Lateral epicondylalgia: a musculoskeletal physiotherapy perspective

Tennis elbow or lateral epicondylalgia (LE) is a challenging musculoskeletal condition to treat. This is largely due to the lack of research-based evidence of the clinical efficacy of the myriad of treatment approaches espoused in the literature. In view of this, successful rehabilitation of LE is based on choosing treatments that address the physical impairments found during clinical examination. The primary physical impairment in LE is a deficit in grip strength predominately due to pain and its consequences on motor function. Hence the mainstay of successful management of this condition is therapeutic exercise, providing it is not pain provocative. Adjunctive procedures such as manipulative therapy and sports taping techniques have recently been shown to provide substantial initial pain relief. Early relief of pain in the rehabilitation program helps accelerate recovery and most importantly motivates the client to persist with the therapeutic exercise program. The manipulative therapy and taping treatments presented in this masterclass warrant consideration in the clinical best practice management of LE, and serve as a model for other similar musculoskeletal conditions. (C) 2003 Elsevier Science Ltd. All rights reserved.

Motor and functional skills of children with developmental coordination disorder: A pilot investigation of measurement issues

This paper reports on the motor and functional outcomes of 20 children with developmental coordination disorder (DCD) aged 4-8 years consecutively referred to a pediatric physiotherapy service. Children with a Movement ABC (M-ABC) score less than the 15th percentile, and with no concurrent medical, sensory, physical, intellectual or neurological impairments, were recruited. The Motor Assessment Outcomes Model (MAOM) [Coster and Haley, Infants and Young Children 4 (1992) 11] provided the theoretical base for measurement selection, and preliminary findings at the activities and participation levels of the model are reported in this article. Children with DCD performed at the lower end of the normal range on the Pea-body Developmental Motor Scales (fine motor total score) (M = 85.65, SD = 12.23). Performance on the Visual Motor Integration Test (VMI) standard scores was within the average range (M = 96.15, SD = 10.69). Videotaped observations of the children's writing and cutting indicated that 29% were left-handed and that a large proportion of all children (31%) utilized unusual pencil grasp patterns and immature prehension of scissors. Measurement at the participation level involved use of the Pictorial Scale of Perceived Competence and Social Acceptance (PCSA) and Pediatric Evaluation of Disability Inventory (PEDI). Overall, these young children rated themselves towards the more competent and accepted end of the PCSA over the dimensions of physical and cognitive competence and peer and maternal acceptance. The PEDI revealed generally average performance on social (M = 49.98, SD = 16.62) and mobility function (M = 54.71, SD = 3.99), however, self-care function was below the average range for age (M = 38.01, SD = 12.19). The utility of the MAOM as a framework for comprehensive measurement of functional and motor outcomes of DCD in young children is discussed. (C) 2003 Elsevier B.V. All rights reserved.

Synaptic vesicle transport and synaptic membrane transporter sites in excitatory amino acid nerve terminals in Alzheimer disease

The apparent L-[H-3]glutamate uptake rate (v') was measured in synaptic vesicles isolated from cerebral cortex synaptosomes prepared from autopsied Alzheimer and non-Alzheimer dementia cases, and age-matched controls. The initial synaptosome preparations exhibited similar densities of D-[H-3]aspartate membrane binding sites (B-MAX values) in the three groups. In control brain the temporal cortex D-[H-3]aspartate B-MAX was 132% of that in motor cortex, parallel with the L- [H-3]glutamate v' values (temporal = 139% of motor; NS). Unlike D- [H-3]aspartate B-MAX values, L- [H-3]glutamate v' values were markedly and selectively lower in Alzheimer brain preparations than in controls, particularly in temporal cortex. The difference could not be attributed to differential effects of autopsy interval or age at death. Non-Alzheimer dementia cases resembled controls. The selective loss of vesicular glutamate transport is consistent with a dysfunction in the recycling of transmitter glutamate.

In ovo electroporation of Crim1 in the developing chick spinal cord

The novel mammalian gene Crim1 encodes a transmembrane bound protein with similarity to the secreted bone morphogenetic protein (BMP) antagonists, vertebrate Chordin, and its Drosophila homologue short gastrulation. Crim1 is expressed in the neural tube in mouse in a restricted pattern, but its function in central nervous system development is largely unknown. We isolated the chicken Crim1 orthologue and analyzed its expression in the developing neural tube. Chicken CRIM1 shares strong homology to human/mouse CRIM1 and C. elegans CRIM1-like proteins. Crim1 is expressed in a similar but not identical pattern to that in the developing spinal cord of mouse, including the notochord, floor plate, motor neurons, and the roof plate. Unlike follistatin, a secreted inhibitor of BMPs, in ovo electroporation of CRIM1, as a full-length transmembrane bound or secreted ectodomain was not sufficient to disrupt early patterning of the neural tube. However, ectodomain CRIM1 overexpression leads to an approximate 50% decrease in populations of specific ventral neuronal populations, including ISL-1(+) motor neurons, CHX-10(+) V1, and EN-1(+) V2 interneurons.

