Progressive exercise therapy in muscle dystrophy: two case studies in adult patients with DM2 and LGMD2D

These two case studies aimed to investigate the effect and acceptance of progressive strength training in patients with muscular dystrophy. Case 1 completed a progressive resistance exercise over 12 weeks. The results showed increases in leg extensor strength, hand strength and balance. Furthermore, the anaerobic test showed an increase in the maximum glycolysis rate. Creatine kinase levels were reduced while maintaining low muscle soreness. Case 2 conducted seven weeks of electronically assisted strength training and electromyostimulation. In the course of the training, an increase in the self-contribution of the performance in the execution of movement was observed in the assisted strength training. Furthermore, an increase in the intensity of external stimuli was observed. The creatine kinase showed a reduction with physiological behavior of muscle soreness. The results demonstrate the acceptance and feasibility of progressive exercise protocols used to increase performance in two cases of muscular dystrophy.

Physiotherapists and physical activity at work among in Benin and France

Physical activity at work is an important indicator of the level of activity. Physiotherapists are one of professionals for the prevention against sedentary lifestyle. Objective: To assess the level of physical activity at work among physiotherapists in Benin and France. Method: Descriptive and analytical cross-sectional study, conducted from July 2017 to July 2018. With physiotherapists who consent to participate to this study we use a pedometer. They wear it at work for five consecutive days. The average number of daily steps at work was determined. Physiotherapist’s level of inactivity was assessed using the Baecke questionnaire. Data was analyzed using Epi Info 13.0. X2 of Pearson’s and ANOVA tests. They were used for the comparison of qualitative and quantitative variables respectively. Significance level was set at 0.05. Results: Among fifty-four physiotherapists evaluated, forty-four (81.5%) were sedentary, with a significant level of sedentary lifestyle in twenty-six cases (48.11%). This limitation of physical activity at the workplace and the level of sedentary lifestyle of the subjects were comparable among Beninese and French physiotherapists and they were not associated with any of the factors studied. Conclusion: The level of physical activity of physiotherapists at work is limited. Raising the awareness of these actors seems essential.

Peripheral Neuropathy Impacts Gait Motor Components in Hispanic-Latinx living with HIV

HIV can cause numerous health-related complications that can lead to disabilities and affect the quality of life. Some problems added with HIV, like peripheral neuropathy (PN), may develop additional impediments in this population. Purpose: This study investigated PN’s impact on the cardio-motor profile of Hispanic Latino living with HIV. Methods: A submaximal cardiovascular test (Ross test) was conducted to obtain the study’s cardiomotor results. Cardiomotor data were compiled from records of members enrolled at La Perla de Gran Precio Community Centre on HIV in San Juan, Puerto Rico. Results: The motor profile included the speed and inclination of the treadmill. The cardiovascular data had blood pressure and heart rate at the time Ross’s test was terminated. Two hundred and ninety-one participants were further designated as 225 in the non-PN and 66 in the PN group. Both groups average comparable amounts of CD4 counts. An ANOVA was used to determine variations in the PN group with a considerable (P < 0.05) increase in the time of HIV diagnosis and a reduction in gait velocity and treadmill inclination distinguished to counterpart. Conclusion: Hispanic Latino living with HIV and PN displayed distinctive motor gait deficiencies. Gait parameters, such as gait speed, were further impaired in those suffering from both conditions. We encourage healthcare providers to incorporate the specific cardio-motor items alluded to in this investigation to identify the process influencing gait that further alters the quality of life in those with HIV.

Repair of avulsion fracture of the anterior superior iliac spine by knotless suture bridge: Surgical technique and a review of 5 cases

Background: Avulsion fracture of the anterior superior iliac spine (ASIS) is a rare form of apophyseal avulsion fracture of the pelvis, and there is a lack of evidence-based guidelines for the selection of treatment options. There are various surgical procedures, but there is the risk of secondary removal of internal fixator and growth disturbance caused by epiphyseal fixation. Methods: We treated 5 patients with avulsion fracture of the anterior superior iliac spine by knotless suture bridge technique who visited our hospital from 2015 to 2020.The surgical treatment results were retrospectively analyzed. Results: 5 patients with fractures were healed after the surgery, no associated complications, the mean postoperative follow-up was 29.2 months (6-60months), all patients were not reported pain symptoms (visual analogue score of 0), they don’t have the limitation of daily activities, and the hip joint function recovered well, and very pleased with the results (Harris score 100 points) at the final follow-up. Conclusion: Knotless suture bridge technique is simple and effective in the repair of the avulsion fracture of anterior superior iliac spine. For such patients, this surgical technique can provide stable and reliable fixation, allow early recovery, and provide a feasible scheme for clinical practice.

