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McLeod MM, Kim JS, Moley P, Fontana MA, Blevins J, Chalmers B, Bamman M, Bostrom MP. Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 4: Nonoperative Options, Machine Learning in Predicting Total Hip Arthroplasty, Robotics, and Phenotyping to Guide Precision Rehabilitation. HSS J 2023; 19:473-477. [PMID: 37937083 PMCID: PMC10626938 DOI: 10.1177/15563316231193367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Abstract
Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation (AF), in partnership with the Hospital for Special Surgery (HSS), convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations gleaned from presentations given in the "late-stage osteoarthritis" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City. It covers conservative treatment, decision-making in end-stage hip osteoarthritis, advancements in robotics, and the role of phenotyping in precision rehabilitation post-total hip arthroplasty (THA).
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Affiliation(s)
| | | | - Peter Moley
- Hospital for Special Surgery, New York City, NY, USA
| | | | - Jason Blevins
- Hospital for Special Surgery, New York City, NY, USA
| | | | - Marcus Bamman
- Florida Institute for Human & Machine Cognition, Pensacola, FL, USA
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Cotton RJ, Segal Rick RL, Seamon BA, Sahu A, McLeod MM, Davis RD, Ramey SL, French MA, Roemmich RT, Daley K, Beier M, Penttinen S, Raghavan P, Searson P, Wegener S, Celnik P. Precision Rehabilitation: Optimizing Function, Adding Value to Health Care. Arch Phys Med Rehabil 2022; 103:1883-1884. [PMID: 35690092 PMCID: PMC9979846 DOI: 10.1016/j.apmr.2022.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 01/16/2023]
Affiliation(s)
- R James Cotton
- Department of Physical Medicine and Rehabilitation, Northwestern University; Shirley Ryan AbilityLab, Chicago, Illinois
| | - Richard L Segal Rick
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; National Center of Neuromodulation for Rehabilitation, Medical University of South Carolina, Charleston, South Carolina; NIH/NICHD/NCMRR Medical Rehabilitation Research Resource Network National Coordinating Center, Charleston, South Carolina
| | - Bryant A Seamon
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Amrita Sahu
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Michelle M McLeod
- National Center of Neuromodulation for Rehabilitation (NC NM4R), Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Randal D Davis
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; National Center of Neuromodulation for Rehabilitation, Medical University of South Carolina, Charleston, South Carolina
| | - Sharon Landesman Ramey
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia; VTC School of Medicine, Roanoke, Virginia
| | - Margaret A French
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Ryan T Roemmich
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Meghan Beier
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Sharon Penttinen
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Peter Searson
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Pablo Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
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Abstract
CONTEXT Persistent neuromuscular deficits in the surgical limb after anterior cruciate ligament reconstruction (ACLR) have been repeatedly described in the literature, yet little is known regarding their association with physical performance and patient-reported function. OBJECTIVE To describe (1) interlimb differences in neuromuscular and functional outcomes and (2) the associations of neuromuscular outcomes with measures of physical and knee-related patient-reported function. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty individuals after primary, unilateral ACLR (19 males; age = 21.5 years [range, 14-41 years]; 8 months [range = 6-23 months] postsurgery). MAIN OUTCOME MEASURE(S) Knee-extensor isometric and isokinetic peak torque was measured with an isokinetic dynamometer. Cross-sectional area (CSA) was measured bilaterally for each of the quadriceps muscles via magnetic resonance imaging. We measured quadriceps central activation bilaterally via the superimposed-burst technique. Physical performance (single-legged hop tests, step length via spatiotemporal gait analysis) and patient-reported outcomes (International Knee Documentation Committee questionnaire and Knee Injury and Osteoarthritis Outcome Score Sport and Recreation subscale) were also recorded. We conducted Wilcoxon signed rank tests to identify interlimb differences. Spearman ρ correlation analyses revealed associations between limb symmetry and neuromuscular and functional outcomes, as well as with patient-reported function. RESULTS Deficits in the surgical limb as compared with the nonsurgical limb were present for all outcomes (P values < .05). Greater single-legged hop-test symmetry (83%) was significantly correlated with greater symmetry in knee-extensor isometric (63%; rs = 0.567, P = .002) and isokinetic (68%; rs = 0.540, P = .003) strength, as well as greater cross-sectional area of the vastus medialis (78%; rs = 0.519, P = .006) and vastus lateralis (82%; rs = 0.752, P < .001). A higher International Knee Documentation Committee questionnaire score (82.2) was significantly correlated with greater symmetry in knee-extensor isokinetic strength (rs = 0.379, P = .039). CONCLUSIONS Although deficits were observed in the surgical limb for all neuromuscular measures, greater symmetry in the size and strength of the quadriceps, rather than activation, was more strongly associated with physical performance after ACLR. Greater symmetry in strength was also more strongly associated with patient-reported function.
