A scoping review of the contralateral effects of unilateral peripheral stimulation on neuromuscular function.

It is known that resistance exercise using one limb can affect motor function of both the exercised limb and the unexercised contralateral limb, a phenomenon termed cross-education. It has been suggested that cross-education has clinical implications, e.g. in rehabilitation for orthopaedic conditions or post-stroke paresis. Much of the research on the contralateral effect of unilateral intervention on motor output is based on voluntary exercise. This scoping review aimed to map the characteristics of current literature on the cross-education caused by three most frequently utilised peripheral neuromuscular stimulation modalities in this context: electrical stimulation, mechanical vibration and percutaneous needling, that may direct future research and translate to clinical practice. A systematic search of relevant databases (Ebsco, ProQuest, PubMed, Scopus, Web of Science) through to the end of 2020 was conducted following the PRISMA Extension for Scoping Review. Empirical studies on human participants that applied a unilateral peripheral neuromuscular stimulation and assessed neuromuscular function of the stimulated and/or the unstimulated side were selected. By reading the full text, the demographic characteristics, context, design, methods and major findings of the studies were synthesised. The results found that 83 studies were eligible for the review, with the majority (53) utilised electrical stimulation whilst those applied vibration (18) or needling (12) were emerging. Although the contralateral effects appeared to be robust, only 31 studies claimed to be in the context of cross-education, and 25 investigated on clinical patients. The underlying mechanism for the contralateral effects induced by unilateral peripheral stimulation remains unclear. The findings suggest a need to enhance the awareness of cross-education caused by peripheral stimulation, to help improve the translation of theoretical concepts to clinical practice, and aid in developing well-designed clinical trials to determine the efficacy of cross-education therapies.

Potential therapeutic implications of ergogenic compounds on pathophysiology induced by traumatic brain injury: A narrative review.

Traumatic brain injury (TBI) is a devastating condition that often triggers a sequel of neurological disorders that can last throughout lifespan. From a metabolic viewpoint, the compromising of the energy metabolism of the brain has produced evidence linking the severity of brain injury to the extent of disturbances in the cerebral metabolism. The cerebral metabolic crisis, however, displays that regional heterogeneity varies temporally post-injury. It is important to note that energy generation and mitochondrial function are closely related and interconnected with delayed secondary manifestations of brain injury, including early neuromotor dysfunction, cognitive impairment, and post-traumatic epilepsy (PTE). Given the extent of post-traumatic changes in neuronal function and the possibility of amplifying secondary cascades, different therapies designed to minimize damage and retain/restore cellular function after TBI are currently being studied. One of the possible strategies may be the inclusion of ergogenic compounds, which is a class of supplements that typically includes ingredients used by athletes to enhance their performance. The combination of these compounds offers specific physiological advantages, which include enhanced energy availability/metabolism and improved buffering capacity. However, the literature on their effects in certain biological systems and neurological diseases, such as TBI, has yet to be determined. Thus, the present review aims to discuss the role of ergogenic compounds popularly used in secondary damage induced by this neurological injury. In this narrative review, we also discuss how the results from animal studies can be applied to TBI clinical settings.

Work-related acute physical injuries, chronic overuse complaints, and the psychosocial work environment in Danish primary care chiropractic practice - a cross-sectional study.

