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Background: Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies. Methods: A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale. Results: Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment. Conclusions: These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults. [ABSTRACT FROM AUTHOR]

Background: Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies. Methods: A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale. Results: Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment. Conclusions: These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults.

Abstract Background Work-related musculoskeletal disorders (WMSDs) represent an important socio-economic burden. The current risk assessment and management involved in the ethiopathogenesis of WMSDs is based on observational tools and checklists, which have some limitations in terms of accuracy and reliability. The aim of this study was to assess WMSD prevalence and identify possible correlations with several socio-demographic and work-related variables in a large cohort representative of Italian workers in order to improve our understanding of the WMSD phenomenon. Methods This study includes data from INSuLa, a cross-sectional nationally representative survey of health and safety at work, developed by the Italian Workers’ Compensation Authority. A total of 8000 Italian workers were included. Multivariate logistic regression analyses were performed to evaluate the association of independent variables, such as workers’ perceptions of exposure to biomechanical/ergonomic and video display unit (VDU) risks (Risk Perceived) and the actual risk exposure (Risk Detected) on Back, Lower and Upper limb pain. Socio-demographic, occupational and other health-related variables were included to investigate possible association with musculoskeletal disorders. Results Workers perceiving a significant exposure to biomechanical/ergonomic and VDU risks but not included in a health surveillance program for them (Risk Perceived/No Risk Detected) have had significantly higher odds of reporting musculoskeletal disorders. Regarding the biomechanical/ergonomic risk these workers are in the 19–24 age range (39.9%), transportation, warehousing/information and communication sectors (38.9%) and are employed in companies with more than 250 workers (35.8%). Regarding VDU risk, workers are in the 45–54 age range (24.5%), professional, financial and business services (38.0%) and come from companies with more than 250 employees (25.6%). Conclusions Within the occupational safety and health management systems an appropriate assessment of occupational risk factors correlated to musculoskeletal disorders (mainly biomechanical/ergonomic and VDU) and the correct definition of their exposure levels is essential to adequately prevent the onset of WMSDs. In this regard, our findings provide useful information to design novel approaches, aimed at improving our understanding of emerging risks, identifying gaps in current risk assessment strategies and enhancing workplace interventions are mandatory to improve the occupational risk assessment and management process and therefore implement the subsequent health surveillance systems.

Purpose: This study aimed to clarify how children with congenital limb deficiencies visually attend to their bodies, particularly their limbs and prostheses. Methods: Participants included children with and without congenital limb deficiencies. They were shown photographs of themselves and their visual attention was measured using an eye tracker. Results: Six children with lower limb deficiencies (age [mean ± SD]: 8.8 ± 2.9; 2 girls and 4 boys), six children with upper limb deficiencies (age: 7.0 ± 2.3; 2 girls and 4 boys), and ten control children (age: 7.7 ± 1.9; 5 girls and 5 boys) were included. Children with congenital upper/lower limb deficiencies looked at their upper/lower limbs as often or more than the control children. Prompts to direct their visual attention to their limbs had limited efficacy. Conclusions: To improve the body knowledge of limbs, approaches other than visual recognition prompting, such as improving linguistic understanding, might be considered. [ABSTRACT FROM AUTHOR]

