Botulinum toxin as adjuvant therapy for hypertonic dysfunction in a neuro-rehabilitation cohort

Purpose: Botulinum toxin (BTX) is a neurotoxin produced by the bacterium Clostridium botulinum, in recent decades, BTX has become an important adjunct treatment to neurological or rehabilitative strategies.We aimed to describe the clinical aspects of patients admitted to a rehabilitation hospital who were treated with BTX for spasticity and dystonia. Methods: This was a historical cohort; data was collected from the electronic charts of all outpatients treated with BTX between 2014 and 2016 in the spasticity and movement disorders service of a quaternary, open access, rehabilitation hospital. The inclusion criteria were limb spasticity due to traumatic brain injury (TBI), and stroke; limb tremor; cervical dystonia; and generalized limb dystonia from any cause in addition to pain that limits rehabilitation. We used relatively lower doses than those generally published in the literature. Therapeutic response was determined by the Goal attainment scale (GAS), pain (graded by visual analogue scale ), independence for daily living activities, target joint range of motion (pre- and post-application), and gait analysis (only for walkers patients). Results: A total of 63 patients were enrolled in this study with a mean follow-up of 2 years. There was significant improvement in joint restriction ) with 66.7% of patients reporting improvement in the GAS scale, best improvement occurred with ortheses and limb adjustments. Conclusions: Most patients have improved functionality on the GAS scale after treatment with BTX, which is used as an adjunct therapy in subjects already in rehabilitation programs. The main rehabilitation objectives with the GAS scale were achieved in most patients.

The “Fight Bite” Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies

Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, index, long, ring, and small fingers was 0.16 mL (0.1-0.3 mL), 0.19 mL (0.1-0.3 mL), 0.21 mL (0.1-0.4 mL), 0.17 mL (0.1-0.3 mL), and 0.16 mL (0.1-0.3 mL), respectively. Cadaver age, laterality, and joint range of motion were not significantly associated with the injected volume at extravasation( P > .05, each). Injection volumes of 0.3 and 0.32 mL were required to detect arthrotomies at 95% and 99% sensitivities across all MCPJs. None of the MCPJs required > 0.4 mL to detect arthrotomy. Conclusions: Saline joint loading volumes to detect traumatic arthrotomy were similar for all MCPJs. Injection volumes of 0.32 mL is suggested for 99% sensitivity. Our findings provide the first report, to our knowledge, on intra-articular injection volumes expected to detect an arthrotomy of MCPJ. This is critical for further validation using in vivo clinical studies.

Application of Multimode Health Education Combined with Humanistic Care in Pain Management of Patients with Femoral Fracture and Its Influence on VAS Score

Objective. To explore the application of multimode health education combined with humanistic care in pain management of patients with femoral fracture and its influence on VAS score. Methods. A total of 120 patients with femoral fracture admitted in our hospital (May 2017–May 2021) were selected as the research objects. The patients who received routine health education were included into the routine group, and the patients who received multimode health education combined with humanistic care were included into the combined group, with 60 cases in each group. The pain management effect of the two groups was compared after nursing intervention. Results. No significant difference was found in age, BMI, fracture sites, gender, education degree, and residence between the two groups ( P > 0.05). The awareness rate of health knowledge of the combined group was as high as 93.33%, which was obviously higher than that of the routine group ( P < 0.05). Compared with the routine group, excellent rates of sitting durability and joint range of motion in the combined group were obviously higher ( P < 0.05), and poor rates of sitting durability and joint range of motion in the combined group were obviously lower ( P < 0.05). Compared with the routine group, VAS scores of the combined group at 1 d, 2 d, and 3 d after admission and at 1 d, 2 d, and 3 d after surgery were remarkably lower ( P < 0.05). Compared with the routine group, compliance of exercise, medical waist belt using, and working posture of the combined group 1 week, 1 month, and 6 months after surgery was obviously higher ( P < 0.05). Compared with the routine group, the scores of Rasmussen and Johner-Wruhs of the combined group 6 months after surgery were conspicuously higher ( P < 0.05). Conclusion. The application of multimode health education combined with humanistic care in pain management of patients with femoral fracture can effectively relieve pain, improve the awareness rate of health knowledge, promote the recovery of lower limb function, and enhance the prognosis of quality of life for patients.

Penerapan Latihan ROM (RANGE OF MOTION) Terhadap Rentang Gerak Ekstremitas Pada Pasien Stroke

