High Velocity Low Amplitude Research Articles

Safety in the application of high-velocity low-amplitude technique in upper cervical in elderly: Preliminary study

Background: The literature is still controversial regarding the safety of applying high-velocity, low-amplitude (HVLA) techniques to the upper cervical spine, as well as the effects on heart rate variability (HRV) in the elderly. To date, there are no studies reporting the safety of applying these techniques to elderly. Objective: To verify the safety and immediate effects on HRV after applying an HVLA technique to elderly, for the purpose of conducting a future clinical trial. Materials and Methods: This is a preliminary, randomized, crossover study. Six physically active elderly individuals without cardiovascular disease were recruited. The subjects underwent two interventions, with a seven-day interval between them: intervention one consisted of an HVLA technique to the upper cervical spine, while intervention two was a simulated (sham) technique. Data on self-reported symptoms after applying the techniques were collected, in addition to HRV, to assess autonomic function. Results: There were no records of immediate adverse effects after applying the intervention techniques. However, a significant increase in the root means square difference between adjacent normal RR intervals over a time interval (RMSSD) and in the instantaneous beat-to-beat heart rate recording (SD1) was observed in the HVLA group when compared to the sham group. Conclusion: The application of the HVLA technique in the upper cervical spine did not produce self-reported adverse effects in elderly. The HVLA technique increased the activity of the parasympathetic nervous system, producing adjustments in HRV, thus indicating that there may be a significant parasympathetic stimulation in elderly.

Effects of High-Velocity Spinal Manipulation on Quality of Life, Pain and Spinal Curvature in Children with Idiopathic Scoliosis: A Systematic Review.

Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person's life. The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics. The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS). The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies. Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle-Ottawa scale (for observational studies). The protocol of this systematic review was registered in PROSPERO (CRD42024532442). Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life. HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life. However, this therapy may have significant effects on reducing pain in these patients.

Diagnosis and Management of Knee Arthrofibrosis and Associated Pain-Related Fear Using Multidimensional Clinical Reasoning and Exposure In Vivo Concept: A Case Report

BACKGROUND: A plethora of treatment approaches are used to manage persistent pain, disability, and fear associated with restricted knee range of motion following knee surgery. We used the pain and disability driver model and exposure in vivo concepts to manage pain-related fear and disability. CASE PRESENTATION: A 68-year-old male who underwent arthroscopic partial meniscectomy presented to physical therapy with a medical diagnosis of Complex Regional Pain Syndrome Type I and knee range-of-motion restriction. Despite extensive medical care and physical therapy for 3 years (202 visits), he continued to experience debilitating knee pain and demonstrated a high level of fear. To ambulate, he wore a knee brace and used a trekking pole. OUTCOME AND FOLLOW UP: Interventions to address the knee stiffness included combined tibiofemoral joint mobilization and high-velocity low-amplitude thrust manipulation targeting tibial internal rotation and low-load long-duration sustained capsular stretching using total end range time principle for extension. His fear was managed using techniques inspired by in vivo exposure concepts. Total knee range of motion improved 110 degrees and the patient was able to ambulate for 30 minutes (0.5 mile) without an assistive device with <2/10 pain intensity. DISCUSSION: Outside-the-box clinical reasoning suggested that poor outcomes with previous interventions were likely due to hypervigilance and pain-related fear. This case delineates the value of nonreductionist clinical reasoning in diagnosis and management of musculoskeletal conditions. It also outlines how the exposure in vivo approach helped the patient overcome his long-established avoidance behaviors. JOSPT Cases 2024;4(3):121-132. Epub 2 July 2024. doi:10.2519/josptcases.2024.0034

THE EFFECT OF SINGLE HIGH-VELOCITY, LOW-AMPLITUDE SPINE MANIPULATION ON POSTURE, FUNCTIONAL STATE OF TORSO, THIGH MUSCLES, AND VERTICAL JUMP HEIGHT

