Effect of multichannel transcranial direct current stimulation to reduce hypertonia in individuals with prolonged disorders of consciousness: A randomized controlled pilot study.

BACKGROUND: Spasticity management in severely brain-injured patients with disorders of consciousness (DOC) is a major challenge because it leads to complications and severe pain that can seriously affect quality of life. OBJECTIVES: We aimed to determine the feasibility of a single session of transcranial direct current stimulations (tDCS) to reduce spasticity in chronic patients with DOC. METHODS: We enrolled 14 patients in this double-blind, sham-controlled randomized crossover pilot study. Two cathodes were placed over the left and right primary motor cortex and 2 anodes over the left and right prefrontal cortex. Hypertonia of the upper limbs and level of consciousness were assessed by the Modified Ashworth Scale (MAS) and the Coma Recovery Scale-Revised (CRS-R). Resting state electroencephalography was also performed. RESULTS: At the group level, spasticity was reduced in only finger flexors. Four responders (29%) showed reduced hypertonicity in at least 2 joints after active but not sham stimulation. We found no behavioural changes by the CRS-R total score. At the group level, connectivity values in beta2 were higher with active versus sham stimulation. Relative power in the theta band and connectivity in the beta band were higher for responders than non-responders after the active stimulation. CONCLUSION: This pilot study highlights the potential benefit of using tDCS for reducing upper-limb hypertonia in patients with chronic DOC. Large-sample clinical trials are needed to optimize and validate the technique.

Influence of proprioceptive neuromuscular facilitation on the muscle tonus and amplitude of movement in HTLV-1-infected patients with HAM/TSP.

An HTLV-1-infected patient can develop paraparesis that limits their movements. Rehabilitation techniques could improve the motor abilities of these patients. The present study investigates five cases of physical therapy intervention in HTLV-1 patients to evaluate the influence of functional rehabilitation on the tonus and range of motion (ROM) of HTLV-1 patients with spasticity. The patients had a gain of ROM, especially in the lower limb, and reduction in hypertonia/spasticity after functional treatment. The reduction in hypertonia increased the ROM. Thus, functional methods may be valuable for the rehabilitation of HTLV-1 patients with neurological damage.

Influence of proprioceptive neuromuscular facilitation on the muscle tonus and amplitude of movement in HTLV-1-infected patients with HAM/TSP

Abstract An HTLV-1-infected patient can develop paraparesis that limits their movements. Rehabilitation techniques could improve the motor abilities of these patients. The present study investigates five cases of physical therapy intervention in HTLV-1 patients to evaluate the influence of functional rehabilitation on the tonus and range of motion (ROM) of HTLV-1 patients with spasticity. The patients had a gain of ROM, especially in the lower limb, and reduction in hypertonia/spasticity after functional treatment. The reduction in hypertonia increased the ROM. Thus, functional methods may be valuable for the rehabilitation of HTLV-1 patients with neurological damage.

Cuantificación de la espasticidad autopercibida. Revisión de escalas y cuestionarios / Quantification of self-perceived spasticty. Review of scales and questionnaires

A pesar de la gran cantidad de herramientas disponibles para evaluar la espasticidad, su fluctuación durante el día, la interferencia en la vida diaria y la falta de correlación entre los diferentes síntomas, fundamentan la cuantificación de la percepción del paciente de su propia espasticidad. Esta revisión pretende analizar los principales métodos de valoración de la espasticidad autopercibida por el paciente con enfermedad neurológica, descritos en la literatura científica, y realizar una descripción y análisis crítico de sus ventajas y limitaciones. Tras analizar las principales escalas de valoración de la espasticidad percibida, se concluye que existen pocas herramientas de cuantificación de la espasticidad que contemplen la percepción del paciente y, comparadas con las escalas de evaluación clínica tradicionales, han sido poco utilizadas en la literatura científica. Sin embargo, para su correcta valoración, es fundamental incluir al menos una medición que valore la autopercepción de espasticidad (AU)

Several tools are available to evaluate spasticity. However, because of factors such as fluctuation within the day, interference with daily activities and the absence of correlation among spasticity symptoms, there is a need for tools that measure self-perceived spasticity. This review aims to analyse the main methods for the evaluation of self-perceived spasticity by individuals with neurologic disorders and to discuss their advantages and disadvantages. Analysis of the main scales of self-perceived spasticity revealed that there are few spasticity measurement tools that include the patient's subjective point of view and that very few are used in the scientific literature compared with traditional clinical spasticity scales. However, for a comprehensive evaluation of spasticity, it is crucial to include at least one scale that assesses self-perceived spasticity (AU)

Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes.

