Neck Flexor Research Articles

Effects of breathing reeducation on cervical and pulmonary outcomes in patients with non specific chronic neck pain: A double blind randomized controlled trial.

ObjectiveThe purpose of this randomized controlled trial was to study effects of breathing reeducation in the treatment of patients with non specific chronic neck pain.MethodsA total of sixty eight eligible patients with chronic neck pain were randomly allocated to breathing reeducation (BR) group (n = 34) and routine physical therapy (RPT) group (n = 34). Clinical outcomes were neck pain measured through visual analogue score, cervical active range of motion through CROM device, strength of neck muscles through hand held dynamometer and endurance of neck muscles measured through craniocervical flexion test. The neck disability was measured through neck disability index (NDI) and pulmonary outcomes such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio were measured through Spirolab 4. The outcomes were assessed at baseline and at 4 and at 8 weeks from baseline.ResultsThere were significant improvements in the BR group compared with the RPT group (P = 0.002) for cervical flexion, extension (P = 0.029), endurance (P = 0.042), strength of neck flexors (P <0.001), neck extensors (P = 0.034). Likewise there was a significant change in NDI (P = 0.011), FEV1 (P = 0.045), FVC (P <0.001), and FEV1/FVC ratio (P <0.001) in the BR group compared with the RPT group. The cervical side flexion and rotation showed no significant difference in breathing reeducation group with p > 0.05.ConclusionBreathing reeducation combined with routine physical therapy is an effective treatment in patients with non specific chronic neck pain.Trial registrationIRCT 20200226046623N1, https://www.irct.ir/trial/46240.

Prevalence, clinical manifestations, laboratory findings, treatment, and outcome of intermediate syndrome in anticholinesterase pesticide intoxication of dogs: A retrospective study

Organophosphates and carbamates are important anticholinesterase intoxicants of humans and dogs. Intermediate syndrome (IMS) typically occurs 7–96 h following a toxicity-associated acute cholinergic crisis (ACC), and manifests clinically as weakness of the proximal limb, respiratory, and neck flexor muscles. The aim of this study was to describe the prevalence, clinical findings, and outcome of IMS in dogs. The medical records of a veterinary teaching hospital were searched for dogs diagnosed with ACC, IMS, or both, between 2017 and 2021. Case files were retrospectively reviewed. Six historical IMS cases were additionally reviewed. Thirty-two dogs were diagnosed with anticholinesterase intoxication during the search period, of which 23 (72 %) were only diagnosed with ACC, seven (22 %) progressed from ACC to IMS, and two (6 %) were only diagnosed with IMS. Duration of hospitalisation was longer in the IMS group compared to the ACC only group (P = 0.005). When all dogs with IMS (n = 15, including the six historical cases) were considered, survival was 100 %, including four (27 %) that required positive pressure mechanical ventilation following respiratory failure. Serum butyrylcholine esterase activity, a marker of cholinesterase activity, was below reference interval when first measured in 14 (93 %) of dogs; however, was not a useful as a recovery marker. IMS should be suspected in dogs demonstrating respiratory, neck, and proximal limb muscle paresis or paralysis, especially following clinical signs consistent with ACC. Absence of clinical signs consistent with ACC or butyrylcholine esterase activity within the reference interval does not exclude IMS as a differential.

Deep Cervical Muscles and Functionality in Patients with Chronic Tension-Type Headache: An Observational Study.

