Deep Reinforcement Learning for Control of Time-Varying Musculoskeletal Systems With High Fatigability: A Feasibility Study.

Functional electrical stimulation (FES) can be used to restore motor function to people with paralysis caused by spinal cord injuries (SCIs). However, chronically-paralyzed FES-stimulated muscles can fatigue quickly, which may decrease FES controller performance. In this work, we explored the feasibility of using deep neural network (DNN) controllers trained with reinforcement learning (RL) to control FES of upper-limb muscles after SCI. We developed upper-limb biomechanical models that exhibited increased muscle fatigability, decreased muscle recovery, and decreased muscle strength, as observed in people with chronic SCIs. Simulations confirmed that controller training time and controller performance are impaired to varying degrees by muscle fatigability. Also, the simulations showed that large muscle strength asymmetries between opposing muscles can substantially impair controller performance. However, the results of this study suggest that controller performance for highly-fatigable musculoskeletal systems can be preserved by allowing for rest between movements. Overall, the results suggest that RL can be used to successfully train FES controllers, even for highly-fatigable musculoskeletal systems.

Ain't Just Imagination! Effects of Motor Imagery Training on Strength and Power Performance of Athletes during Detraining.

PURPOSE: This study aimed to investigate the effects of motor imagery (MI) training on strength and power performances of professional athletes during a period of detraining caused by the COVID-19 outbreak. METHODS: Thirty male professional basketball players (age, 26.1 ± 6.2 yr) were randomly assigned to three counterbalanced groups: two MI training groups, who completed imagery training by mentally rehearsing upper and lower limb resistance training exercises loaded with either 85% of one repetition maximum (85%1RM) or optimum power loads (OPL), or a control group. For six consecutive weeks, although all groups completed two weekly sessions of high-intensity running, only the MI groups performed three additional MI sessions a week. Maximal strength and power output were measured through 1RM and OPL assessments in the back squat and bench press exercises with a linear positioning transducer. Vertical jump and throwing capabilities were assessed with the countermovement jump and the seated medicine ball throw tests, respectively. Kinesthetic and visual imagery questionnaires, and chronometry and rating of perceived effort scores were collected to evaluate MI vividness, MI ability, and perceived effort. RESULTS: Physical performances improved significantly following both MI protocols (range, ~2% to ~9%), but were reduced in the control group, compared with preintervention (P ≤ 0.016). Moreover, interactions (time-protocol) were identified between the two MI groups (P ≤ 0.001). Whereas the 85%1RM led to greater effects on maximal strength measures than the OPL, the latter induced superior responses on measures of lower limb power. These findings were mirrored by corresponding cognitive and psychophysiological responses. CONCLUSIONS: During periods of forced detraining, MI practice seems to be a viable tool to maintain and increase physical performance capacity among professional athletes.

Effects of wheelchair Tai Chi ball exercise on physical and mental health and functional abilities among elderly with physical disability.

The purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability. Twenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores. The results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.

Validity of judo-specific tests to assess neuromuscular performance of judo athletes.

Uchi-komi Fitness Test (UFT) is a specific judo test that evaluates physiological fitness of judo athletes in similar conditions to judo matches. Neuromuscular parameters obtained by generic and judo-specific tests would aid to get more information about its criterion validity. This study aimed to analyse the relationship between UFT and shoulder external (PTEX) and internal (PTINT) rotation torque, handgrip strength (HGS) and vertical jumps (VJs) performance. The relationship between UFT and Judogi grip strength test (JGST) was also investigated. Eighteen male judo athletes participated in this study. Athletes performed neuromuscular tests (VJ, PTEX, PTINT and HGS) and judo-specific tests (JGST and UFT). Pearson's correlation was used with the level set at p < 0.05. Significant correlation was found between UFT and all VJ variables (r = 0.50-0.72, p < 0.004), UFT a + b (two first series of UFT) and PTEX (r = 0.49, p = 0.033), UFT and PTINT (r = 0.47, p = 0.044). Also, UFT was correlated to JGST (r = 0.50-0.72, p < 0.044, respectively). We conclude that muscle power of lower limbs, PTEX and PTINT was related to UFT. Strength-endurance in the upper limbs (JGST) was also related to the UFT performance.