Background: Little is known about the physical and psychosocial work environment of chiropractors and their work-related health complaints, and this has never been described for Danish chiropractors. The aim of this study was, therefore, to describe work-related acute physical injuries, overuse complaints, and psychosocial stress in Danish chiropractic work settings. Methods: We developed a questionnaire specifically for this study and distributed it electronically in August 2016 using SurveyXact to all 575 members of the Danish Chiropractors' Association working in primary care clinics. Chiropractors were asked about their work-related acute physical injuries and overuse complaints as well as any psychosocial stress they experienced at work during the previous year. We described our sample and variables using means, medians, ranges, and confidence intervals where appropriate. Statistically significant differences between genders, types of complaints and injuries, and between clinic owners and associates were examined using Chi-square and Fischer's exact tests, where appropriate, or by examining confidence intervals for non-overlap. Results: 355 (65.2%) chiropractors answered the survey. Of these, 216 (61%, 95% CI 56-66) had experienced a work-related acute physical injury and/or overuse complaint during the previous year. Work-related overuse complaints were most commonly reported in the low back, wrist, thumb, and shoulder, and were more common among women (63%, 95% CI 56-70) than men (51%, 95% CI 43-59). Chiropractors with more than five years in practice (59%, 95% CI 52-64) reported significantly fewer work-related acute injuries and overuse complaints during the previous year compared with chiropractors with less than five years in practice (83%, 95% CI 73-91). In general, these practicing Danish chiropractors reported having a good psychosocial work environment, and 90% of chiropractors "always" or "often" felt that they were motivated and committed to their work. Conclusion: This sample of Danish practicing chiropractors commonly reported work-related acute physical injuries or overuse complaints. Overuse complaints were most commonly reported in the low back, wrist, thumb, and shoulder and were more common among women than men. Newly educated chiropractors reported more overuse complaints than experienced chiropractors. Collectively, this sample of Danish chiropractors reported that they had a good psychosocial work environment.

Neuromuscular degenerative effects of Ankaferd Blood Stopper® in mouse sciatic nerve model.

PURPOSE: Ankaferd Blood Stopper® (ABS), a licenced medicinal herbal extract, is commonly used as an effective topical haemostatic agent. This study is designed to investigate whether topical ABS application may cause peripheral nerve degeneration and neuromuscular dysfunction in a mouse sciatic nerve model. METHODS: Twenty mice were randomly divided into two groups; an ABS treated experimental group and a saline-treated control group. Left sciatic nerves were treated with 0.3 ml of ABS in the experimental group and 0.3 ml of sterile saline in the control group for 5 min. Peripheral nerve degeneration and neuromuscular dysfunction were evaluated by behavioural tests, electrophysiological analysis and weight ratio comparison of target muscles. RESULTS: The motor function, assessed by the sciatic function index, was significantly impaired in ABS-treated animals as compared to the animals treated with saline. Motor coordination, evaluated with the rotarod test, was significantly decreased (-42%) in ABS-treated animals compared to the saline-treated animals. The degree of pain, assessed by the reaction latency to thermal stimuli (hot-plate test), was significantly prolonged (313%) in ABS-treated mice when compared to the saline-treated mice. ABS-treated mice showed a significant reduction in motor nerve conduction velocity (MNCV) (-52%) and the compound muscle action potential (CMAP) (-47%); however, it significantly prolonged onset latency (23%). The gastrocnemius muscles weight ratio of the ABS group was considerably lower than that of the control group. CONCLUSIONS: These findings demonstrate that ABS triggers peripheral nerve degeneration and functional impairment and, thus promotes a deterioration of sciatic nerves.

[Magnesium: a supercation misunderstood? Overview and survey of GPs in "Ille-et-Vilaine"]. / Le magnésium: un super cation méconnu? Revue générale et enquête auprès des généralistes d'Ille-et-Vilaine.

Since the introduction of the first magnesium pharmaceutical specialty in 1928, multiple medical indications were attributed to magnesium supplementation, despite rigorous scientific researches, leading to a very confuse therapeutic chapter. Real hypomagnesemia, acute or chronic, is rare, however oral magnesium drugs are numerous and widely prescribed. Moreover, in France, only proven magnesium deficiency, isolated or combined, are accepted by the HAS for magnesium supplementation. The purpose of this article is to review current knowledges on magnesium and analyze the prescribing practices of GPs. After telephone agreement, 100 doctors of Ille-et-Vilaine received an e-questionnaire that included 27 questions (38 items). These questions concerned the prescribing practices of magnesium, magnesium knowledge, and demographic data: 70% of responders say that prescribing magnesium shows an interest in their daily practice and 96% of responders that they often prescribe magnesium leading to 26% who prescribe magnesium even if they do not see the point! In only 7% of cases, prescription is the renewal of a specialist, and in 7% of cases, the request comes from the patient. GPs report that their knowledge on magnesium and its treatment indications come from the pharmaceutical industry. There is also a significant number of requirements driven by the patient himself, probably under the influence of the media especially Internet forums.

