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Hintergrund: Spielbedingte muskuloskelettale Beschwerden (engl.: playing-related musculoskeletal disorders = PRMDs) stellen ein erhebliches Gesundheitsproblem für Schlagzeuger_innen dar. Die Prävalenz auftretender Symptome ist in der oberen Extremität am höchsten, gefolgt von Beschwerden im unteren Rücken und der unteren Extremität. Forschung zur Kinematik beim Schlagzeugspiel beschränkte sich meist auf die obere Extremität und motorische oder leistungsbezogene Fragestellungen. Wenige Studien untersuchten mögliche Ursachen von PRMDs in der 3D-Kinematik. Daher besteht ein Mangel an Bewegungsanalyseprotokollen zur Bewertung von PRMDs bei Schlagzeuger_innen in klinischen Kontexten wie der Physiotherapie.
Zielsetzung: Ziel ist es, die Entwicklung und Evaluation eines Bewegungsanalyseprotokolls zur Bewertung der funktionellen Bewegungen des Ober- und Unterkörpers unter Schlagzeug-spezifischen Bedingungen während des Instrumentenspiels in einer klinischen Umgebung vorzustellen. Das Protokoll zielt darauf ab, den physiotherapeutischen Befunderhebungsprozess von PRMDs zu unterstützen.
Methoden: Die methodische Umsetzung erfolgte durch die Verknüpfung eines optoelektrischen Messsystems für den Oberkörper und eines inertialen Messsystems für den Unterkörper. Erforderliche Kalibrierungs- und Bewegungsaufgaben für die funktionelle Untersuchung wurden spezifiziert. Das Protokoll wurde an acht Schlagzeuger_innen getestet und die Daten im Hinblick auf die klinische Anwendbarkeit ausgewertet.
Ergebnisse: Die meisten Rotationswinkel wiesen eine angemessene Variabilität zwischen den Probanden auf, mit Ausnahme der Halswirbelsäule, des Ellbogens und der Hüftgelenke. Reproduzierbare Winkelverläufe zeigten sich vorwiegend in der oberen Extremität, Brust- und Lendenwirbelsäule sowie der rechten unteren Extremität.
Schlussfolgerung: Die Ergebnisse legen nahe, dass objektive Parameter ausgewertet und funktionelle Bewegungen während des Schlagzeugspiels quantifiziert werden können. Die Evaluation deutet darauf hin, dass nicht alle gemessenen 3D-Kinematiken reliable Winkel-Zeit-Verläufe für eine klinische Analyse produzieren. Das entwickelte Protokoll kann den physiotherapeutischen Befunderhebungsprozess zusammen mit einem prä-post-interventionellen Vergleich sowie die Erforschung biomechanischer Ursachen von PRMDs bei Schlagzeuger_innen unterstützen.
The excitement sparked by the emergence of AI open platforms has encountered significant scrutiny from educators and educational planners, who have raised valid concerns about issues such as plagiarism, testing protocols, and the authenticity of content submitted by students. While these concerns are timely and crucial, it's essential not to overlook other pressing issues that often go unnoticed in the lived educational experience of learners, particularly within the field of social sciences. This paper aims to advocate for a humanistic approach with a focus on education in the generative AI Era.
Methods: Systematic review of randomized controlled trials (RCT). Searches were conducted in five electronic databases. Studies were selected if they included patients with NP over 18 years old treated with aerobic exercise (AE) (e.g., cycling, running, hiking, and walking). The main outcome of interest was pain intensity. Qualitative and quantitative data were extracted. The risk of bias (RoB) was determined using the Cochrane RoB Tool-2 and the overall certainty of the evidence with the GRADE recommendations.
Results: Out of 21,585 initial records screened, a total of six individual studies published in ten manuscripts were included. There was a great heterogeneity between protocols, comparisons, and studies’ results (different magnitudes and directions). When looking at the effect of aerobic exercise versus control groups or other interventions on pain intensity measured with the VAS, not statistically (nor clinical) significant differences between aerobic exercise and control groups (MD [95%CI] 5.16 mm [-6.38, 16.70]) were identified. The combined effect of AE plus other interventions seems to be effective. Strength exercise obtained better effects than aerobic exercises (MD [95%CI]: -11.34 mm [-21.6, -1.09]).
