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1.
Nat Rev Neurol ; 19(4): 221-234, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36879033

RESUMO

People with psychotic disorders can show marked interindividual variations in the onset of illness, responses to treatment and relapse, but they receive broadly similar clinical care. Precision psychiatry is an approach that aims to stratify people with a given disorder according to different clinical outcomes and tailor treatment to their individual needs. At present, interindividual differences in outcomes of psychotic disorders are difficult to predict on the basis of clinical assessment alone. Therefore, current research in psychosis seeks to build models that predict outcomes by integrating clinical information with a range of biological measures. Here, we review recent progress in the application of precision psychiatry to psychotic disorders and consider the challenges associated with implementing this approach in clinical practice.


Assuntos
Psiquiatria , Transtornos Psicóticos , Humanos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia
2.
Schizophr Bull ; 49(4): 893-902, 2023 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-36916850

RESUMO

BACKGROUND AND HYPOTHESIS: Treatment response to specific antipsychotic medications is difficult to predict on clinical grounds alone. The current study hypothesizes that the baseline complement pathway activity predicts the treatment response and investigates the relationship between baseline plasma biomarkers with treatment response to antipsychotic medications. STUDY DESIGN: Baseline plasma samples were collected from first episode of psychosis patients (n = 243) from a multi-center clinical trial. The participants were treated with amisulpride for 4 weeks. Levels of complement and coagulation proteins at baseline were measured using both data-dependent and data-independent mass spectrometry approaches. The primary outcome was remission status at 4 weeks and the secondary outcomes included change in psychotic and functional symptoms over the period of treatment. In addition, immunoassays were performed at baseline for complement C1R, as well as for activation markers C4a and sC5b-9. STUDY RESULTS: The plasma level of complement variant C4A was significantly associated with remission at 4 weeks. Moreover, higher levels of several complement and coagulation pathway proteins were associated with a reduction in psychotic symptoms and an improvement in functioning. Immunoassays showed an association of baseline levels of C1R and C4a as well as complement activation marker sC5b-9 levels with treatment response. CONCLUSION: The results demonstrated that the response to antipsychotic treatment might be related to pre-treatment levels of plasma complement and coagulation pathway proteins. This is consistent with independent evidence associating immune dysfunction with the pathophysiology of psychosis. Moreover, these results inform the development of novel therapeutic approaches that target the complement system for psychosis.


Assuntos
Antipsicóticos , Transtornos Psicóticos , Humanos , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Transtornos Psicóticos/diagnóstico
3.
BMC Musculoskelet Disord ; 20(1): 231, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101039

RESUMO

BACKGROUND: There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR. METHODS: A controlled clinical trial was conducted at the Orthopedic University Hospital of Rion, Greece involving allocation concealment to patients. Fifty-two patients electing to undergo TKR were randomised to either early-initiated SMT [experimental] or functional exercise training [control] in a home-based environment. Groups were prescribed equivalent duration of exercise during 12-weeks, 3-5 sessions of ~ 40 min per week of home-based programmes. Muscle strength and activation (peak force [PF]; peak amplitude [Peak Amp.] and root mean square of integrated electromyography [RMS iEMG]), muscular size (including rectus femoris muscle cross-sectional area [CSARF]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery). RESULTS: Patients undertaking SMT rehabilitation showed significantly greater improvements over the 14 weeks compared to control in outcomes including quadriceps PF (25.1 ± 18.5 N vs 12.4 ± 20.8 N); iPeak Amp. (188 ± 109.5% vs 25 ± 105.8%); CSARF (252.0 ± 101.0 mm2 vs 156.7 ± 76.2 mm2), respectively (p < 0.005); Knee ROM did not offer clinically relevant changes (p: ns) between groups over time. At 14 weeks post-surgery, the SMT group's and control group's performances differed by relative effect sizes (Cohen's d) ranging between 0.64 and 1.06. CONCLUSION: A prescribed equivalent time spent in SMT compared to usual practice, delivered within a home-based environment, elicited superior restoration of muscle strength, activation and size in patients following TKR. TRIAL REGISTRATION: ISRCTN12101643 , December 2017 (retrospective registration).


