Examination of Dry Needling Dose and Effect Duration for Individuals With Chronic Ankle Instability.

OBJECTIVE: The purpose of this study was to evaluate the effect of a single treatment vs serial dry needling (DN) treatments of the fibularis longus on individuals with chronic ankle instability and to determine the longevity of any effect found. METHODS: Thirty-five adults with chronic ankle instability (24.17 ± 7.01 years, 167.67 ± 9.15 cm, 74.90 ± 13.23 kg) volunteered for a university laboratory repeated-measures study. All participants completed patient-reported outcomes and were objectively tested using the Star Excursion Balance Test (SEBT), threshold to detect passive motion (TTDPM) measurements, and single limb time-to-boundary measurements. Participants received DN treatment to the fibularis longus once weekly for 4 weeks on the affected lower extremity by a single physical therapist. Data were collected 5 times: baseline 1 week before initial treatment (T0), pre-treatment (T1A), immediately after the first treatment (T1B), after 4 weekly treatments (T2), and 4 weeks after the cessation of treatment (T3). RESULTS: Significant improvements were found for clinician-oriented (SEBT-Composite P < .001; SEBT-Posteromedial P = .024; SEBT-Posterolateral P < .001; TTDPM-Inversion P = .042) and patient-oriented outcome measures (Foot and Ankle Ability Measure-Activities of Daily Living P < .001; Foot and Ankle Ability Measure-Sport P = .001; Fear Avoidance Belief Questionnaire P = .021) following a single DN treatment. Compounding effects from additional treatments exhibited improvement of TTDPM (T1B to T2). No significant losses were noted 4 weeks after cessation of treatment (T2 to T3). CONCLUSION: For the participants in this study, outcomes improved immediately following the first DN treatment. This improvement was sustained but not further improved with subsequent treatments.

If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community.

OBJECTIVES: Some communities across the nation are utilizing alternative funding sources to better support home and community-based services for older adults. METHODS: A variety of methods identified local initiatives across the United States. An online survey was distributed to a total of 377 communities in 15 states identified as using locally raised funds to provide aging services, yielding a 55% response rate. RESULTS: Total funding from programs generated almost 400 million dollars annually with funding ranging from $8000-$47 million. Commonly provided services with local funds include home-delivered and congregate meals, transportation, and homemaker services with provision varying by the size of the levy initiative. Additionally, six in 10 initiatives reported local funds being used to provide at least one family or friend caregiver service. CONCLUSION: Locally-funded initiatives fill a gap in long-term services needs for older adults, yet policy concerns regarding potential inequities across states and communities warrant attention.

Dry needling equilibration theory: A mechanistic explanation for enhancing sensorimotor function in individuals with chronic ankle instability.

Patients with chronic ankle instability (CAI) experience a dynamic interplay between impaired mechanical structures and sensorimotor deficiencies that contribute to recurrent sprains and sensations of instability. Concomitantly, muscular trigger points (MTrPs) are known to occur following trauma, maximal or submaximal concentric contractions, and unaccustomed eccentric loads. Additionally, MTrPs are theorized to be exacerbated in low-load and repetitive strain activities. MTrPs located within a muscle are associated with altered motor control, reaction delay, and decreased strength, deficits also found among those with CAI. Dry needling (DN) is reported to improve muscle range of motion, motor control, and pain in a myriad of neuromusculoskeletal conditions by decreasing spontaneous electrical activity and stiffness of taut muscle bands while improving filament overlap. Building on evidence supporting neuromechanical decoupling in chronic ligamentous injury with what is known about the development of MTrPs, this paper proposes a centrally mediated mechanism for improved sensorimotor function following DN for individuals with CAI. Dry needling equilibration theory (DNET) states that proprioception is improved following DN in the lower extremity by changing the muscle's length-tension relationship and leveraging minor acute discomfort to improve muscle spindle afferent information via the gamma motor system. The application of DNET for individuals with CAI may provide a mechanistic explanation for improved descending cortical output, resulting in enhanced sensorimotor function.

Effect of Dry Needling on Spinal Reflex Excitability and Postural Control in Individuals With Chronic Ankle Instability.

