Magnetic resonance imaging study of cross-sectional area of the cervical extensor musculature in an asymptomatic cohort

Magnetic Resonance Imaging (MRI) can be regarded as the gold standard for muscle imaging; however there is little knowledge about in vivo morphometric features of neck extensor muscles in healthy subjects and how muscle size alters across vertebral segments. It is not known how body size and activity levels may influence neck muscle cross-sectional area (CSA) or if the muscles differ from left and right. The purpose of this study was to establish relative CSA (rCSA) data for the cervical extensor musculature with a reliable MRI measure in asymptomatic females within a defined age range and to determine if side-side and vertebral level differences exist. MRI of the cervical spine was performed on 42 asymptomatic female subjects within the age range of 18-45. The rCSA values for the cervical extensor muscles were measured from axial T1-weighted images. We found significant side-side rCSA differences for the rectus capitis posterior minor, major (P < 0.001), multifidus (P = 0.002), and the semispinalis cervicis/capitis (P = 0.001, P < 0.001). There were significant vertebral level differences in rCSA of the semispinalis cervicis/capitis, multifidus, splenius capitis, and upper trapezius (P < 0.001). Activity levels were shown to impact on the size of semispinalis cervicis (P = 0.027), semispinalis capitis (P = 0.003), and the splenius capitis (P = 0.004). In conclusion, measuring differences in neck extensor muscle rCSA with MRI in an asymptomatic population provides the basis for future study investigating relationships between muscular atrophy and symptoms in patients suffering from persistent neck pain. Clin.

Cardiovascular assessment in the orthopaedic practice setting

As consumer access to physical therapy practice expands, it is important that physical therapists are familiar with and implementing accepted methods of identifying the cardiovascular status of their clients. Established guidelines for assessing cardiovascular risk prior to initiating aerobic exercise programs are available and can be readily adopted by physical therapists in diverse clinical settings. We have provided a process for integrating existing guidelines into clinical practice. Because little evidence exists regarding the clinical behaviors and knowledge of orthopedic physical therapists in the area of cardiovascular risk, we conducted a survey to assess current practice patterns. The results suggest that orthopedic physical therapists are performing cardiovascular screening at frequencies similar to other components of the history and systems review, but that monitoring baseline or exercising vital signs does not occur with every exercise session.

Magnetic resonance imaging analysis of the upper cervical spine extensor musculature in an asymptomatic cohort: an index of fat within muscle

AIM

To establish a simple method to quantify muscle/fat constituents in cervical muscles of asymptomatic women using magnetic resonance imaging (MRI), and to determine whether there is an age effect within a defined age range.

MATERIALS AND METHODS

MRI of the upper cervical spine was performed for 42 asymptomatic women aged 18-45 years. The muscle and fat signal intensities on axial spin echo T1-weighted images were quantitatively classified by taking a ratio of the pixel intensity profiles of muscle against those of intermuscular fat for the rectus capitis posterior major and minor and inferior obliquus capitis muscles bilaterally. Inter- and intra-examiner agreement was scrutinized.

RESULTS

The average relative values of fat within the upper cervical musculature compared with intermuscular fat indicated that there were only slight variations in indices between the three sets of muscles. There was no significant correlation between age and fat indices. There were significant differences for the relative fat within the muscle compared with intermuscular fat and body mass index for the right rectus capitis posterior major and right and left inferior obliquus capitis muscles (p=0.032). Intraclass correlation coefficients for intraobserver agreement ranged from 0.94 to 0.98. Inter-rater agreement of the measurements ranged from 0.75 to 0.97.

CONCLUSION

A quantitative measure of muscle/fat constituents has been developed, and results of this study indicate that relative fatty infiltration is not a feature of age in the upper cervical extensor muscles of women aged 18-45 years.

Using the number needed to treat in clinical practice

The number needed to treat (NNT) is gaining attention as a method of reporting the results of clinical trails with dichotomous outcome measures. The NNT is defined as the number of patients who would need to be treated, on average, with a specific intervention to prevent 1 additional bad outcome or to achieve 1 desirable outcome in a given time period. Because it reports outcomes in terms of patient numbers, it is extremely useful to clinicians for making decisions about the effort expended with a particular intervention to achieve a single positive outcome. This special communication describes the NNT statistic and its utility for choosing clinical interventions.

Anticipatory modulation of precision grip force with variations in limb velocity of a curvilinear movement

The authors examined the relationship between peak velocity of a discrete horizontal elbow flexion movement in which the hand path was curvilinear and premovement modulation of precision grip force. The velocity of the movements of 7 participants was varied from maximal velocity to a velocity that required several seconds to reach a target. An object instrumented with force transducers for the forefinger and thumb measured precision grip force. There was a positively accelerating quadratic relationship between grip force change before movement and peak velocity of the ensuing limb movement. On some low-velocity trials, premovement grip force modulation reflected a net decrease. In contrast, high-velocity trials were preceded by net increases in grip force. Using cluster analysis, the authors classified grip forces in low-velocity movements as an empirically distinct set of entities from grip forces in high-velocity movements. The cluster of high-value grip forces suggested an anticipatory strategy that allowed participants a large safety margin in grip force to avoid object slip on movement initiation. The cluster of low-value grip forces at movement initiation suggested a second anticipatory strategy in which participants changed grip force very little, perhaps to increase the ability of proprioceptors in the hand to sense force changes. Those findings suggest that modulation of grip force before initiation of movements in which the hand path is curvilinear may be governed by two distinct velocity-dependent anticipatory strategies.

