Search

In the last decade there has been incredible interest and advancement in the surgical care of adult patients with upper motor neuron (UMN) injuries. Spasticity represents a prevalent and debilitating feature of UMN syndrome, which can result from cerebral palsy, spinal cord injury, cerebrovascular accident and traumatic or anoxic brain injury. While several diagnostic tools and management strategies have been described for upper limb spasticity, evidence-based practice guidelines do not currently exist due to low patient volume and a paucity of surgeons routinely performing surgeries in UMN syndrome patients. As such, expert consensus may help provide guidance for patients, therapists and clinicians alike. In this article an expert panel was assembled, and the Delphi method was utilized to present diagnostic considerations, define operative indications, discuss surgical treatment modalities and encourage a standard set of outcome measures for patients with upper extremity spasticity. [ABSTRACT FROM AUTHOR]

Due to a highly variable distribution of intramuscular collagen content within muscle, the amount collagen content itself does not relate to the actual passive muscle properties during mechanical testing as was shown in mouse hind limb muscles (Binder-Markey et al.). Keywords: muscle mechanics; extracellular matrix; connective tissue; neuromusculoskeletal interaction; adaptation; pathology; force production - transmission phenomena EN muscle mechanics extracellular matrix connective tissue neuromusculoskeletal interaction adaptation pathology force production - transmission phenomena 1 6 6 12/08/21 20211206 NES 211206 There is a growing emphasis on the importance of muscle extracellular matrix on muscular mechanics and specifically on the effects of the interaction of the extracellular matrix (ECM) and the contractile apparatus. An experimental assessment using multi-photon excitation microscopy in mouse tibialis anterior muscle surgically dissected from the tibia and surrounding muscles showed that in isometrically activated muscle the sarcomeres re-organize their lengths into a more uniform pattern over time, whereas in the passive state their length non-uniformity remained the same (Moo and Herzog). They demonstrate how a passively lengthened muscle can also have shortened parts and how an isometric contracting muscle can also have lengthened parts along the muscle fascicles. [Extracted from the article]

Abstract: Spastic cerebral palsy can be divided into diagnostic groups by the relative severity of the arm impairment. This study investigates if hemiplegic, tetraplegic or diplegic cerebral palsy (CP) results in different patterns of myosin heavy chain (MyHC) expression in the flexor carpi ulnaris muscle from 17 young patients with CP. Using enzyme-immunohistochemistry and gel electrophoresis techniques we found a higher percentage of fibers expressing fast MyHC IIx (52%) in tetraplegic CP compared to hemiplegic patients (32%), (p <0.05). Tetraplegic CP also resulted in a lower amount of fibers expressing slow MyHC I (18%) compared to hemiplegic CP (40%), (p <0.005). The proportion of muscle fibers containing fetal MyHC was higher in tetraplegic CP compared to other groups, (p <0.005). Taken together theses results indicate that tetraplegic CP is associated with a shift from slow to fast myosins and that regenerative events are more prominent in tetraplegic CP compared with milder brain damage. [Copyright &y& Elsevier]