Effects of rhythmic auditory stimulation on upper-limb movement speed in patients with schizophrenia spectrum disorders.

Movement slowness, linked to dysfunctional basal ganglia and cerebellum, is prevalent but lacks effective therapy in patients with schizophrenia spectrum disorders. This study was to examine immediate effects of rhythmic auditory stimulation (RAS) on upper-limb movement speed in patients. Thirty patients and 30 psychiatrically healthy people executed the right-hand task and the both-hand task of the Purdue Pegboard Test when listening to RAS with two tempi: normal (equal to the fastest movement tempo for each participant without RAS) and fast (120% of the normal tempo). The testing order of the RAS tempi for each participant was randomized. Patients had lower scores of right-hand and both-hand tasks than did psychiatrically healthy people. Scores of right-hand and both-hand tasks were higher in the fast-RAS condition than the normal-RAS condition in participants. This is the first study to explore the possibility of applying RAS to movement therapy for patients with schizophrenia spectrum disorders. The results demonstrated that faster RAS was effective in inducing faster upper-limb movements in patients and psychiatrically healthy people, suggesting that manipulating RAS may be a feasible therapeutic strategy utilized to regulate movement speed. The RAS may involve alternative neural pathways to modulate movement speed and thus to compensate for impaired function of basal ganglia and cerebellum in patients.

Normative reference values for handgrip strength, shoulder and ankle range of motion and upper-limb and lower limb stability for 137 youth judokas of both sexes.

OBJECTIVES: To provide reference values for handgrip strength, shoulder and ankle range of motion (ROM) and upper-limb and lower limb stability for youth judokas of both sexes and investigate the effects of sex and side dominance. DESIGN: Cross-sectional. METHODS: A total of 137 youth judokas from under-18 (n=60) and under-21 (n=77) categories of both sexes were assessed. Handgrip strength was assessed using a Jamar dynamometer, ankle ROM was measured by lunge test, shoulder ROM was assessed by an inclinometer and upper-limb and lower limb stability were assessed by the Closed Kinetic Chain Upper Extremity Stability Test and by the Modified Star Excursion Balance Test (mSEBT). RESULTS: In both categories, males had greater handgrip strength. In the under-18 category, the dominant side had greater handgrip strength, the non-dominant side of females had smaller shoulder external rotation ROM than the dominant side and also than both sides of males, and females had greater shoulder IR ROM. In the under-21 category, the dominant side of females had greater ankle dorsiflexion ROM than the dominant side of males, the dominant sides and females had greater shoulder ER ROM, and males had better performance in the mSEBT. CONCLUSIONS: This study provided reference values for handgrip strength, shoulder and ankle ROM, upper and lower limb stability for youth judokas, which can be used to guide assessment during preseason. Sex influenced on shoulder ER and IR ROM, handgrip strength and lower limb stability. In addition, side dominance influenced on shoulder ER ROM and on handgrip strength.

The impact of beetroot juice supplementation on muscular endurance, maximal strength and countermovement jump performance.

