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ABSTRACT: To determine if motor evoked potentials (MEPs), postconcussion signs and symptoms, and neurocognitive functions follow a similar recovery pattern after concussion.
Nine collegiate athletes with acute concussion (>24 hours after injury) participated in this retrospective time series design. Transcranial magnetic stimulation was applied over the motor cortex, and MEPs were recorded from the contralateral upper extremity. Self-reported symptoms were evaluated using the Head Injury Scale, and the Concussion Resolution Index was used to assess neurocognitive function. All measures were repeated on days 3, 5, and 10 after injury.
Composite scores on the Head Injury Scale were significantly higher on day 1 after injury (F3,51 = 15.3; P = 0.0001). Processing speed on the Concussion Resolution Index was slower on days 1, 3, and 5 compared with that on day 10 (F3,24 = 6.75; P = 0.0002). Median MEP latencies were significantly longer on day 10 compared with day 1 after concussion (t8 = -2.69; P = 0.03). Ulnar MEP amplitudes were significantly smaller on day 3 after concussion compared with day 5 (t8 = -3.48; P = 0.008).
Acutely concussed collegiate athletes demonstrate changes in MEPs, which persist for up to 10 days after injury and do not follow the same recovery pattern as symptoms and neuropsychological test performance. The apparent differential rates of recovery most likely indicate different pathophysiological processes occurring in the immediate postconcussion period.
Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society 02/2012; 29(1):23-32. · 1.47 Impact Factor
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ABSTRACT: Rib injuries are common in collegiate rowing. The purpose of this case report is to provide insight into examination, evaluation, and treatment of persistent costochondritis in an elite athlete as well as propose an explanation for chronic dysfunction. The case involved a 21 year old female collegiate rower with multiple episodes of costochondritis over a 1-year period of time. Symptoms were localized to the left third costosternal junction and bilaterally at the fourth costosternal junction with moderate swelling. Initial interventions were directed at the costosternal joint, but only mild, temporary relief of symptoms was attained. Reexamination findings included hypomobility of the upper thoracic spine, costovertebral joints, and lateral ribs. Interventions included postural exercises and manual therapies directed at the lateral and posterior rib structures to improve rib and thoracic spine mobility. Over a 3-week time period pain experienced throughout the day had subsided (visual analog scale - VAS 0/10). She was able to resume running and elliptical aerobic training with minimal discomfort (VAS 2/10) and began to reintegrate into collegiate rowing. Examination of the lateral ribs, cervical and thoracic spine should be part of the comprehensive evaluation of costochondritis. Addressing posterior hypomobility may have allowed for a more thorough recovery in this case study.
The Journal of manual & manipulative therapy 06/2010; 18(2):64-8.
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ABSTRACT: Assessment of concussion is primarily based on self-reported symptoms, neurological examination and neuropsychological testing. The neurophysiologic sequelae and the integrity of the corticomotor pathways could be obtained by evaluating motor evoked potentials (MEPs).
To compare MEPs obtained through transcranial magnetic stimulation (TMS) in acutely concussed and non-concussed collegiate athletes.
Eighteen collegiate athletes (12 males, six females, aged 20.4 +/- 1.3 years) including nine subjects with acute concussion (<or=24 hours) matched to nine control subjects. TMS was applied over the motor cortex and MEP responses were recorded from the contralateral upper extremity. MEP thresholds (%), latencies (milliseconds per metre) and amplitudes were assessed. Central motor conduction time (CMCT) was calculated from MEP, M response and F wave latencies. Testing was performed on days 1, 3, 5 and 10 post-concussion.
Ulnar MEP amplitudes were significantly different between post-concussion days 3 and 5 (F(3,48) = 3.13, p = 0.041) with smaller amplitudes recorded on day 3 (0.28 +/- 0.10 ms m(-1)). Median MEP latencies were significantly longer (F(3,48) = 4.53, p = 0.023) 10 days post-concussion (27.1 +/- 1.4 ms m(-1)) compared to day 1 (25.7 +/- 1.5 ms m(-1)). No significant differences for motor thresholds or CMCTs were observed (p > 0.05).