The effects impact of single high-velocity, low-amplitude (HVLA) spinal manipulation on posture, torso, and thigh functional condition, and the height of the vertical jump have not been adequately studied. The research aims to investigate the immediate changes caused by a single spinal vertebral HVLA manipulation 3 weeks after posture, torso, and thigh muscle functional state, and vertical jump height. The study involved 46 men aged 18-25 years old who practiced indoor volleyball training at least twice a week, as well as a deviation of the vertebral vertebrae from the non-thymic position. Initially, posture was assessed using the photogrammetry method and muscle length was assessed using the goniometry method. A vertical jump height test was performed by the Sargent Jump test. A single HVLA spinal manipulation was performed by a certified chiropractor for segment correction. Then, a re-assessment of posture (photogrammetry), re-assessment of movement volume (goniometry) as well a re-assessment of vertical jump height test- the Sargent Jump test was performed. After 3 weeks post HVLA manipulation participants were retested. The main findings are: immediately after the HVLA spinal correction changes in posture were observed in all evaluated parameters, deviations from the norm decreased by 25.45% ± 1.27% (p < .005), while the vertical jump height test results immediately after HVLA increased by 4.34% ± 0.11% (p < .005). After 3 weeks post HVLA spine manipulation therapeutic effect was reduced by 5.48% ± 1.27% (p < .005), while the Sargent Jump test result 3 weeks after manipulation decreased by 0.05% ± 0.11% (p > .005). Conclusion: the persistence of the effect of a single HVLA spine manipulation was maintained for 3 weeks after the manipulation into the posture.

The effect of HVLA manipulation on static and dynamic postural parameters – a case study of a patient with a blocked atlanto-occipital transition

Objective. The study aimed to assess the effects of high velocity low amplitude (HVLA) manipulations on force distribution, pressures, and balance in individuals with atlanto-occipital blockage, focusing on post-treatment improvements. Research methods. Diagnostic tests (cervical spine compression, Spurling, de Kleyn) and pedobarography (using an EPS/R2 mat and BIOMECH STUDIO software) assessed functionality and postural parameters pre and post HVLA therapy. Results. Initial diagnosis showed significant disturbances in force distribution, balance, and gait. Post-HVLA therapy improvements included: 1. Balanced forefoot load during standing, with a decrease in heel load percentage. 2. Improved global body pressure distribution, with a notable decrease in left-side body pressure. 3. Enhanced anteroposterior and lateral body oscillation ranges, with a reduced ratio of extreme deflection distances to deflection surface and a decreased average speed of displacements. 4. Normalization of the right foot abduction angle, with no significant change in the left foot's visitation angle. 5. Slight improvements in foot vault index (AI) and average foot pressure during gait, with minimal changes in maximum foot pressure during gait. Conclusions. HVLA manipulation significantly improves static balance parameters but shows minimal improvement in gait parameters. This indicates a complex relationship between atlanto-occipital blockage and postural disorders, suggesting the need for further research to explore the association between postural defects and atlanto-occipital transition blockage, as well as the impact of these blockages on postural changes. Keywords atlanto-occipital blockage, HVLA manipulation, postural disorders, balance improvement, pedobarography

A randomized controlled trial comparing different sites of high-velocity low amplitude thrust on sensorimotor integration parameters

Increasing evidence suggests that a high-velocity, low-amplitude (HVLA) thrust directed at a dysfunctional vertebral segment in people with subclinical spinal pain alters various neurophysiological measures, including somatosensory evoked potentials (SEPs). We hypothesized that an HVLA thrust applied to a clinician chosen vertebral segment based on clinical indicators of vertebral dysfunction, in short, segment considered as “relevant” would significantly reduce the N30 amplitude compared to an HVLA thrust applied to a predetermined vertebral segment not based on clinical indicators of vertebral dysfunction or segment considered as “non-relevant”. In this double-blinded, active-controlled, parallel-design study, 96 adults with recurrent mild neck pain, ache, or stiffness were randomly allocated to receiving a single thrust directed at either a segment considered as “relevant” or a segment considered as “non-relevant" in their upper cervical spine. SEPs of median nerve stimulation were recorded before and immediately after a single HVLA application delivered using an adjusting instrument (Activator). A linear mixed model was used to assess changes in the N30 amplitude. A significant interaction between the site of thrust delivery and session was found (F1,840 = 9.89, p < 0.002). Pairwise comparisons showed a significant immediate decrease in the N30 complex amplitude after the application of HVLA thrust to a segment considered “relevant” (− 16.76 ± 28.32%, p = 0.005). In contrast, no significant change was observed in the group that received HVLA thrust over a segment considered “non-relevant” (p = 0.757). Cervical HVLA thrust applied to the segment considered as “relevant” altered sensorimotor parameters, while cervical HVLA thrust over the segment considered as “non-relevant” did not. This finding supports the hypothesis that spinal site targeting of HVLA interventions is important when measuring neurophysiological responses. Further studies are needed to explore the potential clinical relevance of these findings.

