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1.  Continuing Education Case Study Quiz 
Hospital Pharmacy  2013;48(4):332-333.
Goal— The goal of this program is to educate pharmacists about the use of perampanel for the treatment of multiple sclerosis.
Objectives—At the completion of this program, the reader will be able to:Describe the pharmacology and pharmacokinetics of perampanel.Discuss the risks associated with the use of perampanel.Discuss the potential benefit of perampanel for an individual patient.Apply the information on the use of perampanel to a case study.
doi:10.1310/hpj4804-332
PMCID: PMC3839446  PMID: 24421483
anticonvulsants; new drugs; perampanel
2.  Continuing Education Case Study Quiz 
Hospital Pharmacy  2013;48(3):241-242.
Goal—The goal of this program is to educate pharmacists about the use of teriflunomide for the treatment of multiple sclerosis (MS).
Objectives—At the completion of this program, the reader will be able to:Describe the pharmacology and pharmacokinetics of teriflunomide.Discuss the risks associated with the use of teriflunomide.Discuss the potential benefit of teriflunomide for an individual patient.Apply the information on the use of teriflunomide to a case study.
doi:10.1310/hpj4803-241
PMCID: PMC3839510  PMID: 24421468
multiple sclerosis; new drugs; teriflunomide
3.  Continuing Education Case Study Quiz 
Hospital Pharmacy  2013;48(1):57-59.
Goal— The goal of this program is to educate pharmacists about the use of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (df) combination tablet for the treatment of HIV infection.
Objectives—At the completion of this program, the reader will be able to:Describe the pharmacology and pharmacokinetics of elvitegravir/cobicistat/emtricitabine/tenofovir df combination.Discuss the risks associated with the use of elvitegravir/cobicistat/emtricitabine/tenofovir df combination.Discuss the potential benefit of elvitegravir/cobicistat/emtricitabine/tenofovir df combination for an individual patient.Apply the information on the use of elvitegravir/cobicistat/emtricitabine/tenofovir df combination to a case study.
doi:10.1310/hpj4801-57
PMCID: PMC3905829  PMID: 24550569
cobicistat; elvitegravir; emtricitabine; HIV; new drugs; obesity; phentermine; topiramate; Stribild; tenofovir disoproxil fumarate
4.  Continuing Education Case Study Quiz 
Hospital Pharmacy  2013;48(2):153-155.
Goal—
The goal of this program is to educate pharmacists about the use of linaclotide for the treatment of irritable bowel syndrome and constipation.
Objectives—
At the completion of this program, the reader will be able to:Describe the pharmacology and pharmacokinetics of linaclotide.Discuss the risks associated with the use of linaclotide.Discuss the potential benefit of linaclotide for an individual patient.Apply the information on the use of linaclotide to a case study.
doi:10.1310/hpj4802-153
PMCID: PMC3905830  PMID: 24550570
constipation; linaclotide; new drugs
5.  The Animal Model of Spinal Cord Injury as an Experimental Pain Model 
Pain, which remains largely unsolved, is one of the most crucial problems for spinal cord injury patients. Due to sensory problems, as well as motor dysfunctions, spinal cord injury research has proven to be complex and difficult. Furthermore, many types of pain are associated with spinal cord injury, such as neuropathic, visceral, and musculoskeletal pain. Many animal models of spinal cord injury exist to emulate clinical situations, which could help to determine common mechanisms of pathology. However, results can be easily misunderstood and falsely interpreted. Therefore, it is important to fully understand the symptoms of human spinal cord injury, as well as the various spinal cord injury models and the possible pathologies. The present paper summarizes results from animal models of spinal cord injury, as well as the most effective use of these models.
doi:10.1155/2011/939023
PMCID: PMC3062973  PMID: 21436995
6.  Swimming as a Model of Task-Specific Locomotor Retraining After Spinal Cord Injury in the Rat 
Background
The authors have shown that rats can be retrained to swim after a moderately severe thoracic spinal cord contusion. They also found that improvements in body position and hindlimb activity occurred rapidly over the first 2 weeks of training, reaching a plateau by week 4. Overground walking was not influenced by swim training, suggesting that swimming may be a task-specific model of locomotor retraining.
Objective
To provide a quantitative description of hindlimb movements of uninjured adult rats during swimming, and then after injury and retraining.
Methods
The authors used a novel and streamlined kinematic assessment of swimming in which each limb is described in 2 dimensions, as 3 segments and 2 angles.