Background and objectives: Chronic tension-type headache (TTH) is the type of headache with the highest prevalence. The involvement of musculoskeletal structures in TTH is supported by evidence in the scientific literature. Among these, deep cervical muscle strength appears to be related to the function of the cervical spine and the clinical characteristics of TTH. This study aimed to correlate anatomical, functional, and psychological variables in patients with TTH. Materials and methods: An observational descriptive study was carried out with 22 participants diagnosed with TTH for at least six months. The characteristics of headaches, including ultrasound-based deep neck flexor and extensor muscle thickness, range of motion (ROM), and pressure pain threshold (PPT), were recorded. We also conducted the Pain Vigilance and Awareness Questionnaire (PVAQ) and the Craniocervical Flexion Test (CCFT). Results: Moderate–large negative correlations were found between the PVAQ and the muscle thickness of right deep flexors contracted (r = −0.52; p = 0.01), left multifidus contracted (r = −0.44; p = 0.04), right multifidus at rest (r = −0.48; p = 0.02), and right multifidus contracted (r = −0.45; p = 0.04). Moderate–large positive correlations were found between the CCFT score and the left cervical rotation ROM (r = 0.53; p = 0.01), right cervical rotation ROM (r = 0.48; p = 0.03), muscle thickness of left multifidus contracted (r = 0.50; p = 0.02), and muscle thickness of right multifidus at rest (r = 0.51; p = 0.02). The muscle thickness of the contracted right deep cervical flexors showed a moderate negative correlation with headache intensity (r = −0.464; p = 0.03). No correlations were found between PPT and the rest of the variables analyzed. Conclusions: In patients with TTH, a higher thickness of deep cervical muscles was associated with higher ROM and higher scores in the CCFT. In turn, the thickness of deep cervical muscles showed negative correlations with pain hypervigilance and headache intensity. These results contribute to a better understanding of the physical and psychosocial factors contributing to the development of TTH, which is useful for implementing appropriate prevention and treatment measures.

To Study the Effects of Deep Neck Flexor Strengthening Exercises and Mckenzie Neck Exercises on Smart Phone Users Suffering From Neck Pain: A Comparative Study

Smartphone has become an integral part of our lives, they generally have a small screen because of which it is more likely to induce a slouched posture creating a line of sight mostly below eye level, formulating an improper posture when used for a prolonged period of time, for example, forward head posture (FHP) leading to neck pain. The purpose of the study is to compare the effectiveness of Deep neck flexor strengthening exercises with that of McKenzie neck extension exercises on smartphone users suffering from neck pain. It is a comparative experimental study. This study included (N=40) subjects with neck pain within the age group of 25-45 years. They arerandomly assigned into 2 groups (Group A and B). Group A had 20 (N=20) subjects who are treated with Deep neck flexor strengthening exercises, Group B had 20 (N=20) who are treated with McKenzie neck extension exercises. The subjects were given intervention 5 days a week for 6 weeks. For within-group analysis Paired sample t-test was used and to analyze between-group variables Independent sample t-test was done. Between DNF and McK groups no significant difference was found in NDI(p&lt;1.18 ) and SFMPQ(p &lt;1.17) while all outcome measures showed a significant difference in both DNF and McK groups(p=0.00)within the groups The results indicated that although both the treatment techniques, DNF and McK are effective in alleviating the neck pain in Smartphone users in terms of decreasing pain intensity and increasing functional ability as there was a significant difference within the two groups, but there was no significant difference between the DNF and McK group in decreasing pain intensity, increasing functional ability

Combined effect of myofascial trigger point therapy and rehabilitative exercise on upper cross syndrome among men software professionals

The aim of this study was to examine combined effect of myofascial trigger point therapy and rehabilitative exercise on upper cross syndrome among men software professionals. A total of thirty men patient with upper cross syndrome were randomly selected as subjects and their age ranged between 35 to 45 years. They were divided into two groups. Group I treated as myofascial trigger point therapy and rehabilitative exercise (n=10), and Group II acted as control group (n=10). The experimental group participated in the myofascial trigger point therapy and rehabilitative exercise treatment for a period of ten weeks. The pain intensity, range of motion and neck flexor index were assessed before and after treatment through visual analog scale, Goniometer and performance index measure test respectively. Data were analyzed on SPSS 25. The results showed that patients in the treatment group decreased pain intensity and improved range of motion and neck flexor index. In conclusion the treatment program consisting of myofascial trigger point therapy and rehabilitative exercise may be more effective in reducing pain intensity and improving the range of motion (ROM) and neck flexor index in upper cross syndrome men software professionals.

Correlation of Intensity of Pain, Functional Disability and Deep Neck Flexor Endurance in Individual with Chronic Non-Specific Neck Pain: An Observational Study

Background: Musculoskeletal deficits of the craniocervical region play an important role in causing various cervical disorders. Cervical disorders and neck pain are almost as prevalent as low back pain and like low back pain; in most of the cases it is difficult to determine the actual cause of neck pain hence it is regarded as “non-specific neck pain”. This study was conducted to determine the correlation between deep neck flexor endurance, the intensity of pain, and functional disability in individuals with chronic non-specific neck pain. Materials and methods: A cross-sectional observational study was conducted on twenty individuals with chronic non-specific neck pain. Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), and Craniocervical Flexion Test (CCFT) were used to measure neck pain intensity, neck disability, and deep neck flexor endurance respectively. The correlation was found using the Pearson Correlation Coefficient test. Result: The results showed that there was a positive correlation found between NPRS and NDI, and CCFT has negative correlations with NPRS and NDI respectively. Conclusion: The findings suggest that the lesser deep neck flexor endurance corresponded to greater neck pain intensity and disability. Keywords: cervical spine, neck disability index, neck pain, craniocervical flexion test, deep neck flexors endurance, correlation.

