The Role of Dynamic Neuromuscular Stabilization Exercises in Stress Urinary Incontinence Among Females Aged 18-40 Years.

BACKGROUND AND OBJECTIVE: Stress urinary incontinence (SUI) is prevalent among females across various age groups, yet societal taboos and unawareness contribute to under-reporting and hinder effective management strategies. This study aimed to evaluate the efficacy of dynamic neuromuscular stabilization (DNS) compared to traditional Kegel exercises in females with stress urinary incontinence, focusing on assessing the impact of DNS on pelvic floor strength and core musculature activation to provide valuable insights into urinary continence management. METHODOLOGY: This is a single-blinded, randomized trial with 90 females aged 18-40 years assessed perineometer readings, pelvic floor electromyography (EMG), and transverse abdominis activation via pressure biofeedback. RESULTS: Significant improvements in pelvic floor strength and core musculature activation were observed in the DNS group compared to the Kegel exercise group. Perineometer values, EMG measurements, and pressure biofeedback unit readings demonstrated substantial enhancements post-intervention in both groups. Effect sizes, including Cohen's D and point biserial correlation coefficient, indicated medium to large effects favoring the DNS intervention. CONCLUSION: DNS is superior to Kegel exercises for SUI management, emphasizing the importance of targeting core musculature. Future research should explore long-term outcomes and patient-reported measures for a comprehensive understanding.

Effect of dynamic neuromuscular stabilization training using the inertial load of water on functional movement and postural sway in middle-aged women: a randomized controlled trial.

BACKGROUND: Chronic stress and diseases occur more frequently in middle-aged compared to younger women and this is often the result of physical, psychological and socio-economic changes. These health consequences reduce lower body muscle mass and flexibility, leading to generalized impairments in functional movement and balance. Dynamic Neuromuscular Stabilization (DNS) training using the inertial load of water is known for its positive impact on functional strength improvement and muscle stabilization. OBJECTIVE: This study aimed to determine the effect of DNS training using inertial water loads on functional movement and postural sway in middle-aged women. METHOD: A sample of 24 middle-aged women participated in the study and were randomly divided into two groups: the experimental group, n = 12 (age: 58.33 ± 1.48 yrs, height: 162.16 ± 1.27 cm, weight: 61.77 ± 2.21 kg) and control group, n = 12 (age: 59.58 ± 1.13 yrs, height: 160.1 ± 1.13 cm, weight: 57.51 ± 1.12 kg). Center of Pressure (COP), moving distance, Root Mean Square (RMS), movement area and Functional Movement Screen (FMS) were conducted and analyzed pre- and post-examination. Participants engaged in the DNS training regimen, which utilized the inertial load of water, for 60 min each session, conducted twice weekly for 12 weeks. RESULTS: There were significant differences in the COP distance (p < 0.001), RMS (p < 0.05), COP area and FMS test (p < 0.001) in the pre-post comparison of each group. And significant differences were found in COP distance (p < 0.05), RMS (p < 0.05), COP area (p < 0.05) and FMS test (p < 0.05) between groups. The DNS training improved the dynamic stability of single-leg standing, torso stability and functional movement in middle-aged women. CONCLUSION: DNS training programs using the inertial load of water have been shown to be effective in movement improvement and posture retention ability, which is beneficial for functional movement, equilibrium strategy, and dynamic stability of middle-aged women. Furthermore, the DNS training method designed in this study can be useful for trainees who require posture correction in a safe and effective way regardless of their age and gender.

Effect of Dynamic Neuromuscular Stabilization and Vojta Therapy on Respiratory Complications in Neuromuscular Diseases: A Literature Review.

Objective: The purpose of this study was to review the literature on the effect of dynamic neuromuscular stabilization (DNS)/Vojta on respiratory complications of neuromuscular diseases. Methods: The search strategy was conducted, based on the population, intervention, comparison, and outcome method, in the PubMed, Embase, ISI Web of Knowledge, ProQuest, and Scopus databases from inception to August 2021. The quality assessment of included papers was performed through the Physiotherapy Evidence Database scale. A narrative analysis was performed since a meta-analysis could not be conducted. Results: A total of 7 papers were chosen for the final assessment. All studies, except 1, evaluated individuals with neurological disease. Three studies evaluated Vojta therapy effects, and 4 studies evaluated DNS effects on respiratory parameters. Although the studies had limitations in their methodology according to the Physiotherapy Evidence Database scale, 4 were identified as level 1 evidence. None of the studies reported any adverse effects of Vojta therapy or DNS on respiratory parameters. However, not enough clinical trials were found to examine the effect of DNS on respiratory disease. Conclusion: Although the studies were weak in internal and external validity, this review suggests that Vojta therapy and DNS may influence respiratory parameters, such as blood gases, diaphragm movements, and functional respiratory parameters, in patients with neuromuscular diseases.