Neuromuscular symptoms in a patient with familial pseudohypoparathyroidism type Ib diagnosed by methylation-specific multiplex ligation-dependent probe amplification.

Pseudohypoparathyroidism type Ib (PHP-Ib) is a rare genetic disorder characterized by hypocalcemia and hyperphosphatemia due to imprinting defects in the maternally derived GNAS allele. Patients with PHP-Ib are usually identified by tetany, convulsions, and/or muscle cramps, whereas a substantial fraction of patients remain asymptomatic and are identified by familial studies. Although previous studies on patients with primary hypoparathyroidism have indicated that hypocalcemia can be associated with various neuromuscular abnormalities, such clinical features have been rarely described in patients with PHP-Ib. Here, we report a 12-year-old male patient with familial PHP-Ib and unique neuromuscular symptoms. The patient presented with general fatigue, steppage gait, and myalgia. Physical examinations revealed muscular weakness and atrophies in the lower legs, a shortening of the bilateral Achilles' tendons and absence of deep tendon reflexes. Laboratory tests showed hypocalcemia, hyperphosphatemia, elevated serum intact PTH level, and impaired responses of urinary phosphate and cyclic AMP in an Ellsworth-Howard test, in addition to an elevated serum creatine kinase level. Clinical features of the patient were significantly improved after 1 month of treatment with alfacalcidol and calcium. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) and subsequent PCR analyses identified a methylation defect at exon A/B of GNAS and a microdeletion involving exons 4-6 of the GNAS neighboring gene STX16 in the patient and in his asymptomatic brother. The results suggest that various neuromuscular features probably associated with hypocalcemia can be the first symptoms of PHP-Ib, and that MS-MLPA serves as a powerful tool for screening of GNAS abnormalities in patients with atypical manifestations.

Neuromuscular disease in the dialysis patient: an update for the nephrologist.

Neuromuscular disease is an extremely common complication of end-stage kidney disease (ESKD), manifesting in almost all dialysis patients, and leading to weakness, reduced exercise capacity, and disability. Recent studies have suggested that hyperkalemia may underlie the development of neuropathy. As such, maintenance of serum K(+) within normal limits between periods of dialysis in ESKD patients manifesting early neuropathic symptoms may reduce neuropathy development and progression. For patients with more severe neuropathic syndromes, increased dialysis frequency or a switch to high-flux dialysis may prevent further deterioration, while ultimately, renal transplantation is required to improve and restore nerve function. Exercise training programs are beneficial for ESKD patients with muscle weakness due to neuropathy or myopathy, and are capable of improving exercise tolerance and quality of life. Specific treatments have recently been evaluated for symptoms of autonomic neuropathy, including sildenafil for impotence and midodrine for intra-dialytic hypotension, and have been shown to be effective and well tolerated. Other important management strategies for neuropathy include attention to foot care to prevent callus and ulceration, vitamin supplementation, and erythropoietin. Treatment with membrane-stabilizing agents, such as amitryptiline and gabapentin, are highly effective in patients with painful neuropathy.

High prevalence of vitamin D inadequacy and implications for health.

During the past decade, major advances have been made in vitamin D research that transcend the simple concept that vitamin D is Important for the prevention of rickets in children and has little physiologic relevance for adults. Inadequate vitamin D, in addition to causing rickets, prevents children from attaining their genetically programmed peak bone mass, contributes to and exacerbates osteoporosis in adults, and causes the often painful bone disease osteomalacia. Adequate vitamin D is also important for proper muscle functioning, and controversial evidence suggests it may help prevent type 1 diabetes mellitus, hypertension, and many common cancers. Vitamin D inadequacy has been reported in approximately 36% of otherwise healthy young adults and up to 57% of general medicine inpatients in the United States and in even higher percentages in Europe. Recent epidemiological data document the high prevalence of vitamin D inadequacy among elderly patients and especially among patients with osteoporosis. Factors such as low sunlight exposure, age-related decreases in cutaneous synthesis, and diets low in vitamin D contribute to the high prevalence of vitamin D inadequacy. Vitamin D production from cutaneous synthesis or intake from the few vitamin D-rich or enriched foods typically occurs only intermittently. Supplemental doses of vitamin D and sensible sun exposure could prevent deficiency in most of the general population. The purposes of this article are to examine the prevalence of vitamin D inadequacy and to review the potential implications for skeletal and extraskeletal health.

