Effect of Proximal Muscle Strengthening on Distal Muscle Facilitation in Guillain Barre Syndrome

In Guillain Barre Syndrome (GBS), there is symmetrical muscle weakness which ranges from mild weakness to severe palsy of all limbs. The motor symptoms start distally and move proximally. Proximal muscle weakness is primary and common factor in GBS. To overcome the weakness, one has to strengthen the muscle. Muscle activity of proximal segment is necessary for activation of distal segment. In fact, stable activity of distal parts needs controlling of the proximal parts. As distal muscle weakness is a major problem in post GBS individuals, they need to be facilitated with the help of proximal muscle strengthening. MethodsAfter obtaining the ethical committee clearance an experimental study was conducted among a total of 30 GBS subjects selected through convenience sampling. OPD subjects were given proximal muscle strengthening for 6 weeks. Each subject was examined by modified sphygmomanometer test (MST) and functional independence measure scale (FIMS) before and after the study. ResultsResult was calculated by using MST and FIMS. Exercises showed extremely significant difference on MST [p = 0.0001, t = 11.924] on handgrip strength, [p value = 0.0001) t = 12.334] on plantar flexion, [p value = 0.0001, t = 9.558] on dorsiflexion. FIMS [p value = 0.0001, t = 25.699] extremely significant difference was seen. ConclusionsProximal muscle strengthening is found to be effective for distal muscle facilitation in Guillain Barre Syndrome.

Infra-abdominal muscles activation brings benefits to the pulmonary function of patients with ternal instability after cardiac surgery

Abstract Objective: To compare physical therapy strategies involving abdominal muscle stabilization, with and without upper limb movement, in patients with sternal instability after heart surgery and during in-hospital care. Methods: This prospective, longitudinal, randomized, and comparative clinical study included 20 patients, which were divided into two groups: ARM, the arm group (n=10), and LEG, the leg group (n=10). The study involved the evaluation of scores of visual analog scales for sternal instability, pain, discomfort, functional impairment, lung function, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) before and after the interventions. Two protocols consisting of abdominal exercises in both groups with upper limb movements (ARM) and just abdominal activation with leg movements (LEG) were used for three weeks. Results: There were statistically significant (P≤0.01) improvements in pain, discomfort, and functional impairment scores, and in MIP (P=0.04) and MEP (P≤0.01) after intervention in both groups and just LEG showed improvement in forced vital capacity (P=0.043) and forced expiratory volume in one second (P=0.011). Conclusion: Both strategies promoted improvement in pain, discomfort, and functional impairment scores and in the values of inspiratory and expiratory pressures. Perhaps they were influenced by the time and resolution of the infection process, although exercises with upper limb movements seem to be safe in this population. The activation of the infra-abdominal muscles through leg movements seems to bring more benefits to lung function.

Trunk Stabilization by the Bad Ragaz Method in Sedentary Women / 日本温泉気候物理医学会雑誌

Introduction: Optimization of muscle strength is crucial for motor control efficiency and the prevention of musculoskeletal disorders. Objective: Analyze the effects of aquatic physiotherapy using the Bad Ragaz method for the strengthening and endurance of the trunk muscles. Methods: An experimental, descriptive and quantitative study. Sixteen healthy, sedentary women with an average age of 19.4±1.6 years and BMI of 22.8±2.7 took part in this study. The trunk muscle strength was evaluated using isokinetic dynamometry and abdominal (one min test) and lumbar endurance tests. Results: The Shapiro-Wilk normality test, Cochran test, t-Student parametric test and Wilcoxon non-parametric test were applied at a significance level of p ≤ 0.05. There was a significant improvement in the trunk extensor muscle strength for peak torque, p = 0.000, work, p = 0.000 and power, p = 0.008. With respect to the trunk flexor muscle strength, increases in the values for work, p = 0.032 and power, p = 0.022 were detected. A significant improvement in the flexor/ extensor ratio for work, p = 0.023, was also noted, and also in the abdominal endurance (p = 0.000) and Lumbar muscular-endurance (p = 0.000) tests.Conclusions: The aquatic physiotherapy program using the Bad Ragaz method was efficient in strengthening the trunk musculature of young, healthy and sedentary women.

Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis

Background: Lumbar Spondylitis (LS) is a common term that denotes degenerative changes that develop in trauma-center patients, specific age groups, and head injury patients. A study done on Indian population reported 60% to 90% of radiological changes of L4 at L5-S1 levels in asymptomatic individuals. These degenerative changes in the lumbar spine may remain asymptomatic or can present as pure axial lumbar pain, lumbar radiculopathy, lumbar myelopathy, or lumbar myeloradiculopathy. So, the aim of the study was to check the effectiveness of hip flexor muscle strengthening, femoral nerve muscle stretching with facet joint mobilization for lumbar spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of two measures - RolandMorris Low Back Pain and Disability Questionnaire for disability and Visual Analog Scale (VAS). Goniometer was used for range motion of lumbar spine movements done in each group. The Subjects in Group-A were given hip flexor muscles strengthening with femoral nerve stretching for lumbar region for 45 minutes for 4 days in a week for four weeks where the subject were sitting. The Subjects in Group-B were given femoral nerve stretching with facet joint mobilization for 45 minutes for 4 days in a week for four weeks where the subjects were in supine and prone position and remain Sreenivasu Kotagiri, Neeti Mathur, Ashwin Kumar. Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis. IAIM, 2019; 6(9): 49-57. Page 50 relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and RMQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and RMQ. The overall study proved that hip flexor muscle strengthening, femoral nerve stretching with facet joint mobilization for lumbar spondylitis in improving Pain and decreasing the disability level in lumbar radiculopathy and reduce tightness subjects. Conclusion: The analysis obtained indicated that Group B (femoral nerve stretching with facet joint mobilization) showed more significant improvement when compared to Group A ( hip flexor muscles strengthening with femoral nerve stretching).

Trunk Stabilization by the Bad Ragaz Method in Sedentary Women / 日本温泉気候物理医学会雑誌

Introduction: Optimization of muscle strength is crucial for motor control efficiency and the prevention of musculoskeletal disorders. Objective: Analyze the effects of aquatic physiotherapy using the Bad Ragaz method for the strengthening and endurance of the trunk muscles. Methods: An experimental, descriptive and quantitative study. Sixteen healthy, sedentary women with an average age of 19.4±1.6 years and BMI of 22.8±2.7 took part in this study. The trunk muscle strength was evaluated using isokinetic dynamometry and abdominal (one min test) and lumbar endurance tests. Results: The Shapiro-Wilk normality test, Cochran test, t-Student parametric test and Wilcoxon non-parametric test were applied at a significance level of p ≤ 0.05. There was a significant improvement in the trunk extensor muscle strength for peak torque, p = 0.000, work, p = 0.000 and power, p = 0.008. With respect to the trunk flexor muscle strength, increases in the values for work, p = 0.032 and power, p = 0.022 were detected. A significant improvement in the flexor/ extensor ratio for work, p = 0.023, was also noted, and also in the abdominal endurance (p = 0.000) and Lumbar muscular-endurance (p = 0.000) tests. Conclusions: The aquatic physiotherapy program using the Bad Ragaz method was efficient in strengthening the trunk musculature of young, healthy and sedentary women.

Association between Number of Days of Muscle Strengthening Activity and Serum Lipid: The Seventh Korea National Health and Nutrition Examination Survey, 2016–2018

BACKGROUND: According to Statistics Korea estimates (2016), the mortality rate associated with heart disease is 41.1%. Dyslipidemia is a major risk factor for heart disease and warrants timely treatment. Muscle strengthening activity is one of the best therapeutic interventions for low-risk treatment groups. This study aimed to investigate the association between the number of days of muscle strengthening activity and serum lipid levels.METHODS: We analyzed data obtained from the Korea National Health and Nutrition Examination Survey (2016–2018). Subjects were categorized into 3 groups based on the number of days of muscle strengthening activity performed (never, 1–2 days, ≥3 days). The association between muscle strengthening activity and serum lipid levels was determined using covariance analysis after adjusting for variables.RESULTS: A statistically significant difference was observed among the 3 groups with respect to serum triglyceride and high-density lipoprotein (HDL)-cholesterol levels (P=0.007 and 0.047, respectively). However, no significant differences were observed in the total serum cholesterol and low-density lipoprotein cholesterol levels (P=0.824 and 0.396, respectively).CONCLUSION: A statistically significant difference was observed among the 3 groups with respect to serum triglyceride and HDL-cholesterol levels. This is a significant observation and serves as the rationale for the inclusion of muscle strengthening activity in the Korean guidelines for the management of dyslipidemia (2015). Further studies are warranted to conclusively establish the optimal quantity and quality of physical activity required for individuals with dyslipidemia.

