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1.
Arch Osteoporos ; 14(1): 65, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31222628

RESUMO

The interaction of body fat percentage and height with appendicular BMC for LBM was analyzed. Only body fat had significant negative correlation with the appendicular BMC for LBM. PURPOSE/INTRODUCTION: For the clinical evaluation of the functional muscle-bone unit, it was proposed to evaluate the adaptation of the bone to the acting forces. A frequently used parameter for this is the total body less head bone mineral content (TBLH-BMC) determined by dual-energy X-ray absorptiometry (DXA) in relation to the total body lean body mass (LBM). Body fat percentage seemed to correlate negatively and height positively with TBLH-BMC for LBM. It was supposed that appendicular BMC for LBM is a more accurate surrogate for the functional muscle-bone unit since appendicular LBM does not incorporate the mass of internal organs. The aim of this study was to analyze the interaction of body fat percentage and height with appendicular BMC for LBM. METHODS: As part of the National Health and Nutrition Examination Survey (NHANES) study, between the years 1999 and 2004, whole-body DXA scans on randomly selected Americans from 8 years of age were carried out. From all eligible DXA scans, three major US ethnic groups were evaluated (non-Hispanic Whites, non-Hispanic Blacks, and Mexican Americans) for further statistical analysis. RESULTS: For the statistical analysis, the DXA scans of 8190 non-Hispanic White children and adults (3903 female), of 4931 non-Hispanic Black children and adults (2250 female), and 5421 of Mexican American children and adults (2424 female) were eligible. Only body fat had a significant negative correlation with the appendicular BMC for LBM. CONCLUSIONS: Only body fat had significant negative correlation with appendicular BMC for LBM, and thus, should be addressed when evaluating functional muscle-bone unit.


Assuntos
Tecido Adiposo , Composição Corporal , Estatura , Osso e Ossos , Músculo Esquelético , Absorciometria de Fóton , Adolescente , Adulto , Negro ou Afro-Americano , Fatores Etários , Idoso , Densidade Óssea , Criança , Feminino , Humanos , Masculino , Americanos Mexicanos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fatores Sexuais , População Branca
2.
Arch Osteoporos ; 13(1): 120, 2018 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-30397843

RESUMO

Lumbar spine bone mineral density (LS-BMD) assessed by dual-energy X-ray absorptiometry (DXA) is used in children with cerebral palsy (CP) to evaluate bone health. LS-BMD results in children with CP are influenced significantly by their height, BMI, and mobility level. An adjustment for these parameters might improve the clinical significance of the method. PURPOSE/INTRODUCTION: DXA evaluation is considered useful in children with CP to assess bone health. For this purpose, LS-BMD is often used. The aim of the study was to estimate the effect of height, BMI, and reduced mobility level of children with CP on LS-BMD and to develop a method to adjust individual results of LS-BMD for these factors. METHODS: We conducted a monocentric retrospective analysis of data collected in children and adolescents with CP, who participated in a rehabilitation program and had no history of recurrent fractures. The DXA scan was part of the routine examination for participants older than 4 years of age. The relationship between height and BMI for age Z-scores and age-adjusted LS-BMD Z-scores was analyzed. RESULTS: LS-DXA scans of 500 children and adolescents with CP (Gross Motor Function Classification System levels I-V) were included in the statistical analysis (217 female). The mean age was 9.4 years (± 3.7 years). Children with moderate to severe CP had significantly (p < 0.001) lower LS-BMD Z-scores than children with mild CP. We provided nomograms to adjust individual LS-BMD results to their height, BMI, and mobility level. CONCLUSIONS: LS-BMD results in children with CP were influenced significantly by their height, BMI, and mobility level. An adjustment of the LS-BMD results to height, BMI, and mobility level might improve the clinical significance of an individual result.