Results
The kinematics of uninjured rats do not change over 4 weeks of daily swimming, suggesting that acclimatization does not involve refinements in hindlimb movement. After spinal cord injury, retraining involved increases in hindlimb excursion and improved limb position, but the velocity of the movements remained slow.
Conclusion
These data suggest that the activity pattern of swimming is hardwired in the rat spinal cord. After spinal cord injury, repetition is sufficient to bring about significant improvements in the pattern of hindlimb movement but does not improve the forces generated, leaving the animals with persistent deficits. These data support the concept that force (load) and pattern generation (recruitment) are independent and may have to be managed together with respect to postinjury rehabilitation.
doi:10.1177/1545968308331147
PMCID: PMC2836886  PMID: 19270266
Spinal cord injury; Swimming; Task-specific learning; Rat; Locomotor retraining; Rehabilitation
7.  Swim Training Initiated Acutely after Spinal Cord Injury Is Ineffective and Induces Extravasation In and Around the Epicenter 
Journal of neurotrauma  2009;26(7):10.1089/neu.2008-0829.
Activity-based rehabilitation is a promising strategy for improving functional recovery following spinal cord injury (SCI). While results from both clinical and animal studies have shown that a variety of approaches can be effective, debate still exists regarding the optimal post-injury period to apply rehabilitation. We recently demonstrated that rats with moderately severe thoracic contusive SCI can be re-trained to swim when training is initiated 2 weeks after injury and that swim training had no effect on the recovery of overground locomotion. We concluded that swim training is a task-specific model of post-SCI activity-based rehabilitation. In the present study, we ask if re-training initiated acutely is more or less effective than when initiated at 2 weeks post-injury. Using the Louisville Swim Scale, an 18-point swimming assessment, supplemented by kinematic assessment of hindlimb movement during swimming, we report that acute re-training is less effective than training initiated at 2 weeks. Using the bioluminescent protein luciferase as a blood-borne macromolecular marker, we also show a significant increase in extravasation in and around the site of SCI following only 8 min of swimming at 3 days post-injury. Taken together, these results suggest that acute re-training in a rat model of SCI may compromise rehabilitation efforts via mechanisms that may involve one or more secondary injury cascades, including acute spinal microvascular dysfunction.
doi:10.1089/neu.2008-0829
PMCID: PMC2848951  PMID: 19331515
activity-based rehabilitation; microvascular; rat; spinal cord injury; swimming
8.  Effects of Swimming on Functional Recovery after Incomplete Spinal Cord Injury in Rats 
Journal of neurotrauma  2006;23(6):908-919.
One of the most promising rehabilitation strategies for spinal cord injury is weight-supported treadmill training. This strategy seeks to re-train the spinal cord below the level of injury to generate a meaningful pattern of movement. However, the number of step cycles that can be accomplished is limited by the poor weight-bearing capability of the neuromuscular system after injury. We have begun to study swimming as a rehabilitation strategy that allows for high numbers of steps and a high step-cycle frequency in a standard rat model of contusive spinal cord injury. The purpose of the present study was to evaluate the effect of swimming as a rehabilitation strategy in rats with contusion injuries at T9. We used a swimming strategy with or without cutaneous feedback based on original work in the chick by Muir and colleagues. Adult female rats (n = 27) received moderately-severe contusion injuries at T9. Walking and swimming performance were evaluated using the Open-Field Locomotor Scale (BBB; Basso et al., 1995) and a novel swimming assessment, the Louisville Swimming Scale (LSS). Rats that underwent swim-training with or without cutaneous feedback showed a significant improvement in hindlimb function during swimming compared to untrained animals. Rats that underwent swim-training without cutaneous feedback showed less improvement than those trained with cutaneous feedback. Rats in the non-swimming group demonstrated little improvement over the course of the study. All three groups showed the expected improvement in over-ground walking and had similar terminal BBB scores. These findings suggest that animals re-acquire the ability to swim only if trained and that cutaneous feedback improves the re-training process. Further, these data suggest that the normal course of recovery of over-ground walking following moderately-severe contusion injuries at T9 is the result of a re-training process.
doi:10.1089/neu.2006.23.908
PMCID: PMC2831776  PMID: 16774475
contusion injury; rehabilitation; re-training; swimming
9.  Spontaneous Development of Full Weight-Supported Stepping after Complete Spinal Cord Transection in the Neonatal Opossum, Monodelphis domestica 
PLoS ONE  2011;6(11):e26826.
