Juliusz Huber

Transplantation of autologous olfactory ensheathing cells in complete human spinal cord injury.

Numerous studies in animals have shown the unique property of olfactory ensheathing cells to stimulate regeneration of lesioned axons in the spinal cord. In a Phase I clinical trial, we assessed the safety and feasibility of transplantation of autologous mucosal olfactory ensheathing cells and olfactory nerve fibroblasts in patients with complete spinal cord injury. Six patients with chronic thoracic paraplegia (American Spinal Injury Association class A-ASIA A) were enrolled for the study. Three patients were operated, and three served as a control group. The trial protocol consisted of pre- and postoperative neurorehabilitation, olfactory mucosal biopsy, culture of olfactory ensheathing cells, and intraspinal cell grafting. Patients clinical state was evaluated by clinical, neurophysiological, and radiological tests. There were no adverse findings related to olfactory mucosa biopsy or transplantation of olfactory ensheathing cells at 1 year after surgery. There was no evidence of neurological deterioration, neuropathic pain, neuroinfection, or tumorigenesis. In one cell-grafted patient, an asymptomatic syringomyelia was observed. Neurological improvement was observed only in transplant recipients. The first two operated patients improved from ASIA A to ASIA C and ASIA B. Diffusion tensor imaging showed restitution of continuity of some white matter tracts throughout the focus of spinal cord injury in these patients. The third operated patient, although remaining ASIA A, showed improved motor and sensory function of the first spinal cords segments below the level of injury. Neurophysiological examinations showed improvement in spinal cord transmission and activity of lower extremity muscles in surgically treated patients but not in patients receiving only neurorehabilitation. Observations at 1 year indicate that the obtaining, culture, and intraspinal transplantation of autologous olfactory ensheathing cells were safe and feasible. The significance of the neurological improvement in the transplant recipients and the extent to which the cell transplants contributed to it will require larger numbers of patients.

Functional regeneration of supraspinal connections in a patient with transected spinal cord following transplantation of bulbar olfactory ensheathing cells with peripheral nerve bridging.

Treatment of patients sustaining a complete spinal cord injury remains an unsolved clinical problem because of the lack of spontaneous regeneration of injured central axons. A 38-year-old man sustained traumatic transection of the thoracic spinal cord at upper vertebral level Th9. At 21 months after injury, the patient presented symptoms of a clinically complete spinal cord injury (American Spinal Injury Association class A-ASIA A). One of the patients olfactory bulbs was removed and used to derive a culture containing olfactory ensheathing cells and olfactory nerve fibroblasts. Following resection of the glial scar, the cultured cells were transplanted into the spinal cord stumps above and below the injury and the 8-mm gap bridged by four strips of autologous sural nerve. The patient underwent an intense pre- and postoperative neurorehabilitation program. No adverse effects were seen at 19 months postoperatively, and unexpectedly, the removal of the olfactory bulb did not lead to persistent unilateral anosmia. The patient improved from ASIA A to ASIA C. There was improved trunk stability, partial recovery of the voluntary movements of the lower extremities, and an increase of the muscle mass in the left thigh, as well as partial recovery of superficial and deep sensation. There was also some indication of improved visceral sensation and improved vascular autoregulation in the left lower limb. The pattern of recovery suggests functional regeneration of both efferent and afferent long-distance fibers. Imaging confirmed that the grafts had bridged the left side of the spinal cord, where the majority of the nerve grafts were implanted, and neurophysiological examinations confirmed the restitution of the integrity of the corticospinal tracts and the voluntary character of recorded muscle contractions. To our knowledge, this is the first clinical indication of the beneficial effects of transplanted autologous bulbar cells.

The body balance training effect on improvement of motor functions in paretic extremities in patients after stroke. A randomized, single blinded trial

OBJECTIVE Study evaluates movement selectivity improvement in hemiparetic post-stroke patients after balance training. METHODS Study included 26 patients and 15 healthy subjects (control group C). Patients were divided into two groups with 20-day balance training (A) and without (B). Normal standing weight distribution was expressed in percentages, center of feet pressure (COP) sway velocities were evaluated in anterior-posterior and medio-lateral (Y, X) directions for normal standing with eyes open and closed (EO, EC) and for tandem. Brunnström scale assessed movement selectivity. RESULTS Weight distribution dissymmetry (Δ10%) was found. It was reduced (Δ2%) after training in group A. COP were higher for X direction (±6mm/s vs ±12mm/s) in normal standing. Difference (±12mm/s) was found for Y in tandem. Brunnström score increased in group A from 0.3 to 0.6. It was negatively correlated with average COP for EO and EC in Y and X and for tandem in X. CONCLUSION Training reduces weight-bearing dissymmetry and improves movement selectivity.

