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Annals of Physical and Rehabilitation... Apr 2009The physiology of urinary continence is complex and the respective role of active and passive mechanisms is still subject to debate. Many different sacral reflexes are... (Review)
Review
OBJECTIVE
The physiology of urinary continence is complex and the respective role of active and passive mechanisms is still subject to debate. Many different sacral reflexes are involved in these processes. The present literature review focuses on the neuromuscular mechanisms, which are involved in the pathophysiology of female stress urinary incontinence (SUI).
MATERIAL AND METHODS
We performed a systematic review of the literature in the Medline, Pascal and Embase databases by using the following keywords: reflex, perineal, sacral, urethral pressure, urethra, pelvic floor, fatigue, continence, incontinence and muscle.
RESULTS
In recent years, new pathophysiological hypotheses concerning abnormal pelvic floor muscle reflex responses to stress have been discussed and included an abnormal time course of pelvic floor muscle activation during coughing. It has also been suggested that unusually rapid fatigue of the pelvic floor muscle reflex may be involved in some women.
CONCLUSION
Overall, there are arguments in favour of the involvement of neuromuscular dysfunction in the pathophysiology of female SUI - particularly dysfunctional and delayed pelvic floor muscle reflex responses during coughing. It would be useful to establish whether these neuromuscular dysfunctions may be remedied by physiotherapeutic pelvic floor muscle training.
Topics: Cough; Female; Humans; Lumbosacral Region; Muscle, Skeletal; Pelvic Floor; Reflex, Abnormal; Urinary Incontinence, Stress
PubMed: 19522039
DOI: 10.1016/j.rehab.2008.12.013 -
Dynamic Medicine : DM Jun 2008Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to...
BACKGROUND
Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue, arterial system, and innervation to the patellofemoral joint in order to supply the clinician with the knowledge required to assess the anatomy and make recommendations to patients identified as potentially at risk. The purpose of this article is to review knee anatomy and the literature regarding potential risk factors associated with patellofemoral pain syndrome and prehabilitation strategies. A comprehensive review of knee anatomy will present the relationships of arterial collateralization, innervations, and soft tissue alignment to the possible multifactoral mechanism involved in PFPS, while attempting to advocate future use of different treatments aimed at non-soft tissue causes of PFPS.
METHODS
A systematic database search of English language PubMed, SportDiscus, Ovid MEDLINE, Web of Science, LexisNexis, and EBM reviews, plus hand searching the reference lists of these retrieved articles was performed to determine possible risk factors for patellofemoral pain syndrome.
RESULTS
Positive potential risk factors identified included: weakness in functional testing; gastrocnemius, hamstring, quadriceps or iliotibial band tightness; generalized ligamentous laxity; deficient hamstring or quadriceps strength; hip musculature weakness; an excessive quadriceps (Q) angle; patellar compression or tilting; and an abnormal VMO/VL reflex timing. An evidence-based medicine model was utilized to report evaluation criteria to determine the at-risk individuals, then a defined prehabilitation program was proposed that begins with a dynamic warm-up followed by stretches, power and multi-joint exercises, and culminates with isolation exercises. The prehabilitation program is performed at lower intensity level ranges and can be conducted 3 days per week in conjunction with general strength training. Based on an objective one repetition maximum (1RM) test which determines the amount an individual can lift in good form through a full range of motion, prehabilitation exercises are performed at 50-60% intensity.
CONCLUSION
To reduce the likelihood of developing PFPS, any individual, especially those with positive potential risk factors, can perform the proposed prehabilitation program.
PubMed: 18582383
DOI: 10.1186/1476-5918-7-9 -
Neurology Jan 2005The objective of this report was to develop a case definition of distal symmetric polyneuropathy to standardize and facilitate clinical research and epidemiologic... (Review)
Review
Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.
The objective of this report was to develop a case definition of distal symmetric polyneuropathy to standardize and facilitate clinical research and epidemiologic studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetric polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiologic studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach to defining distal symmetric polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiologic research studies will ensure greater consistency of case selection.
Topics: Clinical Protocols; Clinical Trials as Topic; Diabetic Neuropathies; Diagnosis, Differential; Diagnostic Techniques, Neurological; Electrodiagnosis; Electromyography; Evidence-Based Medicine; Expert Testimony; Humans; Neural Conduction; Neurologic Examination; Polyneuropathies; Reflex, Abnormal; Sensitivity and Specificity; Societies, Medical; Terminology as Topic
PubMed: 15668414
DOI: 10.1212/01.WNL.0000149522.32823.EA -
The Cochrane Database of Systematic... 2003Neuropathic pain is defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system. Some examples of this condition are phantom limb pain,... (Review)
Review
BACKGROUND
Neuropathic pain is defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system. Some examples of this condition are phantom limb pain, post-stroke pain and complex regional pain syndrome type I (reflex sympathetic dystrophy) and type II (causalgia). Treatment options include drugs, physical treatments, surgery and psychological interventions. The concept that many neuropathic pain syndromes, particularly RSD and causalgia are "sympathetically maintained pains" has historically led to attempts to temporarily or permanently interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy the sympathetic chain, but this effect is temporary until regeneration of the sympathetic chain occurs. Surgical ablation can be performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using stereotactic thermal or laser interruption.
OBJECTIVES
The review aimed to assess the effects of both chemical and surgical sympathectomy for neuropathic pain. Secondary objectives were to compare the effects of sympathectomy with no treatment, placebo or conventional treatment, and to evaluate whether the technique of sympathectomy influences the outcomes of the procedure.
