1,721,014 research outputs found
Le risposte psicofisiche di atleti disabili alla pratica del nuoto agonistico.
No full textDopo un’ampia e dettagliata descrizione del mondo del nuoto paralimpico e dei protocolli di classificazione degli atleti per valutare attraverso test fisici e tecnici il grado di funzionalità fisica (Capitolo 1), si indagherà sul ruolo della pratica sportiva agonistica nel migliorare il benessere psicofisico percepito di atleti disabili (Capitolo 2). Successivamente si svilupperà un metodo di allenamento per atleti con sindrome del motoneurone superiore per la preparazione fisica di tre eventi internazionali di nuoto paralimpico. Nel corso della strutturazione dell’allenamento si è studiato e preso in considerazione le risposte fisiopatologiche all’allenamento tipiche di questa sindrome (Capitolo 3). Avendo chiarito nel precedente Capitolo le risposte fisiche indotte dal nuoto agonistico negli atleti affetti da sindrome del motoneurone superiore, si sperimenterà una strategia terapeutica al fine di migliorare la performance di nuoto in atleti paralimpici riducendo spasticità e clono, attraverso l’applicazione del Kinesio Taping che è una tecnica di taping innovativa basata sull'uso di un sottile nastro elastico incollato sulla pelle (Capitolo 4)
BOTULINUM TOXIN IS PRESCRIBED FOR SPASTICITY OR SPASTIC DYSTONIA?
No full textIntroduction: Following clinical examination, botulinum toxin is injected into muscles perceived as hypertonic during passive stretches. An effective reduction of resistance during muscle elongation is often clearly appreciated as long as muscle motor units are preserved and the amount of fibrosis is low. Surface electromyography (EMG) can be used to assess if resistance to passive muscle stretching is due to the activation of motor units through recording of the electric activity generated. Spasticity is defined as a velocity-dependent increase of muscle tone associated with an increased stretch reflex in subjects with an upper motor neuron syndrome (UMNS). A less well-known positive phenomenon called spastic dystonia can be responsible for generating the resistance to passive movements that leads the clinician to use botulinum toxin. Spastic dystonia is characterized by the inability to relax a muscle leading to a spontaneous, although stretch-sensitive, tonic contraction. Although spastic dystonia is a recognized cause of muscle hypertonia, its prevalence among hypertonic muscles of stroke subjects has never been investigated. The objective of this study is to understand the prevalence of spastic dystonia and spasticity in a group of stroke survivors presenting with muscle hypertonia where botulinum toxin treatment is indicated.
Methods: In 23 hemiparetic stroke survivors showing increased muscle tone of wrist flexors, surface EMG was used to investigate the presence of spontaneous, stretch-sensitive EMG activity in the flexor carpi radialis.
Results: Results of the study are shown in the Figure. Stretch-sensitive EMG activity was found in 17 subjects while the muscle was kept elongated. In the remaining 6 subjects, EMG activity was present only during the dynamic phase of muscle stretches.
Conclusions: The majority of stroke subjects is affected by spastic dystonia in their hypertonic wrist flexor muscles, while only a minority of subjects is affected by spasticity. Botulinum toxin is therefore more often used to treat spastic dystonia rather than spasticity. To stop spastic dystonia from being the neglected aspect of UMNS, it is essential to link its definition to increased muscle tone, as occurred for spasticity. Recognizing the real phenomena underlying muscle hypertonia could improve its management
Impact of the 2018 World Para Swimming classification revision on the race results in international Paralympic swimming events
No full textParalympic swimmers compete in classes, according to their swimming functional abilities. The classification protocol of physical and technical tests carried out to assign a class has undergone multiple revisions over time, the latest one in 2018. As a consequence, most of the athletes with physical impairment were required to attend an evaluation session to have their class re-assigned. We monitored the impact of this latest revision on the race results in two international Paralympic swimming events which took place prior to and just after the implementation of the classification revisions. Despite no dramatic changes being observed in the overall class performances and in the within-class performance variability, the race times of athletes that had their class changed were significantly more in trend with the mean times of the new classes than with those of the former classes. However, considering class increments/decrements separately, this was the case only for class increments. Further investigations could clarify this result and possibly provide indications for further improvements in the classification system