Spinal cord trauma in the adult nervous system usually results in permanent loss of function below the injury level. The immature spinal cord has greater capacity for repair and can develop considerable functionality by adulthood. This study used the marsupial laboratory opossum Monodelphis domestica, which is born at a very early stage of neural development. Complete spinal cord transection was made in the lower-thoracic region of pups at postnatal-day 7 (P7) or P28, and the animals grew to adulthood. Injury at P7 resulted in a dense neuronal tissue bridge that connected the two ends of the cord; retrograde neuronal labelling indicated that supraspinal and propriospinal innervation spanned the injury site. This repair was associated with pronounced behavioural recovery, coordinated gait and an ability to use hindlimbs when swimming. Injury at P28 resulted in a cyst-like cavity encased in scar tissue forming at the injury site. Using retrograde labelling, no labelled brainstem or propriospinal neurons were found above the lesion, indicating that detectable neuronal connectivity had not spanned the injury site. However, these animals could use their hindlimbs to take weight-supporting steps but could not use their hindlimbs when swimming. White matter, demonstrated by Luxol Fast Blue staining, was present in the injury site of P7- but not P28-injured animals. Overall, these studies demonstrated that provided spinal injury occurs early in development, regrowth of supraspinal innervation is possible. This repair appears to lead to improved functional outcomes. At older ages, even without detectable axonal growth spanning the injury site, substantial development of locomotion was still possible. This outcome is discussed in conjunction with preliminary findings of differences in the local propriospinal circuits following spinal cord injury (demonstrated with fluororuby labelling), which may underlie the weight bearing locomotion observed in the apparent absence of axons bridging the lesion site in P28-injured Monodelphis.
doi:10.1371/journal.pone.0026826
PMCID: PMC3206848  PMID: 22073202
10.  The Louisville Swim Scale: A Novel Assessment of Hindlimb Function following Spinal Cord Injury in Adult Rats 
Journal of neurotrauma  2006;23(11):1654-1670.
The majority of animal studies examining the recovery of function following spinal cord injury use the BBB Open-Field Locomotor Scale as a primary outcome measure. However, it is now well known that rehabilitation strategies can bring about significant improvements in hindlimb function in some animal models. Thus, improvements in walking following spinal cord injury in rats may be influenced by differences in activity levels and housing conditions during the first few weeks post-injury. Swimming is a natural form of locomotion that animals are not normally exposed to in the laboratory setting. We hypothesized that deficits in, and functional recovery of, swimming would accurately represent the locomotor capability of the nervous system in the absence of any retraining effects. To test this hypothesis, we have compared the recovery of walking and swimming in rats following a range of standardized spinal cord injuries and two different retraining strategies. In order to assess swimming, we developed a rating system we call the Louisville Swimming Scale (LSS) that evaluates three characteristics of swimming that are highly altered by spinal cord injury— namely, hindlimb movement, forelimb dependency, and body position. The data indicate that the LSS is a sensitive and reliable method of determining swimming ability and the improvement in hindlimb function after standardized contusion injury of the thoracic spinal cord. Furthermore, the data suggests that when used in conjunction with the BBB Open-field Locomotor Scale, the LSS assesses locomotor capabilities that are not influenced by a retraining effect.
doi:10.1089/neu.2006.23.1654
PMCID: PMC2833969  PMID: 17115911
swimming; functional recovery; contusion injury; outcome measure
11.  Prevention and Treatment of Swimmer's Shoulder 
Swimmer's shoulder is a musculoskeletal condition that results in symptoms in the area of the anterior lateral aspect of the shoulder, sometimes confined to the subacromial region. The onset of symptoms may be associated with impaired posture, glenohumeral joint mobility, neuromuscular control, or muscle performance. Additionally, training errors such as overuse, misuse, or abuse may also contribute to this condition. In extreme cases, patients with swimmer's shoulder may have soft tissue pathology of the rotator cuff, long head of the biceps, or glenoid labrum. Physical therapists involved in the treatment of competitive swimmers should focus on prevention and early treatment, addressing the impairments associated with this condition, and analyzing training methods and stroke mechanics. The purpose of this clinical commentary is to provide an overview of the biomechanics of swimming, the etiology of the clinical entity referred to as swimmer's shoulder, and strategies for injury prevention and treatment.
PMCID: PMC2953356  PMID: 21522219
Swimmer's shoulder; injury prevention; rotator cuff
12.  Swim Training Initiated Acutely after Spinal Cord Injury Is Ineffective and Induces Extravasation In and Around the Epicenter 
Journal of Neurotrauma  2009;26(7):1017-1027.