Effect of the Dynamic Neuromuscular Stabilization Technique on Functional Capacity in Overweight and Obese Individuals: A Randomized Controlled Trial.

Background Individuals with overweight and obesity (OW/OB) have poor performance in weight-bearing exercises, resulting in low functional capacity. The dynamic neuromuscular stabilization (DNS) technique was created to engage the core-postural chain in conjunction with the core muscles, generating enough intra-abdominal pressure to dynamically support the spine through muscular activity. DNS is a strategy that emphasizes the activation of the spine's intrinsic stabilizers, as well as proper breathing patterns, before any intended functional movement. The aim and objective of this study was to determine the effectiveness of the DNS technique on functional capacity in OW/OB individuals and to compare the effectiveness of the DNS and conventional approach. Methods The study recruited 100 individuals, who were separated into an experimental group (DNS technique) and a control group (conventional exercises), each with 50 participants. Outcome measures, including a six-minute walk test (SMW test) and body mass index (BMI), were taken pre-treatment and post-treatment. Results and discussion Based on the inclusion criteria of this study, the age group included was 20 to 25 years old. Pre- and post-treatment statistically significant changes were observed in the experimental and control groups in the BMI and SMW test. However, the BMI (kg/m2) was not statistically significant in the experimental group (t-value=-0.15, p=0.87) and control group (t-value=-0.22, p=0.82). Moreover, in the SMW test (meter), no statistical significance was found in the experimental group (t-value=-0.15, p=0.87) and control group (t-value=- 0.22, p=0.82). Conclusions Both groups are effective in increasing the functional capacity of obese and overweight individuals. The study indicates a strong need for further research into its long-term effectiveness in the OW/OB population.

The effects of dynamic neuromuscular stabilization approach on clinical outcomes in older patients with chronic nonspecific low back pain: a randomized, controlled clinical trial.

OBJECTIVE: We aimed to examine the effects of Dynamic Neuromuscular Stabilization (DNS) approach in older patients with chronic non-specific low back pain (CNSLBP). METHODS: A total of 72 participants with CNSLBP were assigned to either the experimental group (n = 36) or control group (n = 36) in this randomized study. A conventional physiotherapy program was administered to the participants in the control group for 3 days per week for a total of 6 weeks. In addition to the conventional program, DNS exercise protocol was performed for 3 days per week for 6 weeks for the participants in the experimental group. While quality of movements and exercise capacity were our primary outcomes, functional balance and quality of life constituted our secondary outcomes. The participants were assessed both at baseline and post-treatment. RESULTS: The improvement in a deep squat, in-line lunge, hurdle step, shoulder flexibility, rotary trunk stability, total Functional Movement Screening score, and Timed-up and Go Test score was greater in the experimental group (p<.05). The improvement was similar in both groups in terms of the rest of outcome measures. DISCUSSION: This study demonstrated the effectiveness of the DNS approach on some functional movement patterns and functional balance performance in older patients with CNSLBP.

Effect of Dynamic Neuromuscular Stabilization on Balance, Trunk Function, Falling, and Spasticity in People With Multiple Sclerosis: A Randomized Controlled Trial.

OBJECTIVE: To compare the effects of core stabilization (CS) and dynamic neuromuscular stabilization (DNS) on balance, trunk function, mobility, falling, and spasticity, in people with multiple sclerosis (PWMS). DESIGN: Two-group randomized controlled trial. SETTING: General community and referral center. PARTICIPANTS: A total of 64 PWMS, between 30 and 50 years old, and an expanded disability status scale between 2 and 5, participated in this study (N=64). INTERVENTIONS: Participants were randomly assigned to CS (n=32) and DNS (n=32) groups. Both groups received a total of 15 sessions of CS or DNS exercises, 60 minutes per session, 3 times a week during the 5 weeks. OUTCOME MEASURES: Balance function was measured as the primary outcome measure. Trunk function, postural stability, falling rate, fear of falling, falling index, mobility, and spasticity were measured as secondary outcomes. RESULTS: DNS group had significant improvement in Berg balance scale, trunk impairment scale, postural stability, activities-specific balance confidence, reduced falling rate, the timed Up and Go (TUG), multiple sclerosis walking scale-12, and multiple sclerosis spasticity scale in PWMS compared with the CS group, (P<.0001) after 5 weeks of intervention and 17 weeks of follow-up. Except for the modified Ashworth scale (MAS), significant improvements were seen in all outcome measures in both groups after 5 weeks of intervention. CONCLUSION: This is the first clinical evidence to support the importance of DNS exercise in improving balance, trunk function, and fall prevention in PWMS. This study provides clinical evidence that DNS may be more effective for PWMS than CS.

