Bakgrund Droppfot är vanligt vid många sjukdomar och tillstånd, och resulterar i en oförmåga att dorsalextendera fotleden. I vissa fall måste en sentransferering av tibialis posterior utföras för att återställa förmågan att dorsalextendera. Operationen utförs på olika sätt, är väldokumenterad och väl beforskad. För att operationen ska ge önskat resultat krävs god rehabilitering postoperativt. Rehabiliteringen är mindre dokumenterad och saknar tydliga direktiv att förhålla sig till.  Syfte Syftet med denna scoping review var att sammanställa och granska den tillgängliga kunskapen angående rehabiliteringen efter en sentransferering av tibialis posterior.   Metod En scoping review valdes som studiedesign då artikelutbudet är begränsat. Studien utfördes enligt riktlinjer av Arksey & O’Malley (2005), samt Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA).  Resultat Resultatet av sökningen och artikelurvalet på 28 artiklar visade på en stor inkonsekvens i hur rehabiliteringen utförs. De data som extraherades var; antal deltagare, typ av operation, belastning postoperativt, immobiliseringstid, samt beskrivning av fysioterapeutiska insatser. Vissa studier vittnar om 11-12 veckors immobilisering i gips, medan andra mobiliserar inom en vecka postoperativt och undviker att gipsa. Den stora inkonsekvensen kan delvis förklaras med att deltagarnas grunddiagnoser varierar mellan de inkluderade studierna, samt att de kirurgiska tillvägagångssätten skilde sig åt, samt inkluderade andra operationer. Endast två studier behandlade rehabiliteringen som sitt huvudsyfte. Slutsats Bristfällig forskning finns för att kunna dra några vetenskapliga slutsatser. Mer forskning behövs, både som adresserar fysioterapeutiska interventioner och rehabiliteringsfasen i helhet. Mer specifik forskning gällande rehabiliteringen vid sentransferering av tibialis posterior med beaktande av de enskilda diagnoserna behövs också.

<p>It is known that there is an intraindividual amplitude variation in motor electroneurography when the same person is examined at different times. This variation affects the evaluation the status of the patient. The aim of this study was to investigate if the intraindividual amplitude variation decreased by photographing the electrode position, that later is used in the follow-up study. Twenty test persons were examined by four laboratory scientists. The nerves that were examined were median, ulnar, peroneal and tibial nerve. At the first examination the laboratory scientists used method guidelines and took photographs of the electrode position. The photographs were then used in the follow-up. The results showed that there was an indication of decreased of the intraindividual amplitude variation when photographic documentation was used instead of method guidelines.</p>

It is known that there is an intraindividual amplitude variation in motor electroneurography when the same person is examined at different times. This variation affects the evaluation the status of the patient. The aim of this study was to investigate if the intraindividual amplitude variation decreased by photographing the electrode position, that later is used in the follow-up study. Twenty test persons were examined by four laboratory scientists. The nerves that were examined were median, ulnar, peroneal and tibial nerve. At the first examination the laboratory scientists used method guidelines and took photographs of the electrode position. The photographs were then used in the follow-up. The results showed that there was an indication of decreased of the intraindividual amplitude variation when photographic documentation was used instead of method guidelines.

No description available.

Loss of muscle due to aging is often associated with significant detrimental effects. Therefore, it is crucial to understand signaling molecules that may trigger the muscle loss or prevent the process. The transcription factor, Nuclear Factor Kappa-B (NF-κB), is associated with both catabolic and anabolic pathways of muscle metabolism and may be involved in age-related muscle loss. Leucine is an essential amino acid that is required for both protein synthesis and intracellular signaling pathways that regulate protein synthesis and degradation. The current study examined muscle NF-kB levels in male Sprague-Dawley rats, aged 6 (adult) and 21 months (old) fed a diet containing suboptimal leucine levels for 10-17 days. We found that old rats consumed less grams of food per body weight (BW) each day than adult rats (1.45% g diet/g BW vs. 2.4% g diet/g BW). Weight loss during the study was not significantly different between age groups. However the average mass of gastrocnemius and soleus muscles (g muscle/g BW) was significantly lower in old rats. Reduction in gastrocnemius (g muscle/g BW*10²) was associated with 1.8 fold higher muscle cell NF-κB in old vs. adult rats (p = 0.0443). There was also a higher level of ubiquitinated proteins in old gastrocnemius muscle cells relative to the adult gastrocnemius, however differences did not reach statistical significance. For tibialis anterior muscle, the average mass (g muscle/g BW*10²), NF-κB levels and ubiquitinated proteins were not significantly different between adult and old rats. Our findings suggest that aging affects muscle loss and NF-kB in a tissue-specific manner in rats fed a diet with suboptimal leucine levels.

