Hemiparetic Research Articles

Dynamic Video Assessment of Axial Postural Abnormalities in Parkinson's Disease: A Pilot Study.

Axial postural abnormalities (APAs) are frequent and disabling axial symptoms of Parkinson's disease (PD). Image-based measurement is considered the gold standard but may not accurately detect the true severity of APAs because these symptoms can appear or get worse under dynamic conditions. The aim was to evaluate quantitative changes in APAs degree during prolonged standing and walking in both single- and dual-task conditions (motor + cognitive). We measured the degree of anterior and lateral trunk flexion (LTF) of 16 PD patients using AutoPosturePD during 4 tasks of 3 min each: (1) standing in place in a quiet condition, (2) standing in place while reading, (3) walking without performing other tasks, and (4) walking performing a cognitive task. During prolonged standing, we found a significant LTF worsening under both single- and dual-task conditions over time (P: 0.010 and 0.018); anterior trunk flexion (ATF) with thoracic and lumbar fulcrum showed a significant worsening only under dual-task conditions (P < 0.05). All trunk flexion angles were higher during dual task compared to single task, and the difference in dual task was already statistically significant after 1 min. During walking, only ATF with lumbar fulcrum showed a significant worsening (P < 0.05), observed in dual task already after 1 min. Our pilot study suggests that one minute standing while reading may be sufficient to obtain a more reliable measure of the severity of LTF and ATF, with an expected change of ~ 7° for LTF and ATF with thoracic fulcrum and 11° for ATF with lumbar fulcrum.

Challenges in Describing Tremor and Dystonia.

Tremor is defined as an oscillatory and rhythmical movement. By contrast, dystonia is defined by sustained or intermittent abnormal postures, repetitive movements, or both. Tremor and dystonia often coexist in the same individual. Sometimes tremor and dystonia occur in the same body region, and sometimes they occur in separate body regions. In other cases, dystonic movements are rapid and repetitive, and they may mimic tremor. The varied clinical phenomenology of dystonia and tremor were recognized in the earliest descriptions of dystonia, and various terms have been used to describe the relationships between tremor and dystonia. The term dystonic tremor was first introduced to distinguish tremor-like movements in dystonia from more common tremors such as essential tremor. Subsequently, the same term was adopted to refer to any combination of dystonia and tremor in the same body region. Both applications of this term continue to be used in the modern literature. Other related terms have also been proposed such as tremor associated with dystonia, tremulous dystonia, dystonia-tremor syndrome, and dystonia with tremor. The proliferation of terms has become confusing, and expert opinion regarding application of these terms is divided, so a group of specialists was assembled to review the terminology and to develop recommendations for a more consistent approach. The group agreed that the term tremor should exclusively refer to rhythmic movements. The group also agreed that repetitive dystonic movements that are grossly arrhythmic should not be labeled with terms that imply they are a type of tremor. Moreover, when tremor and dystonia coexist, it may be clinically more useful to describe them separately, using descriptive terms rather than hybrid terms that imply suspected etiology. Easy-to-use clinical terms are essential, although bedside discrimination of movements may sometimes be challenging. In the future, motion analysis or physiologic measures may aid in the discrimination of movements that remain clinically uncertain.

Cortical involvement of lateral trunk flexion and verticality misperception in Parkinson's disease