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Affiliation(s)
| | | | - Harris S Slone
- Department of Orthopaedics, College of Medicine, and Department of Health Science & Research, Medical University of South Carolina, Charleston
| | - Chris M Gregory
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston
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Hunnicutt JL, McLeod MM, Slone HS, Gregory CM. Spatiotemporal Variables During Self-selected And Fastest-comfortable Walking Speeds In Individuals Following Acl Reconstruction. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561286.11277.f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hunnicutt JL, Gregory CM, McLeod MM, Woolf SK, Chapin RW, Slone HS. Quadriceps Recovery After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Versus Patellar Tendon Autografts. Orthop J Sports Med 2019; 7:2325967119839786. [PMID: 31041332 PMCID: PMC6482652 DOI: 10.1177/2325967119839786] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Quadriceps tendon (QT) autografts are being increasingly used for anterior cruciate ligament reconstruction (ACLR). A paucity of studies exist that compare QT autografts with alternative graft options. Additionally, concerns exist regarding quadriceps recovery after graft harvest insult to the quadriceps muscle-tendon unit. Purpose/Hypothesis The purpose of this study was to compare quadriceps recovery and functional outcomes in patients with QT versus bone-patellar tendon-bone (BPTB) autografts. The hypothesis was that those with QT autografts would demonstrate superior outcomes. Study Design Cohort study; Level of evidence, 3. Methods Active patients with a history of primary, unilateral ACLR with soft tissue QT or BPTB autografts participated. Quadriceps recovery was quantified using variables of strength, muscle size, and activation. Knee extensor isometric and isokinetic strength was measured bilaterally with an isokinetic dynamometer and normalized to body weight. Quadriceps activation was measured with the superimposed burst technique. The maximal cross-sectional area of each quadriceps muscle was measured bilaterally using magnetic resonance imaging. Assessors of muscle size were blinded to the graft type and side of ACLR. Functional tests included hop tests and step length symmetry during walking, measured via spatiotemporal gait analysis. Self-reported function was determined with the International Knee Documentation Committee (IKDC) questionnaire. Neuromuscular and functional outcomes were expressed as limb symmetry indices (LSIs: [surgical limb/nonsurgical limb]*100%). Wilcoxon rank-sum tests were used to compare the LSIs and IKDC scores between groups. Results There were 30 study participants (19 male, 11 female; median age, 22 years [range, 14-41 years]; median time since surgery, 8 months [range, 6-23 months]), with 15 patients in each group. There were no significant between-group differences in demographic variables or outcomes. LSIs were not significantly different between the QT versus BPTB group, respectively: knee extensor isokinetic strength at 60 deg/s (median, 70 [range, 41-120] vs 68 [range, 37-83]; P = .285), activation (median, 95 [range, 85-111] vs 92 [range, 82-105]; P = .148), cross-sectional area of the vastus medialis (median, 79 [range, 62-104] vs 77 [range, 62-95]; P = .425), single-leg hop test (median, 88 [range, 35-114] vs 77 [range, 49-100]; P = .156), and step length symmetry (median, 99 [range, 93-104] vs 98 [range, 92-103]; P = .653). The median IKDC scores between the QT and BPTB groups were also not significantly different: 82 (range, 67-94) versus 83 (range, 54-94); respectively (P = .683). Conclusion Patients with QT autografts demonstrated similar short-term quadriceps recovery and postsurgical outcomes compared with patients with BPTB autografts.
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Affiliation(s)
- Jennifer L Hunnicutt
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chris M Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle M McLeod
- Department of Health and Human Performance, College of Charleston, Charleston, South Carolina, USA
| | - Shane K Woolf
- Department of Orthopaedics and Physical Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Russell W Chapin
- Department of Radiology and Radiological Science, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Harris S Slone
- Department of Orthopaedics and Physical Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Hunnicutt JL, Hand BN, Gregory CM, Slone HS, McLeod MM, Pietrosimone B, Kuenze C, Velozo CA. KOOS-JR Demonstrates Psychometric Limitations in Measuring Knee Health in Individuals After ACL Reconstruction. Sports Health 2018; 11:242-246. [PMID: 30444674 DOI: 10.1177/1941738118812454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Measurement properties of the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR) are not established in individuals after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine the extent to which the KOOS-JR measures the construct of knee health in individuals post-ACLR using Rasch analysis. HYPOTHESIS The KOOS-JR will fit the Rasch model, but significant ceiling effects will be present. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Rasch analysis of the KOOS-JR from 166 individuals 10 months post-ACLR was conducted. Unidimensionality, a key criterion of the Rasch model, was evaluated using confirmatory factor analysis. Model fit of the rating scale, items, and persons were evaluated. Mean square fit statistics ≥1.6 and standardized z-scores ≥2.0 were indicative of person or item misfit. Additionally, reliability indicators including person reliability and separation indices were examined. RESULTS The KOOS-JR fit the criteria of unidimensionality. All items demonstrated model fit; however, ceiling effects were noted (n = 36; 22%). Person reliability was low (0.47). Calculation of person strata revealed that the KOOS-JR did not separate participants into more than 1 stratum. The mean person measure was 3.56 logits higher than the mean item measure, indicating that this sample is skewed toward increased knee health. CONCLUSION Although the KOOS-JR represented a unidimensional construct with items and persons fitting the Rasch model, several limitations were noted: ceiling effects, low person reliability, and poor person differentiation. Ceiling effects indicate that many individuals in this sample experienced better knee health than the KOOS-JR items were able to measure. CLINICAL RELEVANCE Evaluating the measurement properties of the KOOS-JR is necessary to determine its clinical value in sports medicine. In later stages after ACLR recovery, administration of the KOOS-JR may not be adequate.
