Research Roundup: May 2020

 

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Consolidation of Use-Dependent Motor Memories Induced By Passive Movement Training

G. Tays et al. Consolidation of use-dependent motor memories induced by passive movement training. Neuroscience Letters 732 (2020) 135080.

This study examined the lasting effect of passive training on visuomotor adaptation within a 24-hour timeline.

 

Key Points
  • Adapting to a sensorimotor environment requires complex and dynamic systems that can adjust to the environment within minutes, resulting in long-term performance changes.
  • Adaptation is driven by two primary learning mechanisms:
    • Error-based, model-based, or algorithmic learning; and
    • Use-dependent, model-free, or instant-reliant training.
  • Use-dependent learning occurs both during active and passive movements.
  • Passive movement training has the capacity to facilitate subsequent visuomotor adaptation.
    • Results showed improvement after one-hour and 24-hour delay conditions.

  • Use-dependent learning alongside passive movement training enhances the consolidation of motor memories, which can last at least 24-hours post initial training.
  • Use-dependent-based training methods could be applied as a neurorehabilitation technique in clinical settings.
  • Visuomotor adaptation led to  motor memory consolidation at 24 hours, but not after five minutes.
  • Provision of proprioceptive and visual inputs was more effective for optimal motor learning compared to provision of just proprioceptive inputs.

 

Clinically: Teaching Pilates in Practice
  • Use vision to support the learning of new motor patterns; while it can be great to close our eyes and “feel” the body moving, visual inputs are important for stimulating motor learning.
  • Often, we see patients who have a greater passive than active range of motion; this can be exploited for learning new movement patterns when in earlier stages of rehabilitation. Consider integrating closed chain exercises that support passive mobility around a joint while still teaching the desired functional movement.
  • Active ranges are often pain-limited. Incorporating an active-assisted, or passive component to exercises can help maintain pain-free ranges of movement, while still assisting the learning of new motor patterns.

 

 

Linking Joint Impairment and Gait Biomechanics in Patients with Juvenile Idiopathic Arthritis

Erica Montefiori et al. Linking Joint Impairment and Gait Biomechanics in Patients with Juvenile Idiopathic Arthritis. Annals of Biomedical Engineering 2019; 47(11): 2155-2167

Researchers used a musculoskeletal model to predict joint contact forces and investigate the variations of joint contact forces due to joint impairment in 18 juvenile idiopathic arthritis patients.

 

Key Points
  • Juvenile idiopathic arthritis (JIA) is the commonest rheumatic condition in childhood, although the etiology remains unknown.
  • JIA encompasses several subgroups but most generally presents as peripheral arthritis.
    • Clinical presentation includes fever, joint swelling and pain, hepatomegaly, lymphadenopathy, cardiac involvement, splenomegaly, and skin rashes.
  • Medical imaging of JIA:
    • Ultrasound is used to assess joint synovial and tendon inflammation.
    • MRI helps with early diagnosis of JIA, identifying synovitis, bone erosions, and bone marrow edema.
  • Medical imaging only provides information about local impairment.
  • Gait analysis is also used as a tool to assess joint kinematics in JIA patients.
    • Hyper-flexion of the hip and knee joints are often observed.
    • Reduced plantarflexion of the ankle, and decreased ankle moment and power, are also commonly observed.
  • There is a direct relationship between internal joint loading and loading of bone and cartilage.
    • A reduction in internal load is observed in inflamed joints, as a protective response to pain.
    • This compensatory strategy, however, overloads other joints in the limbs.

  • This study failed to observe patterns of hip and knee hyperflexion or decreased ankle plantarflexion, but the authors do note the extremely small study size. 
  • Overloading of the knee joint was observed, especially in those with a bilateral impairment.
    • Increased loading of the less affected knee was especially observed in push-off during gait.
  • Increased loading in the contralateral hip was also observed in the most impaired patients.
  • Overloading of both hips was observed in early stance phase of gait. 
  • From this study, only knee joint contact forces are recommended as a candidate for predicting JIA activity.
    • This may also act as an indicator of compensatory mechanisms in the other limb.
  • A dynamic gait assessment is proposed as part of any JIA assessment.