Severe Congenital Myopathy and Neuropathy with Congenital Cataracts due to GFER Variant: A Neuropathological Study

We describe the clinical, muscle and nerve biopsy, and genetic findings in a 10-year-old girl with a profound and rapid global regression. She presented during neonatal period with hypotonia, followed by weakness in the facial, bulbar, respiratory, and neck flexor muscles. She developed bilateral cataracts at 4 months of age and started to regress. Quadriceps muscle biopsy revealed extensive fiber atrophy but sparing of some, predominantly type 1, fibers. Sural nerve biopsy showed depletion of myelinated and unmyelinated fibers; most remaining myelinated fibers were of small caliber. Neuroimaging revealed global brain atrophy. Although the investigations indicated a multisystem disorder, extensive genetic and metabolic investigations were negative. She was tracheostomy- and ventilator-dependent for most of her life. The child died at 10 years of age. Further deoxyribonucleic acid analysis undertaken via whole genome sequencing revealed a novel pathogenic GFER sequence variant consistent with the patient's clinical presentation.

Overcoming a 'forbidden phenotype': the parrot's head supports, propels and powers tripedal locomotion.

No vertebrate, living or extinct, is known to have possessed an odd number of limbs. Despite this 'forbidden phenotype', gaits that use odd numbers of limbs (e.g. tripedalism or pentapedalism) have evolved in both avian and mammalian lineages. Tripedal locomotion is commonly employed by parrots during climbing, who use their beaks as an additional support. However, it is unclear whether the beak functions simply as a stabilizing hook, or as a propulsive limb. Here, we present data on kinetics of tripedal climbing in six rosy-faced lovebirds (Agapornis roseicollis). Our findings demonstrate that parrots use cyclical tripedal gaits when climbing and the beak and hindlimbs generate comparable propulsive and tangential substrate reaction forces and power. Propulsive and tangential forces generated by the beak are of magnitudes equal to or greater than those forces generated by the forelimbs of humans and non-human primates during vertical climbing. We conclude that the feeding apparatus and neck flexors of parrots have been co-opted to function biomechanically as a propulsive third limb during vertical climbing. We hypothesize that this exaptation required substantive alterations to the neuromuscular system including enhanced force-generating capabilities of the neck flexors and modifications to locomotor central pattern generators.

The implementation of a neck strengthening exercise program in elite rugby union: A team case study over one season

ObjectivesTo investigate the effect of a neck strengthening program on maximal isometric neck strength and incidence of head and neck injuries including concussion, and to evaluate the acceptability and feasibility of the program within one professional men's rugby union team over one season. DesignPre- and post-intervention study. MethodsA phased neck strengthening program was implemented in one rugby union team (n = 26 Forward Group; n = 13 Back Group) throughout the 2020 Super Rugby season, with maximal isometric neck strength measured at each training phase. Strength changes were analysed using one-way, repeated measures analysis of variance and paired samples t-test. Injury data from 2019 to 2020 were compared using incidence rate ratios (IRR). Player and staff surveys, reported as percentage of agreement, assessed program acceptability and feasibility. ResultsForward Group's neck flexors (p < 0.001), left-lateral flexors (p = 0.04) and flexor/extensor ratio (p < 0.001) and Back Group's neck flexors (p = 0.01) significantly improved across the season, with uncertain evidence to support the reduction of head and neck injuries (IRR:0.86 (0.23–2.56) and concussion (IRR:0.63 (0.06–3.34) between seasons. Survey responses revealed high percentages of agreement for the program's acceptability and feasibility. ConclusionsTargeted sport-specific neck exercises have the potential to increase the maximal isometric neck strength of professional rugby players and may assist in reducing head and neck injuries including concussion.

From the discovery of combat gases to insecticides and bioterrorism – a brief history

The identification of organophosphate (OP) compounds dates back to the 1800s. OPare largely used pesticides in the agricultural field and households but prior use as a chemical weapon was considered during wars. Their toxicity on humans has been previously studied and addresses both acute intoxication and low-level chronic exposure. Symptoms of acute exposure describe a cholinergic syndrome with bradycardia, miosis, confusion, fasciculations, tearing, sialorrhea, diarrhea, bronchorrhea, and bronchospasm. The intermediate syndrome causes paralysis of the gait muscles, neck flexors, and respiratory failure. Moreover, unrestricted access to OP has increased the rate of suicide, accounting for around 30% of cases, increasing concern about OP availability. Western countries have drastically restricted access to OP by imposing regulations regarding handling these hazardous substances, but efforts have to be made to globally reduce this struggle

The effect of McKenzie protocol vs. deep neck flexor and scapulothoracic exercises in subjects with chronic neck pain - a randomized controlled study.

This study investigated the impact of McKenzie exercises against deep neck flexor (DNF) combined with scapulothoracic exercises on improving pain severity, cervical mobility, and functional disability. Fifty-five subjects suffering from chronic neck pain participated in this randomized controlled study. They were randomly assigned to three groups; the DNF group, which was treated by traditional physical therapy (i.e., physical therapy agents, stretching, and isometric exercises), combined with DNF, and scapulothoracic exercises; the McKenzie group, treated by traditional physical therapy, combined with McKenzie exercises; and finally, a control group, treated by traditional physical therapy. Before and after 6 weeks of treatment, they were assessed for neck pain severity, cervical range of motion (ROM), and functional disability using a visual analog scale (VAS), a gravity-reference goniometer, and the Copenhagen neck functional disability scale (CNFDS), respectively. Compared to baseline, all groups showed a significant decrease in neck pain severity and disability (p <0.05), and there was a significant increase in neck flexion/extension, lateral right flexion/left flexion, and right/left rotation ROMs (p<0.05). The improvement of the McKenzie group was significantly higher than the DNF group, and control group. Moreover, the improvement of the DNF group was significantly higher than the control group (p<0.05). The McKenzie exercises were better than DNF combined with scapulothoracic exercises to treat neck pain, functional disability, and mobility.

Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial.

Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP). A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up. There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found. Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6months. Further studies are needed to explore the effect of these interventions for longer follow-ups.

TIDAK ADA PERBEDAAN PENGARUH DEEP NECK FLEXORS STRENGTHENING EXERCISE DENGAN SCAPULAR STABILIZATION EXERCISE UNTUK PERBAIKAN FORWARD HEAD POSTURE

Background: One of the posture disorders experienced by adolescents is forward head posture. Methods:This research uses quasi experimental group with two group pre-test post-test design. Research sample population is 15–17 years old students with 16 persons on each groups. The 1stgroup given deep neck flexor strengthening exercise and the 2ndgroup given scapular stabilization exercise.Intervention is performed 9 times with 3 times repetition in a week. The measurement of this research is craniovertebral angle. Normality test used Shapiro-wilk test, homogeneity test used wilcoxon test, and the test of difference of intervention impact given is performed by mann whitney test. Result: The value of intervention impact test of 1stgroup is p=0,000, the 2ndgroup test results the value of p=0,000. The result of both diference impact, results value of p=0,597. Conclusion: There is no difference between twointervention

P050 Rapidly worsening subcutaneous oedema in a young boy: a case of juvenile dermatomyositis