OBJECTIVE: The purpose of this study was to compare postural control and neurophysiologic components of balance after dry needling of the fibularis longus between individuals with chronic ankle instability (CAI) and a healthy control group. METHODS: This quasi-experimental university-laboratory study included 50 adult volunteers-25 with CAI (16 female, 9 male; age: 26 ± 9.42 years; height: 173.12 ± 9.85 cm; weight: 79.27 ± 18 kg) and 25 healthy controls (15 female, 10 male; age: 25.8 ± 5.45 years; height: 169.47 ± 9.43 cm; weight: 68.47 ± 13 kg). Participants completed the Star Excursion Balance Test (SEBT), single-leg balance, and assessment of spinal reflex excitability before and after a single treatment of dry needling to the fibularis longus. The anterior, posterolateral, and posteromedial directions of the SEBT were randomized, and reach distances were normalized to a percentage of leg length. A composite SEBT score was calculated by averaging the normalized scores. Postural control was assessed in single-limb stance on a force plate through time-to-boundary measurements in eyes-open and eyes-closed conditions. Fibularis longus and soleus spinal reflexes were obtained by providing electrical stimulation to the common fibular and tibial nerves with participants lying prone. A Group × Time analysis examined changes in performance, and effect sizes were calculated to assess significance. RESULTS: Significant group × time interactions were identified for composite (P = .006) and posteromedial (P = .017) SEBT scores. Significant time effects for all directions of the SEBT, time to boundary with eyes open, and the mediolateral direction with eyes closed indicate improved postural control following treatment (P < .008). Within-group effect sizes for significant time effects ranged from small to large, indicating potential clinical utility. CONCLUSION: Dry needling demonstrated immediate short-term improvement in measures of static and postural control in individuals with CAI as well as healthy controls.

Local Initiatives to Fund Services for Older Americans: Community Recognition of the Importance of Social Care.

Despite the growing proportion of older adults in the United States, federal and state funding for nonmedical supportive services remains limited. To meet increasing demand, some communities across the nation are exploring alternative funding sources for aging services. Although no systematic database exists to track such local programs, through an array of data sources including a national survey, telephone contacts, and a web review, we identified 15 states that are using local funding to support aging services. Communities are using a variety of local revenue streams, such as property tax levies, payroll, and sales taxes to provide services for older adults and/or their family or friend caregivers. There are considerable differences in community approaches including the following: amount of revenue generated, service eligibility criterion, type of services covered, and management infrastructure. Critical policy questions surrounding equity issues within and across states are raised as communities create these alternative funding mechanisms.

Novel application of dry needling for neuropathic myofascial ankle pain and dysfunction following insidious integumentary infection: A case report.

BACKGROUND: Dry needling (DN) was effectively applied to a patient whose primary complaint was hyperalgesia and decreased ankle function meeting criteria for neuropathic myofascial pain following an integumentary infection, skin grafting and immobilization. CASE DESCRIPTION: A 33-year-old male serving on active duty in the United States Air Force was referred to physical therapy for decreased ankle range of motion and pain, eight weeks after an integumentary infection on his ankle. The infection was complicated by tissue loss requiring skin grafting for closure. Two months of traditional rehabilitation was unsuccessful and this patient was referred for DN treatment. OUTCOMES: Clinically relevant improvements were achieved after one treatment. After 48 hours, the patient's reported Pain Quality Assessment Scale (PQAS) dropped from a baseline 67 to 34 and Lower Extremity Functional Scale (LEFS) increased from 44 to 56. Plantarflexion and dorsiflexion improved by 15° and inversion and eversion by five degrees. After one year and 11 DN treatments, function continued to improve as demonstrated by single leg stance time improvement from 4 s to more than 60 seconds, without pain, a final LEFS of 72 and a return to unrestricted full duty. CONCLUSION: DN is an increasingly utilized treatment option for myofascial pain. This case report represents a unique application of DN to an atypical patient presenting with neuropathic myofascial pain syndrome that demonstrated improvement with DN as the sole intervention. Further research regarding the application of DN as a treatment option for neuropathic myofascial pain syndromes is needed.

Not so Dangerous After All? Venom Composition and Potency of the Pholcid (Daddy Long-Leg) Spider Physocyclus mexicanus.

Pholcid spiders (Araneae: Pholcidae), officially "cellar spiders" but popularly known as "daddy long-legs," are renown for the potential of deadly toxic venom, even though venom composition and potency has never formally been studied. Here we detail the venom composition of male Physocyclus mexicanus using proteomic analyses and venom-gland transcriptomes ("venomics"). We also analyze the venom's potency on insects, and assemble available evidence regarding mammalian toxicity. The majority of the venom (51% of tryptic polypeptides and 62% of unique tryptic peptides) consists of proteins homologous to known venom toxins including enzymes (astacin metalloproteases, serine proteases and metalloendopeptidases, particularly neprilysins) and venom peptide neurotoxins. We identify 17 new groups of peptides (U1-17-PHTX) most of which are homologs of known venom peptides and are predicted to have an inhibitor cysteine knot fold; of these, 13 are confirmed in the proteome. Neprilysins (M13 peptidases), and astacins (M12 peptidases) are the most abundant venom proteins, respectively representing 15 and 11% of the individual proteins and 32 and 20% of the tryptic peptides detected in crude venom. Comparative evidence suggests that the neprilysin gene family is expressed in venoms across a range of spider taxa, but has undergone an expansion in the venoms of pholcids and may play a central functional role in these spiders. Bioassays of crude venoms on crickets resulted in an effective paralytic dose of 3.9 µg/g, which is comparable to that of crude venoms of Plectreurys tristis and other Synspermiata taxa. However, crickets exhibit flaccid paralysis and regions of darkening that are not observed after P. tristis envenomation. Documented bites on humans make clear that while these spiders can bite, the typical result is a mild sting with no long-lasting effects. Together, the evidence we present indicates pholcid venoms are a source of interesting new peptides and proteins, and effects of bites on humans and other mammals are inconsequential.

