This study was designed to measure in vivo muscle architecture of the rectus femoris in adults with Down syndrome, testing possible relationships with functional parameters of the knee motion. Ten adults with Down syndrome and ten typically developed participated in the study. Pennation angle and thickness of the rectus femoris and subcutaneous layer of the thigh were measured via ultrasound imaging. Knee kinematics and electromyographic activity of the rectus femoris were recorded during free leg dropping. Muscle thickness was reduced and subcutaneous layer was thicker in persons with Down syndrome with respect to typically developed adults, but there were no differences in the pennation angle. The area of the rectus femoris EMG activity during the leg flexion was greater in Down syndrome with respect to typically developed adults. The leg movement velocity was lower in Down people than in controls, but the knee excursion was similar between the groups. Functional parameters correlated with pennation angle in the persons with Down syndrome and with muscle thickness in typically developed persons. The description of muscle architecture and the relationships between morphological and functional parameters may provide insights on the limits and the opportunities to overcome the inherent biomechanical instability in Down syndrome.
Abstract:It is well known that, in spite of its crucial role in the posture, locomotion and voluntary movements, trunk has received less consideration from researchers than upper and lower limbs. On the other hand, rehabilitative interventions of patients with upper motoneuron syndrome have always been focused firstly on treatment and recovery of trunk's posture during standing, sitting and walking.Trunk is a complex anatomical structure and it is composed by a large variety of bones, articulations, ligaments and muscles. From a functional point of view, trunk muscles have been subdivided into two systems: a local system which ensures stability and a global system which enables movements. Muscles of these two systems work by eccentric and concentric contractions, according to the functional needs.Surprisingly, in the literature are reported only a few studies regarding the trunk muscle activations during walking. These studies investigated the electromyographic activation patterns in different experimental conditions as walking on a walkway, over a treadmill at different velocities, in water or in deep-water. Furthermore, data analysis was differently performed by analyzing the qualitative and quantitative features of timing and amplitude of electromyographic recordings for each muscle or by other more sophisticated methods as cluster analysis or principal components analysis. Finally, some variability has been observed in the normal population also including sex differences. The aim of this review is to show the state of art of this topic, in normal subjects.
The Objectives were twofold, first to evaluate the efficacy of steroids in refractory epilepsy in children, and second, to assess the effectiveness of the steroid treatment protocols used. We included 30 patients with medically refractory epilepsy, according to the international definition for the disorder. The data analyzed included epilepsy type and etiology, seizure reduction, and type of the steroid treatment protocols associated with the best seizure outcome. Our data showed a statistically significant seizure reduction in children with structural etiology and immune-mediated/infectious etiologies at 15 days after the steroid treatment initiation which was still sustained after at 30 days after starting steroids. In comparison, refractory epilepsy secondary to genetic causes did not show similar response to steroid treatment. While there isn't significant steroid response on seizure control to follow-up at 6 months, regardless of the etiological cause. The second aim of this study was to evaluate the efficiency of the 4 steroid treatment protocols used for seizure control in children with medically refractory epilepsy. Out of the four therapeutic used in our study, the protocols with best efficacy were the IV methylprednisolone 30 mg/Kg/day for 3 days and IV methylprednisolone 15 mg/Kg/day for 5 days. In the DRE, inflammatory mediators are likely to significantly contribute to the onset and recurrence of seizures. What our study adds, is providing supportive evidence on efficacy of steroids in drug resistant epilepsy. Use of steroids for refractory seizures appears to be safe, and it is associated with clinical reduction of seizures as well as EEG improvement.
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