Pilot study quantifying muscle glycosaminoglycan using bi-exponential T1ρ mapping in patients with muscle stiffness after stroke

Muscle physiology in spasticity and muscle stiffness

This paper examines the physiological changes in spastic muscles contributing to spasticity and muscle stiffness, focusing on the underlying mechanisms and their clinical implications. Spasticity, which is prevalent in neurological conditions such as multiple sclerosis, cerebral palsy, spinal cord injury, stroke, and traumatic brain injury, is characterized by disordered sensorimotor control and often results in increased muscle stiffness and resistance to movement. Recent developments in the understanding of spasticity suggest the importance of architectural changes in muscles that may contribute to increased passive resistance, potentiate reflex mechanisms, and progression to fibrosis, with hyaluronan (HA), a glycosaminoglycan, playing a pivotal in modulating the properties of the muscle extracellular matrix (ECM). The hyaluronan hypothesis of muscle stiffness postulates that the accumulation and biophysical alteration of HA in the ECM of muscle increases its viscosity, resulting in increased passive mechanical resistance. This is turn mayincrease muscle sensitivity to stretch, potentiating spasticity, and lead to cellular differentiation of myofibroblasts to fibroblasts ultimately leading to fibrosis and contracture. A deeper understanding of HA's role in ECM dynamics offers promising avenues for novel treatments aimed at mitigating stiffness and preventing long-term disability in patients with spasticity.

Relief of benign paroxysmal positional vertigo and temporomandibular disorder using a myofascial induction in genu recurvatum patients: Case reports

BACKGROUND

In the realm of research, the single case study has been recognized as a valuable tool for sharing insights, demonstrating new concepts, discovering novel phenomena, consolidating hypotheses, and sparking original ideas. In this physician-guided narrative, phenomena previously unreported in the clinical context are explored. These case studies aim to offer insights that may inform an existing theoretical model that encapsulates a distinct therapeutic intervention. Original research in fascia-focused therapies presents many challenges, including the lack of universal terminology, inconsistent techniques, and difficulties in quantifying treatment effects. Tensegrity-based approaches, which concentrate on tissue tension, also face challenges in establishing their validity within living organisms. For centuries, fascia was seen only as ribbons and sheets of soft, inert, mostly fatty tissue. Consequently, most anatomy textbooks provide a sterile view of anatomical structures devoid of the context of unifying fascia. Now, however, consensus of research describes fascia as an omnipresent, ubiquitous, body-wide tissue that acts as a system, transmitting mechanical information via tensional force changes.

METHODS AND RESULTS

The clinical outcomes in the cases provided in this narrative report suggest that induction of thigh fascia resulted in immediate anatomically distant therapeutic benefit, as reported by the patients.

CONCLUSIONS

Rather than measuring treatment efficacy, these two case studies utilize a specific myofascial induction performed at high velocity to elucidate the possibility of a fascia-based, tensegrity-mediated, mechanism for commonly managed, yet often incurable conditions - Benign Paroxysmal Positional Vertigo (BPPV) symptoms and Temporomandibular Joint (TMJ) pain (within the spectrum of Temporomandibular Disorder (TMD)).

How Does Stroke Affect Skeletal Muscle? State of the Art and Rehabilitation Perspective

Long-term disability caused by stroke is largely due to an impairment of motor function. The functional consequences after stroke are caused by central nervous system adaptations and modifications, but also by the peripheral skeletal muscle changes. The nervous and muscular systems work together and are strictly dependent in their structure and function, through afferent and efferent communication pathways with a reciprocal “modulation.” Knowing how altered interaction between these two important systems can modify the intrinsic properties of muscle tissue is essential in finding the best rehabilitative therapeutic approach. Traditionally, the rehabilitation effort has been oriented toward the treatment of the central nervous system damage with a central approach, overlooking the muscle tissue. However, to ensure greater effectiveness of treatments, it should not be forgotten that muscle can also be a target in the rehabilitation process. The purpose of this review is to summarize the current knowledge about the skeletal muscle changes, directly or indirectly induced by stroke, focusing on the changes induced by the treatments most applied in stroke rehabilitation. The results of this review highlight changes in several muscular features, suggesting specific treatments based on biological knowledge; on the other hand, in standard rehabilitative practice, a realist muscle function evaluation is rarely carried out. We provide some recommendations to improve a comprehensive muscle investigation, a specific rehabilitation approach, and to draw research protocol to solve the remaining conflicting data. Even if a complete multilevel muscular evaluation requires a great effort by a multidisciplinary team to optimize motor recovery after stroke.