Threshold Training of Respiratory Muscles after Stroke:A Meta-analysis / 中国康复理论与实践

Objective To study the effects of threshold training of respiratory muscles on respiratory muscle function and pulmonary in-fection after stroke with meta-analysis. Methods The randomized controlled trials about threshold training of respiratory muscles in stroke patients in Cochrane Library, PubMed, Medline, Embase, OVID, Chinese Biomedical Database, WanFang database and CNKI full-text data-base from January, 2005 to June, 2015 were systematically searched. Literatures were evaluated and extracted by two researchers. Results Four studies were included, with a total of 167 cases, 84 cases in the intervention group (threshold training of respiratory muscles) and 83 cases in the control group. Compared with the control group, the intervention might improve the respiratory muscle strength (for maximum inspired pressure, MD=9.46, 95%CI=4.61~14.32, P<0.001;for maximum expired pressure, MD=9.44, 95%CI=2.68~16.20, P=0.006), and decreased pulmonary infection (OR=0.35, 95%CI=0.13~0.97, P=0.04). Conclusion Threshold training of respiratory muscles can improve respiratory muscle function and reduce the incidence of pulmonary infection.

Pain pressure threshold algometry of the abdominal wall in healthy women

The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years) were included. All volunteers had regular menstrual cycles (27-33 days) and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test). There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

Extracorporeal Shock Wave Therapy in Myofascial Pain Syndrome of Upper Trapezius

OBJECTIVE: To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analogue scale (VAS) and pressure threshold by digital algometer. METHOD: Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm2, 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm2. The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer. RESULTS: There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91+/-1.76 to 2.27+/-1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4+/-9.94 N to 61.2+/-12.16 N in the treated group (p<0.05), but there was no significant change in the control group. CONCLUSION: ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.

Effects of Jazz Dance Program on Musculoskeletal Pains of Telephone Operators

OBJECTIVE: The purpose of this study was to estimate the effects of a jazz dance program on musculoskeletal pains of female telephone operators. METHOD: Ten female telephone operators with neck and upper extremity discomfort were studied. The jazz dance program was carried out three times a week for 12 weeks. The effect of the jazz dance program was assessed with visual analogue scale (VAS) and the pressure thresholds of muscles of right neck and shoulder (the upper trapezius, rhomboideus, infraspinatus, and levator scapulae) with pressure algometer before and after exercise in every week. RESULTS: There was significant increase of the pressure thresholds on four muscles of right neck and shoulder (p<0.05). There was significant decrease of the averages of VAS of neck and upper extremity (p<0.05). CONCLUSION: Jazz dance program is an effetive tool for the prevention and treatment of musculoskeletal pains in Visual Display Terminal (VDT) workers.

Pain Patterns of Experimental Muscle Pain Using Hypertonic Saline

OBJECTIVE: The aim of the present study was to investigate the pain intensity, quality, and pattern in experimental muscle pain. METHOD: Eleven healthy adults and eleven myofascial pain syndrome (MPS) patients participated in this study. Hypertonic saline (5%) was injected into upper trapezius, infraspinatus and tibialis anterior muscles of 11 healthy adults. A continuous recording of ongoing pain intensities of the local pain and referred pain was measured. After pain had subsided, the subjects completed a Korean version of the McGill Pain Questionnaire (MPQ). This study included 11 patients who have trigger point on upper trapezius muscle. Pain pressure thresholds (PPTs) and pain intensity ratings of different pressure stimuli in upper trapezius muscles were compared with experimental group. RESULTS: In experimental group, local pain became maximal after one minute and referred pain after one and a half minutes. At that time, Visual analogue scale (VAS) score was 3.8 and 1.9 each other. The referred pain of upper trapezius muscle primarily radiated to the posterolateral side of neck. The one of infraspinatus muscle radiated to the shoulder joint and anterolateral side of upper arm area and the one of tibialis anterior muscle radiated to the shin and dorsum of ankle joint. The PPTs were found to be significantly lower in upper trapezius muscle of patients with myofascial pain syndrome (MPS) than in those of experimental group. The slope of VAS to different stimuli showed the linear relationship at both group, and in that of patient groups was found to be significantly steeper than in that of experimental group. The experimental muscle pain group had no difference in pain quality compared with MPS patients except affective subscale. CONCLUSION: The present results suggest that intramuscular injection of hypertonic saline can be used a experimental pain model of MPS, and PPTs and pain intensity ratings of different pressure stimulus are valuable tools for quantitative description of chronic and experimental muscle pain.

