Effects of the Proprioceptive Exercises on Isokinetic Strength and Postural Control

OBJECTIVE: To investigate the effects of lower extremity proprioceptive training on postural control and strength of the knee and ankle muscles. METHOD: Twenty-two healthy subjects (age 27+/-4 yrs) were randomly assigned to a training (TRN, n=11) or a control (CTL, n=11) group. TRN group participated in the dominant leg proprioceptive training that was performed on a balance board and mini-trampoline without strength training for 6 weeks. All subjects were evaluated for leg muscle strength and postural sway using the isokinetic device and force platform before and after the training. Assessed parameters were 1) concentric and eccentric strength of knee flexor/ extensor and concentric strength of ankle plantar flexor/dorsiflexor and invertor/evertor 2) the standard deviation of the postural sway with eyes open or closed. RESULTS: Statistically significant improvements in both medial-lateral and anterior-posterior parameters of postural sway with eyes closed were observed after training in TRN group (p < 0.05) compared to CTL group. But no significant changes in any isokinetic strength parameters were observed after training in TRN group. CONCLUSION: The proprioceptive exercises that we used could improve one-leg balance without significant strength gain after 6 weeks training.

The Effect of Intrathecal Baclofen Injection on Muscle Stretch Reflex in Spinal Cord Injured Rabbit

OBJECTIVE: To develop an experimental model that is useful to evaluate the effect of antispastic medication administered intrathecally and to titrate the intrathecal baclofen effect quantitatively by using muscle stretch reflex. METHOD: Ten rabbits were laminectomized posteriorly and intrathecal catheter was inserted. Then the spinal cords were contused by 12.5 gx20 cm weight drop around 12th thoracic vertebra. After 8~12 days, muscle stretch reflex was measured before intrathecal baclofen injection (ITBI) and after ITBI 30 minutes, 60 minutes, and 120 minutes. Rabbits' triceps surae were dissected and stretched 5 mm at the rate of 2 mm/sec using a step motor. The change of muscle tension was graphed into the time (length)-tension curve. The slope in the time (length)-tension curve was defined as stiffness index (SI). RESULTS: The measurement of muscle stretch reflex was available in 5 of 10 spinal cord injured rabbits. The proportion of SI reduced significantly at 60 minutes and 120 minutes compared to baseline (p=0.005, p<0.001). CONCLUSION: Our data proved the antispastic effect of ITBI quantitatively by using muscle stretch reflex. We concluded that the quantitative measurement method of the antispastic effect of ITBI will be useful in evaluating antispastic effect by intrathecal administration of the other antispastic medications.

The Effect of Gabapentin on Muscle Stretch Reflex in Spinal Cord Injured Rabbit

OBJECTIVE: To document the anti-spastic effect and dose-response relationship of gabapentin (GBP) quantitatively using muscle stretch reflex in spinal cord injured rabbits. METHOD: Spinal cords of 25 rabbits were contused by 20 gx20 cm weight drop in the 11th thoracic spine. After 2 weeks, muscle stretch reflex was measured. Triceps surae was dissected and stretched for 5 mm at the rate of 2 mm/sec and the length-tension curve were obtained. The slope in the length-tension curve was defined as stiffness index (SI). After baseline measurement, group I (n=6) received 50 mg/kg GBP IM injection and group II (n=8) received 100 mg/kg GBP IM injection, but control group (n=5) did not. Muscle stretch reflex was measured again after 30 minutes and 60 minutes, and then after sciatic nerve section. Active tension was calculated by subtracting passive tension from total tension. Proportion of SI was calculated by dividing follow-up SI with baseline SI. RESULTS: The proportion of SI of active tension reduced significantly at 30 minutes and 60 minutes compared to baseline (p<0.001, p<0.001). The proportion of SI of active tension in both group I and group II reduced significantly than control group (p=0.041, p<0.001). The proportion of SI of active tension in group II reduced than group I, but it was not statistically significant (p=0.166). CONCLUSION: The GBP reduced significantly muscle stretch reflex in spinal cord injured rabbits and showed dose-response tendency.

Musculoskeletal Causes of Anterior Chest Wall Pain

OBJECTIVE: To investigate the musculoskeletal causes of anterior chest pain and know the prevalencies of the diseases. METHOD: During 4-year periods (1997-2001), 37 patients with anterior chest wall pain was analyzed with regard to the causes of pain and the frequencies of the diseases. RESULTS: 17 patients (45.9%) had systemic diseases and 20 patients (54.1%) had focal joint problems. Systemic disease included the undifferentiated spondyloarthropathy (18.9%), ankylosing spondylitis (13.5%), psoriatic arthritis (2.7%), SAPHO (Synovitis, Acne, Psoriasis, Hyperostosis, Osteitis) syndrome (8.1%), and rheumatoid arthritis (2.7%). Focal joint diseases included costochondritis (10.8%), sterno clavicular inflammatory arthropahty (5.4%), sternoclavicular hyperostosis (2.7%) and infective arthritis (2.7%). Other focal joint problems were pain in sternoclavicular joint with the tenderness and swelling (2.7%), pain in costochondral joint (13.6%), sternoclavicular joint (5.4%), xyphoid process (2.7%) with only focal tenderness. 3 (8.1%) patients had pain in chest wall which had no focal tenderness and swellings on the joint. CONCLUSION: Diverse systemic diseases were identified as causes of the anterior chest wall pain. So physiatrist keep in mind this result and make use of them in diagnostic approaching of the anterior chest pain due to chest wall skeletal involvemen.

Diabetic Muscle Infarction in Diabetes; Three cases report

Spontaneous muscle infarction in diabetic patients is a rare condition that usually occurs in those with advanced diabetic complications. Increased clinical awareness is important for early recognition, particularly in a diabetic patient presenting with a painful thigh or leg swelling. However, the disorder has received little attention in the rehabilitation medicine literature. Magnetic resonance imaging is the diagnostic choice of study, and in the appropriate clinical setting, may obviate the need for a muscle biopsy. We reported three patients with diabetic muscle infarction, review additional reported cases, and discussed the principles of diagnosis and management.