Reliability and construct validity of the Craniocervical Flexion Test in patients with migraine.

BACKGROUND: Migraine may be accompanied by several cervical musculoskeletal dysfunctions, for example an altered performance on the Craniocervical Flexion Test (CCFT). However, CCFT measurement properties are still unclear in patients with migraine. OBJECTIVES: To determine intra- and inter-examiner reliability, construct validity, standard measurement error (SEM), and minimal detectable change (MDC) of the CCFT in patients with migraine. METHODS: Women diagnosed with migraine were considered eligible for this study. Participants were assessed by two examiners for the inter-examiner reliability, and with 7-10 days interval for the intra-examiner reliability. Construct validity was assessed considering headache and neck pain frequency and intensity, and self-reported questionnaires, including the Headache Impact Test - 6 items (HIT-6), the 12-item Allodynia Symptom Checklist/Brazil (ASC-12), and the Neck Disability Index (NDI). In addition, participants performed cervical endurance and maximal voluntary isometric contraction of the cervical flexors. RESULTS: A total of 103 women with migraine were recruited. The intra-examiner reliability was rated as good (ICC= 0.81, 95% CI: 0.73, 0.87), while the inter-examiner reliability was rated as moderate (ICC= 0.55, 95% CI: 0.40, 0.67). The intra and inter-examiner SEM were 1.31 and 1.36 mmHg respectively, and MDC were 3.63 and 3.77 mmHg. The HIT-6 and the cervical endurance flexion test were associated with the CCFT in a multiple linear regression model (p = 0.004, R = 0.35). CONCLUSION: The CCFT presents adequate intra- and inter-examiner reliability. Better performance on the CCFT test was associated with better HIT-6 scores and greater cervical endurance time, which was not influenced by the presence of neck pain.

Gender Differences in the Co-Use of Tranquilizers, Sedatives, Sleeping Pills and Alcohol among Spanish Adolescents: A Nationwide Population-Based Study.

Adolescence is a critical developmental stage for the initiation of substance use worldwide, which is one of the main risk-taking behaviors that may impact adolescents' physical and mental well-being. The aims of this study were to (1) assess the prevalence of the co-use of tranquilizers, sedatives, and sleeping pills with alcohol (TSSp&AC) by gender in the Spanish adolescent population in 2018 and (2) identify the variables associated with TSSp&AC. An observational cross-sectional study following STROBE guidelines was conducted. We analyzed data from 38,010 adolescents aged 14 to 18 years old (18,579 males and 19,431 females) who participated in ESTUDES (Survey on Drug Use in Secondary Education in Spain) 2018. Female adolescents reported a higher prevalence of TSSp&AC than males (p < 0.001). The factors associated with female co-use were being 16-18 years of age (OR 1.65); the consumption of tobacco (OR 1.73), cocaine (OR 1.84), other illicit psychoactive drugs (OR 1.89); and novel illicit psychoactive drugs (OR 1.74); no perceived health risk from the consumption of TSSps (OR 2.45); and the perceived availability of TSSps (OR 2.23) and alcohol (OR 2.09). There are several factors associated with TSSp&AC in Spanish female adolescents with potential implications for healthcare providers.

Quality of life, socioeconomic and psychological concerns in parents of children with tuberous sclerosis complex, STXBP1 and SYNGAP1 encephalopathies: a mixed method study.

Background: Developmental and Epileptic Encephalopathies (DEEs) occur in childhood and are associated with severe epileptic seizures and neurological impairment. The aim of this study was to combine quantitative and qualitative methodologies to comprehensively describe factors related to quality of life, impact on the family and psychosocial factors in parents of children with TSC, STXBP1 and SYNGAP1 variants. Methods: A convergent parallel mixed design including parents of children with DEE. In the cross-sectional study, 20 parents (10STXBP1, five SYNGAP1, five TSC) were given questionnaires on quality of life, impact on the family and psychological factors. In the descriptive qualitative study, in-depth interviews were conducted with 18 parents (nine STXBP1, five TSC, four SYNGAP1) using a semi-structured questionnaire. A thematic analysis was carried out. The results of the two studies were combined by showing similarities and differences through tables, figures, accounts, and joint displays. Results: In terms of quality of life, the integrated results were consistent in highlighting the importance of family interaction, although in the qualitative section the influence of the relationship between the children's siblings, the relationship with health professionals and the difficulties in obtaining public aid were highlighted. In terms of impact, the integrated results show that the illness has a significant impact on the family; the financial burden is highlighted, and the experience of the illness is discussed in depth. Finally, the psychological aspects, symptoms such as anxiety, stress and strain, were consistent. Most of the participants reported sleep disturbance, as identified in the questionnaire, although not mentioned in the interviews. Conclusions: The combined results of the mixed method provide an in-depth analysis of the impact of DEEs on parents of children with STXBP1, SYNGAP1 and TSC.

