Ulrike H. Mitchell

Restless legs syndrome and near-infrared light: An alternative treatment option

There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1–4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.

Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome

Ekbom disease (EKD), formerly known as restless legs syndrome (RLS) has affected and bothered many people over the centuries. It is one of the most prevalent neurological disorders in Europe and North-America, affecting about 10% of the population. The main characteristics are the strong urge to move, accompanied or caused by uncomfortable, sometimes even distressing, paresthesia of the legs, described as a “creeping, tugging, pulling” feeling. The symptoms often become worse as the day progresses, leading to sleep disturbances or sleep deprivation, which leads to decreased alertness and daytime functions. Numerous studies have been conducted assessing the efficacy of dopaminergic drugs, opioids, and other pharmacologic agents in alleviating EKD symptoms. However, there is also a growing body of evidence demonstrating the effectiveness of nonpharmacologic treatments including life style changes, physical activity programs, pneumatic compression, massage, near-infrared light therapy, and complementary therapies. The working mechanisms behind these alternatives are diverse. Some increase blood flow to the legs, therefore reducing tissue hypoxia; some introduce an afferent counter stimulus to the cortex and with that “close the gate” for aberrant nerve stimulations; some increase dopamine and nitric oxide and therefore augment bio-available neurotransmitters; and some generate endorphins producing an analgesic effect. The advantages of these treatments compared with pharmacologic agents include less or no side effects, no danger of augmentation, and less cost.

Comparison of two infrared devices in their effectiveness in reducing symptoms associated with RLS.

This study was conducted to assess whether two kinds of near-infrared light devices, using different wavelengths and frequencies, impact symptoms associated with restless legs syndrome (RLS) differently. A recent randomized controlled study showed that symptoms associated with RLS can be diminished with near-infrared light treatment for a limited time. We wanted to assess whether different wavelengths and frequencies had an impact on its effectiveness. Twenty-five volunteers with symptoms of RLS were randomly assigned to either Anodyne® or HealthLight™ treatment. Both groups underwent 12 treatments with near-infrared light, three times a week for 4 weeks. A validated RLS rating scale was used to track changes. The two groups were not different in reported symptoms at baseline (p=0.37) and after 4 weeks of treatment (p=0.88). There was a significant improvement of symptoms between week 0 and week 4 (p<0.001); the difference in change indicated virtually the same improvement between the two groups. Although the two near-infrared light devices used different wavelengths and frequencies and one device used additional red light, they both produced significant improvement in the symptoms associated with RLS after 4 weeks of treatment.

Topical analgesic added to paraffin enhances paraffin bath treatment of individuals with hand osteoarthritis

Purpose. To compare treating patients with symptomatic hand osteoarthritis (OA) with paraffin baths only (PO) (100% wax) or paraffin baths 80% wax with 20% topical analgesic (PTA). Methods. Subjects met criteria of the American College of Rheumatology for classifying symptomatic hand OA and had a Dreisers index score >5 points. Current and average pain at rest and with movement was assessed with visual analogue scales. Hand function was assessed by the functional index for hand OA (FIHOA). Results. Both groups had a significant reduction in their ‘current’ pain 15 min after the first and twelfth treatments compared to pre-treatment but there was no difference between groups (t = 0.10, p > 0.05). The PTA group had greater improvement over the 12 treatment sessions for their pain at rest (t = 2.92, p < 0.05) and with movement (t = 4.73, p < 0.05) than the PO group. The PTA group also showed greater improvement in their FIHOA following 12 treatments than the PO group (t = 3.52, p < 0.05). Conclusion. Our results indicate that the addition of a topical analgesic to paraffin produced significantly greater pain relief at rest and during movement than paraffin baths alone after 12 treatments. Additionally, the PTA group experienced greater improved hand function.

Effect of Whole Body Vibration on Skin Blood Flow and Nitric Oxide Production

Background: Vascular dysfunction due to hyperglycemia in individuals with diabetes is a factor contributing to distal symmetric polyneuropathy (DSPN). Reactive oxygen species reduce the bioavailability of nitric oxide (NO), a powerful vasodilator, resulting in reduced circulation and nerve ischemia. Increases in blood NO concentrations and circulation have been attributed to whole body vibration (WBV). The purpose of this study was to the determine the effects of low-frequency, low-amplitude WBV on whole blood NO concentrations and skin blood flow (SBF) in individuals with symptoms of DSPN. Methods: Ten patients with diabetes and impaired sensory perception in the lower limbs participated in this crossover study. Each submitted to 2 treatment conditions, WBV and sham, with a 1-week washout period between. Blood draws for NO analysis and laser Doppler imager scans of SBF were performed before, immediately after, and following a 5-minute recovery of each of the treatments. Results: Low-frequency, low-amplitude WBV significantly increased SBF compared to the sham condition (F2,18 = 5.82, P = .0115). Whole blood NO concentrations did not differ between the WBV and sham conditions immediately or 5 minutes after treatment (F2,18 = 1.88, P = .1813). Conclusions: These findings demonstrate that patients with diabetes respond to WBV with increased SBF compared to the sham condition. The implication is that WBV is a potential nonpharmacological therapy for neurovascular complications of diabetes.

Relationship Between Functional Movement Screen Scores, Core Strength, Posture, and Body Mass Index in School Children in Moldova

Abstract Mitchell, UH, Johnson, AW, and Adamson, B. Relationship between Functional Movement Screen scores, core strength, posture, and body mass index in school children in Moldova. J Strength Cond Res 29(5): 1172–1179, 2015—The assessment of functionality should include parameters that consider postural control, limb asymmetries, range of motion limitations, proprioceptive deficits, and pain. An increasingly popular battery of tests, the Functional Movement Screen (FMS), is purported to assess the above named parameters. The purpose of our study was twofold: (a) to report differences in total FMS scores in children, provide preliminary normative reference values of each of the 7 individual FMS scores for both genders and report on asymmetries and (b) to evaluate the relationship between total FMS scores, age, body mass index (BMI), core strength/stability, and postural angles to explore the possibility of using the FMS in the assessment of childrens functional fitness. Descriptive data on 77 children aged 8–11 years were collected. The children performed core strength/stability exercises. Photographs were taken from a lateral view for later calculation of postural angles. The children performed the FMS while being videotaped for later review. The average total FMS score (of 21) was 14.9 (+1.9), and BMI was 16.4 (+2.2). Static posture is not related to results of the FMS. Core strength was positively correlated to the total FMS score (r = 0.31; p = 0.006). Over 60% demonstrated at least 1 asymmetry. The individual test scores indicate that none of the test items is too difficult for the children. Based on the screens correlation to core strength, and the fact that it identifies areas of asymmetry, we suggest to further investigate its possible use in the assessment of childrens functional fitness.

Vibration and skin blood flow changes in subjects with restless legs syndrome

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Journal of Parkinsonism and Restless Legs Syndrome 2014:4 9–16 Journal of Parkinsonism and Restless Legs Syndrome Dovepress

Effect of high-speed treadmill training with a body weight support system in a sport acceleration program with female soccer players.

Abstract Johnson, AW, Eastman, CS, Feland, JB, Mitchell, UH, Mortensen, BB, and Eggett, D. Effect of high-speed treadmill training with a body weight support system in a sport acceleration program with female soccer players. J Strength Cond Res 27(6): 1496–1502, 2013—Maximum running speed and acceleration are essential components in many sports. The identification of specific training protocols to maximize sprint speed would be useful knowledge for coaches and players. The purpose of this study was to determine the effect of a high-speed treadmill (HST) with the use of a body weight support (BWS) system in a 6-week sport acceleration program (SAP) on female soccer athlete’s 40-yard sprint time and maximal isometric knee flexor and extensor strength. Two treatment groups and one control group were created. Both treatment groups participated in a 12-session SAP. The first treatment group (n = 12) used a BWS system while running on a HST; the second group (n = 12) used a standard treadmill (ST) with no BWS system. The participants of the control group (n = 8), NT, did not participate in a sports acceleration program and did not alter their exercise routines outside of the study. An analysis of covariance was performed using baseline measures as the covariate. The 40-yard sprint times for both treatment groups were shown to improve significantly compared with the control group (p < 0.001). Isometric knee flexor strength showed a greater increase in the ST group (p = 0.026) than in the other 2 groups, whereas knee extensor strengths did not show significant differences between treatment groups and control group (p > 0.05). Participants in the ST group had a much higher rate (66%) of shin splints and foot pain throughout the study than those in the HST (8%) and NT (0%) groups. These results can help high school coaches and athletes determine the optimal treadmill training regime.

The Effect of Being Aerobically Active vs. Inactive on Cutaneous Vascular Conductance during Local Heat Stress in an Older Population

Objective: To test the hypothesis that long- term aerobically trained elderly individuals have a greater amount of bioavailable nitric oxide (NO) and have a larger cutaneous vasodilation during local heat stress compared to their inactive elderly counterparts. Methods: Eight aerobically trained and 8 inactive older men (>60 years old) participated in this study. NO bioavailability in blood and intradermal dialysate were measured with an ozone based chemiluminescence NO analyzer. Cutaneous vasodilator response to local heating was obtained using laser Doppler velocimetry. Results: Whole blood NO were similar in older- trained and inactive subjects (0.75 ± 0.56 and 0.38 ± 0.32 μM, respectively; Mann–Whitney, p = 0.153), as was intradermal dialysate NO before (7.82 ± 6.32 and 4.18 ± 1.89 μM, respectively) and after local heating (7.16 ± 6.27 and 5.88 ± 3.97 μM, respectively, p = 0.354). The cutaneous vasodilator response of the older- inactive group was smaller than the older- trained group [Group-Time interaction, F(24, 264) = 12.0, p < 0.0001]. When compared to a young group the peak vasodilator response of the older- trained subjects was similar. However, the time to initial dilation was 3.1 and 2.2 times longer (p < 0.05) in older- inactive and older- trained subjects, respectively, compared to young subjects. Conclusions: Our data support the hypothesis that the age-related reductions in cutaneous vasodilation can possibly be restored by maintaining an aerobic training regimen (at least 3 years). However, some residual effects of aging remain, specifically a delayed cutaneous vasodilator response to local heating is still present in active older adults. We found no evidence for an increase in systemic or local NO-bioavailability with an extended commitment to aerobic fitness.

Decreased Symptoms without Augmented Skin Blood Flow in Subjects with RLS/WED after Vibration Treatment

STUDY OBJECTIVES Vascular disturbances leading to tissue hypoxia have been named as a possible cause for RLS/WED. Vibration to the whole body (WBV) in subjects with RLS/WED results in increased skin blood flow (SBF). The aims of this investigation were to (1) determine if a two-week treatment with WBV will decrease symptoms associated with RLS/WED and, (2) if so, determine if the mechanism for improvement in symptoms is related to an increase in SBF, as measured in flux. METHODS Eleven subjects with RLS/WED underwent 2 weeks of 14-minute intermittent WBV and a 2-week sham treatment in randomized order. Pre and post intervention RLS symptom severity were compared. Baseline SBF was compared between subjects with RLS/WED and an age- and sex-matched control group. A crossover design (aim 1) and a matched case-control design and repeated measures design (aim 2) were used. The data analyses consisted of 2-sample and paired t-tests; where applicable we used a standard crossover design adjustment. RESULTS WBV did significantly decrease symptoms associated with RLS/WED compared to baseline data and compared to sham treatment. The baseline flux was significantly lower in RLS/WED subjects than matched controls, but this deficit was negated with WBV. There was no increase in resting SBF over the 2 weeks of treatment. CONCLUSIONS Subjects with RLS/WED have decreased SBF but are able to increase flux to the same level as normal subjects with WBV. A 2-week intervention with WBV decreases symptoms associated with RLS/WED, but this does not seem to be related to an increase in resting SBF.