Evaluation of Palpation, Pressure Algometry, and Electromyography for Monitoring Trigger Points in Young Participants

OBJECTIVE The aims of this study were to assess trigger points (TrPs), their pain threshold, and the activity of motor units in the neck and shoulder girdle muscles of young volunteers and to assess palpation, algometry, and surface electromyography (EMG) for their detection. METHODS Seventy participants aged from 19 to 26 years (20.6 ± 1.4 years [mean ± SD]) were examined to identify TrPs through palpation, an algometer test for pressure pain threshold (PPT), a test for the activity of muscle motor units at rest (rEMG) and at maximal contraction (mcEMG) with surface EMG recordings. RESULTS Palpation studies revealed numerous symmetrical nonreferring latent TrPs (379/560 performed tests), referring latent TrPs (91/560), and few active TrPs (4/560). Algometry confirmed the lowest PPT in active TrPs and the highest PPT in participants with no TrPs (86/560). Pressure pain thresholds were lower in nonpregnant women than in men, especially in the trapezius and sternocleidomastoid muscles with nonreferring and referring latent TrPs. Trigger points evoked a moderate increase of rEMG amplitude but with no evident changes in mcEMG. CONCLUSIONS This study showed that the preliminary algometry and rEMG recordings monitored a decrease in PPT and an increase in muscle tension in all cases of TrPs in each of the 3 types detected in people younger than 30 years.

Reinvestigation of the dysfunction in neck and shoulder girdle muscles as the reason of cervicogenic headache among office workers

Purpose: Dysfunction of cervical and shoulder girdle muscles as reason of cervicogenic headache (CEH) was reinvestigated with clinical and neurophysiological studies. Methods: Forty office workers were randomized into two groups to verify efficiency of supervised kinesiotherapy (N = 20) aimed with improvement of muscle’s activity and headache symptoms releasing. Headache intensity was evaluated with visual analog scale (VAS), range of cervical movement (ROM) with goniometer, trigger points (TrPs) incidence with palpation and muscle’s strength with Lovett’s scale. Reaction of patients for muscle’s elongation was also evaluated. Surface electromyographical recordings were bilaterally analyzed at rest (rEMG) and during maximal contraction (mcEMG). Results: Deficits of cervical flexion and muscles strength were found in all patients. TrPs occurred predominantly in painful trapezius muscle. Incidence of trigger points coexisted with intensity of CEH. Results indicated on muscles dysfunction which improved only after supervised therapy. Positive correlations between increase in rEMG amplitudes and high VAS scores, high-amplitude rEMG recordings incidence and increased number of TrPs were found. Negative correlation was detected between amplitude in mcEMG and amplitude of rEMG recordings. Conclusions: Dysfunction of trapezius muscle was most responsible for CEH etiology. Proposed algorithm of kinesiotherapy was effective as complementary method of the CEH patients treatment.

The effect of early isometric exercises on clinical and neurophysiological parameters in patients with sciatica: An interventional randomized single-blinded study

Objective: To determine the effects of early introduction of isometric exercises on pain intensity and trunk and lower extremity muscles strength in patients with sciatica. Methods: Fifty two patients treated for disc herniation with sciatica were included in this randomized controlled single-blinded study. They were examined twice, before and after twenty days of rehabilitation, with neuroimaging, visual analog scale (VAS), straight leg rising test (SLR), range of spine movement in a saggital plane, muscle strength, electromyography (EMG), electroneurography (ENG) and intensity of current vs stimulus duration tests (IC-SD). Twenty-six patients, selected randomly, were ordered to reduce the physical activity and frequent loading of the spine (conventional [C] group) while 26 patients underwent a program of supervised isometric exercises (intervention [I] group). A control group of healthy subjects performed once the same examination. Results: Following treatment the muscle strength and flexibility of the spine showed significant (P < 0.05) improvement in I group with a significantly lower pain level and number of positive SLR tests. The same tests performed in C group indicated no parallel improvement. EMG Parameters increased in almost all muscles, but only in the I group were they associated with simultaneous improvement in ENG examinations of peroneal nerves. Conclusion: Early introduction of isometric exercises, 14 days after the incidence, is a relevant choice in cases of patients with sciatica caused by the disc herniation.

Investigation of the relationship between stimulus parameters and a human muscle contraction force during stimulation of the gastrocnemius muscle.

The article presents the results of investigations on the influence of biphasic stimulus parameters such as duration and stimulus interphase interval (IPI) on a gastrocnemius muscle contraction force. Seven healthy volunteers participated in this experiment, and 24 different stimuli patterns were tested. Special attention was paid to the comfort level of a sensory perception while the electrostimulation was applied. During the test, an optimal stimulus pattern evoking contraction at the level over 15% maximum voluntary contraction force and preserving a good comfort perception reported by all of the participants was investigated. It was found that bursts of pulses with width 175 micros and the IPI from 50 to 1000 micros satisfied these criteria. Moreover, it was observed that the increase of the IPI duration generated a significantly stronger contraction force in comparison with the stimulation with the standard biphasic pulses (IPI = 0 micros) having the same amplitude, frequency, and pulse duration. This shows that the modulation of the IPI might be a potentially useful support for the standard force-control methods and may find an application in neuromuscular electrical stimulation systems.