Reference Values for Cervical Muscle Strength in Healthy Women Using a Hand-Held Dynamometer and the Association with Age and Anthropometric Variables.

Knowledge of reference values for cervical muscle strength is a key tool for clinicians to use as a clinical reference measure and to establish goals during rehabilitation. The objective was to establish reference values for the maximal strength of cervical muscles in healthy women using a handheld dynamometer and verify the association of cervical muscle strength with age and anthropometric measurements. A hundred women were classified into four groups (n = 25) according to age: 18-29 years, 30-39 years, 40-49 years, and 50-60 years. Maximal muscle strength of the cervical spine was measured using a Lafayette® handheld dynamometer for flexion, extension, and bilateral lateral flexion. No differences in cervical muscle strength were observed among the groups (p > 0.05). However, the 18-29-year-old group took less time to reach the peak of force for flexion than the 50-60-year-old group. Moderate correlations were observed between cervical flexor strength and weight, body mass index, and neck circumference, and between cervical extensor strength and weight and body mass index (r = 0.43-0.55; p < 0.05). Reference values for cervical muscle strength in healthy women were established using a handheld dynamometer, and the association between muscle strength and anthropometric data was moderate.

Balance alterations are associated with neck pain and neck muscle endurance in migraine.

BACKGROUND: Migraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored. OBJECTIVES: This study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine. METHODS: Sixty-five patients with migraine underwent the sensory organization test assessed with the Equitest-Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored. RESULTS: Patients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = -0.33; p = 0.007), migraine frequency (r = -0.29; p = 0.021), neck pain intensity (r = -0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability. CONCLUSION: Neck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.

Knee Kinetics and Kinematics of Young Asymptomatic Participants during Single-Leg Weight-Bearing Tasks: Task and Sex Comparison of a Cross-Sectional Study.

This cross-sectional study aimed to describe and compare kinetic and kinematic variables of the knee joint during stair descent, single-leg step down, and single-leg squat tasks. It also aimed to investigate potential sex difference during the tasks. Thirty young asymptomatic individuals (15 males, 15 females) were assessed during the performance of single-leg weight-bearing tasks. The kinetic and kinematic data from the knee were evaluated at the peak knee moment and at peak knee flexion. Single-leg squat presented a higher peak knee moment (2.37 Nm/kg) and the greatest knee moment (1.91 Nm/kg) at knee peak angle in the frontal plane, but the lowest knee flexion (67°) than the other two tasks (p < 0.05). Additionally, the single-leg step down task presented a higher varus knee angle (5.70°) when compared to stair descent (3.71°) (p < 0.001). No substantial sex difference could be observed. In conclusion, in asymptomatic young individuals, single-leg squats presented the greatest demand in the frontal and sagittal planes. Single-leg step down demanded a greater angular displacement than stair descent in the frontal plane. We did not identify a significant difference among the sex and studied variables.

Exploring Sentiment and Care Management of Hospitalized Patients During the First Wave of the COVID-19 Pandemic Using Electronic Nursing Health Records: Descriptive Study.

