To evaluate reorganization in motor pathways following amputation, we studied motor evoked potentials (MEPs) to transcranial magnetic stimulation in 7 patients with unilateral upper limb amputations, a patient with congenital absence of a hand, and 10 normal subjects. Electromyographic recordings were made from biceps and deltoid muscles immediately proximal to the stump and the same contralateral muscles. Magnetic stimulation was delivered by a Cadwell MES-10 magnetic stimulator through a 'figure eight' magnetic coil over scalp positions separated by 1-2.5 cm. Maximal M responses were elicited by peripheral nerve stimulation at Erb's point. The amplitude of MEPs was expressed both as absolute values and as a percentage of maximal responses to peripheral nerve stimulation. Threshold for activation of muscles ipsilateral and contralateral to the stump and the region of excitable scalp positions were also determined in 7 patients. Magnetic scalp stimulation induced a sensation of movement in the missing hand or fingers in the patients with acquired amputation, but failed to do so in the patient with congenital absence of a limb. It evoked larger MEPs, recruited a larger percentage of the motoneuron pool, and elicited MEPs at lower intensities of stimulation in muscles ipsilateral to the stump than in contralateral muscles. Muscles ipsilateral to the stump could be activated from a larger area than those contralateral to the stump. These results are compatible with cortical or spinal reorganization in adult human motor pathways targeting muscles proximal to the stump after amputations.

No abstract

Thirty-eight spinal cord injured (SCI) males (median age = 26) completed an 80-item multiple choice questionnaire (median 37 months postinjury) which assessed sexual functioning pre- and post-spinal cord injury in four areas: (i) sexual activities and preferences, (ii) sexual abilities, (iii) sexual desire, arousal, and satisfaction, and, (iv) sexual adjustment. Frequency of sexual activity decreased following SCI with a reduction in intercourse and increased interest in alternative sexual activities. Of complete quadriplegic subjects 38% reported the ability to have an orgasm accompanied by ejaculation underscoring the need for physiological studies. Partner's desire for sex as perceived by the SCI individual was correlated with frequency of sex and numbers of sexual partners postinjury. Subject's perceptions of their own and partner's sexual desire decreased following SCI. Sexual satisfaction decreased postinjury and was positively correlated with both the patients' and their partners' interest in penile-vaginal intercourse. Of the subjects, 27% reported sexual adjustment difficulties and 74% relationship difficulties but only 22% received counseling. Results indicate the importance of the availability and desire of a sexual partner in the sexual activities and satisfaction of the SCI individual. SCI patient and staff sexual education and counseling continue to be strong needs.

The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.

No abstract

No abstract

Abstract-Dynamic posturography has become an important tool for understanding standing balance in clinical settings. A key test in the NeuroCom International (Clackamas, Oregon) dynamic posturography system, the Sensory Organization Test (SOT), provides information about the integration of multiple components of balance. The SOT test leads to an outcome measure called the "equilibrium score" (ES), which reflects the overall coordination of the visual, proprioceptive, and vestibular systems for maintaining standing posture. Researchers, therapists, and physicians often use the ES from the SOT as a clinically relevant measure of standing balance. We discuss here the formula used for evaluating the ES and propose an additional measure of postural stability, called the Postural Stability Index (PSI), that accounts for shear force and individual anthropomorphic measures. We propose that this new measure provides a clinically important adjunct to the current SOT and can be calculated from data already collected by the NeuroCom forceplate during the SOT.

The palpable sensations of tissue release that are often reported by osteopathic physicians and other manual therapists cannot be due to deformations produced in the firm tissues of plantar fascia and fascia lata. However, palpable tissue release could result from deformation in softer tissues, such as superficial nasal fascia.