Purpose: Dietary nitrate has been shown to enhance muscle contractile function and has, therefore, been linked to increased muscle power and sprint exercise performance. However, the impact of dietary nitrate supplementation on maximal strength, performance and muscular endurance remains to be established. Methods: Fifteen recreationally active males (25 ± 4 y, BMI 24 ± 3 kg/m2) participated in a randomized double-blinded cross-over study comprising two 6-d supplementation periods; 140 mL/d nitrate-rich (BR; 985 mg/d) and nitrate-depleted (PLA; 0.37 mg/d) beetroot juice. Three hours following the last supplement, we assessed countermovement jump (CMJ) performance, maximal strength and power of the upper leg by voluntary isometric (30° and 60° angle) and isokinetic contractions (60, 120, 180 and 300°·s-1), and muscular endurance (total workload) by 30 reciprocal isokinetic voluntary contractions at 180°·s-1. Results: Despite differences in plasma nitrate (BR: 879 ± 239 vs. PLA: 33 ± 13 µmol/L, P < 0.001) and nitrite (BR: 463 ± 217 vs. PLA: 176 ± 50 nmol/L, P < 0.001) concentrations prior to exercise testing, CMJ height (BR: 39.3 ± 6.3 vs. PLA: 39.6 ± 6.3 cm; P = 0.39) and muscular endurance (BR: 3.93 ± 0.69 vs. PLA: 3.90 ± 0.66 kJ; P = 0.74) were not different between treatments. In line, isometric strength (P > 0.50 for both angles) and isokinetic knee extension power (P > 0.33 for all velocities) did not differ between treatments. Isokinetic knee flexion power was significantly higher following BR compared with PLA ingestion at 60°·s-1 (P = 0.001), but not at 120°·s-1 (P = 0.24), 180°·s-1 (P = 0.066), and 300°·s-1 (P = 0.36). Conclusion: Nitrate supplementation does not improve maximal strength, countermovement jump performance and muscular endurance in healthy, active males.

Upper Limb Strikes Reactive Forces in Mix Martial Art Athletes during Ground and Pound Tactics.

Athletes of mixed martial arts use a ground and pound strategy with the strikes in the dominant ground position. The aim of this study was to compare the average peak force (Fpeak) among three punches and to estimate the probability of achieving a skull bone fracture force of 5.1 kN for each type of strike in male and female athletes. A total of 60 males and 31 females (26 ± 8 years, 75 ± 20 kg, 177 ± 11 cm) practicing professional self-defense at the advanced and professional levels performed 15 strikes on a force plate. The analyses of 1360 trials showed significant differences among the strikes Fpeak in females (p < 0.01) and males (p < 0.01). Straight punches had lower Fpeak than palm strikes and elbow strikes in both genders, and palm strikes had higher Fpeak than elbow strikes in females. No difference was observed between palm strikes and elbow strikes in males (p = 0.09). The ground and pound strikes resulted in higher impacts than previously reported strikes in the standing position. Male athletes can deliver a Fpeak above 5.1 kN with a probability of 36% with elbow and palm strikes. Such forces can cause head injury; therefore, the use of these strikes in competition should be carefully considered.

Hyperbaric oxygen and focused rehabilitation program: a feasibility study in improving upper limb motor function after stroke.

Neuroplasticity and recovery after stroke can be enhanced by a rehabilitation program pertinent to upper limb motor function exercise and mental imagery (EMI) as well as hyperbaric oxygen therapy (HBOT). We assessed feasibility and safety of the combined approach utilizing both HBOT and EMI, and to derive preliminary estimates of its efficacy. In this randomized controlled trial, 27 patients with upper extremity hemiparesis at 3-48 months after stroke were randomized to receive either a complementary rehabilitation program of HBOT-EMI (intervention group), or EMI alone (control group). Feasibility and safety were assessed as total session attendance, duration of sessions, attrition rates, missing data, and intervention-related adverse events. Secondary clinical outcomes were assessed with both objective tools and self-reported measures at baseline, 8 weeks (end of treatment), and 12-weeks follow-up. Session attendance, duration, and attrition rate did not differ between the groups; there were no serious adverse events. Compared with baseline, there were significant sustained improvements of objective and subjective outcomes' measures in the intervention group, and a single improvement in an objective measure in the control group. Between-group outcome comparisons were not statistically significant. This study demonstrated that the combination HBOT-EMI was a safe and feasible approach in patients recovering from chronic stroke. There were also trends for improved motor function of the affected upper limb after the treatments. ClinicalTrials.gov registration no.: NCT02666469. Novelty HBOT combined with an upper limb exercise and mental imagery rehabilitation program is feasible and safe in chronic stroke patients. This combined approach showed trends for improved functional recovery.

