Background Prior promising results have been reported with deep brain stimulation (DBS) of the anterior limb of the internal capsule in cases with severe obsessive compulsive disorder (OCD) who had exhausted conventional therapies. Methods In this pilot study, six adult patients (2 male; 4 female) meeting stringent criteria for severe (minimum Yale-Brown Obsessive Compulsive Scale [Y-BOCS] of 28) and treatment-refractory OCD had DBS electrode arrays placed bilaterally in an area spanning the ventral anterior limb of the internal capsule and adjacent ventral striatum referred to as the ventral capsule/ventral striatum. Using a randomized, staggered-onset design, patients were stimulated at either 30 or 60 days following surgery under blinded conditions. Results After 12 months of stimulation, four (66.7%) of six patients met a stringent criterion as “responders” (≥35% improvement in the Y-BOCS and end point Y-BOCS severity ≤16). Patients did not improve during sham stimulation. Depressive symptoms improved significantly in the group as a whole; global functioning improved in the four responders. Adverse events associated with chronic DBS were generally mild and modifiable with setting changes. Stimulation interruption led to rapid but reversible induction of depressive symptoms in two cases. Conclusions This pilot study suggests that DBS of the ventral capsule/ventral striatum region is a promising therapy of last resort for carefully selected cases of severe and intractable OCD. Future research should attend to subject selection, lead location, DBS programming, and mechanisms underpinning therapeutic benefits.
Objective-To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis.Design-This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention.Results-Regardless of group assignment, participants demonstrated significant gains on the primary outcome measures: the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL)-Amount of Use, and on secondary outcome measures including the Box and Block Test (BBT) and the MAL-How Well. Participants receiving rTMS failed to show differential improvement on either primary outcome measure.Conclusions-Although this study provided further evidence that even relatively brief sessions of CIT can have a substantial effect, it provided no support for adjuvant use of rTMS. KeywordsStroke; Neuronal Plasticity; Transcranial Magnetic Stimulation; Rehabilitation; Hemiparesis Since its introduction as a noninvasive method to stimulate the human brain, 1 repetitive transcranial magnetic stimulation (rTMS) has provided a potential means to modulate cortical excitability and function. Depending on essential parameters of the stimulation frequency and number of trains of stimuli, rTMS can produce lasting up-or down-regulation of the corticospinal system. At higher frequencies (≥5 Hz) rTMS has been shown to increase excitability in the motor nervous system. 2-4 The extent to which these effects persist over time
Few studies exist in the literature investigating the impact of idiopathic Parkinson’s Disease (IPD) on swallow-related quality of life. We therefore aimed in this project to: (1) evaluate swallow-specific quality of life in IPD; (2) delineate potential relationships between IPD duration and severity with swallow-specific quality of life; (3) investigate relationships between swallow-specific quality of life and general health-related quality of life; and (4) investigate relationships between swallow-specific quality of life and depression. Thirty-six patients diagnosed with IPD with and without dysphagia filled out self-report assessments of the SWAL-QOL, Parkinson’s Disease Questionnaire-39 (PDQ-39), and Beck Depression Inventory (BDI). A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 10 SWAL-QOL domains. Spearman’s Rho correlation analyses were performed between the SWAL-QOL and (1) PDQ-39; (2) Hoehn and Yahr stage; (3) PD disease duration; (4) UPDRS “on” score; and (5) the BDI. The dysphagia swallowing group reported significant reductions compared to the nondysphagic group for the total SWAL-QOL score (P = 0.02), mental health domain score (P = 0.002) and social domain score (P = 0.002). No relationships existed between swallow-specific quality of life and disease duration or severity. Significant relationships existed between swallow-specific quality of life and general health-related quality of life (rs =−0.56, P = 0.000) and depression (rs = −0.48, P = 0.003). These exploratory data highlight the psychosocial sequelae that swallowing impairment can have in those with IPD and suggest a possible association between swallowing, social function, and depression.
