Excitability at the motoneuron pool and motor cortex is specifically modulated in lengthening compared to isometric contractions

Excitability at the motoneuron pool and motor cortex is specifically modulated in lengthening compared to isometric contractions. J Neurophysiol 101: 2030–2040, 2009. First published January 28, 2008; doi:10.1152/jn.91104.2008. Neural control of muscle contraction seems to be unique during muscle lengthening. The present study aimed to determine the specific sites of modulatory control for lengthening compared with isometric contractions. We used stimulation of the motor cortex and corticospinal tract to observe changes at the spinal and cortical levels. Motor-evoked potentials (MEPs) and cervicomedullary MEPs (CMEPs) were evoked in biceps brachii and brachioradialis during maximal and submaximal lengthening and isometric contractions at the same elbow angle. Sizes of CMEPs and MEPs were lower in lengthening contractions for both muscles (by 28 and 16%, respectively; P 0.01), but MEP-to-CMEP ratios increased (by 21%; P 0.05). These results indicate reduced excitability at the spinal level but enhanced motor cortical excitability for lengthening compared with isometric muscle contractions.

No difference in 1RM strength and muscle activation during the barbell chest press on a stable and unstable surface

Exercise or Swiss balls are increasingly being used with conventional resistance exercises. There is little evidence supporting the efficacy of this approach compared to traditional resistance training on a stable surface. Previous studies have shown that force output may be reduced with no change in muscle electromyography (EMG) activity while others have shown increased muscle EMG activity when performing resistance exercises on an unstable surface. This study compared 1RM strength, and upper body and trunk muscle EMG activity during the barbell chest press exercise on a stable (flat bench) and unstable surface (exercise ball). After familiarization, 13 subjects underwent testing for 1RM strength for the barbell chest press on both a stable bench and an exercise ball, each separated by at least 7 days. Surface EMG was recorded for 5 upper body muscles and one trunk muscle from which average root mean square of the muscle activity was calculated for the whole 1RM lift and the concentric and eccentric phases. Elbow angle during each lift was recorded to examine any range-of-motion differences between the two surfaces. The results show that there was no difference in 1RM strength or muscle EMG activity for the stable and unstable surfaces. In addition, there was no difference in elbow range-of-motion between the two surfaces. Taken together, these results indicate that there is no reduction in 1RM strength or any differences in muscle EMG activity for the barbell chest press exercise on an unstable exercise ball when compared to a stable flat surface. Moreover, these results do not support the notion that resistance exercises performed on an exercise ball are more efficacious than traditional stable exercises.

Two maximal isometric contractions attenuate the magnitude of eccentric exercise-induced muscle damage

This study investigated whether maximal voluntary isometric contractions (MVC-ISO) would attenuate the magnitude of eccentric exercise-induced muscle damage. Young untrained men were placed into one of the two experimental groups or one control group (n = 13 per group). Subjects in the experimental groups performed either two or 10 MVC-ISO of the elbow flexors at a long muscle length (20° flexion) 2 days prior to 30 maximal isokinetic eccentric contractions of the elbow flexors. Subjects in the control group performed the eccentric contractions without MVC-ISO. No significant changes in maximal voluntary concentric contraction peak torque, peak torque angle, range of motion, upper arm circumference, plasma creatine kinase (CK) activity and myoglobin concentration, muscle soreness, and ultrasound echo intensity were evident after MVC-ISO. Changes in the variables following eccentric contractions were smaller (P < 0.05) for the 2 MVC-ISO group (e.g., peak torque loss at 5 days after exercise, 23% ± 3%; peak CK activity, 1964 ± 452 IU·L^–1; peak muscle soreness, 46 ± 4 mm) or the 10 MVC-ISO group (13% ± 3%, 877 ± 198 IU·L^–1, 30 ± 4 mm) compared with the control (34% ± 4%, 6192 ± 1747 IU·L^–1, 66 ± 5 mm). The 10 MVC-ISO group showed smaller (P < 0.05) changes in all variables following eccentric contractions compared with the 2 MVC-ISO group. Therefore, two MVC-ISO conferred potent protective effects against muscle damage, whereas greater protective effect was induced by 10 MVC-ISO, which can be used as a strategy to minimize muscle damage.

Interobserver reliability of radial head fracture classification : two-dimensional compared with three-dimensional CT

Background: The Broberg and Morrey modification of the Mason classification of radial head fractures has substantial interobserver variation. This study used a large web-based collaborative of experienced orthopaedic surgeons to test the hypothesis that three-dimensional reconstructions of computed tomography (CT) scans improve the interobserver reliability of the classification of radial head fractures according to the Broberg and Morrey modification of the Mason classification.