MEP abnormalities among acutely concussed collegiate athletes provide direct electrophysiologic evidence for the immediate effects of concussion.
Brain Injury 01/2010; 24(6):904-13. · 1.36 Impact Factor
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ABSTRACT: To examine the effects of a four-week balance training programme on ankle kinematics during walking and jogging in those with chronic ankle instability. A secondary objective was to evaluate the effect of balance training on the mechanical properties of the lateral ligaments in those with chronic ankle instability.
Randomized controlled trial.
Laboratory.
Twenty-nine participants (12 males, 17 females) with self-reported chronic ankle instability were randomly assigned to a balance training group or a control group.Intervention: Four weeks of supervised rehabilitation that emphasized dynamic balance stabilization in single-limb stance. The control group received no intervention.
Kinematic measures of rearfoot inversion/eversion, shank rotation, and the coupling relationship between these two segments throughout the gait cycle during walking and jogging on a treadmill. Instrumented ankle arthrometer measures were taken to assess anterior drawer and inversion talar tilt laxity and stiffness.
No significant alterations in the inversion/eversion or shank rotation kinematics were found during walking and jogging after balance training. There was, however, a significant decrease in the shank/rearfoot coupling variability during walking as measured by deviation phase after balance training (balance training posttest: 13.1 degrees +/- 6.2 degrees , balance training pretest: 16.2 degrees +/- 3.3 degrees , P = 0.03), indicating improved shank/rearfoot coupling stability. The control group did not significantly change. (posttest: 16.30 degrees +/- 4.4 degrees , pretest: 18.6 degrees +/- 7.1 degrees , P40.05) There were no significant changes in laxity measures for either group.
Balance training significantly altered the relationship between shank rotation and rearfoot inversion/eversion in those with chronic ankle instability.
Clinical Rehabilitation 06/2009; 23(7):609-21. · 2.12 Impact Factor
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ABSTRACT: The purpose of the study was to compare the central activation ratio (CAR) of eccentric contractions to isometric contractions at 30 and 70 degrees of knee flexion.
A repeated-measures design was used. CARs were measured at 30 and 70 degrees of knee flexion in 16 healthy subjects during both eccentric and isometric modes of contraction. CARs were measured using the superimposed burst technique.
Isometric CARs at 30 degrees (0.88+/-0.069) of knee flexion were significantly higher (P<0.001) than at 70 degrees (0.77+/-0.116). Eccentric CARs were significantly higher (P=0.013) at 70 degrees (0.87+/-0.085) of knee flexion compared with 30 degrees (0.8+/-0.09). At 30 degrees of knee flexion, isometric CARs were significantly higher (P=0.003) than eccentric CARs. At 70 degrees, eccentric CARs were higher (P<0.001) when compared with isometric CARs.
Our results provide evidence that isometric measures at a single joint angle are not sufficient in generalizing activation of an entire muscle group for dynamic movements. CARs are significantly affected by joint angle and mode of contraction.
American Journal of Physical Medicine & Rehabilitation 03/2008; 87(2):100-8. · 1.58 Impact Factor
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ABSTRACT: Context: A neuromuscular relationship exists between the lumbar extensor and quadriceps muscles during fatiguing exercise. However, this relationship may be different for persons with low back pain (LBP). Objective: To compare quadriceps inhibition after isometric, fatiguing lumbar extension exercise between persons with a history of LBP and control subjects. Design: A 2 x 3 factorial, repeated-measures, time-series design with independent variables of group (persons with a history of LBP, controls) and time (baseline, postexercise set 1, postexercise set 2). Setting: University research laboratory. Patients or Other Participants: Twenty-five subjects with a history of LBP were matched by sex, height, and mass to 25 healthy control subjects. Intervention(s): Electromyography median frequency indexed lumbar paraspinal muscular fatigue while subjects performed 2 sets of isometric lumbar extension exercise. Subjects exercised until a 15% downward shift in median frequency for the first set and a 25% shift for the second set were demonstrated. Main Outcome Measure(s): Knee extension force was measured while subjects performed an isometric maximal quadriceps contraction. During this maximal effort, a percutaneous electric stimulus was applied to the quadriceps, causing a transient, supramaximal increase in force output. We used the ratio between the 2 forces to estimate quadriceps inhibition. Quadriceps electromyographic activity was recorded during the maximal contractions to compare median frequencies over time. Results: Both groups exhibited significantly increased quadriceps inhibition after the first (12.6% +/- 10.0%, P < .001) and second (15.2% +/- 9.7%, P < .001) exercise sets compared with baseline (9.6% +/- 9.3%). However, quadriceps inhibition was not different between groups. Conclusions: Persons with a history of LBP do not appear to be any more or less vulnerable to quadriceps inhibition after fatiguing lumbar extension exercise.
