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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.
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.
Objectives:
The purpose of this study was to determine the motor function of the abdominal muscles in singers with and without functional voice disorders and to examine them for possible differences. Additionally, the breathing behaviour and posture control was investigated.
Study Design
Observational study.
Methods:
Female subjects (n = 20) with differing levels of professional competence were used to provide the data for analysis. By using the Singing Voice Handicap Index (SVHI) the grade of dysphonia could be measured, and the subjects were organized in groups. The change of muscle thickness of the M. transversus abdominis (TVA) and the M. obliquus internus abdominis (OIA) during different singing tasks was measured by using ultrasound. The subjects were then asked to perform the Abdominal Hollowing Test (AHT) with the STABILIZER. Finally, the subjects were all filmed while singing. The videos recordings of the singing sessions were analysed by an independent clinical expert regarding breathing and secondary motor activities (SMA). For the statistical analysis, the Mann-Whitney-U Test and the Chi-Square-Test was mainly used.
Results:
The results showed a significantly thinner TVA in the group with dysphonia in comparison to the group without dysphonia. Ultrasound measurements showed significantly higher changes of muscle thickness of the TVA during singing tasks in the group with dysphonia. Regarding the AHT there was a significant difference between the two groups. The group with dysphonia was not able to increase the pressure by 15mmHg. Furthermore, the healthy subjects demonstrated abdominal breathing, while the group with dysphonia present with thoracic breathing. Additionally, it was noted that the subjects with dysphonia showed a higher level of associated movements especially at and/or on the lumbar spine, cervical spine and the left arm and shoulder.
Conclusion:
Differences in TVA-recruitment, breathing behaviour and secondary motor activities while singing were found. This study sparks new ideas for neuromusculoskeletal assessments and therapy.
Key Words
Transversus abdominis, Abdominal muscles, Dysphonia, Ultrasound, Singing voice, Singers
The management of patients experiencing chronic orofacial pain is a great challenge, due to the complexity of chronic pain itself, combined with an increased peripheral sensitization in the craniofacial itself. Therefore, patients with orofacial pain may present a clear distortion of the somatorepresentation after some time. In this review, the authors develop a neurophysiological explanation of orofacial distortion, as well as propose assessment and treatment options, based on scarcely available scientific evidence and their own clinical experience. The assessments of facial somatosensory, cognitive-affective and motor dysfunctions are crucial to establish the most accurate treatment; the assessment tools are described in the article. Two-point discrimination, laterality recognition and emotion recognition are altered in patients with orofacial pain. Other sensorimotor assessment tools, such as motor acuity and auditory acuity, are also explained. Finally, the authors review their treatment proposals, based on the integration of brain training techniques and biobehavioral interventions. Somatosensory reintegration (tactile acuity training), facial emotion recognition, movement representation techniques, orofacial motor training and therapeutic patient education are explained in detail, and this may challenge new directions in rehabilitation and research.
Bei dieser mit dem dbl-Nachwuchspreis 2018 ausgezeichneten Pilotstudie erhielten sechs ProbandInnen in der Akutphase ihres erstmaligen Schlaganfalls eine hochfrequente Therapie in Anlehnung an die Propriozeptive Neuromuskuläre Fazilitation (PNF) kombiniert mit motorischer Imagination einer autobiografischen Erinnerung oder nur in Anlehnung an PNF. Zentrale Fragestellungen vor und nach der Intervention waren die Veränderungen des Schweregrades der Fazialisparese und der krankheitsbezogenen Lebensqualität der Betroffenen.
Schmerzen im Bereich des Steißbeins werden häufig unter dem Begriff Kokzygodynie zusammengefasst. Ursache der Beschwerden können hierbei lokal oder entfernt liegende Strukturen sein. Außerdem gibt es eine Reihe von inneren und psychischen Erkrankungen, die eine Kokzygodynie vortäuschen können und differenzialdiagnostisch abgeklärt werden müssen.