SEARCH STRATEGY
We searched MEDLINE and EMBASE up to February 2003 and the latest issue of the Cochrane Library (Issue 1, 2003). We screened references in the retrieved articles, literature reviews and book chapters. We also contacted experts in the field of neuropathic pain.
SELECTION CRITERIA
Clinical trials and observational studies assessing the effects of sympathectomy (surgical or chemical) for neuropathic pain of both central or peripheral origin were included.
DATA COLLECTION AND ANALYSIS
Two reviewers applied the selection criteria to titles and abstracts. Full articles of potentially eligible trials were obtained and the same reviewers applied the inclusion criteria to the studies. The methodological quality of the studies was evaluated. The studies were also evaluated for clinical relevance according to a classification developed by our group. Statistical pooling was not possible due to heterogeneity of data; instead a narrative description of each included study was performed.
MAIN RESULTS
We included four studies. One randomized trial comparing radiofrequency sympatholysis with phenol sympathectomy was rated as low methodological quality and it showed that radiofrequency sympatholysis does not offer advantage over phenol techniques. However, a modified technique produced sympatholysis comparable to that produced by 6% phenol, with less incidence of post-sympathectomy neuralgia.
REVIEWER'S CONCLUSIONS
The practice of surgical and chemical sympathectomy is based on poor quality evidence, uncontrolled studies and personal experience. Furthermore, complications of the procedure may be significant, in terms of both worsening the pain or producing a new pain syndrome; and abnormal forms of sweating (compensatory hyperhidrosis and pathological gustatory sweating). Therefore, more clinical trials of sympathectomy are required to establish the overall effectiveness and potential risks of this procedure.
Topics: Humans; Pain Management; Peripheral Nervous System Diseases; Sympathectomy; Sympathectomy, Chemical
PubMed: 12804444
DOI: 10.1002/14651858.CD002918 -
Diabetic Medicine : a Journal of the... Apr 2000To review the clinical manifestations of the Charcot foot in diabetes mellitus, with particular reference to theories concerning aetiology. (Review)
Review
AIMS
To review the clinical manifestations of the Charcot foot in diabetes mellitus, with particular reference to theories concerning aetiology.
METHODS
Systematic review of the published literature, searching for the keywords 'Charcot', 'foot and diabetes' and 'neuropathy' on Medline, as well as by examination of the references in recent published reviews.
CONCLUSIONS
The Charcot foot of diabetes mellitus is a common problem, and yet is not widely recognized by non-specialists. The failure of professionals to identify the condition in its early phases is probably largely responsible for the gross deformity which follows continued weight-bearing. The condition is confined to those with severe peripheral neuropathy. It is thought to result from three factors: motor neuropathy leading to the development of abnormal forces within the foot, subsequent disorganization of the foot as a result of associated osteopenia and progressive destruction from continued weight-bearing, enabled by reduced pain sensation. The cause of the osteopenia is not known, but it is associated with increased bone blood flow, which may be mainly the result of loss of sympathetic innervation. The importance of increased limb blood flow in the pathogenesis of the Charcot foot has been recognized for over a century. Paradoxically, the increased flow is associated with evidence of macrovascular disease, in that the prevalence of vascular calcification of pedal vessels approaches 90%. After an interval of many months, the condition tends to evolve: the increased blood flow lessens, the osteopenia is reduced and the disorganized bones become sclerotic. This tendency for the condition to evolve remains unexplained, since it would not be expected if the condition was caused solely by progressive denervation. As a result, it is suggested that another factor may be involved in the pathogenesis of the Charcot foot: an abnormal vasomotor reflex, analogous to reflex sympathetic dystrophy, occurring against a background of severe peripheral neuropathy. The resolution of the condition occurs because it is the reflex component of the hyperaemia which proves self-limiting.
Topics: Diabetic Foot; Diabetic Neuropathies; Gait Disorders, Neurologic; Humans; MEDLINE; Weight-Bearing
PubMed: 10821290
DOI: 10.1046/j.1464-5491.2000.00233.x -
Journal of Neurology Oct 1999We conducted a systematic review of the literature from 1965-1994 to assess the value of history and physical examination in the diagnosis of sciatica due to disc... (Meta-Analysis)
Meta-Analysis
We conducted a systematic review of the literature from 1965-1994 to assess the value of history and physical examination in the diagnosis of sciatica due to disc herniation; we also included population characteristics and features of the study design affecting diagnostic value. Studies on the diagnostic value of history and physical examination in the diagnosis of sciatica due to disc herniation are subject to important biases, and information on numerous signs and symptoms is scarce or absent. Our search revealed 37 studies meeting the selection criteria; these were systematically and independently read by three readers to determine diagnostic test properties using a standard scoring list to determine the methodological quality of the diagnostic information. A meta-analysis was performed when study results allowed statistical pooling. Few studies investigated the value of the history. Pain distribution seemed to be the only useful history item. Of the physical examination signs the straight leg raising test was the only sign consistently reported to be sensitive for sciatica due to disc herniation. However, the sensitivity values varied greatly, the pooled sensitivity and specificity values being 0.85 and 0.52, respectively. The crossed straight leg raising test was the only sign shown to be specific; the pooled sensitivity and specificity values were 0.30 and 0.84, respectively. There was considerable disagreement on the specificity of the other neurological signs (paresis, sensory loss, reflex loss). Several types of bias and other methodological drawbacks were encountered in the studies limiting the validity of the study results. As a result of these drawbacks it is probable that test sensitivity was overestimated and test specificity underestimated.
Topics: Evaluation Studies as Topic; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Medical Records; Physical Examination; Sciatica
PubMed: 10552236
DOI: 10.1007/s004150050480