Proprioceptive Neuromuscular Facilitation for Accessory Respiratory Muscles Training in Patients After Ischemic Stroke.

This study focused on how pulmonary function is affected by proprioceptive neuromuscular facilitation (PNF) of accessory respiratory muscles in the chronic post-stroke phase. The study involved patients who had had ischemic stroke 6 months or more before the PNF treatment investigated. The objective was to define the effect of PNF on bioelectrical resting and maximum activity of the accessory muscles. Patients were randomly assigned to PNF treatment and just positioning treatment as a reference for comparison; 30 patients each. Electromyography of accessory muscles was investigated before and after physiotherapeutic treatments. We found that there was a greater reduction in EMG activity in all muscles investigated after PNF compared to positioning treatment alone. A reduction of muscle activity due to PNF concerned both affected and unaffected body side, but it was greater on the affected side. We conclude that a reduction of the accessory respiratory muscle activity due to PNF treatment could be of benefit in chronic stoke patients in that it would help normalize breathing pattern and thereby prevent the development of hypoxia.

[Post-stroke spasticity management including a chosen physiotherapeutic methods and improvements in motor control - review of the current scientific evidence.]

Cerebrovascular diseases based on stroke etiology concern millions of people worldwide, and annual rates of disease are still increasing. In the era of an aging society and suffering from a number of risk factors, in particular those modifiable, strokes and muscles' spastic paresis, subsequently resulting in damage of upper motor neuron structures will become a serious problem for the entire health care system. Effective management and physiotherapy treatment for post-stroke spasticity persisted, both in the acute and chronic, is still a significant medical problem in the interdisciplinary aspect. Care procedures for this type of patient becomes a kind of challenge for specialists in neurology, internal medicine, cardiology, dermatology or neurosurgery, but also for physiotherapists in their everyday clinical practice. The aim of this paper is to present the issues of cerebral stroke and resulting spastic hypertonia in terms of current pharmacological treatment and surgery, and primarily through the use of effective physiotherapy methods, the use of which was confirmed in the way of reliable scientific research in accordance with the principles of Evidence Based Medicine and Physiotherapy (EBMP).

[Extracorporeal shock waves (ESW) as an alternative treatment method for improving the limb muscles' spasticity after cerebral stroke - a systematic review of the literature].

Extracorporeal shock wave (ESW) is a physical factor, of which the clinical use is observed in a wide range of disorders, particularly musculoskeletal dysfunctions. Recently, one can observe that the list of indications for ESW treatment is continuously growing and adapting the increasingly different systemic diseases in terms of etiology and pathomechanism. Nevertheless, it should be remembered that the potential biological mechanisms of ESW stimulation conditioning advantageous and desirable therapeutic effects are not clearly explained. In the world of science is the lack of irrefutable evidence, supported by advanced research in the field of observation and recording biophysical mechanisms under the influence of ESW stimulation in a number of neurological disorders, especially in patients after stroke suffer from the damage of upper motor neuron (UMN). The aim of this paper is to provide an overview of current research reports evaluating the efficacy and safety of ESW in reducing a post-stroke spasticity of limbs and recover a motor finctions in stroke patients. A number of 8 research articles were qualified into review, only in English, which appeared in the years 2005 - 2015. The following summary includes a total group of 83 patients with spasticity of the lower limbs and 79 in the upper limbs. Review of scientific reports were based on international medical databases. All classified papers were characterized in detail, taking into account the methodology of research, patient characteristics, establish treatment parameters, as well as the results obtained on the basis of subjective and objective indicators. Despite a promising effectiveness of ESW therapy, the results of which have been described so far in several pilot studies, there is a legitimate need for further verification of this subject of research in terms of clinical application.

Assessment of bioelectrical activity of pelvic floor muscles depending on the orientation of the pelvis in menopausal women with symptoms of stress urinary incontinence: continued observational study.

