OBJECTIVE:

The aim of this study was to observe the changes in endothelial and inflammatory markers in middle-aged male runners with exercise-induced hypertension (EIH) at baseline and at 100-km, 200-km, and 308-km checkpoints during a prolonged endurance ultramarathon.

DESIGN:

Among a total of 62 ultramarathon volunteers, 8 with systolic blood pressure higher than 210 mm Hg and 8 with normal systolic blood pressure were selected for this study. The subjects were designated to EIH and control (CON) groups. Blood was collected for the analysis of soluble vascular cell adhesion molecule-1, soluble E-selectin, leukocytes, creatine kinase, and high-sensitivity C-reactive protein.

RESULTS:

Soluble vascular cell adhesion molecule-1 showed a significantly greater increase in the EIH group than in the CON group at 100 km and 200 km. Soluble E-selectin also showed a significantly greater increase in the EIH group than in the CON group at 100 km. Leukocytes significantly increased in the EIH group than in the CON group at 308 km. Creatine kinase and high-sensitivity C-reactive protein showed no group differences.

CONCLUSIONS:

Leukocytes, creatine kinase, and high-sensitivity C-reactive protein showed delayed-onset increases in both groups. Increased exercise intensity may stimulate greater endothelial responses independent of the inflammatory markers in EIH. The loss of a protective effect may be greater in those with EIH than in CONs. Acknowledging and prescribing proper exercise intensity may be critical in preventing possible vascular-related complications in runners with EIH.

OBJECTIVE:

The objective of this study was to examine the accuracy of ultrasound-guided intra-articular (IA) injections on three different sites of the knee using midmedial, midlateral, and superolateral portals.

DESIGN:

Ultrasound-guided IA injection and a radiographic evaluation were performed on 120 knees with osteoarthritis. Five milliliters of a mixed material consisting of 1% lidocaine (1 ml), 20 mg of triamcinolone (1 ml), and nonionic contrast (3 ml) was injected into the IA space of the knee through three different portals. After each injection, a radiographic evaluation was performed to determine whether the injected material had reached the IA space or infiltrated into the soft tissue.

RESULTS:

Of 40 injections administered through the midmedial portal, 38 were confirmed as having been placed in the IA space on the first attempt (95% accuracy rate). Thirty-nine of 40 injections administered through the midlateral portal were IA on the first attempt (98.5% accuracy rate), as were 40 of 40 injections administered through a superolateral portal (100% accuracy rate). No significant differences (P > 0.05) were observed in the accuracy rate obtained with placement through the midmedial, midlateral, and superolateral portals.

CONCLUSIONS:

All three ultrasound-guided IA injections may be used to access the knee joint, with a high rate of accuracy.

OBJECTIVE:

The aim of this study was to compare the short-term effects and advantages of ultrasound-guided caudal epidural steroid injections with fluoroscopy-guided epidural steroid injections for unilateral radicular pain in the lower lumbar spine.

DESIGN:

A total of 120 patients with unilateral radicular pain were enrolled and randomly assigned to either the fluoroscopy or the ultrasound group. Complication frequencies during the procedures, treatment effects, functional improvement, and adverse events were compared after the procedures.

RESULTS:

The verbal numerical rating scale and the Oswestry Disability Index improved 2 and 12 wks after the injections in both groups. Statistical differences were not observed in the verbal numerical rating scale, the Oswestry Disability Index, or the effectiveness of the procedure between the groups. Two cases of intravascular injections were observed in the fluoroscopy group, without the prevalence of complication between the groups.

CONCLUSIONS:

The ultrasound approach with color Doppler mode may avoid intravascular injection-induced complications. The results showed similar improvements in short-term pain relief, function, and patient satisfaction with both ultrasound and fluoroscopic guidance.

OBJECTIVE:

The aim of this study was to determine the association of increased kyphosis with declines in mobility, balance, and disability among community-living older adults.

DESIGN:

The 18-mo follow-up visit data from 2006 to 2009 for 620 participants from the population-based Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study of older adults was used. Cross-sectional multivariable regression analyses were performed to assess the relationship between kyphosis (measured using the kyphosis index) and measures of mobility performance (Short Physical Performance Battery), balance (Berg Balance Scale score), and disability (self-reported difficulty walking a quarter of a mile or climbing a flight of stairs). The authors then evaluated the men and the women separately. Adjustment variables included demographic factors (age, sex, race, and education), body mass index, self-rated health, comorbidities (heart disease, diabetes, stroke, and depressive symptoms), back pain, knee pain, and falls self-efficacy.

