Neuromuscular Exercise Research Articles

Ankles back in randomized controlled trial (ABrCt): Braces versus neuromuscular exercises for the secondary prevention of ankle sprains

Ankles back in randomized controlled trial (ABrCt): Braces versus neuromuscular exercises for the secondary prevention of ankle sprains

The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: ‘SCOPEX’ a randomised control trial protocol

BackgroundMeniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy.Methods/design62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters.DiscussionThe findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during various tasks in people with a partial medial meniscectomy. If shown to reduce the knee adduction moment, neuromuscular exercise has the potential to prevent the onset of osteoarthritis or slow its progression in those with early disease.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12612000542897

Long-term effects of sport: preventing and managing OA in the athlete

Sports participation is associated with an increased risk of future osteoarthritis (OA), much of which results from joint injury. No strong evidence exists that moderate sporting activity in the presence of normal joints predisposes to OA. Whether high-level participation in sport, particularly impact-type sports, is truly associated with OA is unclear owing to difficulties in differentiating the confounding effect of joint injury. Attention to strategies that prevent joint injury in athletes is paramount. Evidence does support the use of targeted neuromuscular exercise programmes, ankle taping and/or bracing and equipment or rule changes to prevent joint injuries in athletes. Optimal injury management, including rehabilitation and surgery if appropriate, is needed to facilitate healing and address biomechanical and neuromuscular impairments to reduce the risk of re-injury and minimize the onset and extent of joint symptoms. Management of OA in athletes requires attention to load-reducing strategies, activity modification, muscle strengthening and weight control.

Neuromuscular Electrical Stimulation and Exercise for Reducing Trapezius Muscle Dysfunction in Survivors of Head and Neck Cancer: A Case-Series Report

Damage to the spinal accessory nerve (SAN) can result in denervation of the trapezius muscle in patients undergoing surgery for head and neck cancer. Trapezius denervation leads to muscle weakness and dysfunction that, for some patients, persists despite the return of conduction along the SAN. This prospective case series describes an intervention involving a combination of a novel type of neuromuscular electrical stimulation (NMES) with bilateral exercise. Three survivors of head and neck cancer participated in the 6-week program. NMES was applied over the region of the SAN on the affected side while subjects performed bilateral voluntary scapular retraction and elevation exercises against resistance. The NMES was delivered using relatively wide pulse widths and high frequencies to enhance the electrically evoked sensory volley and was triggered by the onset of trapezius muscle activity on the non-affected side. Shoulder range of motion (ROM) assessments and patient-rated outcomes were administered at baseline and 6 weeks. All patients showed improvements in shoulder flexion and abduction ROM and reported reductions in pain and disability. This combination of NMES and bilateral exercise may prove to be an effective component of a comprehensive shoulder rehabilitation program for patients with persistent trapezius muscle dysfunction as a result of SAN damage.

Neuromuscular exercise (NEMEX-TJR) improves knee extension muscle power and chair stands ability in patients with severe knee osteoarthritis compared to controls: a randomized controlled trial

Neuromuscular exercise (NEMEX-TJR) improves knee extension muscle power and chair stands ability in patients with severe knee osteoarthritis compared to controls: a randomized controlled trial

Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol

BackgroundOsteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people, giving rise to pain and loss of function. Many people experience progressive worsening of the disease over time, particularly those with varus malalignment and increased medial knee joint load. Therefore, interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression. Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load. A neuromuscular exercise program, emphasising optimal alignment of the trunk and lower limb joints relative to one another, as well as quality of movement performance, while dynamically and functionally strengthening the lower limb muscles, may be able to reduce medial knee load. Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature. This randomised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading, pain and function in individuals with medial knee joint osteoarthritis. We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program.Methods/Design100 people with medial knee pain, radiographic medial compartment osteoarthritis and varus malalignment will be recruited and randomly allocated to one of two 12-week exercise programs: quadriceps strengthening or neuromuscular exercise. Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home. The primary outcomes are medial knee load during walking (the peak external knee adduction moment from 3D gait analysis), pain, and self-reported physical function measured at baseline and immediately following the program. Secondary outcomes include the external knee adduction moment angular impulse, electromyographic muscle activation patterns, knee and hip muscle strength, balance, functional ability, and quality-of-life.DiscussionThe findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load, pain and physical function in people with medial knee osteoarthritis and varus malalignment.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12610000660088