Whey protein isolate or concentrate combined with concurrent training does not augment performance, cardiorespiratory fitness, or strength adaptations.

BACKGROUND: Protein supplementation alters both strength and endurance training adaptations individually; however less is known regarding protein supplementation during concurrent training. The primary purpose of this study was to investigate the effects of whey protein supplementation during six weeks of concurrent training on performance, cardiorespiratory fitness, and maximal strength adaptations, as well as acute hormonal and immune responses. A secondary purpose was to explore the effects of two types of whey protein powders on these latter variables. METHODS: Thirty-one participants were randomly assigned to supplement with a placebo (PLA; N.=10), whey protein isolate (WPI; N.=10), or whey protein concentrate (WPC; N.=11) in addition to their habitual diet. Total protein intake was 1.2, 3.5, and 3.5 g/kg/day for PLA, WPI, WPC groups, respectively. Exercise testing was performed before and after 6 weeks of concurrent training. Blood samples were obtained at rest, and 5 and 60 minutes after a simulated 2000 m rowing race prior to and after training. RESULTS: There were similar but significant improvements in cardiorespiratory fitness (PLA +7.5%; WPI +3.9%; WPC +6.9%), upper body strength (PLA +5.5%; WPI +5.1%; WPC +6.7%), lower body strength (PLA +13.6%; WPI +9.4%; WPC +14.1%) and 2000m rowing performance (PLA -2.5%; WPI -2.3%; WPC -2.3%) in all groups, P<0.05. As well, hormonal and immune responses to acute exercise were similar over time and between groups. CONCLUSIONS: Whey protein supplementation did not differentially influence performance, cardiorespiratory fitness, upper and lower body strength, immune or hormonal adaptations following 6 weeks of concurrent training.

Cortical Plasticity in Rehabilitation for Upper Extremity Peripheral Nerve Injury: A Scoping Review.

IMPORTANCE: Poor outcomes after upper extremity peripheral nerve injury (PNI) may arise, in part, from the challenges and complexities of cortical plasticity. Occupational therapy practitioners need to understand how the brain changes after peripheral injury and how principles of cortical plasticity can be applied to improve rehabilitation for clients with PNI. OBJECTIVE: To identify the mechanisms of cortical plasticity after PNI and describe how cortical plasticity can contribute to rehabilitation. DATA SOURCES: PubMed and Embase (1900-2017) were searched for articles that addressed either (1) the relationship between PNI and cortical plasticity or (2) rehabilitative interventions based on cortical plastic changes after PNI. STUDY SELECTION AND DATA COLLECTIO: : PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Articles were selected if they addressed all of the following concepts: human PNI, cortical plasticity, and rehabilitation. Phantom limb pain and sensation were excluded. FINDINGS: Sixty-three articles met the study criteria. The most common evidence level was Level V (46%). We identified four commonly studied mechanisms of cortical plasticity after PNI and the functional implications for each. We found seven rehabilitative interventions based on cortical plasticity: traditional sensory reeducation, activity-based sensory reeducation, selective deafferentation, cross-modal sensory substitution, mirror therapy, mental motor imagery, and action observation with simultaneous peripheral nerve stimulation. CONCLUSION AND RELEVANCE: The seven interventions ranged from theoretically well justified (traditional and activity-based sensory reeducation) to unjustified (selective deafferentation). Overall, articles were heterogeneous and of low quality, and future research should prioritize randomized controlled trials for specific neuropathies, interventions, or cortical plasticity mechanisms. WHAT THIS ARTICLE ADDS: This article reviews current knowledge about how the brain changes after PNI and how occupational therapy practitioners can take advantage of those changes for rehabilitation.

Assessment of the Efficacy of EEG-Based MI-BCI With Visual Feedback and EEG Correlates of Mental Fatigue for Upper-Limb Stroke Rehabilitation.