Comparing the Efficacy of Dynamic Neuromuscular Stabilization Exercises and Kegel Exercises on Stress Urinary Incontinence in Women: A Pilot Study.

Background and objective Stress urinary incontinence (SUI) is a prevalent condition affecting women of various age groups, significantly impacting their quality of life. To address this multifaceted issue, a comprehensive approach that goes beyond traditional pelvic floor exercises is needed. Dynamic neuromuscular stabilization (DNS) exercises, targeting the integrated spinal stabilization system, offer a promising alternative. Thus, this study aimed to compare the effectiveness of DNS exercises and Kegel exercises in managing SUI among women. Methods This single-blinded, pilot study involved 24 women aged 18-40 years with mild to moderate SUI. Participants were divided into DNS and Kegel exercise groups. Outcome measures included perineometer readings, electromyography (EMG) data, and the Urogenital Distress Inventory-6 (UDI-6). Statistical analysis compared baseline and 12-week data within and between groups, and rank-biserial correlation coefficient (r) as a measure of effect size in our study was calculated. Results At 12 weeks, the DNS group showed significant improvement in pelvic floor muscle strength compared to Kegel exercises (p = 0.005). Both groups had significantly enhanced pelvic floor muscle strength (p < 0.05). A significant change occurred for EMG average, EMG peak, and EMG maximum voluntary contraction (MVC) at 12 weeks (average p = 0.005; peak p = 0.001; MVC p = 0.009), with significant improvements in both groups (p < 0.05). For UDI-6, a significant difference emerged between the two groups at 12 weeks (p < 0.05), with significant improvements in both groups individually from baseline to 12 weeks (p < 0.05). The effect size "r" for all variables indicated a medium to large effect size, underscoring the substantial and significant impact of DNS exercises in managing SUI among women compared to Kegel exercises. Conclusion This study suggests that DNS exercises, emphasizing the coordinated activation of the diaphragm, abdominals, multifidus, and pelvic floor, may provide a more effective approach for managing SUI in women compared to traditional Kegel exercises.

Abdominal wall tension increases using Dynamic Neuromuscular Stabilization principles in different postural positions.

BACKGROUND: Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles. OBJECTIVE: To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles. METHODS: In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles. RESULTS: AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < .01; Cohen's d = -1.13 to -2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position. CONCLUSION: The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.

Comparison of yoga and dynamic neuromuscular stabilization exercise in chronic low back pain on magnetic resonance imaging of lumbar multifidus- protocol for a randomized controlled trial.

Background: Degeneration of Lumbar muscle in chronic low back pain (CLBP) is characterized by an increase in fat infiltration of paraspinal muscle, decrease in the cross-sectional area (CSA) of lumbar multifidus muscle (LMM) and increased thickness of Thoracolumbar fascia (TLF) by 25%. The study objective is to compare the effects of yoga and dynamic neuromuscular stabilization (DNS) exercise on CSA, fat infiltration of LMM with magnetic resonance imaging (MRI), and TLF thickness using musculoskeletal ultrasound imaging (MSK-USI) in CLBP. Methods: One hundred and forty-four participants with CLBP, which persisted longer than three months, will be recruited for this trial. Both group interventions focused on LMM. The experimental group will receive structured yoga sessions, and the Control Group will receive exercise based on DNS. In each group, exercises will be performed for 3-5 days/week and progressed for 12 weeks. Baseline data will be collected, followed by the recording of primary outcome measure (MRI) and secondary outcome measures (MSK-USI, Oswestry disability index, visual analogue score, optimism, self-efficacy, mood, physical activity, fear of movement, pain catastrophizing, and coping) at baseline and the end of 12th weeks. The normality of data will be verified. Based on the data distribution, within-group analysis and between-group analysis will be performed. Discussion: This will be the first RCT to compare the effect of yoga and DNS exercise among chronic low back pain participants. This will provide evidence of these interventions' impact on CSA, fat infiltration of LMM, and thickness of TLF in CLBP. Registration number: CTRI/2021/08/035984 (This trial was registered prospectively).