BACKGROUND: The COVID-19 pandemic has changed the usual working of many hospitalization units (or wards). Few studies have used electronic nursing clinical notes (ENCN) and their unstructured text to identify alterations in patients' feelings and therapeutic procedures of interest. OBJECTIVE: This study aimed to analyze positive or negative sentiments through inspection of the free text of the ENCN, compare sentiments of ENCN with or without hospitalized patients with COVID-19, carry out temporal analysis of the sentiments of the patients during the start of the first wave of the COVID-19 pandemic, and identify the topics in ENCN. METHODS: This is a descriptive study with analysis of the text content of ENCN. All ENCNs between January and June 2020 at Guadarrama Hospital (Madrid, Spain) extracted from the CGM Selene Electronic Health Records System were included. Two groups of ENCNs were analyzed: one from hospitalized patients in post-intensive care units for COVID-19 and a second group from hospitalized patients without COVID-19. A sentiment analysis was performed on the lemmatized text, using the National Research Council of Canada, Affin, and Bing dictionaries. A polarity analysis of the sentences was performed using the Bing dictionary, SO Dictionaries V1.11, and Spa dictionary as amplifiers and decrementators. Machine learning techniques were applied to evaluate the presence of significant differences in the ENCN in groups of patients with and those without COVID-19. Finally, a structural analysis of thematic models was performed to study the abstract topics that occur in the ENCN, using Latent Dirichlet Allocation topic modeling. RESULTS: A total of 37,564 electronic health records were analyzed. Sentiment analysis in ENCN showed that patients with subacute COVID-19 have a higher proportion of positive sentiments than those without COVID-19. Also, there are significant differences in polarity between both groups (Z=5.532, P<.001) with a polarity of 0.108 (SD 0.299) in patients with COVID-19 versus that of 0.09 (SD 0.301) in those without COVID-19. Machine learning modeling reported that despite all models presenting high values, it is the neural network that presents the best indicators (>0.8) and with significant P values between both groups. Through Structural Topic Modeling analysis, the final model containing 10 topics was selected. High correlations were noted among topics 2, 5, and 8 (pressure ulcer and pharmacotherapy treatment), topics 1, 4, 7, and 9 (incidences related to fever and well-being state, and baseline oxygen saturation) and topics 3 and 10 (blood glucose level and pain). CONCLUSIONS: The ENCN may help in the development and implementation of more effective programs, which allows patients with COVID-19 to adopt to their prepandemic lifestyle faster. Topic modeling could help identify specific clinical problems in patients and better target the care they receive.

Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial.

BACKGROUND: Migraine patients have musculoskeletal disorders and pain in the cervical. And, despite the pathophysiology demonstrating the relationship between migraine and the cervical spine, the effectiveness of craniocervical exercises in these patients has not been verified. So, the aimed of this study was verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients.  METHODS: A two-armed, parallel-group randomized controlled trial with a 3-month follow-up was performed. For eight weeks, the volunteers in the intervention group (n = 21) performed a protocol of CMSE, while those in the sham ultrasound group (n = 21) received the application of disconnected therapeutic ultrasound in the upper trapezius and guideline for home-stretching. The primary outcomes were the frequency and intensity of the headache. The secondary outcomes were questionnaires about migraine and neck disability, and satisfaction with the treatment, cervical range of motion, the pressure pain threshold, craniocervical flexion test (CCFT), cervical muscle strength and endurance test, and the cervical muscle activity during the physical tests. RESULTS: No differences were observed for the changes observed in primary outcomes after eight weeks and at the 3-months follow up (p > 0.05). For the secondary outcomes, craniocervical exercises improved the sensitivity of the frontal muscle (p = 0.040) and promoted a reduced amplitude of muscle activity of the anterior scalene and upper trapezius in the last stages of CCFT (p ≤ 0.010). There was also reduced muscle activity of the anterior scalene and splenius capitis in the endurance test (p ≤ 0.045), as evaluated by surface electromyography. CONCLUSION: CMSE were insufficient in reducing the frequency and intensity of headache, improving the performance of the cervical muscles, or reducing migraine and neck pain-related disabilities. This was found despite a decreased electromyographic activity of the cervical muscles during the last stages of CCFT and increased median frequency during the endurance test. TRIAL REGISTRATION: Accession code RBR-8gfv5j , registered 28/11/2016 in the Registro Brasileiro de Ensaios Clínicos (ReBEC).

Reliability and agreement of the Nine Hole Peg Test in patients with unilateral spastic cerebral palsy.

Upper extremity involvement is one of the most common motor impairments in children with unilateral spastic cerebral palsy (CP). One tool for the assessment of manual function in CP is the Nine Hole Peg Test (NHPT). However, the reliability of the NHPT in patients with unilateral CP is unknown. This study aimed to analyze the intra-rater inter-session reliability of the NHPT in unilateral spastic CP, for its use in clinical practice and research. A total of 27 participants with spastic unilateral CP were included. Reliability was verified by the intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland-Altman method. An excellent intra-rater reliability was observed for the non-affected side (ICC = 0.94) and the affected side (ICC = 0.96). The minimal detectable change was 4 and 12 s for the non-affected and affected side, respectively. There were no significant biases between repetitions.   Conclusions: The NHPT showed excellent intra-rater inter-session reliability in patients with spastic unilateral CP. In addition, the test shows adequate agreement and proportionally small errors to assess manual dexterity. What is Known: • The Nine Hole Peg Test (NHPT) is widely used to assess dexterity in patients with neurological conditions. • The NHPT has demonstrated appropriate measurement properties in healthy children and adults with neurological conditions. What is New: • The NHPT presents excellent reliability, small measurement errors, and adequate agreement for the assessment of patients with cerebral palsy. • The measurement error of the NHPT in unilateral cerebral palsy may be up to 13% of the total time to perform it.