Supervised versus uncontrolled rehabilitation of patients after rotator cuff repair-clinical and neurophysiological comparative study.

Purpose The purpose of this study was the evaluation of the effectiveness of supervised rehabilitation in comparison to uncontrolled exercise therapy after surgical reconstruction of rotator cuff interrupted tendons. Methods Twenty two patients with comparable level of disability after the same type of surgery were randomly divided into two equal groups. The first group took part in a supervised therapy and the second one performed simple exercises without supervision. Clinical and neurophysiological examinations were performed prior to rehabilitation and after 20 and 40 days of treatment. The evaluation included the assessment of the pain level with visual analog scale, active range of motion with goniometer, activity of muscles motor units at rest and during maximal effort with electromyography and transmission of motor fibers in brachial plexus with electroneurography (M-wave stimulation studies). Results In the group of supervised patients the active range of movement changed significantly from 26.4° to 101.5° on average for flexion with adduction while flexion with abduction improved from 21° to 95.5°. Pain sensation changed from 6.4 to 3.2. The mean resting electromyogram amplitude decreased to the greatest degree from 80.9μV to 36.8μV in trapezius muscle while maximal effort electromyogram amplitude increased in this muscle from 381.8μV to 790.9μV. The mean values of amplitudes in electroneurographical suprascapular nerve examinations increased from 536.4μV to 1691μV. No significant differences at P=0.05 were found in these parameters recorded in the patients performing uncontrolled exercises. Conclusion The supervised exercise therapy is more effective than uncontrolled one after the rotator cuff surgical reconstruction.

Evaluation of Mandibular Movement Functions Using Instrumental Ultrasound System

PURPOSE The article deals with routinely performed instrumental temporomandibular joint (TMJ) examinations and interpretation of findings obtained from the Arcus Digma ultrasound device in individuals with or without clinical symptoms of temporomandibular disorders (TMD). The aim of this study was to analyze mandibular movement functions and the relationship between incisors and condylar movement parameters during jaw opening, which may be helpful for clinical evaluation in these patients. MATERIALS AND METHODS The study group consisted of 84 young students with no dental problems and other serious acute or chronic diseases in the medical history; the students were examined both clinically and with the Arcus Digma ultrasound device. RESULTS Helkimo Di = I was the most common score in 49 participants, and Helkimo Di = II in a significantly (p < 0.01, Di = I vs. Di = II) smaller number of participants. Medical history revealed symptoms of unilateral mastication in 15 participants and a statistically significant increased (p < 0.02, participants with symptoms of unilateral mastication vs. asymptomatic) condylar range of motion parameter during retrusion. Also a significant decrease (p < 0.03, participants with symptoms of unilateral mastication vs. asymptomatic) of the incisal and condylar ranges of motion during mouth opening was found. Limitation of mouth opening, defined as a decrease of inter-incisal distance, appeared in 19 participants (22.6%) and in 25 participants (29.8%) measured instrumentally with the Arcus Digma device. A comparison of instrumental result examinations of the right and left TMJs showed positive correlations of the range of mandible opening movement with the Posselt opening movement (r = 0.75) and opening/closing movements with the Posselt closing movements (r = 0.70). A correlation was demonstrated (r = 0.81) between the condylar range of motion studied on the left and on the right TMJ during mandible opening movement. Correlations were also found between opening-closing movements and the condylar range of motion of the left TMJ, and between the opening-closing movement and the condylar range of motion of the right TMJ during the opening movement. CONCLUSIONS According to the results of this study with instrumental Arcus Digma ultrasound device measurements of mandibular movements, data were provided on irregularities in TMJ function not detected in participants with or without clinical symptoms of TMD.

Visual biofeedback exercises for improving body balance control after anterior cruciate ligament reconstruction.

[Purpose] To evaluate the effects of balance training after arthroscopic anterior cruciate ligament reconstruction. [Subjects and Methods] Sixteen patients (mean 33 ± 8 years old) who underwent anterior cruciate ligament reconstruction three months prior to participating in a one-month rehabilitation program. The control group included 15 people aged 34 ± 4 years. Patients’ functional level was evaluated according to the Lysholm knee score, and balance quality was ascertained by static and dynamic tests. A balance platform was used to measure the center of foot pressure deflection. Two dynamic balance tests evaluated time of task execution. [Results] Lysholm knee score improved significantly after rehabilitation. Balance in the sagittal plane with eyes closed improved significantly after rehabilitation. The average velocity of center of foot pressure swing in both the frontal and sagittal planes with eyes closed differed significantly from those of controls. Execution time required for the two dynamic tests decreased significantly after rehabilitation and were significantly better than those in the controls. [Conclusion] Maintaining static balance with eyes closed is very challenging after anterior cruciate ligament reconstruction. Maintaining balance in the sagittal plane is particularly difficult. A one-month rehabilitation program partially improves static and dynamic balance.