RESUMO
Chronic pain affects mental and physical health and alters brain structure and function. Interventions that reduce chronic pain are also associated with changes in the brain. A number of non-invasive strategies can promote improved learning and memory and increase neuroplasticity in older adults. Intermittent fasting and glucose administration represent two such strategies with the potential to optimize the neurobiological environment to increase responsiveness to recognized pain treatments. The purpose of the pilot study was to test the feasibility and acceptability of intermittent fasting and glucose administration paired with a recognized pain treatment activity, relaxation and guided imagery. A total of 32 adults (44% W, 56% M), 50 to 85 years of age, with chronic knee pain for three months or greater participated in the study. Four sessions were completed over an approximate two-week period. Findings indicate the ability to recruit, randomize, and retain participants in the protocol. The procedures and measures were reasonable and completed without incident. Participant adherence was high and exit interview feedback positive. In summary, the pilot study was feasible and acceptable, providing the evidence necessary to move forward with a larger clinical trial.
Assuntos
Dor Crônica/terapia , Jejum , Glucose/administração & dosagem , Imagens, Psicoterapia/métodos , Plasticidade Neuronal/fisiologia , Terapia de Relaxamento/métodos , Idoso , Idoso de 80 Anos ou mais , Artralgia/fisiopatologia , Artralgia/terapia , Dor Crônica/fisiopatologia , Terapia Combinada , Ingestão de Alimentos/fisiologia , Ingestão de Alimentos/psicologia , Estudos de Viabilidade , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/métodos , Medição da Dor , Limiar da Dor/fisiologia , Limiar da Dor/psicologia , Projetos Piloto , Resultado do TratamentoRESUMO
OBJECTIVE: Restoring quadriceps muscle strength following anterior cruciate ligament reconstruction (ACLR) may prevent the posttraumatic osteoarthritis that affects over 50% of knees with ACLR. However, a fundamental gap exists in our understanding of how to maximize muscle strength through rehabilitation. Neurological deficits and muscle atrophy are 2 of the leading mechanisms of muscle weakness after ACLR. High-intensity neuromuscular electrical stimulation (NMES) and eccentric exercise (ECC) have been shown to independently target these mechanisms. If delivered in succession, NMES and then ECC may be able to significantly improve strength recovery. The objectives of this study were to evaluate the ability of NMES combined with ECC to restore quadriceps strength and biomechanical symmetry and maintain cartilage health at 9 and 18 months after ACLR. METHODS: This study is a randomized, double-blind, placebo-controlled, single-center clinical trial conducted at the University of Michigan. A total of 112 participants between the ages of 14 and 45 years and with an anterior cruciate ligament rupture will be included. Participants will be randomly assigned 1:1 to NMES combined with ECC or NMES placebo combined with ECC placebo. NMES or NMES placebo will be delivered 2 times per week for 8 weeks beginning 10 to 14 days postoperatively and will be directly followed by 8 weeks of ECC or ECC placebo delivered 2 times per week. The co-primary endpoints are change from baseline to 9 months and change from baseline to 18 months after ACLR in isokinetic quadriceps strength symmetry. Secondary outcome measures include isometric quadriceps strength, quadriceps activation, quadriceps muscle morphology (cross-sectional area), knee biomechanics (sagittal plane knee angles and moments), indexes of patient-reported function, and cartilage health (T1ρ and T2 relaxation time mapping on magnetic resonance imaging). IMPACT: The findings from this study might identify an intervention capable of targeting the lingering quadriceps weakness after ACLR and in turn prevent deterioration in cartilage health after ACLR, thereby potentially improving function in this patient population.
Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Músculo Quadríceps , Ensaios Clínicos Controlados Aleatórios como Assunto , Adolescente , Adulto , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Fenômenos Biomecânicos , Terapia Combinada/métodos , Método Duplo-Cego , Humanos , Michigan , Pessoa de Meia-Idade , Força Muscular , Debilidade Muscular/reabilitação , Modalidades de Fisioterapia , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: The relative contribution of muscle size and voluntary activation (VA) on quadriceps strength after anterior cruciate ligament (ACL) reconstruction remains inconclusive. Here, we aimed to determine the contributions of muscle size and VA on quadriceps strength in ACL-reconstructed patients and determine if contributions were similar if unilateral outcomes (i.e. ACL-reconstructed limb) or the LSI was used. DESIGN: A cross-sectional study. SETTING: A university research laboratory. PARTICIPANTS: Sixteen individuals 6-12 months after ACL reconstruction (Age: 22.3 ± 6.0yr, Height: 1.7 ± 0.1 m, Mass: 68.7 ± 11.5 kg) were recruited. MAIN OUTCOME MEASURES: Quadriceps isometric strength and VA, via the interpolated triplet technique, were assessed bilaterally. Ultrasound images were acquired of the vastus lateralis to calculate cross-sectional area (CSA) in both legs. LSI's were computed for all variables by expressing values of the reconstructed leg as a percent of the non-reconstructed leg. Separate stepwise linear regressions were performed to examine the contribution of VA and CSA on quadriceps strength. Model 1 used LSI for all outcomes and model 2 used outcomes from the reconstructed leg. RESULTS: We observed between limb deficits of 27.78% in quadriceps strength, 13.61% in vastus lateralis CSA, and 13.18% in VA (P < 0.05). Strength LSI was significantly predicted by VA LSI (R2 = 0.45, P < 0.01), but not by CSA LSI (R2 = 0.01, P =0.87). Reconstructed leg strength was significantly predicted by VL CSA (R2 = 0.50, P < 0.01) but not quadriceps VA (R2 = 0.08, P =0.11). CONCLUSIONS: The contributions of VA and CSA on quadriceps PT differed greatly if LSI or reconstructed leg outcomes were used. Evaluation of VA and CSA in unison may be provide a more holistic understanding of the sources of muscle weakness after ACL reconstruction.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Força Muscular , Músculo Quadríceps/fisiologia , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Debilidade Muscular/epidemiologia , Atrofia Muscular/epidemiologia , Músculo Quadríceps/diagnóstico por imagem , Ultrassonografia/métodos , Adulto JovemRESUMO
"Gaydar" is the ability to distinguish homosexual and heterosexual people using indirect cues. We investigated the accuracy of gaydar and the nature of "gaydar signals" conveying information about sexual orientation. Homosexual people tend to be more sex atypical than heterosexual people in some behaviors, feelings, and interests. We hypothesized that indicators of sex atypicality might function as gaydar signals. In Study 1, raters judged targets' sexual orientation from pictures, brief videos, and sound recordings. Sexual orientation was assessed with high, though imperfect, accuracy. In Study 2, different raters judged targets' sex atypicality from the same stimuli. Ratings of sexual orientation from Study 1 corresponded highly with targets' self-reports of sex atypicality and with observer ratings of sex atypicality from Study 2. Thus, brief samples of sex-atypical behavior may function as effective gaydar signals.