Ankles back in randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomised controlled trial

BackgroundAnkle sprains are the most common sports and physical activity related injury. There is extensive evidence that there is a twofold increased risk for injury recurrence for at least one year post injury. In up to 50% of all cases recurrences result in disability and lead to chronic pain or instability, requiring prolonged medical care. Therefore ankle sprain recurrence prevention in athletes is essential. This RCT evaluates the effect of the combined use of braces and neuromuscular training (e.g. proprioceptive training/sensorimotor training/balance training) against the individual use of either braces or neuromuscular training alone on ankle sprain recurrences, when applied to individual athletes after usual care.Methods/DesignThis study was designed as three way randomized controlled trial with one year follow-up. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain in the two months prior to inclusion, were eligible for inclusion. After subjects had finished ankle sprain treatment by means of usual care, they were randomised to any of the three study groups. Subjects in group 1 received an eight week neuromuscular training program, subjects in group 2 received a sports brace to be worn during all sports activities for the duration of one year, and group 3 received a combination of the neuromuscular training program and a sports brace to be worn during all sports activities for the duration of eight weeks. Outcomes were assessed at baseline and every month for 12 months therafter. The primary outcome measure was incidence of ankle sprain recurrences. Secondary outcome measures included the direct and indirect costs of recurrent injury, the severity of recurrent injury, and the residual complaints during and after the intervention.DiscussionThe ABrCt is the first randomized controlled trial to directly compare the secondary preventive effect of the combined use of braces and neuromuscular training, against the use of either braces or neuromuscular training as separate secondary preventive measures. This study expects to identify the most effective and cost-efficient secondary preventive measure for ankle sprains. The study results could lead to changes in the clinical guidelines on the prevention of ankle sprains, and they will become available in 2012.Trial registrationNetherlands Trial Register (NTR): NTR2157

An investigation on the effects of Neuromuscular exercise on Balance, gait and the depression of paitent with MS

Introduction: Multiple sclerosis is the most common progressive neurologic disorder among young adults. This disease leads to lesions regarded to as demylinating plaques which are scattered in the white matter of CNS hence create various neurological problems. Materials and Methods: This was a single-blinded prospective quasi-experimental study with the aim of evaluating the effects of neuromuscular exercise on balance, gait and depression level of patients with MS. It was carried out in Isfahan during the year 2008. 24 patients with M.S (mean age: 33.33yr; mean height: 169.66 cm; mean weight: 66.87 kg, mean duration of disease: 6.64 years) underwent 10 sessions of neuromuscular exercise on an every-two-day basis. Data was obtained before initiating treatment program, after termination of the treatment and at 2 months follow up. Berg Balance scale, Dynamic Gait Index and Beck Depression Questionnaire were respectively used for evaluating balance, gait, and depression. To compare patients' condition at these stages, obtained data were analyzed through Paired t-test using SPSS software. Results: Pre- and Post treatment evaluation of balance, gait and depression showed significant differences (p=0.00). Also, there was a meaningful difference between pre-treatment and follow up ratings with regard to balance (p=0.00) and gait (p=0.03). Moreover, comparison of balance (p=0.00) and gait measurements (P=0.01) at pre-treatment and at two months follow up revealed a significant difference. But there was no meaningful difference in depression status either comparing post-treatment and two-month follow up ratings (p=0.14) or pre-treatment and two-month follow up evaluations (p=0.06). Conclusion: The study results show that continuous neuromuscular exercise may result in improved balance and Gait and in reduced depression in patients with MS. With regard to the course of disorder, initial condition may return if the exercises are discontiued. Key words: Multiple sclerosis, Balance, Gait, depression, Neuromuscular exercise

