Selections From This Month in the Archives

Article Outline

• Sensorimotor Deficits Remain Despite Resolution of Symptoms Using Conservative Treatment in Patients With Tennis Elbow: A Randomized Controlled Trial
• Botulinum Toxin Dilution and Endplate Targeting in Spasticity: A Double-Blind Controlled Study
• Classification Schema of Posttraumatic Amnesia Duration-Based Injury Severity Relative to 1-Year Outcome: Analysis of Individuals with Moderate and Severe Traumatic Brain Injury
• Redefining the Manual Wheelchair Stroke Cycle: Identification and Impact of Nonpropulsive Pushrim Contact

Leanne M. Bisset, PhD

Michel W. Coppieters, PhD

Bill T. Vicenzino, PhD

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Sensorimotor Deficits Remain Despite Resolution of Symptoms Using Conservative Treatment in Patients With Tennis Elbow: A Randomized Controlled Trial 

Although lateral epicondylitis (LE) is known to be associated with slowed reaction times and limb movement, little is known about their time course or response to treatment. Bisset and colleagues examine this issue in a single-blinded randomized controlled trial of almost 200 adults with unilateral LE. Subjects were divided into 3 groups that received either 8 sessions of physical therapy, corticosteroid injections, or ergonomic advice. The authors found that their subjects displayed delays in reaction times and limb movement speeds in both their affected and unaffected arms that, while improving over time, persisted throughout the 52-week course of the study. No statistically significances were detected between the treatment groups and the authors speculate that their findings might be explained by pain-associated changes within the brain's somatosensory cortex. • SEE PAGE 1

Jean-Michel Gracies, MD

Mara Lugassy, MD

Donald J. Weisz, PhD

Michele Vecchio, MD

Steve Flanagan, MD

David M. Simpson, MD

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Botulinum Toxin Dilution and Endplate Targeting in Spasticity: A Double-Blind Controlled Study 

Botulinum neurotoxin (BTX) is used successfully to treat muscle spasticity and dystonia, but the benefits of various injection techniques remain debated. Gracies and colleagues studied this controversy with a double blind randomized controlled trial of 21 adults with spastic hemiparesis. All subjects received four 60-unit injections of BTX-A in their involved biceps brachii. Seven, however, received a low volume (0.4ml/site) nontargeted technique; 7 a similar low volume (0.4ml/site) injectate targeted to the muscle's motor endplates; and 7 a high volume (2ml/site) nontargeted injection. The investigators found that while all groups obtained benefits, that high-volume and endplate-targeted injections were associated with the best results in terms of greater neuromuscular blockade and improvements in co-contraction, spasticity, and active range of motion. • SEE PAGE 9

Risa Nakase-Richardson, PhD

Arash Sepehri, MA

Mark Sherer, PhD

Stuart A. Yablon, MD

Clea Evans, PhD

Tanja Mani, PhD

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Classification Schema of Posttraumatic Amnesia Duration-Based Injury Severity Relative to 1-Year Outcome: Analysis of Individuals with Moderate and Severe Traumatic Brain Injury 

The duration of posttraumatic amnesia (PTA) has been used since the 1940s to predict traumatic brain injury (TBI) outcome. Nakase-Richardson and colleagues, however, note that much has been learned over the intervening period and propose to revisit this issue by deriving a classification schema based on the outcomes of 280 TBI Model System participants with a TBI and a known or inferred PTA duration. Participants were separated into 4 injury severity groups on the basis of differences in their 1-year productivity status. The authors found that individuals with PTA less than 14 days had relatively favorable 1-year outcomes (68% were defined as productive) while those with PTA's greater than 28 days did less well (18% productive). The authors conclude that if their findings are validated by other investigators that their proposed schema may be useful in determining a prognosis for people with TBI. • SEE PAGE 17

Andrew M. Kwarciak, MS

Sue Ann Sisto, PT, PhD

Mathew Yarossi, BS

Robert Price, MSME

Eugene Komaroff, PhD

Michael L. Boninger, MD

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Redefining the Manual Wheelchair Stroke Cycle: Identification and Impact of Nonpropulsive Pushrim Contact 

Wheelchair propulsion is often viewed as consisting of 2 components; a push phase and a recovery phase. Kwarciak and colleagues, however, note that this definition may be too simplistic and note that in a sample of 54 people with well established paraplegia that not only were periods of nonpropulsive pushrim contact common, but that they represented significant portions of the contact angle. In addition, the investigators established that these periods were associated with power losses that became more prominent as velocities increased. The investigators conclude that their proposed definition provides a more practical and useful description of the stroke cycle that will help in understanding the role of nonpropulsive pushrim forces during the stroke cycle. • SEE PAGE 20