Tania F. Salvini

Gait Training Combining Partial Body-Weight Support, a Treadmill, and Functional Electrical Stimulation: Effects on Poststroke Gait

Background and Purpose: Treadmill training with harness support is a promising, task-oriented approach to restoring locomotor function in people with poststroke hemiparesis. Although the combined use of functional electrical stimulation (FES) and treadmill training with body-weight support (BWS) has been studied before, this combined intervention was compared with the Bobath approach as opposed to BWS alone. The purpose of this study was to evaluate the effects of the combined use of FES and treadmill training with BWS on walking functions and voluntary limb control in people with chronic hemiparesis. Subjects: Eight people who were ambulatory after chronic stroke were evaluated. Methods: An A1-B-A2 single-case study design was applied. Phases A1 and A2 included 3 weeks of gait training on a treadmill with BWS, and phase B included 3 weeks of treadmill training plus FES applied to the peroneal nerve. The Stroke Rehabilitation Assessment of Movement was used to assess motor recovery, and a videography analysis was used to assess gait parameters. Results: An improvement (from 54.9% to 71.0%) in motor function was found during phase B. The spatial and temporal variables cycle duration, stance duration, and cadence as well as cycle length symmetry showed improvements when phase B was compared with phases A1 and A2. Discussion and Conclusions: The combined use of FES and treadmill training with BWS led to an improvement in motor recovery and seemed to improve the gait pattern of subjects with hemiparesis, indicating the utility of this combination method during gait rehabilitation. In addition, this single-case series showed that this alternative method of gait training—treadmill training with BWS and FES—may decrease the number of people required to carry out the training.

Motor and Sensory Nerve Conduction Are Affected Differently by Ice Pack, Ice Massage, and Cold Water Immersion

Background It is well known that reducing tissue temperature changes sensory and motor nerve conduction. However, few studies have compared the effect of different cold modalities on nerve conduction parameters. Objective The purpose of this study was to compare the effects of ice pack, ice massage, and cold water immersion on the conduction parameters of the sural (sensorial) and tibial motor nerves. Design An experimental study was conducted in which the participants were randomly assigned to 1 of 3 intervention groups (n=12 per group). Independent variables were cold modality and pre- and post-cooling measurement time. Dependent variables were skin temperature and nerve conduction parameters. Methods Thirty-six people who were healthy, with a mean (SD) age of 20.5 (1.9) years, participated in the study. Each group received 1 of the 3 cold modalities, applied to the right calf region for 15 minutes. Skin temperature and nerve conduction parameters were measured before and immediately after cooling. Results All 3 modalities reduced skin temperature (mean=18.2°C). There also was a reduction in amplitude and an increase in latency and duration of the compound action potential. Ice massage, ice pack, and cold water immersion reduced sensory nerve conduction velocity (NCV) by 20.4, 16.7, and 22.6 m/s and motor NCV by 2.5, 2.1, and 8.3 m/s, respectively. Cold water immersion was the most effective modality in changing nerve conduction parameters. Limitations The cooling area of the ice massage and ice pack was smaller than that of the cold water immersion. The examiner was not blinded to the treatment group. The population included only participants who were healthy and young. Conclusions All 3 modalities were effective in reducing skin temperature and changing sensory conduction at a physiological level that is sufficient to induce a hypoalgesic effect. The results suggest that cold water immersion, as applied in this study, is the most indicated modality for inducing therapeutic effects associated with the reduction of motor nerve conduction.