Conclusions: Aerobic exercise presented positive results to reduce pain intensity, and improving disability, and physical and emotional functioning. However, the evidence is restricted, low quality, and heterogeneous.
Methods: The searches were conducted on five electronic databases. RCTs or CTs with patients over 18 years old of both sexes with OFP diagnoses were targeted. The intervention of interest was AE (i.e., walking, cycling, and running), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. Risk of bias (RoB) was done with the Cochrane RoB tool (RoB 2). The overall certainty of the evidence was evaluated with GRADE.
Results: Out of 21,585 initial records found in the initial database search, only one study (reported on three manuscripts) was included. The diagnosis of interest was headache plus temporomandibular disorders (TMD). Three treatment groups (strengthening (Str) exercise + manual therapy (MT) (G1); AE + MT + Str exercises (G2); AE (G3)) were compared. The main outcome was pain; the secondary outcomes included disability, strength, anxiety, and quality of life. The combined treatment (AE+MT+Str exercises) had the strongest effect to decrease pain and headache intensity in patients with OFP (SMD: 9.99 [95%CI: 7.19, 12.80].
Conclusions: a multimodal treatment strategy achieved the greatest positive effects on pain and other outcomes in the short/medium term. AE seems to be an important component of this strategy. However, the scientific evidence supporting AE’s isolated effect is limited, indicating a research gap in this scientific field.
Sängerinnen und Sänger gehören zu der Gruppe der sogenannten „Professional Voice User“ bzw. der BerufssprecherInnen. Diese Gruppe ist den höchsten Anforderungen hinsichtlich der Stimmqualität und der Stimmbelastung ausgesetzt. Deshalb haben SängerInnen ein hohes Risiko eine Stimmstörung zu entwickeln, die wiederum ihre Arbeitsfähigkeit und Lebensqualität beeinträchtigen kann. Neben Stimmstörungen mit organischen Ursachen gibt es funktionelle Stimmstörungen, die z.B. durch ein ungünstiges Atemmuster oder Hypertonus der Schulter-, Nacken- und Halsmuskulatur verursacht werden können. In diesem Vortrag werden die unterschiedlichen Risikofaktoren für die Entwicklung einer Stimmstörung bei SängerInnen aufgezeigt. Anschließend werden physiotherapeutische Behandlungsansätze vorgestellt, die als Teil eines multidisziplinären Managements von funktionellen Stimmstörungen bei SängerInnen eingesetzt werden können.
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.
Ziel des Workshops ist es, das besondere Potential der Physiotherapie im multidisziplinären Management von Sängerinnen und Sängern mit funktionellen Stimmstörungen aufzuzeigen. Anhand eines Fallbeispiels aus der physiotherapeutischen Musikersprechstunde wird der physiotherapeutische Behandlungsansatz vorgestellt. Die Sängerin mit ärztlich diagnostizierter hyperfunktioneller Stimmstörung zeigte Symptome wie ein sternales Atemmuster und Hypertonus der Nacken-, Kiefer- und der äußeren Kehlkopf-Muskulatur. Basierend auf der aktuellen Evidenzlage und der Anatomie werden die theoretischen Überlegungen der klinischen Urteilsbildung erläutert. Das Vorgehen im Behandlungsprozess wird beschrieben und einige praktische Beispiele von Behandlungstechniken, z.B. manualtherapeutische Techniken am Kehlkopf, werden demonstriert.
rationale: Musculoskeletal problems are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. Additionally, various other factors might contribute to performance-related musculoskeletal problems. In order to provide a specific physiotherapeutic management for performing artists, it is important to gain information about the performing art, the individual (biomechanical) demands and contributing factors. The subjective examination is the basis of the clinical reasoning process and the hypothesis forming, which is important for goal setting in further clinical examination and biomechanical analysis. In the present protocol, the subjective examination consists of a questionnaire based section and an interview based section and is part of the evaluation process of the neuromusculoskeletal examination of a performing artist specific reference laboratory.
purpose: The aim of this study was to develop a standardized protocol for an interview based subjective examination of performing artists with musculoskeletal problems. The results of this section of the subjective examination will be combined with the results of the questionnaire based subjective examination , in order to gather as much relevant information as possible to specifically address the individual’s musculoskeletal health status.