Immunological Response to Exercise in Athletes with Disabilities: A Narrative Review of the Literature
No full textFor a person with a disability, participating in sports activities and/or competitions can be a challenge for the immune system. The relationship between exercise and immunity response in disabled athletes is, indeed, extremely complex for several reasons, including (1) the chronic low-grade inflammatory and immunodepression-"secondary immune deficiency"-state imposed by the disability/impairment; (2) the impact of the disability on an array of variables, spanning from physical fitness to well-being, quality of life, sleep, and nutritional aspects, among others, which are known to mediate/modulate the effects of exercise on human health; (3) the variability of the parameters related to the exercise/physical activity (modality, frequency, intensity, duration, training versus competition, etc.); and (4) the intra- and inter-individual variability of the immunological response to exercise. In able-bodied athletes, previously published data described several exercise-induced changes affecting various immunological subsets and subpopulations, ranging from neutrophils to lymphocytes, and monocytes. Broadly, moderate intensity workout is accompanied by optimal immunity and resistance to infections such as upper respiratory tract infections (URTI) in athletes. Periods of intense training with insufficient recovery can cause a temporary state of immunosuppression, which should end with a few days of rest/recovery from exercise. Disabled athletes are relatively overlooked and understudied with respect to their able-bodied counterparts. Findings from the few studies available on paralympic and disabled athletes are here summarized and analyzed utilizing a narrative approach to review and determine the major features of the immunological and inflammatory responses to exercise in this specific population. Moreover, a few studies have reported behavioral, dietary, and training strategies that can be adopted to limit exercise-induced immunosuppression and reduce the risk of infection in people with disabilities. However, given the paucity of data and contrasting findings, future high-quality investigations on paralympic and disabled athletes are urgently needed.Scopu
"Spastic dystonia" or "Inability to voluntary silence EMG activity"? Time for clarifying the nomenclature
No full textWe thank Lumsden and colleagues for their comments on ourpaper ‘‘Spastic dystonia in stroke subjects: prevalence and featuresof the neglected phenomenon of the upper motor neuron syn-drome” (Trompetto et al., 2019). We agree with them that preciseterminology is essential for unambiguous communication andsharing of knowledge. Since this goal is far from being achievedin the field of the positive phenomena of the upper motor neuronsyndrome (UMNS), we agree that the time has come to find anomenclature able to capture the essential and unique featuresof the phenomenon so far reported as ‘‘spastic dystonia”, therebyeliminating eventual confusion. Realistically, this should be matterof dedicated reflections, but we welcome the opportunity offeredby Lumsden and colleagues (Lumsden et al., 2019).The main points of the subject (and debate) are the following.First, the currently used term ‘‘spastic dystonia” refers to theinability of patients with UMNS to voluntary silence muscle activ-ity on command (Gracies, 2005; Sheean and McGuire, 2009;Trompetto et al., 2014). This inability leads to spontaneous tonicmuscle contractions, which prove stretch-sensitive (Gracies,2005), and ultimately amplify the velocity-dependent hypertonia(Marinelli et al., 2017; Trompetto et al., 2019Trompetto et al., 2019).Second, as an inability to relax muscles at will, the phenomenonfalls in the most recent definition of dystonia, ‘‘a movement disor-der characterized by sustained or intermittent muscles contrac-tions causing abnormal, often repetitive, movements, postures, orboth” (Albanese et al., 2013).Third, since ‘‘spastic dystonia” may occur in the absence ofvelocity-dependent hypertonia (Denny-Brown, 1966), which isthe hallmark of spasticity, why qualifying this phenomenon as‘‘spastic”? But: if this is not ‘‘spastic”, should it be simply ‘‘dysto-nia”, ‘‘secondary dystonia”, or ‘‘dystonia in the context of theUMNS”?As delineated above, the debate prompts comments that movefrom the phenomenological to the pathophysiological level. Weshortly review strengths and weaknesses for each point, and post-pone eventual solution to more thorough review.From a phenomenological point of view, we consider as undis-puted that dystonia and ‘‘spastic dystonia” manifest similarly,therefore the involuntary muscle activity we are dealing with isdystonic in nature. But it is only one nature of the abnormal move-ment, the second one being its exquisite sensitivity to musclelengthening.Equally undisputed is the clearly distinct pathophysiologybetween ‘‘dystonia” and ‘‘spastic dystonia”. The overwhelmingmajority of papers using the term ‘‘dystonia” refers to