RESUMO
BACKGROUND: Pain is a major symptom in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. Although the underlying mechanism causing generalized pain in children with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome is unclear, central sensitization has been suggested as a possible explanation. The aim of this study was to explore the feasibility of a study protocol for a future case-control study, investigating features of central sensitization in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. METHODS: Central sensitization features were measured in ten patients and nine healthy controls aged 13-17 years via experimental pain measurement quantifying primary and secondary hyperalgesia, endogenous pain modulation, and exercise-induced hyperalgesia. Descriptive statistics were used. Frequency, median, and range values were calculated. RESULTS: Eleven out of 57 patients chose to participate. No control could be recruited through public schools. Therefore, a convenience sampling strategy was used for the recruitment of the control group. The process of assessing primary and secondary hyperalgesia, endogenous pain modulation, and exercise-induced hyperalgesia was well tolerated by all participants (patients and controls). When assessing endogenous pain modulation via conditioned pain modulation, two participants in the patient group and three in the control group did not achieve a pain experience ≥ 3 on the numerical rating scale when immersing their hands in cold water. CONCLUSION: This study investigated the feasibility, safety, and toleration of experimental pain measurements in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. Although the test protocol proved to be sufficiently feasible for use with the participant group, it will need to be adapted in the main study in order to obtain more reliable data. Recruitment, especially of participants for the control group, can be a major obstacle for future studies and requires careful planning. TRIAL REGISTRATION: Researchweb.org, 270,501. Registered on 9 May 2019.
RESUMO
This study focuses on the treatment of the muscle function imbalance and asymmetric head posture for infants with congenital muscular torticollis (CMT). The aim of this study was to compare treatment time for groups with different strategies for muscle function training. The treatment goal was to achieve a symmetric head posture. Thirty-seven infants were randomised to three groups. Group I was treated only with handling strategies. Group II got the same handling strategies but also received specific strength exercises. Group III received the same treatment as group II but was also provided with weekly training by a physiotherapist. Mean age at the start of treatment was 4.5 months of age, range 1-10.5. The possible effect of covariates was also investigated; age at the start of treatment, range of motion (ROM) in rotation of the neck, ROM in lateral flexion of the neck, the muscle function scale (MFS) score, plagiocephaly, and gender were analysed with ANCOVA. Thirty-one treated infants achieved symmetric head posture before the age of 12 months. Mean treatment time (3.5 month) did not differ significantly between the groups. All infants randomised to group I could stay in that group. The MFS score and age at the start of the treatment influenced treatment time (p < 0.05). The treatment time for all groups was similar. Early referral to physical therapy of infants with CMT and muscle function imbalance in lateral righting could shorten treatment time. Studies about natural course and long-term effects of muscular imbalance must be investigated in future research.