Effect of dynamic neuromuscular stabilization on balance and trunk function in people with multiple sclerosis: protocol for a randomized control trial.

BACKGROUND: Multiple sclerosis is a chronic and disabling neurological disease among young people. One of the major complaints in patients with multiple sclerosis (PWMS) is falling. There are a number of factors that risk factors for falling, including balance disorder and spasticity. Core stability (CS) exercises such as trunk muscle strengthening exercises can improve balance and mobility and reduce falling. Dynamic neuromuscular stabilization (DNS) exercise is a new functional rehabilitation strategy that optimizes motor function based on the principles of developmental kinesiology. This trial will evaluate the effectiveness of DNS in comparison to CS on balance, spasticity, and falling in PWMS. METHODS: A total of 64 PWMS, between 30 and 50 years old and expanded disability status scale (EDSS) between 2 to 5, will be recruited from neurophysiotherapy clinic, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences to participate in this 2-armed parallel study. Participants will be randomly divided into two groups to receive CS exercise or DNS exercise. All participants will receive exercise treatment for 15 sessions during a period of 5 weeks (3 sessions per week). Primary outcome measures will be balance. Falling rate, fear of falling, patient mobility, as well as spasticity, will be measured as secondary outcomes. All outcome measures will be measured at baseline, the day after the completion of the 15th session, and after 17 weeks. DISCUSSION: Dynamic neurostabilization exercises utilize the subconscious stimulation of special zones to reflexively mediate the diaphragm and other core stabilization muscles, which is extremely effective for individuals with reduced somatosensory or movement awareness. Findings from the proposed study are expected to benefit the knowledge base of the physiotherapist, and it can be a good alternative for the rehabilitation program and even reduce medication use in patients with multiple sclerosis. These exercises are easy to understand and applicable for these patients and their partners as well. TRIAL REGISTRATION: The trial was registered in the Iran registry organization with code IRCT20140222016680N5 and was approved on April 7th, 2020. Address: IRCT administration team, Central Library Building, Iran University Campus, Hemmat Freeway, next to Milad tower, Tehran, Iran. postal code:14496-14535.

Six Weeks Effects of Dynamic Neuromuscular Stabilization (DNS) Training in Obese Postpartum Women With Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: The worldwide prevalence of obesity and low back pain (LBP) has recently dramatically increased and is mainly indicated among postpartum women, leading to a range of adverse health consequences. OBJECTIVE: This study aimed to investigate the effects of 6 weeks of Dynamic Neuromuscular Stabilization training (DNS) in obese postpartum women with LBP. METHOD: This was a pretest-posttest study design. The study was conducted with 40 obese postpartum women with LBP randomized to receive DNS (n = 20) or General Exercise (GE, n = 20) 6 times a week for 6 weeks. The data were gathered before and after the 6-week intervention. RESULTS: Forty participants completed the study (mean ± SD, age 29.30 ± 3.77 years; weight 88.10 ± 6.09 kg; height 165.40 ± 6.31 cm; and BMI, 32.19 ± 1.07 kg/m2). The overall group-by-time interaction was significant for Numeric Pain-Rating Scale, Modified Oswestry Disability Questionnaire, Fear-Avoidance Beliefs Questionnaire, Inspiration and Expiration Breath Hold Time, and Respiratory Rate outcomes. The global rating of change was significantly different between groups (p < .05). The rate of improvement was higher in the DNS group compared to the GE group in all 6 tests. CONCLUSION: The present study confirms that DNS is applicable in obese postpartum women with LBP and effectively improved NPRS, MODQ, FABQ, BHT, and RR. It is clinically suggested that DNS is imperative based on ideal ontogenetic patterns to attain optimal results for obese postpartum women with LBP.

Comparison of core stabilization techniques on ultrasound imaging of the diaphragm, and core muscle thickness and external abdominal oblique muscle electromyography activity.

BACKGROUND: To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another. OBJECTIVE: The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude. METHODS: Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P< 0.05. RESULTS: Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P< 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS. CONCLUSIONS: DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.

An 18-month follow-up study on the effect of a neuromuscular stabilization technique on Cobb's angle in adolescent idiopathic scoliosis: A single-blind, age-matched controlled trial.