Observations of Performance and Body Composition Following 8-weeks of Progressive Resistance Training in Participants With Cerebral Palsy

Purpose: To observe the effects of progressive resistance training on performance and body composition in participants with cerebral palsy. Methods: Four quadriplegic (3 male, 1 female) and two hemiplegic (2 female) participants (22 ± 5 yr, mean ± SD) completed moderate to high intensity resistance training 2-3 days a week for 8-weeks. Strength training programs were developed for each participant based on their physical ability. Measurements of exercise performance and body composition (InBody 270 & S10) were collected prior to and following training. Data from all participants was pooled, and samples with 5-6 subjects were analyzed using a paired t-test with significance set at p < 0.05. Results: Measurements of muscular fitness improved, including plank performance (pre: 64 ± 40, post: 95 ± 61 s, n = 6), supine sled leg press 1RM (pre: 225 ± 69, post: 378 ± 124 lb, n = 6) and bench/sled press 1RM (pre: 92 ± 54, post: 115 ± 58 lb, n = 5). There was no change in peak sprint capacity (pre: 89 ± 32, post: 96 ± 29 W, n = 5) or peak aerobic capacity (pre: 303 ± 136, post: 370 ± 246 s, n = 4). Measurements of body weight (pre: 151 ± 40, post: 151 ± 42 lb, n = 6) and skeletal muscle mass (pre: 53 ± 8, post: 54 ± 9 lb, n = 6) were unchanged following training. Conclusion: Preliminary data is encouraging that the unique and challenging strength training program employed with these participants can be utilized to gain meaningful improvements in muscular fitness. However, a larger sample size and longer training period may be necessary to significantly increase muscle mass.

The Impact of a Rotating Balance Platform on Leg Neuromuscular Activity in Healthy Young Adults

Balance is a functional activity that must be implemented in every type of rehabilitation for the back and lower extremities’ injury and pathology. With issues in these regions, balance is lessened, requiring exercises that enhance the patient’s stability. Purpose: To determine the impact of activities on a rotating balance platform with tracking tasks for lower limb muscle activation. Method: Twenty-five participants performed seven tasks on a balance board with a fixed middle fulcrum. For each trial, activation of the gastrocnemius and tibialis anterior muscles was recorded using surface electromyography. Upon examination of the EMG data, the following variables were quantified: time to peak muscle activation, time to decay of muscle contraction, and time of muscle contraction duration. Results: A repeated measures ANOVA revealed that TA exhibited significant modifications (P<0.001) with less time to peak, duration, and decay, whereas GA only notably compensated (P<0.001) with shorter duration and decay. Conclusion: For subjects with balance alterations due to slower nerve conduction or muscle weakness in the lower limb, we suggest incorporating activities with rotational movements on the balance board, where muscle activation is challenged due to surface and tracking activities. When endurance is prescribed, front-to-back tasks contribute to prolonged muscle activation. Balance rehabilitation should consider muscle activation timing with tracking tasks for more precise and targeted muscle execution.

The comparison of the shoulder muscle activation in patients with rotator cuff tear under an abduction brace among the three postures

Background: Immobilization using an abduction brace is essential for the relaxation of the rotator cuff and scapular muscles and the prevention of a retear in patients with rotator cuff tear after arthroscopic rotator cuff repair (ARCR). However, thus far, the comparison of the scapular muscle activities has not been compared among different postures under an abduction brace in patients after ARCR. Objectives: The purpose of our study was to compare the scapular muscle activities among the supine position, sitting position, and walking under an abduction brace before and after ARCR Study Design: Observational, repeated measures study. Methods: Twelve patients with full-thickness rotator cuff tears were studied. The mean patient age was 64.7 years. The scapular muscle activations of the ipsilateral limbs were measured using surface electromyography in three postures: supine position, sitting position, and walking. The integrated electromyography relative values of the upper trapezius, anterior deltoid, middle deltoid, and biceps brachii were compared preoperatively and at two weeks after ARCR. Results: The trapezius, biceps brachii, and middle deltoid in the walking showed significantly higher integrated electromyography relative values than those in the supine position, preoperatively and at two weeks after surgery. The anterior deltoid in the sitting position had significantly higher integrated electromyography relative values than those in the supine position. Conclusions: Postures affected the scapular muscle activities in ARCR patients under an abduction brace. Understanding the influence of posture on the scapular muscle activity after ARCR will help rehabilitation accurately and appropriately.

Medial tibial stress syndrome: The relationship between gender and lower-extremity functional performance among collegiate track and field athletes