Methods: Eighty-five orthopaedic surgeons evaluated twelve radial head fractures. They were randomly assigned to review either radiographs and two-dimensional CT scans or radiographs and three-dimensional CT images to determine the fracture classification, fracture characteristics, and treatment recommendations. The kappa multirater measure (κ) was calculated to estimate agreement between observers.

Results: Three-dimensional CT had moderate agreement and two-dimensional CT had fair agreement among observers for the Broberg and Morrey modification of the Mason classification, a difference that was significant. Observers assessed seven fracture characteristics, including fracture line, comminution, articular surface involvement, articular step or gap of ≥2 mm, central impaction, recognition of more than three fracture fragments, and fracture fragments too small to repair. There was a significant difference in kappa values between three-dimensional CT and two-dimensional CT for fracture fragments too small to repair, recognition of three fracture fragments, and central impaction. The difference between the other four fracture characteristics was not significant. Among treatment recommendations, there was fair agreement for both three-dimensional CT and two-dimensional CT.

Conclusions: Although three-dimensional CT led to some small but significant decreases in interobserver variation, there is still considerable disagreement regarding classification and characterization of radial head fractures. Three-dimensional CT may be insufficient to optimize interobserver agreement.

Short-interval intracortical inhibition is not affected by varying visual feedback in an isometric task in biceps brachiii muscle

Purpose : To establish if visual feedback and force requirements influence SICI.

Methods : SICI was assessed from 10 healthy adults (5 males and 5 females aged between 21 and 35 years) in three submaximal isometric elbow flexion torque levels [5, 20, and 40% of maximal voluntary contraction (MVC)] and with two tasks differing in terms of visual feedback. Single-pulse and paired-pulse motor-evoked potentials (MEPs), supramaximal M-wave, and background surface electromyogram (sEMG) were recorded from the biceps brachii muscle.

Results : Repeated measures MANOVA was used for statistical analyses. Background sEMG did not differ between tasks (F = 0.4, P = 0.68) nor was task × torque level interaction observed (F = 1.2, P = 0.32), whereas background sEMG increased with increasing torque levels (P = 0.001). SICI did not differ between tasks (F = 0.9, P = 0.43) and no task × torque level interaction was observed (F = 2.3, P = 0.08). However, less SICI was observed at 40% MVC compared to the 5 and 20% MVC torque levels (P = 0.01–0.001).

Conclusion : SICI was not altered by performing the same task with differing visual feedback. However, SICI decreased with increasing submaximal torque providing further evidence that SICI is one mechanism of modulating cortical excitability and plays a role in force gradation.

Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT

Interobserver reliability for the classification of proximal humeral fractures is limited. The aim of this study was to test the null hypothesis that interobserver reliability of the AO classification of proximal humeral fractures, the preferred treatment, and fracture characteristics is the same for two-dimensional (2-D) and three-dimensional (3-D) computed tomography (CT). Members of the Science of Variation Group--fully trained practicing orthopaedic and trauma surgeons from around the world--were randomized to evaluate radiographs and either 2-D CT or 3-D CT images of fifteen proximal humeral fractures via a web-based survey and respond to the following four questions: (1) Is the greater tuberosity displaced? (2) Is the humeral head split? (3) Is the arterial supply compromised? (4) Is the glenohumeral joint dislocated? They also classified the fracture according to the AO system and indicated their preferred treatment of the fracture (operative or nonoperative). Agreement among observers was assessed with use of the multirater kappa (κ) measure. Interobserver reliability of the AO classification, fracture characteristics, and preferred treatment generally ranged from "slight" to "fair." A few small but statistically significant differences were found. Observers randomized to the 2-D CT group had slightly but significantly better agreement on displacement of the greater tuberosity (κ = 0.35 compared with 0.30, p < 0.001) and on the AO classification (κ = 0.18 compared with 0.17, p = 0.018). A subgroup analysis of the AO classification results revealed that shoulder and elbow surgeons, orthopaedic trauma surgeons, and surgeons in the United States had slightly greater reliability on 2-D CT, whereas surgeons in practice for ten years or less and surgeons from other subspecialties had slightly greater reliability on 3-D CT. Proximal humeral fracture classifications may be helpful conceptually, but they have poor interobserver reliability even when 3-D rather than 2-D CT is utilized. This may contribute to the similarly poor interobserver reliability that was observed for selection of the treatment for proximal humeral fractures. The lack of a reliable classification confounds efforts to compare the outcomes of treatment methods among different clinical trials and reports.