A Hole in One

This case report discusses the presentation, diagnosis, and treatment of trigger finger in a 62-year-old right-handed male with a history of two months of right index finger pain and locking sensation. The patient's occupation and activities, such as typing, golfing, running, and biking, potentially contributed to the development of trigger finger. Physical examination revealed tenderness near the A1 pulley, a palpable nodule, and limited extension and abduction of the affected finger. Imaging showed mild degenerative changes and a small sesamoid bone. The patient received a corticosteroid injection to the tendon sheath, along with high-velocity low-amplitude (HVLA) manipulation and myofascial release to correct associated somatic dysfunctions. The patient experienced reduced pain and improved range of motion after treatment, and follow-up at one month showed complete resolution of symptoms.

Assessment of chiropractic intervention influence on pain and life quality in cervicogenic headache afflicted office workers: a review

Cervicogenic headache, characterized by referred pain perceived in the head but originating from the cervical spine, is a prevalent non-migraine headache impacting a significant proportion of the global population, particularly office workers. Recent studies have identified a co-occurrence of cervicogenic headaches with neck pain, often exacerbated by long hours of stationary sitting and computer use common in desk jobs. Despite the growing evidence supporting the effectiveness of chiropractic treatment in mitigating head and neck pain, a distinct gap persists in the literature concerning chiropractic interventions specifically targeting office workers suffering from cervicogenic headaches. This review aims to scrutinize the current literature on the effectiveness of chiropractic interventions on pain management and life quality improvement for office workers afflicted with cervicogenic headaches. Specifically, the review will delve into high-velocity, low-amplitude (HVLA) thrust maneuvers, a widely employed strategy in spinal manipulative therapy, an extension of chiropractic treatment. In the context of cervicogenic headaches, the link between the Rectus Capitis Posterior Minor (RCPM) muscle and the Dura Mater, and how neck strains affecting this connection can instigate headaches, will be explored. Through the comprehensive evaluation of existing literature and studies, this review seeks not only to elucidate the potential of chiropractic treatment in improving the life quality of office workers suffering from cervicogenic headaches, but also to stimulate further research in this essential yet under-explored area of study.

Application of high-velocity low-amplitude technique in cervicothoracic junction produces cardiovascular responses in subjects with C7-T1 dysfunction: Randomized crossover trial

BackgroundNeural structures of cardiac sympathetic and parasympathetic conduction emerge from the segments of the cervicothoracic spine. The application of high-velocity low-amplitude (HVLA) techniques at this segment can generate responses in heart rate (HR), blood pressure and sympathetic nervous activity of the skin. However, it is not known whether these responses occur in subjects with C7-T1 dysfunction. ObjectiveTo evaluate the effects of HVLA technique in cervicothoracic junction in HR, blood pressure and skin temperature (ST), in subjects with C7-T1 dysfunction. DesignThis is a randomized crossover trial. MethodsTwelve male subjects were randomized into two groups: HVLA and Sham. HVLA group received a single manipulation technique for C7-T1 dysfunction, while the sham group received a simulated HVLA. HR, blood pressure and ST were measured pre, immediately after and 10 min after the application of the interventions. ResultsImmediately after the application of the interventions, an increase in HR, systolic blood pressure (SBP) and ST was observed, in addition to a reduction in diastolic blood pressure (DBP). Also, 10 min after, a significant reduction in SBP and DBP was observed in the HVLA group when compared to Sham group. ConclusionThe application of a single HVLA technique in the cervicothoracic junction produced significative effects on HR, BP and ST in subjects with C7-T1 dysfunction. Implications for Practice·This study showed that a musculoskeletal technique has effect on autonomic nervous system, suggesting that there are still hidden mechanisms behind HVLA techniques.·HVLA techniques for cervicothoracic junction can generate changes in cardiovascular variables.·HVLA techniques did not cause adverse hypertensive peaks.

