Task Oriented Training Activities Post Stroke Will Produce Measurable Alterations in Brain Plasticity Concurrent with Skill Improvement.

BACKGROUND: Task-oriented training with upper extremity (UE) skilled movements has been established as a method to regain function post stroke. Although improved UE function has been shown after this type of therapy, there is minimal evidence that brain plasticity is associated with this training. The accelerated skill acquisition program (ASAP) is an example of an approach for promoting UE function using targeting movements. OBJECTIVE: To investigate the effects of a single 2-hour session of ASAP in individuals with stroke on measures of brain plasticity as represented by corticospinal excitability (CE) and determine associations with reach-to-grasp (RTG) performance. METHODS: Eighteen post-acute stroke patients were randomized to two groups. Experimental group (n = 9) underwent ASAP for 2 hours, while the control group (n = 9) received dose equivalent usual and customary care. Both groups were evaluated for CE and RTG performance prior to the session and then four times after training: immediately, 1 day, 6 days, and 12 days. RESULTS: Significant alterations in CE were found in the peak-to-peak of Motor Evoked Potential amplitude of elbow and wrist extensor muscles in the lesioned hemisphere. The experimental group also demonstrated improved execution (shortened total movement time, TMT), feed-forward mechanism (deceleration time, DT) and planning (lengthened relative time to maximum hand aperture, RTApmax) compared to the control group. CONCLUSION: Alterations in brain plasticity occur concurrently with improvements in RTG performance in post-acute stroke patients with mild impairment after a single 2-hour session of task-oriented training and persist for at least 12 days.

Effect of a one-semester conditioning class on physiological characteristics of college students.

Long-term exercise is known to have positive effects on the health of adults. Some college "activity" courses are designed to give participants exposure to, and practice with, safe exercise techniques. Whether these 1-semester courses, usually 12-14 weeks, are sufficient to alter physiological characteristics, such as blood pressure or strength, has not been established. Therefore, the purpose of our investigation was to evaluate physiological and performance measures in college students to determine whether changes would result after 14 weeks of a general conditioning activity course. This study involved 79 students from several sections of exercise and conditioning classes at our university. Classes included a variety of fitness- and strength-oriented exercises. Physiological and performance measurements were collected in weeks 2 (pretest) and 14 (posttest), and compared pre with post using paired t-tests subject to Bonferroni correction (significant p < 0.0055). There were significant improvements in resting heart rate (HR) (73 vs. 70 b·min, p < 0.002), hand grip strength (250 vs. 272 N, p < 0.001), push-ups (29 vs 37, p < 0.001), sit-ups (32 vs. 35, p < 0.001), and step test HR recovery (122 vs. 110 b·min, p < 0.001). Systolic and diastolic blood pressures, body weight, and percent body fat did not change. These results suggest that 14 weeks of regular exercise in an organized college-based activity class can result in significant improvements in some measures of fitness and strength in college-aged participants.

Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care.

Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in early identification and treatment of breast cancer-related lymphedema (BCRL). Early intervention may reduce the need for intensive rehabilitation and may be cost saving. This perspective article compares a prospective surveillance model with a traditional model of impairment-based care and examines direct treatment costs associated with each program. Intervention and supply costs were estimated based on the Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast cancer who were receiving interval prospective surveillance, assuming that one third would develop early-stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the paradigm of physical therapy toward a prospective surveillance model is warranted.

The effects of multiaxial and uniaxial unstable surface balance training in college athletes.

The purpose of this study was to compare the effects of 2 different types of unstable surface balance training (uniaxial on a rocker board [RB] and multiaxial on a dynadisc [DD]) on balance in division 1 collegiate athletes in sports that are at high risk for ankle sprains. Subjects (n = 36) consisted of male soccer players and female volleyball and soccer players who were equally and randomly assigned to 1 of 3 groups (CON, DD, and RB). Balance training consisting of balancing on 1 leg on either the RB or DD, while repeatedly catching a 1-kg ball was performed 3 times per week for 4 weeks. Balance was tested with the Star Excursion Balance Test (SEBT) before, halfway through, and at the completion of the balance training. Control (CON) subjects also were given the balance test but did not participate in the training. A 3-way repeated analysis of variance revealed that no group individually changed SEBT scores from pre (CON, 0.98 +/- 0.086; DD, 0.98 +/- 0.083; RB, 0.97 +/- 0.085) to post (CON, 1.00 +/- 0.090; DD, 1.01 +/- 0.088; RB, 1.02 +/- 0.068) after balance training. When the 2 treatment groups were combined (DD and RB), the p value decreased and came closer to significance (p = 0.136). When all 3 groups were combined, there was a significant difference in SEBT scores from pretraining (CON + DD + RB; 0.98 +/- 0.085) to posttraining (CON + DD + RB; 1.01 +/- 0.082), which likely indicates low statistical power. The increase in physical activity the subjects experienced during the return to in-season activity, may have contributed to the significant differences in SEBT scores over time but not between DD or RB training. Therefore, a threshold level of physical activity may exist that is necessary to maintain balance during the off-season.