Clinical features and risk factors of oedematous Mycobacterium ulcerans lesions in an Australian population: beware cellulitis in an endemic area

Introduction
Oedematous lesions are a less common but more severe form of Mycobacterium ulcerans disease. Misdiagnosis as bacterial cellulitis can lead to delays in treatment. We report the first comprehensive descriptions of the clinical features and risk factors of patients with oedematous disease from the Bellarine Peninsula of south-eastern Victoria, Australia.

Methods
Data on all confirmed Mycobacterium ulcerans cases managed at Barwon Health, Victoria, were collected from 1/1/1998–31/12/2012. A multivariate logistic regression model was used to assess associations with oedematous forms of Mycobacterium ulcerans disease.

Results
Seventeen of 238 (7%) patients had oedematous Mycobacterium ulcerans lesions. Their median age was 70 years (IQR 17–82 years) and 71% were male. Twenty-one percent of lesions were WHO category one, 35% category two and 41% category three. 16 (94%) patients were initially diagnosed with cellulitis and received a median 14 days (IQR 9–17 days) of antibiotics and 65% required hospitalization prior to Mycobacterium ulcerans diagnosis. Fever was present in 50% and pain in 87% of patients. The WCC, neutrophil count and CRP were elevated in 54%, 62% and 75% of cases respectively. The median duration of antibiotic treatment was 84 days (IQR 67–96) and 94% of cases required surgical intervention. On multivariable analysis, there was an increased likelihood of a lesion being oedematous if on the hand (OR 85.62, 95% CI 13.69–535.70; P<0.001), elbow (OR 7.83, 95% CI 1.39–43.96; p<0.001) or ankle (OR 7.92, 95% CI 1.28–49.16; p<0.001), or if the patient had diabetes mellitus (OR 9.42, 95% CI 1.62–54.74; p = 0.02).

Conclusions
In an Australian population, oedematous Mycobacterium ulcerans lesions present with similar symptoms, signs and investigation results to, and are commonly mistakenly diagnosed for, bacterial limb cellulitis. There is an increased likelihood of oedematous lesions affecting the hand, elbow or ankle, and in patients with diabetes.

Unilateral bicep curl hemodynamics: low-pressure continuous vs high-pressure intermittent blood flow restriction

 Light-load exercise training with blood flow restriction (BFR) increases muscle strength and size. However, the hemodynamics of BFR exercise appear elevated compared with non-BFR exercise. This questions the suitability of BFR in special/clinical populations. Nevertheless, hemodynamics of standard prescription protocols for BFR and traditional heavy-load exercise have not been compared. We investigated the hemodynamics of two common BFR exercise methods and two traditional resistance exercises. Twelve young males completed four unilateral elbow flexion exercise trials in a balanced, randomized crossover design: (a) heavy load [HL; 80% one-repetition maximum (1-RM)]; (b) light load (LL; 20% 1-RM); and two other light-load trials with BFR applied (c) continuously at 80% resting systolic blood pressure (BFR-C) or (d) intermittently at 130% resting systolic blood pressure (BFR-I). Hemodynamics were measured at baseline, during exercise, and for 60-min post-exercise. Exercising heart rate, blood pressure, cardiac output, and rate–pressure product were significantly greater for HL and BFR-I compared with LL. The magnitude of hemodynamic stress for BFR-C was between that of HL and LL. These data show reduced hemodynamics for continuous low-pressure BFR exercise compared with intermittent high-pressure BFR in young healthy populations. BFR remains a potentially viable method to improve muscle mass and strength in special/clinical populations.

