Mechanical stimulation of the soles support zones as a countermeasure of negative effects of motor unloading

Revisión sistemática de la eficacia del tratamiento combinado de fisioterapia junto con toxina botulínica tipo A en la espasticidad de miembros inferiores en niños con parálisis cerebral

A decrease in muscle tone induced by space flight requires a standardized assessment of changes to control the state of the neuromuscular system. This study is a step toward the development of a unified protocol, aimed at determining the initial effect of the presence or withdrawal of support on muscle tone, the effects of a 2-h supportlessness in Dry Immersion (DI) experiments, and the changes in muscle tone depending on the site of measurement. To perform measurements of changes in muscle tone, we used a MyotonPRO device. The list of muscles that we assessed includes: trunk – mm. deltoideus posterior, trapezius, erector spinae; leg – mm. biceps femoris, rectus femoris, tibialis anterior, soleus, gastrocnemius; foot – m. flexor digitorum brevis, tendo Achillis, aponeurosis plantaris. The study involved 12 healthy volunteers (6 men, 6 women) without musculoskeletal disorders and aged 32.8 ± 1.6 years. At the start of DI, there was a significant decrease in muscle tone of the following muscles: mm. tibialis anterior (−10.9%), soleus (−9.6%), erector spinae (−14.4%), and the tendo Achillis (−15.3%). The decrease continued to intensify over the next 2 h. In contrast, the gastrocnemius muscle demonstrated an increase in muscle tone (+7.5%) 2 h after the start of DI compared to the immediate in-bath baseline. Muscle tone values were found to be site-dependent and varied in different projections of mm. erector spinae and soleus. In previous experiments, we observed a high sensitivity of the myotonometry technique, which was confirmed in this study. To make it possible to compare data from different studies, a standardized protocol for measuring muscle tone for general use in gravitational physiology needs to be developed.

Background: Patients with lumbar spinal stenosis show abnormal changes in muscle activity due to pain and limited range of motion of the lumbar spine. Excessive increased muscle tone and decreased muscle activity patterns threaten the patients’ quality of life. However, there have been a few studies showing how to improve muscle performance in patients with lumbar spinal stenosis. Among these, joint mobilization is one way of improving muscle performance through pain relief and increasing the range of motion. Objectives: To investigate the effect of lumbar mobilization by orthopedic manual physical therapy on paravertebral muscle activity and tone in patients with lumbar spinal stenosis. Design: A randomized controlled trial. Methods: In this study, 24 patients with lumbar spinal stenosis were randomized (1:1 ratio) into two groups. The experimental group underwent lumbar posteroanterior mobilization, and the control group underwent conventional physical therapy (conventional transcutaneous electrical nerve stimulation) for 15 minutes each. For outcome measures, MyotonⓇPRO was used to evaluate muscle tone when resting of the paravertebral muscle in the pain area. For muscle activity evaluation, the reference voluntary contraction of the paravertebral muscle was evaluated using surface electromyography. Results: Muscle tone and activity were significantly improved after intervention in both the experimental and control groups. In addition, the experimental group showed more significant decrease in muscle tone and activity than the control group. Conclusion: These results suggest that lumbar mobilization improving muscle performance in patients with lumbar spinal stenosis.

The aim of this paper is to report a case of brachial plexus avulsion (BPA) in a domestic cat, treated at the Polyclinic Veterinary School of the University Center of Valença – UNIFAA. The brachial plexus is a branch of nerves that emerge from the spinal cord and innervate the thoracic limb. Avulsion in this plexus occurs when the nerves are frayed, by abduction or violent traction of the foreleg, caused in trauma that often happens to domestic cats (Felis catus). The most evident clinical signs are inability to extend the elbow, drag the back of the limb on the ground, difficulty in supporting weight, neurogenic muscle atrophy, absence or decrease in muscle tone and segmental reflexes, with the use of an Elizabethan collar and the fixation of a bracing around the involved limb. Horner's Syndrome is another common clinical sign in brachial plexus injuries, due to damage to the nerve roots of the spinal segments T2 and T3. The diagnosis of BPA is made through the patient's history, anamnesis, neurological physical examination, clinical signs, electrodiagnosis and complementary exams, the biggest obstacle being to discover the extension and exact location of the lesion. Treatment can be conservative if there is improvement in the clinical picture after three weeks of treatment, surgical if the animal is showing signs of pain and self-mutilation, or neurotization by transposition and microsurgical anastomosis. The prognosis will depend on the location, extension and type of injury. She was seen at the Polyclinic Veterinary of the UNIFAA, a cat, with no defined breed, weighing 5.2 kg. The tutor reported that he found her inside the engine compartment of a car. On physical examination, the patient did not show any pain response to the tests performed, nor proprioception in the right thoracic limb (MTD). After neurological examination, it could be identified that the animal had Horner's Syndrome and spinal cord injury between C6-T2 due to brachial plexus avulsion. Conservative treatment was instituted until ambulation improved, and then high MTD amputation surgery was indicated. It is concluded that this report can contribute to the literature as a source of study in anatomy, neurology, surgical technique, diagnosis and treatment for brachial plexus avulsions in cats.

