Muscle Tone Research Articles

Is sleep bruxism in obstructive sleep apnea only an oral health related problem?

BackgroundThe etiology of sleep bruxism in obstructive sleep apnea (OSA) patients is not yet fully clarified. This prospective clinical study aimed to investigate the connection between probable sleep bruxism, electromyographic muscle tone, and respiratory sleep patterns recorded during polysomnography.Methods106 patients with OSA (74 males, 31 females, mean age: 56.1 ± 11.4 years) were divided into two groups (sleep bruxism: SB; no sleep bruxism: NSB). Probable SB were based on the AASM criteria: self-report of clenching/grinding, orofacial symptoms upon awakening, abnormal tooth wear and hypertrophy of the masseter muscle. Both groups underwent clinical examination for painful muscle symptoms aligned with Temporomandibular Disorders Diagnostic Criteria (DC/TMD), such as myalgia, myofascial pain, and headache attributed to temporomandibular disorder. Additionally, non-complaint positive muscle palpation and orofacial-related limitations (Jaw Functional Limited Scale-20: JFLS-20) were assessed. A one-night polysomnography with electromyographic masseter muscle tone (EMG) measurement was performed. Descriptive data, inter-group comparisons and multivariate logistic regression were calculated.ResultsOSA patients had a 37.1% prevalence of SB. EMG muscle tone (N1-N3, REM; P = 0.001) and the number of hypopneas (P = 0.042) were significantly higher in the sleep bruxism group. While measures like apnea–hypopnea-index (AHI), respiratory-disturbance-index (RDI), apnea index (AI), hypopnea-index (HI), number of arousals, and heart rate (1/min) were elevated in sleep bruxers, the differences were not statistically significant. There was no difference in sleep efficiency (SE; P = 0.403). Non-complaint masseter muscle palpation (61.5%; P = 0.015) and myalgia (41%; P = 0.010) were significant higher in SB patients. Multivariate logistic regression showed a significant contribution of EMG muscle tone and JFLS-20 to bruxism risk.ConclusionIncreased EMG muscle tone and orofacial limitations can predict sleep bruxism in OSA patients. Besides, SB patients suffer more from sleep disorder breathing. Thus, sleep bruxism seems to be not only an oral health related problem in obstructive apnea. Consequently, interdisciplinary interventions are crucial for effectively treating these patients.Trial registrationThe study was approved by the Ethics Committee of Philipps-University Marburg (reg. no. 13/22—2022) and registered at the “German Clinical Trial Register, DRKS” (DRKS0002959).

Vortioxetine Exposure During Pregnancy and Lactation: A Japanese Case Study of Neonatal Implications and Quantitative Milk and Plasma Analyses.

Background: Information about influences of vortioxetine on pregnant women and neonates during perinatal period is almost unknown. Case Presentation: The case was a 28-year-old Japanese woman in her first pregnancy, treated for depression with vortioxetine (20 mg daily) among other medications. At 36 weeks of gestation, she was admitted for premature rupture of the membranes and delivered a girl with no apparent congenital anomalies. Immediately after birth, the neonate required brief respiratory support due to her dyspnea and poor muscle tone. Her respiratory condition improved in 6 days after delivery, and she demonstrated normal developmental progress afterward. Maternal plasma and breast milk samples, collected 4 days postpartum, revealed vortioxetine concentrations of 11.4 ng/mL and 9.3 ng/mL, respectively. The calculated relative infant dose (RID) was estimated at 0.32%. After discharge from hospital, the infant presented no detectable drug-related adverse effects, with over 50% of nutrition derived from breastfeeding. Conclusion: This case showed minimal transfer of vortioxetine into breast milk, reflected in a low RID. The findings suggest limited neonatal exposure to the drug, with no adverse developmental effects observed in the infant. However, the case also indicated the potential for vortioxetine use during pregnancy to contribute to the onset of severe neonatal asphyxia. Further research is needed for a comprehensive understanding of its impact on neonatal health.

Smart Sensing Chairs for Sitting Posture Detection, Classification, and Monitoring: A Comprehensive Review.