OBJECTIVE: This single-arm multisite trial investigates the efficacy of the neurostyle brain exercise therapy towards enhanced recovery (nBETTER) system, an electroencephalogram (EEG)-based motor imagery brain-computer interface (MI-BCI) employing visual feedback for upper-limb stroke rehabilitation, and the presence of EEG correlates of mental fatigue during BCI usage. METHODS: A total of 13 recruited stroke patients underwent thrice-weekly nBETTER therapy coupled with standard arm therapy over six weeks. Upper-extremity Fugl-Meyer motor assessment (FMA) scores were measured at baseline (week 0), post-intervention (week 6), and follow-ups (weeks 12 and 24). In total, 11/13 patients (mean age 55.2 years old, mean post-stroke duration 333.7 days, mean baseline FMA 35.5) completed the study. RESULTS: Significant FMA gains relative to baseline were observed at weeks 6 and 24. Retrospectively comparing to the standard arm therapy (SAT) control group and BCI with haptic knob (BCI-HK) intervention group from a previous similar study, the SAT group had no significant gains, whereas the BCI-HK group had significant gains at weeks 6, 12, and 24. EEG analysis revealed significant positive correlations between relative beta power and BCI performance in the frontal and central brain regions, suggesting that mental fatigue may contribute to poorer BCI performance. CONCLUSION: nBETTER, an EEG-based MI-BCI employing only visual feedback, helps stroke survivors sustain short-term FMA improvement. Analysis of EEG relative beta power indicates that mental fatigue may be present. SIGNIFICANCE: This study adds nBETTER to the growing literature of safe and effective stroke rehabilitation MI-BCI, and suggests an additional fatigue-monitoring role in future such BCI.

Combined upper limb and breathing exercise programme for pain management in ambulatory and non-ambulatory multiple sclerosis individuals: part II analyses from feasibility study.

PURPOSE: The present small semi-controlled feasibility study investigated a possible efficacy of a combined upper limb and breathing exercise programme in managing pain in ambulatory and non-ambulatory patients with EDSS from 0.0-8.0. METHOD: People with MS (N = 19) were enrolled in this single-blind randomized controlled study and divided into 2 groups: exercise group (5 ambulatory, 5 non-ambulatory; Expanded Disability Status Scale (EDSS), 1.0-8.0) and related control group that performed no exercise (4 ambulatory, 5 non-ambulatory; EDSS, 1.0-7.5). The exercise group performed combined upper limb and breathing exercises in a group led by a physiotherapist (2 days/week, 60 min/session) accompanied by independent home exercises (3 days/week, ≥ 20 min/session). Participants underwent measures of pain level (visual analogue scale) for physical pain, functional independence of daily activities (Barthel index) and handgrip strength (HGS) for dominant (D) and non-dominant (ND) hand evaluated by a dynamometer before and after the 4-week period by the blinded assessor. RESULTS: The VAS for pain showed statistically significant group-by-time interaction only in non-ambulatory (p = .049) individuals, but with large intervention effects on both subgroups (ambulatory, p = .159; non-ambulatory, d = 0.97). Functional independence in daily activities (Barthel index) showed statistically non-significant group-by-time interaction in ambulatory (p = .195, d = 0.89) and non-ambulatory (p = .102, d = 1.64) individuals, but despite the absence of statistical significance, there were large intervention effects. Handgrip strength was significantly improved for both hands in ambulatory (D, p = .012; d = 2.07; ND, p = .025, d = 1.77) and only non-dominant hand in non-ambulatory individuals (D, p = .288, d = 0.83; ND, p = .012, d = 2.21). CONCLUSION: This small pilot study provides preliminary proof-of-concept data supporting low-intensity upper limb and breathing exercise programme for potential reduction of pain and improvement of functional independence in both ambulatory and non-ambulatory individuals with MS in a larger sample and that strengthening the upper limbs might be an additional pain relief mechanism. TRIAL REGISTRATION: NTC03222596.

Design of Virtual Reality-Enabled Surface Electromyogram-Triggered Grip Exercise Platform.