Mental Practice and Manipulative Skills Training Among People With Multiple Sclerosis: A Pilot Study.

IMPORTANCE: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that produces both motor and cognitive dysfunctions. Impairments in limb function as a result of MS cause a decline in the performance of activities of daily living (ADLs). OBJECTIVE: To determine whether the use of mental practice (MP) or MP combined with training in motor manipulation skills (skills training) would improve gross and fine motor skills and treatment satisfaction among people with MS. DESIGN: Pilot study with a duration of 3 mo plus 3-mo follow-up. SETTING: Two MS associations. PARTICIPANTS: Thirty-five patients diagnosed with MS of the relapsing-remitting and progressive secondary subtypes, ages 25 to 60 yr. INTERVENTION: The participants were allocated to one of three groups according to their order of inclusion in the study: (1) MP, (2) MP + skills training, or (3) control group. The treatment protocol had a 6-wk duration and a total of 12 sessions. Outcomes and Measures: Blinded evaluators performed three assessments for each patient (pretreatment, posttreatment, and 3-mo follow-up) using the Nine-Hole Peg Test, Box and Block Test, ABILHAND, and Canadian Occupational Performance Measure (COPM). RESULTS: We found no evidence of benefits in self-perceived performance of ADLs with respect to gross and fine motor skills; however, there was an improvement in perceived satisfaction and in the performance of activities, independent of the treatment received. CONCLUSIONS AND RELEVANCE: Perceived ADL performance and satisfaction with performance increases among people with MS when they receive MP, MP + skills training, and conventional rehabilitation treatment. What This Article Adds: Mental practice combined with conventional treatment could contribute to patients perceiving improved performance of ADLs. Self-reported outcome measures, such as the COPM, could provide highly valuable information about occupation performance that may not match the objective evidence.

Essence of the Bobath concept in the treatment of children with cerebral palsy. A qualitative study of the experience of Spanish therapists.

Objective: The aim was to explore the experiences of a group of Spanish physical therapists who apply the Bobath concept in the treatment of children with cerebral palsy, specifically to identify the components they experience as core and essential to the Bobath concept.Design: A qualitative phenomenological study.Methods: This study used purposive sampling. Non-structured interviews were carried out with 10 Spanish Bobath-trained physical therapists who treat children with cerebral palsy. Thematic analysis was applied.Results: Five themes regarding the essence of the Bobath concept emerged: 1) "normal movement" as a guide; 2) a "global" concept; 3) observation; 4) the centrality of tone; and 5) working with families. Within these themes, additional principles were reflected cross-sectionally, such as therapy being a continuous process of assessment and treatment, the application of principles of motor learning, and the importance of carryover of treatment into function.Conclusions: The results demonstrated themes traditionally identified as core to the Bobath concept, including working with families, which is also considered integral to the approach. The study participants used outdated terminology at times when discussing tone and movement. However, they reported that they no longer adhere to the theoretical perspective of pathological reflexes and reflex/tone inhibition. This study provides insight into how treatment of children with cerebral palsy based on the Bobath concept is experienced by a group of Spanish physiotherapists, who identified five main themes that they perceive as essential. The results provide grounds for further research into the application of the Bobath concept in children.

Comparison of cervical muscle isometric force between migraine subgroups or migraine-associated neck pain: a controlled study.