Abstract
Activity-based rehabilitation is a promising strategy for improving functional recovery following spinal cord injury (SCI). While results from both clinical and animal studies have shown that a variety of approaches can be effective, debate still exists regarding the optimal post-injury period to apply rehabilitation. We recently demonstrated that rats with moderately severe thoracic contusive SCI can be re-trained to swim when training is initiated 2 weeks after injury and that swim training had no effect on the recovery of overground locomotion. We concluded that swim training is a task-specific model of post-SCI activity-based rehabilitation. In the present study, we ask if re-training initiated acutely is more or less effective than when initiated at 2 weeks post-injury. Using the Louisville Swim Scale, an 18-point swimming assessment, supplemented by kinematic assessment of hindlimb movement during swimming, we report that acute re-training is less effective than training initiated at 2 weeks. Using the bioluminescent protein luciferase as a blood-borne macromolecular marker, we also show a significant increase in extravasation in and around the site of SCI following only 8 min of swimming at 3 days post-injury. Taken together, these results suggest that acute re-training in a rat model of SCI may compromise rehabilitation efforts via mechanisms that may involve one or more secondary injury cascades, including acute spinal microvascular dysfunction.
doi:10.1089/neu.2008.0829
PMCID: PMC2848951  PMID: 19331515
activity-based rehabilitation; microvascular; rat; spinal cord injury; swimming
13.  Epidemiology of Injuries and Prevention Strategies in Competitive Swimmers 
Sports Health  2012;4(3):246-251.
Context:
Competitive swimmers are predisposed to musculoskeletal injuries of the upper limb, knee, and spine. This review discusses the epidemiology of these injuries, in addition to prevention strategies that may assist the physician in formulating rehabilitation programs for the swimmer following an injury.
Evidence Acquisition:
A literature search was performed by a review of Google Scholar, OVID, and PubMed articles published from 1972 to 2011.
Results:
This study highlights the epidemiology of injuries common to competitive swimmers and provides prevention strategies for the sports health professional.
Conclusions:
An understanding of swimming biomechanics and typical injuries in swimming aids in early recognition of injury, initiation of treatment, and design of optimal prevention and rehabilitation strategies.
doi:10.1177/1941738112442132
PMCID: PMC3435931  PMID: 23016094
competitive swimmer; injury; prevention; shoulder; knee; spine
14.  Acute Schmorl's Node during Strenuous Monofin Swimming: A Case Report and Review of the Literature 
Global Spine Journal  2012;2(3):159-168.
Study Design This case report describes an acute Schmorl's node (SN) in an elite monofin athlete during exercise. The patient presented with severe back pain and leg numbness and was managed successfully with conservative treatment.
Objective The aim of our communication was to describe a rare presentation of a common pathological condition during an intense sport.
Background Swimming is not generally considered to be a sport activity that leads to spinal injuries. SNs are usually asymptomatic lesions, incidentally found on imaging studies. There is no correlation between swimming and symptomatic SN formation.
Case Report A 16-year-old monofin elite athlete suffered from an acute nonradiating back pain during extreme exercise. His back pain was associated with a fracture of the superior L5 end plate and an acute SN at the L5 vertebral body with perilesional bone marrow edema. The pain resolved with nonsteroidal anti-inflammatory drugs and bed rest. The athlete had an excellent outcome and returned to his training activities 6 months after his incident.
Conclusion SN should be considered in the differential diagnosis of severe back pain, especially in sport-related injuries. SNs present with characteristic imaging findings. Due to the benign nature of these lesions, surveillance-only management may be the best course of action.
doi:10.1055/s-0032-1307262
PMCID: PMC3864465  PMID: 24353963
acute Schmorl's node/giant; monofin swimming; MR imaging/diagnosis; conservative treatment
15.  High force reaching task induces widespread inflammation, increased spinal cord neurochemicals and neuropathic pain 
Neuroscience  2008;158(2):922-931.