OBJECTIVE: To assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS). DESIGN: Observational reliability study of the SCATS. SETTING: Inpatient rehabilitation unit at an education and research hospital. PARTICIPANTS: Subjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interrater and test-retest reliability of the SCATS. RESULTS: The SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05). CONCLUSIONS: The SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.

Efecto inmediato del vendaje neuromuscular aplicado en tronco para disminuir la espasticidad en extremidades superiores e inferiores en niños con parálisis cerebral nivel V conforme al sistema de clasificación de la función motora gruesa / Immediate effect of neuromuscular bandage applied on trunk to reduce spasticity in upper and lower limbs in children with cerebral palsy

Objetivo: Evaluar el efecto inmediato de la aplicación del vendaje neuromuscular en el tronco para disminuir la espasticidad en las extremidades superiores e inferiores en niños con parálisis cerebral GMFS V. Diseño: Se llevó a cabo un estudio prospectivo, comparativo, de enfoque ensayo clínico, tipo cuasiexperimental, con mediciones pretest-postest, donde se estudió a 21 pacientes con parálisis cerebral GMFS V. La espasticidad se evaluó con la escala de Ashworth modificada para miembros superiores e inferiores, escala del tono aductor bilateral de caderas y mediciones goniométricas de los ángulos de flexión, extensión y abducción de caderas, flexión y extensión de rodillas, dorsiflexión y flexión plantar de tobillos, flexión, extensión y abducción de hombros, flexión y extensión de codos, todas las anteriores tomadas por el médico especialista en rehabilitación pediátrica. Para el análisis estadístico se utilizó la prueba no paramétrica de Wilcoxon para muestras apareadas, previa comprobación de la distribución de los datos, con el paquete estadístico SPSS versión 17.0, tomando un valor de p ≤ 0,05 como estadísticamente significativo. Resultados: La disminución obtenida en la espasticidad de las 4 extremidades, como la disminución del tono muscular de los aductores de caderas y el aumento en los rangos de flexión, extensión y abducción de caderas y hombros, en la flexión, extensión de rodillas y tobillos, fue estadísticamente significativa, p < 0.05, y clínicamente relevante en una sesión de aplicación del vendaje neuromuscular. Conclusiones: El vendaje neuromuscular aplicado en el tronco es un método efectivo para disminuir la espasticidad

Objective: To evaluate the immediate effect of the application of neuromuscular bandage on trunk to reduce spasticity in upper and lower limbs in children with cerebral palsy GMFS V. Design: We performed a prospective comparative study, clinical testing approach, quasi-experimental with measures pre test-post test, where 21 patients with cerebral palsy GMFS V were studied. Spasticity was assessed with the modified Ashworth scale for upper and lower limbs, bilateral adductor tone scale hips and goniometric measurements of the angles of flexion, extension and hip abduction, knee flexion and extension, dorsiflexion and plantar flexion ankles, flexion, extension and shoulder abduction, elbow flexion and extension, all of the above made by the specialist physician in pediatric rehabilitation. For statistical analysis nonparametric Wilcoxon test was used for paired samples, after verification of the distribution of the data using SPSS version 17.0, considering a P value ≤.05 as statistically significant. Results: The obtained reduction in spasticity in all four limbs, decreased muscle tone hip adductors and increased ranges of flexion, extension and abduction of the hips and shoulders, bending, knee extension and ankle was statistically significant, P<.05 and clinically relevant in an application session of neuromuscular bandage. Conclusions: The neuromuscular bandage applied on the trunk is an effective method to reduce spasticity

Evaluation of HEXORR Tone Assistance Mode Against Spring Assistance.

Robots are a promising tool for rehabilitation, and research suggests combining assistance with subject participation to maintain motivation and engagement. In this study, we compare two different types of robotic assistance for hand rehabilitation: Tone, a novel method designed to directly compensate for the user's hypertonia, and Spring, a commonly used method simulating a spring-like force attracting the subject to the target position. Eight chronic stroke subjects played a Gate Game, where they guide a ball through a sweeping, on-screen gate. Each subject was exposed to 5 modes: unassisted, assisted by the Spring and Tone modes, and "delay" modes where the assistance was provided after a period without assistance. Compared to unassisted trials, subjects produced less positive work and more negative work with all types of assistance but also reached a larger ROM and scored higher on the game. Notably, subjects produced more positive work overall with Tone compared to Spring. Further, subjects produced positive work over a significantly shorter range with Spring compared to Unassisted, while there was no difference between Tone and Unassisted. While both modes were effective at enabling the training of a larger workspace, these results suggest Tone assistance maintains a greater level of subject engagement and participation, likely making it a useful tool for hand rehabilitation.