The presence of patients in a state of chronic disorders consciousness leads to the development of dysfunction (weakness, paresis) of their skeletal muscles – polyneuropathy and myopathy of critical states. It is of interest to study the mechanisms of pathology development and assess the rehabilitation potential of such patients. Positron emission computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) and pathomorphological studies with immunohistochemistry were used to obtain data on structural and metabolic changes in the skeletal muscles of the upper extremities in 22 patients with chronic disorders consciousness. The study showed that structural changes in skeletal muscles have a non-specific degenerative-atrophic character with more pronounced manifestations on the side of paresis. The metabolic disorders of the shoulder girdle muscles revealed by the decrease in the level of 18F-FDG metabolism in patients with chronic disorders consciousness developed symmetrically, regardless of the degree of decrease in muscle tone and deep reflexes. Along with degenerative changes, including damage to the contractile elements of sarcomeres, loss of desmin and dystrophin, a decrease in the level of 18F-FDH metabolism, signs of adaptive structural and functional rearrangements were observed in the skeletal muscles of patients- modification of the phenotype of muscle fibers by the fast type and activation of the autophagic pathway.

Introduction. At an osteopathic doctor’s appointment, musculoskeletal neck pain is the most common reason for consultation, reaching 60 %. Osteopathic doctors use a wide range of manual techniques to diagnose and correct somatic musculoskeletal dysfunction, including articulation and muscle-energy techniques (MET). Both types of techniques can increase cervical spine mobility, decrease neck muscle tone, and alter the viscoelastic properties of soft tissue, including in asymptomatic individuals. No studies on the effect of MET and articulation techniques on neck muscle tone according to surface electromyography (SEMG) were found. Comparison of the effect of different osteopathic techniques on the bioelectrical activity of neck muscles in one group of subjects was also not conducted.The aim of the study: to compare the effect of muscle-energetic and articulation osteopathic techniques on the bioelectrical activity of neck muscles in young people with no complaints of neck pain.Materials and methods. From December 2023 to March 2024, a study was conducted at the Department of Osteopathy of I. I. Mechnikov NWSMU (Saint-Petersburg) with 30 participants aged 22 to 44 years (median 27 years), including 17 women and 13 men. At the time of examination, they actively did not present complaints of musculoskeletal pain. Inclusion criteria were the presence of diseases and/or conditions that were absolute contraindications to osteopathic correction, a history of neck trauma; the presence of metal structures in the spine; taking medications affecting muscle tone at the time of the study; and neuromuscular diseases. Each participant in the study was treated twice: in the first stage of MET on the neck and in the second stage at least one month of articulation on the neck. Before and immediately after osteopathic treatment, the tone of the sternocleidomastoid muscles (SCMM) was palpatory examined and the average amplitude of their electrical activity A av. (pV) at rest was recorded using SEMG, which was performed on the Kolibri wireless electrophysiologic signal monitoring complex («Neurotech», Russia). Recordings were made synchronously from the right and left sides of the body, then the asymmetry of electrical activity was calculated as the modulus of the difference A av. between the left and right sides.Results. During palpatory examination before the exposure at both stages, the tone of the SCMM was most often evaluated as normal or elevated. After application of both MET and articulation, the number of persons with hypertonus statistically significantly decreased and increased with normotonus (p=0,02), while the groups before and after application of these techniques did not differ from each other (p>0,05). The average amplitude of the electrical activity of the SCMM after both MET and articulations was statistically significantly decreased, indicating a decrease in muscle tone. There was no statistically significant difference in this index before and after osteopathic techniques at the first and second stages (p>0,05). After MET, there was a tendency to decrease the asymmetry of the average electrical activity between the left and right SCMM, but these changes were not statistically significant (p=0,11). After articulation, the asymmetry of average electrical activity between the left and right SCMM decreased statistically significantly (p=0,032).Conclusion. A single application of osteopathic techniques of MET and articulation equally reduces muscle tone and, accordingly, the electrical activity of the sternocleidomastoid muscles. At the same time, articulations additionally reduce the asymmetry of electrical activity of these muscles, i. e. they normalize muscle tone more harmoniously. To objectify for the doctor and the patient such an important result of osteopathic correction as a decrease in muscle tone and reduction of its asymmetry, the method of surface EMG is recommended. If the method of electrode application and examination is followed, this method gives reliable and repeatable results, which is the basis for its use as an objective method of proving the effectiveness of osteopathic techniques.