Stroke is a disease caused by an acute neurological deficit in blood vesseldisorders leading to the brain that occur suddenly and can cause physical disability or death.The common complain are mobility impairment or decreased range of movement of the extremities.This study aimed to increase the range of movement of the extremities by doing Range on Motion exercises in families who have a history of stroke.There are two post-stroke patients involved in this study and give the Range of Motion exercise.The method used is to measure the degree of joint range of motion before performing ROM exercises then ROM exercises ranging from flexion, extension, hyperextension, adduction, abduction, and so on then measure the degree of joint range of motion with a goniometer measuring instrument and the results are recorded on the observation sheet.Goniometer was used to measurement the range of movement of the extremities.Range of Motion was performed for 7 days, each movement of 10 seconds duration.The results show that the range of movement increased in both patients. Accordingly, the Range of Motion exercises proved can increase the range of movement of the extremities in stroke patients.Families are expected to doing the Range of Motion exercise independently at home.Keywords:Range of motion; Range of movement; Stroke. AbstrakStroke adalah penyakit yang disebabkan oleh defisit neurologis akut pada gangguan pembuluh darah menuju otak yang terjadi secara tiba-tiba dan dapat menyebabkan kecacatan fisik atau kematian.Keluhan yang sering dikeluhkan adalah gangguan mobilitas atau penurunan jangkauan gerak ekstremitas. Penelitian ini bertujuan untuk meningkatkan jangkauan gerak ekstremitas dengan melakukan latihan Range on Motion pada keluarga yang memiliki riwayat stroke.Ada dua pasien pasca stroke yang terlibat dalam penelitian ini dan memberikan latihan Range of Motion.Metode yang dilakukan mengukur derajat rentang gerak sendi sebelum dilakukan latihan ROM kemudian latihan ROM mulai dari gerakan fleksi, ekstensi, hiperekstensi, addukksi, abduksi, dan lain sebagainya kemudian mengukur kembali derajat rentang gerak sendi dengan alat ukur goniometer dan hasilnya catat dilembar observasi.Goniometer digunakan untuk mengukur jangkauan gerakan ekstremitas.ROM dilakukan selama 7 hari, setiap gerakan durasi 10 detik.Hasil penelitian menunjukkan bahwa rentang gerak meningkat pada kedua pasien. Dengan demikian, latihan Range of Motion terbukti dapat meningkatkan jangkauan gerak ekstremitas pada pasien stroke. Keluarga diharapkan melakukan latihan Range of Motion secara mandiri di rumah.Kata kunci:Range of motion; Rentang gerak; Stroke.

Low-Complexity 2D-MUSIC for Joint Range and Angle Estimation of Frequency Modulated Continuous-Wave Radar

A pre-processing technique is proposed to reduce the complexity of two-dimensional multiple signal classification (2D-MUSIC) for the joint range and angle estimation of frequency-modulated continuous-wave (FMCW) radar systems. By using the central symmetry of the angle steering vector from a uniform linear array (ULA) antenna and the linearity of the beat signal in the FMCW radar, this preprocessing technique transforms 2D-MUSIC from complex values into real values. To compare the computational complexity of the proposed algorithm with the conventional 2D-MUSIC, we measured the CPU processing time for various numbers of snapshots, and the evaluation results indicated that the 2D-MUSIC with the proposed pre-processing technique is approximately three times faster than the conventional 2D-MUSIC.

Functional Movement Screen task scores and joint range-of-motion: a construct validity study

Little is known about the construct validity of the Functional Movement Screen (FMS). We aimed to assess associations between FMS task scores and measures of maximum joint range-of-motion (ROM) among university varsity student-athletes from 4 sports (volleyball, basketball, ice hockey, and soccer). Athletes performed FMS tasks and had their maximum ankle, hip and shoulder ROM measured. Multivariable linear regression was used to estimate associations between FMS task scores and ROM measurements. 101 university student-athletes were recruited (52 W/49 M; mean age 20.4±1.9 years). In general, athletes with higher FMS task scores had greater ROM compared to those with lower task scores. For example, athletes who scored 2 on the FMS squat task had 4˚ (95% CI, 1˚ to 7˚) more uni-articular ankle dorsiflexion ROM compared with those who scored 1, while those who scored 3 on the FMS squat task had 10˚ (4˚ to 17˚) more uni-articular ankle dorsiflexion ROM compared with those who scored 1. Large variation in ROM measurements was observed. In sum, substantial overlap in joint ROM between groups of athletes with different FMS task scores weakens the construct validity of the FMS as an indicator of specific joint ROM.

Acute Effects of Static Self-Stretching Exercises and Foam Roller Self-Massaging on the Trunk Range of Motions and Strength of the Trunk Extensors

Although the effectiveness of static self-stretching exercises (SSSEs) and foam roller self-massaging (FRSM) in joint range of motion and muscle strength of the lower limbs has been extensively investigated, little is known about their effectiveness on the posterior trunk muscles. The present study aimed to investigate the acute effects of two 7-min SSSEs and FRSM intervention protocols on the range of trunk movements and the strength of the trunk extensors. Twenty-five healthy active males (n = 14) and females (n = 11) performed each intervention separately, one week apart. The range of motion (ROM) of the trunk-hip flexion (T-HF), the ROM of the trunk side-flexion (TSF) and rotation (TR) bilaterally, as well as the isometric maximum strength (TESmax) and endurance (TESend) of the trunk extensors were measured before and after each intervention. The ROMs of T-HF, TSF, and TR were significantly increased following both SSSEs and FRSM. The TESmax and TESend were also significantly increased after FRSM, but decreased following SSSEs. While both interventions were effective in increasing the range of motion of the trunk, a single 7-min session of FRSM presented more advantages over a similar duration SSSEs protocol due to the increase in the strength of the trunk extensors it induced.