Alcohol and other drug use disorders among older-aged people

In Australia people aged 65 years or older currently comprise 12.1% of the population. This has been estimated to rise to 24.2% by 2051. Until recently there has been relatively little research on alcohol and other drug use disorders among these individuals but, given the ageing population, this issue is likely to become of increasing importance and prominence. Epidemiological research shows a strong age-related decline in the prevalence of alcohol and other drug use disorders with age. Possible reasons for this include: age-related declines in the use and misuse of alcohol and other drugs; increased mortality among those with a lifetime history of alcohol and other drug use disorders; historical differences in exposure to and use of alcohol and other drugs. Despite the age-related decline in the prevalence of these disorders, they do still occur among those aged 65 years or older and, given historical changes in exposure to and use of illicit drugs, it likely that the prevalence of these disorders among older-aged individuals will rise. Specific issues faced by older-aged individuals with alcohol and other drug use problems are discussed. These include: interactions with prescribed medications, under-recognition and treatment of alcohol and drug problems, unintentional injury and social isolation. Finally, a brief discussion of treatment issues is provided.

Will chymase inhibitors be the next major development for the treatment of cardiovascular disorders?

Chymase is contained in the secretory granules of mast cells. In addition to the synthesis of angiotensin II, chymase is involved in transforming growth factor-beta activation and cleaves Type I procollagen to produce collagen. NK301 and BCEAB are orally-active inhibitors of chymase. NK301 was tested in a dog model of vascular intimal hyperplasia after balloon injury and shown to reduce the increased chymase activity in the injured arteries and prevent intimal thickening. In a hamster model of cardiac fibrosis associated with cardiomyopathy, BCEAB reduced the increased cardiac chymase activity in cardiomyopathy and reduced fibrosis. Chymase inhibitors may be an important development for the treatment of cardiovascular injury associated with mast cell degranulation.

Parvalbumin-, calbindin-, and calretinin-immunoreactive neurons in the prefrontal cortex of the owl monkey (Aotus trivirgatus): A standardized quantitative comparison with sensory and motor areas

Recent studies have revealed regional variation in the density and distribution of inhibitory neurons in different cortical areas, which are thought to reflect area-specific specializations in cortical circuitry. However, there are as yet few standardized quantitative data regarding how the inhibitory circuitry in prefrontal cortex (PFC), which is thought to be involved in executive functions such as cognition, emotion and decision making, compares to that in other cortical areas. Here we used immunohistochemical techniques to determine the density and distribution of parvalbumin (PV)-, calbindin (CB)-, and calretinin (CR)-immunoreactive (ir) neurons and axon terminals in the dorsolateral and orbital PFC of the owl monkey (Aotus trivirgatus), and compared them directly with data obtained using the same techniques in 11 different visual, somatosensory and motor areas. We found marked differences in the density of PV-ir, CB-ir, and CR-ir interneurons in several cortical areas. One hundred and twenty eight of all 234 possible between-area pairwise comparisons were significantly different. The density of specific subpopulations of these cells also varied among cortical areas, as did the density of axon terminals. Comparison of PFC with other cortical areas revealed that 40 of all 66 possible statistical comparisons of the density of PV-ir, CB-ir, and CR-ir cells were significantly different. We also found evidence for heterogeneity in the pattern of labeling of PV-ir, CB-ir, and CR-ir cells and axon terminals between the dorsolateral and orbital subdivisions of PFC. These data are likely to reflect basic differences in interneuron circuitry, which are likely to influence inhibitory function in the cortex. Copyright (C) 2003 S. Karger AG, Basel.

Expression of hNP22 is altered in the frontal cortex and hippocampus of the alcoholic human brain

Background: Human neuronal protein (hNP22) is a gene with elevated messenger RNA expression in the prefrontal cortex of the human alcoholic brain. hNP22 has high homology with a rat protein (rNP22). These proteins also share homology with a number of cytoskeleton-interacting proteins. Methods: A rabbit polyclonal antibody to an 18-amino acid epitope was produced for use in Western and immunohistochemical analysis. Samples from the human frontal and motor cortices were used for Western blots (n = 10), whereas a different group of frontal cortex and hippocampal samples were obtained for immunohistochemistry (n = 12). Results: The hNP22 antibody detected a single protein in both rat and human brain. Western blots revealed a significant increase in hNP22 protein levels in the frontal cortex but not the motor cortex of alcoholic cases. Immunohistochemical studies confirmed the increased hNP22 protein expression in all cortical layers. This is consistent with results previously obtained using Northern analysis. Immunohistochemical analysis also revealed a significant increase of hNP22 immunoreactivity in the CA3 and CA4 but not other regions of the hippocampus. Conclusions: It is possible that this protein may play a role in the morphological or plastic changes observed after chronic alcohol exposure and withdrawal, either as a cytoskeleton-interacting protein or as a signaling molecule.