Journal of athletic training 02/2006; 41(3):264-9. · 1.80 Impact Factor
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ABSTRACT: The purpose of this study was to determine the contribution of hamstrings and quadriceps fatigue to quadriceps inhibition following lumbar extension exercise. Regression models were calculated consisting of the outcome variable: quadriceps inhibition and predictor variables: change in EMG median frequency in the quadriceps and hamstrings during lumbar fatiguing exercise. Twenty-five subjects with a history of low back pain were matched by gender, height and mass to 25 healthy controls. Subjects performed two sets of fatiguing isometric lumbar extension exercise until mild (set 1) and moderate (set 2) fatigue of the lumbar paraspinals. Quadriceps and hamstring EMG median frequency were measured while subjects performed fatiguing exercise. A burst of electrical stimuli was superimposed while subjects performed an isometric maximal quadriceps contraction to estimate quadriceps inhibition after each exercise set. Results indicate the change in hamstring median frequency explained variance in quadriceps inhibition following the exercise sets in the history of low back pain group only. Change in quadriceps median frequency explained variance in quadriceps inhibition following the first exercise set in the control group only. In conclusion, persons with a history of low back pain whose quadriceps become inhibited following lumbar paraspinal exercise may be adapting to the fatigue by using their hamstring muscles more than controls
Journal of Sports Science and Medicine. 01/2006;
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ABSTRACT: Arthrogenic muscle inhibition (AMI) impedes rehabilitation following knee joint injury by preventing activation of the quadriceps. AMI has been attributed to neuronal reflex activity in which altered afferent input originating from the injured joint results in a diminished efferent motor drive to the quadriceps muscles. Beginning to understand the mechanisms responsible for muscle inhibition following joint injury is vital to control or eliminate this phenomenon. Therefore, the purpose of this investigation is to determine if quadriceps AMI is mediated by a presynaptic regulatory mechanism. Eight adults participated in two sessions: in one session their knee was injected with saline and in the other session it was not. The maximum Hoffmann reflex (H-reflex), M-wave, reflex activation history, plasma epinephrine, and norepinephrine were recorded at: baseline, post needle stick, post lidocaine, and 25 and 45 min post effusion. Measures for the control condition were matched to the effusion condition. The percent of the unconditioned reflex amplitude for reflex activation history and the maximum H-reflex were decreased at 25 and 45 min post effusion as compared to measures taken at baseline, post needle stick, and post lidocaine (P<0.05). No differences were noted for the maximum M-wave or plasma epinephrine and norepinephrine levels in either the effusion or noneffusion admission (P>0.05). No differences were detected at any time interval for any measure during the control admission (P>0.05). Quadriceps AMI elicited via an experimental knee joint effusion is, at least in part, mediated by a presynaptic mechanism.
Knee Surgery Sports Traumatology Arthroscopy 08/2005; 13(5):370-6. · 2.21 Impact Factor
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ABSTRACT: Knee joint effusion results in quadriceps inhibition and is accompanied by increased excitability in the soleus musculature. The purpose of this study was to determine if soleus arthrogenic muscle response is regulated by pre- or post-synaptic spinal mechanisms. Ten healthy adults (two females and eight males) were measured on two occasions. At the first session, subjects had their knee injected with 60 ml of saline and in the other session they did not. Pre- and post-synaptic spinal mechanisms were measured at baseline, immediately following a needle stick, immediately following a Xylocaine injection, and 25 and 45 min post-saline injection. A mixed effects model for repeated measures was used to analyze each dependent variable. The a priori alpha level was set a P < or = 0.05. The percentage of the unconditioned reflex amplitude for recurrent inhibition (P < 0.0001) and reflex activation history (P < 0.0001) significantly increased from baseline at 25 and 45 min post-effusion. Soleus arthrogenic muscle response seen following knee joint effusion is mediated by both pre- and post-synaptic mechanisms. In conclusion, the arthrogenic muscle response seen in the soleus musculature following joint effusion is regulated by both pre- and post-synaptic control mechanisms. Our data are the first step in understanding the neural networks involved in the patterned muscle response that occurs following joint effusion.