This study aimed to verify if migraine frequency or migraine-associated neck pain were associated with a reduction of normalized force and altered electromyographic activity during maximal cervical muscle isometric contractions. Additionally, it aimed to assess the correlation of normalized isometric force with years with migraine, headache frequency, headache intensity, migraine-related disability, and severity of cutaneous allodynia. The sample comprises 71 women with migraine (40/31 episodic/chronic, 42/18 with/without neck pain) and 32 women without headache. Cervical muscle isometric force in flexion, extension, and lateral flexion was assessed synchronized with the acquisition of superficial electromyography from the cervical muscles. Women with episodic migraine presented lower normalized isometric force in extension, flexion, and right and left lateral flexions than controls (P < 0.05). Women with migraine and neck pain exhibited lower cervical extension and right/left lateral-flexions normalized isometric force than controls (P < 0.05). No significant differences were observed in antagonist activity. Normalized isometric force in all directions showed weak to moderate correlations with the severity of self-reported symptoms of cutaneous allodynia (- 0.25 ≥ r ≥ - 0.39). No additional linear correlation with clinical migraine features was observed. In conclusion, cervical muscle weakness may be associated with episodic migraine and neck pain concurrent with migraine attacks without altered antagonist activity. Additionally, it may also be related to the severity of cutaneous allodynia.

Trends in Incidence and Outcomes of Hospitalizations for Urinary Tract Infection among Older People in Spain (2001-2018).

(1) Background: To assess time trends in the incidence and in-hospital outcomes of urinary tract infection (UTI) in older people (≥65 years) in Spain (2001-2018) according to sex and to identify the factors independently associated with in-hospital mortality (IHM). (2) Methods: Using the Spanish National Hospital Database, we analyzed comorbidity, procedures, diagnosis, isolated microorganisms, and outcomes. (3) Results: We included 583,693 admissions (56.76% women). In both sexes, the incidence increased with age over time (p < 0.001). In men and women, the highest IHM was found among the oldest patients (>84 years) with values of 9.16% and 8.6%, respectively. The prevalence of bacteremia increased from 4.61% to 4.98% from 2001 to 2018 (p < 0.001) and sepsis decreased from 3.16% to 1.69% (p < 0.001). The risk of dying increased with age (>84 years) (OR 3.63; 95% CI 3.5-3.78) and with almost all comorbidities. Urinary catheter was a risk factor for women (OR 1.1; 95% CI 1.02-1.18) and protective for men (OR 0.71; 95% CI 0.66-0.76). Isolation of Staphylococcus aureus increased the risk of IHM by 40% among men (OR 1.4; 95% CI 1.28-1.53). After adjusting for confounders, IHM decreased over time. (4) Conclusions: The incidence of UTIs was higher in older patients and increased over time; however, IHM decreased during the same period. Female sex, age, comorbidities, sepsis, and a Staphylococcus aureus isolation increased risk of IHM.

Craniocervical flexion test in patients with migraine: Discriminative validity and accuracy.

OBJECTIVES: To evaluate the discriminative validity and provide a clinical cut-off of the craniocervical flexion test (CCFT) in migraineurs stratified by the report of neck pain, headache-related disability and neck disability. METHODS: Fifty women without headache and 102 women with migraine were recruited by convenience from a local tertiary care setting. Migraine diagnosis followed the International Classification of Headache Disorders. All volunteers underwent the CCFT. Patients with migraine answered the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) questionnaires. Discriminative validity was verified by group comparison, and the clinical cut-off was obtained and classified according to the diagnostic accuracy of the CCFT. RESULTS: The CCFT presented discriminative validity for comparing control (median = 28, IQR = 6) with migraine (median = 26, IQR = 4, P = .01) and migraine with neck pain (median = 26, IQR = 4, P = .01), but not among the migraine subtypes with disability by migraine or neck pain-related disability on the MIDAS and NDI. The diagnostic accuracies were classified between poor and not discriminating with the area under the receiver operating characteristic curve ranging from 57% to 69% and non-acceptable values of sensitivity, specificity and positive and negative likelihood ratios. CONCLUSION: The CCFT can discriminate asymptomatic controls from migraine patients with and without neck pain. However, it cannot discriminate patients with migraine according to their pain-related disability. Also, the CCFT does not offer an optimal cut-off value in migraine patients adequate to clinical practice.

Are There Gender Differences in Neck Pain and Musculoskeletal Disorders of the Cervical Spine Associated with Migraine?