This case report describes how a physiotherapy program with Ayres Sensory Integration was associated with changes in a 3 years old child with low muscle tone and speech disorders. To see how the Ayres Sensory Integration Physiotherapy Program affects muscle tone, speech, and the relation between muscle tone and speech, a 24-week physiotherapy program with Ayres Sensory Integration was initiated. Before and after the therapy, Development Screening Test, speech, muscle tone, and Antigravity Test were assessed and recorded. Muscle tone, speech, Development Screening Test and Antigravity Test results have all improved. Children with low muscle tone and speech difficulties can benefit from physiotherapy programs involving Ayres Sensory Integration. In addition to speech therapy, children with speech issues should get sensory integration therapy

The effect of dopamine receptor agonist cabergoline on muscle tone and contractility was studied in healthy volunteers. Variations in muscle tone were evaluated by means of transcranial magnetic stimulation under resting conditions. Muscle contractility was estimated from kinematic parameters of voluntary movements. Oral administration of cabergoline in a dose of 2 mg was followed by a decrease in muscle tone and increase in muscle contractility. Our findings indicate that the brain dopaminergic system regulates voluntary movements by decreasing the tone and increasing contractility of skeletal muscles. Under resting conditions, prolonged exposure of D1 receptors to dopamine in a low concentration decreases excitability threshold of the motor cortex and reduces muscle tone. During voluntary movements, short-term stimulation of D2 receptors with dopamine in a high concentration increases excitability of the motor cortex and induces muscle contraction. The movement occurs when D2 receptor-mediated excitation of the cortex and induced muscle contraction exceed the decrease in muscle tone and excitability threshold caused by stimulation of D1 receptors.

Deterioration of the voluntary movement control is a consistent consequence of space flights as well as hypokinesia experiments. Deep changes in a locomotor act structure, disturbances of upright posture, an increased time of motor task performance are always observed even after comparatively short-term exposures to real or simulated hypogravity (Tchkhaidze, 1968; Kubis et al., 1977; Kozlovskaya et al., 1982). The data obtained allowed the suggestion that the support unloading acts as a trigger initiating alteration in the activity of motor control systems under these conditions. As it is known support stimuli play an important role in organization of muscle tonic reactions of posture synergies; the support afferentation is deeply involved in the control of activity of spinal extensor motor neurones. In the absence of support load the tone of gravitational muscles decreases (Mitarai et al., 1978; Kozlovskaya et al., 1983). According to the clinical observations this decrease is in turn the factor that initiates changes in different components of the motor system: muscle afferents and motoneuron entities, reflex mechanisms and trophic apparatus whose activity as shown recently is also determined by the motoneuronal activity (McComas, 1977).

Objectives: The aim of this investigation is to assess the effectiveness of spinal cord stimulation (SCS) in different groups of patients with spasticity of different origin. Materials and Methods: A retrospective study of the use of the method of SCS in 71 patients. The patient population was divided into two groups: 52 cerebral palsy (CP) cases and 19 patients diagnosed with spasticity caused by spinal injury. The mean age was 7.14 ± 4.06 and 35.68 ± 12.42 years, respectively. The CP group included 41 cases of paraparesis and 11 cases tetraparesis. One quadripolar electrode was implanted into the posterior epidural space at Th10-Th12 level and an implantable pulse generator (Itrel3, Medtronic) was placed in a standard fashion. We performed 3-5 stimulation sessions per day; each lasted 30 min. The stimulation parameters were as follows: rate 100-130 Hz, pulse width 120-300 ms, amplitude 1.5-4 V. The follow-up ranged from 2 to 9 years. Results: Decrease in muscle tone was observed in all cases in the group of patients with spinal spasticity: from 3.71 ± 0.61 on the Ashworth scale before the operation to 2.26 ± 0.56 after the operation (p < 0.001). In the group of cerebral spasticity a significant decrease in muscle tone was observed only in patients with spastic lower paraparesis: from 3.36 ± 0.41 before the operation to 1.97 ± 0.91 after the operation (p < 0.005). In patients with spastic tetraparesis we did not observe any significant change in muscle tone. In 8 cases we discontinued the therapy several years after the procedure due to improvement in spasticity: in the CP group in 7 cases and in 1 spinal spasticity case, where SCS systems were explanted. Conclusion: Chronic SCS may be a method of choice for patients with moderate spinal and cerebral spasticity with predominant spastic lower paraparesis. In patients with spastic tetraparesis SCS therapy did not prove to be effective. We encountered improvement of the spasticity and no need for further SCS therapy in a small group of patients (11%). This phenomenon requires further investigation.

