abnormalities (75 and 81%), including conduction defects. There was a marked difference between the two types of MD in intellectual and cognitive function. Seventy-five percent of C-MD subjects showed impairment, frequently severe, compared with 35% impairment, usually mild, for NC-MD individuals. Functional evaluation was not markedly affected, but timed motor performance showed significant disability especially for individuals with C-MD.

Profiles of neuromuscular diseases. Limb-girdle syndromes

Sixty-six individuals with Limb-Girdle Syndrome (LGS) were evaluated over a 10-yr period and classified into three types: 19 severe autosomal recessive muscular dystrophy of childhood (ARMDC), alternatively referred to by some as SCARMD, 18 autosomal dominant late onset (ADLO), and 29 pelvifemoral (PF) individuals. ARMDC subjects showed the greatest weakness, 2.5 +/- 1.0, mean Manual Muscle Test (MMT) grade for all muscles combined, and the only significant progression of loss of strength, -0.59 MMT unit decline per decade. Strength loss in ADLO and PF types was about the same, 3.7 +/- 0.7 and 4.0 +/- 0.7 grades, respectively. Quantitative strength measurements in ADLO and PF types were more sensitive than MMTs, showing losses of 30-40% strength in muscle groups with MMT grades of 4 or higher. All three types showed greater proximal and lower extremity weakness but usually no difference between flexor and extensor strength. There was a high percentage (44%) of mild very slowly progressive scoliosis in ARMDC, but spine deformity was unusual in ADLO and PF (11%) LGS. Contractures were few, slowly progressive, and usually mild in severity in all types, although more frequent in ARMDC. There also was a low frequency of severe restrictive lung disease in all types (10%) but a high percentage of electrocardiogram abnormalities (62-73%). The most common electrocardiogram abnormalities were increased R/S ratio in V1 and infranodal conduction defects. Intellectual and cognitive functions were within normal limits. Mobility and extremity function reflected the strength differences between the ARMDC and other types of LGS. Eight-five percent of ARMDC individuals relied on a wheelchair for all or part of their mobility, and all were unable to complete timed motor performance tests within the 99th percentile range for controls.

Profiles of neuromuscular diseases. Becker's muscular dystrophy

Fifteen subjects with Becker's muscular dystrophy (BMD) were studied prospectively over a 10-yr period to provide a profile of impairment and disability. Proximal lower extremity musculature (particularly the hip and knee extensors), ankle dorsiflexors, and neck flexors showed significantly early weakness. Extensor muscle groups were weaker than flexor muscles at the elbow and knee. The mean manual muscle test (MMT) strength grade for all muscle groups combined was 3.7 +/- 0.8 MMT units. There was a slowly progressive decline in strength, only -0.31 MMT units per decade, and the decline was relatively equal in all muscle groups. There was not side dominance. Severe contractures did not appear to be a problem until after transition to a wheelchair, and scoliosis was rare. Restrictive lung disease occurred as a late complication in a small percentage of cases; however, maximal expiratory pressure was significantly reduced early in the disease. Only two individuals (19%) had severe restrictive lung disease and a history of significant respiratory complications. There was a slight but significant decline in forced vital capacity and maximal expiratory pressure with age and disease duration. The cardiomyopathy in BMD appeared to be disproportionately severe in some cases. Eleven individuals (73%) had abnormal electrocardiograms, and five (25%) had a history of significant cardiovascular complication, with no age or disease duration effect. Functional evaluations and timed motor performance tests showed only mild disability in most individuals. Mean intellectual and neuropsychologic function was within normal limits, but with a large variability in intelligence quotient scores. This report and others suggest a tremendous heterogeneity of severity among males with BMD.