Repetitive strain injuries (RSI), which include several musculoskeletal disorders and nerve compression injuries, are associated with performance of repetitive and forceful tasks. In this study, we examined the effects of performing a voluntary, moderate repetition, high force (MRHF; 9 reaches/min; 60% maximum pulling force) task for 12 weeks on motor behavior and nerve function, inflammatory responses in forearm musculoskeletal and nerve tissues and serum, and neurochemical immunoexpression in cervical spinal cord dorsal horns. We observed no change in reach rate, but reduced voluntary participation and grip strength in week 12, and increased cutaneous sensitivity in weeks 6 and 12, the latter indicative of mechanical allodynia. Nerve conduction velocity (NCV) decreased 15% in the median nerve in week 12, indicative of low-grade nerve compression. ED-1 cells increased in distal radius and ulna in week 12, and in the median nerve and forearm muscles and tendons in weeks 6 and 12. Cytokines IL-1α, IL-1β, TNF-α, and IL-10 increased in distal forearm bones in week 12, while IL-6 increased in tendon in week 12. However, serum analysis revealed only increased TNF-α in week 6 and macrophage inflammatory protein 3a (MIP3a) in weeks 6 and 12. Lastly, Substance P and neurokinin-1 were both increased in weeks 6 and 12 in the dorsal horns of cervical spinal cord segments. These results show that a high force, but moderate repetition task, induced declines in motor and nerve function as well as peripheral and systemic inflammatory responses (albeit the latter was mild). The peripheral inflammatory responses were associated with signs of central sensitization (mechanical allodynia and increased neurochemicals in spinal cord dorsal horns).
doi:10.1016/j.neuroscience.2008.10.050
PMCID: PMC2661572  PMID: 19032977
spinal cord; macrophages; cytokines; musculoskeletal disorder; nerve injury; repetitive strain injury
16.  Task-specificity vs Ceiling Effect: Step-training in shallow water after spinal cord injury 
Experimental neurology  2010;224(1):178-187.
While activity-based rehabilitation is one of the most promising therapeutic approaches for spinal cord injury, the necessary components for optimal locomotor retraining have not yet been determined. Currently, a number of different activity-based approaches are being investigated including body weight-supported treadmill training (with and without manual assistance), robotically-assisted treadmill training, bicycling and swimming, among others. We recently showed, in the adult rat, that intensive rehabilitation based on swimming brought about significant improvements in hindlimb performance during swimming but did not alter the normal course of recovery of over-ground walking (Smith et al., 2006; 2009). However, swimming lacks the phasic limb-loading and plantar cutaneous feedback thought to be important for weight-supported step training. So, we are investigating an innovative approach based on walking in shallow water where buoyancy provides some body weight support and balance while still allowing for limb-loading and appropriate cutaneous afferent feedback during retraining. Thus, the aim of this study is to determine if spinal cord injured animals show improved overground locomotion following intensive body-weight supported locomotor training in shallow water. The results show that training in shallow water successfully improved stepping in shallow water, but was not able to bring about significant improvements in overground locomotion despite the fact that the shallow water provides sufficient body weight support to allow acutely injured rats to generate frequent plantar stepping. These observations support previous suggestions that incompletely injured animals retrain themselves while moving about in their cages and that daily training regimes are not able to improve upon this already substantial functional improvement due to a ceiling effect, rather than task-specificity, per se. These results also support the concept that moderately-severe thoracic contusion injuries decrease the capacity for body weight support, but do not decrease the capacity for pattern generation. In contrast, animals with severe contusion injuries could not support their body weight nor could they generate a locomotor pattern when provided with body weight support via buoyancy.
doi:10.1016/j.expneurol.2010.03.008
PMCID: PMC2885471  PMID: 20302862
17.  Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients 
European Spine Journal  2009;19(4):552-557.
Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5–C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.
doi:10.1007/s00586-009-1230-3
PMCID: PMC2899837  PMID: 19956985
Cervical trauma; Diving accident; Outcome; Spine cord injury
18.  Acute Spinal-Cord Lesions from Diving—Epidemiological and Clinical Features 
Western Journal of Medicine  1977;126(5):353-361.
The aquatic activity that produces the greatest number of spinal-cord lesions is diving. Persons in the general population at greatest risk are males aged 15 to 19 years. Of the cases identified, 45 percent resulted from diving into a river or stream, 27 percent into swimming pools and 28 percent into lakes, reservoirs or the ocean. Distribution by age differed for the major groups of bodies of water. The incidence of spinal-cord injuries was related to season (spring-summer) and day of the week (weekends). The incidence of injuries was highest in those county areas with the least opportunity for exposure to swimming pools or rivers. Of the injured persons, 60 percent were tetraplegic at hospital admission. The most frequent radiologic finding was wedge fracture. This finding, in the absence of objective evidence that most divers struck the bottom of the water reservoir or a hard object, suggests that hyperventroflexion was the mechanism responsible for injury in most of the cases. Physicians and others should be aware of strategy options for preventing or reducing such injuries.
PMCID: PMC1237583  PMID: 867983
19.  Age-Dependent Transcriptome and Proteome Following Transection of Neonatal Spinal Cord of Monodelphis domestica (South American Grey Short-Tailed Opossum) 
PLoS ONE  2014;9(6):e99080.