Exercise and cancer recovery.

Disease and cancer treatment-related side effects such as decreased energy level, muscle weakness, and declines in functional status and body mass have been well documented. There is evidence that exercise, such as low intensity aerobics walking, Tai Chi, or cycling, results in an overall decrease in fatigue levels over the course of cancer treatment. Additionally, there is evidence that regular physical activity or exercise can decrease emotional stress, blood pressure, the duration of neutropenia, thrombocytopenia, and pain. Exercise also has been shown to increase quality of life and improve the maximal oxygen uptake during exertion, sleep patterns, and cognition. However, the majority of studies of exercise and cancer have been conducted with women with early stage breast cancer, limiting the generalizability of these studies to other cancer populations. The purpose of this systematic review is to provide a synthesis of the extant research evidence about th e benefits of exercise related to cancer recovery.

Biobehavioral mechanisms of work-related upper extremity disorders: a new agenda for research and practice.

BACKGROUND: Epidemiological studies provide support for the role of organizational and individual psychosocial stressors in work-related upper extremity disorders (WRUEDs). Despite this evidence, the biological plausibility of a relationship between exposure to various psychosocial and work organizational stressors and WRUEDs remains unclear METHODS: The Georgetown Symposium on Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders was held in Washington D.C. on November 6-7, 2000 to improve the understanding of potential biobehavioral mechanisms, identify future areas for research and discuss the implications of this body of knowledge for intervention. This meeting involved presentations and discussions by researchers and clinicians from a number of disciplines (epidemiology, occupational medicine, rheumatology, orthopedics, surgery, internal medicine, psychoneuroimmunology, occupational health psychology, behavioral medicine, psychophysiology and experimental and organizational psychology). RESULTS: The symposium generated several papers addressing the following topics: definitions and job stress models; epidemiological foundations; musculoskeletal and biomechanical models; central nervous system models of recurrent and persistent clinical pain; psychophysiology of work; and implications for intervention. These papers comprise this special issue. DISCUSSION: The present paper summarizes the various contributions to this special issue and provides direction for future research on potential biobehavioral pathways.

[Polyneuropathy and neuromyopathy in intensive care. 4 new cases]. / Polyneuropathie et neuromyopathie de réanimation. Quatre nouveaux cas.

Neuromuscular complications acquired in the intensive care unit form a new clinical entity. Three neuromuscular deficits are described: so-called critical illness polyneuropathy where neuromyopathic changes are associated with corticosteroid and/or neuromuscular blocking agents, and catabolic myopathy. We report four new cases: three of them concerning polyneuropathy and one neuromyopathic change.

Compromiso del sistema nervioso periférico en la infección por el virus de la inmunodeficiencia humana / Peripheral nervous system involvement in human immunodeficiency virus infection

El compromiso del SNP en la infección por el VIH/SIDA es frecuente, apareciendo como vulnerables prácticamente todas sus estructuras conformantes. Existen entidades clínicas bien caracterizadas desde el punto de vista clínico, neurofisiológico y patológico. Las diferentes neuropatías asociadas a VIH/SIDA tienden a expresarse preferentemente en determinados períodos de la infección; la polineuropatía desmielinizante inflamatoria suele ser precoz, pudiendo ser la primera manifestación de infección. La expresión de la polineuropatía simétrica distal, la neuropatía más frecuente, aumenta en la medida que la infección progresa. La polirradiculoneuritis progresiva y la mononeuritis múltiple son más frecuentes en el período avanzado de la infección. En un mismo paciente pueden estar presente simultanéamente o en forma desfasada más de una entidad en particular, así como coexistir con compromisos primarios y secundarios del SNC. El objetivo de esta presentación es revisar el espectro de las alteraciones neuromusculares relacionadas a la infección por VIH incluyendo neuropatías y miopatías para facilitar y propiciar su inclusión en los algoritmos de diagnóstico diferencial clínico de los compromisos neuromusculares en general

[The use of electromyostimulation for preventing and treating hypodynamic disorders in gunshot injuries to the extremities]. / Primenenie élektromiostimuliatsii dlia profilaktiki i lecheniia gipodinamicheskikh rasstroistv pri ognestrel'nykh povrezhdeniiakh konechnostei.