Can self-assessment and augmented feedback improve performance and learning retention in manual therapy: results from an experimental study

BackgroundThe purpose of this study was to investigate how feedback and self-assessment strategies affect performance and retention of manual skills in a group of chiropractic students.MethodsSeventy-five students participated in two spinal manipulation (SM) learning sessions using a force-sensing table. They were recruited between May and November 2022 during HVLA technical courses. Students were randomly assigned into three different groups: participants in group 1 received visual feedback, those in group 2 received visual feedback after self-assessment, and participants in group 3 (C) received no feedback. During the first session, participants started with one block of 3 familiarization trials, followed by two blocks of 6 SM HVLA (high velocity low amplitude) posterior-to-anterior thoracic SM trials, with 3 trials performed with a target force of 450 N and 3 others at 800 N. They received feedback according to their group during the first block, but no feedback was provided during the second block. All participants were invited to participate in a second session for the retention test and to perform a new set SM without any form of feedback.ResultsResults showed that visual feedback and visual feedback in addition to self-assessment did not improve short-term SM performance, nor did it improve performance at the one-week retention test. The group that received visual feedback and submitted to self-assessment increased the difference between the target force and the peak force applied, which can be considered a decrease in performance.ConclusionNo learning effects between the three groups of students exposed to different feedback and self-assessment learning strategies were highlighted in the present study. However, future research on innovative motor learning strategies could explore the role of external focus of attention, self-motivation and autonomy in SM performance training.

Effectiveness of thoracic spine manipulation for upper quadrant musculoskeletal disorders: protocol for a systematic review

IntroductionUpper quadrant musculoskeletal disorders (UQMD), comprising of cranial, cervical, shoulder and upper extremity disorders, are among the most frequently reported disorders in clinical practice. Thoracic high velocity low amplitude thrust...

Influence of high-velocity low amplitude manipulation of the lumbar spine on the activity of motor units of the erector spinal muscles with functional assessment in healthy young people

Influence of high-velocity low amplitude manipulation of the lumbar spine on the activity of motor units of the erector spinal muscles with functional assessment in healthy young people

The effect of lumbar spinal manipulation on biomechanical factors and perceived transient pain during prolonged sitting: a laboratory-controlled cross-sectional study

BackgroundSpinal manipulation has been shown to affect muscle activity, posture, and pain. To date, no studies have examined the effect of manipulation on biomechanical factors during sitting. Therefore, the purpose of this study was to investigate the immediate effect of lumbar spinal manipulation on trunk muscle activation, spine posture and movements, and perceived ratings of transient pain in asymptomatic adults during prolonged office sitting.MethodsTwenty healthy adults were recruited for a single laboratory session that included a standardized office sitting/data entry protocol (120 min total, 3 blocks of 40 min). Data were collected between July and August 2012. The first block (baseline) was immediately followed by two experimental blocks. Prior to the start of each experimental block, participants were transferred to a therapy plinth and placed side lying (right side down), and a random presentation of either a control or high velocity low amplitude thrust directed at L4/L5 was delivered. Continuous measures of muscle activity, spine posture, and spine movements were recorded throughout the sitting trials. Perceived transient pain was measured by visual analogue scale at 10-min intervals (including immediately before and after the randomized maneuvers).ResultsThere were no significant differences in spine or pelvic posture or perceived back pain following either the manipulation or control maneuvers. Significantly reduced muscle activity and increased shifts of the lumbar spine angle were identified in the block following manipulation compared to both baseline and post control blocks.ConclusionsSpinal manipulation does not appear to have an immediate impact on spine or pelvic posture in healthy adults but does appear to reduce muscle activity and increase spine movement during sitting. Future work should replicate this study with a larger population in a field setting. It may be worthwhile to explore the implication of reduced muscle activation and increased spine movements during prolonged sitting for office workers that receive manipulations or mobilizations during their workday.

Video head impulse testing: Pitfalls in neurological patients

The video head impulse test (vHIT) assesses the vestibulo-ocular reflex (VOR) during a rapid high-velocity low amplitude (10°–20°) head rotation. Patients with peripheral vestibulopathy have a reduced VOR gain with corrective catch-up saccades during the head turn. There are several pitfalls, mainly technical, which may interfere with interpretation of vHIT data. In addition, intrusive eye movement disorders such as spontaneous nystagmus that affect normal eye position and tracking can affect the vHIT results. To date there has been little study of neurological saccadic eye movements that may interfere with the interpretation of vHIT data. Here, in ten patients with a range of central neurological disorders, we describe oculomotor abnormalities on vHIT in the presence of normal range VOR gain values, recorded at a tertiary vestibular neurology service.

Osteopathic practice in the United Kingdom: A retrospective analysis of practice data.

This study describes osteopathic practise activity, scope of practice and the osteopathic patient profile in order to understand the role osteopathy plays within the United Kingdom's (UK) health system a decade after our previous survey. We used a retrospective questionnaire survey design to ask about osteopathic practice and audit patient case notes. All UK registered osteopaths were invited to participate in the survey. The survey was conducted using a web-based system. Each participating osteopath was asked about themselves, their practice and asked to randomly select and extract data from up to 8 random new patient health records during 2018. All patient related data were anonymised. The survey response rate was 500 osteopaths (9.4% of the profession) who provided information about 395 patients and 2,215 consultations. Most osteopaths were self-employed (81.1%; 344/424 responses) working alone either exclusively or often (63.9%; 237/371) and were able to offer 48.6% of patients an appointment within 3 days (184/379). Patient ages ranged from 1 month to 96 years (mean 44.7 years, Std Dev. 21.5), of these 58.4% (227/389) were female. Infants <1 years old represented 4.8% (18/379) of patients. The majority of patients presented with musculoskeletal complaints (81.0%; 306/378). Persistent complaints (present for more than 12 weeks before appointment) were the most common (67.9%; 256/377) and 41.7% (156/374) of patients had co-existing medical conditions. The most common treatment approaches used at the first appointment were soft-tissue techniques (73.9%; 292/395), articulatory techniques (69.4%; 274/395) and high velocity low amplitude thrust (34.4%; 136/395). The mean number of treatments per patient was 7 (mode 4). Osteopaths predominantly provide care of musculoskeletal conditions, typically in private practice. To better understand the role of osteopathy in UK health service delivery, the profession needs to do more research with patients in order to understand their needs and their expected outcomes of care, and for this to inform osteopathic practice and education.

Comparison of high velocity low amplitude manipulation and dry needle treatment in patients with nonspecific back pain

article: Comparison of high velocity low amplitude manipulation and dry needle treatment in patients with nonspecific back pain - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 December;180(12):815-21 - Minerva Medica - Journals

Effect of lumbar high velocity low amplitude (HVLA) thrust on speed and agility in elite athletes: A randomised controlled trial

Elite athletes constantly seek methods to enhance performance [1]. Pre-competition manipulation is a prevalent but underappreciated technique.[1] Depending on the assessment, HVLA thrust of the spinal or extremities joint is frequently used [1]. A manipulation is a single high-velocity thrust administered to a joint, or a sequence of joints, and the soft tissues around them [2]. Usually, the goal is to alleviate discomfort [2]. These treatments are only used on a patient who is completely relaxed [2]. A manipulative push technique extends the joint's typical physiological range for a brief period of time [2]. Accurate localisation of the joint position before to the procedure, followed by a carefully delivered thrust, will result in a movement that is so quick that the patient will barely notice it has started [2]. HVLA thrust may boost performance since it facilitates motor neuron pool excitability for 20-60s, according to basic physiological studies. When conducted on the joints of the lumbar spine, it results in a considerable increase in surface electromyographically measured erector spinae isometric maximal voluntary contraction muscle output and is helpful in providing short-term pain relief [1]. HVLA thrust, a type of spinal manipulation, has been demonstrated to activate the brain in studies. Mechanoreceptors and proprioceptors from structures in and around the manipulated joint [40]. The altered afferent input arising from the stimulation of these receptors is thought to cause changes in motor neuron excitability, which then results in local or regional muscular changes around the manipulation site [40]. Manipulative treatment has been provided as standard of care to athletes at Olympic Games and other international multisport games [41]. Pre competition manipulation may help enhance musculoskeletal function by warming up soft tissues to optimize joint function [41]. Many articles have shown significant immediate effects of HVLA, however not many studies have focused on long term effects. Shrier I et al. did a pilot study that showed pre event manipulation improved the sprint time in athletes [1]. Therefore, this study will be focusing on effects of lumbar HVLA thrust on speed and agility in elite athletes. Objectives: 1.To check the effect of lumbar HVLA on speed in elite athletes after 2 weeks. 2.To check the effect of lumbar HVLA on agility in elite athletes after 2 weeks. Methodology: With the permission of ethical committee the study was started. Consent was taken from the athletes participating in the study. 42 players were selected for the study based on the inclusion criteria. They were randomly divided into 2 groups Group A (Interventional) (N=22) and Group B (Control) (N=20). Single blinding method was used in this study in which the athletes were kept ignorant of either of the group they are assigned to but the therapist was in possession of this knowledge Group A was given HVLA along with conventional. Group B was given conventional training. Pre intervention speed and agility were recorded in both groups. Post intervention (post 2 weeks) speed and agility was done again in both the groups. For interventional group and control group the training protocol was composed of 10mins warm up exercises with stretching, 40 minutes of exercises with adequate breaks in between, 10mins of cool down exercise. Data was analysed using Wilcoxon rank t test in Group A within the group and Paired t test in group B within the group. And unpaired t test was used to analyse the data of speed between group A & B and Mann Whitney test for agility between group A & B. Result: HVLA thrust showed non-significant improvement (p value- 0.12) for speed in elite athletes when compared to conventional training. HVLA thrust showed not quite significant improvement (p value-0.07) for agility in elite athletes when compared to conventional training. Conclusion: Interventional group showed clinically significant improvement within the group. But on comparing with the control group the results were not significant. Further studies are needed with larger sample size to find the effects of HVLA thrust in performance of elite athletes.

Retention of tissue texture change after cervical muscle energy and high velocity low amplitude intervention: implications for treatment intervals.

When choosing to incorporate osteopathic manipulative treatment (OMT) into a patient's care, the risk-to-benefit ratio, the choice of treatment technique, as well as the frequency of treatments are always taken into consideration. This has been even more important during the COVID-19 pandemic, in which social distancing has been the best preventative measure to decrease exposure. By increasing treatment intervals, one could not only limit possible exposure/spread of viruses but also decrease the overall cost to the system as well as to the individual. This is an expansion of a previous study in which quantifiable changes in cervical hysteresis characteristics post-OMT were documented utilizing a durometer (Ultralign SA201®; Sigma Instruments; Cranberry, PA USA). This study compared two treatment modalities, muscle energy (ME) and high-velocity low-amplitude (HVLA) postcervical treatment. Subjects in this study were allowed to re-enroll, provided that they could be treated utilizing the alternate treatment modality. By allowing repeat subjects, analysis of the data for lasting effects of OMT could be observed. To determine whether a significant change in cervical hysteresis would be observed after each treatment regardless of a short treatment interval. A total of 34 subjects were retrospectively noted to be repeat subjects from a larger, 213-subject study. These 34 subjects were repeat participants who were treated with two different direct-treatment modalities 7-10days apart. Each subject was randomly assigned to receive a single-segmental ME or HVLA treatment technique directed toward a cervical (C)segment (C3-C5 only). Subjects were objectively measured pretreatment in all cervical segments utilizing the Ultralign SA201®, then treated with cervical OMT to a single segment, and finally reassessed at all cervical levels with the Ultralign SA201® posttreatment to assess for change in cervical hysteresis. Statistically significant or suggestive changes (p-values 0.01-0.08) with good clinical effect size (0.30 or greater) were noted in all four components of the Ultralign SA201® at multiple cervical levels after the first treatment, but only one component (frequency) had a statistically significant change after the second treatment (AA cervical level, p-value 0.01) with good clinical effect size (0.45). However, when comparing the post-first-treatment values to the pre-second-treatment values, no statistically significant differences (p-value 0.10 or higher) were observed between them. Statistically significant changes were noted after the first treatment; however, when comparing cervical hysteresis changes after the first treatment to the cervical hysteresis values prior to the second treatment delivered 7-10days later, there were no statistically significant or suggestive changes. This data suggest that several post-OMT changes noted after the first treatment were still in effect and may indicate that follow-up visits for direct manipulation may be deferred for a least two weeks.