This study describes a combined transcriptome and proteome analysis of Monodelphis domestica response to spinal cord injury at two different postnatal ages. Previously we showed that complete transection at postnatal day 7 (P7) is followed by profuse axon growth across the lesion with near-normal locomotion and swimming when adult. In contrast, at P28 there is no axon growth across the lesion, the animals exhibit weight-bearing locomotion, but cannot use hind limbs when swimming. Here we examined changes in gene and protein expression in the segment of spinal cord rostral to the lesion at 24 h after transection at P7 and at P28. Following injury at P7 only forty genes changed (all increased expression); most were immune/inflammatory genes. Following injury at P28 many more genes changed their expression and the magnitude of change for some genes was strikingly greater. Again many were associated with the immune/inflammation response. In functional groups known to be inhibitory to regeneration in adult cords the expression changes were generally muted, in some cases opposite to that required to account for neurite inhibition. For example myelin basic protein expression was reduced following injury at P28 both at the gene and protein levels. Only four genes from families with extracellular matrix functions thought to influence neurite outgrowth in adult injured cords showed substantial changes in expression following injury at P28: Olfactomedin 4 (Olfm4, 480 fold compared to controls), matrix metallopeptidase (Mmp1, 104 fold), papilin (Papln, 152 fold) and integrin α4 (Itga4, 57 fold). These data provide a resource for investigation of a priori hypotheses in future studies of mechanisms of spinal cord regeneration in immature animals compared to lack of regeneration at more mature stages.
doi:10.1371/journal.pone.0099080
PMCID: PMC4051688  PMID: 24914927
20.  Vestibular Lesion-Induced Developmental Plasticity in Spinal Locomotor Networks during Xenopus laevis Metamorphosis 
PLoS ONE  2013;8(8):e71013.
During frog metamorphosis, the vestibular sensory system remains unchanged, while spinal motor networks undergo a massive restructuring associated with the transition from the larval to adult biomechanical system. We investigated in Xenopus laevis the impact of a pre- (tadpole stage) or post-metamorphosis (juvenile stage) unilateral labyrinthectomy (UL) on young adult swimming performance and underlying spinal locomotor circuitry. The acute disruptive effects on locomotion were similar in both tadpoles and juvenile frogs. However, animals that had metamorphosed with a preceding UL expressed restored swimming behavior at the juvenile stage, whereas animals lesioned after metamorphosis never recovered. Whilst kinematic and electrophysiological analyses of the propulsive system showed no significant differences in either juvenile group, a 3D biomechanical simulation suggested that an asymmetry in the dynamic control of posture during swimming could account for the behavioral restoration observed in animals that had been labyrinthectomized before metamorphosis. This hypothesis was subsequently supported by in vivo electromyography during free swimming and in vitro recordings from isolated brainstem/spinal cord preparations. Specifically, animals lesioned prior to metamorphosis at the larval stage exhibited an asymmetrical propulsion/posture coupling as a post-metamorphic young adult. This developmental alteration was accompanied by an ipsilesional decrease in propriospinal coordination that is normally established in strict left-right symmetry during metamorphosis in order to synchronize dorsal trunk muscle contractions with bilateral hindlimb extensions in the swimming adult. Our data thus suggest that a disequilibrium in descending vestibulospinal information during Xenopus metamorphosis leads to an altered assembly of adult spinal locomotor circuitry. This in turn enables an adaptive compensation for the dynamic postural asymmetry induced by the vestibular imbalance and the restoration of functionally-effective behavior.
doi:10.1371/journal.pone.0071013
PMCID: PMC3741378  PMID: 23951071
21.  Meeting Physical Activity Guidelines and Musculoskeletal Injury: The WIN Study 
Introduction
The United States Department of Health and Human Services disseminated physical activity guidelines for Americans in 2008. The guidelines are based on appropriate quantities of moderate-to-vigorous aerobic physical activity and resistance exercise associated with decreased morbidity and mortality risk and increased health benefits. However, increases in physical activity levels are associated with increased risk of musculoskeletal injuries. We related the amount and type of physical activity conducted on a weekly basis with the risk of musculoskeletal injury.
Methods
Prospective, observational study using weekly Internet tracking of moderate-to-vigorous physical activity and resistance exercise behaviors and musculoskeletal injuries in 909 community-dwelling women for up to 3 years. Primary outcome was self-reported musculoskeletal injuries (total, physical activity-related, and non physical activity-related) interrupting typical daily work and/or exercise behaviors for ≥2 days or necessitating health care provider visit.
