Immobilization Group Research Articles

Early return to work and improved range of motion with modified relative motion splinting: a retrospective comparison with immobilization splinting for zones V and VI extensor tendon repairs

Introduction There is a lack of evidence on the best method for rehabilitating extensor tendon injuries in zones V and VI. The purpose of this study was to evaluate the outcomes of modified relative motion splinting compared with immobilization following repair of extensor tendons in zones V and VI. Methods A retrospective analysis compared the outcomes of relative motion splinting with immobilization. Sixteen patients (16 fingers) were treated by conventional immobilization splinting for four weeks (immobilization group) followed by mobilization with avoidance of ‘at-risk/heavy’ activities for a further 4–6 weeks. Twenty-three patients (23 fingers) were treated with the modified relative motion splint (mRMS group) during the day and a resting splint worn overnight for the first four weeks. The relative motion splint was continued for ‘at-risk/heavy’ activities for a further 4–6 weeks. Results The mRMS group demonstrated statistically significant improvement in range of motion compared with the immobilization group. This effect was most marked at six weeks ( P = 0.0194, two-way mixed ANOVA) with the mRMS group achieving a 12% higher mean percentage total active motion ( P = 0.0076, Mann-Whitney U test). Results were similar for both groups 12 weeks postoperatively. Differences in return to work times between groups were statistically significant ( P = 0.0062, Mann-Whitney U test). Average return to work was 9.4 weeks for the immobilization group and 3.3 weeks for the mRMS group, equating to a 42 days earlier return to work for the mRMS group. There was no incidence of tendon rupture in either group. Conclusion This study demonstrates that modified relative motion splintage (finger based without wrist component) can be applied in the postoperative management of single zone V or VI extensor tendon repairs. The main advantages of this protocol, compared with immobilization include the small simple splint design, and straightforward patient instructions that enable earlier mobilization, functional hand use and return to both daily living and work.

Use of a Rugby Helmet Brace for Postoperative Treatment of Muscular Torticollis

Prior to 1992, our postoperative management for congenital muscular torticollis consisted of either plaster cast immobilization or no immobilization, depending on the patient's age and the degree of contracture. However, some patients required further surgery and developed complications. In 1992, we produced rugby helmet braces for postoperative management. The purpose of this study was to compare the clinical results of the previous postoperative management with the results achieved using rugby helmet braces. Twenty-five children aged younger than 6 years underwent caudal partial resection of the sternocleidomastoid muscle. Twelve children aged 6 years and older underwent cranial tenotomy. These 37 patients were divided into 2 groups: no immobilization or plaster immobilization (group A; n=19) and rugby helmet braces (group B; n=18). Canale's method was used for evaluation of clinical results. In group A, the results were good in 12 patients, fair in 4, and poor in 3, whereas all 18 patients in group B had good results. Two patients in group A required further surgery, and complications were observed in 5 patients. In group B, alopecia areata was observed in 1 patient.The rugby helmet brace is easy to put on and remove, providing good retention and allowing for physiotherapy. It provides a useful method of postoperative management for congenital muscular torticollis.

Daily muscle vibration amelioration of neural impairments of the soleus muscle during 2 weeks of immobilization

V-wave, F wave and H-reflex responses of soleus were used to determine neural adaptations to 2-week immobilization and whether muscle vibration intervention during immobilization would attenuate the negative adaptations induced by immobilization. Thirty subjects were divided into the ankle immobilization group and the immobilization with muscle vibration group. Mechanical vibrations with constant low amplitude (0.3 mm) were applied (12 × 4 min daily) with a constant frequency of 100 Hz on the soleus muscle of the subjects in vibration group during the ankle immobilization period. Soleus maximal M-wave (Mmax) and H-reflex (Hmax) were evoked at rest. F-wave was recorded by supramaximal stimulation delivered at rest and V-wave during maximum voluntary contraction (MVC). The EMG during MVC was represented by its root-mean-square (RMS) value. Each subject was examined before and after 2 weeks of immobilization. Results showed that following 2 weeks of immobilization, Mmax, Hmax and F wave all did not change with immobilization in either group ( P > 0.05). After 2 weeks of immobilization, significant reductions in V/Mmax (of 30.78%) ( P < 0.01) and EMG RMS (24.82%) ( P < 0.001) were found in the immobilization group. However, no significant changes occurred in the immobilization with muscle vibration group. Such findings suggested that 2 weeks of immobilization resulted in neural impairments as evidenced by the reduction in EMG and V wave, and that such decrease was prevented by the intervention of muscle vibration during the immobilization period.