Profiles of neuromuscular diseases. Hereditary motor and sensory neuropathy, types I and II

Data were collected prospectively for an impairment and disability profile for 86 hereditary motor and sensory neuropathy, types I and II (HMSN) subjects over a 10-yr period. Our data confirm that HMSN is a slowly progressive disorder that has a very heterogeneous phenotypical expression. The disorder was characterized primarily by diffuse muscle weakness with prominent distal atrophy. The mean manual muscle test (MMT) strength grade for all muscle groups combined was 3.9 +/- 0.7 MMT units. There was a slowly progressive decline in strength, only -0.15 MMT units per decade. Distal muscle groups were weaker than proximal muscles, and the decline in strength of the ankle muscles was greater than for the proximal muscles. There was no side dominance. Anthropometric data revealed that distal atrophy may be masked by subcutaneous fat in female subjects. On average, HMSN subjects produced 20-40% less force than normal controls, using quantitative isometric and isokinetic strength measures, even when MMT scores were normal. Pulmonary and cardiac abnormalities were uncommon, as were spine deformity and joint contractures. Only 1 individual had severe restrictive lung disease, and 12 (14%) had a history of significant respiratory complications with no age or disease duration effect. As with the other neuromuscular diseases, maximum expiratory pressure was more affected than forced vital capacity. Fourteen individuals (30%) had abnormal electrocardiograms, and six (7%) had a history of significant cardiovascular complications with no age or disease duration effect. Kyphosis was the major spine deformity. Cardiopulmonary responses to exercise testing were markedly abnormal, showing reduced aerobic capacity. Functional evaluations and timed motor performance tests showed only mild disability in most individuals. With timed motor performance testing muscle weakness translated to impaired motor performance skills. Overall, mean scores on intellectual function and neuropsychologic profiles were normal.

Profiles of neuromuscular diseases. Duchenne muscular dystrophy

One hundred and sixty-two patients with Duchenne muscular dystrophy (DMD) were followed over a 10-yr period to provide a profile of impairment and disability. The median height and weight of DMD boys were normally distributed before ages 9-10, but during the second decade height was markedly reduced, and weight was no longer normally distributed. Younger boys gained more weight than normals, whereas older individuals actually showed weight loss. Manual muscle test (MMT) measurements showed loss of strength in a fairly linear fashion from ages 5-13 yr, -0.25 MMT units per year. Upper extremity muscles were stronger than lower extremity muscles, proximal muscle groups were weaker than distal muscle groups, and extensor muscles were weaker than flexor muscles. There was no side dominance. There was a change in the rate of strength loss at 14-15 yr, and the decline slowed to only -0.06 MMT units per year. Although MMT and quantitative strength measurement profiles were similar, the latter were far more sensitive. In general, by the time strength declined to MMT grade 4, isometrically measured strength was 40-50% of normal control values. Joint contractures were rare before age 9, increased in frequency and severity with age, and were present in most individuals older than 13. Lower extremity contractures were strongly related to onset of wheelchair reliance, but there was no association between muscle imbalance around a joint. The prevalence of scoliosis increased between ages 11 and 16, with about 50% of the boys acquiring scoliosis between ages 12 and 15, corresponding to the onset of the adolescent growth spurt. Wheelchair reliance and scoliosis were both age-related. Percent predicted forced vital capacity declined at different yearly rates: ages 7-10, -0.3%; ages 10-20, -8.5%; after age 20, -6.2%. There was a direct relationship between percent predicted FVC and MMT scores. Decreased airway pressures, especially maximal expiratory pressure, appeared earlier than reductions in FVC but followed the same pattern. Thirty percent of the DMD boys had a history of respiratory complications, and the frequency increased with age. Spine deformity did not have a significant additive effect on the age-related decrement in pulmonary function. There was a high occurrence (79%) of abnormal electrocardiograms with age-related progression of some abnormalities, but only 30% of the patients had a history of cardiovascular complications. Functional level grades and timed motor performance measurements had a nonlinear relationship with strength and age.(ABSTRACT TRUNCATED AT 400 WORDS)