Abstract Background/Aims Juvenile onset dermatomyositis (JDM) is a rare disease with an incidence of 2-4 per million. The presentation includes skin manifestations of heliotrope rash, Gottron's papules, nail fold changes, bilateral peri-orbital or upper eyelid edema and focal mild facial swelling with muscle weakness. Widespread and generalized subcutaneous oedema is a rare presentation in JDM. Methods A 4-year-old previously healthy boy presented to a tertiary care hospital in Sri Lanka with generalized rash involving the face, limbs and trunk for seven days associated with facial puffiness and hair loss. He also complained of generalized myalgia and irritability and refused to walk. He did not have dysphagia, dysphonia or shortness of breath. He had a prodromal febrile illness two weeks back that had been treated as a viral fever. He had evidence of palatal ulcers, chelitis, malar rash, erythema of eyelids, eyelid swelling and necrotic vasculitic lesions in peripheries. He had tenderness over his thighs with muscle power being MRC grade 3/5 in the proximal muscles of his lower limbs. Arm and neck flexors’ power was normal. Results His ESR was raised at 35 mm/hour and CRP was normal. His CPK was 2726 U/l, AST was raised at 931 U/l, ALT was 511 U/l and albumin was 33 g/l. His ANA, dsDNA and ENA panel was negative. A myositis immunoblot could not be done due to financial constraints. An EMG showed evidence of myositis in his proximal muscles. He fulfilled the criteria for juvenile dermatomyositis based on Bohan and Peter’s criteria. He was treated with high dose steroids, dexamethasone 2 mg 6 hourly. While receiving steroids he deteriorated with worsening subcutaneous oedema of face and neck with high fever spikes. The oedema progressed to involve his whole body. His muscle power deteriorated with involvement of his arms. A venogram ruled out any obstructive venous disease. A CT CAP ruled out any underlying malignancy. His 2D echo revealed normal heart function. He was converted to IV Methylprednisolone 30 mg/kg and was started on plasmapharesis. He improved after the 3rd cycle and was started on cyclophosphamide infusions. He received six cyclophosphamide pulses with a tapering course of steroids. He remains controlled in his disease with no new muscle weakness or skin manifestations. However, he remains steroid dependent and is awaiting treatment with Rituximab. Conclusion Subcutaneous oedema in JDM is attributed to a vasculopathy. This is associated with severe rapidly progresssive disease with high mortality and requires aggressive immunosuppression. As seen in our patient disease is resistant to conventional treatment. Early recognition leads to better outcomes in these patients. Disclosure S. Janagan: None. W.A.E. Udeshika: None. P.M. Samarasinghe: None. J.D. Jagoda: None.

Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses.

The aim of this study was to examine for the presence of differences in neuromuscular and psychological function in individuals with recurrent neck pain (RNP) or chronic neck pain (CNP) following a whiplash trauma compared to healthy controls. A secondary aim was to examine whether neuromuscular characteristics together with psychological features in people with RNP were predictive of future painful episodes. Multiple features were assessed including neck disability, kinesiophobia, quality of life, cervical kinematics, proprioception, activity of superficial neck flexor muscles, maximum neck flexion and extension strength, and perceived exertion during submaximal contractions. Overall, those with RNP (n = 22) and CNP (n = 8) presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to controls (n = 15). Prediction analysis in the RNP group revealed that a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictors of higher neck disability at a 6-month follow-up. This preliminary study shows that participants with RNP presented with some degree of altered neuromuscular features and poorer psychological function with respect to healthy controls and these features were similar to those with CNP. Neck flexor weakness was predictive of future neck disability.

Development and Assessment of a Method to Estimate the Value of a Maximum Voluntary Isometric Contraction Electromyogram from Submaximal Electromyographic Data.

The electromyographic (EMG) normalization (often to maximum voluntary isometric contraction [MVIC]) is used to control for interparticipant and day-to-day variations. Repeated MVIC exertions may be inadvisable from participants' safety perspective. This study developed a technique to predict the MVIC EMG from submaximal isometric voluntary contraction EMG. On day 1, 10 participants executed moment exertions of 100%, 60%, 40%, and 20% of the maximum (biceps brachii, rectus femoris, neck flexors, and neck extensors) as the EMG data were collected. On day 2, the participants replicated the joint moment values from day 1 (60%, 40%, and 20%) and also performed MVIC exertions. Using the ratios between the MVIC EMGs and submaximal isometric voluntary contraction EMG data values established on day 1, and the day 2 submaximal isometric voluntary contraction EMG data values, the day 2 MVIC EMGs were predicted. The average absolute percentage error between the predicted and actual MVIC EMG values for day 2 were calculated: biceps brachii, 45%; rectus femoris, 27%; right and left neck flexors, 27% and 33%, respectively; and right and left neck extensors, both 29%. There will be a trade-off between the required accuracy of the MVIC EMG and the risk of injury due to exerting actual MVIC. Thus, using the developed predictive technique may depend on the study circumstances.

