What is a more effective method of cranio-cervical flexion exercises?

BACKGROUND: Cranio-cervical flexion exercise (CCFE) is a representative exercise that activates the deep muscles of neck pain patients. However, there is a lack of studies that propose specific exercise methods to examine the more effective activity level of the deep cervical flexor. OBJECTIVE: The objective of this study is to propose a more effective exercise method through effect comparison based on an optimal degree of mouth-opening, a mouth-open versus mouth-closed position, eye gaze, and body position change during CCFE. METHODS: As a result of examining the optimal degree of mouth-opening during CCFE using a pressure biofeedback unit with 50 subjects conforming to a selection standard, sternocleidomastoid muscle activity was examined. An optimal degree of mouth-opening during CCFE was examined as well. In addition, muscle thickness and muscle activity were measured based on eye gaze. Then, the effect of the exercise based on body position was examined. RESULTS: The lowest sternocleidomastoid activity was presented at a mouth-opening of 20 mm. A significant difference was presented in sternocleidomastoid and longus colli muscle activity at a mouth-opening of (p< 0.05). The eye gaze of 45∘ below presented the lowest sternocleidomastoid activity. CONCLUSIONS: The results suggest a new type of exercise method with the accompaniment of an optimal degree of mouth-opening of (20 mm), along with an eye gaze of 45∘ below, and an exercise method in the seated position without spatial restriction in order to increase the effect of CCFE, one of the conventional neck stabilization exercise methods.

Cepstral, Spectral and Time-Based Analysis of Voices of Esophageal Speakers.

OBJECTIVE: To evaluate esophageal speech quality in patients after total laryngectomy using cepstral, spectral and time-based measures. PATIENTS AND METHODS: The subjects were all males and included 20 total laryngectomy patients and 20 age-matched normal controls. The sustained vowel /a/ was measured using the tools of MDVP (Multi-Dimensional Voice Program) and ADSV (Analysis of Dysphonia in Speech and Voice). RESULTS: Compared to normal controls, esophageal speakers showed significantly lower values for cepstral peak prominence (CPP) and a low- to high-frequency spectral energy (L/H) ratio, but their mean CPP fundamental frequency (CPP F0) was higher. Highly negative correlations were found between CPP and jitter (percent jitter), shimmer (percent shimmer) and noise-to-harmonics ratio (NHR). Positive correlations were also found between L/H ratio and CPP. CPP F0 showed a positive correlation with F0, shimmer and NHR. In addition, CPP and L/H ratio parameters indicated an area under the curve of 0.93 or higher compared to that for time-based measures. CONCLUSION: This study showed that cepstral and spectral analyses are more effective than time-based analysis in examining the voice quality of alaryngeal speakers. The present findings are expected to contribute to establishing the baseline for voice quality characteristics in total laryngectomy patients.

Development and comparative evaluation of new shapes of pillows.

The purpose of this study was to determine pillow designs suitable for supine and side-lying positions. [Subjects] Twenty female and twenty male subjects with a mean age of 22.7 years (SD = 1.3) participated in the study. [Methods] First, a three-dimensional motion analysis system was used to analyze the movements of the head and the shoulder joints during changes from supine positions to side-lying positions. Second, the height from the face to the shoulder and the height from the floor to the middle of the neck in a side-lying position were measured. Third, the weight distribution ratios of the head and the trunk were compared using general pillows (polyester sponge), memory foam, and prototype pillows. [Results] During position changes from supine positions to side-lying positions, the head moved in a fan shape, and the shoulder joint moved an average of 4.4 cm upward. The height from the face to the shoulder was 9 cm on average. The height from the floor to the middle of the neck was 11 cm on average. The weight distribution ratios between the head and the trunk were compared among general pillows (polyester sponge), memory foam, and prototype pillows. The results showed significant differences in the side-lying position. [Conclusion] Pillows with uniform heights are not suitable for a supine or side-lying position. In the case of both positions, users should be allowed to select pillows in shapes that can support the neck.

Initiation and duration of laryngeal closure during the pharyngeal swallow in post-stroke patients.

As a bolus enters the pharynx during the swallow, the airway is protected by laryngeal closure, a process characterized by approximation of the vocal folds plus approximation of the arytenoid cartilages to the base of the epiglottis. The purpose of this study was to measure initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) in three groups of subjects: (1) ten stroke patients who aspirated before and during the swallow (aspirators), (2) ten stroke patients who did not aspirate (nonaspirators), and (3) ten normal control subjects. Means and standard deviations of ILC and LCD were analyzed for both 5-ml and 10-ml thin-liquid boluses using a 100-ms timer during subsequent analysis of videofluoroscopic swallowing examinations. There were significant differences between aspirators and control subjects for both ILC and LCD, and significant differences between aspirators and nonaspirators for ILC. There were no significant differences between aspirators and nonaspirators for LCD. Both delayed ILC and reduced LCD were associated with post-stroke aspiration. Delayed ILC is a significant indicator of overall risk of aspiration. Clinical implications for these findings are discussed.