The effects of aging on the muscle length (as inferred by joint angle)-tension relationship was studied in the ankle dorsiflexors of male and female subjects aged 20-40 years (x=25.3; 15d, 159) and 60-80 years (x=68.8; 15d, 159) at 10 joint angles {15°0 through 30°P, in 5° increments). Isometric twitches, voluntary contractions, and 1-sec evoked tetanic contractions {20, 50 & 80 Hz) were measured in the R-tibialis anterior muscle. The resting joint angle for the ankle dorsi flexors was similar between elderly and young adults {13°P ± 3.44). On average, evoked and voluntary torque output increased upon muscle lengthening beyond resting length, and decreased upon shortening. Evoked single twitches of the TA revealed that peak total torque occurred at the extreme of plantarflexion (30°P} in both elderly and young adults. Most importantly, elderly individuals produced similar twitch torque values at all joint angles compared to young adults. Maximal voluntary torque was stronger at the more plantarflexed compared to the dorsiflexed angles, for all subjects, regardless of age, with maximum torque plateauing at 15°P. Elderly subjects demonstrated much reduced MVC torque values compared to young adults at all joint angles (ave.= 18% reduction, p<O.Ol) while maintaining no less than 96% motorunit activation (MUA) . Stimulation of the dorsiflexors at 20, 50, & 80 Hz revealed that the 1-sec peak tetanic torques declined from a maximum at 30°P through to 15°0 for all subjects. Elderly adults produced significantly less tetanic torque at all joint angles compared to young adults (p<0.05). There was no difference between the elderly and young adults in the rate at which the rise in tetanic torque was developed at all joint angles, but elderly adults displayed a significantly greater twitch/tetanus ratio as compared to young adults (p<0.005). In conclusion, these results suggest that there is no age-associated change in the elastic properties of the ankle dorsiflexors, and thus, the length-tension relationship of this muscle group is similar between elderly and young adults. / Thesis / Master of Science (MSc)

Neurografi är en grundläggande metod för att diagnosticera perifera nervsjukdomar, metoden reflekterar det funktionella tillståndet av myeliniserade axon. Neurografi är uppdelat i två delar, motorisk och sensorisk neurografi. Vid undersökningen erhålls va-riabler så som amplitud, latenstid och nervledningshastighet, samtliga variabler är på-verkade av vävnadstemperatur. Vid kalla temperaturer sjunker nervledningshastigheten, amplituden förändras och latenstiden förlängs. Syftet med studien är att kartlägga till vilken grad temperaturen påverkar sensorisk neurografi och om motorisk neurografi på-verkas av temperatur. I studien undersöktes den sensoriska och motoriska grenen på n. tibialis vid hudtempe-raturerna &gt; 30° C, mellan 25 – 28° C samt &lt; 24° C. Huden kyldes med vatten och hud-temperaturen mättes med en örontermometer. Sensorisk nervledningshastighet och amplitud visade en signifikant skillnad mellan de tre temperaturintervallerna medan motorisk nervledningshastighet och amplitud inte vi-sade någon signifikant skillnad. / Electroneurography is a fundamental method for diagnosing peripheral nerve disorder, the method reflects the functional condition of the myelin coated axons. Electroneurog-raphy is divided into two parts, sensory and motor neurography. During the examination are variables as amplitude, latency and conduction velocity acquired, all those variables are affected by temperature. At cold temperature conduction velocity declines, ampli-tude changes and latency extend. The purpose of the study is to map out to what degree the temperature is affecting sensory neurography and if motor neurography is affected by temperature. The study examined the sensory and motor branch of n. tibialis at the skin temperature &gt; 30° C, between 25 – 28° C and &lt; 24° C. The skin was cooled by water and the skin temperature was measured by an ear-thermometer. Sensory conduction velocity and amplitude had a significantly difference at the three temperature intervals meanwhile motor conduction velocity and amplitude did not.

Supporters of a nutritional supplement, β-Hydroxy-β-Methylbutyrate (HMB) supplementation, claim that it will increase the muscular strength gains and lean muscle mass gains seen during a resistance training program. It has been suggested that HMB supplementation does this by preventing muscle damage or by regenerating damaged muscle cell membranes. However, no research has evaluated the effect of HMB supplementation on low frequency fatigue. Therefore, the purpose of this study was to determine if three weeks of HMB supplementation could attenuate the effects of low frequency fatigue caused by eccentric muscle contractions of the tibialis anterior muscle. A total of 33 healthy recreationally active subjects (18 males, 15 females; 23.2 ± 4.3 yr) were recruited for this study. All subjects preformed 4 sets of 25 eccentric contractions of the tibialis anterior muscle through a range of motion of 30 degrees. Recovery measures were taken for 20 minutes after the fatigue protocol and at 48 and 96 hours of recovery. The recovery measures included: Maximum voluntary contraction peak torque, 10 Hz peak torque, 50 Hz peak torque, 10/50 Hz peak torque ratio, and EMG measurements. Each subject served as their own control and limbs were randomly assigned to pre-supplement or post-supplement limbs. Following the pre-supplement fatigue protocol and recovery measures each subject completed three weeks of 3g/day HMB supplementation. After the supplementation period the post-supplement fatigue protocol was completed and recovery measures were taken. The 10 Hz peak torque and the 10/50 Hz torque ratio in the pre-supplement limb was still significantly reduced at the 96-hour recovery measurement time, indicating that it was still showing low frequency muscle fatigue at this time. Furthermore, the post-supplement limb, recovered from the fatigue protocol faster, and did not show any signs of low frequency muscle fatigue at the 48-hour recovery measurement time. In addition the pre-supplement limb had significant maximum voluntary contraction torque deficit at the 48-hour recovery measurement time and the post-supplement limb showed no significant deficits. The main findings of this study were that three weeks of HMB supplementation attenuated low frequency fatigue and maximum voluntary contraction torque reduction after an eccentric fatigue protocol.

