scholarly journals The effect of the speed and range of motion of movement on the hyperemic response to passive leg movement

2019 ◽  
Vol 7 (8) ◽  
pp. e14064 ◽  
Author(s):  
Jayson R. Gifford ◽  
Travis Bloomfield ◽  
Trevor Davis ◽  
Amy Addington ◽  
Erin McMullin ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Leg Movement ◽  
Hyperemic Response

scholarly journals The Effect Of The Speed And Range Of Motion Of Movement On The Hyperemic Response To Passive Leg Movement

2019 ◽  
Vol 51 (Supplement) ◽  
pp. 490
Author(s):  
Brady Hanson ◽  
Travis Bloomfield ◽  
Trevor Davis ◽  
Amy Addington ◽  
Erin McMullin ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Leg Movement ◽  
Hyperemic Response

scholarly journals CORP: Ultrasound assessment of vascular function with the passive leg movement technique

2017 ◽  
Vol 123 (6) ◽  
pp. 1708-1720 ◽  
Author(s):  
Jayson R. Gifford ◽  
Russell S. Richardson
Keyword(s):  
Vascular Function ◽  
Cardiovascular Health ◽  
Vascular System ◽  
The Elderly ◽  
Passive Movement ◽  
Flow Mediated Dilation ◽  
Peripheral Vascular ◽  
Ultrasound Assessment ◽  
Leg Movement ◽  
Hyperemic Response

As dysfunction of the vascular system is an early, modifiable step in the progression of many cardiovascular diseases, there is demand for methods to monitor the health of the vascular system noninvasively in clinical and research settings. Validated by very good agreement with more technical assessments of vascular function, like intra-arterial drug infusions and flow-mediated dilation, the passive leg movement (PLM) technique has emerged as a powerful, yet relatively simple, test of peripheral vascular function. In the PLM technique, the change in leg blood flow elicited by the passive movement of the leg through a 90° range of motion is quantified with Doppler ultrasound. This relatively easy-to-learn test has proven to be ≤80% dependent on nitric oxide bioavailability and is especially adept at determining peripheral vascular function across the spectrum of cardiovascular health. Indeed, multiple reports have documented that individuals with decreased cardiovascular health such as the elderly and those with heart failure tend to exhibit a substantially blunted PLM-induced hyperemic response (~50 and ~85% reduction, respectively) compared with populations with good cardiovascular health such as young individuals. As specific guidelines have not yet been put forth, the purpose of this Cores of Reproducibility in Physiology (CORP) article is to provide a comprehensive reference for the assessment and interpretation of vascular function with PLM with the aim to increase reproducibility and consistency among studies and facilitate the use of PLM as a research tool with clinical relevance.

scholarly journals Delineating the age-related attenuation of vascular function: Evidence supporting the efficacy of the single passive leg movement as a screening tool

2019 ◽  
Vol 126 (6) ◽  
pp. 1525-1532 ◽  
Author(s):  
Jay R. Hydren ◽  
Ryan M. Broxterman ◽  
Joel D. Trinity ◽  
Jayson R. Gifford ◽  
Oh Sung Kwon ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vascular Function ◽  
Screening Test ◽  
Vascular Dysfunction ◽  
Peripheral Vascular ◽  
Leg Blood Flow ◽  
Age Related ◽  
Cut Score ◽  
Leg Movement ◽  
Hyperemic Response

Continuous passive leg movement (PLM) is a promising clinical assessment of the age-related decline in peripheral vascular function. To further refine PLM, this study evaluated the efficacy of a single PLM (sPLM), a simplified variant of the more established continuous movement approach, to delineate between healthy young and old men based on vascular function. Twelve young (26 ± 5 yr) and 12 old (70 ± 7 yr) subjects underwent sPLM (a single passive flexion and extension of the knee joint through 90°), with leg blood flow (LBF, common femoral artery with Doppler ultrasound), blood pressure (finger photoplethysmography), and leg vascular conductance (LVC) assessed. A receiver operator characteristic curve analysis was used to determine an age-specific cut score, and a factor analysis was performed to assess covariance. Baseline LBF and LVC were not different between groups ( P = 0.6). The high level of covariance and similar predictive value for all PLM-induced LBF and LVC responses indicates LBF, alone, can act as a surrogate variable in this paradigm. The peak sPLM-induced increase in LBF from baseline was attenuated in the old (Young: 717 ± 227, Old: 260 ± 97 ml/min, P < 0.001; cut score: 372 ml/min), as was the total LBF response (Young: 155 ± 67, Old: 26 ± 17 ml, P < 0.001; cut score: 58 ml). sPLM, a simplified version of PLM, exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction, as evidenced by an age-related attenuation in the peripheral hyperemic response and a clearly delineated age-specific cut score. NEW & NOTEWORTHY Single passive leg movement (sPLM) exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction. sPLM displayed an age-related reduction in the peripheral hemodynamic response for amplitude, duration, initial rate of change, and total change with clearly delineated age-specific cut scores. sPLM has a strong candidate variable that is a simple single numeric value, for which to appraise peripheral vascular function, the 45-s hyperemic response (leg blood flow area under the curve: 45 s).