3D motion matching algorithm using signature feature descriptor

This paper introduces a basic frame for rehabilitation motion practice system which detects 3D motion trajectory with the Microsoft Kinect (MSK) sensor system and proposes a cost-effective 3D motion matching algorithm. The rehabilitation motion practice system displays a reference 3D motion in the database system that the player (patient) tries to follow. The player’s motion is traced by the MSK sensor system and then compared with the reference motion to evaluate how well the player follows the reference motion. In this system, 3D motion matching algorithm is a key feature for accurate evaluation for player’s performance. Even though similarity measurement of 3D trajectories is one of the most important tasks in 3D motion analysis, existing methods are still limited. Recent researches focus on the full length 3D trajectory data set. However, it is not true that every point on the trajectory plays the same role and has the same meaning. In this situation, we developed a new cost-effective method that only uses the less number of features called ‘signature’ which is a flexible descriptor computed from the region of ‘elbow points’. Therefore, our proposed method runs faster than other methods which use the full length trajectory information. The similarity of trajectories is measured based on the signature using an alignment method such as dynamic time warping (DTW), continuous dynamic time warping (CDTW) or longest common sub-sequence (LCSS) method. In the experimental studies, we applied the MSK sensor system to detect, trace and match the 3D motion of human body. This application was assumed as a system for guiding a rehabilitation practice which can evaluate how well the motion practice was performed based on comparison of the patient’s practice motion traced by the MSK system with the pre-defined reference motion in a database. In order to evaluate the accuracy of our 3D motion matching algorithm, we compared our method with two other methods using Australian sign word dataset. As a result, our matching algorithm outperforms in matching 3D motion, and it can be exploited for a base framework for various 3D motion-based applications at low cost with high accuracy.

Are cutout handles used when available in real occupational settings? Description of grips and upper extremities movements during industrial box handling

In order to achieve better postures and decrease musculoskeletal risks adequate design of hand/box couplings for manual materials handling (MMH) are still needed. No studies evaluating upper limb movement thorough direct measurements during box handling in workplace were identified in the literature. In this study we describe the types of grip and movements adopted by ten workers when handling redesigned boxes with cutout handles between different heights on industrial pallets. The new handles were used by 90% of the workers through different types of grip. Electrogoniometric measurements showed relatively safe forearm and wrist movements, although elbow inadequate range of movement was recorded. Despite the good acceptance of the cutout by workers, the new design requires extra internal space in the boxes reducing applications for this alternative of box.

Anthropometric aspects of body seated in school

This study aimed to assess the student-furniture interface from anthropometric parameters of the sitting posture. The sample was composed of 887 students from two public schools in the State of Parana - Brazil, which attended children from 7 to 17 years of age. The data collection used anthropometric measures of the sitting position, a questionnaire containing a human body diagram for indication of discomfort areas and photographic records to verify postural and ergonomic inadequacies in classroom. The following anthropometric variables were measured: popliteal height, sacro-popliteal length, hip width, lumbar support height, and elbow and thigh height. Percentiles 5 and 95 of anthropometric variables showed differences statistically significant, with variation coefficient greater than 30%. In relation to body discomfort, the highest occurrences were recorded for ankle, knees and shoulder joints as well as for spine and buttocks. It was concluded that children use school furniture that does not meet their anthropometric standards, which favored the adoption of incorrect postures and contributed to the emergence of musculoskeletal problems that can interfere with their educational process.

A elasticidade do ligamento colateral medial da articulação do cotovelo de cão não advém de elastina

A literatura relata que ligamentos consistem de tecido conjuntivo denso, composto por água, colágeno tipos I e III, diversas proteoglicanas, pouca elastina e várias outras substâncias. Além disso, os ligamentos, quando testados in vitro com tensão longitudinal e unidirecional, apresentam um comportamento mecânico não-linear, ou seja, as fibras colágenas são alongadas aos poucos, perdendo seu padrão ondulado, até que todas estejam no limite máximo de tração e iniciem o rompimento. Portanto, no presente estudo avaliou-se a presença de fibras elásticas (elastina) no ligamento colateral medial do cotovelo de cães adultos para ponderar se a elasticidade do referido ligamento deve-se à presença de fibras elásticas ou às propriedades elásticas do colágeno ou à combinação de ambas. Foram utilizadas quatro articulações, de machos e fêmeas em igual proporção, das quais foram adquiridas as amostras das porções médias dos ligamentos colaterais mediais para a rotina histológica. Os cortes foram corados pela técnica de Weigert, e não foi observada a presença de fibras elásticas, detectável por esta técnica à microscopia de luz. Concluiu-se que a elasticidade do ligamento colateral medial do cotovelo de cão deve-se, principalmente, ao padrão ondulado das fibras colágenas, devido à quantidade ínfima ou até à inexistência de fibras elásticas nesta estrutura.