Study Design: A prospective, within-subject study was conducted.Objective: We aimed to compare the influence of anesthetic fade under maximum stimulation conditions between constant-current and constant-voltage stimulation techniques.Summary Of Background Data: The monitoring of muscle-evoked potentials after electrical stimulation to the brain [Br(E)-MSEP)] is useful for assessing the integrity of spinal cord motor tracts during major spine surgery. Nonetheless, Br(E)-MSEP responses are known to deteriorate over the duration of surgeries performed under general anesthesia. This phenomenon is known as anesthetic fade.Methods: We recruited 117 patients undergoing various spinal surgeries from the cervical to the lumbar level. We excluded 29 cases with insufficient data. The decrease rate of the Br(E)-MSEP amplitude for each muscle was examined. Br(E)-MSEP monitoring with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions was applied. Compound muscle action potentials (CMAPs) were bilaterally recorded from the abductor pollicis brevis, deltoid, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps muscles. We defined the decrease rate as follows: (initial CMAPs-final CMAPs)/initial CMAPs × 100. Differences in the decrease rate were evaluated between stimulators, limbs (upper vs. lower), and operative time group (lowest quartile vs. highest quartile).Results: The overall decrease rate (across all muscles) increased as the operative time increased, and the rate was higher in the lower limbs than in the upper limbs. In addition, the overall decrease rate was lower with constant-voltage stimulation than with constant-current stimulation. Furthermore, the decrease rate for constant-current stimulation was significantly higher than that for constant-voltage stimulation, regardless of the operative time.Conclusion: The CMAP waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Limb amputation can be defined as a procedure that consists of separating a limb or a segment of a limb from the body. Objectives: To describe the profile of limb amputation procedures performed at a large hospital run by the state of Pernambuco (Brazil). Methods: Cross-sectional descriptive and retrospective study conducted at a large hospital in the city of Recife, PE. Data were collected from the records of patients who underwent amputations during 2017. Records from patients who had had a limb amputation during 2017 were included, unless data were illegible or missing. Results: A total of 328 procedures were performed on 274 patients, the majority of whom were male (57.7%). There was a predominance of lower limb amputations (64.2%), of non-traumatic causes (86.5%), and urgent treatment (96.4%). The majority of patients who underwent amputations remained in hospital for 11 to 25 days (32.1%). The study found that the majority of amputees were discharged (69.7%), although a proportion died. Deaths of lower limb amputees were primarily among elderly women in the age range of 60 to 90 years (76%), females (55%), and patients subjected to a single amputation (91%). Conclusions: The data observed in this study are alarming, particularly considering that many of these amputations could have been avoided, since they were caused by complications of diseases that can be prevented and controlled at healthcare services of a lower level of complexity and at a relatively low cost. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prevention of Work-Related Musculoskeletal Disorders (WRMSDs) is crucial as they jeopardize the well-being of the workforce in workplaces and are prevalent in developed and developing countries. OBJECTIVE: This study aimed to determine the prevalence of WRMSDs among Iranian workers. METHODS: A systematic review and meta-analysis of WRMSDs in Iran was performed by searching relevant keywords in authentic databases and search engines such as SID, Google Scholar, Medlib and PubMed. Twenty-seven published articles in the field of WRMSDs from 2001 to 2010 were searched. Meta-analysis and random effects approach were used to analyze data. Heterogeneity investigation of articles was done using I2 index. RESULTS: The total sample size was 6,090 workers with a mean of 225 samples per study. The upper and lower back had the highest prevalence rate of self-reported WRMSDs with 38.1% (95% CI: 29.9–46.4), and 50% (95% CI: 42.5–57.5), respectively. Also, knee had the highest prevalence among lower extremity disorders with 42.1% prevalence rate (95% CI:35.1–49.1). CONCLUSIONS: A high prevalence of WRMSDs in upper and lower limbs was reported in Iran. Trainings with regard to occupational ergonomics and industrial hygiene programs were recommended for minimizing the work-related risks of musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

