Objective: Spastic dystonia is one of the positive phenomena of the upper motor neuron syndrome (UMNS). It is characterised by the inability to relax a muscle leading to a spontaneous, although stretch-sensitive, tonic contraction. Although spastic dystonia is a recognized cause of muscle hypertonia, its prevalence among hypertonic muscles of stroke subjects has never been investigated.Differently from spasticity, which is an exaggerated stretch reflex, spastic dystonia is viewed as an efferent phenomenon, due to an abnormal central drive to motoneurons.Methods: In 23 hemiparetic stroke subjects showing increased muscle tone of wrist flexors, surface EMG was used to investigate the presence of spontaneous, stretch-sensitive EMG activity in flexor carpi radialis.Results: Spontaneous, stretch-sensitive EMG activity was found in 17 subjects. In the remaining 6 subjects, no spontaneous EMG activity was found. Conclusions:The majority of stroke subjects is affected by spastic dystonia in their hypertonic wrist flexor muscles. Only a minority of subjects is affected by spasticity.Significance: To stop spastic dystonia from being the neglected aspect of UMNS, it is essential to link its definition to increased muscle tone, as occurred for spasticity. Recognizing the real phenomena underling muscle hypertonia could improve its management. Highlights:· 74% of stroke subjects was affected by spastic dystonia in their hypertonic wrist flexor muscles · Only a minority of stroke subjects was affected by spasticity in their hypertonic wrist flexor muscles · Evaluation of EMG activity during static muscle stretch is pivotal to assess spastic dystonia

This study shows for the first time that velocity-dependent hypertonia can be caused by two distinct phenomena: spasticity and spastic dystonia. The habituation of the tonic stretch reflex, which is a typical feature of spasticity, is replaced by a reflex facilitation in the half of the subject with spastic dystonia. These preliminary findings suggest that differentiating the two types of velocity-dependent muscle hypertonia (spasticity and spastic dystonia) could be clinically relevant.

In this systematic review, we collected and analyzed literature works comparing self-reported fatigue and objectively-measured fatigue in individuals with cerebral palsy (CP) and in age-matched typically developing/typically developed (TD) controls (Healthy). The search was conducted on four electronic databases/platforms (PubMed, Web of Science, Cochrane Library, and Scopus) using the key words “cerebral palsy” combined with “fatig*,” where the asterisk was used as a wildcard. As a critical appraisal tool, the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies (2017) was used. A total of 22 studies passed the critical appraisal rating and were included in both narrative and quantitative analyses. The overall evidence quality of the findings was considered very good. Data of objectively-measured fatigue in performing maximal fatiguing tasks indicated lower fatigue levels in participants with CP, possibly due to their pathological inability to recruit highly fatigable muscle fibers. Highly trained individuals with CP and TD controls performing maximal fatiguing tasks seem to be an exception to this, as they exhibited similar levels of fatigue. In submaximal fatiguing tasks, including daily physical activities, either objectively-measured or self-reported fatigue was higher in participants with CP than in TD controls, indicating a lower ability for development of neurophysiological compensation for fatigue among participants with CP. Further studies on fatigue are needed to gain an insight into the multifold mechanisms of fatigue in individuals with CP. Understanding fatigue mechanisms could help in setting up strategies for effective intervention programs, with benefits in healthcare and improved quality of life of individuals with CP.Systematic Review Registration: [PROSPERO 2019], identifier [CRD42019143524].

Regular practice of sport activities yields psychophysical benefits for both the general population and persons affected by physical or intellectual impairments. Practicing competitive sport may add further value to these benefits. The objective of this observational cross-sectional study was to investigate the role of competitive sport practice in enhancing self-perceived psychophysical well-being of some select participants, using the Psychological General Well-Being Index and the Short Form-12 indices. We recruited at national events 100 young Italian competitive swimmers affected by physical or intellectual impairment. These respondents' results were compared with those of a control group of 100 Italian participants who did not practice competitive sport but who were also affected by physical or intellectual impairment, randomly selected from rehabilitation clinics and communities of young people with disabilities. Scores of psychological and emotional well-being were higher by 40% or more for the practitioners of competitive sport ( p < .0001; Cohen's effect size d ≥ 1.3). While our study's results suggest possible positive psychophysical benefits to competitive sport practice for young people affected by physical or intellectual impairment, longitudinal research is needed to be certain that our results are not due to self-selection into sports participation of those persons with disabilities who have a uniquely higher sense of well-being.

BackgroundGrit is a key concept in positive psychology and educational science. The construct measures two related constructs that are interest and effort. Several instruments have been developed to measure this construct in professional and educational contexts, but no tools have been developed considering specific contexts such as physical education and sport.ObjectivesThe objective of this study is to develop and test a measurement scale to assess Grit in the context of physical education and sport.MethodsTwo exploratory (Phase 1) and confirmatory (Phase 2) samples were administered the 16-item PE-Grit scale in Arabic. In addition, the confirmatory sample also was administered the R-SPQ-2F two-factor learning approaches scale. The factor structure was examined first by exploratory factor analysis on the first sample and then by confirmatory factor analysis on the second sample. Reliability testing was performed by checking internal consistency simultaneously by the three indices: McDonald's ω, Cronbach's α and Gutmann's λ6. Concurrent validity was checked by Pearson's correlation between the PE-Grit and the two dimensions of the SPQ-2F.ResultsAfter the exploratory factor analysis, which identified the factors and gave a preliminary validation of the designed instrument, confirmatory factor analysis was performed on three hierarchical models to be able to identify the best fitting model. A third-order hierarchical model with two physical and academic components each formed by interest and effort presented the best fit indices: chi X2 = 192.95 (p &lt; 0.01), and the X2/DF = 1.36; GFI = 0.99; AGFI = 0.99; CFI and TLI close to 1; RMSEA = 0.025. In addition, McDonald's ω, internal consistency, and Gutmann's λ6 ranged from 0.78 to 0.86 for all four scale dimensions.ConclusionThe PE-Grit scale displays adequate factor structure, good reliability, and acceptable concurrent validity and can be administered to assess Grit in physical education and sport students.

Training methods for Paralympic swimmers must take into account different pathologies, competitions classes, athlete’s individual circumstances and peculiar physical adaptation mechanisms, hence general guidelines cannot be found in literature. In this study we present a training program, implemented for the physical preparation of a top level Paralympic swimmer. The athlete under study, affected by infantile cerebral palsy within a clinical picture of a spastic tetraparesis, by the end of 2016 was holder of Italian, European, world and Paralympic titles in the 400-m freestyle competition, S6 class. The training macrocycle was structured in a 3-fold periodization (three mesocycles), in view of the preparation to three international competitions. The 4-month training mesocycles prior to each competition differed substantially in terms of mileage load, intensity and recovery times. The first mesocycle was characterized by a sizeable low-intensity mileage load, the second one was shifted to lower mileage load, carried out at middle-to-high intensity levels, the third one entailed increased effort intensity, counterbalanced by lower mileage load. In all cases, recovery times were balanced to obtain optimized performance through physical adaptation to training stimuli, keeping into account the physiopatological response. Tapering phases were adjusted to maximize performance at competition. As an assessment of the effectiveness of the training method, correspondence between chronometric and technical parameters in the three competitions and the respective mesocycle training programs was found. The results of the present study may support the development of training guidelines for athletes affected by upper motor neuron lesions.

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