A Pragmatic Approach to the Management of Severe Awake Bruxism in an Adolescent with Cerebral Palsy and Global Developmental Delay

Cerebral palsy is a neurological and motor condition characterised by muscle balance and posture impairments. Bruxism and malocclusion were frequently observed in patients with cerebral palsy, in contrast to other oral anomalies. The report outlines how severe awake bruxism is managed in a 16-year-old Korean boy who has nonverbal spastic cerebral palsy and global developmental delay. The treatment protocol involved the fabrication of soft occlusal splints of three and four millimetres in thickness, followed by the placement of stainless-steel crowns on all first permanent molars whilst video recording and a bruxism diary was kept. Fixed restorations demonstrate increased endurance in withstanding bruxism force in persons who are dependent on their caretaker.

Isokinetic and functional shoulder outcomes after arthroscopic capsulolabral stabilization

Introduction Shoulder stability is secured by dynamic and static stabilizers. Rotator cuff is responsible for dynamic stabilization. In cases of shoulder instability their activity is disturbed. Capsulolabral repair restores mainly static stabilization. This surgery treatment technique of shoulder instability was first described by Bankart in 1923. His idea, with further modifications, is commonly used up to this day. Evaluation of muscle shoulder recovery after stabilization should be one of the important criteria to allow patient to return to sport and work. However, not much isokinetic assessment after capsulolabral repair was described. The aim of this study were the following: the comparative assessment of the shoulder rotatory strength in patients following arthroscopic capsulolabral repair of unilateral anterior traumatic instability and clinical assessment with comparison of pre and post-operative results. Material and methods Forty-five patients, 14 women and 31 men, with an average follow-up of 4.4 years were tested bilaterally for internal and external rotation strength at four angular velocities. ASES and UCLA tests were collected before and after surgery. Results The values of peak moment and muscle power parameters were slightly lower for an operated shoulder in comparison to a healthy shoulder for the external rotation. Total work parameter in external rotation was significantly lower for the operated shoulder in comparison to the non-operated side. The internal/external muscle group balance was lower for the operated shoulder in comparison to reference values in the women group. Furthermore, both ASES and UCLA scores were significantly higher after operation. Conclusions After arthroscopic capsulolabral shoulder stabilization, slight differences in isokinetic evaluation, especially in external shoulder rotation, occur. It affects rotators muscle balance. In functional evaluation significant improvement in shoulder function occurs.

Continued Breastfeeding and the Influence of Fatty Acids on Infant Neurological Maturation: a Systematic Review

Breast milk is considered a complete food and the immediate effects of breastfeeding on the babies’neurological development are already recognized. This study aimed to describe the importance of continued breastfeeding and the influence of fatty acids on the infant's neurological maturation. For the study development, a systematic review was adopted, in which online search bases such as SciELO, PubMed and Google Scholar were used and whose publications comprised the period from 2008 to 2021. Out of the 969 articles found, 47 of them were selected that fulfilled the objective of the study. Breast milk is essential for the child's development and the benefits extend into adulthood, such as less chance of developing obesity, cardiovascular diseases, diabetes, hypersensitivity reactions, respiratory and gastrointestinal diseases. The mother-child bond is strengthened, enabling the child to develop emotionally, in addition to reducing the incidence of cancer in the mother. Breast milk has essential fatty acids (AGEs), such as linoleic and alpha-linolenic acid , which are essential for the development of neurological, visual and cellular activities. These compounds are present in breast milk in greater proportion than other types of milk and the more the mother ingests foods such as deep and cold water fish, seeds, flaxseed, chia, the greater the presence of AGEs and more benefits for the embryo-fetal period and for the infant. Thus, encouraging the breast milk consumption through suction improves stomatognathic functions, promoting harmonious orofacial growth, muscle balance, breathing coordination and proper tongue posture. Keywords: Milk, Human. Speech, Language and Hearing Sciences. Stomatognathic System. Resumo O leite materno é considerado um alimento completo e os efeitos imediatos da amamentação no desenvolvimento neurológico dos bebês já é reconhecido. Esse estudo teve como objetivo descrever a importância da amamentação continuada e a influência dos ácidos graxos na maturação neurológica do lactente. Para o desenvolvimento do estudo, adotou-se uma revisão sistemática, no qual foram utilizadas as bases de busca on line como SciELO, PubMed e Google Acadêmico e cujas publicações compreenderam o período entre de 2008 a 2021. Dos 969 artigos encontrados, foram selecionados 48 que atenderam ao objetivo do estudo. O leite materno é fundamental para o desenvolvimento da criança e os benefícios se estendem até a vida adulta, tais como menor chances de desenvolver obesidade, doenças cardiovasculares, diabetes, reações de hipersensibilidade, doenças respiratórias e gastrintestinais. O vínculo mãe-filho fica fortalecido, dando condições à criança de se desenvolver emocionalmente, além de diminuir a incidência de câncer na mãe. O leite materno possui ácidos graxos essenciais (AGE), como linoleico e linolênico, que são fundamentais para o desenvolvimento das atividades neurológicas, visuais e celulares. Esses compostos estão presentes no leite materno em maior proporção que outros tipos de leite e quanto mais a mãe ingerir alimentos como peixes de águas profundas e frias, sementes, linhaça, chia, maior será a presença dos AGE e mais benefícios para o período embriofetal e para o lactente. Desta forma incentivar o consumo de leite materno de forma prolongada, pela sucção melhora as funções estomatognáticas, promovendo crescimento orofacial harmonioso, equilíbrio da musculatura, coordenação da respiração e postura adequada de língua. Palavras-chave: Leite Humano. Fonoaudiologia. Sistema Estomatognatico.

