The purpose of this study was to evaluate the blood flow in the lower limbs of 12 healthy subjects immediately after a 10-min massage of the lateral part of one thigh. Massage was performed under standardized conditions of velocity (0, 1 m.s - 1 ), pressure (10 kPa), and frequency (0,25 Hz), using a semi-automatic device composed of four asymmetric rotative cones. Immediately after massage, a tracer (Tc-99m - MIBI) was injected, allowing scintigraphic evaluation of the blood flow in the entire body, and, for the purpose of this study, in the lateral part of both thighs and legs. The post-massage blood flow reached 2.07 n 0.55% (SD) of the total blood flow in the control thigh, and 1.89 n 0.48% (SD) in the massaged thigh. The paired Student t-test revealed a significant decrease in the massaged thigh (p = 0.047). The blood flow reached 2.5 n 0.65% (SD) of the total blood flow in the control leg, and 2.39 n 0.69% (SD) in the leg corresponding to the massaged thigh. This difference was not significant (p = 0.114). As an influence of the tracer, which was injected only after massage, can be excluded, the decreased blood flow observed in the treated thigh is concluded to be due to indirect effects of massage.
Neuromuscular electrical stimulation (NMES) has many applications in the rehabilitation of locomdisorders. However, depending on the intended purpose, NMES should preferentially stimulate either slow-two or fast-twitch fibers. In the present study the influence of the stimulation frequency on these muscle fibers investigated for 2 current types frequently used for NMES. To be able to examine the influence of the freque and the current type on the intrinsic reactivity of slow and fast muscles fibers, the soleus (slow-twitch) and exter digitorum longus (fast-twitch) muscle. 2 homogeneous muscles of the guinea pig were chosen as a model, studied in vitro to avoid the influence of the skin and the subcutaneous tissues. Both muscles were randomly stimulated at frequencies of 25, 33, 50, 66 and 100 Hz using a low-frequency cur (LFC) (biphasic symmetric rectangular, with a pulse duration of 800 its) and a mid-frequency current (M-(biphasic symmetric rectangular, with an internal frequency of 2500 Hz). The results illustrate that for both, slow and fast-twitch muscle fibers, there is a correlation between the freque: and the isometric contraction force (ICF) induced by NMES. independent of the current type used. ICF is max at a frequency of 33 Hz for slow-twitch fibers, and at 100 Hz for fast-twitch fibers. For clinical applications of NM this optimal frequency might be an indication for the frequency to apply in order to maximally recruit sloy fast-twitch fibers, depending on the goal of NMES. Although energy delivery to the tissue was 6 to 25 times hi with the MFC than with the LFC, the ICF induced by the LFC was equal to or even higher than that induced by MFC, suggesting that the LFC is preferable, which corresponds to in vivo observations.
Kinematic analyses of thoracoabdominal movements and regional changes in lung volume were done in 27 patients with Duchenne muscular dystrophy (DMD) and 9 controls during normal tidal and deep breathing. Changes were correlated with the extent of nocturnal hypoventilation at various stages of the disease. An automatic motion analyzer was adapted and used to compute three-dimensional coordinates of passive markers on the thoracoabdominal wall very accurately at sampling rates of up to 25 Hz. The patients' vital capacities (VC) and maximum inspiratory pressures (MIP) were also measured, and their nocturnal oxyhemoglobin saturations (SaO 2 ) and transcutaneous carbon dioxide tensions (TCP CO2 ) monitored. Kinematic data were related to pulmonary function. In general, patients were significantly less able than controls to expand their upper thoracic segments and increase their lung volumes. The kinematic capacity and ability of patients to increase volumes in the abdominal and upper thoracic regions by deep breathing decreased with the severity of the disease. Among the patients with pulmonary restriction and inspiratory muscle strength at an intermediate-level those with higher kinematic reserve maintained a significantly more normal ventilatory capacity and a more normal nocturnal SaO 2 than those with a lower kinematic reserve. We conclude that kinematic analysis can be helpful in determining differences in regional lung mobility, and that a decreased kinematic reserve correlates with the risk of nocturnal ventilatory dysfunction in DMD patients. Therapeutic interventions must be addressed at maintaining thoracoabdominal kinematic reserve and lung compliance in such patients.
As there is no unanimity found in literature concerning the occurrence (0% to 88.8%) of the Hoffmann-reflex in the abductor hallucis muscle, 56 healthy subjects were examined unilaterally to determine if a Hoffmann-reflex and/or an F-wave could be elicited. Recording was done with surface electrodes at the abductor hallucis muscle, and stimulation was applied to the tibial nerve at the ankle (behind the medial malleolus), and at the popliteal fossa. A Hoffmann-reflex could be recorded in 21.4% of all cases by stimulating at the ankle and recording at the abductor hallucis muscle; F-waves were obtained in 100%. The mean Hoffmann-reflex latency was 49.2 ms with a standard deviation of 3.7. Stimulation at the popliteal fossa also induced a Hoffmann-reflex in 21.4%. From these results we calculated the sensory conduction velocity of the tibial nerve in the lower leg segment to be 50.1 ± 5.0 m/s. Multiple linear regression analysis of F-wave latency, leg length, and age yielded the following regression equation: F-wave latency (ms) = 0.54 leg length (cm) + 0.13 age (years) - 5.67.
