Dynamic analysis of muscles and the internal structure of the peripheral nerve as biomarkers of amyotrophic lateral sclerosis: A pilot study with ultrasound imaging.

INTRODUCTION: The aim of this study was to determine the behaviour of ultrasound biomarkers of fascicle density and muscle strength in patients with amyotrophic lateral sclerosis (ALS). METHODS: We conducted an observational, cross-sectional pilot study of 14 patients with ALS (28.6% women) and 14 controls. Bilateral cross-sectional ultrasound scans were performed in the abductor pollicis brevis (APB) and tibialis anterior (TA) muscles, with recording of muscle thickness (MT) at rest and in contraction, and the difference in thickness. In the median, sciatic, and common peroneal nerves, we analysed the cross-sectional area (CSA), number of fascicles (NF) and fascicle density (FD). Analyses were nested by laterality. RESULTS: Intra- and interrater agreement regarding NF was very good, with a minimum detectable error of < 0.7%. In patients with ALS, MT was lower in the APB both at rest (P = .003; g-Hedges = 1.03) and in contraction (P = .017; g-Hedges = 0.78) and in TA at rest (P = .002; g-Hedges = 0.15) and in contraction (P = .001; g-Hedges = 0.46), with lower thickening capacity. In the nerves, patients displayed lower CSA, with lower NF and higher FD. Significant correlations were found between MT of the ABP and Medical Research Council (MRC) scores for muscle strength (r = 0.34; r2 = 12%; P = .011) and with revised ALS Functional Rating Scale scores (r = 0.44; r2 = 19%; P < .001). The difference in TA thickening correlated with MRC scores (r = 0.30; r2 = 15%; P = .003) and with revised ALS Functional Rating Scale scores (r = 0.26; r2 = 7%; P = .049). NF in the sciatic nerve showed a significant correlation with MRC scores (r = 0.35; r2 = 12%; P = .008). CONCLUSION: MT measurements derived from dynamic testing together with NF and FD may be useful biomarkers for monitoring patients with ALS and establishing a prognosis.

Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial.

INTRODUCTION: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.

[Translation and cross-cultural adaptation of the Gross Motor Function Measure to the Spanish population of children with cerebral palsy]. / Traducción y adaptación transcultural del Gross Motor Function Measure a la población española de niños con parálisis cerebral.

INTRODUCTION: The Gross Motor Function Measure (GMFM) is a measure designed to assess changes in gross motor function over time in children with cerebral palsy. It is an observation instrument, valid, reliable and responsive, widely used both in research and in clinical practice. AIM: To perform the translation and cross-cultural adaptation to the Spanish population of the GMFM. SUBJECTS AND METHODS: The forward-backward translation methodology was used, subjecting the resulting versions to a qualitative analysis of equivalence. Both the score sheet and the instructions were translated through strategies of omission, incorporation, substitution of words or contribution of examples. In addition, understandability, applicability and feasibility were assessed through a pilot study in which assessors and subjects with a heterogeneous profile participated. RESULTS: The items that generated the most difficulty were those that included clinical terms or expressions whose use is not considered natural or equivalent in the Spanish language. Although 57% and 58% of the items of forward and backward translation, respectively, were classified as «partially equivalent¼, no correction was necessary since the modifications made came from the cultural and linguistic adaptation of the items to the Spanish population. CONCLUSIONS: The Spanish version maintains the highest degree of equivalence concerning the original English version and is understandable by all professionals regardless of their professional experience or geographic origin.

TITLE: Traducción y adaptación transcultural del Gross Motor Function Measure a la población española de niños con parálisis cerebral.Introducción. El Gross Motor Function Measure (GMFM) es un instrumento diseñado para evaluar los cambios en la función motora gruesa producidos a lo largo del tiempo en niños con parálisis cerebral. Se trata de un instrumento de observación válido, fiable y sensible, ampliamente utilizado tanto en investigación como en la práctica clínica. Objetivo. Realizar la traducción y adaptación transcultural a la población española de la herramienta de evaluación GMFM. Sujetos y métodos. Se utilizó la metodología de traducción directa e inversa, sometiendo las versiones resultantes a un análisis cualitativo de la equivalencia. Se tradujeron tanto la hoja de puntuación como las instrucciones mediante estrategias de omisión, incorporación, sustitución de palabras o aportación de ejemplos. Además, se valoraron la comprensibilidad, la aplicabilidad y la viabilidad mediante un estudio piloto en el que participaron evaluadores y sujetos con un perfil heterogéneo. Resultados. Los ítems que generaron más dificultad fueron los que incluían términos clínicos o expresiones cuyo uso no se considera natural o equivalente en la lengua española. Aunque el 57% y 58% de los ítems de la traducción directa e inversa, respectivamente, fueron calificados como «parcialmente equivalentes¼, no fue necesaria ninguna corrección porque las modificaciones realizadas provenían de la adaptación cultural y lingüística de los ítems a la población española. Conclusiones. La versión española mantiene el máximo grado de equivalencia con respecto a la versión original en inglés y se garantiza la comprensibilidad por parte de todos los profesionales independientemente de su experiencia profesional o procedencia geográfica.

Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial. / Efectividad de la inhibición suboccipital combinada con corriente interferencial en pacientes con cefalea tensional crónica: un ensayo clínico controlado aleatorizado.

INTRODUCTION: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.

New insights into the pathophysiology of fasciculations in amyotrophic lateral sclerosis: An ultrasound study.

OBJECTIVE: To describe the fasciculation pattern in ALS and to analyse its clinical and pathophysiological significance. METHODS: Ultrasound of 19 muscles was performed in 44 patients with a recent diagnosis (<90 days) of ALS. The number of fasciculations was recorded in each muscle and the muscle thickness and strength were additionally measured in limb muscles. A subgroup of patients were electromyographically assessed. RESULTS: US was performed in 835 muscles and EMG was available in 263 muscles. US detected fasciculations more frequently than EMG. Fasciculations were widespread, especially in upper limbs onset patients and in the cervical region. Fasciculations' number inversely associated with ALSFR-R and body mass index (BMI) and directly with BMI loss and upper motor neuron (UMN) impairment. Our statistical model suggest that fasciculations increase with the initial lower motor neuron (LMN) degeneration, reach their peak when the muscle became mildly to moderately weak, decreasing afterwards with increasing muscle weakness and atrophy. CONCLUSIONS: Our study suggests that both UMN and LMN degeneration trigger fasciculations causing BMI loss. The degree of LMN impairment could account for differences in fasciculations' rates within and between muscles. SIGNIFICANCE: In ALS, fasciculations could explain the link between hyperexcitability and BMI loss.

Relationship between jumping abilities and skeletal muscle architecture of lower limbs in humans: Systematic review and meta-analysis.

The aim of this study was to examine the influence of skeletal muscle architecture (SMA) features measured by 2-D ultrasonography on jumping performance in humans. A systematic review and meta-analysis was conducted, registry number: CRD42016043602. The scientific literature was systematically searched in eight databases, last run on March 14th, 2017. Cross-sectional studies focused on the association between SMA features and vertical jumping performance were selected. A random-effects model was used to analyze the influence of lower-limb SMA and maximal jump height. A total of 11 studies were included in the qualitative synthesis and 6 studies were selected for meta-analysis. 250 correlations were reviewed across studies. The vast majority were either not statistically significant (185; 74%), weak or very weak (169; 68%) for different jump modalities; counter-movement jump (CMJ), squat jump (SJ), and drop jump. There was insufficient data to perform meta-analysis on muscles other than vastus lateralis for CMJ and SJ. The meta-analyses did not yield any significant association between vastus lateralis SMA and SJ height. Only a significant overall association was shown between vastus lateralis thickness and CMJ height (summary-r = 0.28; 95% confidence interval (CI) = -0.05 to 0.48; p = .059) for a 90% CI level. No differences were found between summary-r coefficients for SMA parameters and jump height during both jumps (CMJ: χ2 = 2.43; df   = 2; p = .30; SJ: χ2 = 0.45; df = 2; p = .80) with a low heterogeneity ratio. Current evidence does not suggest a great influence of lower-limb SMA on vertical jumping performance in humans.

Bilateral deficit in explosive force related to sit-to-stand performance in older postmenopausal women.

The purpose of this study was to determine whether the bilateral deficit (BLD) for maximal voluntary force (MVF) and rate of force development (RFD) influences sit-to-stand in older postmenopausal women. Fourteen women performed unilateral and bilateral maximal voluntary contractions during isometric leg-extension. The MVF and RFD over consecutive 50ms periods (0-50, 50-100 and 100-150ms) after force onset and the time to sit-to-stand test were calculated. There was only a BLD for RFD 0-50ms and 50-100ms. The time of sit-to-stand was moderately correlated to BLD for RFD 0-50ms (r=0.505; 95% CI: -0.035 to 0.817; P=0.06), but after controlling for physical activity level the relationship was stronger and statistically significant (r=0.605; 95% CI: 0.109 to 0.859; P=0.029). These results suggest that the BLD for explosive force (0-50ms) might represent a performance-limiting factor for sit-to-stand transfer in postmenopausal women and could be dependent of the physical activity level. Trial registered at Clinical Trials Gov.: NCT02434185.