Incorrect sitting posture, characterized by asymmetrical or uneven positioning of the body, often leads to spinal misalignment and muscle tone imbalance. The prolonged maintenance of such postures can adversely impact well-being and contribute to the development of spinal deformities and musculoskeletal disorders. In response, smart sensing chairs equipped with cutting-edge sensor technologies have been introduced as a viable solution for the real-time detection, classification, and monitoring of sitting postures, aiming to mitigate the risk of musculoskeletal disorders and promote overall health. This comprehensive literature review evaluates the current body of research on smart sensing chairs, with a specific focus on the strategies used for posture detection and classification and the effectiveness of different sensor technologies. A meticulous search across MDPI, IEEE, Google Scholar, Scopus, and PubMed databases yielded 39 pertinent studies that utilized non-invasive methods for posture monitoring. The analysis revealed that Force Sensing Resistors (FSRs) are the predominant sensors utilized for posture detection, whereas Convolutional Neural Networks (CNNs) and Artificial Neural Networks (ANNs) are the leading machine learning models for posture classification. However, it was observed that CNNs and ANNs do not outperform traditional statistical models in terms of classification accuracy due to the constrained size and lack of diversity within training datasets. These datasets often fail to comprehensively represent the array of human body shapes and musculoskeletal configurations. Moreover, this review identifies a significant gap in the evaluation of user feedback mechanisms, essential for alerting users to their sitting posture and facilitating corrective adjustments.

Spinal projecting neurons in rostral ventromedial medulla co-regulate motor and sympathetic tone.

Many behaviors require the coordinated actions of somatic and autonomic functions. However, the underlying mechanisms remain elusive. By opto-stimulating different populations of descending spinal projecting neurons (SPNs) in anesthetized mice, we show that stimulation of excitatory SPNs in the rostral ventromedial medulla (rVMM) resulted in a simultaneous increase in somatomotor and sympathetic activities. Conversely, opto-stimulation of rVMM inhibitory SPNs decreased both activities. Anatomically, these SPNs innervate both sympathetic preganglionic neurons and motor-related regions in the spinal cord. Fiber-photometry recording indicated that the activities of rVMM SPNs correlate with different levels of muscle and sympathetic tone during distinct arousal states. Inhibiting rVMM excitatory SPNs reduced basal muscle and sympathetic tone, impairing locomotion initiation and high-speed performance. In contrast, silencing the inhibitory population abolished muscle atonia and sympathetic hypoactivity during rapid eye movement (REM) sleep. Together, these results identify rVMM SPNs as descending spinal projecting pathways controlling the tone of both the somatomotor and sympathetic systems.

Advancing women's pelvic floor muscle function diagnosis: the EFSMAP examination and its reliability evaluation

BackgroundThe accurate diagnosis of pelvic floor muscle impairments is essential. The plethora of terms and the lack of evidence to support widely used pelvic floor muscle function (PFMF) measurements hinder diagnostic labels. ObjectiveTo structure an examination of PFMF using visual observation and digital palpation and terms consistent with the ICF terminology, and to test its intra and interrater reliability/agreement. MethodsA panel of 9 physical therapists applied Delphi method to structure the PFMF exam under ICF terminology and to verify its measurements reproducibility. For reliability and agreement, a convenience sample of women aged 51.2 ± 14.7 years had the sensitivity to pressure, pain, muscle tone, involuntary movement reaction, control of voluntary movement (contraction/relaxation), coordination, strength, and endurance examined by two raters, in the same day for interrater (n = 40), and one week apart, for intrarater reliability (n = 25). Percent agreement, linear weighted kappa, intraclass correlation coefficient, and Bland-Altman's limits of agreement were calculated (alpha = 0.05). ResultsFour round Delphi discussion structured the PFMF exam, named EFSMAP (Exame das Funções Sensoriais e Motoras do Assoalho Pélvico), set a list of concepts and instructions targeted at reproducibility and established PFMF diagnostic labels. Reliability, except for pain and tone, were moderate to excellent (Kw= 0.67–1.0 and ICC=0.48–0.82). Agreement was substantial for most PFMF features (0.64–1.00), except pain. Conclusions: The EFSMAP was successfully developed as a valid and reliable exam to be used in research and clinical practice; it provides labels for the diagnosis of pelvic floor muscle impairments. It might be easily adopted worldwide as it uses ICF terminology.

