Muscle Re-education Research Articles

Management of Cervicogenic Headache - A Case Study

Purpose: To describe the use of manual therapy and muscle reeducation for an individual with cervicogenic headache. Background: This patient was a 30-year-old woman with complaint of headache. She was functionally limited with posture. She also demonstrated impairments in cervical mobility and muscular performance. Methods and measures: This patient was treated 8 sessions over a 8 week period. Study design: Case study Intervention: Intervention included manual upper cervical spine mobilization techniques, muscle re-education for deep neck flexors muscles and scapular stabilization exercises. Results: Following treatment, the patient demonstrated in an increase in cervical mobility, improved muscular performance, a decrease in headaches, and resolution of functional limitations. Statistical analysis of the data showed significant differences from pre to post intervention from Day 1 to Day 8. There was clinical and statistical significance found in ROM and functional ability. Conclusion: Findings suggest that the mulligans manual therapy with exercises is more effective in reducing headache, improving range of motion of cervical spine and functional ability in patients with Cervicogenic Headache. Keywords: Cervicogenic headache (CGH), mulligans mobilization, snags, manual therapy, sub occipital muscle release.

Pubic osteitis following pubic adenomectomy: Case report

Osteitis pubis is a condition that mainly affects young people. It rarely occurs after urological surgery. It is a diagnostic and therapeutic emergency. Diagnosis is based on clinical findings, which vary widely from simple pelvic tenderness to pain that limits walking. Imaging and additional bone biopsy must be performed to confirm the diagnosis. Treatment is based on long-term antibiotic therapy, appropriate analgesics and muscle re-education with radiological drainage if necessary. In this article, we report a case of osteitis pubis after suprapubic adenomectomy.

Investigation of Real-Time Diagnostic Ultrasound as a Means of Biofeedback Training in Transversus Abdominus Re-Education of Patients with Non-Specific Low Back Pain: A Prospective Randomized Controlled Pilot Study.

Background: It is believed that ultrasound-guided imaging of activation/contraction of the deep abdominal muscles (such as transervsus abdominis) is useful for assisting deep muscle re-education, which is often dysfunctional in non-specific low back pain (NSLBP). Thus, this pilot study aimed to evaluate the use of real-time ultrasound (US) as a feedback device for transverse abdominis (TrA) activation/contraction during an exercise program in chronic NSLBP patients. Methods: Twenty-three chronic NSLBP patients were recruited and randomly assigned to a US-guided (n = 12, 8 women, 47.6 ± 2.55 years) or control group (n = 11, 9 women, 46.9 ± 4.29 years). The same motor control-based exercise program was applied to both groups. All patients received physiotherapy twice per week for seven weeks. Outcome measures, tested at baseline and post-intervention, included Numeric Pain Rating Scale, TrA activation level (measured through a pressure biofeedback unit-based developed protocol), seven established motor control tests, Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale. Results: For each group, all outcome variables yielded statistical differences post-intervention (p < 0.05), indicating significant improvements. However, there were no significant group x time interactions for any of the outcomes (p > 0.05), thus, indicating no superiority of the US-guided group over the control. Conclusions: The addition of US as a visual feedback device for TrA re-education during a motor control exercise program was not proven superior to traditional physiotherapy.

A Single Session of Spinal Decompression with Oscillation and Videofluoroscopy

Background: Computerized spinal decompression using the intervertebral differential dynamics (IDD) therapy protocol has achieved 86–92% positive results in reducing back pain. There are many causes of back pain, and one of the most common is a degenerative disc. The etiology of a degenerative disc is not completely understood, but it can be related to acute injuries, repetitive stress, nutrition, genetic factors, and oxidative stress1. Standard of care may include physical therapy or manipulation to introduce movement to the spinal vertebrae. IDD Therapy® uses a calculated, sinusoidal, logarithmic primary waveform to separate the spinal vertebrae. More recent studies have shown that the addition of a secondary waveform gives a significant increase in efficacy. We observed these effects on the spine during an IDD Therapy® session. Methods: Images of the intervertebral space were taken by videofluoroscopy during the IDD Therapy® session. Results: The expected separation of L5-S1 was achieved. We also noted the separation profile of the vertebrae was uniquely uniform despite the graduated pressures, particularly when the secondary oscillation waveform was introduced. L5-S1 separation was 1 mm in size, and the anterior–posterior correlation was significant (p&lt;0.05). Conclusion: Active oscillatory signaling introduced during the high-tension period of treatment may lead to more compliant muscle re-education and thus enhanced uniform separation of the vertebrae. We believe that IDD Therapy® using Accu-Spina® may achieve 92% positive results because the secondary oscillatory signal induces mechanotransduction of mechanical stimuli into electrochemical activity at the cellular level. Further research will lead to greater confidence and further exploration of mechanotransduction in intradiscal cellular tissues.