Journal of Electromyography and Kinesiology 01/2005; 14(6):631-40. · 1.97 Impact Factor
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ABSTRACT: Knee joint effusion causes quadriceps inhibition and is accompanied by increased soleus muscle excitability. In order to reverse the neurological alterations that occur to the musculature following effusion, we need to understand the extent of neural involvement. Ten healthy adults were tested on two occasions; during one session, subjects had their knees injected with saline and in the other admission, they did not. Soleus Hmax, Mmax, plasma epinephrine, and norepinephrine concentrations were obtained at five intervals. Results showed that Hmax increased following the effusion, while norepinephrine and epinephrine levels were not altered. We suggest that the soleus facilitation seen following knee effusion results from stimulation of joint mechanoreceptors and removal of descending spinal and supraspinal inhibition and is not the result of a sympathetic response.
Neuroscience Letters 09/2004; 366(1):76-9. · 2.11 Impact Factor
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ABSTRACT: Although poor paraspinal muscle endurance has been associated with less quadriceps activation (QA) in persons with a history of low back pain, no authors have addressed the acute neuromuscular response after lumbar paraspinal fatiguing exercise.
To compare QA after lumbar paraspinal fatiguing exercise in healthy individuals and those with a history of low back pain.
A 2 x 4 repeated-measures, time-series design.
Exercise and Sport Injury Laboratory.
Sixteen volunteers participated (9 males, 7 females; 8 controls and 8 with a history of low back pain; age = 24.1 +/- 3.1 years, height = 173.4 +/- 7.1 cm, mass = 72.4 +/- 12.1 kg).
Subjects performed 3 sets of isometric lumbar paraspinal fatiguing muscle contractions. Exercise sets continued until the desired shift in lumbar paraspinal electromyographic median power frequency was observed. Baseline QA was compared with QA after each exercise set.
An electric burst was superimposed while subjects performed a maximal quadriceps contraction. We used the central activation ratio to calculate QA = (F(MVIC)/[F(MVIC) + F(Burst)])* 100, where F = force and MVIC = maximal voluntary isometric contractions. Quadriceps electromyographic activity was collected at the same time as QA measurements to permit calculation of median frequency during MVIC.
Average QA decreased from baseline (87.4% +/- 8.2%) after the first (84.5% +/- 10.5%), second (81.4% +/- 11.0%), and third (78.2% +/- 12.7%) fatiguing exercise sets. On average, the group with a history of low back pain showed significantly more QA than controls. No significant change in quadriceps median frequency was noted during the quadriceps MVICs.
The quadriceps muscle group was inhibited after lumbar paraspinal fatiguing exercise in the absence of quadriceps fatigue. This effect may be different for people with a history of low back pain compared with healthy controls.
Journal of athletic training 41(1):79-86. · 1.80 Impact Factor
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ABSTRACT: A relationship exists between lumbar paraspinal muscle fatigue and quadriceps muscle activation. The objective of this study was to determine whether hip and knee joint moments during jogging changed following paraspinal fatiguing exercise. Fifty total subjects (25 with self-reported history of low back pain) performed fatiguing, isometric lumbar extension exercise until a shift in EMG median frequency corresponding to a mild level of muscle fatigue was observed. We compared 3-dimensional external joint moments of the hip and knee during jogging before and after lumbar paraspinal fatigue using a 10-camera motion analysis system. Reduced external knee flexion, knee adduction, knee internal rotation and hip external rotation moments and increased external knee extension moments resulted from repetitive lumbar paraspinal fatiguing exercise. Persons with a self-reported history of LBP had larger knee flexion moments than controls during jogging. Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.
Journal of Electromyography and Kinesiology.
