Limited Motion Research Articles

Hubungan antara kebiasaan parafungsional dan gangguan temporomandibula pada anak usia remaja (Kajian terbatas di Jakarta)

Background: Temporomandibular disorders (TMD) are musculoskeletal disorders involving the temporomandibular joints, masticatory muscles, and associated structures. The etiology of temporomandibular disorders is complex and multifactorial. Parafunctional activities are considered main factors that are associated with TMD. Objective: To examine the association between parafunctional habits and temporomandibular disorders in adolescence. Methods: An analytical observational study with a cross-sectional design was carried out on 443 children (236 men and 207 women) aged 12-13 years. The data obtained consisted of univariate and bivariate data on parafunctional habits and temporomandibular disorders based on the results of the adolescent’s questionnaire V.2. The data were analyzed by Chi-square test. Result: Bivariate analysis showed a significant association (p <0.05) between sleep clenching and awake clenching with temporomandibular pain (p = 0.047 and p = 0.001). A significant association was found between sleep grinding and biting the lips / cheeks habits with joint sounds (click / pop) (p = 0.045 and p = 0.020). Analysis of the association between sleep grinding and sleep clenching with limited jaw motion also showed a significant association (p = 0.014 and p = 0.004). Conclusion: There are associations between clenching and temporomandibular pain; sleep grinding and biting the lips / cheeks with joint sounds (click / pop); and between sleep bruxism and limited jaw motion.

EXPLORING THE POTENTIAL OF PHLPP INHIBITORS FOR OSTEOARTHRITIS TREATMENT

Abstract Osteoarthritis (OA) is a degenerative joint disease characterized by pain, stiffness, and limited joint motion affecting 7% of the world’s population. PH domain leucine-rich repeat protein phosphates (PHLPPs) have been identified as modifiable targets for cartilage regeneration and joint pain. PHLPP1 and PHLPP2 are abnormally expressed in osteoarthritic cartilage and sensory neurons. PHLPP1-/- mice are protected from cartilage degradation and pain-related behaviors (allodynia and reduced mobility) after surgery that destabilizes the medial meniscus (DMM). Here, we investigate the effects of PHLPP inhibitors (i) on human chondrocytes and the effect of Phlpp1 deletion on cell populations within lumbar dorsal root ganglia (DRGs). Immunohistochemistry was performed on mouse DRGs by cryosectioning fixed L3-5 DRGs and using primary antibodies against Fabp7, Anti tubulin beta 3, and PGP9.5/UCHL1. Human chondrocytes were subjected to Cycloheximide chase experiments and treated with PHLPPi (NSC117079 or NSC45586), followed by Western blot analysis to assess protein levels including Phlpp1, Phlpp2, Sox9, p-AKT (Ser473), total AKT, and B-actin, at various time points. We found that PHLPPi prolongs the phosphorylated AKT response when compared to controls and does not affect degradation of Phlpp1 or Phlpp2; additionally, NSC117079 increased production of cartilage extracellular matrix components (glycosaminoglycans and aggrecan) in over 90% of human articular cartilage explants from OA patients. These data advance our understanding of how PHLPPi function within chondrocytes and provide a basis toward understanding their activity and safety in vivo. Our results indicate that PHLPPi NSC117079 is a novel osteoarthritis disease-modifying drug candidate that may have palliative effects.

Fast monocular visual-inertial calibration and initialization with weak environmental control and motion control

Most existing visual-inertial systems require control of extrinsic environment and extrinsic motion to obtain calibration results and simplify the initialization model. The former limits the usage scenarios of the method, while the latter reduces the estimation accuracy of the state parameters of the navigation system. Therefore, a visual-inertial calibration and initialization method is necessary for weak environmental and motion control conditions. Firstly, to overcome the reliance on environmental control, we establish a motion constraint equation based on the relative consistency of visual-inertial sensing spatial motion and implement a visual-inertial online calibration method. Secondly, to eliminate the reliance on motion control, a dual graph optimization structure is be constructed. The initial optimization outcome serves as the foundation for achieving improved calibration results in the refined optimization. Thirdly, to improve initialization accuracy, a complete initial state model is considered to decouple and calculate the translation extrinsic parameters. These parameters are compensated into subsequent initialization, enhancing the robustness of the initialization process. The proposed method is validated on the EuRoC dataset, and experimental results demonstrate that it achieves more accurate calibration results at a faster rate than VINS-Mono in scenarios without calibration target and with limited vehicle motion. The navigation results of different scenarios demonstrate that our method can more effectively integrate visual-inertial data due to improved calibration and initialization estimates.