ELECTRICAL STIMULATION IMPAIRS EARLY FUNCTIONAL RECOVERY AND ACCENTUATES SKELETAL MUSCLE ATROPHY AFTER SCIATIC NERVE CRUSH INJURY IN RATS

Neuromuscular recovery after peripheral nerve lesion depends on the regeneration of severed axons that re‐establish their functional connection with the denervated muscle. The aim of this study was to determine the effects of electrical stimulation (ES) on the neuromuscular recovery after nerve crush injury in rats. Electrical stimulation was carried out on the tibialis anterior (TA) muscle after sciatic nerve crush injury in a rat model. Six ES sessions were administered every other day starting from day 3 postinjury until the end of the experiment (day 14). The sciatic functional index was calculated. Muscle excitability, neural cell adhesion molecule (N‐CAM) expression, and muscle fiber cross‐sectional area (CSA) were accessed from TA muscle. Regenerated sciatic nerves were analyzed by light and confocal microscopy. Both treated (crush+ES) and untreated (crush) groups had their muscle weight and CSA decreased compared with the normal group (P < 0.05). Electrical stimulation accentuated muscle fiber atrophy more in the crush+ES than in the crush group (P < 0.05). N‐CAM expression increased in both crush and crush+ES groups compared with the normal group (P < 0.05). Regenerated nerves revealed no difference between the crush and crush+ES groups. Nevertheless, functional recovery at day 14 post‐injury was significantly lower in crush+ES group compared with the crush group. In addition, the crush+ES group had chronaxie values significantly higher on days 7 and 13 compared with the crush group, which indicates a decrease in muscle excitability in the crush+ES animals. The results of this study do not support a benefit of the tested protocol of ES during the period of motor nerve recovery following injury. Muscle Nerve, 2010

Effects of 660 and 780 nm low‐level laser therapy on neuromuscular recovery after crush injury in rat sciatic nerve

Post‐traumatic nerve repair is still a challenge for rehabilitation. It is particularly important to develop clinical protocols to enhance nerve regeneration. The present study investigated the effects of 660 and 780 nm low‐level laser therapy (LLLT) using different energy densities (10, 60, and 120 J/cm2) on neuromuscular and functional recovery as well as on matrix metalloproteinase (MMP) activity after crush injury in rat sciatic nerve.

Non-invasive ventilation improves peripheral oxygen saturation and reduces fatigability of quadriceps in patients with COPD

Background and objective:  Non‐invasive ventilation (NIV) might improve peripheral muscle function and exercise capacity in severely disabled patients. This study evaluated the physiological impact of NIV on isokinetic concentric strength and endurance of lower limb muscles in patients with severe COPD.

Bouts of Passive Stretching after Immobilization of the Rat Soleus Muscle Increase Collagen Macromolecular Organization and Muscle Fiber Area

This study evaluated the effect of short bouts of stretching on the soleus muscle after immobilization, by measuring the birefringence of the intramuscular connective tissue (ICT) and the muscle fiber area. Thirty rats were divided into five groups: the left soleus was immobilized in the shortened position; after immobilization the animals remained free; after immobilization, the soleus was stretched daily (10 stretches of 60 sec followed by 30 sec rest); after immobilization, the soleus was stretched 3 times a week; control. Immobilization caused a loss of birefringence of the ICT and of muscle fiber area and only daily stretching increased both compared with the control (p < 0.01). In conclusion, short daily bouts of stretching after immobilization induced molecular reorganization of the collagen bundles and muscle fiber hypertrophy in the rat soleus.

Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome

This study evaluated the effectiveness of a rehabilitation program performed during working hours on function and pain in workers with subacromial impingement syndrome. Fourteen male workers (31.93 ± 5.86 years) in the school supply industry were assessed. The duration of their shoulder pain was 28.50 ± 33.64 months, and their amount of time in this industry was 9.07 ± 3.68 years. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire evaluated function of the upper limbs. The Mc Gill Pain Questionnaire quantified the pain by the number of words chosen and the pain rating index (PRI). Subjects completed an 8-week rehabilitation program, twice a week, consisting of cryotherapy, strengthening, and stretching exercises. Subjects’ outcome data were collected pre- and post-intervention. The results showed that DASH scores improved (p<0.05) and the number of words chosen and PRI decreased (p<0.05) on the McGill Pain Questionnaire at post-intervention. Results should be interpreted cautiously, considering the lack of a control group in the investigation. In conclusion, it is suggested that an intervention program consisting of cryotherapy, strengthening, and stretching applied during working hours and twice a week may be effective to decrease pain and physical impairment in male workers with subacromial impingement syndrome.