Proteomic Analysis of Differential Protein Expression of Achilles Tendon in a Rabbit Model by Two-Dimensional Polyacrylamide Gel Electrophoresis at 21 Days Postoperation

Postoperative early kinesitherapy has been advocated as an optimal method for treating Achilles tendon rupture. However, an insight into the rationale of how early kinesitherapy contributes to healing of Achilles tendon remains to be achieved, and research in the area of proteomic analysis of Achilles tendon has so far been lacking. Forty-two rabbits were randomized into control group, immobilization group, and early motion group, and received postoperative cast immobilization and early motion treatments. Achilles tendon samples were prepared 21 days following microsurgery, and the proteins were separated with two-dimensional polyacrylamide gel electrophoresis. Differentially expressed proteins were first recognized by PDQuest software, and then identified using peptide mass fingerprinting, tandem mass spectrometry, and database searching. A total of 463 ± 12, 511 ± 39, and 513 ± 80 protein spots were successfully detected in the two-dimensional polyacrylamide gels for the Achilles tendon samples of rabbits in the control group, immobilization group, and early motion group, respectively. There were 15, 8, and 9 unique proteins in these three groups, respectively, and some differentially expressed proteins were also identified in each group. It was indicated that some of the differentially expressed proteins were involved in various metabolism pathways and may play an important role in healing of Achilles tendon rupture. Postoperative early kinesitherapy resulted in differentially expressed proteins in ruptured Achilles tendon compared with those treated with postoperative cast immobilization. These differentially expressed proteins may contribute to healing of Achilles tendon rupture through a mechanobiological mechanism due to the application of postoperative early kinesitherapy.

Differentially expressed proteins on postoperative 3 days healing in rabbit Achilles tendon rupture model after early kinesitherapy

Objective Surgical repair of Achilles tendon (AT) rupture should immediately be followed by active tendon mobilization. The optimal time as to when the mobilization should begin is important yet controversial. Early kinesitherapy leads to reduced rehabilitation period. However, an insight into the detailed mechanism of this process has not been gained. Proteomic technique can be used to separate and purify the proteins by differential expression profile which is related to the function of different proteins, but research in the area of proteomic analysis of AT 3 days after repair has not been studied so far. Methods Forty-seven New Zealand white rabbits were randomized into 3 groups. Group A (immobilization group, n=16) received postoperative cast immobilization; Group B (early motion group, n=16) received early active motion treatments immediately following the repair of AT rupture from tenotomy Another 15 rabbits served as control group (Group C). The AT samples were prepared 3 days following the microsurgery. The proteins were separated employing two-dimensional polyacrylamide gel electrophoresis (2D-PAGE). PDQuest software version 8.0 was used to identify differentially expressed proteins, followed by peptide mass fingerprint (PMF) and tandem mass spectrum analysis, using the National Center for Biotechnology Information (NCBI) protein database retrieval and then for bioinformatics analysis. Results A mean of 446.33, 436.33 and 462.67 protein spots on Achilles tendon samples of 13 rabbits in Group A, 14 rabbits in Group B and 13 rabbits in Group C were successfully detected in the 2D-PAGE. There were 40, 36 and 79 unique proteins in Groups A, B and C respectively. Some differentially expressed proteins were enzyme with the gel, matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We successfully identified 9 and 11 different proteins in Groups A and B, such as GAPDH, phosphoglycerate kinase 1, pro-alpha-1 type 1 collagen, peroxiredoxin 1, alpha-1-antiproteinase E a-1 and MAD2L1 binding protein, etc. And some with the molecular chaperone, oxidative stress, energy metabolism, signal transduction, coupled with the tendon cell expression and protein synthesis, proliferate, differentiate and are closely related to the AT healing. The GAPDH protein was further validated through Western blotting. It was indicated that some differentially expressed proteins were involved in various metabolism pathways and may play an important role in initial healing of AT rupture. Conclusion Differentially expressed proteins in rabbit healing AT model may contribute to 3 days healing of AT rupture through a new mechanobiological mechanism due to the application of postoperative early kinesitherapy.