Assuntos
Artroplastia do Joelho/reabilitação , Terapia por Exercício/métodos , Serviços Hospitalares de Assistência Domiciliar , Força Muscular/fisiologia , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Retroalimentação Sensorial/fisiologia , Feminino , Grécia , Humanos , Articulação do Joelho/cirurgia , Masculino , Osteoartrite do Joelho/reabilitação , Músculo Quadríceps/fisiologia , Recuperação de Função Fisiológica , Método Simples-Cego , Estudos de Tempo e Movimento , Resultado do Tratamento
4.
Neuropsychopharmacology ; 44(4): 757-765, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30559463

RESUMO

Telomere length is a promising biomarker for age-related disease and a potential anti-ageing drug target. Here, we study the genetic architecture of telomere length and the repositioning potential of lithium as an anti-ageing medication. LD score regression applied to the largest telomere length genome-wide association study to-date, revealed SNP-chip heritability estimates of 7.29%, with polygenic risk scoring capturing 4.4% of the variance in telomere length in an independent cohort (p = 6.17 × 10-5). Gene-enrichment analysis identified 13 genes associated with telomere length, with the most significant being the leucine rich repeat gene, LRRC34 (p = 3.69 × 10-18). In the context of lithium, we confirm that chronic use in a sample of 384 bipolar disorder patients is associated with longer telomeres (p = 0.03). As complementary evidence, we studied three orthologs of telomere length regulators in a Caenorhabditis elegans model of lithium-induced extended longevity and found all transcripts to be affected post-treatment (p < 0.05). Lithium may therefore confer its anti-ageing effects by moderating the expression of genes responsible for normal telomere length regulation. This is supported by our bipolar disorder sample, which shows that polygenic risk scores explain a higher proportion of the variance in telomere length amongst chronic lifetime lithium users (variance explained = 8.9%, p = 0.01), compared to non-users (p > 0.05). Consequently, this suggests that lithium may be catalysing the activity of endogenous mechanisms that promote telomere lengthening, whereby its efficacy eventually becomes limited by each individual's inherent telomere maintenance capabilities. Our work indicates a potential use of polygenic risk scoring for the prediction of adult telomere length and consequently lithium's anti-ageing efficacy.


Assuntos
Transtorno Bipolar/genética , Lítio/farmacologia , Longevidade/efeitos dos fármacos , Telômero/efeitos dos fármacos , Adulto , Animais , Transtorno Bipolar/tratamento farmacológico , Caenorhabditis elegans , Estudos de Casos e Controles , Feminino , Expressão Gênica/efeitos dos fármacos , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Telômero/genética
5.
Clin Rehabil ; 32(7): 888-898, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29473481

RESUMO

OBJECTIVE: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. DESIGN: A single-blind controlled clinical trial. SETTING: University Hospital of Rion, Greece. SUBJECTS: A total of 52 participants following total knee replacement. OUTCOME MEASURES: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). INTERVENTION: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3-5 sessions/week (35-45 minutes). RESULTS: Consistently greater improvements ( F2,98 = 4.3 to 24.8; P < 0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8 ± 2.9 seconds vs. 4.6 ± 2.6 seconds); balance (2.1 ± 0.9° vs. 0.7 ± 1.2°); joint position error (13.8 ± 7.3° vs. 6.2 ± 9.1°); Knee Outcome Survey Activities of Daily Living Scale (44.2 ± 11.3 vs. 26.1 ± 11.4); and pain (5.9 ± 1.3 cm vs. 4.6 ± 1.1 cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3-6.5. CONCLUSIONS: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.