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Affiliation(s)
- Jennifer L Hunnicutt
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, Georgia
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Chris M Gregory
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.,Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Harris S Slone
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle M McLeod
- Department Health and Human Performance, College of Charleston, Charleston, South Carolina
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | - Craig A Velozo
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.,Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
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Dudgeon WD, Thomas DD, Dauch WJ, McLeod MM, Scheett TP. Seven Days Of Mushroom Blend Supplementation Improve Measures Of Aerobic And Anaerobic Performance. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519532.60337.c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McLeod MM, Pietrosimone B, Gribble PA, Tevald M, Sohn D, Thomas AC. Associations Between Indices of Quadriceps Strength and Self-Reported Function in Individuals After Knee Meniscal Surgery. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487650.94916.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
CONTEXT Neuromuscular dysfunction of the leg and thigh musculature, including decreased strength and postural control, is common in patients with chronic ankle instability (CAI). Understanding how CAI affects specific neural pathways may provide valuable information for targeted therapies. OBJECTIVE To investigate differences in spinal reflexive and corticospinal excitability of the fibularis longus and vastus medialis between limbs in patients with unilateral CAI and between CAI patients and participants serving as healthy controls. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 56 participants volunteered, and complete data for 21 CAI patients (9 men, 12 women; age = 20.81 ± 1.63 years, height = 171.57 ± 11.44 cm, mass = 68.84 ± 11.93 kg) and 24 healthy participants serving as controls (7 men, 17 women; age = 22.54 ± 2.92 years, height = 172.35 ± 10.85 cm, mass = 69.15 ± 12.30 kg) were included in the final analyses. Control participants were matched to CAI patients on sex, age, and limb dominance. We assigned "involved" limbs, which corresponded with the involved limbs of the CAI patients, to control participants. MAIN OUTCOME MEASURE(S) Spinal reflexive excitability was assessed via the Hoffmann reflex and normalized to a maximal muscle response. Corticospinal excitability was assessed using transcranial magnetic stimulation. Active motor threshold (AMT) was defined as the lowest transcranial magnetic stimulation intensity required to elicit motor-evoked potentials equal to or greater than 100 μV in 5 of 10 consecutive stimuli. We obtained motor-evoked potentials (MEPs) at percentages ranging from 100% to 140% of AMT. RESULTS Fibularis longus MEP amplitudes were greater in control participants than in CAI patients bilaterally at 100% AMT (control involved limb: 0.023 ± 0.031; CAI involved limb: 0.014 ± 0.008; control uninvolved limb: 0.021 ± 0.022; CAI uninvolved limb: 0.015 ± 0.007; F1,41 = 4.551, P = .04) and 105% AMT (control involved limb: 0.029 ± 0.026; CAI involved limb: 0.021 ± 0.009; control uninvolved limb: 0.034 ± 0.037; CAI uninvolved limb: 0.023 ± 0.013; F1,35 = 4.782, P = .04). We observed no differences in fibularis longus MEP amplitudes greater than 110% AMT and no differences in vastus medialis corticospinal excitability (P > .05). We noted no differences in the Hoffmann reflex between groups for the vastus medialis (F1,37 = 0.103, P = .75) or the fibularis longus (F1,41 = 1.139, P = .29). CONCLUSIONS Fibularis longus corticospinal excitability was greater in control participants than in CAI patients.