Scarless Excision of Second Branchial Cleft Cyst via Retroauricular Hairline Incision.

Second branchial cleft cyst (2nd BCC) is treated by complete excision. Conventional transcervical skin incision on the lesion may leave a prominent scar in the cosmetically sensitive area. The retroauricular hairline incision (RAHI) approach may maintain neurological, mobility, and cosmetic functions of the neck and face after excision. This study evaluated the clinical outcomes and disease control of scarless surgery via RAHI in 57 consecutive patients with 2nd BCC. The patients received the prospective evaluation of postoperative neurological, subjective pain, swallowing, neck motion, and cosmetic functions. Postoperative complications, subjective satisfaction, and recurrence were also assessed in each patient. Excision was performed in all cases without injury to the facial nerve or other neurological complications and conversion to other incisions or approaches with a median operation time of 44min. Complications were minimal, without dysphagia, neurological deficits, or limited neck motion. Postoperative incision scars in the postauricular and hairline region were commonly invisible. Subjective satisfaction with the scar and facial deformity was high after surgery. No patients had a recurrence for a median follow-up of 66months. The RAHI approach for 2nd BCC has excellent cosmetic, functional, and disease control outcomes. This can be safely applied to the treatment of 2nd BCC. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial

IntroductionPiriformis muscle syndrome (PMS) is a condition that can lead to symptoms including gluteal pain, local tenderness, and limitation of hip joint motion in daily activities, and it may have a major impact on some daily functions such as gait. We proposed that dry needling (DN) can improve the gait of individuals with PMS. MethodsThirty-two individuals with PMS were assigned equally and randomly to the treatment group or the wait-list control group. Subjects in the treatment group received three sessions of DN of the piriformis muscle. All participants in both groups were educated to correct their lifestyles. The outcome measures were the gait-related parameters (walking speed, peak hip flexion, peak hip extension, time to peak internal and external hip rotation, and knee sagittal range of motion), which were evaluated at baseline and after treatment. To compare different outcomes, analysis of covariance (ANCOVA) was used, with baseline as the covariance and groups as a factor. ResultAfter DN sessions, peak hip extension during gait showed a statistically significant difference [adjusted MD 1.9 (3.7–0.08), p < 0.05, d = 0.56 (0.1–1.28)] in favor of the DN group. Peak hip flexion, on the other hand, exhibited a marginal statistically significant difference [adjusted MD -3.2 (−6.51 to 0.01), p = 0.053, d = 0.44 (1.16 to −0.02)] compared to the control group. ConclusionThe findings suggest that participants in DN showed significantly greater peak extension angle of the hip during walking in individuals with PMS than in the control group.

A novel lung SBRT treatment planning: Inverse VMAT plan with leaf motion limitation to ensure the irradiation reproducibility of a moving target

This study exposed the implementation of a novel technique (VMATLSL) for the planning of moving targets in lung stereotactic body radiation therapy (SBRT). This new technique has been compared to static conformal radiotherapy (3D-CRT), volumetric-modulated arc therapy (VMAT), and dynamic conformal arc (DCA). The rationale of this study was to lower geometric complexity (54.9% lower than full VMAT) and hence ensure the reproducibility of the treatment delivery by reducing the risk for interplay errors induced by respiratory motion. Dosimetry metrics were studied with a cohort of 30 patients. Our results showed that leaf speed limitation provided conformal number (CN) close to the VMAT (median CN of VMATLSL is 0.78 vs 0.82 for full VMAT) and was a significant improvement on 3D-CRT and DCA with segment-weight optimized (respectively 0.55 and 0.57). This novel technique is an alternative to VMAT or DCA for lung SBRT treatments, combining independence from the patient's breathing pattern, from the size and amplitude of the lesion, free from interplay effect, and with dosimetry metrics close to the best that could be achieved with full VMAT.

Surgical Management of Traumatic Meniscus Injuries.

The menisci increase the contact area of load bearing in the knee and thus disperse the mechanical stress via their circumferential tensile fibers. Traumatic meniscus injuries cause mechanical symptoms in the knee, and are more prevalent amongst younger, more active patients, compared to degenerative tears amongst the elderly population. Traumatic meniscus tears typically result from the load-and-shear mechanism in the knee joint. The treatment depends on the size, location, and pattern of the tear. For non-repairable tears, partial or total meniscal resection decreases its tensile stress and increases joint contact stress, thus potentiating the risk of arthritis. A longitudinal vertical tear pattern at the peripheral third red-red zone leads to higher healing potential after repair. The postoperative rehabilitation protocols after repair range from immediate weight-bearing with no range of motion restrictions to non-weight bearing and delayed mobilization for weeks. Pediatric and adolescent patients may require special considerations due to their activity levels, or distinct pathologies such as a discoid meniscus. Further biomechanical and biologic evidence is needed to guide surgical management, postoperative rehabilitation protocols, and future technology applications for traumatic meniscus injuries.

Arthroscopic remplissage: history, indications, and clinical outcomes.

Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.

The Pedicled Sensate Osteocutaneous Groin Flap for Reconstruction of the Forearm and Hand

Background The groin flap is axial pedicled and versatile. Until now, this flap has been used with many modifications for the reconstruction of forearm and hand defects. However, this flap has not been used in forearm, hand, and thumb reconstruction as a pedicled sensate osteocutaneous flap. In this study, a pedicled sensate osteocutaneous groin flap was used for the reconstruction of composite tissue defects on the forearm, hand, and thumb. Patients and Methods A pedicled sensate osteocutaneous groin flap was used to reconstruction composite tissue defects on the forearm, hand, and thumb in 7 patients. The mean age of the patients was 42 years. The defects were located on the dorsal surface of the forearm and hand in 2 patients, the dorsal surface of the hand and finger in 2 patients, and the thumb in 3 patients. The dimensions of the flap skin paddle ranged from 7 × 11 cm to 8 × 23 cm, and the dimensions of the bone component ranged from 1 × 1.5 × 3.5 cm to 1 × 1.5 × 5 cm. The mean follow-up duration was 26 months. Results All the flaps survived. Flap debulking was performed using 3 flaps. Sensory recovery in the flaps was completed approximately 18 months after the first operation. When the results of static 2-point discrimination test and Semmes-Weinstein monofilament test were evaluated at 18 months postoperatively, it showed that protective sensation was obtained. Except for 1 patient, motion restriction did not develop in the wrist, elbow, or shoulder joints. An acceptable aesthetic result, minimal donor site deformity, and protective sensation were obtained in all patients. Conclusions The pedicled sensate osteocutaneous groin flap can be safely used in the reconstruction of forearm and hand composite tissue defects that do not have available vascular structures for free flaps in the recipient area and in thumb reconstruction where toe transfer and pollicization cannot be performed.

The effect of massage on the plantar flexor muscles during the fixation period in postoperative patients with an ankle fracture

IntroductionAnkle fractures are one of the most common lower extremity fractures. After surgery, the ankle joint is often immobilized in a plantar flexion position, and there have been many reported cases of limited ankle joint range of motion. Therefore, the purpose of the present study was to investigate the effect of regular massage interventions on ankle joint range of motion after removal of fixation. MethodsThe massage group comprised 30 patients who had sustained an ankle fracture and had undergone surgical fixation, physical therapy, and massage between November 2020 and March 2022. These subjects received a 3-min massage twice daily, five times a week. The control group consisted of 38 patients who had sustained an ankle fracture between January 2015 and September 2020 and had undergone surgical fixation as well as regular physical therapy. ResultsThe respective ankle dorsiflexion and plantarflexion ranges of motion after cast removal were 2.50 ± 7.2° and 42.3 ± 7.2° in the massage group and −8.62 ± 2.9° and 34.8 ± 8.3° in the control group. An unpaired t-test showed that the ankle dorsiflexion and plantarflexion ranges of motion in the massage group were significantly greater than those in the control group (p = 0.036 and p < 0.01). ConclusionsOur results indicate that regular 3-min massage interventions of the plantar flexors could prevent the progression of a range of motion limitations in postoperative patients with an ankle fracture more effectively than regular physical therapy alone.

Occupational arm-support and back-support exoskeletons elicit changes in reactive balance after slip-like and trip-like perturbations on a treadmill

The purpose of this study was to investigate the effects of arm- and back-support exoskeletons on reactive balance after slip-like and trip-like perturbations on a treadmill. Twenty-eight participants used two arm-support exoskeletons and two back-support exoskeletons with support (i.e., assistive joint torque) activated or deactivated. In each exoskeleton condition, as well in as a control without any exoskeleton, participants were exposed to 12 treadmill perturbations during upright standing. The exoskeletons did not significantly increase the probability of a failed recovery after the perturbations compared to wearing no exoskeleton, but did elicit effects on kinematic variables that suggested balance recovery was more challenging. Moreover, reactive balance differed when wearing back-support and arm-support exoskeletons, and when wearing an activated exoskeleton compared to a deactivated exoskeleton. Together, our results suggest these exoskeletons may increase the risk of slip- and trip-induced falls. The potential mechanisms of this increased risk are discussed and include the added mass and/or motion restrictions associated with wearing these exoskeletons. Our results do not support the assistive hip/back extension moment provided by back-support exoskeletons adversely affecting fall risk.

Dynamic assessment for low back-support exoskeletons during manual handling tasks.

Exoskeletons can protect users' lumbar spine and reduce the risk of low back injury during manual lifting tasks. Although many exoskeletons have been developed, their adoptability is limited by their task- and movement-specific effects on reducing burden. Many studies have evaluated the safety and effectiveness of an exoskeleton using the peak/mean values of biomechanical variables, whereas the performance of the exoskeleton at other time points of the movement has not been investigated in detail. A functional analysis, which presents discrete time-series data as continuous functions, makes it possible to highlight the features of the movement waveform and determine the difference in each variable at each time point. This study investigated an assessment method for exoskeletons based on functional ANOVA, which made it possible to quantify the differences in the biomechanical variables throughout the movement when using an exoskeleton. Additionally, we developed a method based on the interpolation technique to estimate the assistive torque of an exoskeleton. Ten men lifted a 10-kg box under symmetric and asymmetric conditions five times each. Lumbar load was significantly reduced during all phases (flexion, lifting, and laying) under both conditions. Additionally, reductions in kinematic variables were observed, indicating the exoskeleton's impact on motion restrictions. Moreover, the overlap F-ratio curves of the lumbar load and kinematic variables imply that exoskeletons reduce the lumbar load by restricting the kinematic variables. The results suggested that at smaller trunk angles (<25°), an exoskeleton neither significantly reduces the lumbar load nor restricts trunk movement. Our findings will help increasing exoskeleton safety and designing effective products for reducing lumbar injury risks.

The effect of spinal range of motion on functional balance, quality of life, and perception of appearance in adolescent idiopathic scoliosis after posterior spinal fusion surgery.

Spinal fusion, which is widely used in the surgical treatment of adolescent idiopathic scoliosis (AIS), limits the movements of the vertebral column. In this study, it was aimed to investigate the relationship between spinal mobility in the postoperative period with functional balance, quality of life, and perception of appearance in individuals with AIS. Thirty patients with AIS who underwent posterior spinal fusion surgery 1 to 3years ago were included in the study. A universal goniometer was used to measure a spinal range of motion (ROM), functional reach test for functional balance, Scoliosis Research Society-30 (SRS-30) for quality of life, and Spinal Appearance Questionnaire (SAQ) for perception of appearance. Surgical fusion length was significantly correlated with movements in the sagittal and transverse planes (r = - 0.383-[- 0.608]; p = < 0.001-0.037). Except for spinal left rotation, there was a significant positive correlation between functional balance level and ROM results (r = 0.374-0.523; p = 0.003-0.42). The SRS-30 total score correlated significantly with all other ROM measures except for rotations (r = 0.434-0.574; p = 0.00-0.016). SAQ total data correlated significantly with all ROM measurements (r = - 0.553-[- 0.395]; p = 0.002-0.031). In AIS, limitation of movement in the coronal, sagittal, and transverse planes is observed after fusion surgery. Spinal ROM is affected by the level of fusion performed at surgery. Postoperative spinal limitation of motion adversely affected functional balance, quality of life, and perception of appearance. We believe that comprehensive rehabilitation approaches that improve postoperative range of motion and increase functionality are important for optimal postoperative recovery.

Abstract 16396: A Tale of Two Maladies: An Interplay of Mendelian Principles

A 22-year-old male with no medical history presented in acute decompensated heart failure and cardiogenic shock. Physical exam showed a thin body habitus, reduced muscle bulk, bilateral ptosis, limited extraocular motion, and upper extremity weakness. An echocardiogram revealed severe biventricular dilation and systolic dysfunction. Invasive hemodynamics revealed elevated cardiac filling pressures and low cardiac output. Coronary angiography excluded coronary artery disease and anatomical variants. He was initiated on dobutamine and eventually milrinone given persistently low index and elevated lactate. An evaluation for the etiology of his cardiomyopathy focused on nutritional deficiencies (e.g., Wet Beriberi), myocarditis, genetic mutations, infiltrative cardiomyopathy (e.g., Friedrich’s ataxia), and mitochondrial and myopathy-related cardiomyopathy. CMR had globally elevated T1 and normal T2 values ruling out acute myocarditis or infiltrative processes. Serum thiamine, TSH and B12 were within normal range. Muscle biopsy and mitochondrial genetic testing revealed a pathogenic deletion (m.7416_14556) and 70% heteroplasmy. Physical exam, biopsy and mitochondrial genetics were diagnostic of Kearns-Sayre Syndrome (KSS). Notably KSS does not typically cause severe cardiomyopathy suggesting an alternative cause. A genetic cardiomyopathy panel was sent revealing a pathologic mutation in the plakophilin 2 gene which was the suspected cause of his cardiomyopathy. A heart transplant evaluation was initiated as he developed refractory shock requiring mechanical support via an Impella 5.5, placed via the right innominate artery due to his small body and vessel size. He underwent an uncomplicated heart transplantation and is doing well. This case underscores the significance of a broad differential diagnosis, multidisciplinary collaboration, and a detailed physical examination in diagnosing and managing complex cardiac conditions.

Elastic Taping Application on the Neck: Immediate and Short-Term Impacts on Pain and Mobility of Cervical Spine.

The aim of this study was to measure the effects on three-planar active cervical range of motion (ACROM) and self-perceived pain of elastic taping (ET) application in the cervical area. Thirty participants (n: 22-M and 8-F, age 35.4 ± 4.4 years; body height 173.1 ± 8.4 cm; body mass 73.5 ± 12.8 kg) in the study group (SG) and twenty participants (n: 11-M and 9-F, age 32.6 ± 3.9 years; body height 174.9 ± 10.9 cm; body mass 71.2 ± 12.9 kg) in the control group (CG) were recruited. All subjects had neck and cervical pain in baseline condition. Each group performed an ACROM test and measured the perceived pain in the neck based on the Numerical Rating Scale (NRS 0--10, a.u.) at the baseline (T0), after 20' from the ET application (T1), and after three days of wearing the ET application (T2). Between T0 and T1, an ET was applied to the cervical area of the SG participants. Statistical analysis did not show any significant change in CG in any measurement session for ACROM and neck pain parameters. Conversely, the SG showed significant improvements for ACROM rotation to the left (T0 64.8 ± 7.7°-T2 76.0 ± 11.1° p < 0.000) and right (T0 66.0 ± 11.9°-T2 74.2 ± 9.6° p < 0.000), lateral inclination to the left (T0 37.5 ± 6.9°-T2 40.6 ± 10.8° p < 0.000) and right (T0 36.5 ± 7.9°-T2 40.9 ± 5.2° p < 0.000), extension (T0 47.0 ± 12.9°-T2 55.1 ± 12.3° p < 0.001), and flexion (T0 55.0 ± 3.6°-T2 62.9 ± 12.0° p < 0.006). A significant decrease was also measured in SG for pain NRS between T0 and T2 (T0 7.5 ± 1.0°-T1 5.5 ± 1.4-T2 1.4 ± 1.5° p < 0.000). In conclusion, a bilateral and symmetrical ET cervical application is useful to enhance multiplanar ACROM and reduce subjective self-perceived cervical pain when it is needed. Based on the evidence, the use of ET on the neck is recommended for managing neck motion restrictions and pain in adult individuals.

Radiographic cervical spine injury patterns in admitted blunt trauma patients with and without prehospital spinal motion restriction

ObjectivesSelective prehospital cervical spine motion restriction (C-SMR) following blunt trauma has increasingly been used by emergency medical service (EMS) providers. We determined rates of prehospital C-SMR and concomitant radiographic injury...

