Effectiveness of Botulinum Toxin on Pain in Stroke Patients Suffering from Upper Limb Spastic Dystonia

This observational study aimed at investigating pain in stroke patients with upper limb spastic dystonia. Forty-one consecutive patients were enrolled. A 0–10 numeric rating scale was used to evaluate pain at rest and during muscle tone assessment. Patients were asked to indicate the most painful joint at passive mobilization (shoulder, elbow, wrist-fingers). The DN4 questionnaire was administered to disclose neuropathic pain. All patients were assessed just before and 1 month after incobotulinumtoxin-A treatment. Pain was present in 22 patients, worsened or triggered by passive muscle stretching. DN4 scored < 4 in 20 patients. The most painful joints were wrist–fingers in 12 patients, elbow in 5 patients and shoulder in the remaining 5 patients. Both elbow and wrist–fingers pain correlated with muscle tone. BoNT-A treatment reduced pain in all the joints, including the shoulder. We discussed that nociceptive pain is present in a vast proportion of patients with upper limb spastic dystonia. BoNT-A treatment reduced both spastic dystonia and pain in all the joints but the shoulder, where the effect on pain could be mediated by the reduction of pathological postures involving the other joints.

Effects of Acute and Chronic Stretching on Pain Control

ABSTRACT While muscle stretching has been commonly used to alleviate pain, reports of its effectiveness are conflicting. The objective of this review is to investigate the acute and chronic effects of stretching on pain, including delayed onset muscle soreness. The few studies implementing acute stretching protocols have reported small to large magnitude decreases in quadriceps and anterior knee pain as well as reductions in headache pain. Chronic stretching programs have demonstrated more consistent reductions in pain from a wide variety of joints and muscles, which has been ascribed to an increased sensory (pain) tolerance. Other mechanisms underlying acute and chronic pain reduction have been proposed to be related to gate control theory, diffuse noxious inhibitory control, myofascial meridians, and reflex-induced increases in parasympathetic nervous activity. By contrast, the acute effects of stretching on delayed onset muscle soreness are conflicting. Reports of stretch-induced reductions in delayed onset muscle soreness may be attributed to increased pain tolerance or alterations in the muscle's parallel elastic component or extracellular matrix properties providing protection against tissue damage. Further research evaluating the effect of various stretching protocols on different pain modalities is needed to clarify conflicts within the literature.

Effect of acute static stretching on the passive mechanical properties of the Achilles tendon: a systematic review and meta-analysis

Background/Aims Little is known about the effectiveness of static stretching on the tendinous structures. The aim of this study was to verify the effect of acute static stretching on the passive mechanical properties of the Achilles tendon. Methods Databases were searched with the descriptors ‘muscle stretching exercises,’ ‘adult’ and ‘Achilles tendon’ with a sample consisting of physically active young adults. Two blind reviewers performed the review. Results A total of four studies were selected. After the meta-analysis, no significant difference was observed for range of motion (−0.73; 95% confidence interval −2.18–0.71; I2=0%), muscle-tendon unit (−0.02; 95% confidence interval −0.23–0.19; I2= 83%), muscle (−0.43; 95% confidence interval −0.92–0.06; I2= 0%) and tendon stiffness (3.70; 95% confidence interval 1.57–5,83; I2=0%; P=0.0007) and passive torque (−1.35; 95% confidence interval −4.75–2.05; I2= 0%). Maximum voluntary isometric contraction showed an alteration with a longer stretching time (1215 seconds). Conclusions Passive static stretching (60–1215 seconds) does not significantly alter the analysed variables.