Activation of the arousal response and impairment of performance increase with anxiety and stressor intensity

The purpose of this study was to determine the effect of trait anxiety and stressor intensity on arousal and motor performance during a pinch task. We examined the steadiness of a precision task in the presence and absence of an imposed stressor on subjects with moderate and low trait anxiety. Subjects with the 26 highest and 14 lowest anxiety scores were assigned to one of three groups: a control group (5 women, 5 men), a moderate-anxiety group (8 women, 8 men), or a low-anxiety group (7 women, 7 men). Subjects in the anxiety groups received electric shocks and experienced significant increases in cognitive and physiological arousal compared with baseline and control subjects, especially subjects in the moderate-anxiety group. Heart rate, systolic blood pressure, and electrodermal activity were elevated during the stressor, whereas diastolic blood pressure was unchanged. Cognitive and physiological arousal tended to increase with stressor intensity and was accompanied by changes in steadiness. Although steadiness was markedly reduced with the highest intensity of shock, the average electromyogram activity was unaffected by the stressor. These findings indicate that the increase in arousal and the impairment of steadiness increased with trait anxiety and with the intensity of the noxious stimulus.

Activation of the arousal response can impair performance on a simple motor task

The purpose of this study was to determine the effect of arousal in men and women on the moment-to-moment performance of a simple motor task. We examined the control of a precision task in the presence and absence of imposed stressors. Twenty-nine subjects (14 men, 15 women; 18--44 yr) were randomly assigned to either a control group or one of two stressor groups, Mental Math or Electric Shock. Subjects presented with Math and Shock stressors, which lasted 10 min, experienced significant increases in cognitive and physiological arousal compared with baseline and control subjects. Heart rate, systolic blood pressure, and electrodermal activity were elevated 5--80% with presentation of the stressors, whereas diastolic blood pressure and salivary cortisol were unchanged. The greater levels of cognitive and physiological arousal were associated with reductions in steadiness of a pinch grip for the Shock subjects (approximately 130% reduction from baseline) but not for the subjects in the Math group, who experienced heightened arousal but no change in steadiness (10% reduction from baseline). Although women exhibited more of a reduction in steadiness than men, the effect was largely unrelated to the magnitude of the change in arousal.

Precision-grip force changes in the anatomical and prosthetic limb during predictable load increases

This study examined precision-grip force applied to an instrumented test object held aloft while the weight of the object was predictably varied by transporting and placing loads (50, 100, or 200 g) atop the test object. Transport of the loads was performed either by the subject or the experimenter. Grip force was examined in four non-amputee control subjects and in the anatomical and prosthetic hand of a subject with a prosthetic device. As subjects transported the load, anticipatory grip-force changes occurred in the anatomical hands and prosthetic hand, which were scaled in relation to the load. When the experimenter transported the load to the anatomical hands of control subjects or the prosthetic user, anticipatory increases in grip force occurred that also were scaled in relation to load. However, when the experimenter transported the load to the prosthetic hand, anticipatory grip-force adjustments were absent. During the phase in which the load was being assumed by the postural hand, grip forces in the anatomical hands and prosthetic hand were further scaled to load demands. Ability to adapt grip force in the prosthetic hand during this phase suggested that the subject was utilizing sensory information from the residual limb to adjust grip force. Thus, while anticipatory changes precede the process of adaptation to load changes, actual sensory consequences resulting from added weight remain necessary to fully adapt grip force to load demands, even for the prosthetic user.

Bilateral simultaneous infrapatellar tendon ruptures: a case study

This case study reports on a patient with a diagnosis of bilateral patellar tendon ruptures. Bilateral ruptures of the infrapatellar tendons are rare occurrences; approximately 20 cases have been reported in the medical literature. Much of the medical literature concentrates on surgical repair, immediate postoperative follow-up, and final outcome. There is a void in the literature concerning the rehabilitative process of these patients. The subject of this study is a 26-year-old male former collegiate athlete who suffered simultaneous bilateral patellar tendon ruptures while jumping. A rehabilitation model is provided that may assist others treating patients with similar conditions.

Effects of electrical and electromagnetic stimulation after anterior cruciate ligament reconstruction

A need exists to develop new methods of neuromuscular electrical stimulation (NMES) that are both effective and relatively pain-free. The purpose of this pilot study was to determine the effects of both NMES and a new method of electromagnetic (NMES/PEMF) stimulation for reducing girth loss and for reducing pain and muscle weakness of the knee extensor muscles in patients during the first 6 weeks after reconstructive surgery of the anterior cruciate ligament (ACL). Seventeen patients receiving ACL reconstructive surgery participated as a control group (N = 3), as an NMES group (N = 7), and with combined NMES and magnetic field stimulation (NMES/PEMF) (N = 7). Patients receiving NMES/PEMF rated each type of stimulation for perceived pain and were measured for their torque. Torque results revealed a mean decrease of 13.1% for NMES/PEMF patients. The mean percent of thigh girth decreased 8.3% for controls, 0.5% for NMES, and 2.3% for NMES/PEMF patients. The NMES/PEMF patients rated NMES as causing about twice the pain intensity as NMES/PEMF during treatments. As a result of this data, the authors conclude that both NMES and NMES/PEMF are effective in reducing girth loss and that NMES/PEMF is less painful than NMES alone in treating patients after ACL reconstruction.