OBJECTIVE: To evaluate gender differences in clinical characteristics of migraine by examining presence and severity of cutaneous allodynia, migraine-related disability, neck pain and its associated disability, passive mobility of the upper cervical spine, and performance of the deep neck flexor muscles. DESIGN: Cross-sectional study. SUBJECTS: 30 men and 30 women with migraine. METHODS: Participants responded to the questionnaires Migraine Disability Assessment questionnaire, 12-item Allodynia Symptom Checklist, and Neck Disability Index. The mobility of the upper cervical spine was assessed by using the Flexion-Rotation Test. Performance of the deep neck flexor muscles was evaluated by applying the Craniocervical Flexion Test. Comparison of the groups was carried out by using the Student's t-test or the χ2 test. The prevalence ratio was also calculated. RESULTS: Women showed a higher prevalence of cutaneous allodynia (P = .001) and a 4 times greater risk of having severe cutaneous allodynia than to men (P = 0.007). No gender differences were observed in migraine-related disability (P = .08). Women showed higher prevalence of self-reported neck pain (P = .03) and increased risk of having this symptom in comparison to men (Prevalence Ratio = 1.69; P = 0.025). However, there were no gender differences in neck pain-related disability (P = .25), mobility of the upper cervical spine (P = .92), or performance of the deep neck flexor muscles (P = .52). CONCLUSION: Women with migraine had a higher frequency of self-reported neck pain and higher prevalence and severity of cutaneous allodynia when compared to men. However, the two groups did not differ regarding neck pain-related disability and performance in the physical tests.

Muscle endurance and cervical electromyographic activity during submaximal efforts in women with and without migraine.

BACKGROUND: Despite previous reports supporting cervical muscle weakness and altered motor control in migraine, the endurance under standardized submaximal loads has not been investigated. Therefore, this study aimed to assess the endurance and muscle activity of the cervical musculature during submaximal isometric contractions in women with migraine and those without headache. METHODS: Cervical muscle endurance tests were performed for flexors and extensors at 25%, 50%, and 75% of the output force during maximal isometric contraction using the Multi-Cervical Rehabilitation Unit with customized biofeedback. Initial values and relative rates of changes in root mean square and median frequency were calculated using cervical muscle superficial electromyography. FINDINGS: Women with chronic migraine presented significantly shorter flexor endurance time in all load tests than controls (25%, P = .001, 50%, P = .005; 75%, P = .013), while episodic migraine only differed from controls at 75% (P = .018). The frequency of neck pain and/or pain referred to the head after the endurance test was up 12% in the control group, 40% in the episodic migraine group and 68% of the chronic migraine group. Few differences between groups were observed in the electromyographic variables and none of them was related to a worse performance in the endurance tests. INTERPRETATION: Cervical flexor endurance was reduced in women with chronic migraine when independent of the load, whereas it was reduced to 75% of the maximal force in those with episodic migraine. No difference in the electromyographic variables could be related to this reduced flexor endurance. Also, no differences were detected in extensors endurance.

Women with mechanical neck pain exhibit increased activation of their superficial neck extensors when performing the cranio-cervical flexion test.

BACKGROUND: Several studies have analysed the activity of superficial neck flexors, but the activity of neck extensors has been less investigated in patients with neck pain OBJECTIVES: 1, to investigate the differences in the activation of superficial neck flexor and extensor musculature during the cranio-cervical flexion test (CCFT) in women with mechanical chronic neck pain when compared to asymptomatic women; 2, to investigate the correlation between neck muscle activity and the clinical features of neck pain DESIGN: Cross-sectional METHODS: Surface electromyography was recorded bilaterally from the sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles of 30 women with mechanical chronic neck pain and 30 asymptomatic women as they performed the CCFT. Comparisons of the normalized root mean square between both groups were conducted with 2x5 ANCOVA with task level as the within-subjects variable, group as the between-subjects variable, and pain related-disability as a co-variate RESULTS: Women with mechanical neck pain exhibited increased activity of superficial neck flexors (sternocleidomastoid: F = 14.448, P < 0.001; anterior scalene: F = 21.693, P < 0.001) and superficial neck extensors (splenius capitis: F = 4.692, P < 0.001; upper trapezius: F = 4.245, P < 0.001) as compared to asymptomatic women. Higher pain related-disability was associated with more electrical activity of the anterior scalene and upper trapezius muscles during the CCFT CONCLUSIONS: Women with mechanical chronic neck pain exhibit an increased activity of their superficial neck flexors and superficial neck extensors during a low-load task such as CCFT when compared to asymptomatic pain-free women. Our results should be considered when designing therapeutic exercise programs for this population.

Intrarater and Interrater Reliability of the Flexion Rotation Test and Cervical Range of Motion in People With Migraine.