Adequate grip ability is important for effective execution of daily living activities. Neurological disorders like stroke that result in muscle weakness, limited strength and poor control often lead to reduced grip ability in the affected limb. Conventional rehabilitation for grip training is often monotonous and subjective. Technology-assisted Virtual Reality (VR)-based rehabilitation offers a motivating environment to the participants for rehabilitation. However, the existing systems need specialized set-up architecture, thereby limiting their accessibility. Furthermore, these systems quantify the functional grip ability based on task performance, and do not explore physiological basis of grip ability. In this work, we develop a VR-based rehabilitation platform integrated with physiology-sensitive biofeedback. The developed platform, Gripx makes use of features extracted from sEMG data collected from upper limb muscles to adaptively provide audio-visual biofeedback through a VR environment. We compare task based performance, physiological indices and clinical measures to evaluate the potential of Gripx. The results of our study with 8 healthy and 12 post-stroke participants show the potential of Gripx to contribute to grip rehabilitation over multiple exposures. This approach of integrating VR-based task design with physiology-sensitive biofeedback helps patients to better assess their physiological responses and enhance the efficacy of rehabilitation.

Effects of neuromuscular electrical stimulation and voluntary commands on the spinal reflex excitability of remote limb muscles.

It is well known that contracting the upper limbs can affect spinal reflexes of the lower limb muscle, via intraneuronal networks within the central nervous system. However, it remains unknown whether neuromuscular electrical stimulation (NMES), which can generate muscle contractions without central commands from the cortex, can also play a role in such inter-limb facilitation. Therefore, the objective of this study was to compare the effects of unilateral upper limb contractions using NMES and voluntary unilateral upper limb contractions on the inter-limb spinal reflex facilitation in the lower limb muscles. Spinal reflex excitability was assessed using transcutaneous spinal cord stimulation (tSCS) to elicit responses bilaterally in multiple lower limb muscles, including ankle and thigh muscles. Five interventions were applied on the right wrist flexors for 70 s: (1) sensory-level NMES; (2) motor-level NMES; (3) voluntary contraction; (4) voluntary contraction and sensory-level NMES; (5) voluntary contraction and motor-level NMES. Results showed that spinal reflex excitability of ankle muscles was facilitated bilaterally during voluntary contraction of the upper limb unilaterally and that voluntary contraction with motor-level NMES had similar effects as just contracting voluntarily. Meanwhile, motor-level NMES facilitated contralateral thigh muscles, and sensory-level NMES had no effect. Overall, our results suggest that inter-limb facilitation effect of spinal reflex excitability in lower limb muscles depends, to a larger extent, on the presence of the central commands from the cortex during voluntary contractions. However, peripheral input generated by muscle contractions using NMES might have effects on the spinal reflex excitability of inter-limb muscles via spinal intraneuronal networks.

Effects of Two Modalities of Whole-body Electrostimulation Programs and Resistance Circuit Training on Strength and Power.

The main purpose of this study was to compare the effects on strength and muscle power of a training program based on two different modalities of whole-body electrostimulation (WB-EMS) with respect to a resistance-training program aimed at improving dynamic strength. Twenty-two subjects participated in this study: Thirteen male (age 25.2±2.8 years; height 1.78±0.1 m; body mass 72.8±6.4 kg; body fat 11.6±2.3%) and nine female (age 28.2±3.5 years; height 1.63±0.05 m; body mass 56.8±7.6 kg; body fat 19.1±4.7%). Participants were randomly assigned to three groups that underwent three different 6-week training programs: two modalities of WB-EMS, based on different electrical parameters (experimental), and circuit training with overloads (control). Force-velocity curves were calculated for each participant before and after treatment. All groups improved their level of strength and muscle power (paired sample t-Test, p<0.01; d>1) with a similar magnitude. No significant differences were observed between groups (two-way 2×3 Anova, p>0.05) at the end of the experimentation. This study suggests that WB-EMS might be considered as a valid and faster alternative - or an important complementary procedure - to a traditional overload-based resistance-training program for the development of the DS.