Profiles of neuromuscular diseases. Facioscapulohumeral muscular dystrophy

Data were collected prospectively over a 10-yr period from 53 subjects with facioscapulohumeral muscular dystrophy (FSHD) to provide a profile of impairment and disability. Manual muscle testing (MMT) indicated greater involvement of proximal musculature, although a subgroup demonstrated early weakness of the ankle dorsiflexors. Asymmetry of upper extremity musculature was noted, with greater weakness of selected dominant limb muscle groups. Weakness, in general, was relatively mild, with an overall mean MMT score of 3.7 units. The rate of strength loss was quite slowly progressive, a decline of only -0.22 MMT units per decade of age. An early age of onset was associated with greater likelihood of more severe and progressive weakness. Isometric and isokinetic quantitative strength testing revealed that all muscle groups were 36-68% weaker than a control population. Although nearly 50% of the subjects had vital capacity evidence of restrictive lung disease, only 13% had severe involvement, and only 22% had a history of pulmonary complications. There was no age or disease duration effect on pulmonary function measurements or complications. As with the other neuromuscular diseases, maximal expiratory pressure measurements were more sensitive than other pulmonary function tests. Abnormal electrocardiogram findings were rare and minor and not related to overt cardiac disease. Contractures were rare and mild. Thirty-five percent of the patients had spine deformity; however, most had hyperlordosis. Intellectual function was normal, and there were few abnormalities on personality tests. Functional testing demonstrated wide variation in disability with FSHD, but motor weakness uniformly translated into impaired motor performance skills. This profile demonstrates the clinical heterogeneity of FSHD.

Profiles of neuromuscular diseases. Spinal muscular atrophy

Forty-five individuals with spinal muscular atrophy (SMA) types II and III were evaluated prospectively over a 10-yr period to develop an impairment and disability profile. SMA II subjects showed marked weakness and progressive decline of strength. Mean manual muscle test (MMT) score for all muscles combined was 2.3 +/- 0.6, with a decline in strength of -0.24 MMT units per decade. SMA III individuals had a relatively static or very slowly progressive course and were far stronger. Mean MMT score for all muscles combined was 3.8 +/- 0.7, and the decline in strength per decade was not significant. In both types proximal weakness was greater than distal, but there was greater involvement of the lower extremities and the extensor muscle groups only in SMA II. Contractures, progressive scoliosis, and restrictive lung disease (RLD) were present in most of the SMA II individuals, but these complications were rare in SMA III. Maximal expiratory pressures were affected earlier and to a greater degree than vital capacity. Seventy-eight percent of those with SMA II had scoliosis with a mean Cobb angle of the primary curve of 62 +/- 37 degrees. Forty-one percent had severe RLD, and 17% had moderate RLD. In both types, 63% had abnormal electrocardiograms although most had minor findings. Timed motor performance and functional evaluations indicated that muscle weakness translated to substantial disability in both SMA II and III, with more severe impairment noted in SMA II. Neither type was associated with abnormal means scores on intellectual and neuropsychologic test batteries.

Profiles of neuromuscular diseases. Design of the protocol

The purpose of this 10-yr investigation was to develop comprehensive impairment and disability profiles of the clinical characteristics of seven neuromuscular diseases: spinal muscular atrophy, hereditary motor sensory neuropathy, Duchenne muscular dystrophy, Becker's muscular dystrophy, facioscapulohumeral muscular dystrophy, limb-girdle syndrome, and myotonic dystrophy. Based on the World Health Organization's classification of disablement, as applied to neuromuscular diseases, impairment was evaluated by measurements of strength, range of motion, spine deformity, cardiac and pulmonary function, and intellectual capacity. Disability was evaluated by measures of mobility and upper extremity function, cardiopulmonary adaptations, cardiac and pulmonary complications, and psychosocial adjustment.

Effect of voluntary wheel-running exercise on muscles of the mdx mouse

The purpose of this study is to determine whether dystrophin-deficient mdx mice are more susceptible to muscle injury and functional impairment than normal C57 mice when allowed to exercise voluntarily on mouse wheels. The mdx mice were significantly impaired when compared to controls as shown by functional, contractile and morphometric responses. The distance young mdx mice ran was 67-78% of young C57 mice, while adult mdx mice ran 31-48% of adult controls. After exercise the slow, oxidative soleus of young and adult mdx mice exhibited hypertrophy with no changes in strength or fatiguability, while the young C57 mice increased strength and the adults became less fatiguable. In the adult mdx mice the fast EDL, which is primarily glycolytic, exhibits slight hypertrophy with a loss of strength, while the young exhibit no changes. These results indicate that the mdx mouse adapts differently than the C57 mouse to even moderate exercise.