BACKGROUND: Menopausal women often experience the prolapse of the uterus, bladder and rectum resulting from the failure and weakening of the pelvic floor muscles (PFM). Strengthening of the PFM through the standard exercises is recognized as an effective way of preventive measures and conservative treatment of the symptoms listed above, but still need to be improved. AIM: The goal was the objective assessment of resting and functional bioelectrical activity of PFM in women during menopause and its comparison in three different positions of the pelvis: anterior pelvic tilt - position 1 (P1), posterior pelvic tilt - position 2 (P2), and neutral pelvic tilt - position 3 (P3). DESIGN: Prospective, cross-sectional observational study. SETTING: Department and Clinic of Urology of a University Hospital. POPULATION: The target group of this study included women in the menopausal period (inpatient and outpatient). METHODS: The study evaluating resting and functional activity of the PFM depending on the orientation of pelvis. Bioelectric activity was assessed with an electromyographic instrument (sEMG) and endovaginal electrodes. The inclination angle was measured with an inclinometer. The comparisons of results between the values obtained in P1, P2, and P3 were performed using one-way Analysis of Variance (ANOVA). RESULTS: One hundred thirty-one registered for the study were screened for inclusion and exclusion criteria and on the basis of the results 82 participants were enrolled for analysis. The highest mean resting activity of sEMG PFM (µV) was observed in P2 and it amounted to 11.6 µV (SD=5.5 µV) in P1 the value equaled 9.8 µV (SD=4.8 µV) and P3-9.0 µV (SD=4.2 µV). The results revealed a significant statistical difference (main effect: P=0.0007). Considering the functional sEMG activity of PFM (µV), the highest mean value was recorded in P2. CONCLUSIONS: Posterior pelvic tilt position determines higher resting and functional bioelectric activity of PFM. Additionally, electromyographic activity of PFM increases during the pelvic movement backwards. CLINICAL REHABILITATION IMPACT: These positions should be implemented in therapy in order to improve the effectiveness of the effect on the pelvic floor.

Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study.

OBJECTIVES: In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position. MATERIALS AND METHODS: This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance. RESULTS: In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A - 20.3±11.8 µV, position B - 19.9±10.6 µV, and position C - 25.3±10.9 µV (P=0.0104). CONCLUSION: The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM.

Effects of extracorporeal shock wave on upper and lower limb spasticity in post-stroke patients: A narrative review.

BACKGROUND: Effective treatment strategies for post-stroke muscle spasticity are still a significant interdisciplinary issue and challenge for neurologists, neurosurgeons, physiatrists nurses and physiotherapists. Extracorporeal shock wave (ESW) treatment is a well-supported physical modality used in a wide range of musculoskeletal disorders. The list of justified indications for ESW treatment and scientific areas of investigations is continuously evolving and adapting to different pathologies, including spasticity after stroke. OBJECTIVES: To analyze the relevant available research and clinical studies demonstrated that the treatment potentials and effectiveness of ESW procedure including mechanisms of the anti-spastic action within hypertonic muscles after stroke. LITERATURE SEARCH: A computer research was performed using MEDLINE, PubMed, PEDro, CINAHL, and EMBASE databases. Assessment of eligibility of papers was determined by two independent reviewers. The inclusion criteria comprised: publication in peer-reviewed journals, studies published in the last 10 years, involving clinical trials, full-version available and written in English only. DISCUSSION: A total of 91 articles were collected, 83 of which were non relevant. Ultimately, 8 clinical studies within a total of 195 patients met inclusion criteria for this review. Only one randomized controlled trial was found and then scored using the Cochrane-based assessment. The other studies involving were analyzed separately according to their methodological quality in a descriptive manner. CONCLUSIONS: ESW was found to be safe and effective. The mechanism of ESW action is still under investigation.

Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinence: a preliminary observational study.

OBJECTIVE: Muscles such as adductor magnus (AM), gluteus maximus (GM), rectus abdominis (RA), and abdominal external and internal oblique muscles are considered to play an important role in the treatment of stress urinary incontinence (SUI), and the relationship between contraction of these muscles and pelvic floor muscles (PFM) has been established in previous studies. Synergistic muscle activation intensifies a woman's ability to contract the PFM. In some cases, even for continent women, it is not possible to fully contract their PFM without involving the synergistic muscles. The primary aim of this study was to assess the surface electromyographic activity of synergistic muscles to PFM (SPFM) during resting and functional PFM activation in postmenopausal women with and without SUI. MATERIALS AND METHODS: This study was a preliminary, prospective, cross-sectional observational study and included volunteers and patients who visited the Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Forty-two patients participated in the study and were screened for eligibility criteria. Thirty participants satisfied the criteria and were categorized into two groups: women with SUI (n=16) and continent women (n=14). The bioelectrical activity of PFM and SPFM (AM, RA, GM) was recorded with a surface electromyographic instrument in a standing position during resting and functional PFM activity. RESULTS: Bioelectrical activity of RA was significantly higher in the incontinent group than in the continent group. These results concern the RA activity during resting and functional PFM activity. The results for other muscles showed no significant difference in bioelectrical activity between groups. CONCLUSION: In women with SUI, during the isolated activation of PFM, an increased synergistic activity of RA muscle was observed; however, this activity was not observed in asymptomatic women. This may indicate the important accessory contribution of these muscles in the mechanism of continence.