Alternating Hot–Cold Water Immersion Facilitates Motor Function Recovery in the Paretic Upper Limb Following Stroke: A Pilot Randomized Controlled Trial

ObjectiveThis study aimed to assess the effectiveness of alternating hot–cold water immersion (AHCWI) in patients with acute stroke. DesignA single-blind pilot randomized controlled trial SettingDepartment of rehabilitation medicine of a medical center ParticipantsTwenty-four early stroke survivors with moderate-to-severe arm paresis Interventions: In addition to conventional rehabilitation, eligible patients were randomly assigned to an AHCWI group (n = 12, for AHCWI) or a control group (n = 12, for upper limb (UL) cycling exercises) five times per week for 6 weeks. Main Outcome MeasuresThe Fugl–Meyer Assessment motor UL (FMA-UL) score, Motricity Index UL (MI-UL) score, modified Motor Assessment Scale, (including its UL sections, MMAS and MMAS-UL), Berg Balance Scale, Barthel Index (BI), and modified Ashworth Scale were assessed by the same uninvolved physical therapist at baseline and after 4 and 6 weeks of intervention. ResultsCompared with the control group, the AHCWI group performed better, with significant group effects (P < 0.05), and exhibited significant improvements in FMA-UL, MI-UL, and MMAS-UL scores at 4 and 6 weeks (P < 0.05). Although the remaining outcomes were not significantly different, they favored the AHCWI group. Notably, a significant difference was observed in the BI at 4 weeks (P = 0.032). Significant changes in the muscle tone or adverse effects were not observed in either group after the intervention. ConclusionsAHCWI with stroke rehabilitation is feasible and may facilitate motor function recovery of the paretic UL after a stroke.

Every Picture Tells A Story: Managing Exertional Heatstroke with Rotating Ice Water Towels.

A 23-year-old woman completing her first marathon collapsed near the finish line at 4 hours 6 min with a rectal temperature of 41.8°C. She was in good health before the race with no recent illness, had completed a full training program, and was taking no medications or supplements. On the initial exam, she was unconscious with a response to painful stimulus, spontaneous breathing, rapid pulse, eyes closed, fully dilated pupils, poor muscle tone, and pale skin that was warm to touch. The medical team initiated whole-body cooling using rapidly rotating ice water towels and ice packs placed in the neck, axilla, and groin. She developed echolalia during active cooling. About 20 minutes into the cooling procedure, she "woke up," was able to answer questions coherently, and her pupils were normal size and reactive. She was discharged home with instructions to follow-up in 2 d for evaluation and blood chemistry testing.

Tutorial on MUedit: An open-source software for identifying and analysing the discharge timing of motor units from electromyographic signals

We introduce the open-source software MUedit and we describe its use for identifying the discharge timing of motor units from all types of electromyographic (EMG) signals recorded with multi-channel systems. MUedit performs EMG decomposition using a blind-source separation approach. Following this, users can display the estimated motor unit pulse trains and inspect the accuracy of the automatic detection of discharge times. When necessary, users can correct the automatic detection of discharge times and recalculate the motor unit pulse train with an updated separation vector. Here, we provide an open-source software and a tutorial that guides the user through i) the parameters and steps of the decomposition algorithm, and ii) the manual editing of motor unit pulse trains. Further, we provide simulated and experimental EMG signals recorded with grids of surface electrodes and intramuscular electrode arrays to benchmark the performance of MUedit. Finally, we discuss advantages and limitations of the blind-source separation approach for the study of motor unit behaviour during tonic muscle contractions.