Interval training-induced alleviation of rigidity and hypertonia in patients with Parkinson's disease is accompanied by increased basal serum brain-derived neurotrophic factor.

OBJECTIVE: To examine the effects of cycloergometric interval training on parkinsonian rigidity, relaxed biceps brachii muscle tone in affected upper extremities, and serum level of brain-derived neurotrophic factor. DESIGN: Case series, repeated-measures design, pilot study. SUBJECTS/PATIENTS: Eleven patients with mild-to-moderate Parkinson's disease (Hoehn & Yahr scale 2.3 ± 0.72), recruited from a neurological clinic, underwent cycle training and were tested along with non-trained, healthy control subjects (n = 11) in a motor control laboratory. METHODS: Patients underwent 8 weeks of interval training (3 × 1-h sessions weekly, consisting of a 10-min warm-up, 40 min of interval exercise, and 10-min cool-down) on a stationary cycloergometer. Parkinsonian rigidity (Unified Parkinson's Disease-Rating-Scale) in the upper extremity, resting biceps brachii muscle tone (myometric stiffness and frequency), and brain-derived neurotrophic factor level were measured 1-3 days before interval training cycle started and 6-10 days after the last training session. RESULTS: Training resulted in a decrease in rigidity (p = 0.048) and biceps brachii myometric muscle stiffness (p = 0.030) and frequency (p = 0.006), and an increase in the level of brain-derived neurotrophic factor (p = 0.035) relative to pre-training values. The increase in brain-derived neurotrophic factor level correlated with improvements in parkinsonian rigidity (p = 0.025), biceps brachii myometric stiffness (p = 0.001) and frequency (p = 0.002). CONCLUSION: Training-induced alleviation of parkinsonian rigidity and muscle tone decrease may be associated with neuroplastic changes caused by a training-induced increase in the level of brain-derived neurotrophic factor.

Therapist recognition of impaired muscle groups in simulated multi-joint hypertonia.

It is common in today's clinical practice for a therapist to physically manipulate patients' limbs to assess hypertonic conditions (e.g. spasticity, rigidity, dystonia, among others). We present a study that evaluates the capabilities of expert therapists to correctly identify the location of a hypertonic impairment of an arm through standard manipulation. Therapists interacted with a hypertonic virtual arms rendered on a robotic device. Our results show that testing joints independently can cause misjudgment of the mechanical contributions of pluri-articular muscles to multi-joint impairment.

The impact of abnormal muscle tone from hemiplegia on reclining wheelchair positioning: a sliding and pressure evaluation.

BACKGROUND: Little is known about the influence of existing muscle tone abnormality on the sitting posture of stroke patients in reclining wheelchairs. AIM: To investigate the impact of muscle tone abnormality from hemiplegia on the forward sliding and pressure of stroke patients while sitting in reclining wheelchairs. DESIGN: Experimental study. SETTING: The Assistive Devices/Technology Center at the Rehabilitation Department of hospital. POPULATION: 14 able-bodied elders and nonambulatory elderly stroke patients with flaccid (N.=12) or spastic hemiplegia (N.=13) participated in this study. Of the 12 patients with flaccid hemiplegia, 8 suffered from left-sided hemiplegia and 4 from right-sided hemiplegia. Of the 13 patients with spastic hemiplegia, 6 suffered from left-sided hemiplegia and 7 from right-sided hemiplegia. METHODS: We performed 3 reclining cycles in wheelchairs with conventional seats and V-shaped seats for each participant. The sliding along the backrest (BS) plane and the seat (SS) plane, mean sitting pressure (MP), and sacral peak pressure (SPP) of the participants were recorded. The Kruskal-Wallis test was used to compare the difference in BS, SS, MP, and SPP between able-bodied elders and stroke patients. RESULTS: The BS, SS, and SPP during repetitive reclining were generally greatest in flaccid hemiplegic participants, followed by spastic hemiplegic participants, and finally by able-bodied participants. There was no significant difference in MP among three subject groups on both conventional seats and V-shaped seats in most comparisons. Able-bodied participants' buttocks tended to slide forward on conventional seats but backward on V-shaped seats, whereas hemiplegic participants' buttocks slid forward on both seat types. CONCLUSION: Stroke patients with flaccid hemiplegia are the most vulnerable to sacral sitting and higher sacral pressure in reclining wheelchairs, followed by patients with spastic hemiplegia. There is a difference in the displacement pattern between participants with normal muscle tone and those with abnormal muscle tone during wheelchair positioning. People who have hemiplegia with spasticity do not have incremental forward sliding with repetitive reclining in the same way as those who have a flaccid hemiplegia. CLINICAL REHABILITATION IMPACT: The findings are valuable for wheelchair prescription and caregiver education.

