After spinal cord injury (SCI), motoneuron death occurs at and around the level of injury which induces changes in function and organization throughout the nervous system, including cortical changes. Muscle affected by SCI may consist of both innervated (accessible to voluntary drive) and denervated (inaccessible to voluntary drive) muscle fibers. Voluntary activation measured with transcranial magnetic stimulation (VATMS) can quantify voluntary cortical/subcortical drive to muscle but is limited by technical challenges including suboptimal stimulation of target muscle relative to its antagonist. (...) The motor evoked potential (MEP) in the biceps compared to the triceps (i.e., MEP ratio) may be a key parameter in the measurement of biceps VATMS after SCI. We used paired pulse TMS, which can inhibit or facilitate MEPs, to determine whether the MEP ratio affects VATMS in individuals with tetraplegia. Ten individuals with tetraplegia following cervical SCI and ten non-impaired individuals completed single pulse and paired pulse VATMS protocols. Paired pulse stimulation was delivered at 1.5, 10, and 30 ms inter-stimulus intervals (ISI). In both the SCI and non-impaired groups, the main effect of the stimulation pulse (paired pulse compared to single pulse) on VATMS was not significant in the linear mixed-effects models. In both groups for the stimulation parameters we tested, the MEP ratio was not modulated across all effort levels and did not affect VATMS. Linearity of the voluntary moment and superimposed twitch moment relation was lower in SCI participants compared to non-impaired. Poor linearity in the SCI group limits interpretation of VATMS. Future work is needed to address methodological issues that limit clinical application of VATMS. (shrink)

This systematic review identifies and critically evaluates instruments that have been developed to measure clinical trial informed consent comprehension in non-cognitively-impaired adults.Literature searches were carried out on Medline (Ovid), PsycInfo, CINHAL, ERIC, ScienceDirect, and Cochrane Library for English language articles published between January 1980 and September 2008. Instruments were excluded if they focused on consent onto paediatric trials, the construct under study was primarily capacity or competency, or the instrument was developed specifically for psychiatric or cognitively-impaired populations. Instruments selected for (...) review were evaluated against the following criteria: (1) method of item generation; (2) type and format of test items; (3) administration and interpretation of test results; and (4) psychometric properties.Three instruments met our defined inclusion criteria: the Deaconess Informed Consent Comprehension Test (DICCT), the Quality of Informed Consent (QuIC) questionnaire and the Brief Informed Consent Protocol (BICEP). Each instrument varied in terms of content measured. Significantly, these are the first standardized instruments developed to assess comprehension in non-cognitively-impaired adults. Yet, each instrument had its own set of limitations such as the lack of generalizability and the absence of details pertaining to how test results should be used to guide clinical decision-making.Standardized clinical trial informed consent comprehension assessments have been developed to identify gaps in research participants' understanding and ensure that respect for patient autonomy is satisfied. (shrink)

The use of upper limb vibration during exercise and rehabilitation continues to gain popularity as a modality to improve function and performance. Currently, a lack of knowledge of the pathways being altered during ULV limits its effective implementation. Therefore, the aim of this study was to investigate whether indirect ULV modulates transmission along spinal and corticospinal pathways that control the human forearm. All measures were assessed under CONTROL and ULV conditions while participants maintained a small contraction of the right flexor (...) carpi radialis muscle. To assess spinal pathways, Hoffmann reflexes elicited by stimulation of the median nerve were recorded from FCR with motor response amplitudes matched between conditions. An H-reflex conditioning paradigm was also used to assess changes in presynaptic inhibition by stimulating the superficial radial nerve 37 ms prior to median nerve stimulation. Cutaneous reflexes in FCR elicited by stimulation of the SR nerve at the wrist were also recorded. To assess corticospinal pathways, motor evoked potentials elicited by transcranial magnetic stimulation of the contralateral motor cortex were recorded from the right FCR and biceps brachii. ULV significantly reduced H-reflex amplitude by 15.7% for both conditioned and unconditioned reflexes. Therefore, ULV inhibits cutaneous and H-reflex transmission without influencing corticospinal excitability of the forearm flexors suggesting increased presynaptic inhibition of afferent transmission as a likely mechanism. A general increase in inhibition of spinal pathways with ULV may have important implications for improving rehabilitation for individuals with spasticity. (shrink)