Low Temperature Plasma Treatment for Immobilization of Biomaterials on Polymer Surface

In some medical use, surface property such as biocompatibility and blood compatibility is very important. To improve the surface property of polymers, ammonia plasma was used to introduce amino group onto polymer surface in order to bind with heparin. The amount and the selectivity of amino group were improved by plasma treatment. The ratio of sulfur contained in heparin to carbon also increased from 0.5% to 10% by plasma process. The positive correlation can be found between heparin immobilization and amino group introduced by plasma. The immobilized heparin is strongly connected and it enhances the anticoagulant property on the surface.

Comparative study on the effect of vitamin K versus combined Ca and vitamin D administration on the prevention of experimentally-induced osteoporosis in adult male albino rats

Introduction Immobilization is one of the important causes of osteoporosis especially after cast application and in the elderly people who might be bedridden or suffering from joint diseases. The aim of this study To compare between the effects of vitamin K and the combined use of Ca and vitamin D on the prevention of experimentally-induced osteoporosis of the femur. Materials and methods This study included 24 adult male albino rats. They were divided into four groups: group 1 (control group), group 2 (immobilization group that were immobilized by casting of their right lower limb for 4 weeks), group 3 (immobilization group that concomitantly received 0.0009 mg/g body weight of vitamin K daily during the casting period), and group 4 [that was given Ca (0.09 mg/g body weight daily) and vitamin D (0.5 μg/kg alfacalcidol daily) during the casting period]. At the end of the experiment, the distal end of the femur of the immobilized limb was taken, processed, and examined by different histological techniques. A morphometric study was conducted to measure cancellous bone thickness, osteoid thickness, osteoid surface percentage, and the eroded surface percentage. The data were statistically analyzed. Results It was observed that immobilization caused marked thinning of the cancellous bone trabeculae. Erosion cavities were frequently seen in both compact and cancellous bones. Increased mean eroded surface percentage and decreased mean osteoid thickness and mean osteoid surface percentage were also noticed with immobilization when compared with the control group. Concomitant administration of vitamin K with casting resulted in significant improvement of most of the above-mentioned bone parameters. With combined administration of Ca and vitamin D with immobilization, erosion cavities were still seen in a few areas. Decreased mean cancellous bone thickness was also noticed when compared with groups 1 and 3. Conclusion According to the results of this experiment, vitamin K proved to be more effective, as a protective agent, than combined Ca and vitamin D administration in cases of immobilization osteoporosis. Level of evidence Level three in vitro (prospective case–control study in vitro).

Optimization of a ligand immobilization and azide group endcapping concept via “Click-Chemistry” for the preparation of adsorbents for antibody purification