Assuntos
Estatura , Índice de Massa Corporal , Densidade Óssea , Paralisia Cerebral/fisiopatologia , Limitação da Mobilidade , Absorciometria de Fóton/métodos , Adolescente , Paralisia Cerebral/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Nomogramas , Estudos Retrospectivos
3.
Arch Osteoporos ; 13(1): 117, 2018 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-30374788

RESUMO

Lumbar spine bone mineral density (LS-BMD) assessed by dual-energy X-ray absorptiometry (DXA) is used in children to evaluate bone health. LS-BMD results in children are influenced significantly by height and BMI. An adjustment for these parameters may improve the clinical use of the method. PURPOSE/INTRODUCTION: DXA evaluation is considered useful in children to assess bone health. For this purpose, lumbar spine bone mineral density (LS-BMD) and bone mineral apparent density (LS-BMAD) are often used. The aim of the study was to estimate the effect of height and BMI on LS-BMD and LS-BMAD in children and adolescents and to develop a method to adjust individual results for these factors. METHODS: As part of the National Health and Nutrition Examination Survey (NHANES) study, between the years 2005 and 2010 lumbar DXA scans on randomly selected Americans from 8 to 20 years of age were carried out. From all eligible DXA scans, three major US ethnic groups were evaluated (Non-Hispanic Whites, Non-Hispanic Blacks, and Mexican Americans) for further statistical analysis. The relationship between height as well as BMI for age Z-scores and age-adjusted LS-BMD and LS-BMAD Z-scores was analyzed. RESULTS: For the statistical analysis, the DXA scans of 1799 non-Hispanic White children (823 females), of 1696 non-Hispanic Black children (817 females), and of 1839 Mexican American children (884 females) were eligible. The statistical analysis showed that taller and heavier children had significantly (p < 0.001) higher age-adjusted LS-BMD Z-scores than shorter and lighter children. But on LS-BMAD, only BMI and not height had a significant influence. CONCLUSIONS: LS-BMD results in children were influenced significantly by their height and BMI, the LS-BMAD results were only influenced by their BMI. For the first time, the proposed method adjusts LS-BMD and LS-BMAD to BMI. An adjustment of the LS-BMD and LS-BMAD results to these factors might improve the clinical significance of an individual result.


Assuntos
Absorciometria de Fóton/estatística & dados numéricos , Estatura , Índice de Massa Corporal , Densidade Óssea , Vértebras Lombares/diagnóstico por imagem , Absorciometria de Fóton/métodos , Adolescente , Adulto , População Negra/estatística & dados numéricos , Criança , Feminino , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Americanos Mexicanos/estatística & dados numéricos , Inquéritos Nutricionais , Valores de Referência , População Branca/estatística & dados numéricos , Adulto Jovem
4.
Osteoporos Int ; 29(5): 1069-1079, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29455248

RESUMO

The aim was to describe the effect of age, gender, height, different stages of human life, and body fat on the functional muscle-bone unit. All these factors had a significant effect on the functional muscle-bone unit and should be addressed when assessing functional muscle-bone unit in children and adults. INTRODUCTION: For the clinical evaluation of the functional muscle-bone unit, it was proposed to evaluate the adaptation of the bone to the acting forces. A frequently used parameter for this is the total body less head bone mineral content (TBLH-BMC) determined by dual-energy X-ray absorptiometry (DXA) in relation to the lean body mass (LBM by DXA). LBM correlates highly with muscle mass. Therefore, LBM is a surrogate parameter for the muscular forces acting in everyday life. The aim of the study was to describe the effect of age and gender on the TBLH-BMC for LBM and to evaluate the impact of other factors, such as height, different stages of human life, and of body fat. METHODS: As part of the National Health and Nutrition Examination Survey (NHANES) study, between the years 1999-2006 whole-body DXA scans on randomly selected Americans from 8 years of age were carried out. From all eligible DXA scans (1999-2004), three major US ethnic groups were evaluated (non-Hispanic Whites, non-Hispanic Blacks, and Mexican Americans) for further statistical analysis. RESULTS: For the statistical analysis, the DXA scans of 8190 non-Hispanic White children and adults (3903 female), of 4931 non-Hispanic Black children and adults (2250 female) and 5421 of Mexican-American children and adults (2424 female) were eligible. Age, gender, body height, and especially body fat had a significant effect on the functional muscle-bone unit. CONCLUSIONS: When assessing TBLH-BMC for LBM in children and adults, the effects of age, gender, body fat, and body height should be addressed. These effects were analyzed for the first time in such a large cohort.


Assuntos
Tecido Adiposo/fisiologia , Envelhecimento/fisiologia , Estatura/fisiologia , Densidade Óssea/fisiologia , Músculo Esquelético/fisiologia , Absorciometria de Fóton , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Antropometria/métodos , Composição Corporal/fisiologia , Criança , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Caracteres Sexuais , Adulto Jovem
5.
J Musculoskelet Neuronal Interact ; 17(4): 259-267, 2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29199184

RESUMO

OBJECTIVES: The aim of this study was to evaluate the effect of scoliosis specific exercises (SSE) on a side-alternating whole body vibration platform (sWBV) as a home-training program in girls with adolescent idiopathic scoliosis (AIS). METHODS: 40 female AIS patients (10-17 years) wearing a brace were randomly assigned to two groups. The intervention was a six months, home-based, SSE program on a sWBV platform five times per week. Exercises included standing, sitting and kneeling. The control group received regular SSE (treatment as usual). The Cobb angle was measured at start and after six months. Onset of menarche was documented for sub-group analysis. RESULTS: The major curve in the sWBV group decreased significantly by -2.3° (SD±3.8) (95% CI -4.1 to -0.5; P=0.014) compared to the difference in the control group of 0.3° (SD±3.7) (95% CI -1.5 to 2.2; P=0.682) (P=0.035). In the sWBV group 20% (n=4) improved, 75% (n=15) stabilized and 5% (n=1) deteriorated by ≥5°. In the control group 0% (n=0) improved, 89% (n=16) stabilized and 11% (n=2) deteriorated. The clinically largest change was observed in the 'before-menarche' sub-group. CONCLUSIONS: Home-based SSE combined with sWBV for six months counteracts the progression of scoliosis in girls with AIS; the results were more obvious before the onset of the menarche.


Assuntos
Terapia por Exercício/métodos , Escoliose/radioterapia , Vibração , Adolescente , Feminino , Humanos
6.
J Musculoskelet Neuronal Interact ; 17(3): 237-245, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28860426

RESUMO

OBJECTIVES: Jumping mechanography provides robust motor function indicators among healthy children. The aim of the study was to assess the reproducibility and validity of jumping mechanography conducted as single two-legged jump (S2LJ) in children with cerebral palsy (CP). METHODS: 215 S2LJ investigations from a sample of 75 children with CP were eligible for evaluation. For the estimation of the reproducibility, only the baseline set of data per patient were used. Gross motor function was evaluated by the Gross Motor Function Measure (GMFM-66). In 135 S2LJ investigations, GMFM-66 was assessed within a week in the same child. This data was used for validity assessment. RESULTS: Coefficients of variation for the main outcome parameters ranged between 6.15-9.71%, except for jump height (CV%=27.3%). The intraclass correlation coefficients for peak velocity (Vmax) and peak power relative to body weight (Pmax/mass) was 0.927 and 0.931. Vmax and Pmax/mass were also the test parameters with the strongest correlation to the GMFM-66 score (⟩0.7). CONCLUSIONS: S2LJ assessed in the present study provided reproducible outcome measures particularly for Vmax and Pmax/mass in children with CP. Further, Vmax and Pmax/mass showed the strongest correlation with the GMFM-66 score and seem to be the most relevant evaluation criteria.


Assuntos
Acelerometria/métodos , Paralisia Cerebral/fisiopatologia , Avaliação da Deficiência , Criança , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
7.
J Musculoskelet Neuronal Interact ; 17(2): 38-49, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28574410

RESUMO

OBJECTIVES: We hypothesized that progressive whole-body vibration (WBV) superimposed to progressive high intensity resistance training has greater effects on muscle cross-sectional area (CSA), muscle force of leg muscles, and jump performance than progressive high intensity resistance training alone. METHODS: Two groups of healthy male subjects performed either 6 weeks of Resistive Vibration Exercise (RVE, squats and heel raises with WBV, n=13) or Resistive Exercise (RE, squats and heel raises without WBV, n=13). Squats under RVE required indispensable weight loading on the forefoot to damp harmful vibrations to the head. Time, intervention, and interaction effects were analyzed. RESULTS: After 6 weeks of training, knee extensor CSA, isometric knee extension force, and counter movement jump height increased equally in both groups (time effect, P⟨0.001, P≤0.02, and P≤0.03, respectively), whereas only in RVE ankle plantar flexor CSA and isometric ankle plantar flexion force reached significance or a tendency, respectively, (time effect, P=0.015 and P=0.069, respectively; intervention effect also for the latter, P=0.006). Drop jump contact time did significantly more improve in RVE (interaction effect, P=0.042). CONCLUSIONS: RVE showed better training effects than RE only in plantar flexor muscles. RVE seems to be suitable in professional sports with a special focus on calf muscles.


