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.

HANDBALL PLAYER’S RECOVERY AFTER THE INJURY OF THE ANTERIOR CRUCIATE LIGAMENT

In this study, we have tried to make a recovery treatment with kinetic exercises, for the postoperative recovery of the rupture of the anterior cruciate ligament and its reconstruction by ligamentoplasty, of a performance handball player, active for 13 years, male, 24 years old, in helping him return to his sporting life and the active life he has, in the shortest possible time. Thereason why I chose to do this study is obvious in the foreground being my personal recovery after ligamentoplasty, also to improve my theoretical and practical knowledge about this condition, and as a physiotherapist to be able to help other athletes, colleagues, who face the problem of returning to the sports field as soon as possible, and to have the same performance as before the surgery. The duration of the kinetic recovery program was 5 weeks, starting from the first day after the intervention. This program began with an initial assessment by joint testing and muscle testing on the first day, before starting the proposed recovery program. The physiotherapy program consists of 26 exercises, which can be done in a physiotherapy room, with the help of a physiotherapist. This program was applied twice a day to theresearch subject, obtaining positive results.

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.

The Potential Win-win Strategy for Healthy Aging and Environmental Protection: Environmental Volunteering

Purpose To explore the physical activity level of community environmental volunteering (CEV) participants and the differences in physical functions and daily activity patterns between the older adults who engaged in intensive CEV (≥15 hours/week) and non-intensive CEV (<15 hours/week) groups. Design Cross-sectional study. Setting Three recycling stations in Taiwan. Sample In total, 113 community-dwelling older adults who regularly participated in CEV. The response rate was 53%. Measures The ActiGraph wGT3x-BT accelerometer for the percentage of sedentary, light, and moderate to vigorous physical activity (MVPA) of CEV time and awaken time; the Jamar hand dynamometer for grip strength; and the MicroFET3 muscle testing dynamometer for knee extension strength. Analysis Analysis of covariance with the baseline characteristics as covariates. Results Overall, MVPA, light, and sedentary activities accounted for 53.73%, 41.10%, and 5.23% of CEV time, respectively. The intensive group (n = 61) displayed greater dominant handgrip strength ( P = .004) and higher MVPA percentage in daily life ( P = .044) than the non-intensive group (n = 52). Conclusion CEV provides sufficient opportunities for older adults to perform physical activity. Intensive CEV is related to greater handgrip strength but not lower limb strength. Further study is needed to establish the causal relationship between CEV and health variates.

Effectivity of Exoskeleton Robot-Assisted Therapy on Improving Muscle Strength in Post-Stroke Patient

Background: Upper limb weakness is the most disability caused by stroke. The availability of physiotherapists is still limited in Indonesia. The exoskeleton robot is a developing technology that involve in stroke rehabilitation therapy. Objective: To evaluate the effectiveness of exoskeleton robot-assisted therapy on improving muscle strength of patients after stroke. Methods: An experimental study with two groups pre-test and post-test design carried out using consecutive sampling among outpatient stroke patients in Diponegoro National Hospital (RSND) and William Booth Hospital (RSWB), Semarang. Patients in the robotic group (RG) (n=8) received 16 training sessions. Each session consists of 30 passive and ten active-weighted elbow flexion-extension with the exoskeleton robot. Meanwhile, the control group (CG) (n=8) received equivalent training of conventional therapy. The primary outcome of muscle strength was measured by Manual Muscle Testing (MMT) and handheld dynamometer. Pre and post-test MMT score data in each group were analyzed by Wilcoxon test, while handheld dynamometer score data were analyzed by paired t-test. Data between the two groups were analyzed by Mann-Whitney test and unpaired t-test. Results: Significant improvements were shown for the MMT score (RG: p=0.014, CG: p=0.034). There were significant handheld dynamometer score improvements on muscle strength for elbow flexor and extensor in RG (p = 0.008 and p = 0.005 respectively) and in CG (p=0.036 and p=0.008 respectively). No significant differences for MMT and handheld dynamometer score between the two groups. Conclusion: The exoskeleton robot-assisted therapy was as effective as conventional therapy for improving muscle strength in stroke patients.