Dieser Artikel gibt eine Übersicht über Anatomie, Ätiopathologie, Diagnostik, Differenzialdiagnostik und Therapiemöglichkeiten bei Kokzygodynie. Der Schwerpunkt liegt dabei auf muskuloskeletaler Therapie. Es werden Techniken am Steißbein aus 4 manualtherapeutischen Konzepten vorgestellt.
Der N. mandibularis und seine Äste müssen sich bei Bewegungen des Kiefers und der HWS an die veränderten umliegenden Strukturen anpassen, um die Funktionsfähigkeit zu erhalten. Ziel dieser Querschnittstudie war herauszufinden, ob sich die Neurodynamik des N. auriculotemporalis mithilfe von Sonografie untersuchen lässt. Dazu wurde bei 21 Probanden der N. auriculotemporalis im Querschnitt (transversal) und in longitudinaler Ansicht während verschiedener kombinierter Kiefer- und zervikaler Bewegungen aufgezeichnet und beurteilt.
Die transversale Untersuchung ergab die signifikant größten Bewegungen bei hochzervikaler Flexion der HWS und gleichzeitiger Laterotrusion der Mandibula zur Gegenseite. Die longitudinale Untersuchung zeigte eine vermehrte Bewegung des Nervs bei Einstellung der HWS in hochzervikaler Flexion im Vergleich zur habituellen Position bei Depression und Laterotrusion der Mandibula zur Gegenseite (nicht signifikant). Eine Korrelation zwischen den Resultaten der transversalen longitudinalen Messung war nicht nachweisbar. Die Ergebnisse lassen annehmen, dass vor allem hochzervikale Flexion, Laterotrusion und Depression einen Einfluss auf die Dynamik des N. auriculotemporalis haben.
Der N. medianus besitzt die Fähigkeit, bei Extremitätenbewegungen in seinem umliegenden Gewebe zu gleiten. Dieses wichtige physiologische Phänomen minimiert bei Engpasssyndromen Zug und Druck auf den Nerv. Das Karpaltunnelsyndrom (CTS) stellt in der Praxis die am häufigsten auftretende und stark behandlungsresistente periphere Neuropathie dar. Die verminderte Dynamik des N. medianus kann ein beitragender Faktor eines lange bestehenden CTS sein. Die vorliegende Querschnittstudie untersuchte die transversale Gleitfähigkeit des N. medianus mittels sonografischer Diagnostik an CTS-Patienten (Gruppe A). Die Nervenbewegung wurde hierfür durch passive Bewegungsmanöver an der HWS mittels einer Kontralateralflexion und einem Cervical lateral glide sowie durch aktive Bewegungen der Finger und der Schulter provoziert. Die Ergebnisse wurden im Anschluss mit den Resultaten einer früheren Untersuchung gleicher Art an gesunden Probanden (Gruppe B) verglichen. Die Bewegungsmanöver der oberen Extremität wurden zudem an gesunden Probanden durchgeführt (Gruppe B2). Das Ziel der Studie war es herauszufinden, ob die Manöver einen signifikanten Einfluss auf die Gleitfähigkeit sowie auf die Größe des Flächeninhalts des N. medianus ausüben und ob sich die Veränderungen in der CTS-Gruppe im Gegensatz zur Kontrollgruppe signifikant unterschiedlich darstellen. Sowohl distale Bewegungen der Fingergelenke als auch die zervikalen Bewegungsmanöver beeinflussten das transversale und longitudinale Gleiten des N. medianus. Am Unterarm zeigten sich deutliche Unterschiede in der Nervenbewegung zwischen den gesunden und den CTS-Probanden, was auf einen möglichen Einfluss des Cervical lateral glide auf die Neurodynamik des N. medianus bei CTS hindeutet.
Bruxismus ist keine Krankheit, sondern ein Sammelbegriff für Parafunktionen wie Zähnepressen oder Knirschen. Um Begleitsymptome des Bruxismus zu beeinflussen, ist eine Untersuchung des orofazialen und kraniozervikalen Systems sinnvoll. Die gefundenen auffälligen Zeichen leiten die Therapeuten in der muskuloskelettalen Therapie, die aus Hands-on und -off-Techniken besteht.
The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.