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Objectives
Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion–rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6–12 years. Another important purpose was to identify the presence of pain during the FRT.
Methods
Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device.
Results
Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32° for rotation, 5.30° for side flexion, and 10.89° for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10.
Discussion
Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.
Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for musicians follows a specific concept-b and requires knowledge of instruments and musician-specific complaints. Based on the consulting hour in a clinic in Osnabrueck, 614 case reports were part of this sample, of which 558 data sets were complete. The focus of the analysis is the instrument and the primary complaint. Also, the type of therapy is characterized, and the amount is calculated. Primary complaints of musicians, in general, are found most frequently in the spine and upper extremity. Musician complaints are different between instruments. Instrumentalists have a significantly higher chance to suffer from a primary complaint in the area of the upper extremity. Furthermore, the groups without an instrument (e.g., singing or dancing) are developing complaints in the anatomical area which they primarily use. Therefore, these types of therapy were used: physiotherapy, manual therapy, and osteopathy with an average of 5.9 treatment units. This study underpinned the importance of musician-specific physiotherapy as a profession to treat musicians. Also, an interdisciplinary approach is necessary to treat all aspects of complaints.
Background: Singers belong to the group of professional voice users with the highest demands regarding voice quality and vocal load. Thus, they also have a high risk of developing a voice disorder, which in return has major impact on their ability to work. Besides voice disorders caused by organic changes, there are functional voice disorders caused by, e.g., a hypertonia of the larynx, shoulder and neck muscles or insufficient breathing patterns. In these cases, physiotherapy can be one component of a multidisciplinary approach to treatment.
The purpose of this presentation is, based on anatomical considerations and current evidence, to inform about and demonstrate physiotherapy techniques for treating singers with functional voice disorders.
Approach of Presentation: A case from a special physiotherapy outpatient clinic for vocalists will be described. Based on this example, information on the evidence of physiotherapy approaches for functional voice disorders will be provided. Afterwards, some practical hands-on techniques will be demonstrated for participants to try.
Content of Presentation: This workshop will focus on the physiotherapy treatment for a vocalist with functional voice disorders. The vocalist experienced changed pitch and hypertonia in both the muscles of the shoulder-neck region and the extrinsic laryngeal muscles. Paralaryngeal manual techniques, in addition to posture and breathing exercises, will be demonstrated with the purpose of mobilizing the larynx and relaxing the hypertonic muscles.
Conclusions and Practical Relevance: This workshop highlights the special potential of physical therapy in the treatment of functional voice disorders in singers.
The objective of this review is a global assessment of the economics of second‐generation biorefineries, with a focus on the use of food waste and agricultural residues for chemical production by applying biotechnological processes. Analyses are conducted on feedstock and product distribution, applied economic models, and profitability figures for the period 2013–2018. In a study of 163 articles on different biorefinery systems, the production of chemicals is identified as the second major product class, after bioenergy. Bagasse and straw are frequently analyzed second‐generation feedstocks. Based on the evaluation of 22 articles, second‐generation biorefineries producing chemicals by applying biotechnological processes proves to be economically feasible. On average, both the internal rate of return (IRR) and the return on investment (ROI) are 20% and the payback period (PP) is 6 years. The cost share of feedstock in biorefineries is between 0–50%. The price of the end product and the fermentation yields have the most impact on profitability. The processing of food waste that has industrial and municipal origins appears more economical than the processing of agricultural residues. Scientists, policy makers and entrepreneurs with an appropriate risk tolerance are advised to pay particular attention to municipal food waste and the potential economic production of carboxylic acids. For various economic issues related to biorefineries, dynamic‐deterministic models are recommended, which can be extended by a stochastic model. This review provides an initial overview of the economic feasibility of second‐generation biorefineries. Further techno‐economic analyses are required to produce statistically significant statements on key profitability figures. © 2020 The Authors. Biofuels, Bioproducts, and Biorefining published by Society of Chemical Industry and John Wiley & Sons, Ltd.
Business-driven development favors the construction of process models
at different abstraction levels and by different people. As a consequence, there is a demand for consolidating different versions of process models by merging them. In this paper, we study a basic scenario, derive requirements and present a prototype for detecting and resolving changes between process models.
Transport operations are climate sensitive. Despite this, scientific literature and corporate practice present little evidence on how corporate actors use climate adaptation measures to prepare their transport operations for climate change. This paper explores two research questions: How can the acceptance among corporate decision-makers towards climate adaptation measures for their transport operations be explained? Based on the Theory of Planned Behavior and the Diffusion of Innovations we develop a theoretical framework for dealing with climate adaptation measures for transport operations (step 1). We support the use of this framework through a literature review (1989–2020) (step 2) and semi-structured interviews with German companies that have implemented best practice measures (step 3). The results show that the handling of climate adaptation measures for transport operations can be described in three acceptance phases: acceptance of attitude, action, and use. We conclude that these phases determine the approaches required for promoting climate change adaptation.
Objective:
To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder.
Design:
Double-blinded, randomized, experimental study.
Setting:
Outpatient clinic.
Subjects:
We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint.
Interventions:
The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10 days of therapy, 30 minutes each day.
Main measures:
Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy.
Results:
A total of 66 patients were randomized into two groups: The activity-oriented group (n = 33, mean = 44 years, SD = 16 years) including 20 male (61%) and the structural-oriented group (n = 33, mean = 47 years, SD = 17 years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10 days of therapy and at the three-month follow-up (p < 0.05).
Conclusions:
Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.