Obstructive sleep apneas in relation to severity of cervical spinal cord injury.

Thirty-three subjects (28 men, five women) with complete or incomplete cervical cord injury representing a wide range of neurological impairment were investigated with regard to the prevalence of Obstructive Sleep Apnea (OSA). The relation between OSA and neurological function, respiratory capacity, body mass index and symptoms associated with OSA were studied. Overnight sleep recordings employed combined oximetry and respiratory movement monitoring. Pulmonary function tests included static and dynamic spirometry, maximal static inspiratory and expiratory pressures at the mouth. The subjects answered a questionnaire concerning sleep quality and tiredness. The prevalence of OSA was 15% (5/33) in this nonobese cervical cord injury study population. Nine percent of the subjects (3/33) fulfilled the criteria for obstructive sleep apnea syndrome, but daytime sleepiness or fatigue were also common in subjects without OSA. There was an inverse correlation between oxygen desaturation index and American Spinal Injury Association (ASIA) motor score in the subjects with complete injury, while there was no such correlation in the whole study group. There were significant correlations between maximal inspiratory and expiratory pressures and vital capacity and between ASIA motor score and vital capacity.

Dynamic muscle strength training in stroke patients: effects on knee extension torque, electromyographic activity, and motor function.

The effects of training with isokinetic maximal voluntary knee extensions were studied in stroke patients. Two groups of 10 patients each trained twice a week for 6 weeks. One group trained exclusively eccentric movements and the other exclusively concentric movements. The effects were evaluated from the following tests before and after the training period. The maximal voluntary strength in concentric and eccentric actions of the knee extensor and flexor muscles was recorded together with surface electromyography at constant velocities of 60, 120, and 180 deg.s-1 on three different days. The body weight distribution on the legs while rising and sitting down was measured with two force plates. The self-selected and maximal walking speeds and the swing to stride ratio of the paretic leg were measured. After the training period, the knee extensor strength had increased in eccentric and concentric actions in both groups (p < .05). The eccentric and the concentric strength in the paretic leg relative to that of the nonparetic leg increased in the eccentrically trained group (p < .05) but not in the concentrically trained group. The restraint of the antagonistic muscles in concentric movements increased after concentric (p < .05) but not eccentric training. A nearly symmetrical body weight distribution on the legs in rising from a sitting position was noted after eccentric (p < .05) but not concentric training. Changes in walking variables were not significantly different between the groups. Eccentric knee extensor training was thus found to have some advantages as compared to concentric training in stroke patients.