Results
Meeting versus not meeting physical activity guidelines was associated with more musculoskeletal injuries during physical activity (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.05 – 1.85, P = 0.02), but was not associated with musculoskeletal injuries unrelated to physical activity (HR = 0.99, 95% CI = 0.75 – 1.29, P = 0.92), or with musculoskeletal injuries overall (HR = 1.15, 95% CI = 0.95 – 1.39, P = 0.14).
Conclusions
Results illustrate the risk of musculoskeletal injury with physical activity. Musculoskeletal injury risk rises with increasing physical activity. Despite this modest increase in musculoskeletal injuries, the known benefits of aerobic and resistance physical activities should not hinder physicians from encouraging patients to meet current physical activity guidelines for both moderate-to-vigorous exercise and resistance exercise behaviors with the intent of achieving health benefits.
doi:10.1249/MSS.0b013e31825a36c6
PMCID: PMC3445731  PMID: 22525778
MODERATE; PREVALENCE; STRENGTHENING; VIGOROUS
22.  Spinal Cord Contusion Based on Precise Vertebral Stabilization and Tissue Displacement Measured by Combined Assessment to Discriminate Small Functional Differences 
Journal of neurotrauma  2008;25(10):1227-1240.
Contusive spinal cord injury (SCI) is the most common type of spinal injury seen clinically. Several rat contusion SCI models have been described, and all have strengths and weaknesses with respect to sensitivity, reproducibility, and clinical relevance. We developed the Louisville Injury System Apparatus (LISA), which contains a novel spine-stabilizing device that enables precise and stable spine fixation, and is based on tissue displacement to determine the severity of injury. Injuries graded from mild to moderately severe were produced using 0.2-, 0.4-, 0.6-, 0.8-, 1.0-, and 1.2-mm spinal cord displacement in rats. Basso, Beattie, and Bresnahan (BBB) and Louisville Swim Score (LSS) could not significantly distinguish between 0.2-mm lesion severities, except those of 0.6- and 0.8-mm BBB scores, but could between 0.4-mm injury differences or if the data were grouped (0.2–0.4, 0.6–0.8, and 1.0–1.2). Transcranial magnetic motor evoked potential (tcMMEP) response amplitudes were decreased 10-fold at 0.2-mm displacement, barely detected at 0.4-mm displacement, and absent with greater displacement injuries. In contrast, somatosensory evoked potentials (SSEPs) were recorded at 0.2- and 0.4-mm displacements with normal amplitudes and latencies but were detected at lower amplitudes at 0.6-mm displacement and absent with more severe injuries. Analyzing combined BBB, tcMMEP, and SSEP results enabled statistically significant discrimination between 0.2-, 0.4-, 0.6-, and 0.8-mm displacement injuries but not the more severe injuries. Present data document that the LISA produces reliable and reproducible SCI whose parameters of injury can be adjusted to more accurately reflect clinical SCI. Moreover, multiple outcome measures are necessary to accurately detect small differences in functional deficits and/or recovery. This is of crucial importance when trying to detect functional improvement after therapeutic intervention to treat SCI.
doi:10.1089/neu.2007.0388
PMCID: PMC2756607  PMID: 18986224
BBB; spinal cord injury; SSEP; tcMMEP; tissue displacement
23.  Spinal Cord Contusion Based on Precise Vertebral Stabilization and Tissue Displacement Measured by Combined Assessment to Discriminate Small Functional Differences 
Journal of Neurotrauma  2008;25(10):1227-1240.