Assuntos
Artroplastia do Joelho/reabilitação , Terapia por Exercício/métodos , Autogestão , Idoso , Avaliação da Deficiência , Teste de Esforço , Feminino , Humanos , Masculino , Medição da Dor , Equilíbrio Postural , Método Simples-Cego
6.
J Back Musculoskelet Rehabil ; 28(4): 877-82, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25547235

RESUMO

A 22-year-old patient undergoing unilateral surgical reconstruction of the anterior cruciate ligament (ACL) of the right knee volunteered for the research project and followed an established contemporary hospital-based rehabilitation programme. The patient was supervised post-surgically by an experienced and clinically specialized physiotherapist. The clinical outcomes of rehabilitation were assessed by selected validated patient-reported and objectively-measured outcomes of functional performance capability on four different occasions (pre-surgery, 6th, 12th and 24th week post-surgery). The patient scored 30, 56, 60 and 85 on IKDC (maximum score, 100); 46, 53, 90 and 91 on Lysholm (maximum score, 100); 141, 73, 128 and 175 on K-SES (maximum score, 220); 17, 12, 6 and 6 on the symptom subsection of KOOS (maximum score, 28); 7, 7, 5 and 5 on the pain subsection (maximum score, 36); 1, 0, 3 and 1 on the daily function subsection (maximum score, 68); 0, 0, 5 and 5 on the sport and recreation function subsection (maximum score, 20); 13, 11, 15 and 13 on the quality of life subsection (maximum score, 16) of KOOS at pre-surgery and at the 6th, 12th and 24th week following ACL reconstruction, respectively. Moreover, the patient scored 1.96 m, 1.92 m and 1.99 m on single-leg hop (injured leg) when assessed at pre-surgery and at the 12th and 24th week post-surgery, respectively, following ACL reconstruction. The total time spent in supervised rehabilitation by the patient (675 minutes) was computed as the aggregate patient-reported time spent in exercise during each hospital-based rehabilitation session (verified by physiotherapist evaluation) across the total number of sessions. The patient managed to return to the sport in which he had participated prior to the injury, immediately after the completion of the contemporary rehabilitation programme, at 24 weeks post-surgery. A total of fifteen physiotherapy sessions supervised by the physiotherapist, were attended by the patient during the 24 week rehabilitation period. The latter number of physiotherapy sessions was substantially less than the average supervised physiotherapy sessions reported in the literature.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Traumatismos do Joelho/reabilitação , Modalidades de Fisioterapia , Cuidados Pós-Operatórios/métodos , Qualidade de Vida , Seguimentos , Humanos , Traumatismos do Joelho/cirurgia , Masculino , Fatores de Tempo , Adulto Jovem
7.
Disabil Rehabil Assist Technol ; 10(6): 445-451, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24749536

RESUMO

PURPOSE: This exploratory trial investigated the effects of rigid ankle foot orthoses (AFO) with an optimally cast Angle of the Ankle in the AFO (AAAFO) on the gait of children with Cerebral Palsy (CP), and whether tuning of the AFO - Footwear Combination (AFO-FC) further affected gait. METHODS: Eight children with CP underwent gait analysis and tuning of their AFO-FCs using a 3-D motion analysis system. Comparisons were carried out for selected gait parameters between three conditions - barefoot, non-tuned AFO-FC and tuned AFO-FC. RESULTS: In comparison to barefoot gait, walking with a non-tuned AFO-FC produced significant (p < 0.05) improvements in several key gait parameters. Compared to the non-tuned AFO-FC, on average a tuned AFO-FC produced a significant reduction in peak knee extension and knee ROM during gait. However, when examined as case studies, it was observed that the type of gait pattern demonstrated while wearing a non-tuned AFO-FC affected the outcomes of tuning. CONCLUSIONS: The findings of the current study indicate the potential benefits of using rigid AFO-FC with optimal AAAFO and tuning of AFO-FCs. This study emphasises the need for categorising children with CP based on their gait patterns when investigating the effects of interventions such as AFOs. Implications for Rehabilitation Rigid ankle foot orthoses (AFO) cast at an optimal angle to accommodate the length of gastrocnemius muscle may positively influence walking in children with Cerebral Palsy (CP). Tuning of the AFO-Footwear Combination (AFO-FC) has potential benefits to the walking of children with CP, depending on their gait abnormalities. When investigating the effects of interventions such as AFOs, it is important to categorise children with CP based on their gait abnormalities.

