Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

A 64-year-old man presented for evaluation of proximally pronounced weakness of the arms with preserved facial and lower extremity strength. Symptoms slowly developed over the last two years, and the patient’s history was notable for severe Listeria monocytogenes meningitis four years prior to presentation, which was adequately treated with antibiotics. On examination, symptoms clinically reassembled ‘man-in-the-barrel’ syndrome and localized to the cervicothoracic central cord. Blood analysis was unremarkable, and CSF analysis showed no recurrent or persistent infection. Spinal MRI revealed pockets of sequestered CSF from C3 to C4 and areas of CSF space effacement from C3 to T12. MRI findings were interpreted as cord tethering suggestive of adhesive arachnoiditis. CT myelogram showed insufficient contrast agent migration above T10 and contour irregularities of the conus medullaris, confirming the postulated pathomechanism of cord tethering. Final diagnosis was therefore cervicothoracic central cord damage due to cord tethering in the setting of postinfectious adhesive arachnoiditis following bacterial meningitis. The patient failed a course of pulsed methylprednisolone therapy, and symptoms progressed. Best supportive care was provided. The clinical presentation of adhesive arachnoiditis is variable, and advanced imaging techniques and invasive studies such as CT myelogram may be required to establish the diagnosis. Timely diagnosis is warranted as early surgical or medical therapy can improve symptoms.

Lower Limb Proprioception and Strength Differences Between Adolescents With Autism Spectrum Disorder and Neurotypical Controls

Autism spectrum disorder (ASD) is a complex diagnosis characterized primarily by persistent deficits in social communication/interaction and repetitive behavior patterns, interests, and/or activities. ASD is also characterized by various physiological and/or behavioral features that span sensory, neurological, and neuromotor function. Although problems with lower body coordination and control have been noted, little prior research has examined lower extremity strength and proprioception, a process requiring integration of sensorimotor information to locate body/limbs in space. We designed this study to compare lower limb proprioception and strength in adolescents with ASD and neurotypical controls. Adolescents diagnosed with ASD (n = 17) and matched controls (n = 17) performed ankle plantarflexion/dorsiflexion bilateral proprioception and strength tests on an isokinetic dynamometer. We assessed position-based proprioception using three targeted positions (5 and 20-degrees plantarflexion and 10-degrees dorsiflexion) and speed-based proprioception using two targeted speeds (60 and 120-degrees/second). We assessed strength at 60-degrees/second. Participants with ASD performed 1.3-times more poorly during plantarflexion position and 2-times more poorly during the speed-based proprioception tests compared to controls. Participants with ASD also exhibited a 40% reduction in plantarflexion strength compared to controls. These findings provide insight into mechanisms that underly the reduced coordination, aberrant gait mechanics, and coordination problems often seen in individuals with ASD, and the identification of these mechanisms now permits better targeting of rehabilitative goals in treatment programs.

The Effect of 8 Weeks of Zumba Exercıse on Flexbılıty and Some Strength Parameters in Women Aged 25-45

The aim of this study is to examine the effects of 6-week Zumba exercises on flexibility, leg strength, back strength and muscular endurance parameters in women aged 25-45. The research group consists of a total of (n=20) women, (n=10) in the experimental group and (n=10) in the control group, between the ages of 25-45 living in Istanbul. The participants in the experimental group were given 60 minutes of Zumba exercises 3 days a week for 6 weeks, and sit-reach, 1-minute sit-up and strength test measurements were made to the participants before and after the exercise program. Participants in the control group were not included in any exercise program. As a result of the analysis, it was determined that there was a statistically significant difference between the participants' flexibility, leg strength, back strength and muscular endurance values between the pre-test and post-test within the group (p< 0.05). In addition, there was no significant difference between the pre-test and post-test values between the groups (p< 0.05). In conclusion; It was determined that zumba exercises applied to the experimental group did not have a significant effect on flexibility, muscular endurance and back strength. In the leg strength parameter, the effect of zumba exercises applied to the experimental group on leg strength was found to be significant at a rate of 34%. In the light of these data, it was concluded that zumba exercises performed in sedentary women have a positive effect on lower extremity strength. Keywords: Zumba Fitness, Exercise, Women and Exercise

A Retrospective Analysis of Group-Based Boxing Exercise on Measures of Physical Mobility in Patients With Parkinson Disease

Objectives: The purpose of this retrospective study is to further the limited body of evidence regarding the effects of a group-based boxing intervention for those with Parkinson’s disease (PD). Design: A retrospective cohort study was performed analyzing data collected on outcome measures at 6-month intervals up to 2 years. Individuals participated in the standardized “Rock Steady Boxing” (RSB) program for up to 24 months. Every 6 months, measures were taken of balance (Fullerton Advanced Balance [FAB] Scale), functional mobility (Timed-Up and Go [TUG]), lower extremity strength (30-second Chair Stand [30CST]), and gait speed (10 Meter Walk Test [10MWT]). Methods: Statistical significance ( P < .05) was determined by a two-tailed t test. Data were collected from RSB-affiliated programs at 4 locations across the southeastern United States. Current and/or past participants in RSB with baseline and at least one subsequent outcome measure were included, resulting in 68 participants (54 male, 14 female, and mean age of 71.2 years ± 8.56 standard deviation). Results: Statistically significant improvements in FAB scale, TUG, and 30CST over time were found at both 6- and 12-month time points. Significant changes continued through 18 months for FAB and 30CST. No significant changes in 10MWT were observed; however, a moderate effect size was observed at the 1-year point. Conclusions: Participants with PD were able to achieve statistically significant improvements in standard measures of functional mobility, balance, and strength within the timeline of this study. Limitations include the retrospective nature, an inability to monitor adherence, and lack of control over pharmaceutical or other interventions.