Abstract Lateral trunk flexion is a common form of postural abnormality in Parkinson's disease and could be associated with verticality misperception. However, the mechanisms underlying lateral trunk flexion and verticality misperception in Parkinson's disease remain unclear. In the current study, we examined whether lateral trunk flexion is associated with verticality misperception in patients with Parkinson's disease. We also identified the brain regions involved in lateral trunk flexion and altered verticality perception. In this cross-sectional study, we evaluated the verticality perception using the subjective visual vertical test in 81 patients with Parkinson's disease and 14 age-matched healthy controls. According to the 97.5th percentile upper reference limit of the body tilt angle in the healthy controls, patients with Parkinson's disease were grouped into 37 patients with lateral trunk flexion and 44 patients without lateral trunk flexion. The mean of absolute subjective visual vertical angles was compared between Parkinson's disease patients with lateral trunk flexion, those without lateral trunk flexion, and the healthy controls, and the impact of verticality misperception on lateral trunk flexion was evaluated using multivariate logistic regression models. We further performed a voxel-wise comparison of regional cerebral blood flow using N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography (height threshold of P &amp;lt; 0.001, uncorrected for multiple comparisons, extent threshold of 100 voxels) to identify the brain regions associated with lateral trunk flexion, and to investigate the relationship between verticality misperception and regional hypoperfusion. The mean of absolute subjective visual vertical angles was larger in Parkinson's disease patients with and without lateral trunk flexion than in healthy controls (P &amp;lt; 0.001 and P &amp;lt; 0.001). Additionally, the subjective visual vertical angle was associated with the presence of lateral trunk flexion (odds ratio 2.25, 95% confidence interval 1.51–3.36, P &amp;lt; 0.001). The regional cerebral blood flow in Parkinson's disease patients with lateral trunk flexion was decreased in the right inferior parietal lobule, right superior parietal lobule, right superior temporal gyrus, and right dorsal posterior cingulate cortex compared with those without lateral trunk flexion. The subjective visual vertical angle was inversely correlated with regional cerebral blood flow in these regions, except for the dorsal posterior cingulate cortex. Our study reveals that hypofunction in the right temporoparietal association cortices is involved in verticality misperception and the development of lateral trunk flexion in patients with Parkinson's disease. These results provide insights into potential therapeutic targets for addressing lateral trunk flexion.

Acute Dystonia-Induced Airway Compromise During Emergence from Anaesthesia: Implications of Propofol and Ondansetron Administration to&amp;nbsp; Patients with Previous Neuroexcitatory Phenomena

Acute dystonic reactions have been reported during emergence from anaesthesia following the use of propofol or/and ondansetron. We present a 37-year-old lady who developed recurrent and severe involuntary movements and abnormal postures in the upper body during emergence from anaesthesia following propofol and ondansetron, given as part of a general anaesthetic for a gynaecological procedure. Reactions were recurrent and severe with associated spells of severe desaturation. Abnormal movements were reported previously following metoclopramide (IV). Acute dystonic reactions with associated laryngeal dystonia were suspected in the context of clinical findings and by exclusion of others. The frequency and severity of reactions were reduced following benztropine (IM) and midazolam (IV). They were completely controlled following the second dose of benztropine, which was given two hours after the first dose. Oxygenation and ventilation were maintained with gentle bag/mask ventilation during the spells of desaturation. As reported in the literature, Propofol and/or ondansetron are the most likely causative agent(s) alone or in combination. She made an uneventful recovery. Evidence for dystonic reactions following propofol and ondansetron is limited, hence likely to be underdiagnosed and treated empirically with disastrous outcomes. We alert the anaesthetists and intensivists to use propofol and ondansetron with caution in patients who reported previous neuroexcitatory phenomena.

Static Posture Instability as a Sensitive Biomarker for Motor Abnormalities in Pre-ataxic Spinocerebellar Ataxia Type 3 Patients.

Spinocerebellar ataxia type 3 (SCA3) is a neurodegenerative disorder, with balance instability as a feature of the disease. Balance instability often manifests before the onset of obvious ataxic symptoms in patients. However, current clinical scales exhibit limited sensitivity in characterizing changes in pre-ataxic patients. Our research aims to identify appropriate postural characteristics for tracking motor changes in pre-ataxic patients with SCA3 over time. The posturographic platform assessed 102 participants (34 pre-ataxic SCA3 patients, 34 ataxic patients with SCA3, and 34 healthy controls) to measure their postural balance. Multivariate comparative analyses assessed the differential postural characteristics across the three groups. The Taiwanese formula was employed to estimate the age of onset for pre-ataxic patients. A Spearman's rho test was employed to assess correlations between postural characteristics and the time manifestation for pre-ataxic patients. Compared to the healthy control group, we observed significant abnormalities in the static posture of pre-ataxic patients (P < 0.01). Compared to the pre-ataxic group, ataxic patients have significant abnormalities in all variables (P < 0.05). The sway range standard deviation (SD), total sway area, and limits of stability were positively correlated with the estimated time to onset. The total sway area is more closely associated with time to manifestation, whereas the sway range SD in the medial-lateral direction of the center of foot pressure is the most sensitive indicator of postural instability in pre-ataxic patients. Static posture instability is a sensitive diagnostic parameter that may assist in capturing disease progression in the pre-ataxic stage of SCA3. © 2025 International Parkinson and Movement Disorder Society.