OBJECTIVE: The aim of this study was to determine the reliability, standard error of measurement (SEM), and smallest detectable change (SDC) of the flexion rotation test (FRT) and cervical range of motion (CROM) assessed with the CROM device in individuals with and without migraine. METHODS: Twenty-five women with migraine (mean age, 35 years; standard deviation, 10 years) and 25 comparable headache-free women (mean age, 32 years; standard deviation, 11 years) participated in this study. C1/C2 mobility was assessed with the FRT, whereas global cervical range of motion was calculated using a CROM device. To assess the interrater reliability, tests were conducted on the same day at 20-minute intervals, by 2 independent assessors, and they were repeated after a 1-week interval by the same assessor to evaluate the intrarater reliability. The mean value of 3 repetitions was used to calculate the intraclass correlation coefficient ICC(2,k), SEM, and SDC. RESULTS: The intrarater reliability was excellent (ICC > 0.83), and interrater reliability ranged from substantial to excellent (ICC > 0.77) for the FRT. The SEM ranged from 2.44° to 2.85°, and the SDC from 6.78° to 7.9°. Intrarater and interrater reliability for cervical range of motion was substantial to excellent (ICC > 0.65), with the SEM ranging from 2.03° to 5.46° and the SDC from 5.6° to 15.14°. CONCLUSION: The results demonstrate that FRT and global cervical range of motion with a CROM device show high reliability in individuals with migraine. In addition, the SEM and SDC were relatively small. Both assessments can be used for clinical evaluation of the cervical spine in individuals with migraine.

Neck-specific strengthening exercise compared with sham ultrasound when added to home-stretching exercise in patients with migraine: study protocol of a two-armed, parallel-groups randomized controlled trial.

BACKGROUND: Migraine is a highly disabling condition and pharmacological treatment is the gold standard. However, several patients have also positive responses to the application of different manual techniques and therapeutic exercises in terms of reducing the intensity and frequency of migraine attacks. Nevertheless, the effects of a neck-specific exercise program have not yet been evaluated in these patients. OBJECTIVE: To determine the effectiveness of a neck-specific exercise program in reducing the intensity and frequency of migraine attacks as compared to a sham ultrasound group. METHODS: A two-armed, parallel-groups randomized controlled trial with 3 months of follow-up will be conducted. 42 individuals, both genders, aged between 18 and 55 years old with a medical diagnosis of migraine will be included. The intervention group will perform a protocol consisting of exercises for strengthening the muscles of the cervical spine. Participants within the sham ultrasound group will receive detuned ultrasound therapy in the upper trapezius muscle. Both groups will receive a weekly session for 8 weeks. The efficacy of each intervention will be measured by the frequency and intensity of migraine at a 3-months follow-up. TRIAL REGISTRATION: This study was registered under access code RBT-8gfv5j in the Registro Brasileiro de Ensaios Clínicos (ReBEC) in November 28, 2016. CONCLUSION: This study will aim to determine the efficacy of a neck-specific exercise program in reducing the frequency and intensity of migraine attacks. If the results show that a neck-specific exercise program is effective in reducing the frequency and intensity of migraine attacks, therapists will have a low cost and easily applicable tool to treat migraine.

Content Comparison of Aquatic Therapy Outcome Measures for Children with Neuromuscular and Neurodevelopmental Disorders Using the International Classification of Functioning, Disability, and Health.

Currently, aquatic exercise is among the most common physical activity modalities for children with neuromuscular and neurodevelopmental disorders. However, the outcome measures that should be routinely used by therapists working in this specific health-care context have not been widely studied. The purpose of the study was to identify and compare the content of outcome measures used in aquatic physiotherapy for children, employing the International Classification of Functioning, Disability and Health (ICF) as a framework. A literature review was used to identify aquatic functioning outcome measures for children with neuromuscular and neurodevelopmental disorders. Content comparison of outcome measures identified was linked to the ICF following the linking guidelines, and content-related metrics were used to analyze them. Four outcome measures were identified (HAAR, Conatser, WOTA 1 and 2, and SWIM), which contained a total of 116 meaningful concepts and were linked to 35 ICF 2nd level categories. The greatest number of items assessed activity and participation categories. Large differences were found in reference to the density of content. For content diversity, the measures were all below 0.5. The identified outcome measurements showed homogeneity with respect to the theoretical foundation; however, some differences were found in terms of content analysis.