Medial tibial stress syndrome (MTSS) is a common lower extremity injury in track and field athletes. Many risk factors are associated with MTSS, and lower extremity performance may become altered in athletes suffering from prior symptoms, potentially increasing risk of future injury. The purpose of this study was to first examine the effect a prior history of MTSS has on lower-extremity measures, per gender, in collegiate level track and field athletes, and then determine if such measures predict future injury. Fifty-three healthy Division III collegiate track and field athletes (mean age = 19.40 ± 1.13 years) completed an injury history questionnaire along with five preseason lower-extremity functional tests including: ankle dorsiflexion (DF), single-leg anterior reach (SLAR), two timed single-leg balance (SLBAL) tests on a force plate, and single-leg hop for distance (SLH). Performance data were compared across gender and questionnaire data regarding injury history and occurrence of MTSS. Fifteen subjects (28%) reported previous MTSS symptoms within the last 2 years. Chi-square analyses revealed females experienced more diagnoses compared to males (p = .03). Independent t-tests revealed differences between gender on all SLBAL tests, as males performed better on all recorded measures (p < .001 – p = .003). No significant differences were noted in lower-extremity performance tests between subjects with and without prior MTSS injuries. Regression analyses using postseason injury questionnaire data revealed prior MTSS injuries had 17.3 higher odds of experiencing MTSS during the season (adjusted odds ratio [AOR] = 17.33, 95% CI: 3.5 – 86.4; p = .001).

Lower Limb Muscle Activity Adjustment and Lactate Variation in Response to Increased Speed with Proportional Resistance in Young Adults

Background: Various pathologies require physiotherapists to adjust therapy interventions, some of which are to reducing joint loads while strengthening the lower extremity musculature. Tools such as a sled can be used to accomplish a small load with high-repetition-resistance exercises. Purpose: This study examined the impact of pushing a sled with regulated resistance on lower limb muscle activation and fatigue while walking and running. Methods: The neuromuscular activity of the tibialis anterior (TA) and gastrocnemius (GA) muscles of thirty-six young adults were recorded using surface electromyography (EMG) and lactate data from a Nova Biomedical Lactate Plus meter. The sled used was the XPO Trainer, which maintains a steady resistance proportional to the user regardless of the forces applied to accelerate the sled. Baseline lactate was collected and followed by one of three protocols: run, run-push (RP), or walk-push (WP). Each included three trials over a 40 ft distance, during which EMG data were collected per trial, whereas lactate was collected following the completion of the appointed task. Results: Repeated measures ANOVAs were performed, showing a considerable increase (P<0.05) in lactate levels between the WP and RP groups. Pushing the sled at both WP and RP speeds demonstrated substantial (P<0.05) neuromuscular modifications, primarily in the TA, followed by the GA, in comparison to running. Conclusion: Pushing a constant resistance sled provoked distinct modifications in the lower limb musculature associated with speed. Running while pushing the sled elicits a higher blood lactate response associated with a longer maximal amplitude and a shorter time for muscle recruitment in the GA and TA muscles, all indicative of endurance-oriented exercise.

Variations in knee range of motion during repeat knee extension with an amputated lower leg at different contraction rhythms over 8 consecutive days in a patient with severe diabetic neuropathy: A clinical study

Background: This clinical study sought to understand the knee range of motion (KROM) in an amputated stump during repeat voluntary knee extension with or without a 0.5 kg weight in the acute/early phase after amputation can vary between different target knee extension rhythm frequency (KER) levels in the amputated lower leg of a patient with severe diabetic sensory disorder and leg ischemia. Case Presentation: A 51-year-old male patient with severe diabetic neuropathy had a right lower leg amputation due to necrosis and ulcer lesion following a burn injury to the first toes and severe ischemic peripheral vascular disease. In a sitting position with the base of the foot of the non-amputated left leg on the ground, he performed repeat knee extension of the resected stump (knee active extension and passive flexion without a target KROM) for 1 min with both self-controlled free KER and different target KERs (30, 40, 50, 60, and 80 contractions per minute [cpm] using a metronome), with or without a 0.5 kg weight placed on the resected stump over 8 consecutive days. The KROM was measured using a goniometer placed between the resected stump and the thigh muscle with a continuous data acquisition system. The mean values achieved for KER, KROM, and angle rate during a 1 min session was determined during each daily session, and consecutively average values over sessions on 8 consecutive days was also evaluated. The achieved mean KER at all target KERs corresponded closely with the target KER. The average KROM was approximately 60 degrees over a range of targets between 30 and 60 cpm, but the value was lower at approximately 50 degrees at 80 cpm. The angle rate increased consistently with the increase from a target of 30 to 60 cpm, but it was reduced at 80 cpm. The mean KROM was inversely related (r=-0.390, P<0.01, n=40) to the mean KER without the weight, but not significantly (r=-0.256, P=ns, n=40) with the 0.5 kg weight. The achieved KER in the self-controlled free trial with or without the 0.5 kg weight might increase with an increase in sessions over 8 days with a range between approximately 30 and 60 cpm. Conclusion: The present case study showed that a higher contraction frequency may limit KROM determined below 60 cpm because of the reduced angle rate in an amputated lower leg. A low and moderate KER below 60 cpm may be appropriate to maintain KROM with a stable angle rate. Furthermore, voluntary KER with free self-controlled rhythm may increase over the course of multiple sessions as familiarity improves with kicking the amputated limb and generating a potential improvement in performance/ability effect with consecutive leg exercise with no use of a prothesis such as in the early/acute phase post-amputation using audible biofeedback.