Comparison of acute exercise responses between conventional video gaming and isometric resistance exergaming.

Exergaming is a relatively new type of entertainment that couples physical activity and video gaming. To date, research that has focused on the physiologic responses to exergaming has been focused exclusively on aerobic-type activities. The purpose of this project was to describe the acute exercise responses (i.e., oxygen uptake [VO(2)], heart rate, and rate of perceived exertion [RPE]) to exergaming using full-body isometric muscle resistance and to determine whether these responses are different during single- versus opponent-based play. Male subjects (n = 32) were randomly and equally divided into either an experimental (EXP) or control (CON) group. Acute exercise responses VO(2), heart rate, and RPE) were measured in all subjects during both solo- and opponent-based video game play. Subjects in the EXP group played using a controller that relied on full-body isometric muscle resistance to manipulate the on-screen character, whereas CON subjects used a conventional handheld controller. During solo play, the EXP group exhibited significantly higher values for VO(2) (9.60 +/-0.50 mL/kg/min) and energy expenditure (3.50 +/- 0.14 kcal/min) than the CON group VO(2) 5.05 +/- 0.16 mL/kg/min; energy expenditure 1.92 +/- 0.07 kcal/min). These changes occurred with no significant differences in RPE or heart rate between the groups. These results suggest that whole-body isometric exergaming results in greater energy expenditure than conventional video gaming, with no increase in perceived exertion during play. This could have important implications regarding long-term energy expenditure in gamers.

Reliability, validity, and precision of an active stereophotogrammetry system for three-dimensional evaluation of the human torso.

To determine the reliability, stability, validity and precision of a stereophotogrammetry (SP) system for use in quantifying the complex three-dimensional structure of the human torso, we performed assessments of the system using images of geometric solids and a human-form mannequin. Analysis of geometric solids revealed excellent intra- and interrater reliability of the system for linear, surface area and volume measurements (r>0.99, P<0.001). Overall, no significant difference was found between SP and manual measurements (F=4.23, P>0.06). The system exhibited excellent stability in images of the mannequin over time (r>0.99). The limit of precision (error>5%) of the system to detect objects on the surface of the mannequin was estimated at an object size of 23.5cm(2) for surface area and 32mL for volume. These results demonstrate the capability of SP of the torso to be used as a reliable, stable and valid measure of torso morphology to be applied as a clinical outcome tool in studies of bony and soft tissue pathologies such as scoliosis, rib deformities, obesity or edema.

The various perceptions of distance: an alternative view of how effort affects distance judgments.

D. R. Proffitt and colleagues (e. g., D. R. Proffitt, J. Stefanucci, T. Banton, & W. Epstein, 2003) have suggested that objects appear farther away if more effort is required to act upon them (e.g., by having to throw a ball). The authors attempted to replicate several findings supporting this view but found no effort-related effects in a variety of conditions differing in environment, type of effort, and intention to act. Although they did find an effect of effort on verbal reports when participants were instructed to take into account nonvisual (cognitive) factors, no effort-related effect was found under apparent- and objective-distance instruction types. The authors' interpretation is that in the paradigms tested, effort manipulations are prone to influencing response calibration because they encourage participants to take nonperceptual connotations of distance into account while leaving perceived distance itself unaffected. This in no way rules out the possibility that effort influences perception in other contexts, but it does focus attention on the role of response calibration in any verbal distance estimation task.

Acute effects of static, dynamic, and proprioceptive neuromuscular facilitation stretching on muscle power in women.

The purpose of this study was to investigate the acute effects of 3 types of stretching-static, dynamic, and proprioceptive neuromuscular facilitation (PNF)-on peak muscle power output in women. Concentric knee extension power was measured isokinetically at 60 degrees x s(-1) and 180 degrees x s(-1) in 12 healthy and recreationally active women (mean age +/- SD, 24 +/- 3.3 years). Testing occurred before and after each of 3 different stretching protocols and a control condition in which no stretching was performed. During 4 separate laboratory visits, each subject performed 5 minutes of stationary cycling at 50 W before performing the control condition, static stretching protocol, dynamic stretching protocol, or PNF protocol. Three submaximal warm-up trials preceded 3 maximal knee extensions at each testing velocity. A 2-minute rest was allowed between testing at each velocity. The results of the statistical analysis indicated that none of the stretching protocols caused a decrease in knee extension power. Dynamic stretching produced percentage increases (8.9% at 60 degrees x s(-1) and 6.3% at 180 degrees x s(-1)) in peak knee extension power at both testing velocities that were greater than changes in power after static and PNF stretching. The findings suggest that dynamic stretching may increase acute muscular power to a greater degree than static and PNF stretching. These findings may have important implications for athletes who participate in events that rely on a high level of muscular power.

Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.

OBJECTIVES: To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle. DESIGN: We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1beta (IL-1beta), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance. SETTING: A biomedical research facility. PARTICIPANTS: Nine healthy volunteer subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Preselected analyte concentrations. RESULTS: Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01). CONCLUSIONS: We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs.

An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle.