Muscle stretching induces twitch contractions without activation of stretch-activated channels in intact rat trabeculae

Introduction Mechano-electric coupling (MEC) means that muscle stretching can induce action potentials. Stretch-activated channels (SACs) have been believed to play important roles in their induction. Purpose To investigate what degree of muscle stretching can induce MEC-mediated action potentials and what roles SACs play in their induction. Methods Trabeculae were obtained from right ventricles of rat hearts. Force was measured with a strain gauge, sarcomere length (SL) with a laser diffraction technique, and [Ca2+]i with fura-2 (24°C). The SL was set at 2.0 μm at the resting condition. Trabeculae were stimulated electrically at 400-ms intervals for 7.5 s. Various degrees of muscle stretching were applied at 500 ms after the last stimulus of the electrical train to determine the minimal SL (SL-AP) at which an action potential or a twitch contraction was induced by the stretching (0.7 mM [Ca2+]o). Results The SL-AP was 2.34±0.02 μm (n=8) when trabeculae were stretched rapidly from a SL of 2.0 μm (400-ms stimulation intervals, 0.7 mM [Ca2+]o). The SL-AP was not changed by increasing the stimulation intervals from 400 to 2000 ms (n=7), by increasing [Ca2+]o from 0.7 to 2 mM (n=8), and by adding 1 μM isoproterenol (n=8), suggesting that Ca2+ loading within the myocardium has no effect on the SL-AP. Surprisingly, the SL-AP was not changed by adding 5 μM GsMTx4 (n=8), 10 mM Gd3+ (n=9), 100 μM (n=8) and 200 μM streptomycin (n=11), revealing that SACs play no roles in the determination of SL-AP. The SL-AP was not changed by adding 1 μM ryanodine (n=5) and 30 μM cyclopiazonic acid and was not changed by adding 3 μM diphenyleneiodonium chloride (n=8) and 10 μM colchicine, suggesting that Ca2+ leak from the SR and activation of NADPH oxidase has no effect on the SL-AP. In contrast, elevation of temperature from 23 to 36°C decreased the SL-AP from 2.35±0.01 to 2.34±0.02 μm (p&lt;0.05, n=7). Elevation of extracellular K+ ([K+]o) from 5 to 10 mM increased the SL-AP from 2.35±0.01 to 2.38±0.01 μm (p&lt;0.01, n=7), while reduction of [K+]o to 5 mM decreased it to 2.36±0.01 μm (p&lt;0.05, n=7), suggesting that depolarization of membrane potential suppresses MEC-mediated twitch contractions. The SL-AP was increased from 2.34±0.01 to 2.36±0.01 μm (p&lt;0.01, n=7) when stretching was applied at a shorter interval after the last stimulus, i.e., 200 ms. After electrical stimulation at 300-ms stimulation intervals for 30 s, arrhythmias were induced by a MEC-mediated twitch contraction in 6 out of 9 trabeculae when stretching was applied at 500 ms after the last stimulus, while they were induced only in 2 out of 9 trabeculae without the stretching (4 mM [Ca2+]o, 1 μM isoproterenol). Conclusions These results suggest that muscle stretching causes membrane excitation, which potentially induces arrhythmias and that activation of SACs, Ca2+ release from the SR, and activation of NADPH oxidase by muscle stretching are not involved in the excitation. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research (C) from Japan Society for the Promotion of Science.

Measurement of subjective and objective indices after progressive resistance training compared with aerobic training in Patients with Haemophilia: a study protocol

Background: Bleeding episodes in mild haemophilia may occur after major injuries or surgical procedures with some people not experiencing bleeding episodes. People suffering from moderate haemophilia bleed once a month, however they rarely experience spontaneous bleeding. Those suffering from severe haemophilia bleed quite often into muscles or joints, and episodes can occur once to twice a week. Bleeding usually occurs spontaneously.Objective: To investigate the effects of progressive resistance training on quality of life, muscular strength and joint score in patients with haemophilia. Methodology: Sixty patients will be enrolled in the study. Thirty patients will be allocated to control group, and thirty to intervention group. Controls will be administered active muscle stretching and aerobic exercises. Intervention group will be given active muscle stretching, and resistance training. Patients will be randomly allocated to each group. Anthropometric data will be measured pre-test to establish a baseline. Study variables include muscular strength, and quality of life. All tests will be measured pre-test and post-test to compare effects of treatment.Results: Participant recruitment commenced in June 2021. The post intervention phase will be completed by August 2020. Data analysis will commence after this. A write-up for publication is expected to be completed after the follow-up phase is finalized in August 2021.Conclusions: If resistance training is found to be effective in improving quality of life and muscular strength in participants, it could reduce the frequency of factor therapy given prophylactically, or even as acute treatment, thus directing it towards more severe cases. It will also provide financial relief to organizations supporting the treatment of the hemophilic population.The registration number for this trial is NCT04892628.