scholarly journals Mechanistic insights into the modulatory role of the mechanoreflex on central hemodynamics using passive leg movement in humans

2018 ◽  
Vol 125 (2) ◽  
pp. 545-552 ◽  
Author(s):  
Nicholas T. Kruse ◽  
William E. Hughes ◽  
Darren P. Casey
Keyword(s):  
Cardiac Output ◽  
Angular Velocity ◽  
Range Of Motion ◽  
Joint Angle ◽  
Feedback Mechanism ◽  
Fascicle Length ◽  
Percent Change ◽  
Muscle Fascicle ◽  
Angular Velocities ◽  
Leg Movement

The aim of this study was to examine the independent contributions of joint range of motion (ROM), muscle fascicle length (MFL), and joint angular velocity on mechanoreceptor-mediated central cardiovascular dynamics using passive leg movement (PLM) in humans. Twelve healthy men (age: 23 ± 2 yr, body mass index: 23.7 kg/m2) performed continuous PLM at various randomized joint angle ROMs (0°–50° vs. 50°–100° vs. 0°–100°) and joint angular velocities (“fast”: 200°/s vs. “slow”: 100°/s). Measures of heart rate (HR), cardiac output (CO), and mean arterial pressure (MAP) were recorded during baseline and during 60 s of PLM. MFL was calculated from muscle architectural measurements of fascicle pennation angle and tissue thickness (Doppler ultrasound). Percent change in MFL increased across the transition of PLM from 0° to 50° (15 ± 3%; P < 0.05) and from 0° to 100° knee flexion (27 ± 4%; P < 0.05). The average peak percent change in HR (increased, approx. +5 ± 2%; P < 0.05), CO (increased, approx. +5 ± 3%; P < 0.05), and MAP (decreased, approx. −2 ± 2%; P < 0.05) were similar between fast versus slow angular velocities when compared against shorter absolute joint ROMs (i.e., 0°–50° and 50°–100°). However, the condition that exhibited the greatest angular velocity in combination with ROM (0°–100° at 200°/s) elicited the greatest increases in HR (+13 ± 2%; P < 0.05) and CO (+12 ± 2%; P < 0.05) compared with all conditions. Additionally, there was a significant relationship between MFL and HR within 0°–100° at 200°/s condition ( r2 = 0.59; P < 0.05). These findings suggest that increasing MFL and joint ROM in combination with increased angular velocity via PLM are important components that activate mechanoreflex-mediated cardioacceleration and increased CO. NEW & NOTEWORTHY The mechanoreflex is an important autonomic feedback mechanism that serves to optimize skeletal muscle perfusion during exercise. The present study sought to explore the mechanistic contributions that initiate the mechanoreflex using passive leg movement (PLM). The novel findings show that progressively increasing joint angle range of motion and muscle fascicle length via PLM, in combination with increased angular velocity, are important components that activate mechanoreflex-mediated cardioacceleration and increase cardiac output in humans.

scholarly journals The role of the endothelium in the hyperemic response to passive leg movement: looking beyond nitric oxide

2020 ◽  
Author(s):  
Joel D. Trinity ◽  
Oh Sung Kwon ◽  
Ryan M. Broxterman ◽  
Jayson R. Gifford ◽  
Andrew C. Kithas ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Blood Flow ◽  
Vascular Function ◽  
No Synthase ◽  
Ketorolac Tromethamine ◽  
Arterial Infusion ◽  
Healthy Men ◽  
Leg Movement ◽  
Hyperemic Response

Passive leg movement (PLM) evokes a robust and predominantly nitric oxide (NO)-mediated increase in blood flow that declines with age and disease. Consequently, PLM is becoming increasingly accepted as a sensitive assessment of endothelium-mediated vascular function. However, a substantial PLM-induced hyperemic response is still evoked despite NO synthase (NOS) inhibition. Therefore, in 9 young healthy men (25±4 yrs), this investigation aimed to determine if the combination of two potent endothelium-dependent vasodilators, specifically prostaglandin (PG) and endothelium-derived hyperpolarizing factor (EDHF), account for the remaining hyperemic response to the two variants of PLM, PLM (60 movements) and single PLM (sPLM, 1 movement) when NOS is inhibited. The leg blood flow (LBF, Doppler ultrasound) response to PLM and sPLM following the intra-arterial infusion of NG-monomethyl L-arginine (L-NMMA), to inhibit NOS, was compared to the combined inhibition of NOS, cyclooxygenase (COX), and cytochrome P450 (CYP450) by L-NMMA, ketorolac tromethamine (KET), and fluconazole (FLUC), respectively. NOS inhibition attenuated the overall LBF (LBFAUC) response to both PLM (control: 456±194, L-NMMA: 168±127 ml, p<0.01) and sPLM (control: 185±171, L-NMMA: 62±31 ml, p=0.03). The combined inhibition of NOS, COX, and CYP450 (i.e. L-NMMA+KET+FLUC) did not further attenuate the hyperemic responses to PLM (LBFAUC: 271±97 ml, p>0.05) or sPLM (LBFAUC: 72±45 ml, p>0.05). Therefore, PG and EDHF do not collectively contribute to the non-NOS-derived NO-mediated, endothelium-dependent, hyperemic response to either PLM or sPLM in healthy young men. These findings add to the mounting evidence and understanding of the vasodilatory pathways assessed by the PLM and sPLM vascular function tests.

Effectiveness of Spinal Mobilization with Leg Movement Versus McKenzie Back Extension Exercises in Lumbar Radiculopathy

2021 ◽  
Vol 15 (5) ◽  
pp. 1436-1440
Author(s):  
B. Ashraf ◽  
S. Ahmad ◽  
K. Ashraf ◽  
S. Kanwal ◽  
S. Ashraf ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Range Of Motion ◽  
Functional Mobility ◽  
Control Group ◽  
City Hospital ◽  
Lumbar Radiculopathy ◽  
Group A ◽  
Leg Movement ◽  
Group B ◽  
Experimental Group

Background: Lumbar Radiculopathy is characterized as radiating pain along with some sensory and motor deficits in lower back and hip into the leg. Manual therapy techniques like Spinal mobilization with leg movement and McKenzie Extension exercise seems to be effective in treating and managing the symptoms associated with Radiculopathy. Aim: To make comparison between effects of Spinal mobilization with leg Movement versus McKenzie Extension exercise to manage the Lumbar Radiculopathy. Methods: The present Randomized Control Trial included 60 patients of age 28-50 years with Lumbar radiculopathy were grouped into two by sealed envelope method; the first group (A) was Experimental Group, while the other group (B) was the control Group and were selected from City hospital Multan from February 2018 to June 2018. The study participants were requested to complete the protocol for 4 weeks (3 days per week, 30 repetitions in one session). All the subjects were examined before and after the tests, for pain intensity (NPRS), functional Mobility measured by MODI and range of motion by goniometry. Results: Results of the study showed significant decrease in pain intensity on NPRS (P< 0.05) and MODI Scoring (P<0.05) with noticeable improvement in Functions and range of motion measured by Goniometry. (Readings were taken at 1st session and at the end of the completion of the session). Pain was equally reduced in both groups while improvement in MODI scoring and Range of motion was more significant in experimental group (A) with respect to the control group (B). Conclusion: Study showed that both techniques SMWLW and McKenzie Extension Exercises were effective in improving the pain, decreasing the severity and MODI Scoring while SMWLM is more effective in improving range of motion. Keywords: Lumbar Radiculopathy, Spinal mobilization with leg movement, McKenzie Extension Exercises

scholarly journals Nitric oxide-mediated vascular function in sepsis using passive leg movement as a novel assessment: a cross-sectional study

2016 ◽  
Vol 120 (9) ◽  
pp. 991-999 ◽  
Author(s):  
Ashley D. Nelson ◽  
Matthew J. Rossman ◽  
Melissa A. Witman ◽  
Zachary Barrett-O'Keefe ◽  
H. Jonathan Groot ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Vascular Function ◽  
Area Under The Curve ◽  
Organ Damage ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
No Bioavailability ◽  
Leg Movement ◽  
Hyperemic Response

Post-cuff occlusion flow-mediated dilation (FMD) is a proposed indicator of nitric oxide (NO) bioavailability and vascular function. FMD is reduced in patients with sepsis and may be a marker of end organ damage and mortality. However, FMD likely does not solely reflect NO-mediated vasodilation, is technically challenging, and often demonstrates poor reproducibility. In contrast, passive leg movement (PLM), a novel methodology to assess vascular function, yields a hyperemic response that is predominately NO-dependent, reproducible, and easily measured. This study evaluated PLM as an approach to assess NO-mediated vascular function in patients with sepsis. We hypothesized that PLM-induced hyperemia, quantified by the increase in leg blood flow (LBF), would be attenuated in sepsis. In a cross-sectional study, 17 subjects in severe sepsis or septic shock were compared with 16 matched healthy controls. Doppler ultrasound was used to assess brachial artery FMD and the hyperemic response to PLM in the femoral artery. FMD was attenuated in septic compared with control subjects (1.1 ± 1.7% vs. 6.8 ± 1.3%; values are means ± SD). In terms of PLM, baseline LBF (196 ± 33 ml/min vs. 328 ± 20 ml/min), peak change in LBF from baseline (133 ± 28 ml/min vs. 483 ± 86 ml/min), and the LBF area under the curve (16 ± 8.3 vs. 143 ± 33) were all significantly attenuated in septic subjects. Vascular function, as assessed by both FMD and PLM, is attenuated in septic subjects compared with controls. These data support the concept that NO bioavailability is attenuated in septic subjects, and PLM appears to be a novel and feasible approach to assess NO-mediated vascular function in sepsis.

Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

2002 ◽  
Vol 7 (4) ◽  
pp. 8-10
Author(s):  
Christopher R. Brigham ◽  
Leon H. Ensalada
Keyword(s):  
Lumbar Spine ◽  
Range Of Motion ◽  
Disk Herniation ◽  
Fourth Edition ◽  
Recurrent Injury ◽  
Injury Model ◽  
Whole Person ◽  
Spinal Region

Abstract Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.

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