BACKGROUND: The benefits of spinal realignment and stabilization in scoliosis need to be examined. OBJECTIVE: We aimed to investigate the long-term effect of a neuromuscular stabilization technique (NST) on Cobb's angle in patients with adolescent idiopathic scoliosis. METHODS: Twenty females recruited from two hospitals participated in this study. On the basis of convenience of location, participants were allocated to either the experimental group (EG) that underwent the NST, or the control group (CG) that received education for a home exercise program. The NST for the EG was performed for an average of 30 min per session, three times a week for six months, and consisted of spinal realignment and stabilization. Then, 12- and 18-month measurements for long-term follow-ups were conducted for the EG. The outcome measure was Cobb's angle. RESULTS: Between-group comparison revealed a statistically significant difference at post-test (t=-3.26, p< 0.01) but not pre-test (t=-1.36, p= 0.19). Participants of the EG (-6.20 ± 2.49∘) showed greater differences between pre- and post-test scores compared to participants of the CG (-1.40 ± 0.52∘) (p< 0.05). Within-group comparisons showed a significant difference in both groups (p< 0.05). In the EG, Cobb's angle significantly changed across the follow-up sessions (p< 0.05), indicating more improvements by the 12-month (8.50 ± 4.03∘) and 18-month (6.60 ± 3.89∘) follow-ups. CONCLUSION: This study shows that the NST may be a beneficial option to correct spinal alignments in patients with adolescent idiopathic scoliosis.

Osteoartrosis de ATM: recuperar la función / TMJ Osteoarthrosis: recover function

Objetivo: evaluar la rehabilitación funcional de la ATM en pacientes con osteoartrosis, con abordaje neuromuscular. La osteoartrosis se caracteriza por la degeneración del cartílago articular y la cortical ósea, que conduce a dolor e inmovilidad. Se incluyó a 8 mujeres entre 20 y 42 años de edad con dolor en la región orofacial, signos de oclusión disfuncional e imágenes compatibles con trastornos degenerativos en ATM. Clínicamente se evaluó el dolor y la oclusión y, mediante tecnología electrónica, se obtuvieron datos objetivos de los movimientos de apertura-cierre y lateralidades, la velocidad de apertura-cierre mandibulares y de los ruidos articulares. Las mediciones fueron realizadas al inicio y al finalizar el tratamiento de estabilización mandibular con una ortosis neuromuscular. Para determinar la significación estadística se utilizaron el Student`s test de comparaciones múltiples y el análisis de varianza, ANOVA, de un factor. Las diferencias entre medias se consideraron significativas con p <0.05. Los resultados demostraron ausencia de dolor en el 100% de los casos al primer mes de tratamiento. Se incrementaron la apertura bucal (6,73 mm promedio), ambas lateralidades (P=0.0023), velocidad en apertura y en cierre (no estadísticamente significativo). Después de estabilizar la mandíbula se redujo la frecuencia de los ruidos. En conclusión, la oclusión dental disfuncional es el principal factor etiológico de la artrosis de la ATM. El establecimiento de una oclusión fisiológica produce la descompresión de la ATM, aumenta el rango de los movimientos mandibulares y disminuye significativamente el dolor (AU)

Objective: to evaluate the functional rehabilitation of the TMJ in patients with osteoarthritis, with a neuromuscular approach. Osteoarthrosis is characterized by degeneration of articular cartilage and bone cortex, which leads to pain and immobility. Eight women between 20 and 42 years of age with pain in the orofacial region, signs of dysfunctional occlusion, and images consistent with degenerative TMJ disorders were included. Clinically, pain and occlusion were evaluated and, using electronic technology, objective data were obtained on the opening-closing movements and lateralities, the opening-closing speed of the jaws and joint noises. Measurements were made before and at the end of the mandibular stabilization treatment with a neuromuscular orthosis. To determine the statistical significance, the Student`s multiple comparisons test and the analysis of variance, ANOVA, of one factor were used. The differences between means were considered significant with p <0.05. The results showed absence of pain pain in 100% of cases in the first month of treatment. Mouth opening (6.73 mm average), both lateralities (P = 0.0023), opening and closing speed (not statistically significant) were increased. After stabilizing the jaw the noise frequency value was reduced. In conclusion, dysfunctional dental occlusion is the main etiologic factor of TMJ osteoarthritis. Establishing a physiological occlusion causes TMJ decompression, increases the range of mandibular movements, and significantly decreases pain (AU)

Functional postural-stabilization tests according to Dynamic Neuromuscular Stabilization approach: Proposal of novel examination protocol.