Assuntos
Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Treinamento Resistido/métodos , Vibração , Adulto , Humanos , Masculino , Adulto Jovem
8.
Osteoporos Int ; 28(7): 2081-2093, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28365851

RESUMO

Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using only age- and height-adjusted bone mineral content (BMC) and areal bone mineral density (aBMD). When applying the functional muscle-bone unit diagnostic algorithm (FMBU-A), the prevalence of positive results decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP. INTRODUCTION: The prevalence of bone health deficits in children with cerebral palsy (CP) might be overestimated because age- and height-adjusted reference percentiles for bone mineral content (BMC) and areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry (DXA) do not consider reduced muscle activity. The aim of this study was to compare the prevalence of positive DXA-based indicators for bone health deficits in children with CP to the prevalence of positive findings after applying a functional muscle-bone unit diagnostic algorithm (FMBU-A) considering reduced muscle activity. METHODS: The present study was a monocentric retrospective analysis of 297 whole body DXA scans of children with CP. The prevalence of positive results of age- and height-adjusted BMC and aBMD defined as BMC and aBMD below the P3 percentile and of the FMBU-A was calculated. RESULTS: In children with CP, the prevalence of positive results of age-adjusted BMC were 33.3% and of aBMD 50.8%. Height-adjusted results for BMC and aBMD were positive in 16.8 and 36.0% of cases. The prevalence of positive results applying the FMBU-A regarding BMC and aBMD were significantly (p < 0.001) lower than using age- and height-adjusted BMC and aBMD (8.8 and 14.8%). CONCLUSIONS: Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using age- and height-adjusted BMC and aBMD. When applying the FMBU-A, the prevalence decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP.


Assuntos
Densidade Óssea/fisiologia , Paralisia Cerebral/fisiopatologia , Músculo Esquelético/fisiopatologia , Absorciometria de Fóton/métodos , Adolescente , Paralisia Cerebral/complicações , Criança , Feminino , Humanos , Masculino , Osteoporose/etiologia , Osteoporose/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
9.
J Musculoskelet Neuronal Interact ; 16(3): 183-92, 2016 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-27609033

RESUMO

OBJECTIVES: to investigate feasibility, safety and efficacy of home-based side-alternating whole body vibration (sWBV) to improve motor function in toddlers with cerebral palsy (CP). METHODS: Randomized controlled trial including 24 toddlers with CP (mean age 19 months (SD±3.1); 13 boys). INTERVENTION: 14 weeks sWBV with ten 9-minute sessions weekly (non-individualized). Group A started with sWBV, followed by 14 weeks without; in group B this order was reversed. Feasibility (≥70% adherence) and adverse events were recorded; efficacy evaluated with the Gross Motor Function Measure (GMFM-66), Pediatric Evaluation of Disability Inventory (PEDI), at baseline (T0), 14 (T1) and 28 weeks (T2). RESULTS: Developmental change between T0 and T1 was similar in both groups; change scores in group A and B: GMFM-66 2.4 (SD±2.1) and 3.3 (SD±2.9) (p=0.412); PEDI mobility 8.4 (SD±6.6) and 3.5 (SD±9.2) (p=0.148), respectively. In two children muscle tone increased post-sWBV. 24 children received between 67 and 140 sWBV sessions, rate of completed sessions ranged from 48 to 100% and no dropouts were observed. CONCLUSION: A 14-week home-based sWBV intervention was feasible and safe in toddlers with CP, but was not associated with improvement in gross motor function.


Assuntos
Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Vibração/uso terapêutico , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Modalidades de Fisioterapia/instrumentação , Projetos Piloto , Vibração/efeitos adversos
10.
J Musculoskelet Neuronal Interact ; 16(1): 24-32, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26944820