Abnormal Head Posture and The Relationship Between Vision and Posture: The Role of the Optometrist

Abnormal Head Posture and The Relationship Between Vision and Posture: The Role of the Optometrist

Assessment of the occurrence of postural abnormalities in children aged 10-12 practicing various sports disciplines

Assessment of the occurrence of postural abnormalities in children aged 10-12 practicing various sports disciplines

Pathogenic Variant in the 5'-Untranslated Region of GCH1 and Clinical Heterogeneity in a Chinese Family with Dopa-Responsive Dystonia.

Variants in the GCH1 gene, encoding guanosine triphosphate cyclohydrolase, are associated with dopa-responsive dystonia (DRD) and are considered risk factors for parkinson's disease. Comprehensive neurological assessments documented motor and non-motor symptoms in a Chinese family affected by DRD. Whole-exome sequencing (WES) was employed to identify potential mutations, with key variants confirmed by Sanger sequencing and analyzed for familial co-segregation. The proband, a 50-year-old woman with a 10-year history of limb rigidity, abnormal posture, and a 23-year history of neck deviation, showed significant symptom improvement with levodopa treatment. Family evaluation revealed similar motor symptoms in four additional affected members, all responding well to levodopa. WES identified a GCH1 variant (NM_000161.3: c.-22C > T) in the 5'-untranslated region (5' UTR) in four symptomatic individuals (excluding deceased II-3). This variant likely affects translation by introducing an upstream initiation codon and open reading frame (uORF), leading to decreased BH4 levels and disrupted dopamine synthesis. This study reports a pathogenic variant in the 5' UTR of GCH1 in a family with DRD, underscoring the phenotypic heterogeneity associated with this locus. A non-coding variant (c.-22C > T) in the 5' UTR of the GCH1 gene is identified in a Chinese family with DRD.The findings reveal significant clinical heterogeneity within the family, highlighting the complex genotype-phenotype relationship.

Congenital fibrosis of extraocular muscles – A rare case

Congenital fibrosis of extraocular muscles (CFEOM) is an inherited restrictive ocular motility disorder characterized by unilateral or bilateral horizontal and/or vertical gaze impairment with ptosis. We report the clinical and neuro-radiological findings in a patient with CFEOM. An 18-year-old male patient presented to the ophthalmology outpatient department (OPD) seeking a visually disabled certificate. His best-corrected visual acuity was finger counting at half a meter in both eyes. Clinical examination revealed bilateral congenital ptosis, exotropia in both eyes, and severely restricted vertical and horizontal eye movements. Both eyes were fixed in a downward and outward position, accompanied by an abnormal head posture, predominantly chin -up. The patient also exhibited sluggishly reacting pupils in both eyes. Fundus examination revealed bilateral optic disc hypoplasia. Family history was negative. The forced duction test was positive. A definitive diagnosis was established by integrating findings from the clinical examination, fundus photography, forced duction test, and neuro- radiological investigations. MRI of the orbit demonstrated atrophy of all extraocular muscles except the lateral rectus.

Vibro-tactile stimulation of the neck induces head righting in people with cervical dystonia.