Bilateral myofascial trigger points and pressure pain thresholds in the shoulder muscles in patients with unilateral shoulder impingement syndrome: a blinded, controlled study.

Objectives:To identify the presence of myofascial trigger points (TrPs) and pressure pain threshold (PPT) levels in the shoulder muscles of both involved and uninvolved sides in patients with unilateral shoulder impingement syndrome (SIS). Methods:Twenty-seven patients with SIS and 20 matched control patients participated in this study. TrPs of 10 shoulder muscles and 8 PPTs, including tibialis anterior PPT, were assessed. Results:SIS group showed a greater number of TrPs (t=−2.697; P=0.010) than the control group. The muscles of the uninvolved side of the SIS group also presented some active TrPs. PPTs showed small differences between involved and uninvolved sides of patients with SIS and higher differences between both sides of the SIS group and dominant side of controls although with significant difference only in the supraspinatus PPT (F=3.239; P=0.045). The muscle PPTs of the patients presenting TrPs in each muscle of the involved side were lower than the PPTs of the patients without TrPs in the same muscle for both involved and uninvolved sides with few significant differences. Discussion:The high number of TrPs in the involved side of patients with SIS suggests the presence of peripheral sensitization. The results reject the presence of central alterations. Finally, the patients with unilateral SIS may present bilateral deficits related to myofascial pain.

Electrical stimulation based on chronaxie reduces atrogin-1 and myoD gene expressions in denervated rat muscle.

Denervation induces muscle fiber atrophy and changes in the gene expression rates of skeletal muscle. Electrical stimulation (ES) is a procedure generally used to treat denervated muscles in humans. This study evaluated the effect of ES based on chronaxie and rheobase on the expression of the myoD and atrogin‐1 genes in denervated tibialis anterior (TA) muscle of Wistar rats. Five groups were examined: (1) denervated (D); (2) D+ES; (3) sham denervation; (4) normal (N); and (5) N+ES. Twenty muscle contractions were stimulated every 48 h using surface electrodes. After 28 days, ES significantly decreased the expression of myoD and atrogin‐1 in D+ES compared to the D group. However, ES did not prevent muscle‐fiber atrophy after denervation. Thus, ES based on chronaxie values and applied to denervated muscles using surface electrodes, as normally used in human rehabilitation, was able to reduce the myoD and atrogin‐1 gene expressions, which are related to muscular growth and atrophy, respectively. The results of this study provide new information for the treatment of denervated skeletal muscle using surface ES. Muscle Nerve, 2006

Morphological effects of two protocols of passive stretch over the immobilized rat soleus muscle

This study evaluated two different stretching protocols employed during a period of hind‐limb immobilization in terms of their effects on muscle morphology. Quantitative data regarding the soleus muscle were obtained based on the clinical hypothesis that a high frequency of this exercise would improve the recovery of muscle structure. Twenty‐four male Wistar rats were divided into four groups (n = 6 each): the control group (C); the immobilized group, in which the left hind limb was immobilized in order to maintain the soleus muscle in a fully shortened position for 3 weeks (I); the ‘immobilized and stretched every 3 days’ group, in which the left hind limb was immobilized as in the immobilized group, but with the soleus muscle stretched every 3 days for 40 min (Ist3); and the ‘immobilized (as in the immobilized group) and stretched every 7 days’ group (ISt7). All soleus muscles were excised 21 days after the beginning of the experiment, and were processed for (1) haematoxylin and eosin and myosin ATPase to evaluate muscle morphology and cross‐sectional area and the proportions of the different fibre types, and (2) ultrastructural analysis. The cross‐sectional area was found to have decreased in all fibre types (I, II and C), mainly in ISt7, when compared with the C group and ISt3 group. The proportion of the different fibre types did not show statistical difference between groups. Light and electron microscopy examination revealed signs of cell degeneration that was more intense in the group immobilized and stretched three times a week. In conclusion, sessions of passive stretching applied to the soleus during immobilization induce muscle fibre injury, suggesting that this therapeutic tool should be applied carefully to disused muscles.