Screening for Upper Cross Syndrome in Asymptomatic Individuals

Upper cross syndrome (UCS) refers to tightness of muscles such as pectoralis major, upper trapezius and levator scapulae and weakness of deep neck flexors, scalene, rhomboids, serratus anterior, middle and lower trapezius. Poor posture is associated with imbalance created in musculoskeletal system and common condition to be reported as upper cross syndrome. It is commonly seen in people with forward head posture, desk job workers, dentist, beauticians etc. The resulting clinical presentation is complaint of pain in neck and shoulder, cervicogenic headache, hunched upper-back and rounded shoulder. Children are not as proactive today and the rate of the UCS is on the rise. This deviated posture and sedentary lifestyle continues, where it progresses more as the age progresses in adulthood. To screen, detect, early treat as well as prevent upper cross syndrome in young individuals. Asymptomatic individual with 20-40 years of age group was explained about the procedure before commencement of the study. Posture was screened using REEDCO Posture Assessment Scale was used for evaluation. Assessment of muscle tightness and weakness was evaluated using muscle length tests and manual muscle testing. From the current study we conclude that prevalence of UCS is significantly less in asymptomatic individuals as compared to symptomatic. Although it is very important to practice good posture in daily routine in order prevent early signs of UCS. The parameters of outcome measures were analyzed by descriptive statistics only. Based on previous data we conclude that it is essential to screen asymptomatic individual to looks for signs of UCS for early detection, prevention and treatment. Keywords: Upper Cross Syndrome, Manual Muscle Testing, Muscle Length Testing.

Are neck pain, disability, and deep neck flexor performance the same for the different types of temporomandibular disorders?

ABSTRACT Objective To evaluate neck pain, disability, and deep neck flexor (DNF) performance of individuals with temporomandibular disorders (TMD). Methods Eighty individuals were divided into the following: arthrogenic TMD (n = 40), myogenic TMD (n = 12), and mixed TMD (n = 28). Neck pain intensity, neck disability, and DNF performance were evaluated. Results Individuals with arthrogenic TMD reported lower intensity of neck pain when compared to mixed TMD (p = 0.01). Individuals with arthrogenic TMD had less neck disability than individuals with myogenic TMD (p = 0.037) and mixed TMD (p < 0.001). A moderate positive correlation was found between neck pain and neck disability (p < 0.001). No differences were found for DNF performance. Conclusion Neck pain and disability differs according to subtype of TMD, but performance of the deep neck flexors does not. Neck pain intensity and neck disability were correlated in patients with TMD.

The Short and Intensive Rehabilitation (SHAiR) Program Improves Dropped Head Syndrome Caused by Amyotrophic Lateral Sclerosis: A Case Report

Background and Objectives: Dropped head syndrome (DHS) is a syndrome that presents with correctable cervical kyphotic deformity as a result of weakening cervical paraspinal muscles. DHS with amyotrophic lateral sclerosis (ALS) is a relatively rare condition, and there is no established treatment. This is the first case report describing the improvement of both dropped head (DH) and cervical pain after the short and intensive rehabilitation (SHAiR) program in an ALS patient with DHS. Case Report: After being diagnosed with ALS in June 2020, a 75-year-old man visited our hospital in October 2020 to receive treatment for DHS. At the initial visit, the patient’s DH was prominent during standing and walking. The pain intensity of the neck was 9 out of 10 on the numerical rating scale (NRS), which was indicative of severe pain. The patient was hospitalized for 2 weeks and admitted into the SHAiR program. DH began to decrease one week after undergoing the SHAiR program and improved two weeks later. Neck pain decreased from 9 to 6 on the NRS. Results: The SHAiR program is a rehabilitation program aimed at improving DH in patients with idiopathic DHS. The program was designed to improve neck extensor and flexor function and global spinal alignment, and the program may have contributed to the improvement of DH and neck pain. Currently, reports of conservative therapies for this disease are limited to the use of cervical orthosis. Although further research is needed on the safety and indications of treatment, the SHAiR program may be a viable treatment option.

Post-malaria Myasthenia Gravis

We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction ofmedial gaze following an attack of febrile illness. The child was admitted into a rural hospital where shewas misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospitalwhen her condition was not improving and where she developed the eye signs. She was diagnosed as a caseof severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examinationrevealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors &amp; knee flexors.Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis &amp; extensor-digitorumcommunis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvementafter pyridostigmine therapy which continued for three months. Regular follow-up showed no recurrenceof her symptoms.