Cervical dystonia (CD) is characterized by involuntary neck muscle spasms that lead to abnormal head movements or postures. It is associated with somatosensory (tactile and proprioceptive) dysfunction. Here we tested whether vibro-tactile stimulation (VTS) of the cervical muscles constitutes a non-invasive form of neuromodulation of the somatosensory system that can provide temporary symptom relief for people with CD. In a multi-centre study, 67 CD patients (44 female) received VTS to sternocleidomastoid and/or trapezius muscles for up to 45min under 9 different stimulation conditions. Retention was assessed 1, 5 and 20min past VTS. Head angles and neck muscle EMG were recorded. The primary outcome measure was a head angle index (HAI), a composite measure reflecting the head deviation across the three axes of the head. After identifying the most effective VTS condition for each participant, analysis showed that 85% (57/67) of participants experienced an improvement in HAI of at least 10% during the application of VTS. HAI improved by 50% or higher in 26/67 of participants. For those responding to VTS, the effects tended to decay within 20min. For the different CD phenotypes several stimulation sites could induce similarly large relative improvements in head posture. The study provides first systematic evidence that cervical VTS can induce fast-acting improvements in abnormal head posture in patients with CD. It demonstrates that a stimulation of somatosensory afferent networks modulates the innervation of dystonic muscles. It highlights the potential of cervical VTS as an adjuvant, non-invasive neuromodulation treatment in CD.

The Association of Occipital Spur with Craniocervical Posture and Craniofacial Morphology.

This cross-sectional study aimed to evaluate the relationship between occipital spur (OS) with both craniocervical posture and craniofacial morphology. The study involved 240 lateral cephalograms from subjects with and without OS. The craniocervical posture and facial morphology of every individual were assessed through Uceph software analysis of their cephalograms, considering 32 variables. The Independent T-test and the Mann-Whitney U-test were used to evaluate the relationships between the measures and OS. Differences in craniocervical posture and craniofacial morphology between the two groups were investigated by logistic regression. Subjects with OS exhibited more severe forward head posture (FHP) (larger C0-C1, Ba-C3ia, C2ap-C4ip, craniocervical angle, CVT-OPT, and NSL-C2') and larger facial configuration (greater mandibular body length, posterior cranial base length, and posterior facial height) than the subjects without OS. Larger C2ap-C4ip (OR 1.53; 95% CI 1.282~1.82), Craniocervical angle (OR 1.70; 95% CI 1.457~1.977) and NSL-C2' (OR 1.18; 95% CI 1.097~1.264), were associated with greater likelihood of having OS. The subjects with OS were more prone to forward head posture than the control group. For subjects observed with OS on cephalograms, attention should be given to their possible abnormal cervical and head postures.

Effects of kinesio taping on lower limb biomechanical characteristics during dynamic postural control tasks in individuals with chronic ankle instability.

Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI. A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz). KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT. KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI.

Feasibility of Using Pulsed Electromagnetic Field Therapy to Improve the Dynamic Postural Balance of Children with Cerebral Palsy: A Randomized, Sham-Controlled Pilot Study

Cerebral palsy (CP) manifests with abnormal posture and impaired selective motor control, notably affecting trunk control and dynamic balance coordination, leading to inadequate postural control. Previous research has indicated the benefits of pulsed electromagnetic field (PEMF) therapy for various musculoskeletal and neurological conditions. Therefore, we conducted a randomized pilot study to assess the feasibility of our preliminary research design and examine the effect of the PEMF treatment among children with CP. Methods: Twelve children with spastic CP participated, with the study group undergoing PEMF treatment three times a week for four weeks. The treatment involved sine signal form, 20/200 Hz frequencies at an amplitude of 150 μT, initially administered for 8, 12, and 16 min per session. The control group received a sham treatment. Dynamic postural balance was evaluated using a force platform at baseline and post-intervention, and the data were analyzed. Data were processed using IBM SPSS 27 by repeated factorial analysis of variance. The significance level was α = 0.05. Results: No side effects of PEMF therapy were detected; this is important, because this intervention has not yet been applied among CP patients. The treatment group demonstrated a positive trend in fine balance coordination tests (p = 0.049); however, the small sample size and variability in control group performance suggest caution in interpreting these findings. Other test domains did not show significant differences. Conclusion: Our pilot study reveals the safety, feasibility, and potential efficacy of pulsed electromagnetic field (PEMF) therapy for children with cerebral palsy. With no observed side effects, the significant improvement in fine balance coordination suggests a promising avenue.