Short-Term Effects of Kinesio Taping and Cross Taping Application in the Treatment of Latent Upper Trapezius Trigger Points: A Prospective, Single-Blind, Randomized, Sham-Controlled Trial.

Kinesio taping (KT) may be a new treatment in patients with myofascial trigger points (MTrPs). A new method available for taping practitioners is cross taping (CT). The main objective was to determine how CT, KT, and medical adhesive tape (sham group) affect the subjective assessment of resting bioelectrical activity and pain of the upper trapezius muscle (UT) in patients with MTrPs. 105 volunteers were recruited to participate. The primary outcome was resting bioelectrical activity of UT muscle as assessed by surface electromyography (sEMG) in each group and pain intensity on a visual analog scale (VAS). Assessments were collected before and after intervention and after the 24-hours follow-up. No significant differences were observed in bioelectrical activity of UT between pre-, post-, and follow-up results. In three groups patients had significantly lower pain VAS score after the intervention (CT-p < 0.001, KT-p < 0.001, and sham-p < 0.01). The Kruskal-Wallis ANOVA showed no significant differences in almost all measurements between groups. The application of all three types of tapes does not influence the resting bioelectrical activity of UT muscle and may not lead to a reduction in muscle tone in the case of MTrPs.

Comparison of the Short-Term Outcomes after Postisometric Muscle Relaxation or Kinesio Taping Application for Normalization of the Upper Trapezius Muscle Tone and the Pain Relief: A Preliminary Study.

The main purpose of the study was to evaluate the resting bioelectrical activity of the upper trapezius muscle (the UT muscle) before and after one of the two interventions: postisometric muscle relaxation (PIR) and Kinesio Taping (KT). Moreover a comparison between group results was conducted. From the initial 61 volunteers, 52 were selected after exclusion criteria and were allocated randomly to 2 groups: PIR group and KT group. Outcome measures were assessed at baseline and completion of the intervention. The primary outcome measure was change in bioelectrical activity of UT muscle evaluated by surface electromyography (sEMG). Secondary outcomes included subjective assessment of pain using visual analogue scale (VAS). Significant differences were found only in KT group: the average resting bioelectrical activity decreased by 0.8 µV (p = 0.0237) and the average VAS result reduced by 2.0 points (p = 0.0001). Greater decrease of VAS results was recorded in KT group compared to PIR group (p = 0.0010). Both PIR and KT intervention did not influence significantly the resting bioelectrical activity of UT muscle. KT application was better for pain relief in the studied sample compared with PIR intervention.

Kinesiology Taping does not Modify Electromyographic Activity or Muscle Flexibility of Quadriceps Femoris Muscle: A Randomized, Placebo-Controlled Pilot Study in Healthy Volleyball Players.

BACKGROUND: Kinesiology taping (KT) is a popular method of supporting professional athletes during sports activities, traumatic injury prevention, and physiotherapeutic procedures after a wide range of musculoskeletal injuries. The effectiveness of KT in muscle strength and motor units recruitment is still uncertain. The objective of this study was to assess the effect of KT on surface electromyographic (sEMG) activity and muscle flexibility of the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) muscles in healthy volleyball players. MATERIAL AND METHODS: Twenty-two healthy volleyball players (8 men and 14 women) were included in the study and randomly assigned to 2 comparative groups: "kinesiology taping" (KT; n=12; age: 22.30 ± 1.88 years; BMI: 22.19 ± 4.00 kg/m(2)) in which KT application over the RF muscle was used, and "placebo taping" (PT; n=10; age: 21.50 ± 2.07 years; BMI: 22.74 ± 2.67 kg/m(2)) in which adhesive nonelastic tape over the same muscle was used. All subjects were analyzed for resting sEMG activity of the VL and VM muscles, resting and functional sEMG activity of RF muscle, and muscle flexibility of RF muscle. RESULTS: No significant differences in muscle flexibility of the RF muscle and sEMG activity of the RF, VL, and VM muscles were registered before and after interventions in both groups, and between the KT and PT groups (p>0.05). CONCLUSIONS: The results show that application of the KT to the RF muscle is not useful to improve sEMG activity.