RESUMO

OBJECTIVES: Osteogenesis imperfecta (OI) is a rare hereditary disease leading to bone fragility. Denosumab as a RANK ligand antibody inhibiting osteoclast maturation has been approved for osteoporosis treatment in adults. Aim of this study was a 48-week, open-label, pilot study of the safety and efficacy of denosumab in 10 children with OI. METHODS: Ten patients (age range: 5.0-11.0 years; at least two years of prior bisphosphonate treatment) with genetically confirmed OI were studied. Denosumab was administered subcutaneously every 12 weeks with 1 mg/kg body weight. Primary endpoint was change of areal bone mineral density (aBMD) using dual energy x-ray absorptiometry of the lumbar spine after 48 weeks. Safety was assessed by bone metabolism markers and adverse event reporting. RESULTS: Mean relative change of lumbar aBMD was +19 % (95%-CI: 7-31%). Lumbar spine aBMD Z-Scores increased from -2.23±2.03 (mean±SD) to -1.27±2.37 (p=0.0006). Mobility did not change (GMFM-88 +2.72±4.62% (p=0.16); one-minute walking test +11.00±15.82 m (p=0.15). No severe side effects occurred. CONCLUSIONS: On average, there was a significant increase in lumbar spine aBMD percent change after 48 weeks of denosumab. There was no change in mobility parameters and no serious adverse events. Further trials are necessary to assess long-term side effects and efficacy.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Osteogênese Imperfeita/tratamento farmacológico , Absorciometria de Fóton , Densidade Óssea/efeitos dos fármacos , Criança , Pré-Escolar , Feminino , Humanos , Vértebras Lombares/efeitos dos fármacos , Masculino , Projetos Piloto
11.
J Musculoskelet Neuronal Interact ; 15(2): 123-36, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26032204

RESUMO

Traumatic spinal cord injury (SCI) causes a loss of locomotor function with associated compromise of the musculo-skeletal system. Whole body vibration (WBV) is a potential therapy following SCI, but little is known about its effects on the musculo-skeletal system. Here, we examined locomotor recovery and the musculo-skeletal system after thoracic (T7-9) compression SCI in adult rats. Daily WBV was started at 1, 7, 14 and 28 days after injury (WBV1-WBV28 respectively) and continued over a 12-week post-injury period. Intact rats, rats with SCI but no WBV (sham-treated) and a group that received passive flexion and extension (PFE) of their hind limbs served as controls. Compared to sham-treated rats, neither WBV nor PFE improved motor function. Only WBV14 and PFE improved body support. In line with earlier studies we failed to detect signs of soleus muscle atrophy (weight, cross sectional diameter, total amount of fibers, mean fiber diameter) or bone loss in the femur (length, weight, bone mineral density). One possible explanation is that, despite of injury extent, the preservation of some axons in the white matter, in combination with quadripedal locomotion, may provide sufficient trophic and neuronal support for the musculoskeletal system.


Assuntos
Sistema Musculoesquelético/patologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/terapia , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/terapia , Vibração/uso terapêutico , Animais , Atrofia , Axônios/patologia , Osso e Ossos/patologia , Feminino , Fêmur/patologia , Membro Posterior/fisiopatologia , Locomoção , Músculo Esquelético/patologia , Modalidades de Fisioterapia , Desempenho Psicomotor , Ratos , Ratos Wistar , Recuperação de Função Fisiológica , Vértebras Torácicas/lesões
12.
Childs Nerv Syst ; 31(2): 301-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25370032

RESUMO

INTRODUCTION: Spina bifida is the most common congenital cause of spinal cord lesions resulting in paralysis and secondary conditions like osteoporosis due to immobilization. Physiotherapy is performed for optimizing muscle function and prevention of secondary conditions. Therefore, training of the musculoskeletal system is one of the major aims in the rehabilitation of children with spinal cord lesions. INTERVENTION AND METHODS: The neuromuscular physiotherapy treatment program Auf die Beine combines 6 months of home-based whole body vibration (WBV) with interval blocks at the rehabilitation center: 13 days of intensive therapy at the beginning and 6 days after 3 months. Measurements are taken at the beginning (M0), after 6 months of training (M6), and after a 6-month follow-up period (M12). Gait parameters are assessed by ground reaction force and motor function by the Gross Motor Function Measurement (GMFM-66). Sixty children (mean age 8.71 ± 4.7 years) who participated in the program until February 2014 were retrospectively analyzed. RESULTS: Walking velocity improved significantly by 0.11 m/s (p = 0.0026) and mobility (GMFM-66) by 2.54 points (p = 0.001) after the training. All changes at follow-up were not significant, but significant changes were observed after the training period. Decreased contractures were observed with increased muscle function. CONCLUSION: Significant improvements in motor function were observed after the active training period of the new neuromuscular training concept. This first analysis of the new neuromuscular rehabilitation concept Auf die Beine showed encouraging results for a safe and efficient physiotherapy treatment program which increases motor function in children with spina bifida.