Myofascial pain associated with myofascial trigger points (MTrPs) is a common cause of nonarticular musculoskeletal pain. Although the presence of MTrPs can be determined by soft tissue palpation, little is known about the mechanisms and biochemical milieu associated with persistent muscle pain. A microanalytical system was developed to measure the in vivo biochemical milieu of muscle in near real time at the subnanogram level of concentration. The system includes a microdialysis needle capable of continuously collecting extremely small samples (approximately 0.5 microl) of physiological saline after exposure to the internal tissue milieu across a 105-microm-thick semi-permeable membrane. This membrane is positioned 200 microm from the tip of the needle and permits solutes of <75 kDa to diffuse across it. Three subjects were selected from each of three groups (total 9 subjects): normal (no neck pain, no MTrP); latent (no neck pain, MTrP present); active (neck pain, MTrP present). The microdialysis needle was inserted in a standardized location in the upper trapezius muscle. Due to the extremely small sample size collected by the microdialysis system, an established microanalytical laboratory, employing immunoaffinity capillary electrophoresis and capillary electrochromatography, performed analysis of selected analytes. Concentrations of protons, bradykinin, calcitonin gene-related peptide, substance P, tumor necrosis factor-alpha, interleukin-1beta, serotonin, and norepinephrine were found to be significantly higher in the active group than either of the other two groups (P < 0.01). pH was significantly lower in the active group than the other two groups (P < 0.03). In conclusion, the described microanalytical technique enables continuous sampling of extremely small quantities of substances directly from soft tissue, with minimal system perturbation and without harmful effects on subjects. The measured levels of analytes can be used to distinguish clinically distinct groups.

Navicular drop measurement in people with rheumatoid arthritis: interrater and intrarater reliability.

BACKGROUND AND PURPOSE: Navicular drop (ND) measurement may be a valuable examination technique for patients with rheumatoid arthritis (RA). However, no data exist on reliability for this technique in patients with RA. The purposes of this study were: (1) to determine interrater and intrarater reliability of ND measurements in people with RA, (2) to compare ND values of people with RA with published normative data, and (3) to investigate ND measurement error associated with the use of skin markings. SUBJECTS: Ten women (20 feet) with RA consented to participate. METHODS: Patients completed demographic and function questionnaires. Navicular height (NH) measurements were taken by 2 physical therapists and 1 physical therapist student, following four 1-hour training sessions, using standardized methods and a digital height gauge. Four different NH measurements were taken 3 times on each foot by each of the 3 examiners during a morning session and then repeated during an afternoon session on the same day. Navicular drop values were calculated, including ND1 (as reported in the literature), ND2 (compensating for skin error), and ND3 (single-limb stance). Intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs) were used to establish reliability. RESULTS: Means (+/-SD) for each ND measure for sessions 1 and 2, respectively, were as follows: ND1=8.36+/-5.29 mm and 8.29+/-5.24 mm, ND2=9.95+/-5.44 mm and 9.57+/-5.37 mm. The ICCs (2,1 and 2,k, respectively) for all interrater measurements ranged from .67 to .92 (SEM=2.0-3.3 mm) and from .85 to .97 (SEM=1.1-2.0 mm). The ICCs (2,1 and 2,k, respectively) for intrarater measurements ranged from .73 to .95 (SEM=1.3-2.8 mm) and from .90 to .98 (SEM=0.7-1.6 mm). Paired t tests showed the means of ND1 and ND2 for each examiner and for both sessions were significantly different. DISCUSSION AND CONCLUSION: The results suggest that ND measurements for people with RA can be taken reliably by clinicians with varied experience. The ND values for our subjects were slightly greater than reported normal values of 6 to 8 mm. Error associated with skin markings was statistically significant for all sessions and examiners.

Motor Skill Development of Children with HIV Infection Measured with the Peabody Developmental Motor Scales.

PURPOSE: Improved health care for pregnant women who are HIV+has minimized complications during delivery and resulted in a measurable cohort of children entering the health care system who are HIV+ with potential for motor disorders. This study was designed to determine how gross and fine motor skills were affected by HIV infection in children aged five years and younger using the Peabody Developmental Motor Scales, and to follow a subsample of these children for one and a half years to determine if their relative skill performances changed over time. METHODS: A sample of 143 children who were HIV+ was evaluated using the Peabody Developmental Motor Scales for their gross and fine motor skills. Their performance scores were compared with the Peabody normative values for age-matched healthy children. A subset of 22 children were reevaluated at six-month intervals (six months; one year;one year six months) to determine if their gross and fine motor skills would change. Raw scores and Peabody Developmental Motor Quotients (DMQ, normalized to the reference population) were calculated. RESULTS: The children who were HIV+ as a group performed below the 50th percentile of the normal reference population. During the one year six month study period, the children who were HIV+improved in raw scores but did not improve in relative (DMQ) scores. The exceptions were the fine motor skill subcategories of "grasping" and "hand use," for which the children who were HIV+performed comparably with the reference population. CONCLUSIONS: Clinicians working with children who are HIV+ should emphasize intervention strategies generally designed to develop all gross motor skills and the specific fine motor skills of "eye-hand coordination" and "manual dexterity."