Clinical effects of using HEXORR (Hand Exoskeleton Rehabilitation Robot) for movement therapy in stroke rehabilitation.

OBJECTIVE: The goals of this pilot study were to quantify the clinical benefits of using the Hand Exoskeleton Rehabilitation Robot for hand rehabilitation after stroke and to determine the population best served by this intervention. DESIGN: Nine subjects with chronic stroke (one excluded from analysis) completed 18 sessions of training with the Hand Exoskeleton Rehabilitation Robot and a preevaluation, a postevaluation, and a 90-day clinical evaluation. RESULTS: Overall, the subjects improved in both range of motion and clinical measures. Compared with the preevaluation, the subjects showed significant improvements in range of motion, grip strength, and the hand component of the Fugl-Meyer (mean changes, 6.60 degrees, 8.84 percentage points, and 1.86 points, respectively). A subgroup of six subjects exhibited lower tone and received a higher dosage of training. These subjects had significant gains in grip strength, the hand component of the Fugl-Meyer, and the Action Research Arm Test (mean changes, 8.42 percentage points, 2.17 points, and 2.33 points, respectively). CONCLUSIONS: Future work is needed to better manage higher levels of hypertonia and provide more support to subjects with higher impairment levels; however, the current results support further study into the Hand Exoskeleton Rehabilitation Robot treatment.

Managing lower extremity muscle tone and function in children with cerebral palsy via eight-week repetitive passive knee movement intervention.

This study used a repeated measures design to assess the effect of an eight-week repetitive passive movement (RPM) intervention on lower extremity muscle tone and function in children with cerebral palsy (CP). Eighteen children (aged 9.5 ± 2.1 years) with spastic CP were randomly assigned to a knee RPM intervention condition of 3 times a week for 8 weeks or a control condition. The 8 weeks were followed by 4 weeks of washout period, after which the participants were crossed over to the other group. In the RPM condition, each subject's knees were intervened with continuous passive motion device (at a velocity of 15°/s) for 20 min. The subjects were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, after, 1 day after, and 3 days after each intervention. Repeated-measures statistical analyses found significant differences between condition variable on active range-of-motion of the knee (AROM, increased), relaxation index (RI, increased), Modified Ashworth Scale (MAS, decreased), timed up-and-go (TUG, decreased), 6-min walk test (6 MWT, increased); and significant differences among time variable including RI, MAS, and 6 MWT. No difference was found in passive range-of-motion measurements. Repetitive passive movement reduced lower extremity spastic hypertonia in children with cerebral palsy, and it also improved ambulatory function in terms of walking speed. Effects of this treatment protocol on ambulation lasted up to 3 days post intervention. Findings of this study provide clinicians and patients an alternative, effective and efficient strategy for spastic control and ambulatory improvement.

Casting for upper limb hypertonia: a retrospective study to determine the factors associated with intervention decisions.

AIM: To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture. METHODS: Sixty-four intervention decisions (including strength/movement training, splinting and/or casting) were drawn retrospectively from initial reports at a community clinic. Associations between identified upper limb characteristics, stated clinical aims and intervention decisions were analysed using logistic regression. RESULTS: Casting was statistically significantly likely to be chosen in the presence of moderate (CI(95) 1.88-39.80, p=0.01) or severe hypertonicity (CI(95) 1.34-135.98, p=0.03), and if the stated clinical aim was to reduce hypertonicity (CI(95) 2.01-18.10, p=0.001) or contracture (CI(95) 1.31-12.73, p=0.02). When reports included both these clinical aims, there was a highly significant association with the decision to cast (CI(95) 5.67-9.13, p=0.001). Where casting was indicated as appropriate, but not chosen as an intervention, mitigating factors included older age (70-95 years), limited personal support and a clinical aim of comfort/hygiene maintenance. CONCLUSION: Occupational therapists using the Protocol consistently chose casting as an upper limb intervention for adults who demonstrated moderate/severe hypertonicity, contracture or limited functional ability. Prospective research is required to determine intervention outcomes following use of the Protocol.