Changes in the Pressure Threshold of Myofascial Trigger Points Following Freezing Cold Air Application

OBJECTIVE: The purpose of this study is to evaluate the effects of cold air application on the pressure threshold of myofascial trigger points. METHOD: The 60 patients with myofascial trigger points in unilateral infraspinatus muscle were divided into 3 groups with equal number and cold air was applied using CRAis (Kyung-won Century, Korea) for 1, 3 and 5 minutes. We examined the changes of pressure threshold in myofascial trigger points before, immediately after and 30 minutes after cold air application. Also we examined the changes of pressure threshold of contralateral infraspinatus muscles. RESULTS: 1) The pressure threshold of trigger point in infraspinatus muscle were increased immediately and 30 minutes after the cold air application as assessed by the pressure algometer (p0.05). 3) There was no significant correlations among the age, the body mass index and the changes of pressure threshold in myofascial trigger points (p>0.05). CONCLUSION: We conclude that the cold air application is a effective method for treatment of myofascial trigger points.

The Clinical Feature and Pressure Threshold in a Chest Wall Syndrome

Thirty-eight patients with a musculoskeletal chest wall syndrome were evaluated for the musculoskeletal findings of chest wall. All patients had the chest wall tenderness and the typical chest pain could be reproduced by the palpation. There was no significant difference in the diagnostic features of the pain for the onset, location, characteristics, duration, radiation, and area of references for chest pain among the different groups of the patients. However, a reproduction of pain by palpation and the pressure threshold difference between the lesion and control points by using pressure algometry was a reliable and specific diagnostic tool. Pressure threshold difference was correlated with numerical rating scale by the correlation coefficient 0.96. The common causes of the chest wall syndrome were the myofascial pain syndrome, chostochondritis, sternalis syndrome, rib-tip syndrome, xiphodynia in order. Six patients had chest wall disorders in conjunction with other associated intrathoracic condition. Thirty-two patients had an isolated chest wall syndrome. Chest wall syndrome should be considered in all patients with the chest pain, as its recognition could help the patient management.

Changes in the Pressure Threshold of Myofascial Trigger Points of the Shoulder Girdle Muscles Following Stretching Exercise

OBJECTIVE: The purpose of this study is to evaluate the effects of a self-stretching exercise on the pressure threshold of myofascial trigger point. METHOD: We examined the changes of pressure threshold in 66 patients with myofascial trigger points before and after a self-stretching exercise of shoulder girdle and also tested the visual analogue scale (VAS) of the subjective pain intensity. The self-stretching exercise of shoulder girdle includes a stretching exercise of four muscles in shoulder girdle simultaneously, including upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor, which is followed by 1) a sitting position, relaxed, 2) lateral bending of neck to contralateral side, 3) forward and downward stretching of ipsilateral arm with protrusion of scapula and internal rotation of arm maximally to the contralateral foot. Each stretching motion is maintained for 30 seconds. RESULTS: The results of the patients experiencing unilateral or bilateral myofascial neck and shoulder pain showed that the pressure threshold of trigger point increased in response to the self-stretching exercise as assessed by a pressure algometer. Also visual analogue scale (VAS) decreased in response to the self-stretching exercise. CONCLUSION: We conclude that the self-stretching exercise of shoulder girdle is an effective method for the simultaneous stretching of upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor.

Pressure Threshold, Grip and Pinch Strength in Female Telephone Operators

The purpose of this study was to estimate mean pressure thresholds over several skeletal muscles, grip and pinch strengths in female telephone operators. Pressure thresholds on muscles of neck and shoulder were measured with a pressure algometer, and grip and pinch strength were measured with a Jamar dynamometer and a Jamar pinch gauge in 904 female telephone operators. The pressure threshold was highest in the supraspinatus and lowest in the cervical paraspinals. There was no statistically significant difference between right and left corresponding muscles. The mean grip strength was 22.29 kg in the right hand, 21.97 kg in the left hand. The mean tip pinch strength was 0.56 kg in the right, 0.51 kg in the left. The mean lateral pinch strength was 2.21 kg in the right, 2.12 kg in the left. The mean palmar pinch strength was 1.82 kg in the right, 1.66 kg in the left. There was no significant correlation between grip, pinch strength and age(p>0.05). There were positive correlations between height, weight and grip strength. There were positive correlations between exposure duration to visual display terminal and pinch strength.