The convergence of regenerative medicine and rehabilitation: federal perspectives.

Regenerative rehabilitation is the synergistic integration of principles and approaches from the regenerative medicine and rehabilitation fields, with the goal of optimizing form and function as well as patient independence. Regenerative medicine approaches for repairing or replacing damaged tissue or whole organs vary from utilizing cells (e.g., stem cells), to biologics (e.g., growth factors), to approaches using biomaterials and scaffolds, to any combination of these. While regenerative medicine offers tremendous clinical promise, regenerative rehabilitation offers the opportunity to positively influence regenerative medicine by inclusion of principles from rehabilitation sciences. Regenerative medicine by itself may not be sufficient to ensure successful translation into improving the function of those in the most need. Conversely, with a better understanding of regenerative medicine principals, rehabilitation researchers can better tailor rehabilitation efforts to accommodate and maximize the potential of regenerative approaches. Regenerative rehabilitative strategies can include activity-mediated plasticity, exercise dosing, electrical stimulation, and nutritional enhancers. Critical barriers in translating regenerative medicine techniques into humans may be difficult to overcome if preclinical studies do not consider outcomes that typically fall in the rehabilitation research domain, such as function, range of motion, sensation, and pain. The authors believe that encouraging clinicians and researchers from multiple disciplines to work collaboratively and synergistically will maximize restoration of function and quality of life for disabled and/or injured patients, including U.S. Veterans and Military Service Members (MSMs). Federal Government agencies have been investing in research and clinical care efforts focused on regenerative medicine (NIH, NSF, VA, and DoD), rehabilitation sciences (VA, NIH, NSF, DoD) and, more recently, regenerative rehabilitation (NIH and VA). As science advances and technology matures, researchers need to consider the integrative approach of regenerative rehabilitation to maximize the outcome to fully restore the function of patients.

Comparison of nonballistic active knee extension in neural slump position and static stretch techniques on hamstring flexibility.

Nonballistic, active range of motion exercises have been advocated as more effective than static stretching for increasing range of motion, yet no published data exist to support this claim. This study compared the effect of nonballistic, repetitive active knee extension movements performed in a neural slump sitting position with static stretching technique on hamstring flexibility. Forty healthy, adult volunteer subjects with limited right hamstring flexibility (i.e., minimum of 15 degrees loss of active knee extension measured with femur held at 90 degrees of hip flexion) were randomly assigned to one of three groups. Group 1 (static stretch) performed a 30-second stretch twice daily. Group 2 (active stretch) performed 30 repetitions of active knee extension while sitting in a neural slump position twice daily. Group 3 served as a control. Hamstring flexibility was determined by an active knee extension test before and after 6 weeks of stretching. Goniometric measurement of knee joint flexion angle was obtained from videotape recording of the active knee extension test. A 3 (group) x 2 (test) repeated measures analysis of variance and subsequent Tukey post hoc testing revealed no significant difference in knee joint range of motion gains between the static (mean = 8.9 degrees) and active stretch (mean = 10.2 degrees). Both stretch groups' knee joint range of motion improved significantly (p < .05) more than the control group. We conclude that 6 weeks of nonballistic, repetitive active knee extensions (30 repetitions, twice daily) performed in a neural slump sitting position improves hamstring flexibility in uninjured subjects, but is no different compared with static stretching (30 seconds, twice daily).

Retrospective evaluation of graded stress examination of the ankle.

Stress radiography of the ankle commonly is used to evaluate talar tilt in patients with a history of inversion ankle sprains. Manual and instrumented procedures have been variously described in the literature. No reports have documented normative talar tilt as measured using the Telos ankle stress device in a large clinical population. In addition, little has been done to examine the value of using graded displacement forces compared with a single displacement force. Bilateral Telos examinations from 113 consecutive patients taken during a 4-year period were evaluated for this study. No measurable talar tilt was observed in 65.8% of the ankles in this study. Talar tilt ranged from 1.7 degrees to 24.9 degrees in injured ankles. In patients with quantifiable talar tilt, all had greater talar tilt at the 15 kPa force than at all other forces. Because of the variability in talar tilt in injured and comparison ankles, clinical conclusions regarding injury severity cannot be made on measured talar tilt alone. The analysis suggests that inversion stress examination is helpful in documenting gross talar instability, but the discriminant value of the procedure to determine the anatomy and severity of lateral ligament injury is tenuous.

Sexual decision making and object relations theory.

The Sexual Decision-Making Inventory (SDMI) was developed to measure levels of sexual decision making based on the developmental concepts of Object Relations Theory. The inventory asks subjects to report on their thoughts and feelings at the time they decided to have sex in their most recent sexual relationship. The inventory was tested in a pilot study involving 45 male and 49 female undergraduates. A factor analysis was performed on the SDMI and six levels of sexual decision making were defined: Object Constancy, Ambivalence, Need for Merger, Need Gratification, Low Self-esteem, and Narcissistic Gratification. Endorsement of items on these subscales was related to perceptions of the relationship. In a second study involving 79 male and 135 female undergraduates, subjects completed the SDMI, the Bell Object Relations Self-report Inventory, and a questionnaire concerning perceptions of the relationship in which the sexual decision was made. Object Constancy was positively correlated to object relations, satisfaction with the relationship, and durability of the relationship; Ambivalence, Need Gratification, and Low Self-esteem were negatively correlated with object relations, satisfaction with the relationship, and durability of the relationship; Narcissistic Gratification was negatively correlated with object relations and most aspects of the relationship with interesting exceptions such as sexual satisfaction. Sex differences demonstrated that females were more likely to endorse items on the Object Constancy subscale; whereas males were more likely to endorse items on the Ambivalence, Need Gratification, and Narcissistic Gratification subscales. There were no sex differences, however, in quality of general object relations.