This report describes and compares different strategies to deactivate (endcap) epoxide groups and azide groups on bio-chromatographic support surfaces, before and after ligand attachment. Adsorbents possessing epoxide groups were deactivated using acidic hydrolysis or were endcapped with 2-mercaptoethanol or 2-ethanolamine. The influence of surface-bound 2-ethanolamine was demonstrated for the triazine-type affinity adsorbent B14-2LP-FractoAIMs-1, which was tested in combination with the weak anion exchange material 3-aminoquinuclidine-FractoAIMs-3 (AQ-FA3). Azide groups were modified with 2-propargylalcohol using Click-Chemistry. Besides the conventional one-pot Click reaction, an alternative approach was introduced. This optimized Click protocol was employed (i) for the preparation of the weak anion exchange material AdQ-triazole-Fractogel (AdQ-TRZ-FG) and (ii) for the endcapping of residual azide groups with 3-propargyl alcohol. Using the new Click reaction protocol the ligand immobilization rate was doubled from 250 to 500 μmol/g dry adsorbent. Furthermore, the modified support surface was proven to be inert towards the binding of immunoglobulin G (IgG) as well as feed impurities. A thorough evaluation of modified surfaces and adsorbents was performed with dynamic binding experiments using cell culture supernatant containing monoclonal human immunoglobulin G (h-IgG-1). Besides SDS-Page, a recently introduced Protein A – size exclusion HPLC method (PSEC-HPLC) [1] was used to visualize the feed impurity composition and the IgG content of all collected sample fractions in simple PSEC-Plots. A surprising outcome of this study was the irreversible binding of IgG to azide modified surfaces. It was found that organic azide compounds, e.g. 1-azide-3-(2-propen-1-yloxy)-2-propanol (AGE-N3) promote antibody aggregation to a slightly higher extent than the inorganic sodium azide. The possibility that the Hofmeister Series of salt anions may be applicable to predict the properties of the corresponding organic compounds is discussed.

Effect of Early and Delayed Mechanical Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

Modulation of the mechanical environment may profoundly affect the healing tendon graft-bone interface. The purpose of this study was to determine how controlled axial loading after anterior cruciate ligament reconstruction affects tendon-to-bone healing. Our hypothesis was that controlled cyclic axial loading after a period of immobilization would improve tendon-to-bone healing compared with that associated with immediate axial loading or prolonged immobilization. One hundred and fifty-six male Sprague-Dawley rats underwent anterior cruciate ligament reconstruction with use of a flexor digitorum longus autograft. A custom-designed fixture was used to apply an external fixator across the knee parallel to the anterior cruciate ligament graft. Animals were randomly assigned to be treated with immobilization (n = 36) or controlled knee distraction along the long axis of the graft to achieve approximately 2% axial strain beginning (1) immediately postoperatively (n = 36), (2) on postoperative day 4 ("early delayed loading," n = 42), or (3) on postoperative day 10 ("late delayed loading," n = 42). The animals were killed at fourteen or twenty-eight days postoperatively for biomechanical testing, micro-computed tomography, and histomorphometric analysis of the bone-tendon-bone complex. Data were analyzed with use of a two-way analysis of variance followed by a post hoc Tukey test with p < 0.05 defined as significant. Delayed initiation of cyclic axial loading on postoperative day 10 resulted in a load to failure of the femur-anterior cruciate ligament-tibia complex at two weeks that was significantly greater than that resulting from immediate loading or prolonged immobilization of the knee (mean and standard deviation, 9.6 ± 3.3 N versus 4.4 ± 2.3 N and 4.4 ± 1.5 N, respectively; p < 0.01). The new-bone formation observed in the tibial tunnels of the delayed-loading groups was significantly increased compared with that in the immediate-loading and immobilization groups at both two and four weeks postoperatively (1.47 ± 0.11 mm(3) [postoperative-day-10 group] versus 0.89 ± 0.30 mm(3) and 0.85 ± 0.19 mm(3), respectively, at two weeks; p < 0.003). There were significantly fewer ED1+ inflammatory macrophages and significantly more ED2+ resident macrophages at the healing tendon-bone interface in both delayed-loading groups compared with the counts in the immediate-loading and immobilization groups at two and four weeks (2.97 ± 0.7 [postoperative day 10] versus 1.14 ± 0.47 and 1.71 ± 1.5 ED2+ cells, respectively, per high-power field at two weeks; p < 0.02). The numbers of osteoclasts in the delayed-loading groups were significantly lower than those in the immediate-loading and immobilization groups at two and four weeks postoperatively (0.35 ± 0.15 [postoperative-day-10 group] versus 1.02 ± 0.08 and 1.44 ± 0.2 cells, respectively, per high-power field at two weeks; p < 0.01), and the delayed-loading groups also had significantly reduced interface tissue vascularity compared with the other groups (p < 0.003). Delayed application of cyclic axial load after anterior cruciate ligament reconstruction resulted in improved mechanical and biological parameters of tendon-to-bone healing compared with those associated with immediate loading or prolonged postoperative immobilization of the knee.