The pressure to change our bodies is overwhelming. We strive to defy ageing, build our biceps, cure our disabilities, conceal our quirks. Surrounded by filtered photos and surgically-enhanced features, we must contort our physical selves to prejudiced standards of beauty. Perfection is impossible, and even an acceptable body seems out of reach. In this thought-provoking, original work, acclaimed political philosopher Clare Chambers argues that the unmodified body is a key political principle. While defending individuals' right to change their bodies, (...) she argues that the social pressures to modify undermine equality. She shows how the connected ideas of the natural body, the normal body, and the whole body have been used both to disrupt and to maintain social hierarchies - sometimes oppressing, other times liberating. The body becomes a site of political importance- a place where hierarchies of sex, gender, race, disability, age, and class are reinforced. Through a clear-sighted analysis of the power dynamics that structure our society, and with examples ranging widely from bodybuilding to breast implants, deafness to male circumcision, biology to gender identity, Intact stresses that we must break away from the oppressive forces that demand we alter our bodies. Instead, it offers a bold, transformative vision of the human body that is equal without expectation. (shrink)

Leg rigidity is associated with frequent falls in people with Parkinson’s disease, suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be (...) sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls. (shrink)

The present study examined the effects of transcranial direct current stimulation using Halo Sport on the time to exhaustion in relation with muscle activities and corticomuscular coupling of agonist and antagonist muscles during a sustained isometric fatiguing contraction performed with the elbow flexors. Twenty healthy male college students were randomly assigned to tDCS group and control group. The two group participants performed two experimental sessions which consisted of pre-fatigue isometric maximal voluntary contraction, sustained submaximal voluntary contractions performed to exhaustion, and (...) post-fatigue MVC with the right elbow flexor muscles. Sham stimulation and tDCS were applied for control and tDCS group participants 20 min prior to the second session test, respectively. MVC strength in pre- and post-fatigue test, TTE, electroencephalogram, and electromyography of biceps brachii and triceps brachii were recorded during the tests. It was found that tDCS using the Halo Sport device significantly increased TTE and thus improved muscular endurance performance. The improvement may be partly related to the improvement of neuromuscular efficiency as reflected by decrease of antagonistic muscle coactivation activities, which may be related to cortical originated central processing mechanism of neuromuscular activities. (shrink)