Deep fakes Detection Using Human Eye Blinking Pattern: Deep Vision

Abstract: Deepfake technology is developing rapidly and has the ability to create fake videos that pose a threat to people. Modern depth detection methods often rely on facial disparity, but as technology advances these methods become obsolete. In this study, we propose a new method for deepfake detection based on observation of human eye blink patterns. Human eye blinking is a natural and involuntary action that is difficult to accurately replicate in deepfake video. In our study, we used the unique characteristics of individual blink patterns, which are influenced by many factors such as genetics, muscle tone and unconscious reflexes. We use computer vision and machine learning techniques to extract and identify these patterns from video clips. Our preliminary tests show good results in detecting deepfakes with high accuracy. We are focused on continuing to support the fight against the spread of fraud by focusing on a part of human behaviour that is difficult to replicate. This approach has the potential to improve existing tools for in-depth discovery and increase the overall security and reliability of multimedia content in the digital age. This research opens new avenues for the development of more robust, reliable and flexible deep recognition technologies. This represents a significant step forward in the ongoing fight against malicious misuse of electronic devices.

CEREBRAL PALSY. RISK FACTORS, REHABILITATION FEATURES (LITERATURE REVIEW)

The review presents current data on cerebral palsy, a disease that is quite common and characterized by multifactorial etiology, has a complex pathogenesis mechanism based on neuromotor disorders, resulting in impaired motor function, muscle tone and posture. Motor disorders most often characteristic of this pathology are accompanied by impaired sensitivity, perception and the development of secondary problems – disorders of the musculoskeletal system. Given the relevance and ongoing scientific research in this area, rehabilitation measures to restore functional activity among patients using modern physical methods, physical therapy, kinesiotaping are of great interest. KEYWORDS: cerebral palsy, neuromotor disorders, childhood, kinesiotaping, rehabilitation, physical therapy, physical methods of exposure, muscle tone, spasticity, sensitivity.

A Child with Distal (Type 1) Renal Tubular Acidosis Presenting with Progressive Gross Motor Developmental Regression, Medullary Nephrocalcinosis, and Acute Renal Failure - A Case Report

Background: Distal renal tubular acidosis (dRTA) is a condition characterized by the impaired ability to secrete hydrogen ions from the distal tubule. In pediatric patients, common clinical features of dRTA include excessive urine production (polyuria), frequent nighttime urination (nocturia), poor growth and weight gain (failure to thrive), difficulty with bowel movements (constipation), abnormal breathing, and the presence of kidney stones (nephrolithiasis). While urinary tract infections (UTIs) are frequently associated with dRTA, renal failure is uncommon and seldom reported in children. Case Presentation: A 10-year-old girl was referred for the evaluation due to a progressive loss of gross motor milestones over a period of 3 years. She also experienced an acute episode of paralysis and was found to have bilateral medullary nephrocalcinosis (right staghorn calculus) accompanied by moderate renal failure and a UTI. Her development in other areas was appropriate for her age. Importantly, there was a history suggestive of excessive urine production (polyuria), increased thirst (polydipsia), and frequent nighttime urination (nocturia). Physical examination revealed proximal myopathy, characterized by a waddling gait and a positive Gower’s sign, as well as diminished reflexes and muscle tone in the lower limbs. Laboratory tests indicated the presence of sepsis (total leukocyte count – 26,660, CRP-174.29) and elevated renal parameters (serum creatinine – 4.27) along with active urinary abnormalities. Urine culture and sensitivity testing showed significant growth of Escherichia coli (&gt;100,000 CFU). A computed tomography scan of the kidneys, ureters, and bladder revealed a staghorn calculus on the right side, as well as bilateral medullary nephrocalcinosis and swollen kidneys. The patient was diagnosed with dRTA based on several factors, including hypokalemic hyperchloremic metabolic acidosis with a normal anion gap, high urine pH, borderline hypercalciuria, presence of medullary nephrocalcinosis, and after ruling out other potential differential diagnoses. Following treatment for the UTI and sepsis, as well as standard treatment for dRTA, the child exhibited symptomatic improvement. Her creatinine levels returned to 0.8 mg/dL, and the septic markers declined to normal levels. To further investigate the cause of the initial decline in renal function in addition to the UTI, a renal biopsy was performed. Conclusion: This case report emphasizes the significance of including medullary nephrocalcinosis and renal tubular acidosis in the list of potential diagnoses for patients presenting with progressive gross motor developmental regression, acute flaccid paralysis, and proximal myopathy. Timely identification of these conditions can help avoid unnecessary and expensive investigations, while also facilitating prompt clinical recovery in affected children. Early diagnosis plays a crucial role in guiding appropriate management strategies and improving patient outcomes.