Effect of Celastrus paniculatus seed oil (Jyothismati oil) on acute and chronic immobilization stress induced in swiss albino mice

Stress alters the homeostasis and is produced by several factors. Immobilization stress induced due to reduced floor area provided for the mobility results in the imbalance of oxidant and antioxidant status. The modern computer savvy world decreases human mobility in the working environment, leading to the formation of oxygen free radicals and if left untreated might result in severe health problems like hypertension, cardiovascular disease, premature aging and brain dysfunction. Hence, modern medicines rely upon the medicinal plants for some drugs with zero side effects. In this context, Jyothismati oil (JO), extracted from Celastrus paniculatus seeds, was used to treat acute and chronic immobilization induced experimentally. C. paniculatus plant is considered to be rich in antioxidant content and so the seed oil extract's efficacy was tested against immobilization stress in albino mice. The animals were kept in a restrainer for short and long durations, grouped separately and fed with the drug. Animals were sacrificed and the samples were analyzed. The antioxidant enzyme levels of the animals regained and markedly increased in the acute and chronic immobilized groups, respectively. The results suggested that the extract of C. paniculatus seed was highly efficacious in reducing the stress induced by least mobility for hours.

Development and Validation of a Motion and Loading System for a Rat Knee Joint In Vivo

The influence of biomechanical stimuli on modulating cartilage homeostasis is well recognized. However, many aspects of cellular mechanotransduction in cartilage remain unknown. We developed a computer-controlled joint motion and loading system (JMLS) to study the biological response of cartilage under well-characterized mechanical loading environments. The JMLS was capable of controlling (i) angular displacement, (ii) motion frequency, (iii) magnitude of the axial compressive load applied to the moving joint, and it featured real-time monitoring. The accuracy and repeatability of angular position measurements, the kinematic misalignment error as well as the repositioning error of the JMLS were evaluated. The effectiveness of the JMLS in implementing well-defined loading protocols such as moderate Passive Motion Loading (PML) and increased Compressive Motion Loading (CML) were tested. The JMLS demonstrated remarkable accuracy and reliability for the measurement and kinematics tests. Moreover, the effectiveness test demonstrated the ability of the JMLS to produce an effective stimulus via PML that led to the suppression of the catabolic effects of immobilization. Interestingly, the biological response of the CML group was catabolic and exhibited a pattern similar to that observed in the immobilization group. This novel non-invasive system may be useful for joint biomechanics studies that require different treatment conditions of load and motion in vivo.

Effects of rehabilitation training on the expression of synaptophysin in the ischemic cerebral cortex

Objective To study the effects of rehabilitation training on the expression of synaptophysin in the cortex after cerebral ischemia. Methods A model of focal cerebral ischemia was created in rats. The rats were divided into 4 groups at random 24 h after the cerebral ischemia was induced. The rehabilitation group was given bal-ancing, grasping, rotation, walking and other training every day. An immobilization group was fixed in their cages. The model control group and cerebral ischemia group were kept in general cages, taking food and moving freely. Im-munohistochemisty method was used to detect synaptophysin expression at the 1st, 7th, 14th, 21st and 28th day after the cerebral ischemia was induced. Results In the model control group, synaptophysin immunoreactive positive products were observed. In the cerebral ischemia group, the expression of synaptophysin decreased gradually. After rehabilitation training, synaptophysin immunoreactive positive products decreased slowly, but remained more abun-dant than among the immobilized rats. Conclusion After cerebral ischemia, the expression of synaptophysin de-creases. This demonstrates that the synaptic terminals were less injured. Rehabilitation training can enhance synapto-genesis in the cortex after cerebral ischemia. Key words: Cerebral ischemia; Rehabilitation training; Synaptophysin

Avaliação dos parâmetros cardiorrespiratórios, hemogasométricos e da concentração plasmática de cortisol em bovinos submetidos à imobilização eletromagnética