THE DIFFERENCE OF MUSCULOSKELETAL DISORDERS BEFORE AND AFTER WORKPLACE STRETCHING EXERCISE

Background: Workers who undertake occupations that require bending, climbing, crawling, reaching, twisting, excessive activity, or repeated movements may suffer from musculoskeletal disorders (MSDs). MSDs can be prevented by doing Workplace Stretching Exercise (WSE) which is useful for minimizing the risk of musculoskeletal injury, fatigue reduction, muscle balance, and posture improvement, and muscle coordination improvement. Purpose: To analyze the difference before and after giving WSE to the reduction of MSDs complaints. Method: This research takes a quantitative approach, utilizing a quasi-experimental design in one group before and after WSE administration. Total sampling is used for sampling. The respondents of this study were 34 workers in the production division of PT Crown Pratama in 2021. The T-paired test was utilized as a statistical test in this study. Result: The results of the univariate test mean MSDs complaints before and after WSE administration were 42.97 and 36.29. Conclusion: The bivariate test revealed differences in complaints of Musculoskeletal Disorders (MSDs) before and after workplace stretching exercise.

Effect of 12 Weeks of Core Stability Exercises on Functional Movement and Balance of Women Working in Hospitals

Objective: This study aims to assess the effect of 12 weeks of core stability exercises on functional movement and balance of women working in hospitals. Methods: Participants were 34 women aged 30-50 years working in Imam Khomeini Hospital in Tehran, Iran. They were randomly divided into two groups of exercise and control. The exercise group performed core stability exercises for 12 weeks. The functional movement was evaluated using the valid Function Movement Screen (FMS) method. The dynamic balance, power, agility, speed and flexibility of subjects were also measured using Y balance test, Sargent Jump Test, agility T-test, 20-meter running test, and seated bending forward test, respectively before and after exercise. Paired T-test was used to examine the difference between pre- and post-test scores of each group. Analysis of Covariance (ANCOVA) was used to determine the effect of intervention on the study variables. Results: Results of ANCOVA showed that 12 weeks of core stability exercises significantly improved functional movement performance, dynamic balance, power, agility, speed and flexibility in women. Conclusion: Core stability exercises can improve the performance of neuromuscular system leading to proper movement of spinal, pelvic and hip joints, proper muscle balance, enhanced proximal stability, functional strength and resulting in decreased injury.

How the foot and ankle works (mechanics of the foot)

This chapter examines the mechanics of the foot from the clinician’s perspective. The kinematics, kinetics, muscle balance, and stability of the foot and ankle are complex, as the foot has evolved to provide shock absorption, stability, propulsion, and accommodation. It does this by maintaining a stable, balanced structure in all positions of the foot. The mobility of the joints together with their stabilizing structures (the ligaments of the foot), and the complex balance between muscle tension and tendon position relative to the axis of rotation of the joints, are responsible for this function. As a consequence of this complex dynamic structure, the foot stores a significant amount of energy during ambulation, and its efficient use of this is a major reason for the ability of humans to travel long distances.

Rehabilitation Exercises for Dysfunction of the Scapula: Exploration of Muscle Activity Using Fine-Wire EMG