LESÃO MUSCULAR E GERENCIAMENTO DA REABILITAÇÃO ESPORTIVA NO TREINAMENTO DE RESISTÊNCIA DIRECIONADO AOS ESPORTES DE INVERNO

ABSTRACT Introduction: Muscle injury in ski sports training has gradually increased, greatly impairing performance in ice and snow sports competitions. Objective: To study muscle injury and muscle movement during ice and snow sports training and the rehabilitation of muscle injuries. Methods: Thirty skiers with knee muscle injuries were selected as subjects and underwent rehabilitation training for six weeks, and the indicators were statistically evaluated. Results: The ski injuries were mainly muscle strain, muscle or ligament strain, and ligament rupture. The indices after treatment were significantly different from those before treatment (P &lt; 0.05); compared with the three rehabilitation programs, the improvement of each index in group C was significantly different from that in the other two groups (P &lt; 0.05), while there was no significant difference in the improvement of each index between the multi-angle isometric training treatment in group A and the proprioceptive neuromuscular stimulation technique in group B (P&gt;0.05). Conclusion: The influence of recovery training technology on knee muscle re-education was proposed, and a rehabilitation plan for skiing was presented. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Supervised Learning with Muscle Re-education of Hemiparesis patients: A review

Background:The focus of this article is on muscle re-education approaches using supervised learning programs. This also includes a discussion of whether or not this strategy is beneficial and convenient to utilize. Thereof adeficiency of resources and population-scale demands, following in-home rehabilitation, continues to be a question. Stroke is themain cause of hemiparesis, the creation ofindividualized classification methods, involving neural network-based algorithms, to identify rehabilitation activities completed by stroke patients. Wearable sensors based on accelerometry can be worn on both the upper and lower limbs, during therapy to capture movement data. Numerous techniques of supervised learning have been discovered useful in the processing of multimedia content and in machine learning lot of research, activity accounts for supervised learning.To help patients learn and grasp the training, a virtual reality game-based program can be created.

Comprehensive management of posterior shoulder instability: diagnosis, indications, and technique for arthroscopic bone block augmentation.

Recurrent posterior glenohumeral instability is an entity that demands a high clinical suspicion and a detailed study for a correct approach and treatment. Its classification must consider its biomechanics, whether it is due to functional muscular imbalance or to structural changes, volition, and intentionality.Due to its varied clinical presentations and different structural alterations, ranging from capsule-labral lesions and bone defects to glenoid dysplasia and retroversion, the different treatment alternatives available have historically had a high incidence of failure.A detailed radiographic assessment, with both CT and MRI, with a precise assessment of glenoid and humeral bone defects and of glenoid morphology, is mandatory.Physiotherapy focused on periscapular muscle reeducation and external rotator strengthening is always the first line of treatment. When conservative treatment fails, surgical treatment must be guided by the structural lesions present, ranging from soft tissue repair to posterior bone block techniques to restore or increase the articular surface.Bone block procedures are indicated in cases of recurrent posterior instability after the failure of conservative treatment or soft tissue techniques, as well as symptomatic demonstrable nonintentional instability, presence of a posterior glenoid defect >10%, increased glenoid retroversion between 10 and 25°, and posterior rim dysplasia. Bone block fixation techniques that avoid screws and metal allow for satisfactory initial clinical results in a safe and reproducible way.An algorithm for the approach and treatment of recurrent posterior glenohumeral instability is presented, as well as the author’s preferred surgical technique for arthroscopic posterior bone block.

Biofeedback Posture Training for Adolescents with Mild Scoliosis.