Insights into The Prenatal and Postnatal Knowledge &amp; Critical Observations of Parents with Children who Have Down Syndrome: A Single Center Study

Introduction: Down syndrome (DS) is one of the many genetic syndromes commonly confronted by pediatricians. These people commonly share a few features which include a low level of muscle tone (hypotonia), learning disabilities, and abnormalities of the cranium and facial parts. Aims and Objectives: To assess the pre and postnatal knowledge, of parents with Down syndrome children. Place and Duration of study: This descriptive cross-sectional study was conducted in Shifa International Hospital (SIH), by Final year medical students, in association with the Cytogenetics Department. between December 2019 to September 2021 Material and Methods: All the chidren diagnosed with Down Syndrome at the SIH and their parents were invited to participate in our study. Convenience sampling was used depending solely on the number of parents who had accepted our invitation. A total sample size of 35 was included, of which 15 agreed to participate. A detailed questionnaire having both close ended and open questions in English and Urdu was filled out by those parents who consented. Data was entered and analysed using SPSS version 24.0. pvalue ?0.05 was taken as significant. Results: Our results showed that 11 of the 15 DS children i.e., 73.3% were male and 4 out of 15 i.e., 26.6% were females. None of these children had siblings with the same disorder. 13 of the 15 cases (86.6%) were diagnosed post- natally only 2 cases (13.3%) pre-natally. All the cases i.e., 100% were diagnosed by a pediatrician and none were diagnosed by an obstetrician. Surprisingly increasing age of either parent seemed to increase the incidence of DS offspring. 60.0% (9 of the 15) of parents did not know the condition could be diagnosed prenatally. While 10 of 15 (66.6%) of them were aware of its general complications. Answering open ended questions parents identified the lack of awareness, special educational institutes, and presence of communication gap between them and doctors as some of the factors that hindered the welfare of DS children. Conclusion: Only one parent knew about DS complications pre-natally and only a few were aware that a pre-natal diagnosis could be formed. Postnatal knowledge of parents was sketchy also, especially regarding the future complications faced by DS children, Parents critically observed insufficient public awareness, societal taboos, paucity of local DS data and prenatal medical DS training, and consequently lack of govermnnental support required by special needs DS children in our country.

Atypical isolated cataplexy: two case reports and a mini-review

ABSTRACT Cataplexy is the sudden loss of muscle tone often provoked by emotion such as laughter or excitement. Cataplexy is one of the essential diagnostic features of Narcolepsy type 1 (NT1). We describe two cases of isolated cataplexy with different outcomes, highlighting the diagnostic and prognostic challenges. There is conflicting literature as to whether it is a legitimate standalone diagnosis or an early warning sign of narcolepsy. Our cases do not fit with current diagnostic criteria for narcolepsy, yet still share some clinical or laboratory features. These ambiguous cases question what the mechanistic relationship between narcolepsy and cataplexy may be.

Isolated REM Sleep without Atonia Is Not Equivalent to REM Sleep Behavior Disorder in Early-Stage Parkinson's Disease.

