Hesham N. Alrowayeh

Soleus and vastus medialis H-reflexes: similarities and differences while standing or lying during varied knee flexion angles.

The H-reflex may be a useful measure to examine the lower extremity muscles activation and inhibition following an injury. Recording the vastus medialis H-reflex amplitudes in healthy subjects while standing or lying during varied knee flexion angles may establish a reference for comparison for patients with ACL injury. Vastus medialis and soleus H-reflexes were recorded from 14 healthy subjects while lying and standing during 0, 30, 45, and 60 degrees knee flexion. EMG unit was used to electrically stimulate the tibial and femoral nerves (using 0.5 ms pulses at 0.2 pps of H-maximum amplitude) and to record four traces of the soleus and vastus medialis H-wave and one trace of the M-wave peak-to-peak amplitudes. Repeated measures three-way ANOVAs were calculated with the global alpha=0.05. Results showed that (1) the average soleus H-reflex amplitude was significantly less during standing than lying across all knee flexion conditions, (2) the average vastus medialis H-reflex amplitudes showed no measurable significant differences between neutral standing compared with lying, (3) the average vastus medialis H-reflex amplitudes were significantly greater during standing knee flexion conditions (30, 45, and 60 degrees ) than lying or neutral standing, and (4) there were no differences between soleus and vastus medialis H-reflex amplitudes during lying across all knee flexion conditions. Data from H/M ratio follow the same pattern of H-amplitude. Recording the vastus medialis H-reflex amplitude during standing and knee flexion may be a reflective of the knee function. It is more specific than the soleus H-reflex because it reflects the changes in the excitability of the quadriceps motoneurons acting directly around the knee joint.

H-reflex amplitude asymmetry is an earlier sign of nerve root involvement than latency in patients with S1 radiculopathy

BackgroundBased on our clinical experience, the H-reflex amplitude asymmetry might be an earlier sign of nerve root involvement than latency in patients with S1 radiculopathy. However, no data to support this assumption are available. The purpose of this study was to review and report the electrophysiological changes in H-reflex amplitude and latency in patients with radiculopathy in order to determine if there is any evidence to support the assumption that H-reflex amplitude is an earlier sign of nerve root involvement than latency.ResultsPatients with radiculopathy showed significant amplitude asymmetry when compared with healthy controls. However, latency was not always significantly different between patients and healthy controls. These findings suggest nerve root axonal compromise that reduced reflex amplitude earlier than the latency parameter (demyelination) during the pathologic processes.ConclusionContrary to current clinical thought, H-reflex amplitude asymmetry is an earlier sign/parameter of nerve root involvement in patients with radiculopathy compared with latency.

Vastus medialis H-reflex reliability during standing

Summary: Vastus medialis H-reflex is a valid measure to examine quadriceps muscle voluntary activation and inhibition after knee injury. Its reliability during repeated sessions has not been established. The purpose of this study was to establish the intrasession and intersession reliability of vastus medialis H-reflex amplitude recordings during standing with varied knee flexion angles (0, 30, 45, and 60 degrees). Electromyography unit was used to elicit and record the vastus medialis H-reflex from the right leg of five healthy subjects. The femoral nerve was stimulated using 0.5-millisecond pulses at 0.2 pps of H-maximum. Four recordings of the vastus medialis H-reflex amplitude were recorded in three trials for each knee flexion angle within each session for two consecutive days. Reliability was calculated using intraclass correlation coefficients (ICC). Intrasession reliability during standing with varied knee angles was high (ICC [2, 4] range from 0.76 to 0.98), and intersession reliability during standing with varied knee angles was moderate to high (ICC [2, 1] range from 0.51 to 0.84). Recording four traces of vastus medialis H-reflex amplitude per trial was reliable. Vastus medialis H-reflex amplitude recordings while standing during varied knee flexion are reliable within and between sessions.

Research amongst Physical Therapists in the State of Kuwait: Participation, Perception, Attitude and Barriers

Objectives: The objectives of this descriptive study were to investigate the attitudes and perceptions of physical therapists regarding research, the intention to engage in research and the barriers to participating in research amongst physical therapists in the State of Kuwait. Subjects and Methods: A previously validated questionnaire was distributed to 200 non-randomly selected physical therapists. The questionnaire gathered demographic data as well as information regarding research-related activities. Descriptive statistics, frequency and χ2 analyses were used in this study. Results: Of the 200 questionnaires distributed to physical therapists 122 (61%) were completed and returned. The physical therapists had a positive attitude towards reading these findings in order to update their knowledge. However, only 16 (17%) of the physical therapists participated in clinical research. The common reasons given were: minimal role and reduced ability, intention and level of engagement in initiating research, probably due to work overload, time constraints and limited access to resources. Conclusions: Physical therapists in Kuwait had a positive attitude towards the application of research findings to their practice. However, they were not confident in initiating research due to work overload and lack of time as well as limited access to library resources. Therefore, we recommend stimulation to engage in research activities to be a requirement and to develop a system to improve the skills and knowledge of doing research.

