Andrea Tettamanti

Intra-arterial transplantation of HLA-matched donor mesoangioblasts in Duchenne muscular dystrophy

Intra‐arterial transplantation of mesoangioblasts proved safe and partially efficacious in preclinical models of muscular dystrophy. We now report the first‐in‐human, exploratory, non‐randomized open‐label phase I–IIa clinical trial of intra‐arterial HLA‐matched donor cell transplantation in 5 Duchenne patients. We administered escalating doses of donor‐derived mesoangioblasts in limb arteries under immunosuppressive therapy (tacrolimus). Four consecutive infusions were performed at 2‐month intervals, preceded and followed by clinical, laboratory, and muscular MRI analyses. Two months after the last infusion, a muscle biopsy was performed. Safety was the primary endpoint. The study was relatively safe: One patient developed a thalamic stroke with no clinical consequences and whose correlation with mesoangioblast infusion remained unclear. MRI documented the progression of the disease in 4/5 patients. Functional measures were transiently stabilized in 2/3 ambulant patients, but no functional improvements were observed. Low level of donor DNA was detected in muscle biopsies of 4/5 patients and donor‐derived dystrophin in 1. Intra‐arterial transplantation of donor mesoangioblasts in human proved to be feasible and relatively safe. Future implementation of the protocol, together with a younger age of patients, will be needed to approach efficacy.

Efficacy of Trunk Balance Exercises for Individuals With Chronic Low Back Pain: A Randomized Clinical Trial

STUDY DESIGN Randomized clinical trial. OBJECTIVES To determine the efficacy of trunk balance exercises for individuals with chronic low back pain. BACKGROUND The majority of exercises focusing on restoring lumbopelvic stability propose targeting the feedforward control of the lumbopelvic region. Less attention has been paid to feedback control during balance adjustments. METHODS Seventy-nine patients were randomly allocated to 2 different groups. The experimental group performed trunk balance exercises in addition to standard trunk flexibility exercises. The control group performed strengthening exercises in addition to the same standard trunk flexibility exercises. The primary outcome measures were pain intensity (visual analogue scale), disability (Roland-Morris Questionnaire), and quality of life (12-Item Short-Form Health Survey). Secondary outcomes were painful positions, use of analgesic drugs, and referred pain. Analysis of variance and relative risk were used to analyze the data for the primary and secondary outcome measures, respectively. The number of participants reaching the minimal clinically important difference in the 2 groups for each outcome measure was compared using relative risk. RESULTS A significant difference in scores on the Roland-Morris Questionnaire (P = .011) and the physical component of the 12-Item Short-Form Health Survey (P = .048), and in the number of participants reaching the minimal clinically important difference for the Roland-Morris Questionnaire (relative risk, 1.79; 95% confidence interval [CI]: 1.05, 3.04) and the secondary outcome of painful positions (relative risk, 1.37; 95% CI: 1.03, 1.83) were found in favor of the experimental treatment. CONCLUSIONS Trunk balance exercises combined with flexibility exercises were found to be more effective than a combination of strength and flexibility exercises in reducing disability and improving the physical component of quality of life in patients with chronic low back pain.

Myofascial trigger points and innervation zone locations in upper trapezius muscles

BackgroundMyofascial 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.MethodsWe 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.ResultsNo 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.ConclusionsAccording 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.

Improving Hand Functional Use in Subjects with Multiple Sclerosis Using a Musical Keyboard: A Randomized Controlled Trial

BACKGROUND AND PURPOSE Playing an instrument implies neuroplasticity in different cerebral regions. This phenomenon has been described in subjects with stroke, suggesting that it could play a role in hand rehabilitation. The aim of this study is to analyse the effectiveness of playing a musical keyboard in improving hand function in subjects with multiple sclerosis. METHODS Nineteen hospitalized subjects were randomized in two groups: nine played a turned-on musical keyboard by sequences of fingers movements (audio feedback present) and 10 performed the same exercises on a turned-off musical keyboard (audio feedback absent). Training duration was half an hour per day for 15 days. Primary outcome was the perceived hand functional use measured by ABILHAND Questionnaire. Secondary outcomes were hand dexterity, measured by Nine-Hole Peg Test, and hand strength, measured by Jamar and Pinch dynamometers. Two-way analysis of variance was used for data analysis. RESULTS The interaction time × group was significant (p = 0.003) for ABILHAND Questionnaire in favour of experimental group (mean between-group difference 0.99 logit [IC95%: 0.44; 1.54]). The two groups showed a significant time effect for all outcomes except for Jamar measure. DISCUSSION Playing a musical keyboard seems a valid method to train the functional use of hands in subjects with multiple sclerosis.

Longitudinal MRI quantification of muscle degeneration in Duchenne muscular dystrophy

The aim of this study was to evaluate the usefulness of magnetic resonance imaging (MRI) in detecting the progression of Duchenne muscular dystrophy (DMD) by quantification of fat infiltration (FI) and muscle volume index (MVI, a residual‐to‐total muscle volume ratio).