Introduction: The impact of psoriasis varies with the body region affected. In addition, patients have different perceptions of disease improvement and treatment satisfaction based on the location of skin clearance with treatment. The monoclonal antibody secukinumab selectively targets interleukin-17A-a central cytokine of psoriasis-and provides rapid and sustained clearance for moderate-to-severe psoriasis affecting all body regions. The objective of this study was to evaluate the efficacy of secukinumab on moderate-to-severe psoriasis affecting the trunk, upper limbs, and lower limbs. Methods: Data were pooled from four phase 3 studies. To be included in the analysis for each body region, patients were required to have a Psoriasis Area and Severity Index (PASI) score ≥12 for that body region and psoriasis covering ≥10% of the surface area of that region. Secukinumab was administered at Baseline, Weeks 1, 2 and 3, and then every 4 weeks from Week 4 to 48. Results: Across the trunk, upper limbs, and lower limbs, initial PASI subscore responses were sustained to Week 52. At Week 52, trunk (T) PASI 90/100 responses were achieved by 78.4%/71.1% of patients receiving secukinumab 300 mg, respectively, and by 66.3%/56.9% of patients receiving secukinumab 150 mg, respectively. At Week 52, upper limb (UL) PASI 90/100 responses were achieved by 67.3%/59.1% of patients receiving secukinumab 300 mg, respectively, and by 50.3%/43.3% of patients receiving secukinumab 150 mg, respectively. At Week 52, lower limb (LL) PASI 90/100 responses were achieved by 63.9%/55.3% of patients receiving secukinumab 300 mg, respectively, and by 45.1%/36.4% of patients receiving secukinumab 150 mg, respectively. A 50% reduction in mean PASI subscore occurred after 2.8, 2.9, and 3.4 weeks with secukinumab 300 mg on the trunk, upper limbs, and lower limbs, respectively. Conclusion: Secukinumab provided robust and sustained efficacy for moderate-to-severe psoriasis affecting the trunk, upper limbs, and lower limbs. Funding: Novartis Pharmaceuticals Corporation. Trial registration: ClinicalTrials.gov identifiers: NCT01365455, NCT01358578, NCT01555125, and NCT01636687. [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine the effect of training on selected markers of anaerobic capacity of upper and lower limbs in male, Greco-Roman wrestlers from 16 to 19 years of age. The study was conducted four times at one-year intervals on the same group of male competitors (n=12). Every year at the beginning of the second preparatory period all wrestlers performed arm cranking and leg cycling 30 s Wingate tests. The relative peak and mean power of upper limbs were higher in 17-, 18-, and 19-year-old wrestlers compared to 16-year-old ones, but were similar in 17- and 18-year-old athletes. The highest peak and mean power of legs were found in 19-year-old wrestlers. In 18-year-old athletes, the peak power was lower than in 17-year-olds and was similar to 16-year-old wrestlers. The relative mean power in the group of 18-year-old athletes was lower compared to 16- and 17-year-old ones, but it was similar in 17- and 19-year-old wrestlers. Changes in the levels of the relative peak and mean power of upper and lower limb muscles in wrestlers occurred at different periods between the age of 16 and 19. However, it seems that inappropriately chosen training loads may reduce short-term power outputs despite age correct increase in anthropometric parameters. Wrongly applied training did not bring positive effects and could inhibit, for some time, the natural development of power in young wrestlers.

Background: Several recent studies have described the presence of musculoskeletal complaints, presenting evidence that multisite musculoskeletal pain (MP) is more often present than single-site musculoskeletal pain. However, less is known about determinants of this multimorbidity, particularly, concerning the role of occupational factors and, mainly, what determines single or multisite pain. This study described the associations between pain in different body sites and investigated related factors to MP in workers from Brazil.Methods: A total of 1070 workers (228 women and 842 men), from urban cleaning services and from shoe manufacturers, participated in this cross sectional study (response 97 %). Interviewer-administered questionnaire included sociodemographic factors, physical and psychosocial work demands, leisure-time activities and musculoskeletal pain which was presence of pain in previous seven days, considering eight body sites and MP, the sum score of all painful sites, varying 0-8. A factor analysis was performed that captured the nine variables of physical exposure into two latent factors. Associations of pain between different body sites were assessed. Cox regression analyses, presenting the prevalence ratio (PR), showed the related factors to MP.Results: In the previous seven days, 30 % of workers had MP. For all body sites, comorbidity ranged from 72 % to 91 %. Having pain in one body site is associated with pain in other site and the associations between proximal sites were stronger than between more distal sites. High exposure to manual material handling and awkward postures (PR = 1.5, 95 % CI 1.1-2.0), job strain (PR = 1.2, 95 % CI 1.0-1.6), and low social support (PR = 1.3, 95 % CI 1.0-1.7) and being woman (PR = 1.7, 95 % CI 1.3-2.3) were associated with MP. Risk factors for single-site pain and for subsequent musculoskeletal comorbidity were very similar, suggesting an additive effect of risk factors.Conclusions: Most workers reported MP that was associated with several work-related factors. The findings support the idea that multisite pain is a continuum of single-site pain, maintained by exposure to several risk factors, rather than the result of a specific risk factor that initiates the multisite pain but not single-site pain. Workplace interventions are needed to decrease the number of pain sites, in order to improve the worker's health. [ABSTRACT FROM AUTHOR]