Comparison of long-term outcomes of patients with severe traumatic or hypoxic brain injuries treated with intrathecal baclofen therapy for dysautonomia.

PRIMARY OBJECTIVE: To compare the long-term outcome of patients with severe traumatic brain injury and patients with hypoxic brain injury with dysautonomia and hypertonia treated with intrathecal baclofen therapy. METHODS AND PROCEDURES: Fifty-three patients with severe traumatic (n = 43/53) or hypoxic (n = 10/53) brain injuries treated by intrathecal baclofen therapy were included to be evaluated with the Coma Recovery Scale-Revised, the Barthel Index, the Glasgow Outcome Scale, the Ashworth scale, the scores of hypertonic attacks, of sweating episode and of voluntary motor responses. A retrospective analysis highlighted patients' characteristics at admission and before surgery and their complications. MAIN OUTCOMES AND RESULTS: After a mean follow-up time of 9.6 years, 13/53 (24.5%) patients had died. Alive patients with traumatic brain injury had a higher level of consciousness recovery (p < 0.02) and more abilities in activities of daily living (p < 0.008) in the long-term. Their dysautonomia and limb hypertonia also significantly improved, contrary to patients with hypoxic brain injury who needed higher doses of baclofen (p < 0.03). CONCLUSIONS: At long-term follow-up, patients with hypoxic brain injury had a poorer functional outcome than patients with traumatic brain injury with persistent symptoms of dysautonomia associated with uncontrolled hypertonia, despite the use of intrathecal baclofen.

Electromyogram-lengthening velocity relation in plantar flexors during stance phase of gait in patients with hypertonia after acquired brain injury.

OBJECTIVE: To examine the velocity-dependent change in medial gastrocnemius (MG) activity during the stance phase of gait in patients with moderate to severe resting hypertonia after stroke or traumatic brain injury (TBI). DESIGN: Cohort study. SETTING: Motion analysis laboratory in a tertiary-care rehabilitation hospital. PARTICIPANTS: Convenience sample of patients with chronic TBI and stroke (n=11 each), and age- and sex-matched healthy controls (n=22). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Frequency and gain (steepness) of positive (>0) and significant positive (>0 and goodness of fit P≤.05) electromyogram-lengthening velocity (EMG-LV) linear regression slope in MG during the stance phase of gait. RESULTS: Positive and significant positive slopes were found significantly more often on the more affected (MA) than less affected (LA) side in patients with TBI but not stroke. Both the frequencies of positive and significant positive slopes on the MA side in patients with TBI were also significantly higher than in controls. However, neither the gain of positive nor significant positive EMG-LV slope was different between the MA and LA sides or in comparison with controls. Positive slope parameters were not related to Ashworth score on the MA side. CONCLUSIONS: The frequency and gain of positive EMG-lengthening slope did not effectively differentiate patients from controls, nor were they related to the resting muscle hypertonia. Motor output during MG lengthening in the stance phase of gait is apparently not exaggerated or related to resting hypertonia in patients with chronic TBI and stroke. Thus, changes in gait during stance cannot be ascribed to increased stretch reflex activity in MG muscle after acquired brain injury.

[Botulinum toxin in the elderly to the care of limbs spastic hypertonia and toes or fingers dystonias]. / La toxine botulinique chez les sujets âgés dans la prise en charge de l'hypertonie spastique des membres et des dystonies des orteils ou des doigts.

OBJECTIVE: To show the botulinum toxin interest and limits in the elderly presenting a limbs spastic hypertonia and/or a dystonia, through a clinical study and a literature review. METHOD: We report a 6 years and 8 months retrospective single center study, concerning 49 patients, all of them was more than 70 years old and had received one or several botulinum toxin injections for a limbs spastic hypertonia and/or a dystonia. RESULTS: The population average was 76,9 years old (70 to 92 years old). It was possible to realize several sessions for the same patient if respecting a three months interval between two sessions. No major side effects was noticed. More than half of the patients felt a significant improvement of their life quality, their functional status and/or on pain. A multidisciplinary care was systematically associated with the botulinum toxin. CONCLUSION: The botulinum toxin is an additional asset for the spasticity care of the geriatric patient in rehabilitation, if indications and contraindications are advisedly targeted. The age cannot be considered as a limitating factor.

Managing spastic hypertonia in children with cerebral palsy via repetitive passive knee movements.