In early-stage Parkinson's disease (PD), rapid eye movement (REM) sleep behavior disorder (RBD) predicts poor cognitive and motor outcome. However, the baseline significance and disease evolution associated with isolated REM sleep without atonia (iRWA, ie, enhanced muscle tone during 8.7% of REM sleep, but no violent behavior) are not well understood. The objective is to determine whether iRWA was a mild form of RBD and progressed similarly over time. Participants with early PD (<4 years from medical diagnosis) were included from 2014 to 2021 in a longitudinal study. They underwent interviews and examinations in the motor, cognitive, autonomous, psychiatric, sensory, and sleep domains every year for 4 years along with a video polysomnography and magnetic resonance imaging examination of the locus coeruleus/subcoeruleus complex (LC/LsC) at baseline. The clinical characteristics were compared between groups with normal REM sleep, with iRWA and with RBD, at baseline and for 4 years. Among 159 PD participants, 25% had RBD, 25% had iRWA, and 50% had normal REM sleep. At baseline, the non-motor symptoms were less prevalent and the LC/LsC signal intensity was more intense in participants with iRWA than with RBD. Over 4 years, participants with normal REM sleep and with iRWA had a similar cognitive and motor trajectory, whereas participants with RBD had greater cognitive and motor decline. We demonstrated that iRWA is frequent in early PD, but is not a milder form of RBD. Both groups have distinct baseline characteristics and clinical trajectories. They should be distinguished in clinical routine and research protocols. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Randomized Controlled Trial Protocol on the Effects of a Sensory Motor Intervention Associated with Kangaroo Skin-to-Skin Contact in Preterm Newborns

There is still very limited evidence on the effects of neonatal interventions on infant neurodevelopmental outcomes, including general movements (GMs). This research will primarily assess the effects of a sensory motor physical therapy intervention combined with kangaroo skin-to-skin contact on the GMs of hospitalized preterm newborns. Secondary outcomes include body weight, posture and muscle tone, behavioral state, length of hospital stay, and breastfeeding. This study protocol details a two-arm parallel clinical trial methodology, involving participants with a postmenstrual age of 34–35 weeks admitted to a Neonatal Intermediate Care Unit (NInCU) with poor repertoire GMs. Thirty-four participants will be randomly assigned to either the experimental group, receiving a 10-day sensory motor physical therapy associated with kangaroo skin-to-skin contact, or the control group, which will only receive kangaroo skin-to-skin contact. The study will measure GMs (primary outcome), and body weight, posture and muscle tone, behavioral state, length of hospital stay, and breastfeeding (secondary outcomes). Data collection occurs in the NInCU before and after the intervention, with follow-up measurements post discharge at 2–4 weeks and 12–15 weeks post-term. SPSS will be used for data analyses. The results will provide novel information on how sensory motor experiences may affect early neurodevelopment and clinical variables in preterm newborns.

Comparative characteristics of cervical sagittal balance parameters and atlantoaxial instability criteria in normal and Down syndrome children

BACKGROUND: Sagittal balance of the spine has received considerable development in recent years. However, most studies focused on the assessment of vertebral–pelvic parameters. The cervical spine has long received insufficient attention from researchers, but this trend has been changing. The study of cervical sagittal balance in children with Down syndrome is beneficial in approaching the preconditions of atlantoaxial instability. AIM: To perform a comparative analysis of cervical sagittal balance parameters and atlantoaxial instability criteria in normal and Down syndrome children. MATERIALS AND METHODS: Radiographs of the cervical spine in the neutral position in lateral projection and postural radiographs of 110 pediatric patients were analyzed retrospectively. The patients were divided into two groups: group 1 (normal), 60 children aged 4–17 years without spinal pathology, and group 2 (Down syndrome), 50 children aged 4–17 years with Down syndrome. The parameters of cervical sagittal balance (Oc-C2, Oc-C7, C1-C2, C2-C7, C2-C7H, C7S, Th1S, TIA, NT) and criteria for atlantoaxial instability (Nakamura angle, ADI, SAC-C1, SAC-C1/SAC-C4) were obtained, and data was statistically analyzed. RESULTS: Significant differences in the parameters C7S, Th1S, and TIA increased in children with Down syndrome. These parameters are involved in cervical lordosis; however, no significant differences in cervical lordosis angles were found. Furthermore, significant differences were noted in the criteria of atlantoaxial instability ADI, SAC-C1, and SAC-C1/SAC-C4 toward their decreasing in children with Down syndrome. CONCLUSION: In patients with Down syndrome, the indices of cervical lordosis are statistically greater than those in normal children. Moreover, the parameters of cervical lordosis in patients with Down syndrome do not differ from those in normal children. Therefore, during flexion, subcompensation of the cervical spine is observed in children with Down syndrome. Given the statistically smaller indicators ADI, SAC-C1, SAC-C1/SAC-C4, low neck muscle tone, and ligamentous hypermobility, these abnormalities can be considered as congenital predisposition factors for atlantoaxial instability in children with Down syndrome.