Reliability, validity and responsiveness of the Arabic version of the Disability of Arm, Shoulder and Hand (DASH-Arabic)

Abstract Purpose: To investigate the psychometric properties (reliability, validity and responsiveness) of the DASH-Arabic in a cohort of Arabic patients presenting with various upper extremity conditions. Methods: Participants were 139 patients with various upper extremity conditions, who completed the DASH-Arabic at the baseline, 2–5 days later and 30–36 days later. Participants completed demographic data forms, the SF-36 and VAS at baseline, and a Global Rating of Change scale at first and second follow-ups. Results: Cronbach’s alpha of the DASH-Arabic was 0.94. Test–retest reliability was excellent with an ICC of 0.97. The SEM was 3.50 and the MDC95 was 9.28. Construct validity of the DASH-Arabic with the SF-36 subscales and VAS scores ranged from r −0.32 to −0.57, all statistically significant (p < 0.001). The effect size (ES) for the DASH-Arabic was 1.39 and its standard response mean was 1.51. The area under the curve was 0.82 (95% CI = 0.72–0.92, p < 0.001). The optimally efficient cutoff for an improvement was found to be a difference of 15 DASH points. Conclusions: The DASH-Arabic is a reliable, valid and responsive upper extremity outcome measure for patients whose primary language is Arabic; it can be used to document patient status and outcomes and support evidence-based practice. Implications for Rehabilitation The DASH-Arabic demonstrated sound psychometric properties of reliability, validity and responsiveness. It is an effective patient status and outcome tool that will support evidence-based practice. This tool is recommended for evaluating upper extremity work-related injuries and tracking therapeutic outcomes.

Flexor carpi radialis H-reflex modulation during spinal loading and unloading with varied forearm postures.

Flexor carpi radialis (FCR) H-reflex is usually recorded with the patient in lying or sitting postures while the forearm is positioned in supination or pronation to detect C7 radiculopathy. Its amplitude is smaller during forearm supination compared with pronation for unclear reasons and its recordings during postural loading conditions (i.e., sitting or lying) have not been previously reported. The purpose of this study was to examine FCR H-reflex recordings during varied cervical spine loadings and forearm positions. The FCR maximum H-reflex amplitude was recorded from 15 healthy participants during lying, free-sitting and sitting-with-load while the forearm was positioned in either supination or pronation. Four traces were averaged for each combination of conditions. Two-way repeated-measure analysis of variances (2 × 3) was used to examine the statistical differences. The average FCR H-reflex amplitude was significantly greater during free-sitting and sitting-with-load compared with the lying body position. The average FCR H-reflex amplitude was significantly greater when the forearm was positioned in pronation compared with supination. The increase in FCR H-reflex amplitude (augmentation) during forearm pronation and sitting postures compared with supination and lying may have been the result of combined neural and mechanical effects. These results encourage FCR H-reflex recordings during sitting with the forearm in pronation.

Electromyographic activity of quadriceps muscle during sit-to-stand in patients with unilateral knee osteoarthritis

ObjectiveThe sit-to-stand (STS) is a simple test to evaluate the functional performance of the quadriceps muscle in patients with knee osteoarthritis (OA). The aim was to evaluate the electromyographic (EMG) activity of the ipsilateral quadriceps during STS task at different seat heights and feet positions in patients with severe unilateral OA. The EMG activity was recorded in a group of eight participants with unilateral OA during the performance of STS task in four conditions: (1) knee-height seat with feet together, (2) knee-height seat with feet askew (feet side by side and heel-to-toe), (3) low-height seat (25% lower than knee-height seat) with feet together, and (4) low-height seat with feet askew.ResultsThere was a statistically significant difference among the four conditions in the EMG activity (p =0.004). Particularly, the EMG activity of the quadriceps was significantly higher when participants rose from the low height with their feet askew than when they rose from the knee height with their feet placed together (p =0.004) or askew (p =0.002). These results recommend considering initial feet position and seat height when evaluating the functional activity of the quadriceps in patients with unilateral OA using STS test.