As formas de imobilização em bovinos mais utilizadas levam a uma manipulação excessiva e consequentemente estressante para o animal. A dor é uma experiência emocional de sensação desagradável que vem associada a um prejuízo tecidual. Surge no mercado um método de contenção física para bovinos que propõe a utilização de um aparelho que funciona com ondas eletromagnéticas de baixa intensidade promovendo imobilização sem estresse e ou estímulo doloroso para o animal. O objetivo deste projeto foi avaliar os parâmetros cardiorrespiratórios e hemogasométricos bem como os níveis de cortisol de bovinos submetidos à imobilização eletromagnética, a fim de observar se tal método é eficaz na diminuição do estresse e/ou estímulo doloroso. Foram utilizados 6 bovinos, mestiços, peso médio de 300,3 kg (±85,76). Os animais foram alocados aleatoriamente em dois grupos (controle dele mesmo): grupo controle (GC), introdução da sonda via retal (desligada); grupo Imobilizador (GI) introdução da sonda e permanência desta ligada por 5 minutos. Análise estatística utilizou o Teste T pareado entre os grupos (P&lt;0,05) e a avaliação entre tempos dentro de cada grupo análise de variância de uma única via com repetições múltiplas (ANOVA - RM). Momentos avaliados M0: basal; M1: imediatamente após a retirada da sonda; M2 e M3 (30 e 60 minutos após M1 respectivamente). Houve um aumento significativo nas variáveis: frequências cardíaca e respiratória em (M1), na Pressão arterial média (M1, M2, M3) e níveis de cortisol nos momentos M1 e M2 no grupo imobilizador quando comparado ao grupo controle. Com relação à resposta ao estímulo, o GI teve resposta negativa no momento da estimulação, comparado ao GC (resposta máxima). De acordo com os resultados obtidos, podemos concluir que o imobilizador eletromagnético é um método, exclusivamente, de contenção física, não oferecendo nenhum suporte anestésico, para o conforto ou bem estar ao animal.

The Effect of Postoperative Passive Motion on Rotator Cuff Healing in a Rat Model

Surgical repairs of torn rotator cuff tendons frequently fail. Immobilization has been shown to improve tissue mechanical properties in an animal model of rotator cuff repair, and passive motion has been shown to improve joint mechanics in animal models of flexor tendon repair. Our objective was to determine if daily passive motion would improve joint mechanics in comparison with continuous immobilization in a rat rotator cuff repair model. We hypothesized that daily passive motion would result in improved passive shoulder joint mechanics in comparison with continuous immobilization initially and that there would be no differences in passive joint mechanics or insertion site mechanical properties after four weeks of remobilization. A supraspinatus injury was created and was surgically repaired in sixty-five Sprague-Dawley rats. Rats were separated into three postoperative groups (continuous immobilization, passive motion protocol 1, and passive motion protocol 2) for two weeks before all underwent a remobilization protocol for four weeks. Serial measurements of passive shoulder mechanics (internal and external range of motion and joint stiffness) were made before surgery and at two and six weeks after surgery. After the animals were killed, collagen organization and mechanical properties of the tendon-to-bone insertion site were determined. Total range of motion for both passive motion groups (49% and 45% of the pre-injury values) was less than that for the continuous immobilization group (59% of the pre-injury value) at two weeks and remained significantly less following four weeks of remobilization exercise. Joint stiffness at two weeks was increased for both passive motion groups in comparison with the continuous immobilization group. At both two and six weeks after repair, internal range of motion was significantly decreased whereas external range of motion was not. There were no differences between the groups in terms of collagen organization or mechanical properties. In this model, immediate postoperative passive motion was found to be detrimental to passive shoulder mechanics. We speculate that passive motion results in increased scar formation in the subacromial space, thereby resulting in decreased range of motion and increased joint stiffness. Passive motion had no effect on collagen organization or tendon mechanical properties measured six weeks after surgery.