Lower Physical Fitness Is Associated with Injuries in Iranian National Futsal Teams: A Prospective Study

Background: Several studies have investigated risk factors for injury in different sports. However, little scientific information is available in relation to futsal injuries. Objectives: This study prospectively analyzed the influence of physical fitness parameters on the occurrence of futsal injuries in Iranian national teams. Methods: Prior to the season, all 55 players of 3 Iranian national futsal teams took part in a series of tests for physical fitness parameters such as cardio-respiratory fitness, muscle strength, body composition, flexibility, agility, and speed. Team physicians recorded all injuries, medical attention, and time loss due to the injury throughout the match and training sessions. Results: During 18 months, 54 futsal injuries were sustained by 32 players. Injured players had poorer performance at baseline in agility, speed, and vertical jump than players who did not incur an injury during the season. Lower maximal oxygen uptake (VO2max) values were associated with a higher injury risk. No differences between injured and uninjured players were observed in age, anthropometric data, flexibility, and lower extremity strength. Conclusions: Some physical fitness parameters were associated with the risk of injuries in futsal. Therefore, improving physical fitness might help to reduce the number of futsal injuries.

The Association Between Time in Range %, and Physical & Functional Indices Amongst Older People With Type 2 Diabetes: A Cross Sectional Study

Diabetes is a major public health burden associated with high mortality, morbidity, hospitalization and health care services utilization rates. People with diabetes have an increased risk for mobility disability compared to those without diabetes, after controlling for age. People with diabetes also have a higher risk for falls and fractures. Data from the last several years suggests that this increased risk is not only due to diabetes co-morbidities but also due to an accelerated decline in physical capacity due to lower muscle quality and a more rapid decline in muscle mass (sarcopenia) and lower extremity strength over time. HBA1C is a measure of average glucose levels; however, it does not provide information about glycemic variability, or daily patterns of glycemia. In the last several years, several organizations have published consensus statements on the role of continuous glucose monitoring (CGM) in glucose control. The use of CGM has brought about the development of many glucose indices, amongst them is: Time In Range% (TIR) of 70–180 mg/dL (3.9–10 mmol/L). Less is known regarding the association between TIR and sarcopenia, muscle mass loss that leads to deterioration in mobility, disabilities and decline in physical indices in older people with diabetes. Aims: To assess among older people with diabetes type 2, the cross sectional association between: TIR and aerobic capacity, gait speed, strength, balance and frailty indices. Methods: A cross sectional study, conducted amongst people with diabetes over the age of 60. Participants were provided with a blinded CGM system- (I Pro2 carelink, Medtronic) for 1 week and underwent elaborate physical-functional assessment in the beginning and at the end of that week. The association between the % of time in range (Time in Range-TIR) and several physical indices was determined using linear regression. Results: This analysis pertains to 55 men and women who completed the evaluation. After adjustment for age and gender, we found that 1% increase in TIR was associated with a 0.341 higher score on the 30 second Sit to Stand score (a measure of lower extremity strength) (P-value=0.02), a 0.351 higher score on the BERG scale (a measure of balance) (P-value=0.01), a 0.271 lower score on the timed up and go score (a measure of fall risk and balance) (P-value=0.008), a 0.289 higher score on the 6-minute walk score (a measure of aerobic capacity and endurance) (P-value=0.02) and a 0.261 lower score on the 360 turn test (a measure of dynamic balance) (P-value=0.0004). The same was not observed for the relationship between HGA1C & physical indices.

Assessing the feasibility of using the short physical performance battery to measure function in the immediate postoperative period after total knee replacement

Measurements of physical function after total knee arthroplasty (TKA) are uncertain and require investments for special equipment, space, and staff. Therefore, we evaluated the Short Physical Performance Battery (SPPB) 4 to 6 weeks preoperatively and 2 weeks following TKA as this test battery addresses lower extremity strength, coordination, and balance, without additional special investments. For context, we also employed the Six-Minute Walk test (6MWT) and peak torque knee extension. Our analysis consisted of three women and one man, with average ages of 68.3±3.9 years. Patients showed a decrease in all functional measurements: SPPB (mean change: −4.8±1.9, 44% decrease), 6MWT (−0.37±.21 m/s, 34% decrease), and peak torque (−11.8±8.8°/s, 68% decrease). Our findings suggest the SPPB is feasible and can be integrated easily in daily clinical practice.

Reliability of a Barre-Mounted Dynamometer-Stabilizing Device in Measuring Dance-Specific Muscle Performance

BACKGROUND: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions. OBJECTIVE: To assess the intra and inter-rater reliability of a barre-mounted dynamometer stabilizing device in measuring muscle performance in common dance maneuvers. METHODS: Two testers assessed muscle performance of three common dance maneuvers-—développé en avant, à la secondé, and arabesque-—on 11 pre-professional and professional dancers on two separate occasions to establish intra- and inter-rater reliability of the barre-mounted dynamometer stabilizing device. RESULTS: Intra-rater reliability was moderate to high and inter-rater reliability of the device was excellent, with intraclass correlation coefficients ranging from 0.527–0.851 and 0.834–0.953, respectively, for all positions. CONCLUSIONS: The barre-mounted stabilizing device shows promise in mitigating tester strength or fatigue in assessing muscle performance of dancers. Initial assessment of the device suggests further study may be indicated to improve generalizability to applications of larger-scale muscle performance screening and assessment in dancers or other athletic populations who engage in movements that require extensive hip range of motion and multi-joint stability. CLINICAL RELEVANCE: Using a portable, barre-mounted stabilizing device in assessing multi-joint lower extremity muscle performance in dancers improves consistency of testing results. Application of this testing device into wider scale screenings could assist in developing normative data for a population that is lacking.