Abstract
Contusive spinal cord injury (SCI) is the most common type of spinal injury seen clinically. Several rat contusion SCI models have been described, and all have strengths and weaknesses with respect to sensitivity, reproducibility, and clinical relevance. We developed the Louisville Injury System Apparatus (LISA), which contains a novel spine-stabilizing device that enables precise and stable spine fixation, and is based on tissue displacement to determine the severity of injury. Injuries graded from mild to moderately severe were produced using 0.2-, 0.4-, 0.6-, 0.8-, 1.0-, and 1.2-mm spinal cord displacement in rats. Basso, Beattie, and Bresnahan (BBB) and Louisville Swim Score (LSS) could not significantly distinguish between 0.2-mm lesion severities, except those of 0.6- and 0.8-mm BBB scores, but could between 0.4-mm injury differences or if the data were grouped (0.2–0.4, 0.6–0.8, and 1.0–1.2). Transcranial magnetic motor evoked potential (tcMMEP) response amplitudes were decreased 10-fold at 0.2-mm displacement, barely detected at 0.4-mm displacement, and absent with greater displacement injuries. In contrast, somatosensory evoked potentials (SSEPs) were recorded at 0.2- and 0.4-mm displacements with normal amplitudes and latencies but were detected at lower amplitudes at 0.6-mm displacement and absent with more severe injuries. Analyzing combined BBB, tcMMEP, and SSEP results enabled statistically significant discrimination between 0.2-, 0.4-, 0.6-, and 0.8-mm displacement injuries but not the more severe injuries. Present data document that the LISA produces reliable and reproducible SCI whose parameters of injury can be adjusted to more accurately reflect clinical SCI. Moreover, multiple outcome measures are necessary to accurately detect small differences in functional deficits and/or recovery. This is of crucial importance when trying to detect functional improvement after therapeutic intervention to treat SCI.
doi:10.1089/neu.2007.0388
PMCID: PMC2756607  PMID: 18986224
BBB; spinal cord injury; SSEP; tcMMEP; tissue displacement
24.  The prevalence of naturally acquired swimming ability among children in Bangladesh: a cross sectional survey 
BMC Public Health  2014;14:404.
Background
Most rural homes in Bangladesh have ponds nearby to serve as household water sources. As a result children of all ages are exposed to water bodies on a daily basis. Children learn to swim early in childhood from peers and relatives in a natural process that involves play and structured learning. In a large, national injury survey in Bangladesh, the ability to swim was associated with reduced risk of drowning. This study determines the prevalence of swimming ability in children in Bangladesh as a step in assessing whether this is a potential component of a national drowning prevention program.
Methods
A descriptive study design using a subset of a national sample survey determined the prevalence of naturally acquired swimming ability (NASA) reported by children of rural and urban communities in Bangladesh. A total of 2,598 households (1,999 rural and 599 urban) housing 4,336 children (2,263 male and 2,073 female) aged 5-17 years were chosen from 4 randomly selected districts using multistage random sampling. NASA was defined as the ability to cross 25 meters of water deeper than the child’s height using any body movement for self-propulsion.
Results
Reported NASA was greater in males (55.6%) than females (47.9%) and among rural children (57.8%) than urban children (25.5%) for children 5-17 years. The proportion reporting NASA increased with increasing age. At age 5, 5.8% of males and 6.3% of females reported NASA, rising to 84.3% of males and 70.7% of females by age 17. By age 17, 83.1% of rural children and 57.5% of urban children reported NASA.
Conclusion
Most children in Bangladesh report being able to swim 25 meters and learning it by middle childhood. Reported NASA is higher for males than females and for rural children than urban children. High rates of swimming appear to be achievable in the absence of pools and a swim-teaching industry. This may facilitate development of a low cost, national drowning prevention program with swimming an integral part.
doi:10.1186/1471-2458-14-404
PMCID: PMC4014625  PMID: 24767407
Swimming ability; Naturally acquired swimming ability; NASA; Child drowning; Drowning prevention; Bangladesh
25.  Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists 
Background
Neurogenic claudication (NC) is the clinical syndrome commonly associated with lumbar spinal stenosis (LSS). Non-surgical management is recommended as initial treatment, but little is known about current practice in relation to the assessment and management of these patients in the non-surgical setting.
Methods
We conducted a questionnaire survey of physiotherapists in a large UK primary care musculoskeletal service which provides a city-wide multidisciplinary assessment and treatment facility for patients with spinal and other musculoskeletal problems. Data on therapists' recognition and management of patients with NC and LSS were collected.
Results
Fifty out of 54 therapists completed questionnaires, and all but one of these identified a clearly recognised posture-related clinical syndrome of NC. Almost all respondents (48: 96%) reported the routine use of physiotherapy treatments. In particular, advice and education (49: 98%) along with an exercise programme (47: 94%) incorporating flexion-based exercises (41: 82%) and trunk muscle stabilising exercises (35: 70%) were favoured.
Conclusion
Musculoskeletal physiotherapy clinicians in this survey recognised a clear clinical syndrome of NC, based on the findings of posture-dependent symptoms. Most therapists reported the routine use of flexion-based exercise, reflecting recommendations in the literature which are based on theoretical benefits, but for which trial evidence is lacking. There is a need for research evidence to guide the choice of physiotherapy treatments.
doi:10.1186/1471-2474-10-121
PMCID: PMC2762954  PMID: 19796387

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