Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up

The aim of this study was to determine the sustained influence of personalized neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy (mainly, proprioceptive neuromuscular facilitation (PNF)) on the activity of muscle motor units acting antagonistically at the wrist and the ankle in a large population of post-stroke patients. Clinical evaluations of spasticity (Ashworth scale), manual muscle testing (Lovett scale), and surface electromyography recordings at rest (rEMG) and during attempts of maximal muscle contraction (mcEMG) were performed three times in 120 post-stroke patients (T0: up to 7 days after the incidence; T1: after 21 days of treatment; T2: after 60 days of treatment). Patients (N = 120) were divided into two subgroups—60 patients received personalized NMFES and PNF treatment (NMFES+K), and the other 60 received only PNF (K). The NMFES+K therapy resulted in a decrease in spasticity and an increase in muscle strength of mainly flexor muscles, in comparison with the K group. A positive correlation between the increase of rEMG amplitudes and high Ashworth scale scores and a positive correlation between low amplitudes of mcEMG and low Lovett scale scores were found in the wrist flexors and calf muscles on the paretic side. Negative correlations were found between the rEMG and mcEMG amplitudes in the recordings. The five-grade alternate activity score of the antagonists’ actions improved in the NMFES+K group. These improvements in the results of controlled NMFES treatment combined with PNF in patients having experienced an ischemic stroke, in comparison to the use of kinesiotherapy alone, might justify the application of conjoined rehabilitation procedures based on neurophysiological approaches. Considering the results of clinical and neurophysiological studies, we suppose that NMFES of the antagonistic muscle groups acting at the wrist and the ankle may evoke its positive effects in post-stroke patients by the modulation of the activity more in the spinal motor centers, including the level of Ia inhibitory neurons, than only at the muscular level.

Manual Testing of Respiratory Muscles in Adults with Asthma: A Intra and Interrater Reliability and Validity Study

Background: Manual Muscle Testing (MMT) is a useful tool to evaluate ventilatory mechanics in adults with asthma. However, in the reviewed literature, there are few studies that report psychometric features of this test. Therefore, the present study aimed to evaluate MMT reliability and validity in respiratory muscles in adults with asthma.Methods: It was a cross-sectional study. Muscle strength (MMT and static respiratory pressures), sociodemographic and anthropometric variables related to the disease were evaluated. Measurements were carried out by two independent evaluators The reliability of MMT was analyzed with the weighted kappa and the convergent validity was evaluated by comparing the MTT and the respiratory pressure measurements using Pearson's correlation coefficient. The level of significance was p <0.05. Results: Twenty-six adults with stable asthma participated in the study. The intrarater reliability for MMT was between moderate and substantial (kappa=0.45-0.88) for all evaluated muscles while the interrater reliability was slight and fair for intercostal muscles (kappa=0.07-0.24), and fair and substantial (kappa=0.36-0.75) for other muscles. The convergent validity of MMT and respiratory pressures was low (r=0.20-0.48).Conclusions: MMT is a reliable measurement that can be used to evaluate respiratory muscle strength in adults with asthma. This study support MMT application for respiratory muscles at clinical settings when more objective measures such as MIP and MEP are not available. Considering that the MMT is a useful, practical, low-cost tool commonly used by physiotherapists, future studies could evaluate the convergent validity compared with dynamometry or electromyography of the respiratory muscles.

Changes in Function and Muscle Strength of Encephalitis Survivors After Inpatient Rehabilitation

Objective To investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization.Methods Data of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed.Results Most of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization.Conclusion Encephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.