[Evaluation of the effectiveness of extracorporeal shock wave therapy in selected musculoskeletal system disorders of the inflammatory etiology--a critical review of the literature]. / Ocena efektywnosci zewnatrzustrojowej fali uderzeniowej w wybranych schorzeniach narzadu ruchu o etiologii zapalnej --krytyczny przeglad pismiennictwa.

Extracorporeal shockwave therapy (ESWT) is a modern method from the scope of physical medicine. In Poland, atthe end of the last decade, ESWT has become an extremely popular form of treatment for many diseases, especially musculoskeletal. The aim of this study is to provide an overview of the most up to date scientific reports assessing the effectiveness of ESWT in the most common musculoskeletal system disorders of the inflammatory etiology. To review, there were qualified 15 subjects of research works in English language only, which were published between 2002-2013. The following summary includes a total amount of 1326 patients. Review of the scientific reports ware made based on international medical databases review. All qualified articles were characterized in detail in terms of material and research methods with a precise determination of treatment parameters, as well as the results achieved separated fora specific diagnosis. Despite the beneficial therapeutic effects as a result of ESWT treatment, which are described in numerous publications, there is a justified need for further observation the progress of scientific research, in particular with regard to the effectiveness and safety of ESWT.

[Graduated compression therapy in prophylaxis of deep vein thrombosis in patients after stroke--scientific evidence review]. / Kompresjoterapia w profilaktyce zakrzepicy zyl glebokich u pacjentów po udarze mózgu--przeglad dowodów naukowych.

Graduated compression therapy (GCT) is a clinically proven and scientifically validated method of conservative treatment of many different diseases, particularly angiologic in accordance with the principles of evidence based medicine (EBM). The use of GCT in clinical prevention of life-threatening complications of venous thromboembolism pathogenesis (VTE) in patients after a stroke appears to be fully understood and justified. Its primary aim is to prevent of deep vein thrombosis (DVT) and to minimize the risk of death by followed pulmonary embolism (PE). There are a large number of available scientific reports about the effectiveness and reasonableness issues of the use of GCT in thromboprophylaxis afterstroke. Nevertheless a large part o them characterized by a low level of data reliability. Aim of this study is to present the current standards in the use of GCT methods as part of DVT prevention after stoke episodes. The review was based on the latest scientific findings with a high level of evidence data reliability.

Electromyographic Analysis of the Hip Extension Pattern in Visually Impaired Athletes.

The objective of the study was to determine the order of muscle recruitment during the active hip joint extension in particular positions in young visually impaired athletes. The average recruitment time (ART) of the gluteus maximus (GM) and the hamstring muscle group (HMG) was assessed by the means of surface electromyography (sEMG). The sequence of muscle recruitment in the female and male group was also taken into consideration. This study followed a prospective, cross - sectional, randomised design, where 76 visually impaired athletes between the age of 18-25 years were enrolled into the research and selected on chosen inclusion and exclusion criteria. Finally, 64 young subjects (32 men and 32 women) were included in the study (age: 21.1 ± 1.05 years; body mass: 68.4 ± 12.4 kg; body height: 1.74 ± 0.09 m; BMI: 22.20 ± 2.25 kg/m2). All subjects were analysed for the ART of the GM and HMG during the active hip extension performed in two different positions, as well as resting and functional sEMG activity of each muscle. Between gender differences were comprised and the correlations between the ART of the GM and HMG with their functional sEMG activity during hip extension in both positions were shown. No significant differences between the ART of the GM and HMG were found (p>0.05). Furthermore, there was no significant difference of ART among both tested positions, as well in male as female subjects (p>0.05).

Extracorporeal shock wave therapy as an adjunct wound treatment: a systematic review of the literature.