Adolescent idiopathic scoliosis (AIS) is characterized by uneven shoulders, spinal curvature, and uneven hips, and asymmetry in paraspinal muscle activities is common in AIS. This pilot study was aimed at examining the use of a surface electromyography (sEMG) biofeedback posture training program in adolescents with mild scoliosis (Cobb′s angle < 30°) to attenuate asymmetry in paraspinal muscle activities and control the curve progression. Seven female adolescents (age, 12–14 years) with mild scoliosis (Cobb′s angle < 30°) were recruited. The participants received 30 tailor-made sessions of sEMG biofeedback posture training at a rate of one to two sessions per week for approximately 6 months. The activities of the paraspinal muscles (the trapezius, latissimus dorsi, thoracic erector spinae, and lumbar erector spinae) measured by sEMG during habitual sitting postures and spinal deformity evaluated by 3D ultrasound imaging were compared before and after training. The mean values of the root-mean-square sEMG ratio, an index of symmetry in paraspinal muscle activities of the muscle pairs between the concave and convex sides of the spinal curve, revealed significant asymmetry over the trapezius and lumbar erector spinae before the training (p <0.05). After the training, all seven adolescents achieved relatively more symmetrical paraspinal muscle activities over these two muscle pairs (p < 0.05). In two adolescents, the spinal curvature decreased by 5.7° and 5.6°, respectively, whereas the remaining adolescents showed a minimal curve progression with changes in the spinal curvature controlled under 5°. To conclude, sEMG biofeedback posture training can reduce asymmetry in paraspinal muscle activities and control curve progression in adolescents with mild scoliosis and can potentially be considered an alternative early intervention for muscle reeducation in this cohort.

Effect of intramuscular electrical stimulation of articularis genu muscle with mirror therapy on anterior knee pain in a patient with knee osteoarthritis

Knee osteoarthritis (OA) is a degenerative condition that can develop in people who have quadriceps muscle weakness. Knee OA is more likely to develop in people who have weak quadriceps muscles, which extend the knee. Dysfunction of articularis genu muscle (AGM) is thought to be a cause of anterior knee pain in patients having OA of the knee joint. Herein, we report a case of anterior knee pain caused due to the dysfunction of AGM in a 41-year male who was initially treated with physical therapy, and it failed to ease the patient's problems completely. Intramuscular electrical stimulation (IMES) along with mirror therapy relieved his symptoms with no recurrence till 2 months of follow-up. IMES of the AGM combined with mirror therapy can be a viable therapeutic option for muscle reeducation and anterior knee pain.

Gait changes following robot-assisted gait training in children with cerebral palsy.

This study investigated changes of gait pattern induced by a 4-week robot-assisted gait training (RAGT) in twelve ambulatory spastic diparesis children with cerebral palsy (CP) aged 10.4+/-3.2 years old by using computerized gait analysis (CGA). Pre-post intervention CGA data of children with CP was contrasted to the normative data of typically developing children by using cross-correlation and statistically evaluated by a Wilcoxon test. Significant pre-post intervention changes (p<0.01) include: decreased muscle activity of biceps femoris, rectus femoris, and tibialis anterior; a decrease in range of internal hip joint rotation, higher cadence, step length, and increased stride time. This study suggests that RAGT can be used in muscle reeducation and improved hip joint motion range in ambulatory children with CP.

Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries.

Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the 'push-off' test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen's D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups.

How the myobrace appliance works: Advantages and disadvantages

Myofunctional Dentistry is a treatment that acts in the re-education of facial and masticatory muscles, correcting bad myofunctional habits such as mouth breathing, atypical swallowing and incorrect tongue positioning,

Neck Injury-Motor Vehicle Accident

HISTORY: A 57-year-old male was involved in a motorcycle accident, landing on his right side. Injuries included a flaccid right arm and hand, laceration of his right thigh, and a fracture of the 3rd metatarsal of his right foot. Patient’s chief complaint was pain in right shoulder and neck and an inability to complete ADLs. PHYSICAL EXAMINATION: Patient demonstrated flaccid right upper extremity with very little finger movement. Patient was able to achieve some finger flexion of all 5 digits and thumb opposition to index finger, although could not achieve pad to pad contact. All PROM of joints was preserved. Sensation was grossly intact. Patient tolerated initial examination well with mild discomfort during objective measures. No red flags arose during medical screening/systems review. DIFFERENTIAL DIAGNOSIS: 1. Cerebrovascular accident 2. Brachial plexus stretch injury 3. Brachial plexus avulsion injury TESTS AND RESULTS: MRI of cervical spine without contrast – small disc herniation, MRI of brachial plexus with and without contrast - edema involving right scalene and adjacent fascial planes extending into brachial plexus as well as into right C6/C7 and C7/T1 neural foramen to confirm nerve root sleeve tears, CTA of neck – negative for artery involvement, EMG study showed that the brachial plexus was not avulsed, but not currently sending EMG signals to hand. FINAL/WORKING DIAGNOSIS: Brachial plexus stretch injury TREATMENT AND OUTCOMES: 1. Therapeutic exercises (ROM, strength, endurance, stability), 2. Therapeutic activity (work specific, ADL specific), 3. Neuromuscular rehabilitation (muscle re-education, sequencing, coordination, neurodynamics), 4. Patient education (home exercise program, home safety). Patient has been responding well to a treatment plan combining aspects of the above mentioned interventions. Has been showing greater activation of right hand and forearm muscles with ability to complete weak grip at this stage. Right upper extremity remains supported in sling.

Efficacy of electrotherapy in Bell's palsy treatment: A systematic review.

Up to now there is not enough evidence that supports the use of electrotherapy in the treatment of Bell's palsy. Through a systematic review, we aimed to verify whether the use of electrotherapy is effective for treating Bell's palsy or peripheral paralysis. Publications were searched in PubMed, EBSCO and Web of Science. The present systematic review included studies that analyzed the electrotherapy as a therapeutic method for treating individuals with Bell's palsy, in order to recover the function of facial muscles. Seven studies involving a total of 131 cases and 113 controls were included in this systematic review. In the studies analyzed, patients received electrotherapy combined with other treatments such as hot-wet facial napkins, massages and muscle reeducation. Although the effect of electrotherapy alone was not evaluated, the use of electrotherapy combined with other treatments produced a significant improvement in the individuals evaluated. Due to the diverse methodologies used and the small number of individuals included in the studies, we could not fully prove the efficacy of electrotherapy for treating Bell's Palsy. Future studies with larger samples and homogenous populations should be performed to obtain conclusive results.

The Outcome of Biofeedback Muscle Re-Education after Brachial Plexus Reconstruction: a Case Series

The purpose of this report was to evaluate the outcome of biofeedback muscle re-education after brachial plexus reconstruction. A case series was conducted based on registry data of Rehabilitation Outpatient Clinic. A total of 20 subjects underwent surgical reconstruction to restore elbow flexion in the period of 2012-2014 were included in the study. All 20 subjects received biofeedback muscle re-education until end June 2015 (data extraction). Oucome measures were time to recovery (months) after surgical reconstruction and patients’ compliance. Recovery is considered when muscle contraction of biceps (nerve transfer) and gracilis (free functional muscle transfer/ FFMT) are ≥ 100μV, recorded using EMG-surface electrode. Of 4 subjects underwent nerve transfer, all showed recovery with median time of 9 months. Of 16 subjects underwent FFMT, 5 showed recovery with median time of 9 months. The majority of subjects in both groups could comply with once in 2 weeks rehabilitation program.

The Outcome of Biofeedback Muscle Re-Education after Brachial Plexus Reconstruction: a Case Series

The purpose of this report was to evaluate the outcome of biofeedback muscle re-education after brachial plexus reconstruction. A case series was conducted based on registry data of Rehabilitation Outpatient Clinic. A total of 20 subjects underwent surgical reconstruction to restore elbow flexion in the period of 2012-2014 were included in the study. All 20 subjects received biofeedback muscle re-education until end June 2015 (data extraction). Oucome measures were time to recovery (months) after surgical reconstruction and patients’ compliance. Recovery is considered when muscle contraction of biceps (nerve transfer) and gracilis (free functional muscle transfer/ FFMT) are ≥ 100μV, recorded using EMG-surface electrode. Of 4 subjects underwent nerve transfer, all showed recovery with median time of 9 months. Of 16 subjects underwent FFMT, 5 showed recovery with median time of 9 months. The majority of subjects in both groups could comply with once in 2 weeks rehabilitation program.

Safety And Preliminary Efficacy of Magnetic Stimulation of Pelvic Floor with Hifem Technology in Urinary Incontinence