[Efficacy of Music Therapy in Functional Recovery of the Upper Limb After a Stroke: a Systematic Review and Meta-Analysis]. / Eficacia de la terapia musical en la recuperación funcional del miembro superior después de un ictus: una revisión sistemática y meta-análisis.

INTRODUCTION: Formal therapeutic interventions based on music have been used in rehabilitation to stimulate the brain functions involved in movement. OBJECTIVE: The objective of this study was to conduct a systematic review and meta-analysis following the PRISMA recommendations on the effectiveness of music therapy in improving the functionality of the upper limb in patients with hemiparesis secondary to stroke. METHODS: A search of the Pubmed, clinicaltrials.gov and Cochrane databases was performed in September 2018. The articles included in this review had to meet the following criteria: randomised controlled trials with therapeutic interventions that evaluated improvement in manual dexterity, measured with the box and block test in patients older than 18 years with a residual deficit secondary to an ischaemic or haemorrhagic stroke in the previous months. RESULTS: Of 371 studies analysed, six were included in the study and subsequent meta-analysis with a total of 149 patients. The musical interventions improved the functionality of the parietal limb in patients with stroke compared with that in controls who received conventional treatment. This effect was statistically significant in the meta-analysis, with a difference in the standardised mean in the box and block test of 0.40 (95% CI 0.09 - 0.72). CONCLUSIONS: Musical interventions could be beneficial for the functional recovery of the upper extremity. These results are encouraging but a greater number of clinical trials are required to confirm these findings before their subsequent implementation in clinical practice.

The application of "upper-body yoga" in elderly patients with acute hip fracture: a prospective, randomized, and single-blind study.

PURPOSES: Hip fracture leads to decreased activity and an increased risk of pulmonary complications. The main purpose of this study was to observe the lung capacity, cough capacity of the elderly patient with acute hip fracture, and assess the effects and the feasibility of using a special-designed "upper-body yoga" training to treat elderly patients with hip fracture. METHODS: This was a prospective, randomized, and single-blind study. Eighty-four subjects aged over 65 years were randomly divided into either a control group or a yoga group to undergo an abdominal breathing program or an "upper-body yoga" program until 4 weeks after surgery. The primary outcomes were forced vital capacity/predicted value (FVC%), peak cough flow (PCF), Barthel Index (BI), and the incidence of pneumonia. The secondary outcomes were the rates of right skills and inclination. RESULTS: Thirty-nine subjects in the yoga group and 40 subjects in the control group completed this study. At the end of the first training week, FVC% (74.14% ± 13.11% vs. 70.87% ± 10.46%, P = 0.231) showed no significant difference between the two groups, while the value of PCF (204.80 ± 33.45 L/min vs. 189.06 ± 34.80 L/min, P = 0.048) and BI (38.59 ± 8.66 vs. 33.00 ± 9.32, P = 0.009) in the yoga group was higher. After 4 weeks of treatment, FVC%, PCF, and BI were higher in the yoga group (78.83% ± 13.31 % vs. 72.20% ± 10.53%, P = 0.016; 216.16 ± 39.29 L/min vs. 194.95 ± 31.14 L/min, P = 0.008; 70.77 ± 10.23 vs. 65.75 ± 11.30, P = 0.019). One in the control group and nobody in the yoga group was diagnosed with pneumonia. There was no significant difference between the two groups in terms of the rates of right skills, whereas more elderly people preferred the training program of the "upper-body yoga." CONCLUSION: Elderly patients with acute hip fractures are at risk of impaired lung capacity and inadequate cough. "Upper-body yoga" training may improve the quality of daily life, vital capacity, and cough flow in elderly patients, making it a better choice for bedridden patients with hip fracture.

Effect of vitamin D supplementation on upper and lower limb muscle strength and muscle power in athletes: A meta-analysis.

