A controlled trial of amino acid therapy in amyotrophic lateral sclerosis: I. Clinical, functional, and maximum isometric torque data.

We conducted a two center, double-blind, placebo-controlled treatment trial with oral branched chain amino acids (BCAA) (L-leucine 12 g, L-isoleucine 8 g, and L-valine 6.4 g daily) or L-threonine (4 g daily) with pyridoxal phosphate (160 mg daily) for six months in patients with amyotrophic lateral sclerosis (ALS). The effect of treatment on disease progression was estimated every two months by recording clinical muscle strength, maximum isometric muscle torque in selected muscles, forced vital capacity (FVC), activities of daily living pertaining to the upper and lower limbs, and timed tasks. Ninety-five patients were randomized to receive BCAA (n = 31), L-threonine (n = 32), or placebo (n = 32), of whom 77 (81%) completed the trial. Mean weight loss in the placebo group was 1.1 kg and in the L-threonine group was 3.2 kg; the BCAA group gained 0.2 kg (p = 0.04). The estimated decline in FVC was about 2.5 times greater in the BCAA and L-threonine groups as compared to placebo (p = 0.03). Otherwise, no significant differences were found in the changes observed in clinical, functional, timed, or maximum torque measures among treatment groups. The amino acids were well tolerated. The results of our study failed to show a beneficial effect of BCAA or L-threonine treatment for six months on the disease course in ALS. The higher rate of loss of pulmonary function in patients treated with BCAA or L-threonine may have been due to chance, but an adverse effect of these amino acids cannot be ruled out.

Pharmacologic management of hyperglycemia in diabetes mellitus: implications for physical therapy.

Diabetes mellitus is a costly, chronic disease that affects millions of Americans each year. The classic triad of diabetes management includes diet, exercise, and pharmacological intervention. A variety of complications may result due to this chronic disease, and manipulation of the triad of treatment factors may be necessary in order to effectively treat the individual patient. Physical therapists are consulted in both the primary care of patients with diabetes and in the case of complications; therefore, an understanding of the various forms of the disease, the complications, and the treatment approaches is necessary for comprehensive patient management. The purposes of this article are to give an overview of the disease and its common complications and to discuss the various treatment approaches with emphasis on the pharmacological interventions and physical therapy concerns.

Reliability of isokinetic measurements of hip muscle torque in young boys.

The purpose of this study was to determine the reliability of measurements of hip muscle torque obtained with the Cybex II isokinetic dynamometer from healthy young boys. Twenty-nine healthy boys, aged 6 to 10 years, were tested two times at one- to two-week intervals. Torque of the hip flexors and extensors and the hip abductors and adductors was assessed at angular velocities of 30 degrees and 90 degrees/sec. The torque generated by each muscle group at 30 degrees/sec was similar to the torque generated at 90 degrees/sec. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability for measurements of each of the muscle groups at both angular velocities. The ICCs were higher for hip flexion and extension than they were for hip abduction and adduction. The highest ICC (ICC = .84) was found for hip extension at 90 degrees/sec. The ICCs for hip abduction and adduction at both angular velocities were less than .60. Factors that possibly contributed to the relatively low reliability in hip abduction and adduction are discussed.