Assuntos
Modalidades de Fisioterapia , Disrafismo Espinal/reabilitação , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Vibração
13.
Restor Neurol Neurosci ; 33(2): 233-49, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25503507

RESUMO

PURPOSE: Based on several positive effects of whole-body-vibration (WBV) therapy on recovery after SCI, we looked for correlations between functional (analysis of locomotion), electrophysiological (H-reflex) and morphological (density of functioning capillaries) measurements after SCI and WBV-treatment. METHODS: Severe compression SCI at low-thoracic level (T8) in adult female Wistar rats was followed by WBV twice a day (2 × WBV) over a 12-week post-injury period. Intact rats and rats with SCI but no WBV-therapy ("No-WBV") served as controls. Recovery of locomotion was determined by BBB-locomotor rating, foot stepping angle (FSA), rump-height index (RHI), correct ladder steps (CLS) and H-reflex at 1, 3, 6, 9, and 12 weeks after SCI. Animals were sacrificed by an overdose of Isoflurane (Abbott). One hour later their spinal cords were fixed in 4% PFA for 24 h. Samples from the thoracic cord containing the lesion site and from the lumbar intumescence were cut into 10 µm thick longitudinal frozen sections. RESULTS: All functioning capillaries were unequivocally identified because the endogenous peroxidase of the erythrocytes was clearly visualized with 0.05% diaminobenzidine (DAB). A determination of their absolute (in µm2) and proportional areas (percent of photographed tissue) revealed a significantly denser capillary network in the WBV-treated rats: 1,66 ± 0,41% in the "vibrated" rats versus 0,79 ± 0,19% in the "No-WBV" animals. The portion of the capillary network in intact rats was 1,51 ± 0,69%. Surprisingly, even though the vascularization in the treated animals was significantly increased, this had no beneficial influence on the recovery of functions after SCI. CONCLUSION: The results of this study provide for the first time evidence that intensive WBV-therapy leads to a significantly denser capillary network in the lesioned spinal cord. However, since this higher capillary density is not associated with improved functional recovery (possibly because it exceeded the balance necessary for functional improvements), optional treatments with lower intensity or less time of WBV-therapy should be tested.


Assuntos
Capilares/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Compressão da Medula Espinal/fisiopatologia , Compressão da Medula Espinal/terapia , Medula Espinal/irrigação sanguínea , Vibração/uso terapêutico , Animais , Fenômenos Biomecânicos , Capilares/patologia , Modelos Animais de Doenças , Feminino , Reflexo H/fisiologia , Atividade Motora/fisiologia , Modalidades de Fisioterapia , Distribuição Aleatória , Ratos Wistar , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/patologia , Vértebras Torácicas
14.
J Musculoskelet Neuronal Interact ; 14(4): 445-53, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25524970

RESUMO

OBJECTIVE: Osteogenesis imperfecta (OI) is a rare disease leading to recurrent fractures, hyperlaxicity of ligaments, short stature and muscular weakness. Physiotherapy is one important treatment approach. The objective of our analysis was to evaluate the effect of a new physiotherapy approach including side alternating whole body vibration on motor function in children with OI. METHODS: In a retrospective analysis data of 53 children were analyzed. The 12 months approach included 6 months of side alternating whole body vibration training, concomitant physiotherapy, resistance training, treadmill training and 6 months follow up. Primary outcome parameter was the Gross Motor Function Measure after 12 months (M12). RESULTS: 53 children (male: 32; age (mean±SEM): 9.1±0.61, range 2.54-24.81 years) participated in the treatment approach. A significant increase of motor function (GMFM-66 score 55.47±2.45 to 58.67±2.83; p=0.001) and walking distance (47.04 m±6.52 to 63.36±8.25 m (p<0.01) between M0 and M12 was seen. Total body without head bone mineral density increased significantly at M12 (p=0.0189). CONCLUSIONS: In the cohort of OI children which participated in the specialized treatment approach improvements of motor function were observed. Therefore this program should be considered as additional therapeutic approach for children with severe OI.


Assuntos
Terapia por Exercício/métodos , Osteogênese Imperfeita/reabilitação , Adolescente , Densidade Óssea , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Vibração/uso terapêutico , Adulto Jovem
15.
Z Rheumatol ; 73(4): 335-41, 2014 May.
Artigo em Alemão | MEDLINE | ID: mdl-24714928