Purpose: To compare the effects of velocity-based training (VBT) and 1-repetition-maximum (1RM) percentage-based training (PBT) on changes in strength, loaded countermovement jump (CMJ), and sprint performance. Methods: A total of 24 resistance-trained males performed 6 weeks of full-depth free-weight back squats 3 times per week in a daily undulating format, with groups matched for sets and repetitions. The PBT group lifted with fixed relative loads varying from 59% to 85% of preintervention 1RM. The VBT group aimed for a sessional target velocity that was prescribed from pretraining individualized load–velocity profiles. Thus, real-time velocity feedback dictated the VBT set-by-set training load adjustments. Pretraining and posttraining assessments included the 1RM, peak velocity for CMJ at 30%1RM (PV-CMJ), 20-m sprint (including 5 and 10 m), and 505 change-of-direction test (COD). Results: The VBT group maintained faster (effect size [ES] = 1.25) training repetitions with less perceived difficulty (ES = 0.72) compared with the PBT group. The VBT group had likely to very likely improvements in the COD (ES = −1.20 to −1.27), 5-m sprint (ES = −1.17), 10-m sprint (ES = −0.93), 1RM (ES = 0.89), and PV-CMJ (ES = 0.79). The PBT group had almost certain improvements in the 1RM (ES = 1.41) and possibly beneficial improvements in the COD (ES = −0.86). Very likely favorable between-groups effects were observed for VBT compared to PBT in the PV-CMJ (ES = 1.81), 5-m sprint (ES = 1.35), and 20-m sprint (ES = 1.27); likely favorable between-groups effects were observed in the 10-m sprint (ES = 1.24) and nondominant-leg COD (ES = 0.96), whereas the dominant-leg COD (ES = 0.67) was possibly favorable. PBT had small (ES = 0.57), but unclear differences for 1RM improvement compared to VBT. Conclusions: Both training methods improved 1RM and COD times, but PBT may be slightly favorable for stronger individuals focusing on maximal strength, whereas VBT was more beneficial for PV-CMJ, sprint, and COD improvements.
Dentists are a potentially valuable resource for initial patient screening for signs of osteoporosis, as individuals with osteoporosis have altered architecture of the inferior border of the mandible as seen on panoramic radiographs. Our aim was to evaluate the efficacy of combining clinical and dental panoramic radiographic risk factors for identifying individuals with low femoral bone mass. Bone mineral density was measured at the femoral neck and classified as normal, osteopenic or osteoporotic using WHO criteria in 227 Japanese postmenopausal women (33-84 years). Panoramic radiographs were made of all subjects. Mandibular cortical shape and width was determined and trabecular features were measured in each ramus. Mean subject age, height, and weight were significantly different in the three bone-density groups (P<0.0001). A classification and regression trees (CART) analysis using just clinical risk factors identified 136 (87%) of the 157 individuals with femoral osteopenia or osteoporosis. Mean mandible cortical width (P<0.0001), cortical index (P<0.0001) and trabecular features (P=0.02) were also significantly different in the three bone density groups. A CART analysis considering only radiographic features found 130 (83%) of the 157 individuals with femoral osteopenia or osteoporosis, although none of the subjects with osteoporosis was correctly identified. A CART analysis using both clinical and radiographic features found that the most useful risk factors were thickness of inferior border of the mandible and age. This algorithm identified 130 (83%) of the 157 individuals with femoral osteopenia or osteoporosis. The results of this study suggest that 1) clinical information is as useful as panoramic radiographic information for identifying subjects having low bone mass, and 2) dentists have sufficient clinical and radiographic information to play a useful role in screening for individuals with osteoporosis.
Triathlon is a multisport event consisting of sequential swim, cycle, and run disciplines performed over a variety of distances. This complex and unique sport requires athletes to appropriately distribute their speed or energy expenditure (ie, pacing) within each discipline as well as over the entire event. As with most physical activity, the regulation of pacing in triathlon may be influenced by a multitude of intrinsic and extrinsic factors. The majority of current research focuses mainly on the Olympic distance, whilst much less literature is available on other triathlon distances such as the sprint, half-Ironman, and Ironman distances. Furthermore, little is understood regarding the specific physiological, environmental, and interdisciplinary effects on pacing. Therefore, this article discusses the pacing strategies observed in triathlon across different distances, and elucidates the possible factors influencing pacing within the three specific disciplines of a triathlon.