Effects of exhaustive concentric and eccentric exercise on murine skeletal muscle

C57BL/10SnJ mice were run to exhaustion on a treadmill at a 20 degrees incline, uphill or downhill. Contractility, morphology, and histology were evaluated in the soleus and extensor digitorum longus (EDL) muscles at days 0, 3, and 7 postexercise. Serum creatine kinase was elevated immediately postexercise (681% increase downhill and 225% increase uphill). After uphill running, the soleus had a significant increase in cross-sectional area (CSA) and decreased tetanic tension/CSA and twitch contraction time through day 7. The EDL showed increased CSA, decreased tetanic and twitch tension, and increased fatigue at day 0 only, with no other contractile abnormalities. After downhill running, the EDL showed reduced tetanic and twitch tension, but no fatigue or morphometric differences, whereas the soleus showed no significant abnormalities. No significant muscle histopathology was observed at any time following uphill or downhill running. This study indicates that both exhaustive eccentric and concentric exercise may produce significant impairments in muscle contractility without inducing histopathology. Exhaustive concentric exercise also induces muscle swelling and may preferentially impair slow twitch fibers.

Serial manual muscle testing in Duchenne muscular dystrophy

Serial measurements of muscle strength of 34 muscle groups were obtained for up to a seven-year period using manual muscle testing (MMT) in a group of 63 boys (mean age = 11.5 years) with Duchenne muscular dystrophy (DMD) not using lower extremity bracing or corrective surgery for ambulation, in order to define the natural course of strength loss and its relation to anthropometric variables and ambulatory status. When correlating the first MMT assessment of each patient with age, strength was found to decrease linearly (-0.26 +/- 0.30 MMT units/year) with time until approximately age 14 when a marked decrease in progression was noted (-0.06 +/- 0.03 MMT units/year). Analyzing individual patients longitudinally yielded a similar rate of strength loss. The average muscle score was 3.0 MMT units at the point of full-time wheelchair use. The marked decline in MMT deterioration around age 14 may be an important consideration when assessing the efficacy of therapeutic interventions in adolescent boys with DMD.

Fast and slow skeletal muscles: effect of ethanol on contractility of muscles from mice

We examined in vitro the effect of ethanol at four concentrations (0g%, 0.1g%, 0.2g%, and 0.4g%) on contractile parameters of 40 fast extensor digitorum longus (EDL) and 40 slow soleus muscles from healthy mice at 35C. Preparations were curarized to avoid the possible effect of ethanol on the terminal axons or skeletal neuromuscular junction. Contractile parameters measured included: (1) twitch and tetanic tension; (2) rate of tension development; (3) time to peak tension and half relaxation for twitch; (4) time to first evidence of relaxation in the tetanus; and (5) maximum rate of relaxation. The three lower concentrations of ethanol had no significant effect on muscle contractility; however, the 0.4g% dose reduced EDL twitch tension by 9%. High doses of ethanol (2.5g%) reduced the tetanic tension produced by the EDL and soleus muscles 31% and 26%, respectively. Ethanol at 2.5g% also reduced the twitch tension of the EDL and soleus by 50% and 38%, respectively. The data suggested that the 0.4g% is the highest dose of ethanol that should be used to dilute drugs in a solution that will bathe directly stimulated curarized muscle without confounding effects. In addition, it is highly unlikely that a direct effect of ethanol on muscle contractility in humans is related to an impairment in driving.