8.
Arthritis ; 2014: 173857, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25349736

RESUMO

This pilot double blind randomised controlled study aimed to investigate whether the midvastus (MV) approach without patellar eversion in total knee arthroplasty (TKA) resulted in improved recovery of function compared to the medial parapatellar (MP) approach. Patients were randomly allocated to either the MV approach or the MP approach. Achievements of inpatient mobility milestones were recorded. Knee kinematics, muscle strength, Timed Up and Go, WOMAC, and daily step count were assessed before and up to six months after surgery. Cohen's effect size d was calculated to inform the sample size in future trials. Twenty-eight participants (16 males, 12 females) participated. Patient mobility milestones such as straight leg raise were achieved on average 1.3 days (95% CI -3.4 to 0.7, d = 0.63) earlier in the MV group. Knee extensor strength at 6 weeks after surgery was higher (95% CI -0.38 to 0.61, d = 0.73) in the MV group. No trends for differences between the groups were observed in knee kinematics, TUG, WOMAC, or step count. Our results suggest a short term advantage in the first 6 weeks after surgery of the MV approach over the MP approach, but a larger study is required to confirm these findings. This trial is registered with NCT056445.

9.
Eur J Oncol Nurs ; 18(2): 218-27, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24246445

RESUMO

PURPOSE: This study aimed to investigate validity of a newly developed Morbidity Screening Tool (MST) to screen for fatigue, pain, swelling (lymphedema) and arm function after breast cancer treatment. METHODS: A cross-sectional study included women attending reviews after completing treatment (surgery, chemotherapy and radiotherapy), without recurrence, who could read English. They completed the MST and comparator questionnaires: Disability of the Arm, Shoulder and Hand questionnaire (DASH), Chronic Pain Grade Questionnaire (CPGQ), Lymphedema and Breast Cancer Questionnaire (LBCQ) and Functional Assessment of Cancer Therapy questionnaire with subscales for fatigue (FACT F) and breast cancer (FACT B + 4). Bilateral combined shoulder ranges of motion were compared (upward reach; hand behind back) and percentage upper limb volume difference (%LVD =/>10% diagnosed as lymphedema) measured with the vertical perometer (400T). RESULTS: 613 of 617 participants completed questionnaires (mean age 62.3 years, SD 10.0; mean time since treatment 63.0 months, SD 46.6) and 417 completed objective testing. Morbidity prevalence was estimated as 35.8%, 21.9%, 19.8% and 34.4% for fatigue, impaired upper limb function, lymphedema and pain respectively. Comparing those self-reporting the presence or absence of each type of morbidity, statistically significant differences in comparator variables supported validity of the MST. Statistically significant correlations resulted between MST scores focussing on impact of morbidity, and comparator variables that reflect function and quality of life. CONCLUSION: Analysis supports the validity of all four short-forms of the MST as providing indications of both presence of morbidity and impacts on participants' lives. This may facilitate early and appropriate referral for intervention.


Assuntos
Neoplasias da Mama/terapia , Fadiga/etiologia , Linfedema/etiologia , Dor Musculoesquelética/etiologia , Qualidade de Vida , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Quimioterapia Adjuvante , Terapia Combinada , Estudos Transversais , Avaliação da Deficiência , Fadiga/fisiopatologia , Feminino , Humanos , Linfedema/fisiopatologia , Programas de Rastreamento , Mastectomia/métodos , Pessoa de Meia-Idade , Morbidade , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Radioterapia Adjuvante , Índice de Gravidade de Doença , Inquéritos e Questionários , Reino Unido , Extremidade Superior/fisiopatologia
10.
Biomed Res Int ; 2013: 807569, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23853774

RESUMO

This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95-10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema.