Comparison of Gluteal Muscle Strengthening versus Conventional Isometrics in Pain Management of Piriformis Syndrome

Aim: To analyze the effectiveness of gluteal muscles strengthening in piriformis syndrome. Study design: Experimental study Place and duration of study: Department of Physiotherapy, Mayo Hospital, Lahore from 1st February 2019 to 31st July 2019. Methodology: Fifty patients presenting with piriformis syndrome were enrolled. They were divided in two groups. Control group received piriformis stretching, ultrasound and conventional isometrics. Experimental group received piriformis stretching, ultrasound and a gluteal strengthening program. The baseline parameters were assessed using the Visual Analogue Scale (VAS) and Manual Muscle Testing (MMT). Patients were treated for 40 minutes 3 times a week for 4weeks. Results: Reduction in intensity of pain as well as improvement in ROM was seen in both groups. There was significant improvement in lateral rotation of hip in experimental group, and as piriformis is also a lateral rotator of hip joint, hence improvement in range of lateral rotation shows that a gluteal strengthening program has significant in increasing ROM of joint. There was significant improvement in MMT grade of gluteal muscles comparatively in the experimental group. Conclusion: Experimental group showed improvements in decreasing pain and improvements in strength, with a significant improvement in lateral rotation shows that gluteal strengthening program can be used to treat pts with piriformis syndrome. Key words: Manual Muscle Testing, Visual analog scale

Comparison of the Effectiveness of Isometric, Isotonic Eccentric And Isotonic Concentric Exercises in Pain Management

Aim: To compare the effect of isometrics, isotonic concentric and isotonic eccentric strengthening techniques on patients diagnosed with subacromial impingement syndrome. Methods: The study design used is randomized clinical trial. 36 patients are allocated in 3 groups with 12 patients in each group with age limit from 30-50 years treated for 6 weeks on alternate days with isometrics, isotonic concentric and isotonic eccentric with baseline exercise plan respectively. Each patient received 18 sessions of exercise plan. Intervention plan is divided into 2 phases, with each phase of 3 weeks. Outcome measuring tools used are Numeric Pain Rating Scale(NPRS) to measure pain, Manual Muscle Testing (MMT) to measure muscle strength was assessed at Day 0, Week3, and Week 6. Result: Results are generated by using SPSS 21. Post treatment ONE WAY ANOVA showed no significant difference in reduction of pain assessed by NPRS in GROUP1 treated with isometric exercise plan and GROUP2 & GROUP3 treated with isotonic eccentric and isotonic concentric exercise plan respectively. Post treatment One way anova showed p value .117 which is greater than 0.05. Post treatment ONE WAY ANOVA showed significant difference for strength of all the rotator cuff muscles. Conclusion: Isometric exercise plan conclusively proved to be better as compared to isotonic eccentric and isotonic concentric program in strengthening of patients with subacromial impingement syndrome. Keywords: Subacromial Impingement Syndrome, Isometric, Isotonic Eccentric, Isotonic Concentric.

Effect of Isometric and Isotonic Exercise Program on Increased Strength of Quardriceps Muscles in Osteoarthritis Patients in Singgasana Rama Physiotherapy Clinic Blitar

Background: Osteoarthritis is a disease of the joints that can cause disability and is progressive in the joints which cause changes in the water content, proteoglycin content, and collagen in the joints. One of the ways to improve functional ability in osteoarthritis cases is to use isotonic and isometric training exercise. Pain is a clinical symptom of knee osteoarthritis, limiting movement due to pain over time will cause rehabilitation problems such as impaired flexibility and stability, reduction of muscle mass (atrophy). Mild and moderate intensity quadriceps strength training is effective at achieving optimal muscle strength and function without causing significant muscle damage. Destination: The purpose of this study was to analyze the effect of isotonic and isometric exercises on muscle strength. Research methods: This study uses a pre-experimental research type using "One Group Pre - test and Post - Test". This research has carried out the first observation (pretest) so that researchers can test the changes that occur after the treatment, and the control group. Result: with the Wilcoxon signed rank test test the isometric and isotonic groups had p = 0.000 while the control group had a significance value of p = 1,000; and the 3 groups test has different values, namely: isotonic exercise has a value of 27.67; isometric; 28.60; and control 12.73. The conclusion that can be concluded that the value of isometric training has the highest value, namely 28.60 which means it is the most effective exercise to increase the value of Manual Muscle Testing. Conclusion: There is an effect of giving isometric and isotonic exercises in strengthening the quadriceps muscles.