Alunos com paralisia cerebral na escola : linguagem, comunicação alternativa e processos de comunicativos

O estudo assume como problema de investigação analisar as contribuições da Comunicação Alternativa e Ampliada (CAA) aos processos comunicativos de alunos sem fala articulada no contexto da escola, destacando nesses processos o papel potencializador dos interlocutores. Fundamenta-se na abordagem de linguagem e na noção de enunciado discutidas por Bakhtin e nas contribuições de Vigotski sobre a relação entre desenvolvimento e aprendizagem, postulando que a aquisição e o desenvolvimento da linguagem ocorrem no curso das aprendizagens, ao longo da vida. As análises e reflexões empreendidas evidenciam uma discussão acerca da linguagem que se desloca da dimensão orgânica para a dimensão da constituição do sujeito como humano. Sob essa visão, outros conceitos, como os de língua, fala, interação verbal, dialogia, enunciação, aprendizagem e desenvolvimento são problematizados e também considerados como elementos fundantes e presentes nas relações comunicativas entre os sujeitos sem fala articulada e seus interlocutores. Na primeira etapa, o estudo busca conhecer as formas organizativo-pedagógicas de cinco Secretarias Municipais de Educação da Região Metropolitana de Vitória e da Secretaria de Estado da Educação no que diz respeito à identificação dos alunos com Paralisia Cerebral, sem fala articulada, ao acompanhamento técnico-pedagógico e à formação de professores que atuam na Educação Especial. Na segunda etapa, objetiva conhecer a processualidade da organização do trabalho pedagógico instituída nos contextos escolares e investiga os processos comunicativos em/com dois alunos com severos comprometimentos motores e de fala em duas escolas de Ensino Fundamental, localizadas no município de Serra e de Vitória. Nesta etapa, opta pela pesquisa- ação colaborativo-crítica por contribuir, teórica e metodologicamente, para sustentar os fazeres individuais e coletivos nos lócus de investigação. Os resultados revelam que, institucionalmente, ainda não se conhece quem são e quantos são os alunos com Paralisia Cerebral sem fala articulada no contexto de suas reais necessidades. Esse desconhecimento é atribuído pelas gestoras das Secretarias Municipais de Educação investigadas ao considerarem que, via de regra, são tomadas apenas as informações do Educacenso-INEP. As identificações pontuais, quando ocorrem, são decorrentes de estratégias internas adotadas, sendo uma delas o assessoramento pedagógico das equipes às escolas. No que tange ao ensino, à aprendizagem e à avaliação, o estudo constata que são atravessados por concepções equivocadas sobre os sujeitos com Paralisia Cerebral sustentadas, sobretudo, pela baixa expectativa e pelo pouco “esforço” quanto à sua escolarização. Constata também que o uso dos recursos de CAA potencializa os processos comunicativos dos alunos investigados e, movimentados pela linguagem, possibilita-lhes enunciar e fixar posições, opiniões e decisões, assegurando-lhes mais autonomia e fluidez do processo comunicacional. As formas de mediação dos interlocutores assim como as dinâmicas dialógicas por eles utilizadas com os alunos se constituem como elementos importantes nos processos de comunicação e interação. A espera do outro, o apoio e o incentivo à reformulação daquilo que se quer expressar, as modificações e alterações no jogo dialógico são exemplos dessa mediação. Quanto às ações de reorganização do trabalho pedagógico, o estudo registra maior articulação e colaboração entre professores da classe, professora da Educação Especial e estagiária no planejamento das aulas, dos conteúdos, com a inserção no notebook para um dos alunos; o uso das pranchas de comunicação, por ambos os alunos e seus interlocutores, como ação inovadora nos contextos escolares; a realização de atividades pelos alunos, com gradativa autonomia, a partir da disponibilização de recursos de TA/CAA (pasta de conteúdos temáticos, figuras imantadas, quadro metálico, ponteira, plano inclinado, notebook); a proposição de ações intencionais de alfabetização, a partir da reorganização de espaços-tempos no cotidiano da escola. Conclui que as discussões teóricas e práticas das questões relacionadas com a linguagem, com os processos cognitivos e com o uso de recursos de TA/CAA alavancam mudanças na concepção dos profissionais das escolas pesquisadas que, ainda, sob uma visão reducionista quanto às formas de comunicação e de interação verbal, “impõem” limites à escolarização dos alunos com deficiência.