Assuntos
Neoplasias da Mama/complicações , Linfedema/epidemiologia , Linfedema/etiologia , Qualidade de Vida , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Escócia/epidemiologia , Inquéritos e Questionários
11.
BMC Musculoskelet Disord ; 14: 179, 2013 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-23758854

RESUMO

BACKGROUND: Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Thus, it is suggested that MTrPs will be overlap the innervation zone (IZ). The purpose of this work was to describe the location of MTrPs and the IZ in the right upper trapezius. METHODS: We screened 71 individuals and eventually enrolled 24 subjects with neck pain and active MTrPs and 24 neck pain-free subjects with latent MTrPs. Surface electromyography (sEMG) signals were detected using an electrode matrix during isometric contraction of the upper trapezius. A physiotherapist subsequently examined the subject's trapezius to confirm the presence of MTrPs and establish their location. IZ locations were identified by visual analysis of sEMG signals. IZ and MTrPs locations were described using an anatomical coordinate system (ACS), with the skin area covered by the matrix divided into four quadrants. RESULTS: No significant difference was observed between active and latent MTrPs locations (P = 0.6). Forty-five MTrPs were in the third quadrant of the ACS, and 3 were included in second quadrant. IZs were located approximately midway between the seventh cervical vertebrae and the acromial angle in a limited area in the second and third quadrants. The mean distance between MTrP and IZ was 10.4 ± 5.8 mm. CONCLUSIONS: According to the acquired results, we conclude that IZ and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped.


Assuntos
Músculo Esquelético/inervação , Síndromes da Dor Miofascial/patologia , Cervicalgia/patologia , Pontos-Gatilho/patologia , Eletromiografia , Humanos , Contração Muscular , Síndromes da Dor Miofascial/fisiopatologia , Cervicalgia/fisiopatologia , Pontos-Gatilho/fisiopatologia
12.
Physiotherapy ; 99(3): 247-51, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23351956

RESUMO

OBJECTIVE: To investigate the agreement between lower limb volume measurements for the vertically oriented perometer and a tape measure method. DESIGN: Between-methods agreement and test-retest reliability study. SETTING: University setting. PARTICIPANTS: Thirty university staff and students were recruited using convenience sampling with no participant drop-outs. INTERVENTIONS: All participants' dominant lower limb volumes were measured using the vertically oriented perometer and a tape measure method. MAIN OUTCOME MEASURES: The Bland-Altman difference plot was reported for determining the bias between the two methods and its 95% confidence interval. Test-retest reliability and the measurement error for the perometer method were determined using the ICC(2,1) model and within-subject standard deviation (sw) respectively. RESULTS: There was a lack of agreement between the tape measure and perometer method. The Bland-Altman difference plot showed that the tape measure method overestimated limb volume by 157ml compared to the perometer method. A 95% confidence interval of -834ml to 519ml was observed. The test-retest reliability of the perometer method was ICC(2,1)=0.99. The measurement error of the perometer method was clinically acceptable (sw=121ml). CONCLUSIONS: There was a lack of agreement between the two methods investigated. Therefore the perometer and tape measure methods are not interchangeable. It is recommended that future validity and reliability studies for the vertically oriented perometer are conducted on clinical populations.


Assuntos
Antropometria/instrumentação , Antropometria/métodos , Perna (Membro)/anatomia & histologia , Modalidades de Fisioterapia/normas , Adulto , Edema/patologia , Feminino , Voluntários Saudáveis , Humanos , Perna (Membro)/patologia , Masculino , Valores de Referência , Reprodutibilidade dos Testes , Adulto Jovem
13.
Arthritis ; 2012: 185208, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23119158