Electromyographic Responses of Neck, Back, and Limb Outlet Muscles Associated With High-Velocity, Low-Amplitude Manual Cervical and Upper Thoracic Spinal Manipulation of Individuals With Mild Neck Disability: A Descriptive Observational Investigation

ObjectivesThe purpose of this study was to investigate the extent of electromyographic responses associated with manual high-velocity, low-amplitude (HVLA) spinal manipulation systematically applied to the upper and lower cervical and upper thoracic spines in a cohort with mild neck disability. MethodsThe study was a descriptive observational investigation, with all participants receiving the same interventions. Nineteen participants with mild neck disability received 6 manual HVLA manipulations to the cervical and upper thoracic spine. Bipolar surface electromyography electrode pairs were used to measure responses of 16 neck, back, and limb outlet muscles bilaterally. The number of electromyographic responses was then calculated. ResultsElectromyographic responses associated with cervical and thoracic manipulation occurred in a median of 4 of the 16 (range: 1-14) recorded muscles. Cervical spinal manipulation was associated with the highest rates of electromyographic responses in neck muscles, whereas responses in back muscles were highest after upper thoracic manipulation. ConclusionCervical spinal manipulation was associated with the highest rate of electromyographic responses in muscles of the cervical spine (sternocleidomastoid and splenius cervicis), whereas responses in back muscles (upper and middle trapezius, latissimus dorsi, and longissimus thoracis) were highest after upper thoracic manipulations. This result suggests that electromyographic muscular responses associated with spinal manipulation primarily occur locally (close to the target segment) rather than distally.

Влияние обучающей среды на имплицитное и эксплицитное научение новым словам: результаты пилотажного исследования

The availability of virtual reality (VR) tools and the attractiveness of their interactivity for users have influenced the spread of this technology in the field of language educational programs. However, scientific studies of the effectiveness of VR in comparison with traditional methods are few and show conflicting results, which can be explained by the influence of additional factors, such as the learner's motor activity and the speech learning strategies used. In order to clarify the role of these factors, we developed a natural design of learning tasks in VR on a computer monitor, based on the auditory presentation of new words to participants together with their visual referents in the context of interrogative sentences. The controlled variables were speech learning strategies (Fast Mapping/Explicit Encoding) and motor response to the question (high-velocity low amplitude hand movements). 16 respondents learned 8 nouns each in the two learning environments. Learning outcomes were assessed using the recognition task. Accuracy of the answers was analyzed using RM-ANOVA, the reaction time using the Wilcoxon test. The correctness of recognition of new words did not differ significantly after using VR (55%) or a computer monitor (61%). Words learned with high-velocity whole-hand movements were significantly better for participants when they learned through fast mapping, while words learned with low amplitude finger movements were significantly better with explicit encoding while using a computer monitor. Explicit Encoding learned words with small amplitude movements were recognized faster using VR then a computer monitor. The pilot study showed the effectiveness of the semantic assimilation of new words in both learning environments with the combined influence of speech learning strategies and the student's motor activity in this process.