Background: Scapular muscle activity during shoulder exercises has been explored with surface electromyography (EMG). However, knowledge about the activity of deeper-layer scapular muscles is still limited. Purpose: To investigate EMG activation of the deeper-layer scapular stabilizers (levator scapulae [LS], rhomboid major [RM], pectoralis minor [Pm] muscles) together with superficial muscle activity (upper [UT], middle [MT], and lower trapezius [LT] and serratus anterior [SA]) during 4 exercises often used for training scapular function. Based on the amplitude EMG of the deeper-layer muscles, scapular muscle activation ratios for the 4 exercises were calculated, hereby providing knowledge of the optimal muscle balance. Study Design: Descriptive laboratory study. Methods: A total of 26 healthy participants performed 4 shoulder exercises (side-lying external rotation [ER], side-lying forward flexion, prone horizontal abduction with ER, and prone extension) while simultaneously measuring scapular muscle activity. Intramuscular electrodes were used for the deeper layer, in contrast to surface electrodes for the superficial muscles. All data were normalized to percentage of maximal voluntary isometric contraction (%MVIC), and the activation ratios (the muscle activity of the deeper layer relative to the other muscles) were calculated. A 1-way analysis of variance with Bonferroni correction was applied for statistical analysis. Results: Moderate activity was found in all exercises for the LS and RM (25%-45% MVIC). The Pm resulted in low activity during both side-lying exercises (13%-18% MVIC). Ratios involving LS or RM showed values >1 for all exercises (1.28-12.41) except for LS/MT, LS/LT, and LS/RM (0.85-0.98) during side-lying ER, and LS/MT, RM/MT and RM/LS (0.85-0.99) during side-lying forward flexion. Likewise, values <1 were found when MT (0.85) and LS (0.99) were involved with RM in the numerator during side-lying forward flexion. Ratios with Pm in the numerator showed values <1, apart from the ratios with UT and SA in the denominator. Conclusion: The study provides extended knowledge about the deeper-layer scapular muscle activity and related ratios during the 4 shoulder exercises mentioned here. Putting theory into practice, based on our results, we advise both side-lying exercises to be performed to strengthen LT and MT, even in case of hyperactivity of the Pm. However, the 4 exercises should be given carefully to patients with hyperactivity in the LS and/or RM. Clinical Relevance: The findings of this study may assist clinical decision making in exercise selection for restoring scapular function.

8-Year-Old Child with Cerebral Palsy Treated with Pelvic Osteotomies Using 3.5 MM Blade Plate Having Subsequent Bilateral Implant Aseptic Loosening: A Case Report

Background: Cerebral palsy (CP) is a central problem of the brain due to neurological insult that affects muscle posture, tone, and movement, resulting in poor motor control and dysfunctional muscle balance affecting hip joints in the growing child. Surgical treatment of hip and, if present, acetabular dysplasia addresses the femoral neck-shaft angle, appropriate muscle lengthening, and deficiency of acetabular coverage, as necessary. The surgeons perform proximal femoral osteotomies (PFOs) mostly with fixed angled blade plates (ABP) with proven success. The technique using an ABP is common and requires detailed attention to perform and to teach. The Case: In this case, an eight-year-old ambulatory patient with CP underwent bilateral proximal varus femoral derotational and pelvic osteotomies for the neuromuscular hip condition with a 3.5 mm Locking Cannulated Blade System (OP-LCP) by OrthoPediatrics Corp instead of the use of the conventional 4.5 mm ABP procedure, resulting in aseptic loosening. Conclusion: Due to the child’s underdeveloped posture, the surgeon utilized the 3.5 mm instrumentation for a child-size implant, which worked sufficiently for the surgery but may not have loosened if a similar child-size blade plate system of 4.5 mm screws was implanted. While the ABP and OP-LCP systems are fruitful and safe for internal corrections of PFOs, the OP-LCP system may aid the residents in learning the procedure with higher confidence, fewer technical inaccuracies, and refined outcomes. Both systems are safer and viable for the treatment of neuromuscular hip conditions.

Effects of the Proprioceptive Neuromuscular Facilitation Technique on Scapula Function in Office Workers with Scapula Dyskinesis

Background and Objectives; Proprioceptive neuromuscular facilitation (PNF) are effective in improving and maintaining Range of motion(ROM), increasing muscular strength and power, and increasing athletic performance, especially after exercise. The scapula patterns defined in PNF are activated within the upper extremity patterns and scapula motions together. Proper function of the upper extremities requires both motion and stability of the scapula. The purpose of this study was to compare the effects of scapula stabilization exercise training involving muscle strengthening, muscle balance, and movement control exercises on office workers with scapula dysfunction. Materials and Methods: A total of 42 office workers with scapula dyskinesis were recruited and randomly divided into three groups: muscle strengthening exercise group (n = 14), muscle balance exercise group (n = 14), and movement control exercise group (n = 14). The participants underwent 18 sessions (25 min/session, 3 days a week for 6 weeks) of training involving the three types of exercises. Results: The measurement outcomes included the scapula index, measured using a digital Vernier caliper; scapula function, evaluated using the Disability of the Arm, Shoulder, and Hand (DASH) outcome questionnaire (pain and performing, work ability, and sports and art activities); and scapulohumeral movements (scapula upward rotation at humeral abduction angles of 0°, 45°, 90°, 135°, and 180°), evaluated using inclinometers. After the exercise intervention, the scapula index (p = 0.002), DASH pain and performing score (p = 0.000), DASH work ability score (p = 0.000), DASH sports and art activity score (p = 0.027), and scapulohumeral movements (scapula upward rotation at 0° (p = 0.013) and 45° (p = 0.043) humeral abduction) showed significantly greater improvements in the movement control group than in the muscle strengthening and muscle balance groups. Conclusions: Thus, proprioceptive neuromuscular facilitation can be used as a rehabilitation intervention for scapula position and movement, pain reduction, and functional improvement in office workers with scapula dyskinesis.