Improving Upper Extremity Strength, Function, and Trunk Stability Using Wide-Pulse Functional Electrical Stimulation in Combination With Functional Task-Specific Practice

Objectives: To evaluate upper extremity (UE) function, strength, and dynamic sitting balance in individuals with spinal cord injury (SCI) who received an intensive outpatient therapy program focused on UE training augmented with wide pulse/high frequency functional electrical stimulation (WPHF-FES). Methods: This prospective case series was conducted in an outpatient (OP) clinic in an SCI-specific rehabilitation hospital. Participants were a convenience sample (N = 50) of individuals with tetraplegia receiving OP therapy focused on UE recovery. Individuals participated in 60 minutes of UE functional task-specific practice (FTP) in combination with WPHF-FES 5 times/week for an average of 72 sessions. The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS) and the modified functional reach (MFR). Results: Fifty individuals (13 motor complete; 37 motor incomplete SCI) completed an OP UE training program incorporating WPHF-FES and were included in this analysis. On average, participants demonstrated significant improvements in the total CUE-T score of 14.1 (SD = 10.0, p < .0001) points; significant changes were also noted in UEMS and MFR, improving an average of 4.6 (SD = 5.2, p < .0001) points and 13.6 (SD = 15.8, p < .0001) cm, respectively. Conclusion: Individuals with tetraplegia demonstrated significant improvements in UE strength, function, and dynamic sitting trunk balance after receiving UE training augmented with WPHF-FES. Future comparative effectiveness studies need to be completed to guide efficacious treatment interventions in OP therapy.

A Multifactorial Approach for Sarcopenia Assessment: A Literature Review

Sarcopenia refers to a progressive and generalized weakness of skeletal muscle as individuals age. Sarcopenia usually occurs after the age of 60 years and is associated with a persistent decline in muscle strength, function, and quality. A comparison of the risk factors associated with sarcopenia based on the European Working Group on Sarcopenia (1 and 2) in Older People, the Asian Working Group for Sarcopenia (1 and 2), the International Working Group on Sarcopenia, and the Foundation for the National Institutes of Health revealed no consistent patterns. Accordingly, the identification of a single risk factor for sarcopenia is unpredictable due to its “multifactorial” pathogenesis, with the involvement of a multitude of factors. Therefore, the first aim of this review was to outline and propose that the multiple factors associated with sarcopenia need to be considered in combination in the design of new experimentation in this area. A secondary aim was to highlight the biochemical risk factors that are already identified in subjects with sarcopenia to assist scientists in understanding the biology of the pathophysiological mechanisms affecting the old people with sarcopenia. We also briefly discuss primary outcomes (physical) and secondary outcomes (social and financial) of sarcopenia. For future investigative purposes, this comprehensive review may be useful in considering important risk factors in the utilization of a panel of biomarkers emanating from all pathways involved in the pathogenesis of this disease. This may help to establish a uniform consensus for screening and defining this disease. Considering the COVID-19 pandemic, its impact may be exacerbated in older populations, which requires immediate attention. Here, we briefly suggest strategies for advancing the development of smart technologies to deliver exercise in the COVID-19 era in an attempt regress the onset of sarcopenia. These strategies may also have an impact on sarcopenia’s primary and secondary outcomes.

Relationship Between Sarcopenia and Cardiovascular Diseases in the Elderly: An Overview

With the advent of population aging, aging-related diseases have become a challenge for governments worldwide. Sarcopenia has defined as a clinical syndrome associated with age-related loss such as skeletal muscle mass, strength, function, and physical performance. It is commonly seen in elderly patients with chronic diseases. Changes in lean mass are common critical determinants in the pathophysiology and progression of cardiovascular diseases (CVDs). Sarcopenia may be one of the most important causes of poor physical function and decreased cardiopulmonary function in elderly patients with CVDs. Sarcopenia may induce CVDs through common pathogenic pathways such as malnutrition, physical inactivity, insulin resistance, inflammation; these mechanisms interact. In this study, we aimed to investigate the relationship between sarcopenia and CVDs in the elderly. Further research is urgently needed to understand better the relationship, pathophysiology, clinical presentation, diagnostic criteria, and mechanisms of sarcopenia and CVDs, which may shed light on potential interventions to improve clinical outcomes and provide greater insight into the disorders above.