Medication, Surgery, and Physiotherapy Among Patients With the Hypermobility Type of Ehlers-Danlos Syndrome

Rombaut L, Malfait F, De Wandele I, Cools A, Thijs Y, De Paepe A, Calders P. Medication, surgery, and physiotherapy among patients with the hypermobility type of Ehlers-Danlos syndrome. Objectives To describe medication use, surgery, and physiotherapy, and to examine the effect of these treatment modalities on functional impairment and amount of complaints among patients with the hypermobility type of Ehlers-Danlos syndrome (EDS-HT). Design Cross-sectional study. Setting Physical and rehabilitation medicine department and center for medical genetics. Participants Patients with EDS-HT (N=79; 8 men, 71 women) were recruited for this study. Interventions Not applicable. Main Outcome Measures Patients filled out questionnaires regarding type of complaints, medication use, surgery, physiotherapy, and outcome of treatment. Functional impairment in daily life was measured by the Sickness Impact Profile. Pain severity was assessed with visual analog scales. Results Patients reported a large number of complaints, a considerable presence of severe pain, and a clinically significant impact of disease on daily functioning. Most patients (92.4%) used medications, among which analgesics were the most prevalent. Fifty-six patients (70.9%) underwent surgery, including mainly interventions of the extremities and abdomen. Forty-one patients (51.9%) are currently enrolled in a physical therapy program, mainly comprising neuromuscular exercises, massage, and electrotherapy. Patients with a high consumption of analgesics, who visited the physiotherapist, or who underwent surgery had a higher dysfunction in daily life. Only 33.9% of the patients who underwent surgery and 63.4% of patients in physical therapy reported a positive outcome. Conclusions Patients with EDS-HT have numerous complaints and an impaired functional status that strongly determine their high rate of treatment consumption. The outcome of surgical and physiotherapy treatment is disappointing in a large percentage, which illustrates a strong need for evidence-based therapy.

Knee Osteoarthritis and the Efficacy of Kinesthesia, Balance & Agility Exercise Training: A Pilot Study

Kinesthesia, balance and agility (KBA) neuromuscular exercises are commonly used for rehabilitation of lower extremity injuries. KBA combined with strength training (ST) reportedly improves function among persons with knee osteoarthritis (OA), but independent effects of KBA are unknown. The purpose of this study was to determine the efficacy of KBA exercises, independent of ST, to improve function among persons with knee OA. Twenty participants (69.3, SD 11.4 y) were randomized to 8 weeks, 3-days per week, instructor-lead KBA or ST groups. Self-reported physical function (difficulty with daily living activities such as walking, bending, stair climbing, etc.) was measured at baseline and every two weeks. Community physical activity level, negative and positive outcome expectancies for exercise, self-reported knee stability, and timed 10-stair climb, 10-stair descent, and ‘get up and go’ 15 m walk were measured at baseline and follow-up. Physical function improved 59% (p = 0.02) with KBA and 40% (p = 0.02) with ST at 8 weeks. Community physical activity level improved only in KBA (p = 0.04); knee stability improved in both KBA (p = 0.04) and ST (p = 0.01). There were no significant between-group differences (p > 0.05). In conclusion, both interventions appear to improve function and knee stability among persons with symptomatic knee OA. As KBA has never been studied as an independent treatment program, our results indicate it is a promising stand-alone intervention worthy of further study.

Critical illness myopathy and polyneuropathy - A challenge for physiotherapists in the intensive care units.

The development of critical patient related generalized neuromuscular weakness, referred to as critical illness polyneuropathy (CIP) and critical illness myopathy (CIM), is a major complication in patients admitted to intensive care units (ICU). Both CIP and CIM cause muscle weakness and paresis in critically ill patients during their ICU stay. Early mobilization or kinesiotherapy have shown muscle weakness reversion in critically ill patients providing faster return to function, reducing weaning time, and length of hospitalization. Exercises in the form of passive, active, and resisted forms have proved to improve strength and psychological well being. Clinical trials using neuromuscular electrical stimulation to increase muscle mass, muscle strength and improve blood circulation to the surrounding tissue have proved beneficial. The role of electrical stimulation is unproven as yet. Recent evidence indicates no difference between treated and untreated muscles. Future research is recommended to conduct clinical trials using neuromuscular electrical stimulation, exercises, and early mobilization as a treatment protocol in larger populations of patients in ICU.

Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft

The aim of this study was to compare the effects of Endobutton post-fixation and femoral (TransFix) transfixation in ACL reconstruction on lower extremity muscle strength, joint position sense, and knee stability. Subjects who had undergone ACL reconstruction with hamstring tendon using Endobutton post-fixation (n=20, mean age: 26.5 years) or femoral transfixation (n=20, mean age: 29.9 years) were recruited to an ACL rehabilitation program. Twelve months after surgery, quadriceps and hamstring torque values were recorded using an isokinetic dynamometer. Computerized coordination and proprioception tests (Functional Squat System; Monitored Rehab System) were performed to determine the deficits in joint position sense. The anterior translation test was performed using a Kneelax 3 arthrometer to determine knee laxity. Side-to-side differences between groups for hamstring and quadriceps muscle strength, concentric and eccentric motor coordination and anterior tibial laxity were not significantly different (p>0.05). No statistically significant differences in functional outcome were found 1 year after the ACL reconstruction using Endobutton post-fixation and femoral transfixation with hamstring tendon graft. Deficits in hamstring-quadriceps muscle strength, motor coordination and proprioception were still found in both groups. We therefore recommend that long-term follow-up and rehabilitation including neuromuscular exercises should be continued for longer than one year after ACL reconstruction.

Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation are effective in reducing of upper limb sensory in late-stage stroke subjects: a three-group randomized trial

Question: Are Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation and traditional post-stroke therapy more effective in reducing affected upper extremity sensory deficits in late-stage stroke subjects than proprioceptive neuromuscular facilitation combined with traditional therapy or traditional therapy alone? Design: Pretest—posttest three-group randomized clinical experimental design. Participants: A total of 96 late-stage stroke subjects were randomly assigned to three groups. Intervention: The therapeutic programme in the control group was based on traditional post-stroke methods. The second group (experimental 1) received in addition individual therapy based on the proprioceptive neuromuscular facilitation method. The third group (experimental 2) received a combination: traditional therapeutic programme plus individual proprioceptive neuromuscular facilitation exercises plus neuromobilization of the affected upper extremity. All groups received 18 training sessions lasting about 45 minutes each. Outcome measures: Assessment of the two-point discriminatory sense (distance between the tips of the compass when the subject indicated two-point sensation), stereognosia (identification up to 10 objects by touch) and thermaesthesia (using hot and cold cylinders on dermatomes C6—C8) were performed. Results: Analysis of change scores showed that two-point discriminatory sense for experimental group 2 was significantly better than that in the two other groups (P<0.001). Similar results were registered for thermaesthesia (experimental 2 versus experimental 1 P<0.01; experimental 2 versus control P<0.001). For stereognosia the only significant difference was found between experimental group 2 and the control group (P<0.05). Conclusion: In our subjects, application of Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation showed greater effectiveness in reducing sensory deficits than proprioceptive neuromuscular facilitation or traditional therapy alone.

Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention

Hamstring strain injuries remain a challenge for both athletes and clinicians, given their high incidence rate, slow healing, and persistent symptoms. Moreover, nearly one third of these injuries recur within the first year following a return to sport, with subsequent injuries often being more severe than the original. This high reinjury rate suggests that commonly utilized rehabilitation programs may be inadequate at resolving possible muscular weakness, reduced tissue extensibility, and/or altered movement patterns associated with the injury. Further, the traditional criteria used to determine the readiness of the athlete to return to sport may be insensitive to these persistent deficits, resulting in a premature return. There is mounting evidence that the risk of reinjury can be minimized by utilizing rehabilitation strategies that incorporate neuromuscular control exercises and eccentric strength training, combined with objective measures to assess musculotendon recovery and readiness to return to sport. In this paper, we first describe the diagnostic examination of an acute hamstring strain injury, including discussion of the value of determining injury location in estimating the duration of the convalescent period. Based on the current available evidence, we then propose a clinical guide for the rehabilitation of acute hamstring injuries, including specific criteria for treatment progression and return to sport. Finally, we describe directions for future research, including injury-specific rehabilitation programs, objective measures to assess reinjury risk, and strategies to prevent injury occurrence. Diagnosis/therapy/prevention, level 5.