Effects of coupled upper limbs movements on postural stabilisation

The preference for in-phase association of coupled cyclic limbs movements is well described (mirror-symmetrical patterns) and this is demonstrated by the ease of performing in-phase movements compared to anti-phase ones. The hypothesis of this study is that the easiest movement patterns are those with minor postural activity. The aim of this study was to describe postural activity in standing subjects in the sagittal and frontal planes during the execution of three upper limbs tasks (single arm, in-phase, anti-phase) at four different frequencies (from 0.6 to 1.2Hz). We employed six infrared cameras for recording kinematics information, a force platform for measuring forces exerted on the ground, and a system for surface electromyography (SEMG). Outcome measures were: upper limb range of movement and relative-phase, centre of pressure displacement (COP), screw torque (Tz) exerted on the ground, and SEMG recordings of postural muscles (adductor longus, gluteus medius, rectus femoris, and biceps femoris). Our results show that in both the planes the in-phase task resulted in less COP displacement, torque production, and postural muscles involvement than the anti-phase and single arm tasks. This reduced need of postural control could explain the ease of performing in-phase coupled limb movements compared with anti-phase movements.

Evaluation and training of hands and feet movements performed with different strategies: a kinematic study.

OBJECTIVES To assess whether the ability to execute flexion/extension of hands and feet, in different patterns of in-phase and anti-phase association, is influenced by the planning of the movements according to the two body sides (i.e., right vs. left) compared to the upper and lower parts of the body (i.e., hands vs. feet); and to evaluate how training of these movements influences their performance. METHODS Fifteen healthy subjects were studied while performing four different tasks involving simultaneously in-phase and anti-phase movements of the hands and feet in the parasagittal plane. Hand and foot movements were represented by wrist and ankle kinematics, measured before and after training as duration of correct execution, median frequency of movements, median ranges of motion and discrete relative phase (AEø). RESULTS During baseline assessment, subjects performed the task better when instructions were given to focus on in-phase or anti-phase movements of bilateral upper and lower extremities than when instructions were focused on the movements of the left and right side. After the training these differences disappeared. During all the conditions, the duration of correct execution and the movement frequency were significantly different between the baseline and the final assessment (p ranging from 0.001 to 0.04). The AEø did not differ among the four tasks, as well as between the baseline and the final assessment. CONCLUSION Combination of movements of the hands and feet is easier when planning the movements with respect to the upper or lower segments of the body rather than right and left side. These findings might have important implications when subjects have to learn novel coordination patterns as it is the case in rehabilitative and sportive activities.

Finite helical axis for the analysis of joint kinematics: comparison of an electromagnetic and an optical motion capture system

BackgroundThe analysis of joints kinematics is important in clinical practice and in research. Nowadays it is possible to evaluate the mobility of joints in vivo with different motion capture techniques available in the market. Optical systems use infrared cameras and reflective markers to evaluate body movements, while other systems use electromagnetic fields to detect position and orientation of sensors. The aim of this study was the evaluation of two motion capture systems based on different technologies (optical and electromagnetic) by comparing the distribution of finite helical axis (FHA) of rotation during controlled rotations of an object in different positions.MethodsThe distribution of position and angle errors of the FHA were extracted by optical and electromagnetic system recordings during a controlled rotation of a low friction stool in different positions in a controlled environment.ResultsThe optical motion capture system showed lower angle and position errors in the distribution of FHA while the electromagnetic system had higher errors that increased with increasing distance from the antenna.ConclusionsThe optical system showed lower errors in the estimation of FHA that could make it preferable with respect to electromagnetic systems during joint kinematics.

Cognitive training with action-related verbs induces neural plasticity in the action representation system as assessed by gray matter brain morphometry

ABSTRACT Embodied cognition theories of semantic memory still face the need for multiple sources of converging evidence in support of the involvement of sensory‐motor systems in action‐related knowledge. Previous studies showed that training manual actions improves semantic processing of verbs referring to the trained actions. The present work aimed to provide complementary evidence by measuring the brain plasticity effects of a cognitive training requiring sustained lexical‐semantic processing of action‐related verbs. We included two groups of participants, namely the Proximal Group (PG) and the Distal Group (DG), which underwent a 3‐week training with verbs referring to actions involving the proximal and the distal upper limb musculature, respectively. Before and after training, we measured gray matter voxel brain morphometry based on T1 structural magnetic resonance imaging. By means of this 2 (Group: PG, DG) × 2 (Time: pre‐, post‐training) factorial design, we tested whether sustained cognitive experience with specific action‐related verbs induces congruent brain plasticity modifications in target regions of interest pertaining to the action representation system. We found significant post‐ versus pre‐training gray matter volume increases, specifically for PG in the left dorsal precentral gyrus, and for DG in the right cerebellar lobule VIIa. These preliminary results suggest that a cognitive training can induce structural plasticity modifications in brain regions specifically coding for the distal and proximal motor actions the trained verbs refer to. HIGHLIGHTSTraining motor actions improves processing verb meaning referring to those actions.We sought complementary effects by training verbs and measuring brain plasticity.Gray matter volume increased action‐specifically in premotor and cerebellar areas.Cognitive training steered by embodiment theory noticeably affects the action system.