BACKGROUND: Vitamin D may play a role in skeletal muscle because of the discovery of VDR in skeletal muscle. However, vitamin D deficiency is a global problem, including athletes. Studies examining the effect of vitamin D supplementation on muscle function in athletes have inconsistent results. Therefore, we aimed to quantitatively summarize the evidence for the effect of vitamin D supplementation on skeletal muscle strength and explosive power of athletes using a meta-analysis. METHODS: PubMed, EMBASE, Cochrane Library, and Web of Science were searched for studies to identify randomized controlled trials or controlled trials meeting the inclusion criteria. By a meta-analysis, effect sizes (standardized mean differences, SMD) with 95% confidence intervals (CI) was calculated to compare reported outcomes across studies, I2 index was used to assessing heterogeneity, and heterogeneity factors were identified by regression analysis. The potential publication and sensitivity analyses were also assessed. RESULTS: Eight RCTs involving 284 athletes were included. The protocols used to evaluate the muscle strength of athletes were inconsistent across the included studies, and muscle explosive power was assessed via vertical jump tests. The results indicated that vitamin D supplementation had no impact on overall muscle strength outcomes (SMD 0.05, 95% CI: -0.39 to 0.48, p = 0.84). In subgroup analysis, vitamin D supplementation had an effect on lower-limb muscle strength (SMD 0.55, 95% CI:0.12 to 0.98, p = 0.01) but not upper-limb muscle strength (SMD -0.19, 95% CI:-0.73 to 0.36, p = 0.50) or muscle explosive power (SMD 0.05, 95% CI:-0.24 to 0.34, p = 0.73). Vitamin D supplementation was more effective for athletes trained indoors (SMD 0.48, 95% CI:0.06 to 0.90, p = 0.02). CONCLUSIONS: Vitamin D supplementation positively affected lower limb muscle strength in athletes, but not upper limb muscle strength or muscle power. Different muscle groups and functions may respond differently to vitamin D supplementation. Additional studies should focus on determining the appropriate vitamin D supplementation methods and optimal serum 25(OH)D levels for athletes. REGISTRATION: The protocol for our study is registered in the international prospective register of systematic reviews (PROSPERO registration number CRD42016045872).

Upper and lower limb motor axons demonstrate differential excitability and accommodation to strong hyperpolarizing currents during induced hyperthermia.

Length-dependent peripheral neuropathy typically involves the insidious onset of sensory loss in the lower limbs before later progressing proximally. Recent evidence proposes hyperpolarization-activated cyclic nucleotide-gated (HCN) channels as dysfunctional in rodent models of peripheral neuropathy, and therefore differential expression of HCN channels in the lower limbs was hypothesized as a pathophysiological mechanism accounting for the pattern of symptomatology within this study. We studied six healthy participants, using motor axon excitability including strong and long [-70% and -100% hyperpolarizing threshold electrotonus (TEh)] hyperpolarizing currents to preferably study HCN channel function from the median and tibial nerves from high (40%) and low (20%) threshold. This was recorded at normothermia (~32°C) and then repeated during hyperthermia (~40°C) as an artificial hyperpolarizing axon stress. Significant differences between recovery cycle, superexcitability, accommodation to small depolarizing currents, and alterations in late stages of the inward-rectifying currents of strongest (-70% and -100% TEh) currents were observed in the lower limbs during hyperthermia. We demonstrate differences in late IH current flow, which implies higher expression of HCN channel isoforms. The findings also indicate their potential inference in the symptomatology of length-dependent peripheral neuropathies and may be a unique target for minimizing symptomatology and pathogenesis in acquired disease. NEW & NOTEWORTHY This study demonstrates nerve excitability differences between the upper and lower limbs during hyperthermia, an experimentally induced axonal stress. The findings indicate that there is differential expression of slow hyperpolarization-activated cyclic nucleotide-gated (HCN) channel isoforms between the upper and lower limbs, which was demonstrated through strong, long hyperpolarizing currents during hyperthermia. Such mechanisms may underlie postural control but render the lower limbs susceptible to dysfunction in disease states.