RESULTS:

After full adjustment, greater kyphosis index was associated with lower Short Physical Performance Battery scores (adjusted β = -0.08, P = 0.01) but not with lower Berg Balance Scale (adjusted β = -0.09, P = 0.23) or self-reported disability (adjusted β = 1.00; 95% confidence interval, 0.93-1.06) scores. In sex-specific analyses, kyphosis index was associated with only the Short Physical Performance Battery in the women.

CONCLUSIONS:

Greater kyphosis is associated with poorer mobility performance but not with poorer balance or self-reported disability. This association with the Short Physical Performance Battery was observed only among the women. Mechanisms by which increased kyphosis influences physical performance should be explored prospectively.

OBJECTIVE:

The aim of the present study was to analyze the effects of whole-body vibration on lower limb muscle architecture, muscle strength, and balance in stroke patients during a period of 3 mos.

DESIGN:

The inclusion criteria were having had ischemic or hemorrhagic stroke at least 6 mos before the study and a National Institutes of Health Stroke Scale score of greater than 1 and less than 20. The patients were randomly divided into two groups: an experimental group (n = 11, six men and five women; age, 62.4 ± 10.7 yrs; height, 1.64 ± 0.07 m; mass, 69.4 ± 12.9 kg) and a sham group (n = 9, five men and four women; age, 64.4 ± 7.6 yrs; height, 1.62 ± 0.07 m; mass, 75.0 ± 15.8 kg). The experimental group received a whole-body vibration treatment, with an increase in frequency, sets, and time per set during 17 sessions. The sham group performed the same exercises as that of the experimental group but was not exposed to vibration. Outcome variables included the muscle architecture (the rectus femoris, the vastus lateralis, and the medial gastrocnemius), the maximal isometric voluntary contraction of the knee extensors, and the Berg Balance Scale.

RESULTS:

There were no significant differences between the groups on the primary outcomes of lower limb muscle architecture, muscle strength, and balance.

CONCLUSIONS:

It seems that whole-body vibration exercise does not augment the increase in neuromuscular performance and lower limb muscle architecture induced by isometric exercise alone in stroke patients.

OBJECTIVE:

The aim of this study was to review the effect of rimabotulinum toxin (BoNT-B) for focal hypertonicity management in children with cerebral palsy and secondary nonresponse to onabotulinum toxin treated at the authors' tertiary care academic medical center.

DESIGN:

A retrospective review of the medical treatment of children was conducted at the authors' institution (March 16, 2001, to August 2, 2002) using the key words botulinum toxin B and Myobloc (Solstice Neurosciences Inc, South San Francisco, CA). Demographic information was analyzed using descriptive statistics (number [percentage] and mean [range]). The Pearson χ test was used to evaluate differences in incidence of adverse events.

RESULTS:

Eighty-two children had BoNT-B injections (116 treatments). Overall, 26.8% (19/71) of the children or their parents/guardians reported no or minimal response to the injections, with 89.5% (17/19) of these children having secondary nonresponse to onabotulinum toxin. Adverse events were frequent but did not require hospitalization of any patient. No significant differences were found in incidence of adverse events related to BoNT-B dosing, medical fragility, or Gross Motor Function Classification System level.

CONCLUSIONS:

More than one-fourth of the children receiving BoNT-B injections had nonresponse, with most having previous nonresponse to onabotulinum toxin. Adverse events related to BoNT-B injections were frequent and unpredictable but not severe.

There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes.

OBJECTIVE:

This study aimed to characterize the effect of obesity on foot-ground contact in young individuals affected by Down syndrome (DS) during quiet upright stance.

DESIGN:

This is a cross-sectional study on 118 individuals with Down syndrome, 59 with obesity aged 3-18 yrs and 59 with normal weight, age- and sex-matched forming the control group. Both groups were evaluated while standing on a pressure-sensitive mat. Foot-ground contact was characterized using contact area and mean pressure calculated for the rearfoot, the midfoot, and the forefoot.

RESULTS:

The results show that obesity significantly influences the foot-ground interaction, with some differences related to sex. In particular, the females with obesity exhibited larger contact areas and higher plantar pressures (in the forefoot and the midfoot) with respect to the control group, whereas in the males with obesity, only the plantar pressures were found higher than those of the controls. Flatfoot is the prevalent arch type for both groups, but its incidence seems to be unrelated to obesity.

CONCLUSIONS:

The modifications introduced by obesity in foot-ground contact pressure and area may represent a factor capable of aggravating existing negative podiatric issues associated with Down syndrome. Thus, planning periodical monitoring of foot-ground contact during childhood and adolescence is recommended to avoid possible problems related to adverse effects of repeated excessive mechanical stresses on the plantar region.