Context: Osteopathic manipulative treatment (OMT) is often indicated for back pain due to its high tolerability and post-treatment improvement in patients’ self-reported pain and functionality. Specifically, myofascial release (MFR) has been found to yield a significant improvement in both symptoms and quality of life. Until recently, there has not been much data published about the quantifiable effect of MFR and other OMT modalities on muscle physiology, especially taking treatment dose and force into consideration. Therefore, quantifying the changes in muscle characteristics through myotonometry would greatly benefit the field of osteopathic medicine in order to create more personalized treatment plans for patients and to determine the ideal treatment conditions for maximal impact. Objectives: Primary: To determine if there is a significant difference in the paraspinal musculature following MFR at different treatment doses and forces, and whether the effect is modulated by time or force. Secondary: To establish the physiological effect of osteopathic MFR treatment through objectively measurable outcomes, including muscle tone, stiffness and elasticity. Methods: For preliminary results, 15 participants were randomly placed into one of six treatment groups receiving MFR for either 30 or 90 seconds at normal, 0.5x, or 1.5x force. Force was determined using a spring scale attached to a frictionless platform on which the provider stood to exert the required horizontal force on the patient. Measurements of muscle tone, stiffness, and elasticity were taken at the level of T1, 2-3 inches lateral to the spinous process to assess the perpendicular fibers of the trapezius muscle, before and after each treatment using the MyotonPro device. Inclusion criteria: The study population included first through fourth-year medical students at Rowan-Virtua School of Osteopathic Medicine that are 18 years or older and of all genders and ethnic backgrounds. Exclusion criteria: Subjects with a history of any musculoskeletal or neurologic conditions taking medications that may alter muscle tone or those with a body mass index (BMI) &gt; 30 kg/m2 were excluded to avoid potential skewing of data. Results: The study included 15 participants with an average age of 25.4 years, height of 66.23 in, weight of 155.53 lbs, and BMI of 24.86 kg/m². Paired samples t-tests showed no statistically significant changes in muscle tone (t(29) = 1.117, p = 0.273), stiffness (t(29) = 0.709, p = 0.484), or elasticity (t(29) = 0.340, p = 0.737) following MFR treatment. Effect sizes were small across all measures, with Cohen's d values of 0.204 for tone, 0.129 for stiffness, and 0.062 for elasticity. Correlation analysis showed that there was minimal influence of applied force on tissue changes, with Pearson's r values of 0.015 for tone, 0.124 for stiffness, and 0.097 for elasticity. Conclusion: Trends from these preliminary results suggest a small decrease in muscle tone and stiffness following MFR with correlation analysis suggesting that the amount of total force applied has a small influence on the tissue changes seen. Limitations: These results are preliminary and were based on a limited sample size of only 15 participants, which may affect the statistical power and generalizability of our findings. Future directions: We intend to continue recruitment of subjects to achieve the target sample size of 66 participants, thereby enhancing the validity of these findings.

Experienced stroke causes malfunction not only in arm or leg movements, but also the ability to manage torso posture and complete torso movements performed by the torso muscles. Abnormal muscle tone is one of the stroke damage areas. The most common residual effects of stroke are paresis, spasticity and functional movement disorder. Muscle tone regulation acts as a relevant task for the theory and practice of physical therapy. This paper investigates the most effective method of increased muscle tone and its reduction for patients after stroke. It also provides a methodology which could be fully benefited by the entire rehabilitation team. Aim of research: to define the impact of trunk rotational movements on increased muscle tone and functional movements for patients after stroke. The study included patients after stroke and those who had increased muscle tone. The same patients received two means of decreasing the muscle tone: the 1st one based on the trunk rotational movements, the 2nd – stretching exercises for the limbs. The research focused on muscle tone of: flexor carpi radialis, biceps brachii, gastrocnemius and quadriceps femoris. The effectiveness of physiotherapy was assessed by evaluating the change in muscle tone using a Myoton-3 tone meter. Moreover, a change in functional movements before and after physiotherapy was evaluated using Rivermed’s scale for movement assessment. Evaluation group consisted of 15 patients (n = 15). Conclusions: 1. Trunk rotation movements statically significantly decrease an increased muscle tone of: flexor carpi radialis, biceps brachii, gastrocnemius and quadriceps femoris (p &lt; 0.05) 2. The average change in muscle tone for trunk rotation movements was statically significantly higher using the method of trunk rotational movements than using stretching exercises (p &lt; 0.05). 3. Both, trunk rotational movements and stretching exercises, improve the functional movements (p &lt; 0.05), however, trunk rotational movements have a higher impact than stretching exercises (p &lt; 0.05). 4. Trunk rotational movements decrease muscle tone and improve functional movements for patients after stroke (p &lt; 0.05).Keywords: stroke, hypertonus, decreased spasticity.