Elbow Joint Position Sense After Neuromuscular Training With Handheld Vibration

Clinicians use neuromuscular control exercises to enhance joint position sense (JPS); however, because standardizing such exercises is difficult, validations of their use are limited. To evaluate the acute effects of a neuromuscular training exercise with a handheld vibrating dumbbell on elbow JPS acuity. Crossover study. University athletic training research laboratory. Thirty-one healthy, college-aged volunteers (16 men, 15 women, age = 23 + or - 3 years, height = 173 + or - 8 cm, mass = 76 + or - 14 kg). We measured and trained elbow JPS using an electromagnetic tracking device that provided auditory and visual biofeedback. For JPS testing, participants held a dumbbell and actively identified the target elbow flexion angle (90 degrees ) using the software-generated biofeedback, followed by 3 repositioning trials without feedback. Each neuromuscular training protocol included 3 exercises during which participants held a 2.55-kg dumbbell vibrating at 15, 5, or 0 Hz and used software-generated biofeedback to locate and maintain the target elbow flexion angle for 15 seconds. We calculated absolute (accuracy) and variable (variability) errors using the differences between target and reproduced angles. Training protocols using 15-Hz vibration enhanced accuracy and decreased variability of elbow JPS (P < or = .005), whereas 5-Hz vibration did not affect accuracy (F(1,61) = 2.625, P = .100) but did decrease variability (F(1,61) = 7.250, P = .009). The control condition and 0-Hz training protocol had no effect on accuracy or variability (P > or = .200). Our results suggest these neuromuscular control exercises, which included low-magnitude, low-frequency handheld vibration, may enhance elbow JPS. Future researchers should examine vibration of various durations and frequencies, should include injured participants and functional multijoint and multiplanar measures, and should examine long-term effects of training protocols on JPS and injury.

Neuromuscular Training for Rehabilitation of Sports Injuries

Although proprioceptive and neuromuscular exercises are considered to be part and parcel of rehabilitation programs after sport injuries, there is an uncertainty regarding the effectiveness of corresponding training interventions. The objective of this review was to evaluate the effectiveness of proprioceptive and neuromuscular training (PT/NT) for the treatment of ankle, knee, and shoulder joint injuries. Two independent reviewers performed a literature search in various databases and reference lists of articles. Data of included trials were then extracted, and methodological quality was assessed by using predetermined forms. Fifteen trials met the inclusion criteria. PT/NT was effective at increasing functionality as well as at decreasing the incidence of recurrent injuries and "giving way" episodes after ankle sprains and in conservative treatment of anterior cruciate ligament injuries. However, conflicting results or no efficacy of training were reported for static postural control, joint position sense, neuromuscular control, joint laxity, and lower extremity strength. No study that examined PT/NT after shoulder injuries was found. From this review, it can be concluded that proprioceptive and neuromuscular interventions after ankle and knee joint injuries can be effective for the prevention of recurrent injuries and the improvement of joint functionality.