methods: A common physiotherapeutic recording of findings which addresses the relevant questions of the subjective examination of musculoskeletal problems was used. In order to adapt the anamnesis to performing-related musculoskeletal problems, questions specific to instrument playing, singing and dancing were selected on the basis of a literature search and the expertise of the research group.
results: The protocol is based on the five aspects of clinical practice described by Maitland and the Musculoskeletal Clinical Translation Framework by Mitchell et al. (2017) .The performing art specific questions especially address (1) performing art specific considerations including style, genre, education and professional level, practice habits, repertoire, and external factors, e.g. concert conditions, (2) performing art specific physical and psychosocial contributing factors, and (3) performing art specific activities which trigger the musculoskeletal problems and help to form hypotheses for the following clinical examination. Individual tracks lead through the subjective examination so that irrelevant questions are skipped depending on the kind of musculoskeletal problem and the performing art practiced by the individual client.
conclusions: A pretest of this standardized anamnesis protocol is ongoing in a special physiotherapy clinic for performing artists since spring 2022. In an iterative approach, the protocol will be continuously improved based on patient feedback and clinical considerations.
The aim of this European interprofessional Health Informatics (HI) Summer School was (i) to make advanced healthcare students familiar with what HI can offer in terms of knowledge development for patient care and (ii) to give them an idea about the underlying technical and legal mechanisms. According to the students’ evaluation, interprofessional education was very well received, problem-based learning focussing on cases was rated positively and the learning goals were met. However, it was criticised that the online material provided was rather detailed and comprehensive and could have been a bit overcharging for beginners. These drawbacks were obviously compensated by the positive experience of working in international and interprofessional groups and a generally welcoming environment.
Background and Aims
Early identification of nerve lesions and associated neuropathic pain in spine-related pain disorders is important for tailored treatment. Management may consist of surgical intervention for compressive neural lesions.
With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment (Category 1 – assessment within 1 months, Category 2 within 3 months, category 3 within 12 months), a call to support new models of care has been made1, including the evaluation and expansion of workforce models supporting advanced skills in allied health.1
An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2FTE) examine patients from the neurosurgery waitlist for their suitability for spinal surgery. Recommendation of either further investigation and possible assessment by a neurosurgeon or appropriate non-surgical management of the patients’ pain condition is suggested. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. Patient cases are discussed with a neurosurgery consultant on a weekly basis. The aim of this project is to evaluate the ASP service in the year 2022.
Method
A retrospective descriptive analysis of patient data captured in 2022 was performed.
Results
In 2022, 1337 new patient referrals were managed plus 267 follow-ups from the previous year. Category 1 patients (n=81) waited on average 31 days for their first appointment, Category 2 patients (n=394) waited 76 days and Category 3 patients (n=854) waited 376 days.
287 (18%) referrals were discharged without physical assessment of the patient (DNA, cancellations, declined). Of the 1317 patients physically assessed by the ASPs (57%) were discharged directly after assessment, for 290 patients (22%) their outcome was still pending at time of analysis (March 2023) and 281 (22%) patients were referred for review with a neurosurgeon. Of the 229 patients assessed by a neurosurgeon (including patients from 2022), 103 patients (45%) were offered surgery, 52 (23%) were not offered surgery, 46 ( 20%) patients had to be reviewed, and for the remaining (n=18) their outcome was unknown.
Conclusion
Of the 1604 patients managed in the Neurosurgery Spinal Clinic, only 17% needed to see a neurosurgeon. The conversion rate to surgery of 45% is higher compared to an estimated 5%-10% in a non-triaged clinic.
The ASP model of care has proved invaluable to (i) provide access of patient care within the recommended wait times (ii) optimize neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management.
Relevance for Patient Care
The Advanced Scope Physiotherapy model of care at the Neurosurgery Spinal Clinic allows timely assessment of patients with spine-related disorders and supports targeted management of their condition.
Ethical Permissions
This project is registered as a Quality Improvement Project at Sir Charles Gairdner Hospital (QI35728) and as per the National Statement on Ethical Conduct in Human Research was exempt from review by the Sir Charles Gairdner Hospital Human Research and Ethics Committee
References
1Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia