Manual Modalities Research Articles

Effect of manual manipulation on mechanical gait parameters.

A variety of manual manipulation techniques are utilized in clinical practice to alleviate pain and improve musculoskeletal function. Many manual practitioners analyze gait patterns and asymmetries in their assessment of the patient, and an increasing number of gait motion capture studies are taking place with recent improvements in motion capture technology. This study is the first systematic review of whether these manual modalities have been shown to produce an objectively measurable change in gait mechanics. This study was designed to perform a systematic review of the literature to assess the impact of manual medicine modalities on biomechanical parameters of gait. A master search term composed of keywords and Medical Subject Headings (MeSH) search terms from an initial scan of relevant articles was utilized to search six databases. We screened the titles and abstracts of the resulting papers for relevance and then assessed their quality with the Cochrane Risk of Bias Tool. Clinical trials that featured both a manual manipulation intervention and multiple mechanical gait parameters were included. Case reports and other studies that only measured gait speed or other subjective measures of mobility were excluded. We included 20 studies in our final analysis. They utilize manipulation techniques primarily from osteopathic, chiropractic, massage, and physiotherapy backgrounds. The conditions studied primarily included problems with the back, knee, and ankle, as well as healthy patients and Parkinson's patients. Control groups were highly variable, if not absent. Most studies measured their gait parameters utilizing either multicamera motion capture systems or force platforms. Twelve of 20 papers included in the final analysis demonstrated a significant effect of manipulation on gait variables, many of which included either step length, walking speed, or sagittal range of motion (ROM) in joints of the lower extremity. However, the results and study design are too heterogeneous to draw robust conclusions from these studies as a whole. While there are initial indications that certain modalities may yield a change in certain gait parameters, the quality of evidence is low and there is insufficient evidence to conclude that manual therapies induce changes in biomechanical gait parameters. Studies are heterogeneous with respect to the populations studied and the interventions performed. Comparators were variable or absent across the studies, as were the outcome variables measured. More could be learned in the future with consistent methodology around blinding and sham treatment, and if the gait parameters measured were standardized and of a more robust clinical significance.

Manual versus semiautomatic segmentation of soft-tissue sarcomas on magnetic resonance imaging: evaluation of similarity and comparison of segmentation times.

ObjectiveTo evaluate the degree of similarity between manual and semiautomatic segmentation of soft-tissue sarcomas on magnetic resonance imaging (MRI).Materials and MethodsThis was a retrospective study of 15 MRI examinations of patients with histopathologically confirmed soft-tissue sarcomas acquired before therapeutic intervention. Manual and semiautomatic segmentations were performed by three radiologists, working independently, using the software 3D Slicer. The Dice similarity coefficient (DSC) and the Hausdorff distance were calculated in order to evaluate the similarity between manual and semiautomatic segmentation. To compare the two modalities in terms of the tumor volumes obtained, we also calculated descriptive statistics and intraclass correlation coefficients (ICCs).ResultsIn the comparison between manual and semiautomatic segmentation, the DSC values ranged from 0.871 to 0.973. The comparison of the volumes segmented by the two modalities resulted in ICCs between 0.9927 and 0.9990. The DSC values ranged from 0.849 to 0.979 for intraobserver variability and from 0.741 to 0.972 for interobserver variability. There was no significant difference between the semiautomatic and manual modalities in terms of the segmentation times (p > 0.05).ConclusionThere appears to be a high degree of similarity between manual and semiautomatic segmentation, with no significant difference between the two modalities in terms of the time required for segmentation.

Musculoskeletal pain in athletes: A narrative review

Musculoskeletal pain is a major concern in athletes, and its associated disability may contribute to a significant loss of productivity and substantial health-care expenditure. Musculoskeletal pain and disability represent a considerable health burden in the athletic world. Acute musculoskeletal pain generally lasts for a shorter time. The recurrences are frequent. Early intervention and the management of acute pain may reduce the chance of developing it into chronic. Clinical assessment comprising subjective and objective examination is essential to identify the clinical features of severe but rare causes of acute musculoskeletal pain. In most of the clinical conditions, it is difficult to determine the precise cause and management of musculoskeletal pains in the athletic population. Interventions such as manual therapy, electrotherapy modalities, exercises, and active lifestyle maintenance are found to be effective in the management of acute and chronic musculoskeletal pain.

Entity Metaphor, Object Gesture, and Context of Use

ABSTRACTThe study investigates the manifestation of the “IDEA-IS-AN-ENTITY” metaphor across the linguistic and manual modalities by the use of the object gesture in daily conversation, to understand the relationship between metaphorical conceptualization and the context of use. Two types of the entity metaphor were distinguished: “cross-modal entity metaphor” and “gesture-only entity metaphor.” For the former, the metaphor was expressed by metaphorical speech and the object gesture simultaneously. Among all of the 67 cross-modal instances, a wide variety of idea was represented as referring, characterizing, and quantifying referents in speech. Manually, the object gesture was configured in numerous ways. The way the object gesture was configured reveals the facet of the metaphorical conceptualization the speaker focuses on during speaking, and the details about the real-time thinking of a metaphorical object in discourse. For the gesture-only entity metaphor, it was manifested in the single modality of gesture. Among all of the 73 gesture-only instances, the object gesture depicted a stretch of talk as discrete object mainly by configuring a spatial boundary with curled fingers. Metaphor of this type attests that the thinking of phrasal-clausal ideas as entities is as common as that of lexical ideas as entities in conversation. Importantly, the object gesture bears out the emergence of a phrasal or clausal idea being conceptualized as object in natural discourse. Together, the findings demonstrate the inseparability of metaphorical conceptualization from cognition and the context of use.

Exploring Digital and Manual Modalities in Educational Activities for Children with ADHD

Exploring Digital and Manual Modalities in Educational Activities for Children with ADHD

What the hands can tell us about language emergence.

Why, in all cultures in which hearing is possible, has language become the province of speech and the oral modality? I address this question by widening the lens with which we look at language to include the manual modality. I suggest that human communication is most effective when it makes use of two types of formats--a discrete and segmented code, produced simultaneously along with an analog and mimetic code. The segmented code is supported by both the oral and the manual modalities. However, the mimetic code is more easily handled by the manual modality. We might then expect mimetic encoding to be done preferentially in the manual modality (gesture), leaving segmented encoding to the oral modality (speech). This argument rests on two assumptions: (1) The manual modality is as good at segmented encoding as the oral modality; sign languages, established and idiosyncratic, provide evidence for this assumption. (2) Mimetic encoding is important to human communication and best handled by the manual modality; co-speech gesture provides evidence for this assumption. By including the manual modality in two contexts--when it takes on the primary function of communication (sign language), and when it takes on a complementary communicative function (gesture)--in our analysis of language, we gain new perspectives on the origins and continuing development of language.

Chest Physiotherapy in the Pediatric Intensive Care Unit

Despite widespread practice, there is very little, high-level evidence supporting the indications for and effectiveness of cardiopulmonary/chest physiotherapy (CPT) in critically ill infants and children. Conversely, most studies highlight the detrimental effects or lack of effect of different manual modalities. Conventional CPT should not be a routine intervention in the pediatric intensive care unit, but can be considered when obstructive secretions are present which impact on lung mechanics and/or gaseous exchange and/or where there is the potential for long-term complications. Techniques such as positioning, early mobilization, and rehabilitation have been shown to be beneficial in adult intensive care patients; however, little attention has been paid to this important area of practice in pediatric intensive care units. This article presents a narrative review of chest physiotherapy in pediatric critical illness, including effects, indications, precautions, and specific treatment modalities and techniques.

The Effect of Preference Expression Modality on Self-Control

The marketplace affords consumers various modalities to express their preferences (e.g., by pressing a button on a vending machine or making an oral request at a restaurant). In this paper, we compare speaking to manual preference expression modalities (button pressing, writing, and taking) and study their effect on self-control dilemmas. Based on studies of the Stroop task and on neuroscientific evidence, we predict that speaking is less likely than motor movement to evoke self-control. Our prediction relies on the observation that different expression modalities activate different regions of the anterior cingulate cortex (ACC), and, hence, may influence the extent to which emotions rather than cognitions determine an individual’s decision. In six studies conducted both in the lab and the field, we show that speaking prompts more indulgent choice than manual modalities (studies 1a,b-4), but not when individuals speak in a foreign language (study 5).

T2 radiculopathy: A differential screen for upper extremity radicular pain

Radicular pain in the upper extremity can have a cervical origin terminating at the cervicothoracic junction (C8, T1). Review of the literature suggests cutaneous representations of T2 nerve root to the axilla, posteromedial arm, and lateral forearm, suggesting yet another source of upper extremity radicular pain. A 53-year-old female experienced insidious right upper thoracic pain radiating into the right axilla, upper arm, and lateral forearm (10/10 numerical pain rating scale (NPRS)) of 1-week duration. Medical referral suggested cervical radiculopathy, however, cervical spine examination was unremarkable. She presented with mechanical dysfunction of C8, T1; T1, T2; and T2, T3 vertebral segments with restricted cervical extension. Firm compression over the right lateral aspect of the second and third thoracic vertebrae reproduced her symptoms markedly. There was a predominance of right axillary pain. Cervical extension reproduced local upper thoracic pain. Nine treatment visits for a period of 3 weeks addressed mechanical dysfunction at the cervicothoracic junction and upper thoracic region, comprising manual therapy, corrective exercise, and pain modalities. Reduction of local tenderness, and radiating axillary and right arm pain was observed (2/10 NPRS), with improved cervical extension. The second thoracic intercostal nerve and the adjoining intercostobrachial nerve, medial antebrachial cutaneous nerve, and the posterior brachial cutaneous branch of the radial nerve are speculated to be potential symptom mediators. They have a representation to the axilla, medial and posterior arm, and lateral forearm – a representation supporting the speculation of upper extremity radicular symptoms following mechanical dysfunction of the upper thoracic vertebrae.

Complementary and Integrative Oncology in the Cross-Cultural Region of the Middle East and South Asia

Complementary and Integrative Oncology in the Cross-Cultural Region of the Middle East and South Asia

Is a postural-structural-biomechanical model, within manual therapies, viable?: A JBMT debate

In recent years, a number of leading thinkers within manual and physical therapies have questioned traditional models of care. Professor Eyal Lederman DO PhD is one such critic, of what he has termed the postural-structural-biomechanical (PSB) model. Using low back pain as a focus he has asserted that the PSB model is not viable e in fact that there is no reliably proven relationship between low back pain and posture, structure or biomechanical features. e and by implication, that attempts to treat and normalize such features, are meaningless, and a waste of time and resources. Lederman asserts: “We can no longer justify the use of manual techniques to readjust, correct or balanceout the misaligned structure.” The suggestion is that rehabilitation strategies, motor re-education approaches, behaviorally focused methodologies e are the best means of achieving resolution and prevention of dysfunctional states such as low back pain, and that manual modalities have at most short-term effects, and are largely redundant (Lederman, 2010)

Extra! Extra! Semantics in comics!: The conceptual structure of Chicago Tribune advertisements

Recently, increasing attention is turning to comics as a graphic domain using similar cognitive processes to linguistic forms. As in the verbal and manual modalities of expression, various semantic structures arise across sequences of images in interesting and effective ways. This piece examines metonymy, conceptual metaphors, and blending across a three-panel pattern used in strips from an advertising campaign by the Chicago Tribune newspaper.

Triangular interval syndrome: A differential diagnosis for upper extremity radicular pain

ABSTRACTThis case report describes a 57-year-old female who experienced symptoms of scapular pain with pain radiating into the right upper extremity. Initial medical referral suggested, nerve entrapment of a cervical origin. However, the patient did not fit the clinical prediction rule for cervical radiculopathy. Radial nerve bias was positive without cervical provocation, with symptom reproduction at the lateral scapular area. Treatment addressed mechanical dysfunction at the triangular interval formed by the teres major and triceps, comprising manual therapy, neural mobilization, corrective exercise and pain modalities. Reduction in symptoms was observed with a decrease in right scapular and arm pain and improved radial nerve mobility. The triangular interval is described as a predominant contributor to the symptomatology secondary to entrapment and adverse neural tension of the radial nerve. The anatomical and physiological basis is enumerated.

Modulating the masked congruence priming effect with the hands and the mouth.

The authors report a series of experiments in which they use the masked congruence priming paradigm to investigate the processing of masked primes in the manual and verbal response modalities. In the manual response modality, they found that masked incongruent primes produced interference relative to both congruent and neutral primes. This finding, which replicates the standard finding in the masked congruence priming literature, is presumed to reflect the conflict that arises between two incompatible responses and, thus, to index the extent of processing of the masked prime. Somewhat surprisingly, when participants were asked to respond verbally in the same task, masked incongruent primes no longer produced interference, but masked congruent primes produced facilitation. These findings are surprising because they suggest that the processing of nonconsciously perceived primes extends to the response level in the manual, but not verbal, response modality. The authors propose that the modulation of the masked congruence priming effect by response modality is due to verbal, but not manual, responses being mediated by the lexical-phonological production system.

Use of Mobilization with Movement in the Treatment of a Patient with Subacromial Impingement: A Case Report

Mobilization with movement (MWM) is a fairly new therapeutic technique commonly used by physical therapists. The purpose of this case report was to describe the use of MWM in the treatment of a 27-year old left-hand dominant male patient referred to physical therapy with a diagnosis of supraspinatus tendinopathy secondary to impingement. Interventions consisted of MWM and other manual therapy techniques, modalities, and therapeutic exercises. Outcome measures used included goniometric active range of motion (AROM) measurements and manual muscle tests of the shoulder, impingement tests, and the Shoulder Pain and Disability Index (SPADI) and Short Form-36 (SF-36) questionnaires. Specific outcome measures used to describe the response to MWM of the glenohumeral joint included the Numeric Pain Rating Scale (NPRS) and goniometric measurement of abduction AROM. After the first MWM treatment (session 2/12), the 6/10 pre-application NPRS score during shoulder abduction was reduced to 3/10 post-application; however, abduction AROM did not improve (95°). At the final MWM treatment (session 6/12), the pre-application NPRS score during abduction was reduced from 3/10 to 0/10 post-application; abduction AROM increased from 130° to 175°. After 12 sessions, there was a decrease from moderate pain (7/10) to little or no pain (0-1/10) during active shoulder abduction; restricted (95°) to full shoulder abduction active range of motion (180°); and an improvement in the SPADI score from 45% to 8% with no pain or ADL activity difficulty scores >2. This case report indicates that MWM may be an effective treatment intervention for patients with subacromial impingement. Future research is needed to study the efficacy and mechanisms of this treatment technique.

Cervicogenic headache: practical approaches to therapy.

Cervicogenic headache is a relatively common and still controversial form of headache arising from structures in the neck. The estimated prevalence of the disorder varies considerably, ranging from 0.7% to 13.8%. Cervicogenic headache is a 'side-locked' or unilateral fixed headache characterised by a non-throbbing pain that starts in the neck and spreads to the ipsilateral oculo-fronto-temporal area. In patients with this disorder, attacks or chronic fluctuating periods of neck/head pain may be provoked/worsened by sustained neck movements or stimulation of ipsilateral tender points. The pathophysiology of cervicogenic headache probably depends on the effects of various local pain-producing or eliciting factors, such as intervertebral dysfunction, cytokines and nitric oxide. Frequent coexistence of a history of head traumas suggests these also play an important role. A reliable diagnosis of cervicogenic headache can be made based on the criteria established in 1998 by the Cervicogenic Headache International Study Group. Positive response after an appropriate nerve block is an essential diagnostic feature of the disorder. Differential diagnoses of cervicogenic headache include hemicrania continua, chronic paroxysmal hemicrania, occipital neuralgia, migraine and tension headache. Various therapies have been used in the management of cervicogenic headache. These range from lowly invasive, drug-based therapies to highly invasive, surgical-based therapies. This review evaluates use of drug therapy with paracetamol and NSAIDs, infliximab and botulinum toxin type A; manual modalities and transcutaneous electrical nerve stimulation therapy; local injection of anaesthetic or corticosteroids; and invasive surgical therapies for the treatment of cervicogenic headache. A curative therapy for cervicogenic headache will not be developed until increased knowledge of the aetiology and pathophysiology of the condition becomes available. In the meantime, limited evidence suggests that therapy with repeated injections of botulinum toxin type A may be the most safe and efficacious approach. The surgical approach, which includes decompression and radiofrequency lesions of the involved nerve structures, may also provide physicians with further options for refractory cervicogenic headache patients. Unfortunately, the paucity of experimental models for cervicogenic headache and the relative lack of biomolecular markers for the condition mean much is still unclear about cervicogenic headache and the disorder remains inadequately treated.

The role of response in spatial attention: direct versus indirect stimulus–response mappings

Recent research has suggested that inhibition of return (IOR) develops more quickly when subjects must respond with an eye movement than when they make a manual response to the target (Perception and Psychophysics 62 (2000) 1512–1524). Four spatial cueing experiments were conducted where subjects had to indicate the location of visual targets. Within each of the oculomotor and manual modalities, responses could be either directed towards the target (saccade or pointing) or had a more complex stimulus–response (S–R) mapping. For both saccadic and manual responses, IOR onset was delayed as the required S–R mapping became more indirect. This finding further emphasizes the role of response-related processes in spatial attention. Possible explanations for this pattern of results are considered, including the notion that activity in prefrontal cortex, needed for execution of such abstract S–R mappings, may influence the time course of reflexive spatial cueing effects.

Pitch and Timing Abilities in Inherited Speech and Language Impairment

Members of the KE family who suffer from an inherited developmental speech-and-language disorder and normal, age-matched, controls were tested on musical abilities, including perception and production of pitch and rhythm. Affected family members were not deficient in either the perception or production of pitch, whether this involved either single notes or familiar melodies. However, they were deficient in both the perception and production of rhythm in both vocal and manual modalities. It is concluded that intonation abilities are not impaired in the affected family members, whereas their timing abilities are impaired. Neither their linguistic nor oral praxic deficits can be at the root of their impairment in timing; rather, the reverse may be true.

Myofacial trigger point

Myofascial trigger points are one of the most common causes of acute and chronic musculoskeletal pain. Contrary to popular belief, myofascial trigger points can be primary, and not just secondary due to other non-muscular pathology. The main criteria, for which the interrater reliability has been established, include the presence of a taut band, a local twitch response, an exquisite tender point within the taut band, and typical referred pain patterns. During the past few years, the actual existence and high prevalence of myofascial trigger points are supported by worldwide research findings. The “energy crisis theory” describes the peripheral pathophysiologic events of myofascial trigger points. In most cases myofascial trigger points can be treated successfully both in acute and chronic pain syndromes. Several treatment options are available including manual therapy, injections, dry needling, and electrotherapeutic modalities. In some cases neuroplastic changes in the spinal dorsal horn and sympathetic-afferent coupling play a role in the development of chronic pain syndromes and complicate the treatment.