Fisioterapia após substituição artroscópica do ligamento cruzado cranial em cães: II - avaliação artroscópica e anatomopatológica

Avaliou-se o enxerto da fascia lata na substituição artroscópica do ligamento cruzado cranial (LCC), realizou-se a caracterização histológica do enxerto e da interface enxerto-osso e avaliou-se, por meio de exames artroscópicos e anatomopatológicos, o efeito da fisioterapia pós-operatória. Foram utilizados 16 cães, sem raça definida, machos, pesando entre 19,2 e 26,3kg, submetidos à ruptura experimental do LCC e subsequente substituição artroscópica desse ligamento pelo enxerto autógeno da fascia lata. Os animais foram distribuídos em dois grupos de oito cada: no grupo I, os cães foram submetidos ao programa de fisioterapia pós-operatória e, no grupo II, à imobilização temporária do membro. Os exames artroscópicos e histológicos mostraram alterações articulares sugestivas de processo degenerativo aos 60 dias após a cirurgia, que se apresentavam mais acentuadas nos cães do grupo II. Na análise histológica do enxerto, observou-se reorganização das fibras colágenas, que ocorreu de forma mais intensa e precoce nos animais do grupo I. Houve progressiva integração das fibras colágenas na interface enxerto-osso. Conclui-se que é viável utilizar a fascia lata como substituto do LCC por cirurgia artroscópica, que o enxerto sofre processos de ligamentação e de osteointegração, e que a fisioterapia reduz a progressão das alterações degenerativas e incentiva o processo de ligamentação do enxerto.

Evaluation of functional recovery of unstable ankle fractures after cast immobilization and early weight-bearing: a prospective trial

Objective To evaluate the functional recovery of unstable ankle fractures prospectively after early weight-bearing and cast immobilization. Methods From October 2003 to October 2007, 100 patients who had sought medical management in our department for unstable ankle fractures were enrolled in this prospective study. All patients were treated with open reduction and internal fixation (ORIF), according to the AO/ASIF principles. They were randomized into 2 even groups, one receiving early weight-bearing and the other cast immobilization. The functional recovery was evaluated in terms of Olernd score, Tegner score, pain intensity[merical rating scale (NRS)], full weight-bearing time, return-to-work time, and hospital stay time. Results Forty-six patients in early weight-bearing group and 45 patients in immobilization group finished follow-ups. There was no difference in Olernd score, Tegner score or NRS between the 2 groups, and all pa-tients got a good Olerud score and returned to work. Total weight-beating time in early weight-beating group was 4 weeks less than in immobilization group. Conclusion Early weight-bearing may be recommended for patients who have got a stable osteosynthesis of their fractured ankles as judged by their responsible surgeons, fine compliance, and a high motivation. Key words: Ankle joint; Fractures; Recovery of function; Rehabilitation

The effects of rehabilitation on learning,memory and expression of NCAM in rats with vascular dementia

Objective To investigate the effect of rehabilitation training on learning and memory ability and the expression of neural cell adhesion molecule(NCAM)in rats modeling vascular dementia.Methods Foay-five female Sprague-Dawley rats were randomly assigned to a rehabilitation group(20 rats),an immobilization group(20 rats),or a sham-operation group(5 rats).The experimental vascular dementia model was established by repeatedly clipping the common carotid artery to induce repetitive isehemia-reperfusion,and by reducing blood pressure with intra-abdominal injection of sodium nitroprusside.The rats' learning and memory were tested on the 27th and 28th days after the operation using a water-maze step-down avoidance test.A RT-PCR technique was used to detect NCAM expression around the hippocampal area at different times after the operation.Results The rehabilitation group rats showed significantly better learning and memory ability than those in the immobilization group.NCAM was also more strongly expressed in their hippocampi than in those of the immobilization group and sham-operation group.Conclusion Rehabilitation can accelerate recovery of learning and memory ability in rats,and the mechanism possibly is related to the increase of NCAM expression in the hippocampus. Key words: Vascular dementia; Rehabilitation training; Learning and memory; Neural cell adhesion molecule

A Randomized Clinical Trial Comparing Immediate Active Motion With Immobilization After Tendon Transfer for Claw Deformity