Osteoarthritis of the hands and muscle strengthening exercises: an integrative update and review of the literature / Osteoartrite de mãos e exercícios de fortalecimento muscular: uma atualização e revisão integrativa da literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Osteoarthritis of the hands is a highly prevalent disease that can lead to significant deformity and disability. The therapeutic approach in the management of osteoarthritis of the hands is based on pharmacological and non-pharmacological approaches. However, none of these treatments demonstrated a reduction of joint damage, and it presents itself in a purely symptomatic way. Yet, expert practitioners strongly recommend and use hand muscle strengthening in patients with hand osteoarthritis, but there is no consensus for such conduct. The objective of the study was to review the concepts about hand osteoarthritis as well as to bring the current evidence on muscle strengthening as a non-pharmacological treatment for this disease. CONTENTS: The study reviewed the United States National Library of Medicine database (Pubmed). The words used were: hand osteoarthritis, exercises, physiotherapy and rehabilitation. We included 5 articles in English, published in the last 10 years, focused on muscle strengthening exercises for osteoarthritis patients. CONCLUSION: There is no consensus, nor a more effective exercise protocol, although exercises and physiotherapy are still recommended. We suggest conducting randomized controlled clinical trials to improve the evidence on this subject.

RESUMO JUSTIFICATIVA E OBJETIVOS: A osteoartrite de mãos é uma doença altamente prevalente que pode levar à importante deformidade e incapacidade. A abordagem terapêutica no seu manuseio baseia-se em condutas farmacológicas e não farmacológicas; no entanto, nenhum desses tratamentos demonstrou redução da lesão articular e apresenta-se de maneira puramente sintomática. Contudo, profissionais especializados recomendam e utilizam amplamente o fortalecimento da musculatura das mãos em pacientes com osteoartrite de mãos, mas não há um consenso para tal conduta. O objetivo do estudo foi revisar os conceitos sobre a osteoartrite de mãos, bem como trazer as evidências atuais sobre o fortalecimento muscular como forma de tratamento não medicamentoso para esta doença. CONTEÚDO: O estudo foi realizado na base de dados "United States National Library of Medicine" (Pubmed). As palavras utilizadas foram: "hand osteoarthritis", "exercises", "physiotherapy and rehabilitation". Foram incluídos 5 artigos em inglês, publicados nos últimos 10 anos, cujo foco fosse exercícios de fortalecimento muscular para pacientes com osteoartrite de mãos. CONCLUSÃO: Não existe consenso, nem um protocolo de exercícios mais efetivos, embora os exercícios e a fisioterapia ainda sejam recomendados. Sugere-se a realização de estudos clínicos controlados e randomizados para melhorar a evidência sobre este assunto.

Análise comparativa do pico de força e controle motor do músculo tibial anterior após cinesioterapia e estimulação neuromuscular / Comparative analysis of strength peak, and motor control of the tibialis anterior muscle after Kinesiotherapy and Neuromuscular stimulation

Introdução: O fortalecimento muscular pode ser realizado por exercícios ativos, ativos resistidos e também, a estimulação elétrica neuromuscular (EENM), são algumas dentre as diversas técnicas terapêuticas utilizadas pelo fisioterapeuta. Objetivo: Analisar se existe diferença entre o fortalecimento muscular ativo somente e com associação de Eletroestimulação Neuromuscular no músculo Tibial Anterior em mulheres sedentárias. Métodos: Participaram 18 voluntárias, selecionadas aleatoriamente, divididas em 3 grupos com a mesma quantidade em cada, sendo que o primeiro grupo foi realizado apenas fortalecimento ativo com carga (Cinesioterapia), o segundo grupo realizou o fortalecimento ativo com carga do músculo tibial anterior associado a estimulação com a corrente FES, e o terceiro grupo, fortalecimento ativo com carga associado a estimulação com a corrente Russa. Para avaliação foram coletados o Pico máximo de força e Controle motor através da célula de carga. Resultados: Com relação ao pico de força, o grupo que obteve um melhor desempenho mantendo a média mais próxima do valor anterior foi o grupo que associou a corrente FES, já no controle motor o grupo que teve menor variação após a terapêutica foi o que associou a corrente Russa, seguida da que associou corrente FES porém, apenas 48 horas depois. Conclusão Os exercícios de fortalecimento associado a corrente FES teve um melhor desempenho no pico máximo de força, e o grupo associado à corrente Russa teve um melhor controle motor após a terapêutica....(AU)

Introduction: Muscle strengthening can be accomplished by active exercise, weathered assets and also the neuromuscular electrical stimulation (NMES), are some among the various therapeutic techniques used by the physiotherapist. Goal: Analyze whether there are differences between the active muscle strengthening and only with neuromuscular electrical stimulation association in anterior tibialis muscle in sedentary women. Methods: 18 volunteers participated, selected randomly divided into 3 groups with the same amount in each, and the first group was conducted only active strengthening load (kinesiotherapy), the second group performed the active strengthening with load of the tibialis anterior muscle associated with the stimulation current FES, and the third group, strengthening active with load associated with stimulation with Russian current. For evaluation were collected the maximum peak strength and motor control through the load cell. Results: with relation to strength peak, the group that achieved a better performance by keeping the closest measure of the previous value, was the group that used the FES current, about the motor control, the group that had less variation after therapy, was the group that used the Russian current, followed by those who used the FES current, however, only 48 hour after. Conclusion: Strengthening exercises associated with FES current performed better at the max strength peak, and the group associated with the current Russian had a better motor control after therapy...(AU)