Chronic exertional compartment syndrome (CECS) is a common problem within both military and athletic populations that can be difficult to diagnose. Furthermore, it is unclear what causes the development of CECS, particularly in the military population, as personnel undertake a variety of activities that can cause pain with CECS such as fast walking, marching and running. Chronic exertional compartment syndrome has been hypothesised to develop due to excessive muscle activity, foot pronation and abnormal biomechanics predominantly at the ankle. Treatment of CECS through running re-education to correct these abnormalities has been reported to improve symptoms. However no primary research has been carried out to investigate the biomechanical, muscle activation and clinical characteristics of military patients with CECS. The purpose of this thesis was to provide an original contribution to the knowledge through the exploration of these characteristics; and the development of insights into the development of CECS, with implications for prevention and treatment. Study one investigated the clinical characteristics of 93 service personnel with CECS. Plantar pressure variables, related to foot type and anterior compartment muscle activity, and ankle joint mobility were compared during walking between 70 cases and 70 controls in study two. Study three compared three-dimensional whole body kinematics, kinetics and lower limb muscle activity during walking and marching between 20 cases and 20 controls. Study four compared kinematics and lower limb muscle activity during running in a separate case-control cohort (n=40). Differences in electromyography (EMG) intensity during the gait cycle were compared in the frequency and time domain using wavelet analysis. All studies investigated subject anthropometry. Cases typically presented with bilateral, ‘tight’ or ‘burning’ pain in the anterior and lateral compartments of the lower leg that occurred within 10 minutes of exercise. This pain stopped all cases from exercising during marching and/or running. As such subsequent studies investigated the biomechanics of both ambulatory and running gaits. Cases in all case-control studies were 2-10 cm shorter; and were typically overweight resulting in a higher body mass index (BMI) than controls. There was strong evidence from study 3 that cases had greater relative stride lengths than controls during marching gait. This was achieved through an increase in ankle plantarflexion during late stance and a concomitant increase in the gastrocnemius medialis contraction intensity within the medium-high frequency wavelets. Given the differences in height observed, this may reflect ingrained alterations in gait resulting from military training; whereby all personnel are required to move at an even cadence and speed. These differences in stride length were also observed in walking and running gaits although to a lesser extent. There was no evidence from the EMG data that cases had greater tibialis anterior activation than controls during any activity tested, at any point in the gait cycle or in any frequency band. In agreement, there was also no evidence of differences between groups in plantar pressure derived measures of foot type, which modulate TA activity. Toe extensor - related plantar pressure variables also did not differ between groups. In summary, contrary to earlier theories, increased muscle activity of the anterior compartment musculature does not appear to be associated with CECS. The kinematic differences observed during running only partially matched the clinical observations previously described in the literature. Cases displayed less anterior trunk lean and less anterior pelvic tilt throughout the whole gait cycle and a more upright shank inclination angle during late swing (peak mean difference 3.5°, 4.1° and 7.3° respectively). However, no consistent differences were found at the ankle joint suggesting that running is unlikely to be the cause of CECS in the military; and that the reported success of biomechanical interventions may be due to reasons other than modifying pathological aspects of gait. In summary, the data presented in the thesis suggest that CECS is more likely to develop in subjects of shorter stature and that this is associated with marching at a constant speed and cadence. Biomechanical interventions for CECS, such as a change in foot strike or the use of foot orthotics, are unlikely to be efficacious for the military as personnel will continue to be required to march at prescribed speeds to satisfy occupational requirements. Preventative strategies that allow marching with a natural gait and/or at slower speeds may help reduce the incidence of CECS. The lack of association with foot type or muscle activity suggests that foot orthoses would not be a useful prevention strategy or treatment option for this condition.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21042号 / 人健博第58号 / 新制||人健||4(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 坪山 直生, 教授 黒木 裕士, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM