Bone loss from high repetitive high force loading is prevented by ibuprofen treatment.

We examined roles of loading and inflammation on forearm bones in a rat model of upper extremity overuse. Trabecular structure in distal radius and ulna was examined in three groups of young adult rats: 1) 5% food-restricted that underwent an initial training period of 10 min/day for 5 weeks to learn the repetitive task (TRHF); 2) rats that underwent the same training before performing a high repetition high force task, 2 hours/day for 12 weeks (HRHF); and 3) food-restricted only (FRC). Subsets were treated with oral ibuprofen (IBU). TRHF rats had increased trabecular bone volume and numbers, osteoblasts, and serum osteocalcin, indicative of bone adaptation. HRHF rats had constant muscle pulling forces, showed limited signs of bone adaptation, but many signs of bone resorption, including decreased trabecular bone volume and bone mineral density, increased osteoclasts and bone inflammatory cytokines, and reduced median nerve conduction velocity (15%). HRHF+IBU rats showed no trabecular resorptive changes, no increased osteoclasts or bone inflammatory cytokines, no nerve inflammation, preserved nerve conduction, and increased muscle voluntary pulling forces. Ibuprofen treatment preserved trabecular bone quality by reducing osteoclasts and bone inflammatory cytokines, and improving muscle pulling forces on bones as a result of reduced nerve inflammation.

Performance of a repetitive task by aged rats leads to median neuropathy and spinal cord inflammation with associated sensorimotor declines.

Epidemiological studies have demonstrated a relationship between advancing age and susceptibility to risk factors for median neuropathies and musculoskeletal disorders. In this study, we determined if performance of a voluntary reaching task by aged rats induced sensorimotor declines, median nerve dysfunction and increased inflammatory cytokines in peripheral nerves, muscle and spinal cord neurons. Aged (14 mon) rats were trained for 15 min/day for 4 weeks to learn a high repetition, low force (HRLF) task (19 reaches/min; 15% maximum pulling force). Aged task rats performed the task for 2 h/day, 3 days/wk, for 12 weeks (until they were 18 mon of age). No behavioral changes were detected in normal controls (NC) or food-restricted controls (FR C) as they aged. However, grip strength declined in HRLF rats in weeks 6-12 (P<0.01 each) and 12-week trained-only rats (TR; P<0.05), compared to NC. Mechanical hypersensitivity was present in weeks 9 and 12 HRLF reach limb forepaws (P<0.01 and P<0.05, respectively), and 12-week HRLF support limb forepaws (P<0.01) and hindpaws (P=0.03), compared to NC. By week 12, median nerve conduction velocity declined 23%, bilaterally, in HRLF (P<0.001 each), and 13% in TR (P<0.05), compared to NC. Tumor necrosis factor alpha (TNFα) increased in 12-week HRLF muscle (P=0.005), median nerve (P<0.01), and neurons in superficial lamina of HRLF cervical spinal cords (P<0.01), compared to NC. interleukin 1 beta (IL1ß) also increased in superficial lamina neurons (P<0.01). Loss of grip strength was correlated with median nerve conduction slowing (r=0.70) as well as increased nerve and muscle TNFα (r=-0.38 and r=-0.41, respectively); decrease in forepaw withdrawal thresholds was correlated with median nerve conduction slowing (r=0.81), increased nerve TNFα (r=-0.59), and increased TNFα and IL1ß in neurons in spinal cord dorsal horns (r=-0.52 and r=-0.47, respectively). Thus, aged rats performing a repetitive task exhibited sensorimotor declines that were associated with decreased median nerve conduction, and increased pro-inflammatory cytokines in the median nerve and cervical spinal cord neurons.

Präder-Willi syndrome fails to alter cardiac autonomic modulation.

Twenty-six healthy subjects with a diagnosis of Präder-Willi syndrome were compared with 26 age-, gender-, and body mass index-matched controls for autonomic modulation and baroreflex sensitivity. Electrocardiograms, beat-to-beat finger blood pressures, and respiration were recorded for several minutes in the following sequence: (1) supine, (2) after transition from supine to standing, (3) sitting, (4) during a Valsalva maneuver, (5) while performing moderate exercise, and (6) during recovery from exercise while seated. All recordings were channeled and stored in a computer; analyses were carried out at a later date. Power spectral analysis (fast-Fourier transform) of heart period variability was used to assess cardiac autonomic modulation. The slope of the regression equation between heart period and blood pressure rise after the Valsalva maneuver was used as an index of baroreflex sensitivity. Analysis of variance failed to reveal significant differences in any of the autonomic and baroreflex sensitivity variables between the two groups. Because breathing patterns entrain autonomic modulation, we verified respiration and found no differences between the two groups. Therefore, findings in the current investigation indicate that cardiac autonomic modulation in patients with Präder-Willi syndrome does not differ from age and body mass index-matched subjects.

Reducing iliotibial band contractures in patients with muscular dystrophy using custom dry floatation cushions.

