Objective: The purpose of this study was to examine the effects of manual therapy and exercise, with or without the addition of cervical traction, on pain, function, and disability in patients with cervical radiculopathy.

Design: This study was a multicenter randomized clinical trial.

Setting: The study was conducted in orthopedic physical therapy clinics.

Patients: Patients diagnosed with cervical radiculopathy (N=81) were randomly assigned to 1 of 2 groups: a group that received manual therapy, exercise, and intermittent cervical traction (MTEXTraction group) and a group that received manual therapy, exercise, and sham intermittent cervical traction (MTEX group).

Intervention: Patients were treated, on average, 2 times per week for an average of 4.2 weeks.

Measurements: Outcome measurements were collected at baseline and at 2 weeks and 4 weeks using the Numeric Pain Rating Scale (NPRS), the Patient-Specific Functional Scale (PSFS), and the Neck Disability Index (NDI).

Results: There were no significant differences between the groups for any of the primary or secondary outcome measures at 2 weeks or 4 weeks. The effect size between groups for each of the primary outcomes was small (NDI=1.5, 95% confidence interval [CI]=–6.8 to 3.8; PSFS=0.29, 95% CI=–1.8 to 1.2; and NPRS=0.52, 95% CI=–1.8 to 1.2).

Limitations: The use of a nonvalidated clinical prediction rule to diagnose cervical radiculopathy and the lack of a control group without treatment were limitations of this study.

Conclusions: The results suggest that the addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields no significant additional benefit to pain, function, or disability in patients with cervical radiculopathy.

Objective: The aim of this study was to evaluate the short-term effectiveness of high-intensity laser therapy (HILT) versus ultrasound (US) therapy in the treatment of SAIS.

Design: The study was designed as a randomized clinical trial.

Setting: The study was conducted in a university hospital.

Patients: Seventy patients with SAIS were randomly assigned to a HILT group or a US therapy group.

Intervention: Study participants received 10 treatment sessions of HILT or US therapy over a period of 2 consecutive weeks.

Measurements: Outcome measures were the Constant-Murley Scale (CMS), a visual analog scale (VAS), and the Simple Shoulder Test (SST).

Results: For the 70 study participants (42 women and 28 men; mean [SD] age=54.1 years [9.0]; mean [SD] VAS score at baseline=6.4 [1.7]), there were no between-group differences at baseline in VAS, CMS, and SST scores. At the end of the 2-week intervention, participants in the HILT group showed a significantly greater decrease in pain than participants in the US therapy group. Statistically significant differences in change in pain, articular movement, functionality, and muscle strength (force-generating capacity) (VAS, CMS, and SST scores) were observed after 10 treatment sessions from the baseline for participants in the HILT group compared with participants in the US therapy group. In particular, only the difference in change of VAS score between groups (1.65 points) surpassed the accepted minimal clinically important difference for this tool.

Limitations: This study was limited by sample size, lack of a control or placebo group, and follow-up period.

Conclusions: Participants diagnosed with SAIS showed greater reduction in pain and improvement in articular movement functionality and muscle strength of the affected shoulder after 10 treatment sessions of HILT than did participants receiving US therapy over a period of 2 consecutive weeks.

Objective: The purpose of this study was to assess convergent validity of the Step Test (ST) and the knee extension component of the Upright Motor Control Test (UMCe) as measures of paretic-limb loading and of the Repetitive Reach Test (RR) as a measure of weight transfer in the first 6 months after stroke.

Design: This was a prospective cohort study of 33 adults with lower-extremity motor impairment following unilateral, noncerebellar stroke. Participants were tested one time per month from 1 to 6 months poststroke.

Results: Scores on the ST (performed with the nonparetic leg as the stepping leg) and UMCe were positively correlated with peak vertical ground reaction forces (GRFs) beneath the paretic limb during functional tasks (R²=.35–.76 for the ST, pseudo R²=.21–.34 for the UMCe). Scores on the RR were positively correlated with change in vertical GRF beneath the paretic limb during the diagonal reach task (R²=.45) and with weight-transfer time during stepping with the nonparetic limb (R²=.15).

