Back massage: Long term effects and dosage determination for persons with pre-hypertension and hypertension

Significance: Complementary and alternative therapies (CAM) are widely used however the efficacy of many CAM therapies for specific diseases has yet to be verified. Massage therapy, specifically back massage, used to assist in the management of elevated blood pressure is one such unverified therapy. A pilot study completed in 2002 resulted in significant changes in blood pressure using a repeated application of the 10 minute back massage. Research Aims: This study, evolving from a psychophysiology framework, aimed to determine the long term efficacy of a back massage treatment and possible dosage needed to effectively assist in the management of elevated blood pressure. Primary Research Hypotheses: After adjusting for covariates: A. Systolic blood pressure (SBP) and or diastolic blood pressure (DBP) would decrease significantly over time using a back massage treatment in subjects with pre-hypertension or controlled hypertension.B. There would be a significant difference in the SBP (and or DBP) changes over time using 10 applications of back massage versus five applications of back massage in the subjects with pre-hypertension and controlled hypertension.Methods: A priori power analysis determined the three groups by four time points (repeated measures) design required a sample of 45 participants. The sample of men and women, 18-75 years of age, were recruited from a university setting. Outcome Variables: Systolic Blood Pressure, Diastolic Blood Pressure Potential Covariates: Age, BMI, Medications, Years of Hypertension, Salivary cortisol, and State and Trait Personality Indicators (anger, anxiety, depression). Intervention: Group 1: Ten 10-minute back massages given three times a week for 3.5 weeks. Group 2: Five 10-minute back massages given three times a week for 1.5 weeks. Control (group 3): Ten 10-minute relaxation sessions using learned techniques for 3.5 weeks. Findings: For participants with elevated body mass index (\u3e̲27.85) in the 10-massage group, systolic and diastolic blood pressure changed significantly over time. The dosage analysis did not clearly reveal the direction of the trends, therefore further exploration is warranted

The Effect of Therapeutic Massage on Clinically Diagnosed Hypertension

Hypertension, being one of the most pervasive disease processes in the United States, can lead to end organ damage. Though there is no one cause of primary hypertension, the theory of an unchecked long-term stress response continues to be a valid argument. Conversely, eliciting the relaxation response has been claimed to alter the course of the unchecked stress response. Massage therapists have suggested that their therapy elicits the relaxation response and therefore can decrease blood pressure and hypertension. Nursing, using the back rub, has also investigated the eliciting of the relaxation response with inconclusive results regarding decreases in blood pressure. The purpose of this study was to conclusively determine the effects of a regularly applied 10 minute back massage on subjects with clinically diagnosed hypertension. In this experimental, pre-test- post-test control group study, a 10-minute back rub was applied to subjects (n = 8) three times a week for 10 sessions. The control group (n = 6) relaxed in the same environment for 10 minutes three times a week for ten sessions. Both groups achieved the same level of relaxation as measured by decreased heart rate. Both groups experienced similar level of anxiety change as measured by pre-test, post-test STAI. Results of the study showed a decrease in the pre to post blood pressures of the massage group {-11.38 mmHg systolic blood pressure (SBP) and -3.44mmHgdiastoUc blood pressure (DBP)} over the 10-session period. The results for the control showed an increase of both SBP (+6.5 mmHg) and DBP (+5.5 mmHg) over the 10-session period. In this study the author concluded that regular rhythmic massage to the back elicited a decrease in the SBP and DBP among clinically diagnosed hypertensive subjects for at least 48 hours after the massages were discontinued

Development of a comprehensive mobileassessment of pressure (CMAP) system forpressure injury prevention for veterans with spinalcord injury

Objective: This paper reports the iterative redesign, feasibility and usability of the Comprehensive Mobile Assessment of Pressure (CMAP) system’s mobile app used by Veterans with SCI. Design: This three-year, multi-staged study used a mixed-methods approach. Setting: Minneapolis VA Health Care System, Minneapolis, Minnesota. Participants: Veterans with spinal cord injury (N = 18). Interventions: Veterans with spinal cord injury engaged in iterative focus groups and personal interviews, sharing their needs and desires for the CMAP app redesign. App developers used these data for the redesign. The redesigned CMAP app was tested for six-weeks in users’ homes. Outcome Measures: Quantitative (surveys) and qualitative (interviews) methods measured feasibility for self-management of seating pressure. Qualitative data were audio recorded, transcribed, anonymized, and coded. Survey data were analyzed using summary statistics. Results: After the CMAP system’s redesign, the in-home use interview found: (1) any tool that can assist in prevention and monitoring of skin ulcers is important; (2) the desired key features are present in the app; (3) the main barrier to CMAP use was inconsistent functionality; (4) when functioning as expected, the live pressure map was the central feature, with reminders to weight shift also of high importance. The survey found: power wheelchair users tended to score closer than manual wheelchair users to the positive response end ranges on two separate surveys. Conclusions: Overall both the power and manual wheelchair users reported that they wanted to use the system, felt confident using the system, and that the functions of the system were well integrated.This study was funded by the Department of Defense, number W81XWH-15-1-0484

Regionally specific TSC1 and TSC2 gene expression in tuberous sclerosis complex

Tuberous sclerosis complex (TSC), a heritable neurodevelopmental disorder, is caused by mutations in the TSC1 or TSC2 genes. To date, there has been little work to elucidate regional TSC1 and TSC2 gene expression within the human brain, how it changes with age, and how it may influence disease. Using a publicly available microarray dataset, we found that TSC1 and TSC2 gene expression was highest within the adult neo-cerebellum and that this pattern of increased cerebellar expression was maintained throughout postnatal development. During mid-gestational fetal development, however, TSC1 and TSC2 expression was highest in the cortical plate. Using a bioinformatics approach to explore protein and genetic interactions, we confirmed extensive connections between TSC1/TSC2 and the other genes that comprise the mammalian target of rapamycin (mTOR) pathway, and show that the mTOR pathway genes with the highest connectivity are also selectively expressed within the cerebellum. Finally, compared to age-matched controls, we found increased cerebellar volumes in pediatric TSC patients without current exposure to antiepileptic drugs. Considered together, these findings suggest that the cerebellum may play a central role in TSC pathogenesis and may contribute to the cognitive impairment, including the high incidence of autism spectrum disorder, observed in the TSC population

Cerebrospinal Fluid Dehydroepiandrosterone Levels Are Correlated with Brain Dehydroepiandrosterone Levels, Elevated in Alzheimer’s Disease, and Related to Neuropathological Disease Stage

Objective: It is currently unknown whether cerebrospinal fluid (CSF) neurosteroid levels are related to brain neurosteroid levels in humans. CSF and brain dehydroepiandrosterone (DHEA) levels are elevated in patients with Alzheimer’s disease (AD), but it is unclear whether CSF DHEA levels are correlated with brain DHEA levels within the same subject cohort. We therefore determined DHEA and pregnenolone levels in AD patients (n = 25) and cognitively intact control subjects (n = 16) in both CSF and temporal cortex