Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines.

The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.

What is the Fracture Risk in Patients at a Multidisciplinary Neuromuscular Clinic?

Many neuromuscular diseases (NMD) result in muscle weakness, immobility and greater fracture risk. The objective of this study is to determine the fracture risk of adult patients at a multidisciplinary NMD clinic. Fracture risk was calculated using the Fracture Risk Assessment Tool, the presence of osteoporosis was quantified using bone densitometry and contributing co-morbidities were screened through serum markers. Of the 36 patients studied, 47% were found to be of moderate and high fracture risk. Two thirds of these patients had not been previously screened or treated for osteoporosis. These findings suggest that NMD patients warrant routine screening for osteoporosis and early treatment to reduce fragility fracture.

Axial signs and magnetic resonance imaging correlates in Parkinson's disease.

BACKGROUND: Age-related brain changes may contribute to axial features in Parkinson's disease (PD). OBJECTIVES: To determine if ventricular volume and white matter high signal changes (WMC) are related to motor signs in PD and controls independent of age. METHODS: Patients were rated with the Unified Parkinson's Disease Rating Scale (subscore A: tremor, rigidity, bradykinesia, and facial expression; subscore B: speech and axial impairment). Steps and time taken to walk 9.144 meters were measured. Total ventricular volume (TVV) and intracranial volume (ICV) were measured on T1-weighted MRI using manual tracing software. WMC were rated on axial T2-weighted, dual-echo or FLAIR MR images using a visual scale. RESULTS: TVV (cm3) (PD: 36.48 +/- 15.93; controls: 32.16 +/- 14.20, p = 0.21) and WMC did not differ between groups (PD: 3.7 +/- 4.2; controls: 3.2 +/- 3.1, p = 0.55). Age correlated positively with ICV-corrected TVV and WMC in PD (cTVV: r = 0.48, p = 0.003; WMC: r = 0.42, p = 0.01) and controls (cTVV: r = 0.31, p = 0.04; WMC: r = 0.44, p = 0.003). Subscore B (r = 0.42, p = 0.01) but not subscore A (r = 0.25, p = 0.14) correlated with cTVV in PD. Steps and walking time correlated with cTVV and WMC in PD; cadence correlated with cTVV and steps with WMC in controls. Age-adjustment eliminated correlations. CONCLUSION: Subscore B, but not subscore A correlated positively with ventricular volume in PD, though this association was accounted for by age. Age-related brain change super-imposed on PD may contribute to axial features.

Behavioral and electromyographic characterization of mice lacking EphA4 receptors.

EphA4 receptors play an important role in axon guidance during development. Disrupting the expression of these receptors in mice has been shown to modify neuronal connections in the spinal cord and results in the production of a characteristic hopping gait. The EphA4-null mouse has been used in numerous investigations aimed at establishing mechanisms responsible for patterning motor activity during walking. However, there have been no detailed behavioral or electrophysiological studies on adult EphA4-null mice. We used high-speed video recordings to determine the coordination of leg movements during locomotion in adult EphA4-null mice. Our data show that the hopping movements of the hind legs are not always associated with synchronous movements of forelegs. The coupling between the forelegs is weak, resulting in changes in their phase relationship from step to step. The synchronous coordination of the hind legs can switch to an alternating pattern for a short period of time during recovery from isoflurane anesthesia. Comparison of the kinematics of hind leg movements in EphA4-null mice and wild-type animals shows that besides the synchronous coordination in EphA4-null mice, the swing durations and the swing amplitude are shorter. Electromyographic recordings from a knee extensor muscle show double bursting in the EphA4-null animals but single bursts in wild types. This double burst changes to single-burst activity during swimming and when hind legs are stepping in alternation. These observations suggest an influence of sensory feedback in shaping the pattern of muscle activity during locomotion in the mutant animals. Our data give the first detailed description of the locomotor behavior of an adult mouse with genetically manipulated spinal networks.