This study investigated biceps brachii distal myotendinous junction (MTJ) displacement during maximal eccentric elbow flexor contractions to test the hypothesis that muscle length change would be smaller (less MTJ displacement) during the second than the first exercise bout. Ten untrained men performed two eccentric exercise bouts (ECC1 and ECC2) with the same arm consisting of 10 sets of six maximal isokinetic (60°/s) eccentric elbow flexor contractions separated by 4 wk. Biceps brachii distal MTJ displacement was assessed using B-mode ultrasonography, and changes in the displacement (muscle length change) from the start to the end of each contraction during each set and over 10 sets were compared between bouts by two-way repeated-measures ANOVA. Several indirect muscle damage markers were also measured and compared between bouts by two-way repeated-measures ANOVA. The magnitude of MTJ displacement (average of six contractions) increased from set 1 (8.2 ± 4.7 mm) to set 10 (16.4 ± 4.7 mm) during ECC1 (P < 0.05), but no significant changes over sets were evident during ECC2 (set 1: 8.5 ± 4.0 mm; set 10: 9.3 ± 3.1 mm). Changes in maximal voluntary isometric contraction strength, range of motion, muscle thickness, ultrasound echo intensity, serum creatine kinase activity, and muscle soreness (visual analog scale) were smaller (P < 0.05) following ECC2 than ECC1, showing less damage in the repeated bout. These results indicate that the magnitude of muscle lengthening was less during the second than the first eccentric exercise bout, which appears to be a mechanism underpinning the repeated-bout effect.
Context: Delayed-onset muscle soreness (DOMS) is a common muscle pain that many people experience and is often used as a model of acute muscle pain. Researchers have reported the effects of various interventions on DOMS, but different DOMS assessment protocols used in these studies make it difficult to compare the effects.Objective: To investigate DOMS characteristics after elbow-flexor eccentric exercise to establish a standardized DOMS assessment protocol.Design: Descriptive laboratory study. Setting: Research laboratory.Patients or Other Participants: Ten healthy, untrained men (21-39 years).Intervention(s): Participants performed 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors.Main Outcome Measure(s): Indirect muscle-damage markers were maximal voluntary isometric contraction torque, range of motion, and serum creatine kinase activity. Muscle pain was assessed before exercise, immediately postexercise, and 1 to 5 days postexercise using (1) a visual analog scale (VAS), (2) a category ratio-10 scale (CR-10) when applying static pressure and palpation at different sites (3, 9, and 15 cm above the elbow crease), and (3) pressure-pain thresholds (PPTs) at 50 sites (pain mapping).Results: Maximal voluntary isometric contraction and range of motion decreased and creatine kinase activity increased postexercise, indicating muscle damage. Palpation induced greater pain than static pressure, and longitudinal and transverse palpations induced greater pain than circular palpation (P , .05). The PPT was lower in the medial region before exercise, but the pain-sensitive regions shifted to the central and distal regions of the biceps brachii at 1 to 3 days postexercise (P , .05). The VAS was correlated with the CR-10 scale (r ¼ 0.91, P , .05) but not with the PPT (r ¼ À0.28, P ¼ .45).Conclusions: The way in which muscles are assessed affects the pain level score. This finding suggests that pain level and pain threshold cannot be used interchangeably and that the central and distal regions of the biceps brachii should be included in DOMS assessment using the VAS, CR-10 scale, and PPT after elbow-flexor eccentric exercise.Key Words: muscle damage, delayed-onset muscle soreness, pressure-pain threshold, palpation, visual analog scale Key PointsDelayed-onset muscle soreness (DOMS) is induced by exercise consisting of eccentric muscle contractions and is regarded as mechanical hyperalgesia. Because DOMS is often used as a model of acute pain to investigate the effects of interventions on muscle pain in clinical trial studies, it is important to standardize the assessment protocol. However, no standardized protocol for DOMS assessment has been proposed. We propose a standardized protocol to assess DOMS of the biceps brachii after elbow-flexor eccentric exercise, a frequently used model.
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