RESUMO

This study retrospectively analysed the effects of obesity as described by Body Mass Index (BMI) on patient reported outcomes following total knee replacement. Participants (105 females and 66 males) who had undergone surgery under the care of a single surgeon were included in the review and were grouped according to their preoperative BMI into nonobese (BMI < 30 kg/m(2)), (n = 73) obese (BMI ≥ 30 kg/m(2)) (n = 98). Oxford Knee Score (OKS) and Short Form 12 scores (SF12) were taken preoperatively and 6 and 12 months after surgery to analyse differences between groups in the absolute scores as well as changes from before to after surgery. Preoperatively, the obese group had a significantly poorer OKS compared to non obese (44.7 versus 41.2, P = 0.003). There were no statistically significant group effects on follow-up or change scores of the OKS and SF12. Correlations coefficients between BMI and follow-up and change scores were low (r < 0.201). There were no significant differences in the number of complications and revisions (local wound infection, 6.7% non obese, 11% obese, postoperative systemic complication, 8% non obese, 12% obese, revision, 4% nonobese, 3% obese). In conclusion, our findings indicate similar degrees of benefits from the surgery irrespective of patient BMI.

14.
J Man Manip Ther ; 20(4): 171-7, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24179324

RESUMO

OBJECTIVES: Myofascial trigger points (MTrPs) are considered the principal clinical feature of myofascial pain syndrome (MPS). An MTrP consists of spot tenderness within a taut band of muscle fibers and its stimulation can produce both local and referred pain. The clinical diagnosis of MPS depends on correct history taking and a physical examination aimed at identifying the presence of MTrP. The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle. METHODS: Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values. RESULTS: The intraclass correlation coefficient ICC(1,1) values were 0.62 (95% CI: 0.30-0.81) for X and 0.81 (95% CI: 0.61-0.91) for Y. The Bland-Altman plots for X and Y showed a mean of difference of 0.04 and -0.2 mm, respectively. Limits of agreement for X ranged from -26.3 to 26.2 mm and for Y from -27 to 26.4 mm. DISCUSSION: The ICC(1,1) for the observed values revealed a moderate to high correlation and the Bland-Altman analysis showed means of difference very close to zero with narrow limits of agreement. An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol.

15.
J Electromyogr Kinesiol ; 21(5): 827-33, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21752668

RESUMO

The identification of the motor unit (MU) innervation zone (IZ) using surface electromyographic (sEMG) signals detected on the skin with a linear array or a matrix of electrodes has been recently proposed in the literature. However, an analysis of the reliability of this procedure and, therefore, of the suitability of the sEMG signals for this purpose has not been reported. The purpose of this work is to describe the intra and inter-rater reliability and the suitability of surface EMG in locating the innervation zone of the upper trapezius muscle. Two operators were trained on electrode matrix positioning and sEMG signal analysis. Ten healthy subjects, instructed to perform a series of isometric contractions of the upper trapezius muscle participated in the study. The two operators collected sEMG signals and then independently estimated the IZ location through visual analysis. Results showed an almost perfect agreement for intra-rater and inter-rater reliability. The constancy of IZ location could be affected by the factors reflecting the population of active MUs and their IZs, including: the contraction intensity, the acquisition period analyzed, the contraction repetition. In almost all cases the IZ location shift due to these factors did not exceed 4mm. Results generalization to other muscles should be made with caution.


Assuntos
Eletromiografia/métodos , Músculo Esquelético/inervação , Adulto , Retroalimentação , Feminino , Humanos , Contração Isométrica/fisiologia , Masculino , Músculo Esquelético/fisiologia , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por Computador , Extremidade Superior/inervação , Extremidade Superior/fisiologia
16.
Prosthet Orthot Int ; 34(3): 270-6, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20738231

RESUMO

The effects of tuning the AFO footwear combination (AFOFC) for an adult with post-stroke hemiplegia were investigated. Gait analysis and tuning were carried out using a Vicon 3D motion analysis system and two force plates. Tuning of the AFOFC was accomplished by gradually modifying its design over a number of gait trials, to achieve optimal (i.e., as close as possible to normal, within the capability of the patient) knee kinematics and alignment of the Ground Reaction Force vector (GRF) relative to the knee joint. Heel wedges and a stiff rocker were used to tune mid-stance and terminal stance, respectively. Temporal-spatial parameters and selected kinetic and kinematic variables were compared between the non-tuned AFOFC, the tuned AFOFC immediately after tuning, and the tuned AFOFC after three months. There were several changes after three months compared to the non-tuned AFOFC, including improvement in stride length and a reduction in knee hyperextension. A subjective reduction in knee pain and improvement in function were also reported. The feasibility and the lack of objective evidence of tuning AFOFCs as a part of a clinical service need to be addressed in future research.


Assuntos
Articulação do Tornozelo , Articulações do Pé , Hemiplegia/reabilitação , Articulação do Joelho/fisiologia , Aparelhos Ortopédicos , Sapatos , Fenômenos Biomecânicos/fisiologia , Desenho de Equipamento , Feminino , Marcha/fisiologia , Hemiplegia/etiologia , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
17.
Disabil Rehabil Assist Technol ; 4(6): 406-13, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19817654

RESUMO

PURPOSE: This pilot study investigated the feasibility of reducing stance phase knee hyperextension in children with cerebral palsy by tuning the ankle foot orthoses-footwear combination (AFO-FC) using different sizes of wedges. METHODS: Five children with cerebral palsy underwent three dimensional gait analysis and tuning of their AFO-FC using wedges. Data analysis was carried out by comparing relevant gait parameters between the non-tuned and tuned prescription. RESULTS: Knee hyperextension during stance significantly decreased, and the shank to vertical angle was closer to normal after tuning. Although none of the other parameters showed statistically significant changes, the wide confidence intervals and lack of power indicated the likelihood of a type II error. Further, it was noted that the influence of tuning on temporal-spatial parameters was different between children with diplegia and those with hemiplegia. It was estimated that a sample size of 15 is required to detect significant changes at p = 0.05 and power of 0.8. CONCLUSIONS: The findings of this study clearly indicate the potential clinical utility of tuning using wedges to correct knee hyperextension during the stance phase in children with cerebral palsy. However, observations support the need for an adequately powered study to assess the long-term effects of tuning on gait parameters, activity level and quality of life.


Assuntos
Braquetes , Paralisia Cerebral/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Instabilidade Articular/reabilitação , Articulação do Joelho , Sapatos , Fenômenos Biomecânicos , Criança , Pré-Escolar , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Marcha , Humanos , Masculino , Fatores de Tempo
18.
Disabil Rehabil ; 30(18): 1367-73, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18608379

RESUMO

PURPOSE: Lumbar microdiscectomy is becoming increasingly popular in the management of prolapsed intervertebral disc. The early stage of rehabilitation has been under-researched, with little documented about optimal activity levels during the initial six weeks. This study aimed to gain insight into patients' experiences of physiotherapy and activity choices during this period. METHOD: Eight participants were chosen purposively. All had undergone an uncomplicated lumbar microdiscectomy in the preceding six weeks in an acute neurosurgical unit in the Northeast of England. One-to-one semi-structured interviews were conducted in the participants' homes and transcribed. Data were thematically analysed within a constructionist framework. Mechanisms to ensure analytical rigour were implemented. RESULTS: Three major themes were derived inductively from the data. The first, 'wish for precise movement boundaries,' described participants reduced levels of activity postoperatively as being related to high levels of anxiety about the surgery and fear of re-injury. The second theme suggested that physiotherapy failed to help participants explore their potential for activity. The final theme described post-operative fatigue. CONCLUSIONS: High levels of postoperative anxiety about movement and activity were not addressed postoperatively. This has significant clinical implications and highlights the need for further research.