Introduction: BTL EMSELLA™ utilizes High-Intensity Focused Electromagnetic technology (HIFEM) to cause deep pelvic floor muscles stimulation and restoration of the neuromuscular control. Key effectiveness is based on focused electromagnetic energy, in-depth penetration and stimulation of the entire pelvic floor area. A single BTL EMSELLA™ session brings thousands of supramaximal pelvic floor muscle contractions, which are extremely important in muscle reeducation of incontinent patients. Objective: Prospective study to evaluate the safety and preliminary effectiveness of the use of BTL EMSELLA magnetic stimulation in urinary incontinence. Method: Thirty-two patients with light and moderate urinary incontinence were recruited to perform 6 sessions of BTL EMSELLA during three weeks of initial treatment. Follow-up after three months. The patients received sessions lasting 28 minutes, completing the different treatment protocols. Initially the patients underwent a quality of life test before and after treatment, evaluation with advanced ultrasound using elastography to measure the initial tissue's elasticity and be able to compare after treatment, clinical functional evaluation and urodynamic test. Results: No adverse reactions were observed. All the patients finished the treatment sessions. Two patients reported increased pain after treatment in the first session corresponding to a VAS scale greater than 5 with duration greater than three hours. The treatment was highly satisfactory in 84,4% of the patients. After the first three months the improvement was maintained in 77% of the patients. No muscle injuries were observed. Elastographic changes and improvement of muscle tone were detected by advanced ultrasound (elastography) in 100% of patients. Conclusions: BTL EMSELLA is safe, well tolerated and effective for the treatment of mild and moderate urinary incontinence. The observed elastographic changes demonstrate the improvement of pelvic floor muscle tone after treatment. A reduction in the symptoms of urinary incontinence was demonstrated. Recommendations: Continue increasing the number of cases for research and increase the variables that we have decided to incorporate in the next research section such as MRI and pressure calculation.

The Use of Dynamic Assist Orthosis for Muscle Reeducation following Brachial Plexus Injury and Reconstruction.

Therapeutic management of brachial plexus injuries remains complex. The impact of brachial plexus injuries on everyday human functioning should not be underestimated. Early active-assisted range of motion following such injuries may prevent myostatic contractures, minimize muscle atrophy, facilitate muscle fiber recruitment, and enable a faster return to baseline strength levels. The dynamic assist elbow flexion orthosis proposed is designed to provide patients with a graded system for muscle reeducation and function. No clinical data are currently available on the use of this orthosis design; however, this article presents a treatment option based on sound clinical reasoning to facilitate rehabilitation following this devastating injury.

Low back pain in the overhead athletes: Evaluation and treatment based on movement system

Abstract Introduction Low back pain (LBP) is a common problem in sports. There is high risk for back pain occurrence in athletes. The knowledge about LBP in overhead athletes is limited. The Movement System (MS) approach is based on association of symptoms and incorrect movements of the spine. The main goal is to identify the localization and direction of improper movements and to restore appropriate motor control of the movement pattern. Aim To present functional evaluation and therapeutic approach based on the MS in the case of LBP in overhead athlete. Case study The study presents a 26-year-old overhead athlete with chronic mechanical LBP, which is related to his sports activity. He reported exacerbation incidents, which had eliminated him from physical activity. Results and discussion Physical examination of the patient had shown deficit of lumbar motor control in directions of extension and rotation of pelvis coupled with functional alterations in muscles. These movements were associated with pain symptoms. The patient had undergone a 4-month-lenght-therapy program, which was focused on spine motor control training and functional reeducation of muscles. A subsequent examination showed an improvement in motor control of the movement and considerable decrease of pain symptoms. Conclusions (1) The MS approach allows to identify the incorrect movement and to relate it with pain symptoms. (2) Reeducation of motor control based on movement system evaluation allows decreasing pain symptoms.

Radiographic Analysis of Simulated First Dorsal Interosseous and Opponens Pollicis Loading Upon Thumb CMC Joint Subluxation: A Cadaver Study

Therapy programs to treat thumb carpometacarpal (CMC) arthritis may engage selective activation and reeducation of thenar muscles, particularly the first dorsal interosseous (FDI) and opponens pollicis (OP) to reduce subluxation of the joint. We describe the effect of simulated selective activation of the FDI and OP muscles upon radiographic subluxation of the thumb CMC joint. In a cadaver model of CMC subluxation, loads were applied to the FDI, the OP, and then concomitantly at 0%, 25%, 50%, 75%, and 100% maximal loads and radial subluxation of the joint and reduction in subluxation was measured. Selective activation of the OP, alone, improved the subluxation ratio (SR) in a dose-dependent manner. Selective activation of FDI, alone, demonstrated minimal effects on SR. Concomitant activation of OP and FDI improved the SR across all loading states, and activation of 75% and greater, when compared with FDI activation alone, resulted in a statistically significant improvement in SR to within 10% of the presubluxed joint. Concomitant activation of the FDI and OP acts to reduce subluxation of the thumb CMC joint in a dose-dependent fashion. The OP is likely the predominant reducing force. Hand therapy programs that focus on selective strengthening programs likely function in part to encourage patients to activate the easily palpable and easily understood FDI. Concomitant coactivation of the OP may be the major reducing force to elicit clinical and radiographic reduction of subluxation, improved thumb positioning, and reduction of pain and arthritic symptoms.