Immobilization after tendon transfers has been the conventional postoperative management. A recent study indicated beneficial effects of an immediate active motion protocol (IAMP) after tendon transfer for claw deformity correction compared with effects in a historical cohort. In this study, we further tested this hypothesis in a randomized clinical trial comparing the effectiveness of the IAMP with that of conventional immobilization. Fifty supple claw hand deformities were randomized postoperatively into 2 equal groups for IAMP and immobilization. Therapy began on the second postoperative day for the IAMP group and on the twenty-second postoperative day for the immobilization group. The primary outcome measures were deformity correction, active range of motion of digits, tendon transfer insertion pullout, and time until discharge from rehabilitation. Secondary outcome measures were swelling, pain, hand strength, and dexterity. Both groups were compared at discharge from rehabilitation and at the last clinical follow-up (at least 1 year postoperatively). Assessments were available for all 50 patients at discharge and for 23 patients in each group at follow-up. The average follow-up was 18 months for the IAMP group and 17 months for the immobilization group. Deformity correction, range of motion, swelling, dexterity, and hand strength were similar for both groups at discharge and a follow-up. There was no evidence of tendon insertion pullout in any patient of either group. Relief of pain was achieved significantly earlier with IAMP. Morbidity was reduced by, on average, 22 days with IAMP. We found that the immediate active motion protocol is safe and has similar outcomes compared with those of immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function. Immediate motion after tendon transfer can significantly reduce morbidity and speed up the rehabilitation of paralytic limbs, and it may save expense for the patients.

Metabolic and morphometric alterations inherent to neuromuscular electric stimulation in the antagonist muscle submitted to ankle joint immobilization

The aim of this work was to investigate the effect of the neuromuscular electrical stimulation (ES) on the metabolic and morfometric profile of the tibialis anterior muscle, antagonist to the soleus muscle which was stimulate, under the joint immobilization condition of the ankle for 7 and 15 days. The immobilization promoted the reduction in the muscle mass (I7: 17.36%, I15: 20.83%), in the glycogen content (I7: 48%, I15: 48%), in the muscle fibers areas (I7: 27%, I15: 40%) and increase in intramuscular connective tissue density (I7: 122%, I15: 206%). The EE didn't promote significant alterations in the mass of the immobilized groups, however, promoted increase in the glycogen (IEE7: 31.25%; IEE15: 56.25%), reduction in the muscle fibers areas (IEE7: 14%, IEE15: 24.69%) and reduction in the connective tissue density (IEE7: 25.63%, IEE15: 49.09%) when compared with the respective immobilized groups.

Effects of Practice, Visual Loss, Limb Amputation, and Disuse on Motor Imagery Vividness

Background. The ability to generate vivid images of movements is variable across individuals and likely influenced by sensorimotor inputs. Objectives. The authors examined (1) the vividness of motor imagery in dancers and in persons with late blindness, with amputation or an immobilization of one lower limb; (2) the effects of prosthesis use on motor imagery; and (3) the temporal characteristics of motor imagery. Methods. Eleven dancers, 10 persons with late blindness, 14 with amputation, 6 with immobilization, and 2 groups of age-matched healthy individuals (27 in control group A; 35 in control group B) participated. The Kinesthetic and Visual Imagery Questionnaire served to assess motor imagery vividness. Temporal characteristics were assessed with mental chronometry. Results. The late blindness group and dance group displayed higher imagery scores than respective control groups. In the amputation and immobilization groups, imagery scores were lower on the affected side than the intact side and specifically for imagined foot movements. Imagery scores of the affected limb positively correlated with the time since walking with prosthesis. Movement times during imagination and execution (amputation and immobilization) were longer on the affected side than the intact side, but the temporal congruence between real and imagined movement times was similar to that in the control group. Conclusions. The mental representation of actions is highly modulated by imagery practice and motor activities. The ability to generate vivid images of movements can be specifically weakened by limb loss or disuse, but lack of movement does not affect the temporal characteristics of motor imagery.