Características anatômicas e morfométricas do ligamento oblíquo do cotovelo de eqüinos

Neste trabalho, algumas características anatômicas e morfométricas do ligamento oblíquo do cotovelo do eqüino foram descritas em dez animais adultos, sem raça definida, que não apresentavam afecções dos órgãos locomotores. O ligamento oblíquo origina-se dorsal à fossa radial do úmero, atravessa obliquamente a superfície cranial do cotovelo e se divide em uma porção longa, que se insere na tuberosidade radial, e em outra curta, que se une à porção longa do ligamento colateral medial. Foram efetuadas medidas visando a obter o comprimento e a largura máximas entre a origem e a inserção do ligamento oblíquo, não sendo observadas diferenças (P>0,05) nas comparações feitas entre os sexos e os antímeros. O ligamento oblíquo contribui no efeito mola e na manutenção da estabilidade da articulação do cotovelo do eqüino. Pela particularidade de sua localização, cranial à articulação, o ligamento oblíquo possui ação frenadora, impedindo a extensão completa da referida articulação.

Efeitos do apoio dos membros superiores sobre a força muscular respiratória e função pulmonar de pacientes com doença pulmonar obstrutiva crônica

Objective: To analyze the effect of arm bracing posture on respiratory muscle strength and pulmonary function in patients with Chronic Obstructive Pulmonary Disease (COPD).Methods: 20 patients with COPD (11 male; 67 +/- 8 years; BMI 24 +/- 3 Kg . m(-2)) were submitted to assessments of Maximal Inspiratory and Expiratory Pressures (MIP and MEP, respectively) and spirometry with and without arm bracing in a random order. The assessment with arm bracing was done on standing position and the height of the support was adjusted at the level of the ulnar styloid process with elbow flexion and trunk anterior inclination of 30 degrees promoting weight discharge in the upper limbs. Assessment without arm bracing was also performed on standing position, however with the arms relaxed alongside the body. The time interval between assessments was one week.Results: MIP, MEP and maximal voluntary ventilation (MW) were higher with arm bracing than without arm bracing (MIP 64 +/- 22 cmH(2)O versus 54 +/- 24 cmH(2)O, p = 0,00001; MEP 104 +/- 37 cmH(2)O versus 92 +/- 37 cmH(2)O, p = 0,00001 and MW 42 +/- 20 L/min versus 38 +/- 20 L/min, p = 0,003). Other variables did not show statistical significant difference.Conclusion: The arm bracing posture resulted in higher capacity to generate force and endurance of the respiratory muscles in patients with COPD. (C) 2009 Published by Elsevier Espana, S.L. on behalf of Sociedade Portuguesa de Pneumologia. All rights reserved.

Força muscular respiratória e capacidade funcional em idosas hipertensas com sonolência diurna excessiva

The restriction of physical fitness is directly related with hypertension and sleep disorders, while the respiratory muscle strength is associated with hypertension, but the literature is scarce regarding its relationship with sleep disorders and particularly with excessive daytime sleepiness. Objectives: To compare physical fitness and strength of respiratory muscles between people with hypertension with excessive daytime sleepiness (EDS) and non EDS people, those who do not feel excessive daytime sleepiness, in addition to relate aerobics resistance and functional mobility of patients. Methods: An observational, analytical and transversal study, evaluated 32 elderly with hypertension, divided into two groups (EDS and non EDS), in which the following topics were measured; respiratory muscular strength, functional fitness, level of physical activity, level of excessive daytime sleepiness, quality of sleep and intensity of the patients snoring. Results: There was a significant difference in the level of EDS (P=0,00) and quality of sleep (p=0,03), however, the data related to snoring intensity (p=0,18), maximum inspiratory pressure PImax (p=0,39) and maximum expiratory pressure PEmax (p=0,98) did not show any difference. Also, no significant difference was observed concerning physical fitness, presenting p=0,08 for the sitting and getting up test on the chair in 30 ; p=0,54 for the extension and flexing of the elbow test in 30 ; p=0,38 for the walking test 6 ; p=0,38 for the parking gear test 2 , p=0,08 for the sitting and reaching test; p=0,42 for the scratching the back test; p=0,49 for the getting up and walking test; and p=0,62 for the global rate of activity limitation. There was moderate positive correlation between 6MWT and 2MST, r=0,54 (p=0,01) and negative moderate correlation between 6MWT and TUG, r=-0,61 (p=0,000) and between 2MST and TUG, r=-0,60 (p=0,000). Conclusion: The presence of EDS in the hypertension people studied, showed a bad quality of sleep, however this sleepiness did not influence the strength of the respiratory muscles. The physical fitness came out diminished in all hypertension people, regardless of the presence or non presence of sleep disturbance; and there is a close relationship between cardiovascular resistance and physical mobility, since when there is less cardiovascular resistance, there is precarious physical mobility and vice-versa