Analysis of worker posture of Make-Up Artist by Standard Nordic Questionnaire method and Rapid Entire Assessment

Working posture is one of the factors that can influence work productivity because working with an abnormal posture can cause ergonomic problems, especially muscle injuries in workers. This research aims to analyze the worker posture of Make-up Artists (MUA) in Meukek District, South Aceh Regency. The analysis was carried out using the (SNQ) method to identify musculoskeletal complaints and (REBA) with the help of Ergo fellow software to assess worker posture. The research results showed that as many as 80% of MUA workers experienced complaints of musculoskeletal, with the most frequent complaints in the waist, shoulders, and neck. The work posture score of MUA workers is categorized as high risk (REBA score 11) in several activities, such as when cleaning the face and applying eyelashes. Risk factors that cause unergonomic work postures include long work duration (2-3 hours per client), with dynamic body positions. Lack of ergonomic work facilities. Based on the research results, several solutions are recommended to improve MUA work posture, including providing solutions for good body posture when working and designing ergonomic work chairs so that they can help MUA maintain optimal body posture while working and reduce risk musculoskeletal. By having work chairs that suit the design, it is hoped that it can improve the comfort and health of MUA workers and reduce the complaints they have been experiencing.

Impact of Ergonomics on Undergraduate Physiotherapy Students in Bangladesh

Background: Poor ergonomics is a global concern, contributing to musculoskeletal complaints mostly muscle imbalance, strain, and fatigue among university students due to abnormal posture. Purpose: The purpose of the study was to identify the impact of ergonomics on undergraduate physiotherapy students in Bangladesh. Methodology: The cross-sectional study was carried out from November 2021 to July of 2022. The convenience sampling technique was used to collect data from 210 undergrad physiotherapy students studying at different physiotherapy colleges or institute in Bangladesh. The modified ergonomics related self-questionnaire was used to explore the idea, knowledge and awareness about the correct posture, and the Numeric Pain Rating Scale (NPRS) was used to collect data about the severity of musculoskeletal pain. Data was collected through face-to-face interviews, and the Statistical Package for Social Sciences (SPSS) version 26.0 was used for analysis. Results: The mean age ± SD of the students was 23.13 ± 2.484. Out of 210 respondents, the majority of the respondents (54.8%) were males, and most of them from crowed area (50.5%). The most of the student’s was Muslim (89.0%) while maximum were single (80.5%). The most of the students have to attend on the class in sitting posture up to 6-8 hours (69.5%) daily. The students have lack of postural awareness and forward bending is their preferred posture. The maximum participants (57.90%) had lower back pain, while 25.8% of had been prevented from doing their normal work due to pain. The results of the study showed a strong association between the study hours daily and correct sitting posture of the students (χ2 = 11.008, df = 5, and p = 0.004). Conclusion: The study found that professional physiotherapy students have low ergonomics awareness and the benefits of its proper use. The preventive training and physiotherapy programs could effectively reduce musculoskeletal complaints among the undergraduate students.

Effects on Posture of a Two-Diopter Horizontal Prism Base Out on the Non-Dominant Eye.

Background/Objectives: Ocular proprioception is implicated in balance control and heterophoria is associated with abnormal posture, though previous research focused mainly on the role of vertical phoria and the use of vertical prisms. This study aims to evaluate whether ocular misalignment and prismatic correction of horizontal phoria affect posture. Methods: Sixty-nine (N = 69) young healthy subjects were included and equally divided by horizontal distance phoria: orthophoria (n = 23), esophoria (n = 23) and exophoria (n = 23). A prism of low power (two-diopter) was placed base out on the non-dominant eye, reducing misalignment in esophorics and increasing it in exophorics more than in orthophorics. Dynamic computerized posturography was performed with the sensory organization test protocol (SOT) of the EquiTest® NeuroCom® version 8 platform both without and with prism, always maintaining subjects unaware of prism use. A mixed model for repeated measures analysis of variance was run to evaluate the main effect of prism and the interaction effect of prism with baseline phoria. Results: Composite movement strategy score without prism was 88.1 ± 2.8% (ankle-dominant strategy) and slightly increased to 89.0 ± 3.1% with prism insertion (p = 0.004), further shifting toward ankle strategy. Composite equilibrium score without prism was 80.3 ± 6.5% and remained stable with prism insertion (81.3 ± 8.2%, p = 0.117), medio-lateral and antero-posterior projection of center of gravity did not displace significantly under prism insertion (p = 0.652 and p = 0.270, respectively). At baseline, posturographic parameters were statistically independent of individual phoria, and no significant interaction between prism insertion and individual phoria was documented for any parameters (p > 0.05 for all). Secondary analysis and pairwise comparisons confirmed that the effect of prism was strongly selective on condition SOT 5 (eyes-closed, platform sway-referenced) with improvement of equilibrium (70.4 ± 9.7% with prism vs. 65.7 ± 11.6% without) and more use of ankle strategy (81.6 ± 5.3% with prism vs. 78.2 ± 6.0% without), without any interaction of phoria and ocular dominance, while the other conditions were comparable with and without prism. Conclusions: A two-diopter prism base out on the non-dominant eye induces the body to use the ankle joint more independently of individual phoria, suggesting a small improvement in postural control, while maintaining oscillations of the center of gravity unaltered. Prism seems to enhance the function of vestibular system selectively. Phoria adjustments with prismatic correction enable intervention in postural behavior. Extraocular muscles could act as proprioceptors influencing postural stability.

Progressively complex neurorehabilitation: from a severe coma to a vegetative state, minimal consciousness ... and the Phoenix bird survives and is reborn from its ashes

Romania has the highest rate of car accidents and deaths per million inhabitants in the European Union, primarily due to poor driving and substandard road conditions. Victims of car accidents often present with complex medical cases involving multiple injuries across various organs, frequently leading to severe complications. Case report. With the approval of the patient's family and the Ethics Committee (no. 19348/25.04.2024) at the Neuromuscular Rehabilitation Clinic, Emergency Hospital "Bagdasar-Arseni," a case study was conducted. A 22-year-old man without a previous medical history suffered severe polytrauma as a result of a road accident. He was transferred to the Neuromuscular Rehabilitation Clinic in a vegetative state (after multiple fractures of the skull base and visceral cranium, with 3 points GCS), atlantoaxial subluxation (requiring cervical collar immobilization), rib fractures, drained hemothorax, near-complete atelectasis of the left lung, status post-pericardial effusion. The medical intervention involved a multifaceted pharmacological approach. Focal intramuscular injections of botulinum toxin targeted specific muscles significantly alleviated spasticity. Special robotic orthoses were used to correct postural abnormalities and maintain the favorable effects of the botulinum toxin. The patient received a personalized and complex nursing rehabilitation program including tracheal stoma management, nutritional support through IV infusions and percutanous gtrostomy (PEG) feeding, re-education of deglutition, intermittent urinary catheterization, and positioning on a special mattress to prevent pressure ulcers. The kinesiotherapy was progressively adapted to the neurologic and general condition. The patient had slight improvements in motor and cognitive abilities, resulting in simple voluntary gestures and affective response schemes. In time, he progressed to a minimally conscious state; he responded to verbal stimuli through blinking and reactive adequate affective mimic in the context of persistent expressive aphasia. He was safely discharged at home. Our main functional objective is the patient’s reinsertion into his family. Ad vitam prognosis and ad functionem outcomes are guarded. Ad laborem prognosis is nil. The patient was periodically reassessed for further rehabilitative care. This case emphasizes the importance of a complex multidisciplinary and patient-centered approach in managing post-traumatic vegetative status following a road traffic accident. The Phoenix symbolically takes steps toward fulfilling its destiny - to survive and gradually rise from its ashes.

Postural Abnormalities in Children with Congenital Zika Syndrome-Related Neurological and Visual Impairment.