Assuntos
Atividades Cotidianas , Discotomia/psicologia , Discotomia/reabilitação , Autoeficácia , Estudos de Coortes , Terapia por Exercício , Humanos , Entrevistas como Assunto , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Satisfação do Paciente
19.
Physiother Res Int ; 12(1): 25-8, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17432391

RESUMO

BACKGROUND AND PURPOSE: There is no previous research to determine if total hip replacement can lead to anterior knee pain. The idea for the present study came from clinical observation of anterior knee pain (AKP) after total hip replacement, and the objective was to investigate anterior knee pain after total hip replacement. METHOD: The study used a prospective single-system design with a convenience sample. Six men and seven women were assessed before and at six weeks after total hip replacement for the presence and degree of AKP, using a step-down test combined with a visual analogue scale (VAS). Measurements were also taken of leg length, hip and knee motion, thigh circumference and hamstring length using previously validated tests. RESULTS: Eight of thirteen subjects had AKP at six weeks post-operation. Active knee flexion was reduced post-operation (p < 0.0007), and proximal, mid- and distal thigh circumferences were increased (p < 0.0001). Eleven of 13 subjects demonstrated leg lengthening (p < 0.0001), and 10/11 subjects demonstrated a reduction in passive knee flexion (p < 0.002). All biomechanical data were correlated against the VAS. Although none were statistically significant, both decreased active and passive knee flexion, and increased thigh circumference exhibited the greatest trend with the VAS. CONCLUSIONS: The results of the present study cannot be compared to other studies, as there are no previous studies on AKP after total hip replacement. Current outcome measures for total hip replacement do not measure for AKP, although it may potentially hinder full functional recovery. Orthopaedic surgeons and physiotherapists need to be aware if this is a possible complication of total hip replacement, and hence further research is required to test external validity.


Assuntos
Artralgia/etiologia , Artroplastia de Quadril/efeitos adversos , Articulação do Joelho , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/fisiopatologia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Medição da Dor , Amplitude de Movimento Articular
20.
Clin Biomech (Bristol, Avon) ; 22(2): 203-10, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17126461

RESUMO

BACKGROUND: Few studies have reported the biomechanical aspects of stair climbing for this ergonomically demanding task. The purpose of this ethically approved study was to identify normal functional parameters of the lower limb during stair climbing and to compare the actions of stair ascent and descent in young healthy individuals. METHODS: Thirty-three young healthy subjects, (16 M, 17 F, range 18-39 years) participated in the study. The laboratory staircase consisted of four steps (rise height 18 cm, tread length 28.5 cm). Kinematic data were recorded using 3D motion analysis system. Temporal gait cycle data and ground reaction forces were recorded using a force platform. Kinetic data were standardized to body mass and height. FINDINGS: Paired-samples t tests showed significantly greater hip and knee angles (mean difference standard deviation (SD): hip 28.10 degrees (SD 4.08), knee 3.39 degrees (SD 7.20)) and hip and knee moments (hip 0.25 Nm/kg (SD 0.18), knee 0.17 Nm/kg (SD 0.15)) during stair ascent compared to descent. Significantly greater ankle dorsiflexion angles (9.90 degrees (SD 3.80)) and plantarflexion angles (8.78 degrees (SD 4.80)) were found during stair descent compared to ascent. Coefficient of variation (mean (SD)) in percentage between repeated tests varied for joint angles and moments, respectively (2.35% (SD 1.83)-17.53% (SD 13.62)) and (4.65% (SD 2.99)-40.73% (SD 24.77)). INTERPRETATION: Stair ascent was shown to be the more demanding biomechanical task when compared to stair descent for healthy young subjects. The findings from the current study provide baseline measures for pathological studies, theoretical joint modelling, and for mechanical joint simulators.


Assuntos
Tornozelo/anatomia & histologia , Fenômenos Biomecânicos/métodos , Quadril/anatomia & histologia , Joelho/anatomia & histologia , Locomoção/fisiologia , Adolescente , Adulto , Feminino , Marcha , Humanos , Articulação do Joelho , Masculino , Movimento (Física) , Amplitude de Movimento Articular , Caminhada
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