Evaluation of a Combination Approach to Improving Muscle Tone and Decreasing Subcutaneous Tissue Thickness Using a Sequential, Dual-Modality, Energy-Based Device

Abstract Background The body shaping market has long been at the forefront of the aesthetic industry. With technological advances, patient demand for body sculpting in terms of reduction in subcutaneous tissue and enhancement of muscle has seen continual growth. Several devices have emerged in the space, however few that achieve both SQR (Subcutaneous Tissue Reduction) and VMI (Voluntary Muscle Increase) as measured by thickness, during the same treatment session. Objectives This article presents the results of a pilot study on a unique approach to subcutaneous tissue reduction and increasing muscle thickness using a dual modality, energy-based device. Methods 12 compliant subjects (8 female and 4 male with an average age of 40 years were enrolled in this single center, prospective study. All subjects were treated with the dual modality device (850 nm super-luminescent diode matrix and electrical muscle stimulation) with external applicators being placed over the lower abdomen. The subjects received five (5) weekly treatments. Ultrasound measurements, photos, weight and waist measurements were taken at baseline, prior to the start of the 5th treatments and at the two (2) week and two (2) month follow-up visits. Results At the two (2) month follow up visit, the average Subcutaneous Tissue Reduction (SQR) was 34.03% and the Voluntary Muscle Increase (VMI) measured 22.97% in all subjects who completed the study. All subject and physician evaluations rated results as satisfactory or better. There were no complications. Conclusions Preliminary data shows this dual-modality, Electrical Muscle Stimulation/Super Luminescent Diode Matrix (EMS/SDM) system provides both a safe and effective treatment for the reduction of subcutaneous tissue thickness and increase in muscle definition and thickness. Objective and subjective evaluations demonstrated high levels of efficacy and satisfaction in all subjects.

Prediction of Cerebral Palsy and Other Motor Developmental Trajectories in High-Risk Neonate Using the Rapid Neurodevelopmental Assessment (RNDA) and Prechtl’s Method of Qualitative Assessment of General Movement (GMsA)

Background: The integration of the RNDA and Prechtl's Method offers a promising approach to identify high-risk neonates and predict their motor developmental trajectories. This early identification can guide clinicians in providing timely interventions, improving the long-term outcomes and quality of life for infants affected by CP and other motor disorders. Objective: The study investigates the predictive potential of the Rapid Neurodevelopmental Assessment (RNDA) and Prechtl’s Method of Qualitative Assessment of General Movement (GMsA) in high-risk neonates. Method: This longitudinal cohort study at Dhaka Shishu Hospital (January 2016-December 2017) enrolled 16 high-risk neonates. GMsA and RNDA were conducted from birth to 20 weeks post-term age. Muscle tone, primitive reflexes, gross and fine motor skills were evaluated. Impending CP diagnosis was at 1 year. Statistical analysis was performed using SPSS 23.0. Results: The study investigates the association between various developmental markers and the risk of cerebral palsy (CP) in infants. Results reveal a higher prevalence of muscle tone impairment in impending CP cases across preterm, term, and post term ages. Sensitivity, specificity, and predictive values for CP prediction based on muscle tone are presented, showing significant associations. Primitive reflexes also demonstrate higher impairment rates in impending CP cases across different age points, with corresponding sensitivity, specificity, and predictive values. Gross motor and fine motor impairments exhibit significant associations with impending CP, along with predictive values. The distribution of categorical scores for GMsA and RNDA across various age points emphasizes the prevalence of impairments in impending CP cases. Findings indicate a strong association between GMsA scores and CP risk, with significant predictive capabilities across different visits. Overall, the study highlights the utility of these developmental markers in predicting CP ....