Gait Ability and Muscle Strength in Institutionalized Older Persons with and without Cognitive Decline and Association with Falls

Falls are a complex problem, given their multifactorial nature, the comorbidities involved, and due to the dependency of older persons living in nursing homes. Risk, fear of falling, falls themselves, and their recurrence are the main factors behind fragility fractures, lack of independence, and increases in pain prevalence, and other comorbidities in older populations. The objectives of the present quantitative and longitudinal study were: (a) to characterize the cognitive state and fall frequency of older persons living in nursing homes; (b) to analyze the relationship between cognitive status and some fall risk factors; and (c) to associate cognitive decline, gait ability, and muscle strength of the examined institutionalized older persons with fall occurrence and recurrence over 12 months. The participants were 204 older persons who lived in Portuguese nursing homes, and data were collected from January 2019 to February 2020 by consulting medical records and applying the following instruments: the Mini-Mental State Examination, Timed Up and Go Test, and Medical Research Council Manual Muscle Testing Scale. Fall prevalence, assessed in two periods, 12 months apart, was similar in both samples (with and without cognitive decline) and close to 42%, and the annual recurrence rate was 38.3%. Older persons with no cognitive decline showed an association between gait speed and occurrence of first fall and recurrent fall (p < 0.05). Muscle strength and use of gait aid devices were not related to falls and their recurrence, regardless of mental state.

The Association Between Muscular Ultrasonographic Alterations and Clinical Symptoms in Patients With Inflammatory Myopathy

Purpose: We evaluated the ability of muscle ultrasound (MUS), a non-invasive and simple tool, to distinguish between healthy subjects and individuals with inflammatory myopathy. Methods: This study was conducted on 17 patients with recently diagnosed biopsy-proven inflammatory myopathies (12 dermatomyositis, five polymyositis) compared with 17 age- and gender-matched healthy control adults. All patients underwent clinical assessments, including manual muscle testing (MMT) and hand-held dynamometry, as well as MUS evaluations, including thickness and echointensity (EI) in predefined muscle groups. Results: The disease duration was seven months (interquartile range: 3-11). Except for biceps and gastrocnemius, the patients' muscles had significantly higher EI and lower thickness in comparison with the controls, The EI sum-score manifested the highest area under curve (AUC) in comparison with the sum-scores of other variables (EI vs. MMT: AUCs-difference = 0.18, p < 0.01; EI vs. dynamometry: AUCs-difference = 0.14, p = 0.02; EI vs. thickness: AUCs-difference = 0.25, p < 0.01). Conclusion: EI of muscles differed significantly between healthy individuals and those with inflammatory myopathies and may potentially serve as a useful diagnostic biomarker.

Comparison between qualitative and quantitative measurement of strength deficit in shoulder flexors of young females: a cross- sectional study

Objective: To compare accuracy of manual muscle testing in detection of strength differences across grade 4 and 5 at different percentage deficits of dynamometric mean in shoulder flexors of young females. Methods: Cross sectional research design, conducting primary analysis of strength of shoulder flexors measured through manual muscle testing and hand-held dynamometer. Three hundred young healthy females without any ailment of upper extremity or generalized health problem were selected from University of South Asia and Association of Fatima Jinnah Old Graduates, Lahore. Non-probability convenient sampling technique was used. The age group selected was 18-39 years. The strength of shoulder flexors measured through manual muscle testing and hand-held dynamometer was main outcome measure. Results: The overall diagnostic accuracy of manual muscle testing showed better results at 10% dynamometric measures. It was 63.33%(95% CI: 57.74%, 68.59%) in non-dominant shoulder flexors and 61.67% (95% CI: 56.05%, 66.99%) in dominant shoulder flexors. The positive predictive value (PPV) and specificity of manual muscle testing was better at 10% strength deficit in comparison with dynamometric measures, whereas negative predictive value (NPV) and sensitivity was better at 20% strength deficit. Contrasting association was found between positive predictive value (PPV) and sensitivity, negative predictive value and specificity. Conclusion: The subjective area of grade 4 and 5 showed better, although not ideal, diagnostic worth at 10% deficit of dynamometric measures in shoulder flexors. Further exploration through study of contrasting trends between PPV and sensitivity by subgroup analysis is required. Continuous...