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Abstract: Fluid shifts toward the upper body may cause differences in the blood flow of the upper and lower limbs under microgravity compared to that under gravity conditions. Blood flow was compared between the upper and lower limbs in a sitting position under different gravity levels generated by parabolic flight of an airplane. The blood flow of both the upper and lower limbs increased immediately after 0 G. Thereafter, the blood flow of both the upper and lower limbs returned to the normal level observed under 1 G. The blood flow of the upper limbs remained at the normal level during 0 G and after 1.5 G, whereas the blood flow of the lower limbs decreased during 0 G. The decreased blood flow of the lower limbs recovered to the normal level after 1.5 G. We concluded that decreased blood flow, under microgravity conditions, is observed in the lower limbs, but not in the upper limbs. [Copyright &y& Elsevier]

Objective: To investigate the cardiac autonomic responses during upper versus lower limb discontinuous resistance exercise (RE) at different loads in healthy older men. Method: Ten volunteers (65±1.2 years) underwent the one-repetition maximum (1RM) test to determine the maximum load for the bench press and the leg press. Discontinuous RE was initiated at a load of 10%1RM with subsequent increases of 10% until 30%1RM, followed by increases of 5%1RM until exhaustion. Heart rate (HR) and R-R interval were recorded at rest and for 4 minutes at each load applied. Heart rate variability (HRV) was analyzed in 5-min segments at rest and at each load in the most stable 2-min signal. Results: Parasympathetic indices decreased significantly in both exercises from 30%1RM compared to rest (rMSSD: 20±2 to 11±3 and 29±5 to 12±2 ms; SD1: 15±2 to 8±1 and 23±4 to 7±1 ms, for upper and lower limb exercise respectively) and HR increased (69±4 to 90±4 bpm for upper and 66±2 to 89±1 bpm for lower). RMSM increased for upper limb exercise, but decreased for lower limb exercise (28±3 to 45±9 and 34±5 to 14±3 ms, respectively). In the frequency domain, the sympathetic (LF) and sympathovagal balance (LF/HF) indices were higher and the parasympathetic index (HF) was lower for upper limb exercise than for lower limb exercise from 35% of 1RM. Conclusions: Cardiac autonomic change occurred from 30% of 1RM regardless of RE limb. However, there was more pronounced sympathetic increase and vagal decrease for upper limb exercise than for lower limb exercise. These results provide a basis for more effective prescription of RE to promote health in this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Peripheral muscle dysfunction is a common finding in patients with COPD; however, the structural adaptation and functional impairment of the upper and lower limb muscles do not seem to be homogenous. We compared muscle fatigue and recovery time between 2 representative muscles: the middle deltoid and the quadriceps femoris. METHODS: Twenty-one subjects with COPD (FEV1 46.1 ± 10.3% of predicted) underwent maximal voluntary isometric contraction and an endurance test (60% of maximal voluntary isometric contraction, to the limit of tolerance). The maximal voluntary isometric contraction test was repeated after 10 min, 30 min, 60 min, and 24 hours for both the quadriceps femoris and middle deltoid. Surface electromyography was recorded throughout the endurance test. RESULTS: Maximal voluntary isometric contraction significantly decreased only for the middle deltoid between 10 and 60 min after the endurance test. A significant increase of the root mean square and a greater decline in median frequency throughout the endurance test occurred for the middle deltoid, compared with the quadriceps femoris. When dyspnea and fatigue scores were corrected by endurance time, higher values were observed for the middle deltoid (0.07 and 0.08, respectively) in relation to the quadriceps femoris (0.02 and 0.03, respectively). CONCLUSIONS: Subjects with COPD had a higher fatigability of a representative upper limb muscle (middle deltoid) than a lower limb muscle (quadriceps femoris). [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine the effect of training on selected markers of anaerobic capacity of upper and lower limbs in male, Greco-Roman wrestlers from 16 to 19 years of age. The study was conducted four times at one-year intervals on the same group of male competitors (n=12). Every year at the beginning of the second preparatory period all wrestlers performed arm cranking and leg cycling 30 s Wingate tests. The relative peak and mean power of upper limbs were higher in 17-, 18-, and 19-year-old wrestlers compared to 16-year-old ones, but were similar in 17- and 18-year-old athletes. The highest peak and mean power of legs were found in 19-year-old wrestlers. In 18-year-old athletes, the peak power was lower than in 17-year-olds and was similar to 16-year-old wrestlers. The relative mean power in the group of 18-year-old athletes was lower compared to 16- and 17-year-old ones, but it was similar in 17- and 19-year-old wrestlers. Changes in the levels of the relative peak and mean power of upper and lower limb muscles in wrestlers occurred at different periods between the age of 16 and 19. However, it seems that inappropriately chosen training loads may reduce short-term power outputs despite age correct increase in anthropometric parameters. Wrongly applied training did not bring positive effects and could inhibit, for some time, the natural development of power in young wrestlers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify differences in maximum strength after an intense strength training program, contrasting muscle groups from upper limbs versus lower limbs. The sample consisted of 10 healthy elderly males (age 73±6 years) with independent living. The training program lasted 12 weeks (3 × week, 50 to 80% of 1RM, 2- 3 sets, 6 to 12 repetitions). Two muscle groups were analyzed: LOWER (sum of average values of three exercises for the lower limbs) and UPPER (sum of average values of four exercises for the upper limbs). Measurement of 1RM was performed at intervals of 4 weeks by direct methods. Repeated measures ANOVA identified significant differences in muscle groups (F=8.1, p=0.006), time (F=730.0 p=0.000) and also their interaction (F=4.4, p=0.014). The gains in 1RM values were higher for upper limbs. These results may suggest that the muscles of the lower limbs are elicited more frequently and therefore, have a smaller potential to gain strength at older age. The muscles of the upper limbs are in accelerated muscle atrophy and their trainability is probably higher. [ABSTRACT FROM AUTHOR]