Standard care procedures for complex wounds are sometimes supported and reinforced by physical treatment modalities such as extracorporeal shock wave therapy (ESWT). To evaluate available evidence of ESWT effectiveness in humans, a systematic review of the literature was conducted using MEDLINE, PubMed, Scopus, EBSCOhost, and PEDro databases. Of the 393 articles found, 13 met the publication date (year 2000-2013), study type (clinical study), language (English only), and abstract availability (yes) criteria. The 13 studies (n = 919 patients with wounds of varying etiologies) included seven randomized controlled trials that were evaluated using Cochrane Collaboration Group standards. Only studies with randomization, well prepared inclusion/exclusion criteria protocol, written in English, and full version available were analyzed. An additional six publications reporting results of other clinical studies including a total of 523patients were identified and summarized. ESWT was most commonly applied once or twice a week using used low or medium energy, focused or defocused generator heads (energy range 0.03 to 0.25 mJ/mm2; usually 0.1 mJ/mm2), and electrohydraulic or electromagnetic sources. Few safety concerns were reported, and in the controlled clinical studies statistically significant differences in rates of wound closure were reported compared to a variety of standard topical treatment modalities, sham ESWT treatment, and hyperbaric oxygen therapy. Based on this analysis, ESWT can be characterized as noninvasive, mostly painless, and safe. Controlled, randomized, multicenter, blind clinical trials still are required to evaluate the efficacy and cost-effectiveness of ESWT compared to sham control, other adjunctive treatments, and commonly used moisture-retentive dressings. In the future, ESWT may play an important role in wound care once evidence-based practice guidelines are developed.

Evaluation of bioelectrical activity of pelvic floor muscles and synergistic muscles depending on orientation of pelvis in menopausal women with symptoms of stress urinary incontinence: a preliminary observational study.

OBJECTIVES: Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt. DESIGN: Preliminary, prospective observational study. SETTING: Department and Clinic of Urology, University Hospital in Wroclaw, Poland. PARTICIPANTS: Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study. PRIMARY OUTCOME MEASURES: Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe. SECONDARY OUTCOME MEASURES: Evaluation of activity of the synergistic muscles by sEMG and surface electrodes. RESULTS: No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles. CONCLUSIONS: This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM.

[Physiotherapy potentials improve the calf muscle pump function in chronic venous insufficiency]. / Mozliwosci fizjoterapii w usprawnianiu funkcji pompy miesniowej goleni w przewleklej niewydolnosci zylnej.

Mechanism of the calf muscle pump plays a major role in venous blood return from peripheral parts of blood vessels of lower extremities. It enables a smooth venous blood movement from the deep venous system segment located below in a direction to the segment lying above which effectively prevents a distal blood stasis and veno-lymphatic edema of lower limbs. Calf muscle pump dysfunction together with disorders in the construction of blood vessels walls and with endurance weakness of valves, leads to venous hypertension and contributes to the development of venous insufficiency. The aim of this paper is to demonstrate the theoretical basis including venous return physiology and the mechanism of lower limbs venous--muscle pump as well as provide practical application of physiotherapy methods to support the properfunction of presented calf muscle pump. Examples in the field of physical medicine, compression therapy and kinesiotherapy for improving the efficiency of lower extremity muscles, providing a physiological venous return.

The evaluation of bioelectrical activity of pelvic floor muscles depending on probe location: a pilot study.

OBJECTIVES: The main objective was to determine how the depth of probe placement affects functional and resting bioelectrical activity of the PFM and whether the recorded signal might be dependent on the direction in which the probe is rotated. PARTICIPANTS: The study comprised of healthy, nulliparous women between the ages of 21 and 25. OUTCOME MEASURES: Bioelectric activity of the PFM was recorded from four locations of the vagina by surface EMG and vaginal probe. RESULTS: There were no statistically significant differences between the results during functional sEMG activity. During resting sEMG activity, the highest bioelectrical activity of the PFM was observed in the L1 and the lowest in the L4 and a statistically significant difference between the highest and the lowest results of resting sEMG activity was observed (P = 0.0043). CONCLUSION: Different electrodes placement during functional contraction of PFM does not affect the obtained results in sEMG evaluation. In order to diagnose the highest resting activity of PFM the recording plates should be placed toward the anterior vaginal wall and distally from the introitus. However, all of the PFM have similar bioelectrical activity and it seems that these muscles could be treated as a single muscle.