RESUMO

Rheumatic diseases in childhood and adolescence can lead to secondary osteoporosis based on various pathophysiologies. The underlying disease, medication and immobility resulting in a reduced osteoanabolic stimulus contribute to the development of a fragile skeletal system. For diagnostic purposes dual-energy X-ray absorptiometry (DXA) is the most frequently used technology. For interpretation of the areal bone mineral density, age and gender matched reference data have to be used. Particularly in the pediatric field, body height must additionally be taken into consideration. Further techniques which can provide detailed information are peripheral quantitative computed tomography and high resolution magnetic resonance imaging. Nowadays, skeletal assessments have to be interpreted in the context of the muscular system. The concept of the functional muscle-bone unit is widely accepted and uses the muscles as the dominating factor. In a second step the adaptation of the skeletal system to the applied muscle force is evaluated. This allows a differentiation between primary and secondary skeletal diseases depending on the ratio of muscles to bone. Therapeutic options for secondary osteoporosis include reduction of the causative medication, treatment of the underlying disease, antiresorptive treatment with bisphosphonates and different programs to activate the muscles. A multimodal interval rehabilitation program including alternating side vibration shows positive effects on mobility, muscle function and bone mass in children and adolescents.


Assuntos
Antirreumáticos/efeitos adversos , Osteoporose/diagnóstico , Osteoporose/etiologia , Doenças Reumáticas/complicações , Doenças Reumáticas/tratamento farmacológico , Absorciometria de Fóton , Adolescente , Antirreumáticos/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/patologia , Criança , Terapia Combinada , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Osteoporose/tratamento farmacológico , Tomografia Computadorizada por Raios X
16.
Horm Res Paediatr ; 79(5): 257-70, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23735882

RESUMO

The goal of growth hormone (GH) treatment in a short child is to attain a fast catch-up growth toward the target height (TH) standard deviation score (SDS), followed by a maintenance phase, a proper pubertal height gain, and an adult height close to TH. The short-term response variable of GH treatment, first-year height velocity (HV) (cm/year or change in height SDS), can either be compared with GH response charts for diagnosis, age and gender, or with predicted HV based on prediction models. Three types of prediction models have been described: the Kabi International Growth Hormone Study models, the Gothenburg models and the Cologne model. With these models, 50-80% of the variance could be explained. When used prospectively, individualized dosing reduces the variation in growth response in comparison with a fixed dose per body weight. Insulin-like growth factor-I-based dose titration also led to a decrease in the variation. It is uncertain whether adding biochemical, genetic or proteomic markers may improve the accuracy of the prediction. Prediction models may lead to a more evidence-based approach to determine the GH dose regimen and may reduce the drug costs for GH treatment. There is a need for user-friendly software programs to make prediction models easily available in the clinic.


Assuntos
Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento Humano/uso terapêutico , Modelos Biológicos , Adolescente , Adulto , Fatores Etários , Biomarcadores/metabolismo , Criança , Pré-Escolar , Feminino , Transtornos do Crescimento/fisiopatologia , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Fatores Sexuais
17.
J Musculoskelet Neuronal Interact ; 13(2): 147-56, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23728101

RESUMO

OBJECTIVES: A training intervention comparing resistance exercise with or without whole-body vibration (WBV) was conducted to compare acute and chronic effects on functional and molecular parameters. METHODS: A six-week training intervention was performed including 26 healthy males (26 years, SD=4). Two groups were analyzed in a parallel design performing either resistive exercise (RE, n=13) or resistive vibration exercise (RVE, n=13) training with weekly increasing vibration frequencies (20-40Hz). Resting and exercising blood pressure and heart rate were measured before and after the 6-week intervention. RESULTS: Both training interventions decreased resting systolic blood pressure (P=0.003). Resting diastolic blood pressure was significantly decreased only in the RVE group (P=0.01). Exercising diastolic blood pressure was significantly decreased during the final training (P<0.001) with no additional effect of superimposed vibrations. Resistance exercise with superimposed vibrations evoked back pain to a higher degree than resistance exercise alone when training at frequencies above 30Hz (P<0.01). CONCLUSIONS: These data suggest positive effects of resistance exercise upon cardiovascular health and vascular responsiveness and a further beneficial effect of superimposed vibrations in decreasing resting diastolic blood pressure. Finally, development of back pain may be fostered by superimposed vibrations to high training loads, particularly at higher frequencies.