Resistance training is widely recommended to prevent sarcopenia and osteoporosis. However, the effects of upper and lower limb resistance training on arterial stiffness are unclear. The present study investigates the effects of upper and lower limbs resistance training on arterial stiffness. Thirty young healthy subjects (male 19, female 11, aged 20.1 +/- 0.4 years, mean +/- SD) were randomly assigned to upper limb RT group (upper limb group, n = 10, male 7, female 3), lower limb RT group (lower limb group, n = 10, male 7, female 3) and sedentary groups (n = 10, male 6, female 4). The upper and lower limb groups performed RT at 80% of one repetition maximum twice each week for 10 weeks. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). In addition, we measured plasma norepinephrine (NE) concentration. baPWV after training in the upper limb group had significantly increased from baseline (P < 0.05). In addition, plasma NE concentration after training in the upper limb group had significantly increased from baseline (P < 0.05). No such changes were observed in the lower limb and sedentary groups. Moreover, a significant positive correlation between baPWV and plasma NE concentration in upper limb group was observed (P < 0.05). In contrast, no significant correlation between baPWV and plasma NE concentration in lower limb and sedentary groups was observed. These findings suggested that upper limbs resistance training increases plasma NE concentration and promotes the increase of arterial stiffness. [ABSTRACT FROM AUTHOR]

Background: Nerve conduction studies as part of the peripheral neurophysiologic examination are an extension of the clinical history and examination. They can be extremely useful both in localizing lesions and determining the pathological processes. Objective: To establish the normal electrophysiological data for the facial nerve and commonly tested nerves of the upper and lower limbs in healthy Iraqis and to compare with those data published in the literature. Methods: Nerve conduction studies were performed in the upper and lower limbs of 11,437 carefully screened healthy individuals between the ages of 2 months and 89 years using a standardized technique. Results: The data were separately analyzed for different age groups. In the age group less than 10 years, the sensory and motor nerve conduction velocities were progressively increasing with increasing age until adult values were reached. Later, in the adulthood, the conduction velocity of all tested nerves decreased with age and this is pronounced in both lower and upper limbs. Conclusion: Normative conduction parameters of the facial nerve and peripheral nerves in the upper and lower limbs were established for the EMG laboratory in Iraq. The overall mean sensory and motor nerve conduction parameters for the tested nerves compared favorably with the existing literature data. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to examine the relationships of VO2 during unloaded arm cranking and leg cycling exercises to respectively relevant upper and lower limbs anthropometrical characteristics. Method: Fifteen males completed a 5-min unloaded bout on an arm crank ergometer (60rpm) and a cycle ergometer (90rpm). VO2 corresponding to each unloaded exercise (VO2unload), body mass, lengths, and circumferences of upper and lower limbs were measured. Results: Upper limbs cranking showed a significantly lower (P <0.001) VO2unload than lower limbs cycling (499.0±56.5 and 981.6±126.0mlmin−1). Moreover, upper and lower limbs VO2unload values were significantly and positively correlated with circumferences, and length of upper and lower limbs, respectively, with highest correlations obtained between circumferences and VO2unload. The amount of VO2unload is then principally dependent (i) on the inertia of the limbs, which increased with the circumference of the limb and (ii) on the arm level, which increased with the length of the limb. On the other hand, body mass was not or less correlated with VO2unload. This result could be explained by the specificity of the unloaded exercise since only the limb muscles were activated, the entire body mass not being representative of the muscle mass activated. [Copyright &y& Elsevier]