It was found out during the study of multichannel electromyostimulation (EMS) influence upon human organism and the adequacy of its physical load to adoptive and compensative possibilities of cardiovascular system that that method was effective for prophylaxis of disorders and rehabilitation of nervous and muscular system, and locomotor apparatus after a short period of hypodynamia. The EMS increases the working capacity of nervous and muscular apparatus, mass of muscles and their contraction strength due to improvement of nervous and muscular conductivity and blood supply of the extremity. The efficiency of EMS decreases considerably when degenerative changes are taking place.

[Biochemical evaluation of metabolic disorders in the tissues of the locomotor system in patients with occupational diseases caused by physical stress]. / Biokhimicheskaia otsenka metabolicheskikh rasstroistv v tkaniiakh oporno-dvigatel'nogoapparata u bol'nykh professional'nymi zabolevaniiami ot fizicheskogo perenapriazheniia.

A group of patients with occupational disease and female sewing-machine operators were medically examined with a broad set of biochemical techniques aimed at the detection of metabolic disorders in the locomotor system tissues. Noninflammatory dystrophic changes were found. The muscular component was dominating in comparison with the osseous one in the genesis of the degenerative dystrophic processes, which manifested in the clinical course. Laboratory manifestations were revealed related to the lowered energy supply and oxygenation of the skeleton muscles in patients with neuromuscular and osteo-muscular++ syndromes. The metabolic disorders were diagnosed at the early stages of myalgia.

Management of individuals with Parkinson's disease: rationale and case studies.

In this article, we present a systematic approach to physical therapy management of individuals with Parkinson's disease. This approach is based on a model that relates knowledge of the underlying pathology of the disease to impairments and disability. We discuss use of the model to evaluate, interpret, and treat impairments and disabilities of the patient with Parkinson's disease. We emphasize the relative influence of impairments that arise directly from the neuroanatomical pathology and those that arise indirectly through subsequent musculoskeletal alterations. We illustrate the use of the model in setting goals and in developing a treatment program. Two case studies are presented to illustrate the application of this approach to specific patient care. These case studies suggest the efficacy of physical therapy initiated early in the disease process. The first case study illustrates improvements of balance, gait, and functional movement made by an individual who was not yet receiving medication for Parkinson's disease. The second case study illustrates improvements of balance, gait, and functional movement made by an individual who was already receiving medication for the disease. These case studies illustrate the dramatic improvements that can be achieved in the patient with Parkinson's disease.

Studies on the etiology and pathogenesis of motor neuron diseases. II. Clinical and electrophysiologic features of pyramidal dysfunction in macaques fed Lathyrus sativus and IDPN.

A primate model of lathyrism has been produced in well-nourished male cynomolgus monkeys chronically fed a fortified diet composed of Lathyrus sativus (chickling or grass pea) and given daily per os an alcoholic extract of this legume. Animals given a diet of non-neurotoxic Cicer arietinum (chick pea) cross-matched with the nutritional properties of the experimental diet served as controls. Another group of animals received the same diet and oral doses of beta, beta'-iminodipropionitrile (IDPN), a reference compound that has been termed an "experimental neurolathyrogen." Monkeys fed Lathyrus developed clinical and electrophysiologic evidence of corticospinal deficits after 3 to 10 months of feeding. Animals administered IDPN showed clinical and/or electrophysiologic changes in the PNS and CNS motor and sensory pathways, and signs of cerebellar dysfunction. Since the two primate disorders are separable on clinical and electrophysiologic grounds, further use of the term "experimental neurolathyrogen" to describe the neurotoxic properties of IDPN seems inappropriate. These findings demonstrate the feasibility of developing a model of early human lathyrism in adequately nourished nonhuman primates.