Functional Capacity and Muscular Abnormalities in Subclinical Hypothyroidism

BackgroundNeuromuscular abnormalities and low exercise tolerance are frequently observed in overt hypothyroidism, but it remains controversial if they can also occur in subclinical hypothyroidism (sHT). The aim of this study is to evaluate neuromuscular symptoms, muscle strength, and exercise capacity in sHT, compared with healthy euthyroid individuals. MethodsA cross-sectional study was performed with 44 sHT and 24 euthyroid outpatients from a university hospital. Neuromuscular symptoms were questioned. Muscle strength was tested for neck, shoulder, arm, and hip muscle groups, using manual muscle testing (MMT). Quadriceps muscle strength was tested with a chair dynamometer and inspiratory muscle strength (IS) by a manuvacuometer. Functional capacity was estimated based on the peak of oxygen uptake (mL/kg/min), using the Bruce treadmill protocol. ResultsCramps (54.8% versus 25.0%; P<0.05), weakness (45.2% versus 12.6; P<0.05), myalgia (47.6% versus 25.0%; P = 0.07), and altered MMT (30.8% versus 8.3%; P = 0.040) were more frequent in sHT. Quadriceps strength and IS were not impaired in sHT and the same was observed for functional capacity. IS was significantly lower in patients complaining of fatigue and weakness (P<0.05) and tended to be lower in those with altered MMT (P = 0.090). ConclusionNeuromuscular complaints and altered MMT were significantly more frequent in sHT than in controls, and IS was lower in patients with these abnormalities. Results suggest that altered muscle strength by MMT and the coexistence of neuromuscular complaints in patients with sHT may indicate neuromuscular dysfunction.

The Long-term Effect of 2 Postoperative Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction

Background There is no consensus regarding the optimal postoperative rehabilitation program after anterior cruciate ligament (ACL) reconstruction. Purpose The purpose of this study was to examine the long-term outcome of a 6-month neuromuscular exercise (NE) training program versus a traditional strength exercise (SE) training program after ACL reconstruction. Study Design Randomized controlled trial; Level of evidence, 1. Methods Seventy-four patients were randomly assigned to either a NE program or a SE program and tested preoperatively and at 6 months, 1 year, and 2 years after ACL reconstruction. Outcome measurements were as follows: Cincinnati knee score, visual analog scale for pain and global function, Short Form 36, functional knee tests, and isokinetic muscle strength tests. Results There were no significant differences between the NE and SE programs 1 and 2 years after ACL reconstruction for the primary outcome measurement (Cincinnati knee score). There were significantly improved knee function (global function) and reduced pain during activity for the NE group, compared with the SE group, and significantly improved hamstring muscle strength for the SE group, compared with the NE group, 2 years after ACL reconstruction. Conclusion On the basis of these results, a postoperative program combining both NE and SE should be included after ACL reconstruction to improve knee function.

Isolated Spinal Accessory Nerve Palsy After Coronary Artery Bypass: An Unusual Complication

Isolated spinal accessory nerve palsy after coronary artery bypass graft (CABG) surgery is a rare complication. We report a case of a 52-yr-old male patient who presented with right shoulder weakness, drooping of shoulder, and weakness of forward elevation after CABG. A program of neuromuscular electrical stimulation and exercises was started after the diagnosis of right isolated spinal accessory nerve palsy by physical examination and electromyographic study. Involved muscle function recovered after 6 mos of physical therapy and rehabilitation. This case report suggests that isolated spinal accessory nerve palsy should be considered in cases of shoulder pain or weakness after CABG, and conservative treatment is recommended if palsy develops.

Cross-training effects of a proprioceptive neuromuscular facilitation exercise programme on knee musculature

Objectives To examine the cross-training effects of a proprioceptive neuromuscular facilitation training (PNF) program on peak torque and endurance. Design Factorial design. Participants Twenty-three males were assigned to a PNF group ( n=12) or a control group ( n=11). Interventions The PNF program included training of the knee extensor and flexor muscles for a period of 8 weeks, exercising three times a week. PNF training included performance of knee movements through range of motion against manual resistance. Main outcome measures Isokinetic torque and fatigue of the knee flexors and extensors at 60, 180 and 300° s −1 were assessed prior to and immediately after the training period. Results Analysis of variance designs indicated that the PNF group demonstrated significant gains (9.9%) in knee extension torque of the contralateral leg. In contrast, no cross-training effects on peak flexion torque was observed. Conclusions Cross-training effects after PNF exercise were restricted to the knee extensor muscles. Such effects may be important when the aim of a rehabilitation program is to improve the knee extensor muscle function of an immobilized contralateral leg.