En 1670, el autor español Juan Caramuel publicó en Italia el segundo tomo de una magna obra, Mathesis biceps (publicada en latín), sobre el saber matemático de su época. En el mismo se incluía un capítulo (un "sintagma" según el propio Caramuel), titulado Kybeia ("juegos de dados" en griego), donde el autor introduce su idea del origen del juego y resuelve algunos problemas relacionados con los mismos, convirtiéndose en una de las obras tempranas sobre cálculo de probablidades. En este (...) texto se da un repaso a los antecedentes al trabajo de Caramuel relacionados con el cálculo de probabilidades, se analiza punto por punto la aportación de este autor al nuevo cálculo en su Kybeia, y se añade la traducción al castellano del mismo. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Operating Through HatredAndrew G. Shuman“You’re not cutting my ***ing neck. The cancer is in my ***ing mouth.”While many patient encounters are memorable, Mr. K’s introduction to the head and [End Page 20] neck surgical oncology clinic is indelibly imprinted into the minds of all of the clinicians present on that certain autumn morning. This was, quite simply, a man who resonated hate. He was rude and disruptive. He insisted (...) on an expedited workup “without any waiting.” He questioned the ethnicity and nationality of his care providers. He told me, in no uncertain terms, that he did not appreciate my Jewish heritage—the swastika tattooed on his bicep underscored the point. He bragged about his recent incarceration for armed robbery. While my colleagues and I were tempted to simply refuse to assume his care, Mr. K had a bad problem—his recurrent tongue cancer required a major operation in order to offer him any hope for cure.Mr. K initially received an abbreviated course of radiation at an outside institution, which was limited by his non–compliance. While one might debate the wisdom of this decision in retrospect—in general, surgery is preferred for his type of tumor—the die was already cast. A heroic attempt at surgical salvage was now his only curative option. He previously sought care elsewhere... only to be fired by this original surgeon when Mr. K physically threatened him in the outpatient office during preoperative consultation. [It was the doctor’s fault for insulting him in the first place, Mr. K maintained... and no charges were filed.] We were, indeed, his last resort. Other than his recurrent cancer, Mr. K was robust; he was in his sixth decade, physically fit, and on the whole, fairly healthy. In the classic surgical lexicon, he was a reasonable surgical candidate. But was it reasonable to operate on such a person?I remember thinking, at the time, about our obligation to care for such an individual. Of course, being a medical professional carries with it many obligations, including a judicious assumption of personal risk. And, working in a tertiary care center begets the responsibility to assist referring clinicians in the management of difficult cases. Although professional obligations certainly have their limits, defining their bounds is decidedly more difficult. Paramount is creating an atmosphere of mutual trust and acceptance. Naturally, this was easier said than done in regard to Mr. K.Perhaps against our better judgment, we agreed to operate under the condition that he abide by strict behavioral ground rules, on our terms. We agreed upon the extent of the necessary operation (which indeed involved cutting his ***ing neck, much to his chagrin and reluctant acceptance). Mr. K promised to follow instructions for postoperative care. He assured us that he would not swear or yell (again). And, in the presence of hospital security, who reinforced our institutional policies regarding patient behavior, he guaranteed that he would not be verbally or physically violent or inappropriate, and would not make disparaging comments to other patients or staff. It seemed, at least, that we had an understanding.Needless to say, these rules were broken shortly after he awoke from surgery. I vividly remember being summoned from the OR when he threatened to murder his impressionable and terrified nurse a few days later, who would not acquiesce to his unreasonable demands. From that point onward, hospital security was deployed to his room regularly, and anything resembling a potential weapon was safeguarded. Any semblance of a mutual doctor–patient bond was shattered. At this point, everyone’s goal was simply to get Mr. K home.My visceral reactions to his behavior, while intense, were not unexpected, and fell in line with those of the entire team of clinicians caring for him. His antics brought his healthcare team together in collective unity (and condemnation). However, my surgical colleagues and I also felt somewhat guilty and responsible. While surgeons can choose to assume some degree of inherent personal danger in caring for a violent and angry patient, we also put the safety and soundness of the entire perioperative team in jeopardy, without necessarily seeking their input. But once we had decided to... (shrink)

The aim of this paper is to describe and assess the energetic-metabolic activity of selected muscles of upper and lower extremities during Rotational Training (RT). The influence of RT on temperature changes in the biceps and triceps brachii muscles as well as the quadriceps and biceps femoris muscles of healthy university students were verified, in addition to temperature differences between the left and right side before and after RT. The study was conducted on 18 subjects. RT was conducted (...) in accordance with accepted forms of training methodology of collective fitness. An important part of RT was the performance of circular and rotational movements. Thermograms taken before and immediately after RT focused on 4 regions of selected agonists and synergists in the upper and lower body. The camera used was the infrared hand-held CEDIP Titanium 560M IR (USA), located at a distance of 10 m from the subject. After RT, medianTsk(skin temperature) decreased in almost all of the examined ROIs, except for the left and right Qf (the quadriceps femoris, rectus femoris, and sartorius muscles) as well as the left Tb (triceps brachii) in female subjects. In male subjects, left and rightTskof Qf increased both for the left and right Tb. Left-Right ΔTsk(temperature difference) was statistically significant (p<0.05) for Of, Bf, Bb, Tb in female as well as male subjects. It was concluded that thermography is a non-invasive, safe, and low-cost method for the recording of physiological response of the skin to RT. (shrink)

The aim of this study was to evaluate the neuromuscular response to an agility and repeated sprint ability test according to the level of competition in futsal players. A total of 33 players from two elite teams and one amateur team participated in the study. The participants completed an agility t-test, a 30 m-speed test, and a RSA test. A countermovement jump test and a tensiomyography test of the rectus femoris and biceps femoris of both legs were carried out (...) before and after the tests. RSA test revealed better sprint times in elite players compared to amateurs in the seven bouts, as well as in the 30 m sprint and in the agility test. In conclusion, elite players showed greater performance in the RSA test, in the 30 m tests and in the agility test compared to amateur players. The contractile properties were not a key factor in the RSA performance of the futsal players. (shrink)

Objective: Stand-to-sit task is an important daily function, but there is a lack of research evidence on whether knee osteoarthritis affects the postural balance during the task. This study aimed to compare individuals with knee OA and asymptomatic controls in postural balance and identify kinematic and lower extremity muscle activity characteristics in individuals with knee OA during the stand-to-sit task.Methods: In total, 30 individuals with knee OA and 30 age-matched asymptomatic controls performed the 30-s Chair Stand Test at self-selected speeds. (...) Motion analysis data and surface electromyography were collected while participants performed the 30sCST. To quantify postural balance, the displacement of the center of mass and the peak instantaneous velocity of the CoM were calculated. The kinematic data included forward lean angles of the trunk and pelvic, range of motion of the hip, knee, and ankle joints in the sagittal plane. The averaged activation levels of gluteus maximus, vastus lateralis, vastus medialis, rectus femoris, biceps femoris, tibialis anterior, and medial head of gastrocnemius muscles were indicated by the normalized root mean square amplitudes.Results: Compared with the asymptomatic control group, the knee OA group prolonged the duration of the stand-to-sit task, demonstrated significantly larger CoM displacement and peak instantaneous CoM velocity in the anterior-posterior direction, reduced ankle dorsiflexion RoM, greater anterior pelvic tilt RoM, and lower quadriceps femoris and muscles activation level coupled with higher BF muscle activation level during the stand-to-sit task.Conclusion: This study indicates that individuals with knee OA adopt greater pelvic forward lean RoM and higher BF muscle activation level during the stand-to-sit task. However, these individuals exist greater CoM excursion in the anterior-posterior direction and take more time to complete the task. This daily functional activity should be added to the rehabilitation goals for individuals with knee OA. The knee OA group performs reduced ankle dorsiflexion RoM, quadriceps femoris, and TA activation deficit. In the future, the rehabilitation programs targeting these impairments could be beneficial for restoring the functional transfer in individuals with knee OA. (shrink)

Short-term limb immobilization results in skeletal muscle decline, but the underlying mechanisms are incompletely understood. This study aimed to determine the neurophysiologic basis of immobilization-induced skeletal muscle decline, and whether repetitive Transcranial Magnetic Stimulation could prevent any decline. Twenty-four healthy young males underwent unilateral limb immobilization for 72 h. Subjects were randomized between daily rTMS using six 20 Hz pulse trains of 1.5 s duration with a 60 s inter-train-interval delivered at 90% resting Motor Threshold, or Sham rTMS throughout immobilization. (...) Maximal grip strength, EMG activity, arm volume, and composition were determined at 0 and 72 h. Motor Evoked Potentials were determined daily throughout immobilization to index motor excitability. Immobilization induced a significant reduction in motor excitability across time. The rTMS intervention increased motor excitability at 0 h. Despite daily rTMS treatment, there was still a significant reduction in motor excitability, loss in EMG activity, and a loss of maximal grip strength after immobilization. Interestingly, the increase in biceps and posterior forearm skinfold thickness with immobilization in Sham treatment was not observed following rTMS treatment. Reduced MEPs drive the loss of strength with immobilization. Repetitive Transcranial Magnetic Stimulation cannot prevent this loss of strength but further investigation and optimization of neuroplasticity protocols may have therapeutic benefit. (shrink)