The purpose of this methodological study was to evaluate the reliability, internal consistency, and sensitivity of a new self-report functional outcomes profile, the California Functional Evaluation 40 (CAFE 40). The CAFE 40 contains 3 sections: 1. Section I: General health and activity level rated on an ordinal scale; 2. Section II: Independence-assistance needed rated on an ordinal scale; and 3. Section III: Endurance (specific listing of the patient reported amount of time that can be spent at a specific task such as walking, sitting, writing). In this study, Sections I and II were evaluated. Section III was rarely completed by the patients or normal subjects. 38 patients from 5 physical therapy outpatient clinics and 64 healthy adults participated in the reliability study by completing the functional profile twice within a 2 day interval. Test-retest reliability for the total profile score was high (r ic = 0.971). Internal consistency (the correlation between each item and the total section score reaching 0.5 or better) was acceptable for all but one item each in Section I and II (with the Spearman Rank Correlation Coefficient ranging from 0.408 to 0.82 in Section I and 0.463 to 0.748 in Section II). 45 patients participated in the sensitivity study where the subjects completed the CAFE 40 at each physical therapy visit. A significant positive linear trend of improvement was noted (p < 0.001, Page Test). The last score was significantly higher than the first score for both Section I and II (p < 0.001 respectively as measured by Paired Wilcoxon Test). The results indicate that Sections I and II of the CAFE 40, have acceptable reliability, internal consistency, and sensitivity for measuring functional outcomes in healthy adults and patients receiving outpatient physical therapy. A revised profile is currently available for continued test development and broader application. Professionals in rehabilitation are encouraged to use this functional outcomes tool in their outpatient practices and send comments to the California Research Special Interest Group for continued improvement in the questionnaire.
An implantable system with a monopolar half-cuff for selective stimulation of the common peroneal nerve is evaluated in this paper. The results of gait analysis of 2 of 3 hemiplegic patients with implanted stimulator are presented. Several stimuli affecting a selective stimulation of the superficial region of the human common peroneal nerve are proposed in this work: current, charge balanced, and biphasic pulses with a rectangular cathodic component, and an exponentially decaying anodic component delayed for 50 μs. Half-cuff electrodes have shown to be suited for producing long-term selective activation of mainly those muscles that contribute to strong dorsal flexion and moderate eversion of the hemiplegic foot. Moreover, significant improvements of gait without excessive eversion were observed. Gait analyses in 2 patients showed a significant increase in the velocity, cadence, and stride length of natural gait. This increased velocity of gait was achieved by an improvement in all parameters of time and length of the left and right steps. With their gait stimulated, the patients' step parameters (step, stance, swing, double support durations, and step length) shifted towards normal parameters, even though the patients' natural gait was still slower than that of healthy individuals. It was also found that the peaks of both the dorsal/plantar and inversion/eversion angular velocities of the unstimulated foot were higher than the peaks of angular velocity of the stimulated foot. Therefore, the contraction velocities of the anterior tibial and long peroneal muscles were much higher without than with stimulation.
Endofibrosis of the external iliac artery has only recently been recognized as a possible cause of leg pain in cyclists. Due to the typical position on the bicycle (hip in hyperflexion) and to the high haemodynamic load during cycling, endofibrosis develops gradually, producing typical claudicational pain in the affected leg upon (sub)maximal effort. A case report is presented and the diagnostic and therapeutic options are discussed.
Little is known about the effect of ultrasound (US) on the angular orientation of tissues. This study was designed to evaluate the mechanical effects of US on the angular orientation of fibroblasts. 30 dishes of human fibroblasts were seeded and randomly assigned to a control or 1 of 4 treatment groups where the fibroblast media was: 1) circled and sonated; 2) linearly moved and sonated; 3) circled with sham US; or 4) linearly moved with sham US. US was administered for 5 min every other day over 5 d (0.3 W/cm 2 , 1 MHz, pulsating at a 20% duty cycle [ultrasound on 2 ms and off 8 ms]). The sham groups were treated similarly but the US was not turned on. All groups were photographed and measured every other day with the angular changes for each measurement period analyzed using a Two Factor Repeated Measures ANOVA followed with posthoc testing of all meaningful contrasts (Dunn Method). There were significant effects of group, trial, and group by trials. In the control group, the fibroblasts were very stable in their orientation over the 5 d (moved a total of 0.08°) and the sham groups did not move significantly (9.5° and 2.3° respectively for the circular and linear sham groups). Compared to controls, posthoc testing revealed significant changes in the angle of orientation for the fibroblasts that were sonated and circled (25.4°) and those that were sonated and moved linearly (20.3°). The fibroblasts in the linear US group moved significantly more than the linear sham group (18 additional degrees). There were no significant differences between the angular change measured in the fibroblasts in the circular US group compared to the linear US group. This research must be extended to in-vivo human studies to determine if the orientation of collagen fibers can be influenced by the directional movement of the US applicator head or the controlled movement of the tissue under the applicator head. If the origin of collagen fibers can be strategically altered with US, then both the speed and the strength of healing may be enhanced.
Sensory interaction deficits can be identified in elders, but it is not clear if these impairments provide a sensitive and specific measure of fall status. The sensitivity, specificity, and predictive value of a clinical test of sensory interaction for balance (CTSIB) was tested in a population of community-dwelling elders to identify falters. Subjects: 47 elders (8 male and 39 female) participated and were between 65 and 96 years of age (mean age 80.5, SD = 9 years). A case-controlled design was used. Subjects with 2 or more falls in the 6 months prior to study were assigned to a Fall group (n = 16). Those with no history of falling during the same interval of time were assigned to a No-Fall group (n = 31). Classification functions were developed from a discriminant analysis using each sensory condition in the CTSIB. Cross validation of the discriminate functions for fallers and non-fallers was done to test the predictive model on 20% of the subjects randomly selected from each group. The relative risk of falling was estimated using an age-adjusted odds ratio. A composite CTSIB score was also evaluated to determine if the sensitivity of the overall score differed from the sensitivity of the deficit-pattern represented in the classification function. Discriminant functions correctly classified 77% of the non-falters and 63% of the falters. Cross validation analyses predicted that 3 out of 5 non-falters, and 3 out of 4 falters would be classified correctly if the discriminant functions were applied to subjects not included in the present study. For subjects over 81 years of age, the CTSIB correctly classified 83% of the non-falters (10 of 12 subjects) and 80% of the falters (8 of 10 subjects). In contrast, 95% of the non-falters (18 of 19 subjects) and 67% of the falters (4 of 6 subjects) were classified correctly for those younger than 82 years of age. Overall, the odds of falling were 8.67 times greater for those who had an abnormal CTSIB pattern compared to those who did not. The sensitivity measured by discriminant classifications (63 to 80%) was considerably better than that based on a composite stance duration (44%). The CTSIB was found to be a sensitive and specific measure of recurrent falls in community dwelling elders, but only when the pattern of sensory-interaction abnormality during stance on foam was used to determine fall status.
An experimental pilot study of 20 female Fischer rats was conducted to assess the effect of laser on tissue regeneration in burns. Each animal acted as its own control since 2 burns were inflicted (one was treated and the other was left untreated). 2 subpopulations of 10 animals each were studied. In group 1 the experimental burn was treated with He-Ne laser, in group 2 with Ga-As laser. In none, of these groups could any real stimulating effect of laser be demonstrated on the basis of macroscopic and light microscopic studies. The slight differences between the macroscopic and microscopic results are intriguing but in se of little or no relevance as yet
Summary: Long-term ambulatory monitoring of mobility-related activities is a method of collecting data that overcomes some of the shortcomings of most other methods in rehabilitation. The aim of the first phase project is the development of a user- and patient-friendly instrument that enables distinguishing between a Set of selected mobility-related activities in a reliable and valid manner. Accelerometers appear to be the most appropriate sensors to use. In this study a first set of mobili tyrelated activities is formulated. The configuration of sensors and the analytical algorithms, which form the starting point for subsequent investigations, are determined. The set of selected activities consists of lying, sitting, standing, walking, walkin g up- and down stairs and cycling. The study demonstrates that the optimal configuration consists of 3 accelerometers, 2 on the trunk and 1 on the upper leg. With this configuration of sensors and using relatively simple analytical algorithms it is possib le to distinguish the activities mentioned. It appears that the detection of static activities is less complex than the detection of dynamic activities. The reliability and validity of the instrument will be investigated in the next phase of the project. (Eur j phys med rehabil 1995;5: 2-7)
The author performed a double-blind, placebo-controlled study, by applying ultrasonic or placebo underwater treatment to both hands of 50 rheumatoid arthritis patients. A number of clinical parameters improved significantly in the treated group compared with the placebo group, although improvement was observed in several cases of the placebo group as well. No significant change was found in the laboratory parameters
The clinical evidence for the efficacy of physiotherapy found in 180 randomized clinical trials (RCTs) in the literature was summarized. Bibliographic data bases, citation tracking, and correspondence with research in the field provided the material for our study. Focusing on disorders of the musculoskeletal system, a number of criterion-based meta-analyses were performed in order to summarize the available evidence. For each RCT a methodological score was calculated in each meta-analysis. A set of explicit criteria and weight factors were applied to the material by 2 or 3 independent reviewers who were blinded as to the outcome, the journal, and the authors of the publications at issue. In each meta-analysis, the RCTs were put into hierarchical order depending on the score they got for their methodological quality. Meta-analyses were performed for spinal manipulation, exercise therapy, traction, ultrasound, and laser therapy, and for disorders of the back, neck, shoulder and knee. In general, the methodological quality of the studies appears to be rather low, and the efficacy of physiotherapy is convincing for only a few indications and treatments. On the other hand, it is the prevalence of serious methodological flaws that does not allow us to draw the conclusion that physiotherapy has no effect.