In vivo quantification of muscle contractility in humans: healthy subjects and patients with myotonic muscular dystrophy

The purpose of this study was to use direct in vivo contractility measurements to assess muscle function in patients with myotonic muscular dystrophy (MMD). The tetanic and twitch responses and several time parameters of muscle contraction were obtained from nine MMD subjects and nine able-bodied, age-matched controls. After a routine nerve conduction study, in vivo contractility measurements were obtained by stimulating the ulnar nerve at the wrist and recording the isometric flexor function of the intrinsic muscles at the metacarpophalangeal joint of the index finger. A series of single stimuli, paired stimuli, and fused tetanic stimulations were generated during a 20-minute experimental protocol. A stable tetanus was produced at 50Hz for 1.2 seconds. M-wave and contractile data were recorded at 1,000Hz by digitization of the analog signal and storage by the microcomputer. The MMD patients were weaker than controls (p less than .05), as shown by the 39% reduction in tetanic tension and 57% reduction in twitch tension. The MMD patients also had a significant impairment in relaxing their muscles as shown by the 1,100% increase in half-relaxation time after contraction, even though there was no evidence of repetitive firing after cessation of stimulus. These data show that MMD patients exhibit failure of sarcolemmal activation, altered excitation-contraction coupling mechanisms, and failure of the contractile machinery. The myotonia is due in part, to some defect in the contractile machinery; it is not solely due to failure of sarcolemmal activation.

Analysis of human muscle contractility with a microcomputer-controlled stimulus and data acquisition system

This report describes and assesses a technique to indirectly stimulate and quantify the human in vivo muscle response for clinical use. A method has been developed to isolate, stimulate, and record the flexor function of the first dorsal interosseus and first volar interosseus at the metacarpophalangeal (MCP) joint by stimulation of the ulnar nerve at the wrist. A microprocessor-based data acquisition and analysis system was built to deliver the electric stimulus and convert the muscle action potential (M-wave) and force measurements into digital form for analysis. To evaluate the technique, the twitch, paired twitch, and tetanic contractions were analyzed in 81 normal subjects. The tension developed by the youngest subjects (14 to 19 years old) was significantly less than the tension developed by subjects in the three older groups (20 to 34 years, 35 to 50 years, and 50 to 65 years); the tensions in the older groups were not significantly different from each other. Only minor gender differences were noted. This indicates that it is necessary to use age-group controls when looking for evidence of a muscle contractile abnormality in patients with neuromuscular disorders. posttetanic potentiation of the twitch was observed in all healthy subjects, and there was no evidence of an age or gender influence. The posttetanic increase in twitch tension was not associated with a prolongation of the twitch contraction time.

High-repetitive submaximal treadmill exercise training: effect on normal and dystrophic mice

Exercise as a treatment for muscular dystrophy is controversial. Whereas vigorous high-resistive exercise increases skeletal muscle degeneration in animals with neuromuscular disorders, the effect of low-intensity, high-repetitive exercise has been conflicting. The purpose of this study was to determine if low-intensity, high-repetitive exercise has a beneficial effect on dystrophic mice. Dystrophy mice and unaffected littermates were exercised daily starting at age three weeks on a treadmill (4 m/min, 18 degrees incline, 100 meters, three weeks' duration). Exercise increased the dystrophic soleus twitch tension, the rate of twitch tension development, and the rate of twitch tension relaxation by 55%, 58%, and 48%, respectively (p less than .05). The twitch:tetanus ratio increased by 57% (p less than .05). Both the soleus and the extensor digitorum longus from the exercised dystrophic mice had significantly less degeneration (as shown by reduced internal nuclei, necrosis, fiber splitting, and moth-eaten fibers) than the nonexercised dystrophic mice (p less than .05). This study suggests that exercise training programs can be beneficial or at least not result in further muscle fiber degeneration if (1) the exercise program is started early in the course of the disease; (2) submaximal high-repetitive or even high-resistive exercise is used; and (3) the histopathologic degeneration is slowly progressive or in an arrested state.

Effect of hind-limb suspension on young and adult skeletal muscle. II. Dystrophic mice

Disuse atrophy induced by limb immobilization reportedly protects dystrophic mouse muscle from histopathological changes. This study was conducted to determine whether disuse atrophy induced by hind-limb suspension (HS) limits the histopathology and contractile abnormalities typically observed in the dystrophic mouse. Two weeks of hind-limb suspension were applied to dystrophic mice (line 129B6F1) at two ages, 4 weeks (6 mice) and 12 weeks (8 mice). Thirty-one untreated dystrophics served as controls. In general, HS exaggerated the dystrophic signs, especially in the younger mice; it reduced animal weight, muscle weight, maximum tetanic and twitch tensions, and rates of tetanic and twitch tension development. HS further slowed the contractile properties of soleus (SOL) and extensor digitorum longus (EDL) muscles, and increased their fatigue resistance. HS reduced the size of type I and IIA fibers in the 6-week SOL and EDL, but not in the 14-week muscles. HS produced a preferential atrophy of SOL type I fibers, with a parallel increase in type IIA fibers. However, it did not alleviate the fiber size variability, degree of necrosis, central nucleation, inflammation, or muscle fibrosis in dystrophic muscles. These data demonstrate that disuse by hind-limb suspension does not prevent the histopathological deterioration or loss of muscle function in 6- and 14-week dystrophic mice.

Effect of hind-limb suspension on young and adult skeletal muscle. I. Normal mice

The purpose of this study was to determine the effect of hind-limb suspension (HS) on morphometric, histologic, and contractile characteristics of fast extensor digitorum longus (EDL) and slow soleus (SOL) twitch muscles in adult and immature mice. Hind-limb suspension for 2 weeks was used to produce atrophy in two groups of mice, ages 4 and 12 weeks, with nonsuspended animals serving as controls. Young HS mice exhibited marked decreases in SOL weight, length, cross-sectional area (CSA), twitch and tetanic tensions, and rates of tension development and relaxation, with increases in fatigue resistance. HS reduced the diameter of both type I and IIA fibers, increased the percentage of type I fibers, and decreased the percentage of type IIA fibers in both young and adult SOL. Muscle weight, length, CSA, IIA and IIB fiber areas, and maximum rate of tetanic tension development were decreased in EDL of young HS mice; fatigue resistance and EDL half-relaxation times were increased. For most parameters evaluated, slow twitch muscle was more affected than fast twitch. HS affected contractile characteristics less than morphometric or histologic parameters. Rates of tension development and relaxation were the contractile parameters most affected by HS, and the time parameters of contraction were least affected. For all measurements young mice were more affected than adult mice.

Glucocorticoids in muscular dystrophy: beneficial effects of dexamethasone on avian myopathy

A corticosteroid with mixed glucocorticoid-mineralocorticoid actions was previously shown to improve neuromuscular function in muscular dystrophic chickens. The significance of that finding was recently underscored by reports that a mixed-action corticosteroid improved muscle function in Duchenne dystrophy patients, albeit at high doses. In the present study a pure glucocorticoid improved function and retarded muscle histopathology in the chicken, but a pure mineralocorticoid did not. These observations suggest that elucidation of mechanisms by which glucocorticoids beneficially affect dystrophic muscle could lead to development of more effective therapies.

Contractile and EMG studies of murine myotonia (mto) and muscular dystrophy (dy/dy)

This report focuses on the myotonic (mto) mouse, an autosomal recessive neuromuscular mutant first described in 1982. Studies in vivo confirmed the presence of hindlimb rigidity during walking and typical myotonic electromyographic (EMG) discharges that persisted after nerve transection and complete neuromuscular blockade. Studies of the contractility of mto muscles in vitro revealed reduced peak isometric tetanic tension and greatly prolonged relaxation times. Tubocurarine did not affect tension parameters, but did antagonize the delayed relaxation in vitro. On the basis of EMG studies alone this mutant can accurately be described as myotonic. Reduction of the contractile abnormalities by tubocurarine in vitro, however, poses further questions regarding the nature of the disorder. Although the more familiar dystrophic mouse (dy/dy) has been termed "myotonic" by some, the new mto mutant differs from it in all aspects examined.

Serotonin-induced contractile and structural changes in fast and slow skeletal muscles in mice

The effects of serotonin on the contractile properties of the soleus and extensor digitorum longus muscles in mice were studied after chronic intraperitoneal administration with and without a recovery period, and compared to contractile studies of the same muscles performed after acute administration of serotonin. A curarized in vitro preparation of both muscles was used throughout for the contractile studies. In addition, structural changes were studied in the chronic preparations. Chronic serotonin administration produced histologic changes in type 1 and 2A fibers and a reduction in twitch and tetanic tension and the rate of twitch and tetanic tension development limited to the slow (aerobic) soleus muscle. Acute in vitro administration of serotonin altered the contractile properties of both soleus and extensor digitorum longus muscles with the latter being more involved. The effects of chronic serotonin administration appear to be primarily related to ischemia while the effects of acute administration appear to be mediated by direct, nonvascular action on skeletal muscle.

Effect of pentobarbital on contractility of mouse skeletal muscle

Pentobarbital is a hypnotic drug commonly used as anesthesia for in vivo studies in various animals. A direct effect of pentobarbital on the central nervous system and skeletal neuromuscular junction has been known for at least 30 years. A recent study using single fiber preparations from amphibian muscles indicated a significant acute and direct effect on muscle contractility at drug concentrations within the anesthetic range. The present study using whole muscles from mice demonstrated a similar augmentation of twitch tension and rate of tension development whereas tetanic tension was reduced by this drug at similar concentrations. In addition, most time parameters of contraction were prolonged. It is of interest that the slow (oxidative) muscles were considerably more sensitive to pentobarbital than the fast (primarily anaerobic) muscles. We suggest that pentobarbital should not be used as the anesthetic agent for in vivo studies of other interventions when conclusions are based on changes in muscle contractility.

Fast and slow skeletal muscles: contractility evaluated by paired stimuli in mice

The purpose of this study was to evaluate a technique for in vitro study of mouse skeletal muscle, to determine if paired stimuli would allow estimation of new time parameters of contraction. Conventional tension measurements were obtained, plus the time measurements from the paired stimulus studies. The muscles were also subjected to fatigue by repetitive tetanization. A fast muscle (extensor digitorum longus or plantaris) and a slow muscle (soleus) were studied in each preparation. Studies were conducted at physiologic (35C) and at nonphysiologic (20C) temperatures. Data obtained indicate that this isometric in vitro method allows subdivision of results into 3 categories of effect due to treatment related to the functional muscle compartments: 1) chronotropic-excitation contraction coupling mechanisms, 2) inotropic- contractile elements, and 3) metabolic (fatigue)-energy supply mechanisms. When results as 20C were compared with physiologic temperature, a negative chronotropic effect was observed for all parameters in all 3 muscles. A positive inotropic effect was observed for twitch with no change or a negative effect for all other tension parameters. The lower temperature produced slight protection from fatigue. Models were developed to demonstrate how data from isometric studies fit the original concepts developed using isotonic methods. The model and method should prove of value in detecting the acute effect of drugs or of other therapy imposed on skeletal muscles.

Fast and slow skeletal muscles: effect of secobarbital on contractility of muscles from mice

In vitro studies were performed on fast and slow muscles from mice to determine if secobarbital sodium (SCB) has a direct effect on muscle contractility. All preparations were curarized and stimulation was direct. After baseline studies, SCB was added to the muscle bath in 1 of 4 concentrations-10, 20, 100 and 200 microgram/ml. Tetanic tension was reduced for both muscle types at SCB concentrations greater than or equal to 20 microgram/ml, and loss was progressive with increasing dose. In contrast, twitch tension (P) was increased by SCB at the 2 higher concentrations. The increase in P was due to an increase in rate of tension development plus prolongation of the time parameter (duration) of the twitch. Fatigue was accelerated by SCB for both muscle types. The results indicate that SCB has a direct and similar effect on fast and slow skeletal muscles. The probable sites of action of the drug are the excitation contraction coupling mechanisms and the mechanisms for energy production and/or utilization.