Pre-op considerations in neuromuscular scoliosis deformity surgery: proceedings of the half day course at the 58th annual meeting of the Scoliosis Research Society.

Scoliosis is a common complication of neuromuscular disorders. These patients are frequently recalcitrant to nonoperative treatment. When treated surgically, they have the highest risk of complications of all forms of scoliosis. While recent studies have shown an improvement in the rate of complications, they still remain high ranging from 6.3 to 75% depending upon the underlying etiology and the treatment center (Mohamad et al. in J Pediatr Orthop 27:392-397, 2007; McElroy et al. in Spine, 2012; Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Cognetti et al. in Neurosurg Focus 43:E10, 2017). For those patients who are able to recover from the perioperative period without major complications, several recent studies have shown decreased long-term mortality and improved health-related quality of life in neuromuscular patients who have undergone spine fusion (Bohtz et al. in J Pediatr Orthop 31:668-673, 2011; Ahonen et al. in Neurology 101:e1787-e1792, 2023; Jain et al. in JBJS 98:1821-1828, 2016). It is critically important to optimize patients preoperatively to minimize the risk of post-operative complications and maximize long-term outcomes. In order to do so, one must familiarize themselves with the common complications and their treatment. The most common complications are pulmonary in nature. With reported rates as high as 23-29%, pre-operative optimization should be employed for these patients to minimize the risk of post-operative complications (Sharma et al. in Eur Spine J 22:1230-1249, 2013; Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). The next most common cause of complications are implant related, with 13-23% of patients experiencing an implant-related complication that may require a second procedure (Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Sharma et al. in Eur Spine J 22:1230-1249, 2013) Therefore optimization of bone quality prior to surgical intervention is important to help minimize the risk of instrumentation failure. Optimization of muscle tone and spasticity may help to decrease the risk of instrumentation complications, but may also contribute to the progression of scoliosis. While only 3% of patients have neurologic complication, significant equipoise remains regarding whether or not patients should undergo prophylactic detethering procedures to minimize those risks (Sharma et al. in Eur Spine J 22:1230-1249, 2013). Although only 1.8% of complications are classified as cardiac related, they can be among the most devastating (Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). Simply understanding the underlying etiology and the potential risks associated with each condition (i.e., conduction abnormalities in a patient with Rett syndrome or cardiomyopathies patients with muscular dystrophy) can be lifesaving. The following article is a summation of the half day course on neuromuscular scoliosis from the 58th annual SRS annual meeting, summarizing the recommendations from some of the world's experts on medical considerations in surgical treatment of neuromuscular scoliosis.

Myotonometry in machinery operators and its relationship with postural ergonomic risk.

To analyze the association between occupational ergonomic risk, personal characteristics, and working conditions with the biomechanical properties of stiffness and muscular tone in the paravertebral muscles of electric pallet jack and forklift operators in the industrial sector. A total of 75 industrial sector machine operators were evaluated in 2021. Personal characteristics and working conditions were assessed through a questionnaire. Ergonomic risk was assessed using the Rapid Entire Body Assessment (REBA) method, and biomechanical properties of stiffness and muscular tone were obtained using the Myoton Pro device. Stiffness in paravertebral muscles was compared based on the operated machine and observed ergonomic risk. A multilevel linear regression model was employed to quantify the relationship, with mean differences and 95% CI calculated. Very high ergonomic risk was found in 75% of the electric pallet truck drivers. In this group with the highest ergonomic risk, an association between biomechanical properties and older workers was observed. Additionally, among electric pallet truck drivers, stiffness (mean difference 335.9N/m, 95% CI: 46.4 (3.4 to 110.0), P < 0.05) and paravertebral muscle tone (mean difference 17.5 Hz, 95% CI: 1.4 (0.1 to 3.4), P < 0.05) showed statistically significant differences in the very high ergonomic risk category compared to the high-risk category. No significant differences were observed in any of the analyzed variables among forklift drivers. Workers operating electric pallet trucks with very high ergonomic risk according to the REBA method and aged over 40 yr are associated with increased muscle stiffness and tone.