Conclusions: The ST, performed with the nonparetic leg as the stepping leg, is a valid measure of paretic-limb loading during stroke recovery. Of the clinical measures tested, the ST correlated most strongly with the force platform measures.

Objective: The purpose of this study was to determine the effect of load type (elastic, viscous, or mass) on muscle activation and co-contraction during resisted forward reaching in the paretic and nonparetic arms after stroke.

Design: This investigation was a single-session, mixed repeated-measures pilot study.

Methods: Twenty participants (10 with hemiplegia and 10 without neurologic involvement) reached forward with each arm against equivalent elastic, viscous, and mass loads. Normalized shoulder and elbow electromyography impulses were analyzed to determine agonist muscle recruitment and agonist-antagonist muscle co-contraction.

Results: Muscle activation and co-contraction levels were significantly higher on virtually all outcome measures for the paretic and nonparetic arms of the participants with stroke than for the matched control participants. Only the nonparetic shoulder responded to load type with similar activation levels but variable co-contraction responses relative to those of the control shoulder. Elastic and viscous loads were associated with strong activation; mass and viscous loads were associated with minimal co-contraction.

Limitations: A reasonable, but limited, range of loads was available.

Conclusions: Motor control deficits were evident in both the paretic and the nonparetic arms after stroke when forward reaching was resisted with viscous, elastic, or mass loads. The paretic arm responded with higher muscle activation and co-contraction levels across all load conditions than the matched control arm. Smaller increases in muscle activation and co-contraction levels that varied with load type were observed in the nonparetic arm. On the basis of the response of the nonparetic arm, this study provides preliminary evidence suggesting that viscous loads elicited strong muscle activation with minimal co-contraction. Further intervention studies are needed to determine whether viscous loads are preferable for poststroke resistive exercise programs.

Objective: The aim of this study was to determine whether the Vo₂peak measured during an incremental treadmill test is a true reflection of the maximum oxygen uptake (Vo₂max) in children who have spina bifida and are ambulatory.

Design: A cross-sectional design was used for this study.

Methods: Twenty children who had spina bifida and were ambulatory participated. The Vo₂peak was measured during a graded treadmill exercise test. The validity of Vo₂peak measurements was evaluated by use of previously described guidelines for maximum exercise testing in children who are healthy, as well as differences between Vo₂peak and Vo₂ during a supramaximal protocol (Vo₂supramaximal).

Results: The average values for Vo₂peak and normalized Vo₂peak were, respectively, 1.23 L/min (SD=0.6) and 34.1 mL/kg/min (SD=8.3). Fifteen children met at least 2 of the 3 previously described criteria; one child failed to meet any criteria. Although there were no significant differences between Vo₂peak and Vo₂supramaximal, 5 children did show improvement during supramaximal testing.

Limitations: These results apply to children who have spina bifida and are at least community ambulatory.

Conclusions: The Vo₂peak measured during an incremental treadmill test seems to reflect the true Vo₂max in children who have spina bifida and are ambulatory, validating the use of a treadmill test for these children. When confirmation of maximal effort is needed, the addition of supramaximal testing of children with disability is an easy and well-tolerated method.

Case Descriptions. Two individuals who required botulinum toxin treatment for poststroke spasticity were assessed over a course of 20 weeks with both clinical (Modified Ashworth Scale) and neurophysiological (surface electromyography recording of levels of muscle activity) measures of spasticity. Additionally, arm function, arm movement, and pain were measured. The individuals’ responses to treatment with botulinum toxin and overall recovery after stroke are described.

Outcomes. There were discrepancies between the clinical and the neurophysiological measures of spasticity. The clinical measure of spasticity was not effective in consistently identifying the presence of spasticity and, therefore, also was ineffective in documenting the individuals’ responses to treatment. The neurophysiological measure was able to identify when muscle activity levels had been reduced, but a reduction in muscle activity levels did not always correspond with a reduction in Modified Ashworth Scale scores.

Discussion. The accurate identification of spasticity is important not only for assessment but also for the selection of appropriate treatments after stroke.