clinical con-ditions stemming from structural or functional diseases of thebasal ganglia, unrelated to the activity of the stretch reflex. Onthe contrary, ‘‘spastic dystonia” is found in patients having lesionsoutside the basal ganglia, exhibiting clear abnormality in theexcitability of the stretch reflex circuitry. Because definitely dis-tinct pathological mechanisms give rise to muscle overactivitysharing similar phenomenology, the term ‘‘dystonia” seems inade-quate for describing the involuntary muscle contraction we aredealing with.Even from a nosological perspective, the term ‘‘dystonia”appears inappropriate. By definition, ‘‘dystonia” is amovement dis-order, whereas ‘‘spastic dystonia” is not. Indeed, amovement disor-der(meaning to indicate a disease of the basal ganglia) is definedas a ‘‘neurological syndrome in which there is either an excess ofmovement or a paucity of voluntary and automatic movements,unrelated to weakness or spasticity” (Fahn et al., 2011). It is apod-ictic how much ‘‘spastic dystonia” can be related to both weaknessand spasticity. Corollary is that spastic dystonia can neither beconsideredtout-court‘‘a subset of dystonia” (Lorentzen et al.,2018).For old-fashioned ‘‘motorist” neurologists, the term ‘‘spasticdystonia” reflects perfectly the double nature of the stretch-sensi-tive (although not stretch-induced), spontaneous, tonic musclecontraction that can be observed in the absence of movement (assole inability to relax) or during movement (as associated posturalreactions) in patients affected by UMNS. None of the semanticnuances, such as ‘‘dystonic spasticity” (Lorentzen et al., 2018), or‘‘dystonia with spasticity” or ‘‘dystonia accompanying the UpperMotor Neuron Complex” (as suggested by these respected authors)is likely to improve the understanding or the clarity of this simi-larly old-fashioned concept. But as time goes on, the audience ofphysicians dealing with UMNS patients grows, and we see the needfor changing the term ‘‘spastic dystonia”. Nevertheless, we mustacknowledge the difficulty to find an equally efficacious two-worddescriptor, probably reflecting the peculiarity and complexity ofthis motor phenomenon (sensitivity to - but not dependency fromperipheral input; occurrence both in the absence and during move-ment; ability to cause or not abnormal postures).The letter by Lumdsen et al. (2019) proves that ‘‘spastic dysto-nia” seems no more conducive to the recognition of the phe-nomenon that it wants to identify, probably explaining why it is‘‘the neglected phenomenon of the UMNS” (Trompetto et al.,2019). A newly proposed definition as a ‘‘stretch- and effort-unre-lated sustained involuntary muscle activity following centralmotor lesions” (Lorentzen et al., 2018) certainly avoids confusionin terms of dystonia, but it fails to convey the inability to relaxmuscles, it overestimates the ‘‘un-relation” to muscle stretch, anduncouples this involuntary muscle activity from velocity-depen-dent hypertonia, which is the more evident clinical sign in thesepatients (Marinelli et al., 2017; Trompetto et al., 2019).
Aside from shading dystonia vs. spasticity andvice versa,weconsider that ‘‘inability to voluntary silence EMG activity”describes well both the phenomenological and pathophysiologicallevel, the positive phenomenon of the UMNS currently referred toas ‘‘spastic dystonia”. The ensuing stretch-sensitive spontaneoustonic muscle contractions favor/promote velocity-dependenthypertonia, and may produce abnormal postures. This physiologi-cal construct would bring the concept to the clinicians that two arethe causes of velocity-dependent hypertonia: spasticity (Lance,1980) and ‘‘inability to voluntary silence EMG activity”. Such a dis-tinction would help prevent the overdiagnosis of ‘‘spasticity”whenever the clinical examination reveals the presence of veloc-ity-dependent hypertonia, and will strengthen the idea that onlythe use of surface-EMG can discriminate between muscles thatare relaxed prior to passive stretch (i.e., muscles affected by spas-ticity), and those showing stretch-sensitive spontaneous tonic con-tractions (i.e., muscles affected by ‘‘inability to voluntary silenceEMG activity”)
Protocol for the study of self-perceived psychological and emotional well-being of young Paralympic athletes
No full textAbstract Background We present the detailed protocol set up to investigate how agonistic sport affects the self-perceived psychological and emotional well-being of disabled young people. Methods The study will be carried out on a number of subjects as large as 800–1200, using well-established indices that give a quantitative measure of such well-being, namely SF-12 and PGWBI. The related questionnaires will be administered to the participants to a forthcoming international event, the European Para-Youth Games, 9–15 October 2017, Liguria, Italy, as well as to a reference population of a similar number of subjects, made up of young disabled people that do not practice agonistic sport. Discussion We expect that the outcomes of the study may strongly impact not only the socio-sanitary field but also society in general, as disabled people can be considered an extreme situation in the issue of balancing individual needs and environment to pursue psychological well-being. Trial registration ISRCTN14389453 (29 June 2017)
The Effect of Kinesio Taping on Spasticity: A Randomized, Controlled, Double-Blind Pilot Study in Para-Swimmers
No full textContext: Kinesio Taping (KT) produces several clinical effects, including pain relief, edema absorption, and improved muscle performance. When applied in the insertion to origin mode, it is claimed to inhibit excessive muscle contractions. Objective: Investigate whether KT applied in the insertion to origin mode could reduce the exaggerated reflex contraction of spastic muscles. Design: Randomized crossover trial, with a restricted block randomization. Setting: Clinical laboratory and swimming pool. Patients: Seven para-swimmers. Intervention: KT, applied in inhibitory mode, to investigate its effect on knee extensor spasticity. Main Outcome Measures: Primary outcome is stretch reflex, as compared with clinical assessment of spasticity by Modified Ashworth Scale and self-perceived spasticity by numeric rating scale. Secondary outcomes were Medical Research Council for strength of knee extensor muscles and chronometric swimming performance in 100-m freestyle. Results: KT significantly decreased the amplitude of stretch reflex (P < .001), whereas the placebo treatment produced no significant effects. Scores of Medical Research Council for strength and Modified Ashworth Scale did not change after KT, whereas numeric rating scale scores for spasticity significantly decreased (P = .001). The swimming performance was significantly improved after KT treatment as compared with baseline (P < .01). Conclusions: This exploratory study performed on para-athletes suggests that KT could reduce spasticity. This outcome has 3-fold implications for clinical, rehabilitation, and sport methods
Big Data in Cardiology: State-of-Art and Future Prospects
Full text linkCardiological disorders contribute to a significant portion of the global burden of disease. Cardiology can benefit from Big Data, which are generated and released by different sources and channels, like epidemiological surveys, national registries, electronic clinical records, claims-based databases (epidemiological Big Data), wet-lab, and next-generation sequencing (molecular Big Data), smartphones, smartwatches, and other mobile devices, sensors and wearable technologies, imaging techniques (computational Big Data), non-conventional data streams such as social networks, and web queries (digital Big Data), among others. Big Data is increasingly having a more and more relevant role, being highly ubiquitous and pervasive in contemporary society and paving the way for new, unprecedented perspectives in biomedicine, including cardiology. Big Data can be a real paradigm shift that revolutionizes cardiological practice and clinical research. However, some methodological issues should be properly addressed (like recording and association biases) and some ethical issues should be considered (such as privacy). Therefore, further research in the field is warranted
Dual task gait deteriorates gait performance in cervical dystonia patients: a pilot study
No full textDay-to-day walking-related activities frequently involve the simultaneous performance of two or more tasks (i.e., dual task). Dual task ability is influenced by higher order cognitive and cortical control mechanisms. Recently, it has been shown that the concomitant execution of an attention-demanding task affected postural control in subject with cervical dystonia (CD). However, no study has investigated whether dual tasking might deteriorate gait performance in CD patients. To investigate whether adding a concomitant motor and cognitive tasks could affect walking performance in CD subjects.17 CD patients and 19 healthy subjects (HS) participated in this pilot case-control study. Gait performance was evaluated during four walking tasks: usual, fast, cognitive dual task and obstacle negotiation. Spatiotemporal parameters, dual-task cost and coefficients of variability (CV%) were measured by GaitRite® and were used to detect differences between groups. Balance performance was also assessed with Mini-BEST and Four Step Square tests. In CD participants, correlation analysis was computed between gait parameters and clinical data. Significant differences in complex gait and balance performance were found between groups. CD patients showed lower speed, longer stance time and higher CV% and dual-task cost compared to HS. In CD, altered gait parameters correlated with balance performance and were not associated with clinical features of CD. Our findings suggest that complex walking performance is impaired in patients with CD and that balance and gait deficits might be related
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