RESUMEN
OBJECTIVE: Selective neurotomy has been suggested as a permanent treatment for focal spasticity. A systematic literature review was performed to investigate the efficacy of selective neurotomy regarding focal lower limb spasticity. METHODS: A systematic search in PubMed, Medline, Cochrane, and Embase databases was carried out. Studies were included if they reported on the following outcomes: muscle tone, muscle strength, pain, ankle range of motion and/or walking speed, after selective lower limb neurotomy in any type of upper motor neuron syndrome. RESULTS: A total of 25 non-randomized and/or uncontrolled studies and 1 randomized controlled study were selected. The included studies reported improvements in terms of leg muscle tone, pain, passive range of ankle motion, and walking speed. CONCLUSION: The results suggest that selective neurotomy is effective for reducing lower limb spasticity, without any negative effects on walking speed. However, this conclusion is primarily based on uncontrolled case series, whereas conclusions on clinical efficacy should preferably be based on comparison with a reference treatment through (randomized) controlled trials. Future studies should also include quantitative, validated functional assessment tools to further establish the efficacy of selective neurotomy as long-lasting treatment for patients with focal lower limb spasticity.
Asunto(s)
Extremidad Inferior , Espasticidad Muscular , Humanos , Espasticidad Muscular/cirugía , Espasticidad Muscular/etiología , Espasticidad Muscular/fisiopatología , Extremidad Inferior/cirugía , Resultado del Tratamiento , Rango del Movimiento Articular/fisiología , Enfermedad de la Neurona Motora/cirugía , Enfermedad de la Neurona Motora/rehabilitación , Enfermedad de la Neurona Motora/fisiopatología , Fuerza Muscular/fisiologíaRESUMEN
COVID-19 patients admitted to the Intensive Care Unit may develop painful range of motion restrictions of the large joints due to heterotopic ossifications. Here we describe two patients who developed restricted and painful passive and active mobility of the hips, shoulders and elbows after mechanical ventilation because of respiratory failure due to COVID-19 pneumonia. Conventional radiography showed extensive heterotopic ossifications. Retrospectively, alkaline phosphatase levels were elevated. It is likely that local and systemic factors contribute to the development of heterotopic ossifications. Early diagnosis is important to provide complementary non-pharmacological interventions (gentle passive mobilization) and medication (non-steroidal anti-inflammatory drugs, such as indomethacin). If pain and limited joint mobility remain present, surgical removal of ectopic bone could be considered. Future trials are needed to systematically map the prevalence of heterotopic ossifications in COVID-19 patients who were admitted to the Intensive Care Unit, andto evaluate whether prophylactic treatment with non-steroidal anti-inflammatory drug is of relevance.
Asunto(s)
COVID-19 , Articulaciones , Osificación Heterotópica , Neumonía Viral , Respiración Artificial/efectos adversos , Insuficiencia Respiratoria , Antiinflamatorios no Esteroideos/uso terapéutico , COVID-19/fisiopatología , COVID-19/terapia , Femenino , Humanos , Articulaciones/diagnóstico por imagen , Articulaciones/patología , Articulaciones/fisiopatología , Masculino , Persona de Mediana Edad , Terapia Pasiva Continua de Movimiento/métodos , Osificación Heterotópica/etiología , Osificación Heterotópica/fisiopatología , Osificación Heterotópica/terapia , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Radiografía/métodos , Rango del Movimiento Articular , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/virología , SARS-CoV-2/aislamiento & purificaciónRESUMEN
Ischemic preconditioning (IPC) may enhance exercise performance. Cardioprotective effects of IPC are known to re-occur 24h after the stimulus. Whether the delayed effect of IPC has similar effects as IPC on exercise performance is unknown. OBJECTIVES: Examine whether IPC applied 24h (24-IPC) before exercise is equally effective as IPC in improving exercise performance. DESIGN: Randomized, cross-over study METHODS: 12 healthy participants were randomly exposed to SHAM-session, IPC or 24-IPC before a self-paced 5km running trial on a treadmill. Subjects were blinded for time, speed and heart rate. Furthermore, heart rate, BORG, and the local tissue saturation index were measured during exercise, while lactate levels were determined after running. Using a regression model, we explored whether these parameters predicted the change in running time after IPC and 24-IPC. RESULTS: We found no differences in finish time after IPC (SHAM: 1400±105s, IPC: 1381±112s, 24-IPC: 1385±113s; p=0.30). However, we observed a significant positive relation between the change in finish time after IPC and 24-IPC (p=0.016; r=0.677). Using stepwise linear regression, a lower post-exercise blood lactate level after IPC or 24-IPC was significantly related to an improvement in finish time (R2=0.47, ß=-0.687, p=0.007). CONCLUSIONS: Although no significant effect of IPC or 24-IPC on exercise performance was found, individual finish time after IPC and 24-IPC were strongly correlated. Therefore, our data suggest that, at the individual level, the effects of 24-IPC are closely related to the effects of IPC.