Outcomes of oral anticoagulant therapy managed by telephone vs in-office visits in an anticoagulation clinic setting.

BACKGROUND: Anticoagulation management by a dedicated anticoagulation clinic improves patient outcomes compared to routine medical care. Telephone-based anticoagulation management has been described but has not been compared to management with traditional office-based visits. The objective of this study was to compare warfarin-related monitoring outcomes, clinical end points, and the use of health-care resources as a result of warfarin-related complications in anticoagulation clinic patients whose management was conducted by telephone or in-office-based visits. SETTING: Two university-affiliated anticoagulation clinics in Seattle, WA, and Chicago, IL. METHODS: A retrospective, observational cohort design was used to investigate anticoagulation clinic patients who were managed by telephone encounters compared to those managed during face-to-face in-office encounters. RESULTS: A total of 234 patients were evaluated; 117 patients managed by telephone were compared to 117 patients managed in office-based clinic visits. Monitoring outcomes (ie, time in therapeutic range and clinic visits per patient-year) were similar between groups. Differences in major bleeding (5.67% vs 5.62% per patient-year, respectively) and thromboembolic events (1.42% vs 2.81% per patient-year, respectively) between telephone-managed and face-to-face-managed patients did not reach statistical significance. The same was true for differences in the frequency of emergency department visits and hospital admissions to manage complications of warfarin therapy. CONCLUSIONS: Telephone-based management of oral anticoagulation through a pharmacist-staffed anticoagulation clinic yielded clinical outcomes that were at least as favorable as those associated with traditional office-based visits. Telephone follow-up can be successfully used to manage warfarin therapy in patients who are unable to present in person to an anticoagulation clinic.

Assessment of hepatocytes and liver slices as in vitro test systems to predict in vivo gene expression.

The use of in vitro systems to predict in vivo responses to chemical agents provides the benefits of requiring fewer animals, reducing variability between samples, requiring less test material, and enabling higher throughput. In the present study rat tissue slices and primary hepatocytes were compared as in vitro systems to predict in vivo changes in gene expression in response to treatment with known liver toxicants or inducers. Five compounds (phenobarbital, carbon tetrachloride, Wy-14,634, alpha-napthylisothiocyanate, and tacrine) were chosen for their established and diverse mechanisms of hepatoxicity or microsomal induction. Expression profiles from male Sprague-Dawley rats or in vitro systems treated for 24 h were measured by DNA oligonucleotide microarrays containing 8700 probe sets. Qualitative comparison of expression revealed a >80% concordance between in vivo liver and both in vitro systems; however, the responsiveness of both in vitro systems to compound-induced changes in gene expression was far less than that of in vivo. Furthermore, both in vitro systems appeared similar in their ability to reproduce compound-induced changes in gene expression observed in vivo.

Processes in language acquisition: the roles of gender, attention, and maternal encouragement of attention over time.

This longitudinal study including 87 infant-mother dyads examined the relation between infant temperamental attention, maternal encouragement of attention, language, and the effects of gender. At ages 0;4, 0;8, and 1;0, global attention was assessed from Rothbart's (1981) IBQ; manipulative exploration was assessed with the Bayley (1969) IBR; and maternal verbal, visual and physical encouragement of attention were coded from 5 minutes of mother-infant free-play. At 1;0, language was measured using language items from the Bayley Mental Scale and parent-report items from Hendrick, Prather & Tobin's (1984) SICD-Revised. Multiple regressions indicated that gender, infants' manipulative exploration and maternal physical encouragement of attention at 0;4, and maternal verbal encouragement of attention at 1;0, were all positively related to language at 1;0. Interactions indicated that girls high in 0;8 or 1;0 manipulative exploration had more advanced language skills than girls low in manipulative exploration or than boys, regardless of their attention level. Additionally, maternal verbal encouragement of attention appears to be particularly salient in the development of language for boys.