Multicomponent Stress-Strength Reliability Based on Progressive First Failure for Kumaraswamy Model: Bayesian and Non-Bayesian Estimation

It is highly common in many real-life settings for systems to fail to perform in their harsh operating environments. When systems reach their lower, upper, or both extreme operating conditions, they frequently fail to perform their intended duties, which receives little attention from researchers. The purpose of this article is to derive inference for multicomponent reliability where stress-strength variables follow unit Kumaraswamy distributions based on the progressive first failure. Therefore, this article deals with the problem of estimating the stress-strength function, R when X,Y, and Z come from three independent Kumaraswamy distributions. The classical methods namely maximum likelihood for point estimation and asymptotic, boot-p and boot-t methods are also discussed for interval estimation and Bayes methods are proposed based on progressive first-failure censored data. Lindly’s approximation form and MCMC technique are used to compute the Bayes estimate of R under symmetric and asymmetric loss functions. We derive standard Bayes estimators of reliability for multicomponent stress–strength Kumaraswamy distribution based on progressive first-failure censored samples by using balanced and unbalanced loss functions. Different confidence intervals are obtained. The performance of the different proposed estimators is evaluated and compared by Monte Carlo simulations and application examples of real data.

Experimental and Numerical Investigation into Failure Modes of Tension Angle Members Connected by One Leg

This paper presents the results of experimental and numerical tests on angle members connected by one leg with a single row of bolts. This study was designed to determine which failure mode governs the resistance of such joints: net section rupture or block tearing rupture. Experimental tests were insufficient to completely identify the failure modes, and it was necessary to conduct numerical simulations. Finite element analysis of steel element resistance based on rupture required advanced material modelling, taking into account ductile initiation and propagation of fractures. This was realised using the Gurson–Tvergaard–Needleman porous material model, which allows for analysis of the joint across the full scope of its behaviour, from unloaded state to failure. Through experimental testing and numerical simulations, both failure mechanisms (net section and block tearing) were examined, and an approach to identify the failure mode was proposed. The obtained results provided experimental and numerical evidence to validate the strength function used in design standards. Finally, the obtained results of the load capacity were compared with the design procedures given in the Eurocode 3′s current and 2021 proposed editions.

Effects of alcohol on skeletal muscle contractile performance in male and female mice

Background Acute and chronic alcohol use can cause skeletal muscle myopathy in concert with impairments in skeletal muscle strength, function and fatigue resistance. However, the fundamental contractile deficits induced in the presence of alcohol versus those observed in the recovery period following the clearance of alcohol have not yet been characterized nor is it known whether sex influences these outcomes. Methods Male and female mice received an intraperitoneal injection of either saline (Control) or ethanol (EtOH; 5g/kg body weight). Muscle force, fatigue, fatigue recovery and twitch characteristics of the posterior crural muscle complex were measured in situ 1 hour and 24 hours post alcohol. Results In the presence of alcohol (1-hour post treatment) absolute and normalized force generated at 80–150 Hertz was decreased in male and female mice with concurrent reductions in the rate of force development and increases in ½ relaxation time. When expressed as a percentage of maximum force, both males and females also displayed an alcohol-induced leftward shift in the force frequency curve indicative of a type I contractile phenotype. Alcohol enhanced fatigue in both males and females but had no effect on force recovery. Following clearance of alcohol (24-hour post treatment), contractile function was completely restored in females while alcohol treated males experienced sustained reductions in absolute force and had enhanced fatigue compared with male controls. Conclusions In the presence of alcohol, both males and females exhibited significant declines in muscle force production and enhanced fatigue; however, following complete clearance of the alcohol, females recovered all functional parameters, while males did not.