Force Sensation Induced by Electrical Stimulation of the Tendon of Biceps Muscle

Many wearable interfaces have been proposed to present force to the upper limb and elbow joint. One way to achieve a compact wearable haptic interface is to use electrical stimulation, and we have suggested that transcutaneous electrical stimulation above the wrist tendon can produce force a sensation in the direction of the muscle stretching; however, it has not been investigated in detail whether the force sensation presented by the electrical stimulation of the tendon occurs in the upper limb joints. In this study, to investigate whether the force sensation is generated when applying electrical stimulation of the skin at the tendon or at the muscle belly of the biceps brachii muscle, we quantitatively evaluated the direction and amount of the force sensation under the aforementioned conditions. The results showed that the electrical stimulation of the tendon produced significant force sensation in the direction of elbow extension. On the other hand, in some participants, the electrical stimulation of the muscle belly worked as a supporting force, resulting in the sensation of weakened force perception. In general, we concluded that the sensation produced by muscle stimulation was different from that produced by stimulation of the tendon.

Tongue stretching: technique and clinical proposal

Objectives The tongue is an organ with multiple functions, from sucking to phonation, from swallowing to postural control and equilibrium. An incorrect position or mechanics of the tongue can causes sucking problems in the newborn or atypical swallowing in the adult, with repercussions on the position of the head and neck, up to influencing upright posture and other problems. Tongue dysfunctions are quite frequent (10–15%) in the population. For the manual therapist, this frequency indicates one to two subjects every 30 patients. Exercises have been proposed to improve the tone and strength of the swallowing muscles but the results are not so clear in the literature. The aim of this study is to describe and provide a tongue muscle normalization technique that helps the manual therapist in the treatment of problems related to it. Methods The literature has been investigated through pubmed, Google scholar of the last 10 years, the keywords used and combined with the Boolean operators AND and OR, are: “tongue, tongue habits, tongue diseases, taste disorder, neck pain, posture, postural balance, atypical swallowing, muscle stretching exercise, tissue expansion, soft tissue therapy, osteopathic manipulative treatment”. Results and Conclusions The technique is possible to be executed even in a sitting position, in the case the patient is unable to assume a supine position, the subject should provides immediate feedback that allows the therapist to understand if the technique has been correctly executed. The simplicity of execution and application of the technique makes it a possible and immediate therapeutic tool in the clinical setting.

Biceps, Brachialis, and Triceps

Tendon injuries at the elbow affect mostly the distal biceps and can progressively degenerate over time or rupture in an acute event. The degree of retraction may depend on the integrity of the lacertus fibrosus, a fibrous expansion that merges with the forearm flexor fascia. Biceps disorders are frequently associated with fluid or synovitis of the adjacent bicipital bursa; primary bursal disorders (primary inflammatory synovitis) can also be observed. Distal triceps is less frequently injured than the distal biceps, and tears usually manifest as distal ruptures with avulsion of a small flake of bone from the tip of the olecranon. Brachialis injuries are uncommon and the consequence of sudden muscle stretching during forced elbow hyperextension, as in posterior elbow luxation.

Self-contained soft electrofluidic actuators

Soft robotics revolutionized human-robot interactions, yet there exist persistent challenges for developing high-performance soft actuators that are powerful, rapid, controllable, safe, and portable. Here, we introduce a class of self-contained soft electrofluidic actuators (SEFAs), which can directly convert electrical energy into the mechanical energy of the actuators through electrically responsive fluids that drive the outside elastomer deformation. The use of special dielectric liquid enhances fluid flow capabilities, improving the actuation performance of the SEFAs. SEFAs are easily manufactured by using widely available materials and common fabrication techniques, and display excellent comprehensive performances in portability, controllability, rapid response, versatility, safety, and actuation. An artificial muscle stretching a joint and a soft bionic ray swimming in a tank demonstrate their effective performance. Hence, SEFAs offer a platform for developing soft actuators with potential applications in wearable assistant devices and soft robots.