Bone cement has been widely used in orthopedic surgeries since Sir John Charnley first introduced the self‐curing bone cement for the fixation of artificial joints in 1958. Several important aspects of material characteristics of bone cement, including its material compositions, short‐ and long‐term mechanical properties are discussed in this article. This article aims to provide comprehensive information for the orthopedic community on cement applications.The rationale underlying the use of therapeutic heat (thermotherapy) and cold (cryotherapy) is based on their physiological effects. Heating the tissues by a few degrees centigrade increases tissue metabolism, relieves pain, and accelerates the healing process. Other effects of therapeutic heat include increased joint mobility, vasodiltation, and increased muscle tone. Cooling the tissues by a few degrees centigrade limits secondary damage to soft tissues, nerves, and the brain after trauma. Other effects of therapeutic cold, which should ideally be applied as soon as possible after trauma, include relief of pain, reduction of acute inflammation, decreased joint mobility, and decreased muscle tone. The application of cold, to reduce the extent of damage, may be followed by the application of heat, to accelerate healing.There are many methods of applying therapeutic heat and cold. Selection of the most appropriate depends on several factors, including the location of the injury, the depth of penetration of the modality, the dimensions of the area to be treated, the ease of application, the duration of application, cost, and convenience. The choice of modality is frequently limited by contraindications.To use thermotherapy and cryotherapy effectively, the clinician should know:The physiological effects of heat and coldWhat devices are available to produce temperature changesHow they workWhen and when not to use themTheir advantages and disadvantagesThis article provides this information following a brief description of the history of these therapies.

Static stretching is widely performed to decrease muscle tone as a part of rehabilitation protocols. Finding out the optimal duration of static stretching is important to minimize the time required for rehabilitation therapy and it would be helpful for maintaining the patient's motivation towards daily rehabilitation tasks. Several studies have been conducted for the evaluation of static stretching; however, the recommended duration of static stretching varies widely between 15-30 s in general, because the traditional methods for the assessment of muscle tone do not monitor the continuous change in the target muscle's state. We have developed a method to monitor the viscoelasticity of one muscle continuously during static stretching, using a wearable indentation tester. In this study, we investigated a suitable signal processing method to detect the time required to change the muscle tone, utilizing the data collected using a wearable indentation tester. By calculating a viscoelastic index with a certain time window, we confirmed that the stretching duration required to bring about a decrease in muscle tone could be obtained with an accuracy in the order of 1 s.

The aim of the study was to examine whether an improvement in jumping performance after 8 weeks of plyometric training (PT) runs in parallel with changes in lower-limb skeletal muscle contractile properties. Using noninvasive tensiomyography (TMG), we assessed contraction time (Tc) and the maximal amplitude of radial displacement (Dm) in 20 subjects (50% men; age 22.4 ± 4.7 years of age), randomly divided in PT group (N = 10; PLYO) and a control group (N = 10; CTRL). The PLYO performed 8 weeks of PT. Tensiomyography was measured in 5 leg skeletal muscles: vastus lateralis (VL), biceps femoris (BF), tibialis anterior (TA), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL). Additionally, we evaluated countermovement jump (CMJ) height improvement on a ground force plate. Assessments were repeated before and after PT. After 8 weeks of PT, CMJ height increased by 12.2% in PLYO (p = 0.015), but not in CRTL. Contraction time, which is related to myosin heavy-chain type 1 (MHC-1) proportion, decreased in VL (-8.7%; p < 0.001), BF (-26.7%; p = 0.032), TA (-32.9%; p = 0.004), and GL (-25.8%; p = 0.044), but not in GM (-8.1%; p = 0.158). The estimated VL MHC-1 proportion decreased by -8.2% (p = 0.041). The maximal amplitude of radial displacement, inversely related to muscle tone, decreased in BF (-26.5%; p = 0.032), GM (-14.9%; p = 0.017), GL (-31.5%; p = 0.017), but not in TA (-16.8%; p = 0.113) and VL (-6.0%; p = 0.654). After PT, jumping performance increased, which was paralleled by decreased Tc and decreased muscle tone. Additionally, adaptations to contractile properties were muscle specific, which is important for future studies. It seems that adjustments were dose dependent, being higher in muscles with lower habitual load.