Low-Intensity Whole-Body Vibration: A Useful Adjuvant in Managing Obesity? A Pilot Study

The use of whole-body vibration (WBV) for therapeutic purposes is far from being standardized and an empirical foundation for reporting guidelines for human WBV studies has only very recently been published. Controversies about safety and therapeutic dosage still exist. The present study aimed to investigate the metabolic and mechanical effects of low-intensity WBV according to the ISO 2631 norm on subjects with obesity. Forty-one obese subjects (BMI ≥ 35 kg/m2) were recruited to participate in a 3-week multidisciplinary inpatient rehabilitation program including fitness training and WBV training. During WBV the posture was monitored with an optoelectronic system with six infrared cameras (Vicon, Vicon Motion System, Oxford, UK). The primary endpoints were: variation in body composition, factors of metabolic syndrome, functional activity (sit-to-stand and 6-min walking test), muscle strength, and quality of life. The secondary endpoints were: modification of irisin, testosterone, growth hormone, IGF1 levels. We observed significant changes in salivary irisin levels, Group 2 (p < 0.01) as compared to the control group, while muscle strength, function, and other metabolic and hormonal factors did not change after a 3-week low-intensity WBV training with respect to the control group. Future studies are needed to further investigate the potential metabolic effect of low-intensity WBV in managing weight.

Efficacy of powerball versus mulligan mobilization with movement on pain and function in patients with lateral epicondylitis: a randomised control trial

Background: Lateral epicondylitis (LE), most commonly referred to as Lateral Elbow Tendinopathy (LET) or Tennis Elbow is one of the commonest repetitive stress syndromes seen in elbow joint. Tendinopathy, an injury to forearm extensor muscles. These muscles arise from the distal end of humerus from lateral epicondylar region. In many cases, involvement of extensor carpi radialis brevis muscle’s insertion is seen. This study focuses on the treatment of a person with LE which occurs in repeated upper extremity movements. There is no such research relevant to PowerBall device exercises on Lateral epicondylitis patients' pain and function. “PowerBall device” exercise is considered to be an effective resistance training, putting extrinsic and intrinsic pressure on wrist, elbow and shoulder muscles and has been shown to improve strength, function, ROM, tennis elbow pain and quality of life. Whereas MMWM has been proven to reduce the pain in patients with LE. Methods/Design: The participants (n=50) with lateral epicondylitis will be included in a single-blinded, randomised control trial. Participants will be categorised into either a control group or an intervention group after performing baseline assessments and randomization. The participants in the control group will be given Mulligan Mobilisation with Movement, and those in the intervention group will be given “PowerBall device” exercise and conventional physiotherapy. Basic exercises and ultrasound will be given to both groups with the given protocol. We will evaluate pain, function, grip strength and Range of motion, pre and post intervention period. Discussion: Efficacy of the intervention is evaluated by analysing the pain and function in patients with lateral epicondylitis using PRTEE scale, and grip strength using Hand-held Dynamometer. The results from the study will significantly provide affirmation on the application of “PowerBall device” exercise and Mulligan Mobilisation with Movement on the patients with lateral epicondylitis.The clinical trial registry-India(CTRI) registration number for this trial is CTRI/2021/05/033363.

Clinical Scales for the Evaluation of Myopathy Patients

With the rapid increase in the number of clinical trials in myopathy over the past decade, there is an increasing need for clinical scales to reflect patient’s clinical status. This article outlines the process of identifying possible measures. Detailed consideration has been given to key measures of muscle strength, function, and disability. As well as the usual assessment of the validity and reliability of the measures, three key characteristics were identified as necessary to the assessment of clinical scales used in health care: 1) the type of scale; 2) the clinical significance of the property being measured; and 3) the mathematical properties of the data. Consideration of such aspects facilitates the choice of clinical scales and the interpretation of data.

Verification of the Fredlund (2019) Unsaturated Shear Strength Function

There has been a proliferation of equations proposed to describe the unsaturated shear strength envelope going back to the 1970s. However, there have been limited studies to verify the suitability of one unsaturated shear strength equation over another. Most proposed shear strength equations have attempted to relate the shear strength of an unsaturated soil to some aspect(s) of the soil–water characteristic curve (SWCC). Estimation procedures have generally focused on using that of air-entry value (AEV) as defined by the drying (or desorption) branch of the degree of saturation SWCC (S-SWCC). This paper studies the suitability of using two “anchor points” (or reference points) along the drying S-SWCC to estimate the unsaturated soil shear strength function. The anchor points referred to are the air-entry value (AEV) of the soil and the “residual suction point” of the soil defined in terms of the S-SWCC. Shear strength conditions associated with both so-called anchor points are used as “boundary conditions” that should be satisfied when estimating the shear strength function for unsaturated soils. Past research laboratory measurements published in the research literature are used as part of the verification process for this study.