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Affiliation(s)
| | - Phillip A Gribble
- Department of Rehabilitation Sciences, University of Kentucky, Lexington
| | - Brian G Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill. Dr McLeod is now with the Department of Health and Human Performance, College of Charleston, SC
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Harkey M, McLeod MM, Terada M, Gribble PA, Pietrosimone BG. Quadratic Association Between Corticomotor and Spinal-Reflexive Excitability and Self-Reported Disability in Participants With Chronic Ankle Instability. J Sport Rehabil 2015. [PMID: 25759960 DOI: 10-1123/jsr.2014-0282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Spinal-reflexive and corticomotor excitability may have a critical role in altering muscle function needed to stabilize the ankle in people with chronic ankle instability (CAI). OBJECTIVE To determine the association between self-reported disability and both spinal-reflexive and corticomotor excitability in people with CAI. DESIGN Descriptive laboratory study. SETTING Research laboratory. PARTICIPANTS 30 participants with CAI. MAIN OUTCOME MEASURES Soleus spinal-reflexive excitability was measured with normalized Hoffmann reflexes (H:M ratio), and corticomotor excitability was measured with transcranial magnetic stimulation and quantified by normalized motor-evoked-potential (MEP) amplitudes at 120% of active motor threshold (120%MEP). Self-reported disability was quantified with the activities-of-daily-living and sport subscales of the Foot and Ankle Ability Measure (FAAM-ADL and FAAM-S). Separate linear Pearson product-moment correlations and nonlinear quadratic correlations were used to determine associations between the neural-excitability and disability variables. RESULTS Thirty participants were included in the spinal-reflexive-excitability analysis, while only 19 were included in the corticomotor analysis. There was a significant, weak linear association between H:M ratio and FAAM-ADL (R = .39, P = .03) and a nonsignificant, weak linear association between H:M ratio and FAAM-S (R = .36, P = .06). There were significant, moderate quadratic associations between H:M ratio and both FAAM-ADL (R = .48, P = .03) and FAAM-S (R = .50, P = .02). There was a significant, moderate linear association between 120%MEP and FAAM-ADL (R = -.48, P = .04) and a nonsignificant, moderate negative linear association between FAAM-S (R = -.42, P = .07). There was a significant, moderate quadratic association between 120%MEP and FAAM-ADL (R = .57, P = .046) and a significant, strong quadratic correlation between 120%MEP and FAAM-S (R = .71, P = .004). CONCLUSIONS There are significant quadratic associations between self-reported disability and both spinal-reflexive and corticomotor excitability of the soleus. CAI participants with low or high neural excitability present with lower function.
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Affiliation(s)
- Matthew Harkey
- Dept of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Abstract
Background: Neuromuscular alterations are common following lower extremity joint injury and often lead to decreased function and disability. These neuromuscular alterations manifest in inhibition or abnormal facilitation of the uninjured musculature surrounding an injured joint. Unfortunately, these neural alterations are poorly understood, which may affect clinical recognition and treatment of these injuries. Understanding how these neural alterations affect physical function may be important for proper clinical management of lower extremity joint injuries. Methods: Pertinent articles focusing on neuromuscular consequences and treatment of knee and ankle injuries were collected from peer-reviewed sources available on the Web of Science and Medline databases from 1975 through 2010. A theoretical model to illustrate potential relationships between neural alterations and clinical impairments was constructed from the current literature. Results: Lower extremity joint injury affects upstream cortical and spinal reflexive excitability pathways as well as downstream muscle function and overall physical performance. Treatment targeting the central nervous system provides an alternate means of treating joint injury that may be effective for patients with neuromuscular alterations. Conclusions: Disability is common following joint injury. There is mounting evidence that alterations in the central nervous system may relate to clinical changes in biomechanics that may predispose patients to further injury, and novel clinical interventions that target neural alterations may improve therapeutic outcomes.
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Affiliation(s)
- Brian G Pietrosimone
- Joint Injury and Muscle Activation Laboratory, Department of Kinesiology, University of Toledo, Toledo, Ohio
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McLeod MM, Silverthorn KG. AIDS and the ICU nurse. Can Nurse 1988; 84:28-30. [PMID: 3416290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Reynolds PM, McLeod MM, Dick WC. Clozic (ICI 55,897) in rheumatoid arthritis--a controlled comparison with gold. Br J Clin Pract 1981; 35:306-8. [PMID: 6798986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
A short-term, double-blind, placebo-controlled crossover study was completed in 15 patients with classical or definite rheumatoid arthritis to compare the antirheumatic activity of salsalate (3 g/day) with placebo and indomethacin (75 mg/day). Subjective and objective assessments showed that both salsalate and indomethacin were significantly superior to placebo. Grip strength was not improved by either of the drugs. Patient preference was in favour of indomethacin, but the difference between it and salsalate was insignificant.
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Abstract
A double-blind crossover trial was carried out in 15 patients with definite rheumatoid arthritis to compare the effectiveness of 1200 mg azapropazone daily and 750 mg naproxen daily, each drug being given for 2 weeks. Patients also received placebo therapy before and between the two treatment periods. The results of subjective and objective assessments showed that both drugs were significantly superior to placebo, but no significant difference could be demonstrated between the two drugs.
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