Objectives: The co-occurrence of musculoskeletal pain symptoms in seven body sites and their combinations among women in kitchen work were studied. Methods: Data on musculoskeletal pain during the past 3 months in the neck, shoulders, forearms/hands, low back, hips, knees and ankles/feet were gathered by questionnaire from 495 female workers (mean age 45 years) in connection with an ergonomic intervention study in municipal kitchens of four cities in Finland. Altogether 122 kitchens (60% of those eligible) participated in the study. The response rate in the participating kitchens was 98%. Results: The 3-month prevalence of any musculoskeletal pain was 87%, the most common sites being the neck (71%), low back (50%) and forearms/hands (49%). About 73% of the subjects had pain in at least two, 36% in four or more, and 10% in 6–7 sites. In pair wise comparisons, e.g. neck pain was associated with pain in other sites with prevalence ratios (PR) varying from 1.3 to 1.6, and ankle or foot pain with ratios between 1.9 and 2.4. The seven pain symptoms occurred in more than 80 different combinations. When the co-occurrence of pain was studied in three larger anatomical areas, i.e. any pain in the axial (neck and low back), upper limb and lower limb areas, subjects reporting concurrent pain in all three were the largest category (36% of the respondents). Altogether 53% of the workers reported pain in at least the axial and upper limb areas, and 48% in at least the axial and lower limb areas. Conclusions: Widespread co-occurrence of musculoskeletal pain symptoms was common among female kitchen workers with slight predominance in the upper body. [ABSTRACT FROM AUTHOR]

• Decrease with age in measurements of strength depends on muscle group involved. • Handgrip force should be used with caution as a predictor of joint moments of force. • Decrease in strength of lower limb is higher for females than for males. • Decrease in strength of upper limb is higher for males than for females. Handgrip strength can be easily measured; however, lack of a quantitative relationship with other force types restricts its usefulness. The aim of this study was to analyse the relationship between handgrip force and moments of force in upper and lower limb joints in reference to age and sex. Multivariate regression analysis of the measurements resulted in models of decrees of moments of force according to handgrip and age. The study proved that: differences related to age are higher in lower limbs with the highest reserved for knee flexion and extension; difference in the strength of upper limbs in reference to age is higher for males, while for females age influences the strength of lower limbs; handgrip can be a better predictor of strength of limbs muscle groups after scaling with corresponding models; the best approximation of the developed models is for the knee strength. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to examine the effectiveness of botulinum toxin A (BoNT-A) therapy combined with rehabilitation on motor function in post-stroke patients. Methods: The following sources up to December 31, 2018, were searched from inception for articles in English: Pubmed, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL. Trials using injections of BoNT-A for upper and lower limb rehabilitation were examined. We excluded studies that were not performed for rehabilitation or were not evaluated for motor function. Results: Twenty-six studies were included. In addition to rehabilitation, nine studies used adjuvant treatment to improve spasticity or improve motor function. In the upper limbs, two of 14 articles indicated that significant improvement in upper limb motor function was observed compared to the control group. In the lower limbs, seven of 14 articles indicated that significant improvement in lower limb motor function was observed compared to the control group. Conclusions: The effect of combined with rehabilitation is limited after stroke, and there is not sufficient evidence, but results suggest that BoNT-A may help to improve motor function. In future studies, the establishment of optimal rehabilitation and evaluation times of BoNT-A treatment will be necessary for improving motor function and spasticity. [ABSTRACT FROM AUTHOR]