Effects of Respiratory Muscle Strengthening Exercise on Respiratory Function and Activities of Daily Living in Stroke Patients

PURPOSE: This study aimed to demonstrate reduction in stroke symptoms by analyzing the changes in respiratory function and activities of daily living (ADL) after respiratory muscle strengthening exercise in patients who had a stroke and thereby, propose an efficient exercise method. METHODS: Twenty patients with hemiplegic stroke were divided into two groups, with 10 patients in each. The control group (CG) received the traditional exercise therapy, and the experimental group (EG) received the traditional exercise therapy combined with expiratory muscle strengthening training. The training continued for 6 weeks, 5 days a week. Forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1) were measured with a spirometer, SpO₂ was measured with a pulse oximeter, and ADL were assessed by using the modified Barthel index (MBI). A paired t test was applied to compare the differences before and after the intervention, and an independent t test was used to compare the differences between the groups. The level of statistical significance was set as α=0.05. RESULTS: The changes in the FVC and FEV1 values within the group showed significant differences only in the EG (p<0.01). The between-group difference was statistically significant only for FVC and FEV1 in the EG (p<0.01). The changes in SpO₂ and MBI within the group showed significant differences only in the EG and CG (p<0.01). Between-group differences were statistically significant only for SpO₂ and MBI in the EG (p<0.05). CONCLUSION: The interventions with active patient involvement and combined breathing exercises had a positive impact on all the functions investigated in this study.

Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength. .

Prospective Evaluation of the Effectiveness of a Home-Based Program of Isometric Strengthening Exercises: 12-Month Follow-up

BACKGROUND: The aim of this prospective randomized clinical trial was to investigate the efficacy of a home-based program of isometric strengthening exercises for the treatment of the lateral epicondylitis (LE) of the distal humerus. We hypothesized that 1) use of isometric strengthening exercises would result in clinical benefits similar to those provided by medication and pain relief and 2) functional improvements after exercise would be time-dependent. METHODS: Patients were assigned to one of two groups: 1) an immediate physical therapy group (group I), or 2) a delayed physical therapy group (group D). Group I patients (n = 16) were instructed how to do the exercises at their first clinic visit and immediately carried out the exercise program. Group D patients (n = 15) learned and did the exercises after being on medications for 4 weeks. RESULTS: Outcomes at the 1-month clinic visit indicated that pain (measured using a visual analogue scale [VAS]) had been significantly reduced in group I compared to group D (p < 0.01). However, significant differences between groups were not found at 3-, 6-, and 12-month follow-up for either VAS scores or Mayo elbow performance scores. For modified Nirschl/Pettrone scores, a significant difference between groups was found only at the 1-month follow-up visit. By then, the number of participants who returned to all activities with no pain or occasional mild pain was six (37%) in Group I and two (13%) in Group D (p = 0.031). At the final follow-up visit, 88% of all participants performed physical activities without pain. CONCLUSIONS: Isometric strengthening exercises done early in the course of LE (within 4 weeks) provides a clinically significant improvement.

Effects of Muscle Strengthening Exercises Using a Thera Band on Lower Limb Function of Hemiplegic Stroke Patients / 간호학회지

PURPOSE: This study was to verify the effect of muscle strengthening exercises using a Thera-Band on the lower limbs. METHODS: The design utilized for this study was a nonequivalent control group pretest-posttest design. A control group (16) and experimental group (16) were selected from stroke patients of K Oriental Medicine Hospital who were hospitalized for 5 months from December 2005 through April 2006. While only acupuncture therapy and physical therapy were used on the control group, acupuncture, physical therapy and additional muscle strengthening exercises using a red thera band were used on the experimental group. Muscle strengthening was performed 20 minutes per session, more than one session a day for 4 weeks. Hypotheses for this study were verified using Two-way repeated ANOVA and ANCOVA using a pre test score as a covariate. RESULTS: The experimental group with thera band muscle strengthening exercises showed a decrease in asymmetry weight loading percentage(F=14.704, P= .010), range of knee (Z=-3.15, P= .001) & deep tendon reflex score(Z=-2.52, P= .012) and moving performance(F=12.328, P= .001)compared to the control group. CONCLUSION: It is confirmed that muscle strengthening exercises using a Thera-Band can be used as an effective nursing intervention to improve the function of the lower limb of hemiplegic stroke patients.