OBJECTIVE: Custom dry floatation cushions were used to potentially reduce iliotibial band (ITB) contractures in long-term wheelchair users. DESIGN: Time-series with repeated measures pretreatment and posttreatment with follow-up at 6 and 12 months. SETTING: Community wheelchair users seen in private office. PATIENTS: A volunteer sample of nine subjects diagnosed with Duchenne's or limb-girdle muscular dystrophy, nonambulatory at least 3 years, and able to lie prone were included. One subject dropped out owing to adverse effects, one for technical reasons. Seven subjects completed the study and were contacted 6 months later; two were evaluated 1 year later. The participants ranged in age from 9 to 69 years, were nonambulatory an average of 7 years, and spent 12 to 16 hours a day in their wheelchairs. INTERVENTION: Subjects used custom dry floatation (ROHO) wheelchair cushions for 9 weeks. The cushions were designed with a sunken middle portion and separately inflated lateral portions, providing adduction to the thighs. MAIN OUTCOME MEASURES: ITB contractures were measured using goniometry every 3 weeks, twice before and three times after cushion delivery. RESULTS: After 9 weeks, a 13 degrees average decrease in ITB contracture was noted, representing a 34% change from baseline (p < .001, 99% confidence intervals, paired one-tailed t test). CONCLUSION: Using a custom dry floatation cushion for 9 weeks reduced ITB contractures in nonambulatory muscular dystrophy patients by an average 34%. Patients with large initial ITB contractures benefited the most. Such a cushion could be used to reduce ITB contractures in similar patient populations.

Myoelectric evoked potentials versus locomotor recovery in chronic spinal cord injured rats.

The purpose of this study was to determine the utility of descending evoked potentials in evaluating functional recovery in rats after spinal cord contusion injury. Rats received thoracic contusions at T9 using a controlled-displacement impactor. They were evaluated for 5 weeks postinjury using auditory startle responses (ASR) while alert, or by cerebellar motor evoked potentials (CMEP) while anesthetized. ASR and CMEP were recorded electromyographically from forelimb and hindlimb muscles. Open field locomotor performance was also assessed and recovered to almost normal levels by 3 weeks postinjury. Histologic analysis of the injury site indicated that the contusions destroyed approximately 70% of the cross-sectional area of the cord. Although the remaining 30% was sufficient to preserve nearly normal locomotor behavior, ASR and CMEP amplitudes in hindlimb flexors and extensors were reduced by 90% or more after injury and showed virtually no recovery. Significant ASR and CMEP responses were present in the cutaneous trunk muscles of the lower torso after injury. These muscles are innervated via peripheral nerves originating at cord levels above the injury. Multi-wave field potentials normally recorded from the dorsal cord surface in response to cerebellar stimulation were absent in injured rats, suggesting minimal if any activation of segmental neurons via the pathways normally mediating CMEP. The tracts mediating ASR and CMEP thus appear to be highly sensitive to mild spinal cord trauma but are evidently not essential for support or walking.

Upper extremity functional assessment scales in children with Duchenne muscular dystrophy: a comparison.

Twenty-three subjects were assessed using the already established Brooke Upper Extremity Functional Rating Scale and the timed Jebsen Hand Function Test to determine whether the Jebsen test was a more discriminative measure of upper extremity function in patients with Duchenne muscular dystrophy (DMD). The data were analyzed using univariate and forced-entry multiple regression analyses to determine the relationship between the Jebsen and Brooke scales while removing the effects of the other independent variables: age, hand dominance, and visit number. The univariate regression results suggested a positive relationship between the Brooke and Jebsen scales. Discrete sublevels of time on the Jebsen Hand Function Test were not found within the Brooke functional levels. However, the Jebsen test was found to be a more sensitive assessment of hand function than the Brooke scale among the DMD population. Parametric data were gathered, nondominant and dominant hand functions were differentiated, and a constant set of muscle groups was used to complete the tasks of the Jebsen Hand Function Test. The Jebsen Hand Function Test might be used instead of the Brooke scale as a more discriminative method of following DMD patient progress over time, both clinically and during drug treatment trials.

Reliability of testing measures in Duchenne or Becker muscular dystrophy.

In a multiinstitutional collaborative study, we ascertained the interevaluator and intraevaluator reliability of six physical therapists who performed assessment measures on 36 boys (11.7 +/- 3.9 years) with Duchenne or Becker muscular dystrophy. Upper and lower extremities were evaluated by manual muscle testing for function, range of motion, and strength. The data were analyzed using intraclass correlation coefficients (ICCs). For the interevaluator phase, ICCs were as follows: average muscle strength, .90; range of motion, .76; and upper extremity functional performance, .58. For the intraevaluator phase, corresponding ICCs were .80 to .96; .33 to .97; .34 to 1.00. Our results confirm and extend observations by others that these assessment measures are sufficiently reliable for use in a multiinstitutional collaborative effort. Such results can be used to design clinical trials that have sufficient statistical power to detect changes in the rate of disease progression. Investigators planning clinical trials in a multiinstitutional collaborative setting should first standardize the assessment methods, provide evaluator training, and document reliability.

Effects of cast gold surface finishing on plaque retention.

The relationship between the surface finish on cast gold restorations and the amount of plaque deposited on that surface was examined. Six different finishes were tested. The rough finish was found to accumulate significantly less plaque than the other finishes. Every finish exhibited some plaque accumulation, even after the first 24 hours. Each finish accumulated progressively more plaque at each successive time interval.