Recent progress in trajectory smoothing of mobile robots

The mobile robotics is growing rapidly and is being used in a variety of applications, greatly improving productivity. Path planning is a central part of autonomous navigation for mobile robots. However, most paths generated by these methods have sharp turns, which are unacceptable for mobile robots due to their own motion limitations or specific task scenarios. Smoother paths are therefore needed to improve the reliability and efficiency of the robot while adapting to realistic scenarios. This paper summarizes the classical curve smoothing algorithms and relate new research results presented in recent years, and divide them into six categories: polynomial interpolation, non-uniformly interpolated curves, Beizer curves, B spline curves, Reeds-Shepp curves, geometric algorithms, etc. Besides, a brief mathematical description is given along with the algorithms, and some of the algorithms are also given as examples for reference. In the future, better curve smoothing algorithms to satisfy the kinematic laws of different vehicles (robots/ships/UAVs) in multiple environments and non-simple interpolation smoothing algorithms will be proposed.

A Biomechanical Investigation of Children with Type 1 Diabetes Mellitus: Are Children's Feet a Precursor to Adulthood Foot Complications?

There is limited evidence on the biomechanical effects of type 1 diabetes mellitus (T1DM) on children's feet. This study aimed to determine whether children living with T1DM aged 10 to 16 years have altered foot structure and gait parameters compared with same-aged children without medical conditions. A nonexperimental, case-control study was conducted. Thirty-four healthy children and children living with T1DM were recruited. Participants underwent a clinical biomechanical examination followed by instrumented gait analysis using the Oxford Foot Model to investigate foot segment motion. Children with T1DM demonstrated more dermatologic lesions and structural foot abnormalities, including claw toes (33.3%), hammertoes (22.2%), and hallux abducto valgus (11.1%), than their healthy counterparts. Gait analysis results indicate a significant difference between the two groups at the hindfoot-to-tibia angle at heel strike and toe-off, suggesting limited ankle joint motion. Children with T1DM demonstrated a higher frequency of structural foot pathologies than did healthy children possibly associated with limited ankle sagittal plane movement. Screening is warranted to identify and manage these conditions early to reduce their risk of more significant foot problems associated with DM in adulthood.

Adhesions in the setting of hip arthroscopy.

With the growing number of primary arthroscopies performed, patients requiring revision hip arthroscopies for various issues is high including postoperative adhesion formation, a source of pain, mechanical symptoms, range of motion limitation, stiffness, and microinstability. Adhesions are a consequence of biological pathways that have been stimulated by injury or surgical interventions leading to an increased healing response. Preventative efforts have included surgical adjuncts during/after primary hip arthroscopy, biologic augmentation, and postoperative rehabilitation. Treatment options for adhesion formation includes surgical lysis of adhesions with or without placement of biologic membranes aimed at inhibiting adhesion reformation as well as systemic medications to further reduce the risk. Postoperative rehabilitation exercises have also been demonstrated to prevent adhesions as a result of hip arthroscopy. Ongoing clinical trials are further investigating pathways and prevention of adhesion formation.

The Effect Of Integrated Neuromuscular Inhibition Technique On Improving Neck Functional Ability In Tension-Type Headache

Tension-type headache is one of the most common complaints of musculoskeletal pain due to myofascial trigger points. The presence of pain and soreness in the neck and head, tightness, stiffness, spasms, and limitation of motion is a complaint that is often experienced by patients. Methods: This study aims to determine the effect of the Integrated Neuromuscular Inhibition Technique exercise on increasing the functional ability of the neck in Tension-Type Headache conditions. This research is a pre-experimental study with a pre-test and post-test one-group design using an accidental sampling technique with a total sample of 30 people. The place of research was conducted at the Telkomedika Makassar Clinic. A tool to measure the functional ability of the neck using the Neck Disability Index (NDI). Result: The results of the study were an increase in the functional ability of the neck based on measurements of the Neck Disability Index (NDI), namely a pre-test value of 48.80 to a post-test of 41.13 in the condition of Tension-Type Headache at the Telkomedika Clinic Makassar because after being given Integrated Neuromuscular Inhibition Technique therapy (INIT) decreased neck pain, decreased spasm of the neck muscles, and increased functional ability of the neck. Conclusion: Integrated Neuromuscular Inhibition Technique exercises can improve the functional ability of the neck in Tension-Type Headache conditions at the Telkomedika Clinic in Makassar.