OBJECTIVE: Most children with cerebral palsy have increased muscle tension in the lower extremities, which inevitably leads to abnormal gait characteristics. Proper management of excessive muscle tension is therefore of great importance. The aim of this study was to explore the effects of continuous passive motion on children with cerebral palsy, regarding their lower extremity spastic hypertonia and ambulatory function. DESIGN: A repeated measures design. SUBJECTS: Sixteen children with cerebral palsy. METHODS: Intervention was applied to the subject's knees with a continuous passive motion device (at velocities of 15 and 0º/s) for 20 min. Effects were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, immediately after, and 30 min after intervention. RESULTS: For the 15º/s intervention, significant differences were found in time, intervention, and interaction among variables, including active range-of-motion of the knee (increased), relaxation index (increased), Modified Ashworth Scale (decreased), Timed Up-and-Go (decreased), and 6-Minute Walk test (increased). No difference was found in passive range of motion measurements. For the 0º/s control condition, none of the dependent variables demonstrated statistically significant differences. CONCLUSION: Repetitive passive movement can reduce lower extremity spastic hypertonia in children with cerebral palsy, and improve ambulatory function in terms of walking speed.

Gait strategy in patients with Ehlers-Danlos syndrome hypermobility type: a kinematic and kinetic evaluation using 3D gait analysis.

The aim of this study was to quantify the gait patterns of adults with joint hypermobility syndrome/Ehlers-Danlos syndrome (JHS/EDS-HT) hypermobility type, using Gait Analysis. We quantified the gait strategy in 12 JHS/EDS-HT adults individuals (age: 43.08+6.78 years) compared to 20 healthy controls (age: 37.23±8.91 years), in terms of kinematics and kinetics. JHS/EDS-HT individuals were characterized by a non-physiological gait pattern. In particular, spatio-temporal parameters evidenced lower anterior step length and higher stance phase duration in JHS/EDS-HT than controls. In term of kinematics, in JHS/EDS-HT patients the main gait limitations involved pelvis, distal joints and ankle joint. Conversely, hip and knee joint showed physiological values. Ankle moment and power revealed reduced peak values during terminal stance. Differences in stiffness at hip and ankle joints were found between JHS/EDS-HT and controls. JHS/EDS-HT patients showed significant decreased of Kh and Ka parameters very probably due to congenital hypotonia and ligament laxity. These findings help to elucidate the complex biomechanical changes in JHS/EDS-HT and may have a major role in the multidimensional evaluation and tailored management of these patients.

Respiratory retraining therapy in long-term treatment of paradoxical vocal fold dysfunction.

OBJECTIVES: Paradoxical vocal fold dysfunction (PVFD) is a disorder in the larynx featuring involuntary adduction of the vocal folds during the inspiratory phase of breathing. The symptoms include acute episodes of dyspnea and bouts of coughing. To date, there is no universally acknowledged treatment for PVFD, though respiratory retraining therapy is the treatment of choice. AIMS: The purpose of this work was to evaluate the results of long-term respiratory retraining therapy in cases of PVFD. PATIENTS AND METHODS: We treated 20 patients with PVFD for 2 years: 10 subjects were submitted to a cycle of respiratory retraining therapy every 12 months (receiving a total of 3 cycles) while 10 were given a cycle every 3 months (for a total of 9 cycles) no matter what their clinical conditions were. RESULTS: The results show that long-term respiratory retraining is particularly efficacious if the cycles of treatment are repeated, no matter what clinical conditions are present. In fact, when only one cycle of retraining treatment is given a year, there is initial improvement followed by progressive worsening. CONCLUSIONS: Long-term respiratory rehabilitation is effective, especially if the treatment is given at least once every 3 months.

[Use of conditioned reflex therapy in patients with masticatory muscles hypertension].

This work deals with the thoughts on the nature and origin of disorders of masticatory muscles and temporor joint. The authors incline to opinion of their psychosomatic origin. In connection with this point of view the methods of investigations were added by the psychosomatic approach (Eysenk, Spilberger-Hanin, Lichko, Vassermann): so the methods of direct and indirect psychotherapy (behavior therapy and placebo), the same as psychopharmaco-therapy were included in complex rehabilitation. As behaviour therapy method the computer videoautotraining with biological adaptive reverse connection was used. 185 patients (61 men and 124 women) in age of 16-70 (mean age: 34,9+/-1,3 years old) were investigated. Complete recovery or significant improvement of health took place in 97% of patients, insufficient effect - 3% of investigative patients.