Assuntos
Condicionamento Físico Humano/métodos , Treinamento Resistido/métodos , Vibração , Adulto , Pressão Sanguínea/fisiologia , Dieta , Estudos de Viabilidade , Frequência Cardíaca/fisiologia , Hemodinâmica/fisiologia , Humanos , Masculino , Atividade Motora , Esforço Físico/fisiologia , Inquéritos e Questionários , Adulto Jovem
18.
J Musculoskelet Neuronal Interact ; 12(3): 183-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22947550

RESUMO

UNLABELLED: Osteogenesis imperfecta (OI) is a genetically heterogeneous disease leading to bone fragility. OI-VI is an autosomal-recessive form caused by mutations in SERPINF1. There is experimental evidence suggesting that loss of functional SERPINF1 leads to an activation of osteoclasts via the RANK/RANKL pathway. Patients with OI-VI show a poor response to bisphosphonates. We report on four children with OI-VI who had shown continuously elevated urinary bone resorption markers during a previous treatment with bisphosphonates. We treated these children with the RANKL antibody denosumab to reduce bone resorption. INTERVENTION AND RESULTS: Denosumab (1 mg/kg body weight) was injected s.c. every 3 months. There were no severe side effects. Markers of bone resorption decreased to the normal range after each injection. N-terminal Propeptide of collagen 1 was measured in the serum during the first treatment cycle and decreased also. Urinary deoxypyridinoline/creatinine was monitored in a total of seven treatment cycles and indicated that bone resorption reached the pre-treatment level after 6-8 weeks. CONCLUSION: This was the first use of denosumab in children with OI-VI. Denosumab was well tolerated, and laboratory parameters provided evidence that the treatment reversibly reduced bone resorption. Therefore, denosumab may be a new therapeutic option for patients with OI-VI.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Reabsorção Óssea/tratamento farmacológico , Osso e Ossos/efeitos dos fármacos , Osteogênese Imperfeita/tratamento farmacológico , Ligante RANK/antagonistas & inibidores , Adolescente , Reabsorção Óssea/metabolismo , Osso e Ossos/metabolismo , Criança , Denosumab , Humanos , Masculino , Osteogênese Imperfeita/metabolismo , Osteogênese Imperfeita/fisiopatologia
19.
Horm Res Paediatr ; 76(5): 321-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21952409

RESUMO

BACKGROUND/AIMS: Osteogenesis imperfecta (OI) is a hereditary disease causing increased bone fragility. Pamidronate (PAM), which has to be administered as a 3-day course according to the original protocol by Glorieux, is the most frequently used therapy. Other bisphosphonates like neridronate (NER), which can be infused during an outpatient visit, have also proven to be effective. This is the first analysis comparing the effect of PAM and NER using vertebral morphometry. METHODS: 28 patients with OI type III and IV were retrospectively analyzed by matched pairs. RESULTS: No differences were detected between patients treated with PAM or NER at the start of therapy: mean age 4.4 years (p = 0.730), mean height 86.8 cm/85.3 cm (p = 0.854), lumbar vertebral area 208.9 mm(2)/206.0 mm(2) (p = 0.555), and in all vertebral indices. After 1 year of treatment (mean 1.16 years; p = 0.854) both groups showed a significant increase in the vertebral area and improved vertebral indices. Again there were no differences between the groups in the vertebral area (p = 0.590). CONCLUSION: In this study there was no difference between patients treated with PAM or NER regarding vertebral morphometry during the first year of therapy. Because of the possibility of an outpatient setting, NER is convenient for these children.


Assuntos
Remodelação Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Osteogênese Imperfeita/tratamento farmacológico , Coluna Vertebral/efeitos dos fármacos , Absorciometria de Fóton , Adolescente , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pamidronato , Estudos Retrospectivos , Coluna Vertebral/metabolismo , Coluna Vertebral/fisiologia
20.
J Musculoskelet Neuronal Interact ; 10(3): 193-8, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20811143

RESUMO

Whole-body vibration (WBV) is receiving increasing interest as a therapeutic modality to improve neuromuscular performance or to increase bone mass or density. In order to help improve the quality of reports about WBV treatment studies, the International Society of Musculoskeletal and Neuronal Interactions (ISMNI) invited experts in the field to provide suggestions on how the intervention should be described in such reports. The recommendations are presented here.


Assuntos
Comunicação Celular/fisiologia , Doenças Musculoesqueléticas/patologia , Doenças Musculoesqueléticas/terapia , Neurônios/fisiologia , Modalidades de Fisioterapia/tendências , Vibração/uso terapêutico , Protocolos Clínicos , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/normas , Equipamentos e Provisões/normas , Humanos , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Doenças Musculoesqueléticas/fisiopatologia , Neurônios/patologia
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