Deformities, body asymmetries, and muscle contractures are common consequences of atypical postural patterns in children with c ongenital Zika syndrome (CZS). This study aimed to evaluate the posture of children with CZS, considering their neurological and visual impairments. Ophthalmological assessment included binocular best-corrected visual acuity (BCVA) using Teller Acuity Cards II (TAC II) and an ocular motility evaluation. Postural alignment was measured using the PhysioCode Posture (PCP) app. Twenty-four children with CZS (12 [50.0%] female) were included, with a mean age of 6.8 ± 0.7 years (range, 4.0-7.0 years). The majority (79.2% [19/24]) had microcephaly at birth. Visual impairment was detected in 95.2% (20/21) of the children, with 85.0% (17/20) classified as moderate, severe, or blind. Shoulder asymmetry was observed in 95.8% (23/24) of participants, and 75.0% (18/24) presented abnormal postural alignment of the head and hips. Additionally, spinal deviations were found in 41.7% (10/24) of the children. All children with CZS exhibited asymmetries and improper postural patterns, which may result from a combination of neurological and visual impairments as well as environmental factors.

Efficacy of muscle energy technique with stretching versus muscle energy technique with myofascial release in upper cross syndrome

INTRODUCTION: Cervical pain represents one of the most prevalent musculoskeletal disorders, with the potential for secondary complications if left untreated. The primary causes of neck pain are cervical spine and soft tissue disorders, while neck pain due to postural abnormalities is known as upper cross syndrome (UCS). Epidemiological studies indicate that neck pain is prevalent in the general population but is significantly more common among office workers. Optimal management strategies require further investigation to improve treatment outcomes. This study aims to evaluate and compare two therapeutic approaches for managing Upper Cross Syndrome (UCS): Muscle Energy Technique (MET) combined with Myofascial Release Therapy (MFR), and MET combined with Muscle Stretching Exercises. MATERIAL AND METHODS: This non-randomized, active-controlled trial enrolled 40 patients with neck pain, assigned to two intervention groups of 20 participants each: Muscle Energy Technique (MET) with Myofascial Release Therapy (MFR), and MET with Muscle Stretching Exercises. The study assessed pain intensity using the Visual Analogue Scale (VAS) and forward head posture using the Craniovertebral Angle (CVA) at baseline and three weeks post-treatment. RESULTS: VAS score for pain showed a mean change of 1.7 and 1.8 in the MET with MFR group and MET with the Muscle Stretching Exercises group after 11 sessions. The CVA increased by 2.08° in the MET with MFR group and by 1.78° in the MET with the Muscle Stretching Exercises group. Both groups showed significant improvements in pain and forward head posture (p&lt;0.001), with no significant difference between the interventions. CONCLUSION: Both MET combined with MFR and MET with Muscle Stretching Exercises demonstrate improvement in pain and CVA.

The Role of Medical Rehabilitation: Management of Oromotor Dysfunction (Mechanical and Kinetic Movement Dysfunction) and Speech Therapy in Children with Cerebral Palsy

Cerebral palsy (CP) is a non-progressive motor disorder caused by prenatal, perinatal, and postnatal factors, leading to movement and posture abnormalities. In Indonesia, around 0.60% of the total child population has CP (9 cases per 1000 live births). Speech and swallowing difficulties are common, affecting children’s nutritional status and development. Speech and oral motor therapy are effective in improving speaking and oromotor dysfunction. To determine the effectiveness of oromotor and speech therapy in improving swallowing, chewing, and speech abilities in children with CP. A case study was conducted at the "Lombok Care" Children with Disabilities Foundation. Language development was assessed with the Messay Language Test, and oromotor dysfunction was evaluated using Debra C. Gangale’s method. Pre and post-therapy assessments were performed to assess changes in motor and speech functions. The evaluation of 5 respondents showed an increase in speaking skills after speech therapy and swallowing skills after oromotor therapy. Both are shown to be effective in improving communication skills and oropharyngeal muscle coordination, as well as reducing the risk of aspiration. Speech and oral motor therapy are essential and effective in improving eating, swallowing, and speaking abilities in children with CP, and are an important part of holistic medical rehabilitation.