 

 Clinical Pilates in Practice
  • Knee joint loading directly impacts loading and function of the contralateral hip.
  • Work to improve alignment and force transfer through the knee, by promoting balance around the knee: quads, adductors, hamstrings, popliteus, plantaris, and gastrocnemius need to be working in harmony.
  • Double and single leg press on the Reformer to offload the knee from gravity if full weightbearing is painful.
  • Tibial rotations on the Rotator Discs if appropriate. 
  • Work to then balance loading and weightbearing into the hips: standing leg press at the Wunda Chair; standing platform on the Reformer.
  • Integrating hip extension with knee flexion to support both the hip and knee with both ends of the hamstrings: supported hip extension at the Tower (use a box to avoid kneeling).
  • Lid on a box/bend and stretch with feet in straps or leg springs ensuring that the proximal hamstring is supported.

 

  1. Barut K, Adrovic A, Şahin S, Kasapçopur Ö. Juvenile Idiopathic Arthritis. Balkan Med J. 2017;34(2):90-101. doi:10.4274/balkanmedj.2017.0111
  2. Aslan M, Kasapcopur O, Yasar H, Polat E, Saribas S, Cakan H, et al. Do infections trigger juvenile idiopathic arthritis? Rheumatol Int.2011; 31:215–20.
  3. Gonzalez B, Larrañaga C, León O, Díaz P, Miranda M, Barría M, et al. Parvovirus B19 may have a role in the pathogenesis of juvenile idiopathic arthritis. J Rheumatol. 2007; 34:1336–40.

 

 

Bone Pain In Cancer Patients: Mechanisms And Current Treatment

Renata Zajaczkowska et al. Bone Pain in Cancer Patients: Mechanisms and Current Treatment. Int. J. Mol. Sci. 2019, 20, 6047; doi:10.3390/ijms20236047

This paper discusses the mechanisms involved in bone pain during cancer and reviews the recommended treatment methods.

 

Key Points
  • The location of metastatic bone lesions and their severity does not always correlate with the severity of pain experienced by cancer patients.
  • In 20% of patients, a pathological bone fracture or pain constitutes the first symptom of cancer.
  • The intensity of bone pain in cancer patients cannot be predicted by the tumor type or size, the number of metastases, or the bone involvement.
  • The intensity of pain generally intensifies during movement.

  • Bone pain in cancer patients involves complex interactions between bone cells, tumor cells, activated inflammatory cells, and neurons innervating the bone.
  • Cancer pain includes neuropathic and inflammatory processes modified at the level of peripheral nerves and tissues, as well as the central nervous system (brain and spinal cord).

  • Physiological remodeling of bones relies on the balance between osteoblast activity and bone resorption by osteoclasts.
  • Bone metastases depend on the interaction between tumor cells, bone matrix cells, and nerve fibers innervating the bones.
  • Tumor cells do not cause direct damage to the bones. Instead, they activate the receptor activator for nuclear factor kappa B system.

  • Radiotherapy reduces the risk of pathological fractures or metastatic spinal cord compression.
  • External beam radiotherapy or radioisotope treatment should be considered for all patients with bone metastases.
  • External beam radiotherapy is the first line treatment for the majority of patients with metastatic spinal cord compression because of its pain-relieving effect.
  • There is no optimal surgery for spinal metastases. However, posterolateral fusion with autologous bone grafting is widely used.
  • The goal of therapy is not only to relieve pain, but to also prevent the progression of pain and skeletal-related events.
  • Treatment of bone pain in cancer should be multimodal (symptomatic analgesic treatment, causal treatment, pharmacological, and non-pharmacological treatments).
  • Treatments for bone pain should be individualized and targeted at pain relief, increasing patient function, improve quality of life, and prolong survival (where possible).

 

Clinically: Pilates in Practice
  • There is considerable literature to support exercise for pain relief in all populations, including cancer (not discussed here).
  • Because pain is not necessarily triggered through mechanical stimuli with this population, it is important to be open to communication, and assess pain and function on a daily basis. 
  • Ensure intensity, load, and impact are appropriate, especially if working with pathological fractures.
  • Maintain function and build strength within ranges of motion that are pain-free or tolerable.
  • Work with clients to offload painful sites, and decompress painful areas to maintain secondary function. 
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