This paper presents a set of eleven functional Dynamic Neuromuscular Stabilization (DNS) tests corresponding with specific infantile developmental stages, clarifying desired postural-locomotion patterns from a developmental perspective, while also describing frequently-observed disturbances of these patterns.

Effects of dynamic core-postural chain stabilization on diaphragm movement, abdominal muscle thickness, and postural control in patients with subacute stroke: A randomized control trial.

BACKGROUND: Neurodevelopmental treatment (NDT) and Dynamic neuromuscular stabilization (DNS)-based exercise is effective for improving core stability and postural control in stroke patients. OBJECTIVE: To compare the effects of DNS and conventional NDT exercises on diaphragm movement, abdominal muscle thickness, and postural control in stroke patients. METHODS: The participants were randomly allocated into DNS (n = 16) and NDT (n = 15) for 30 minutes each per day, 3 days a week for 4 weeks. Diaphragm movement and abdominal muscle thickness were determined using ultrasonography. The trunk impairment scale (TIS) and Berg Balance Scale (BBS) were used to measure postural control. The functional ambulation category (FAC) was used to evaluate gait ability. Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DNS and NDT exercise groups. RESULTS: ANCOVA revealed the superior effects of DNS in diaphragm movement and abdominal muscle thickness (transversus abdominis, internal oblique), as well as clinical BBS and FAC tests, compared with those of NDT (p < 0.05). CONCLUSIONS: This novel clinical trial suggests that DNS training was more effective than NDT training in improving postural movement control and gait ability via a balanced co-activation of the diaphragm and TrA/IO in stroke patients.

Effects of dynamic neuromuscular stabilization (DNS) training on functional movements.

Functional movements (FMs) dysfunction is a potential risk factor of injuries. A variety of training strategies is proposed to improve the performance of FMs. We investigated if a system of fundamental movement exercises called Dynamic Neuromuscular Stabilization (DNS) could improve FMs. Thirty-four female students were randomly assigned into two matched groups to receive DNS (the study protocol) versus physical fitness (PF) training. The groups practiced for six-weeks (three sessions of 50 min weekly). We used five FMs tests as pre and post measures of exercise effectiveness. Repeated Measures ANOVA showed a significant interaction in all five FMs tests in favour of DNS group (F(1,32) ≥ 4.13, P ≤ .001 and ƞ2 ≥ 0.29), meaning that DNS group had a higher progress rate compared to that of PF group. Based on Eta-square coefficients, the highest and lowest differences in the progression rate were observed in Y-Balance and Functional Movement Screening Tests, respectively. Our findings supported the hypothesis that fundamental movements of DNS could be used to improve FMs. However, the progression coefficient declined as FMs became more specific. Lower progression of "specific FMs" suggests that it might prove more effective to add "specific training" to "fundamental training" for them.

Effects of dynamic neuromuscular stabilization on diaphragm movement, postural control, balance and gait performance in cerebral palsy.

PURPOSE: To determine the effects of a novel dynamic neuromuscular stabilization (DNS) technique on gross motor function, diaphragm movement, and activation of the external oblique (EO) and internal oblique (IO)/transversus abdominal (TrA) muscles in participants with cerebral palsy (CP). METHOD: Fifteen participants with CP (7 females) underwent DNS intervention for 30 minutes/day, 3 days a week for 4 weeks. Gross motor function, diaphragm movement, and muscle activation were determined using a gross motor function measure (GMFM-88), ultrasound, and electromyography measurements, respectively, before and after the DNS core stabilization intervention. Paired t-tests were used at p < 0.05. DESIGN: A single-arm, pretest-posttest clinical trial. RESULTS: GMFM scores for standing, walking, and jumping domains were significantly improved after the intervention (P < 0.05). Diaphragm descending movement (P = 0.0001) and activation of the internal oblique and transversus abdominals were initially undetectable, but remarkably increased after the intervention (P = 0.012). CONCLUSIONS: DNS is a promising, effective intervention for facilitating deep core muscle activation of the underactive muscle chain comprising the diaphragm, internal oblique, and transversus abdominals, thereby improving age-appropriate standing, walking, and jumping in participants with spastic diplegic CP.

The validity and reliability of a dynamic neuromuscular stabilization-heel sliding test for core stability.

BACKGROUND: Core stabilization plays an important role in the regulation of postural stability. To overcome shortcomings associated with pain and severe core instability during conventional core stabilization tests, we recently developed the dynamic neuromuscular stabilization-based heel sliding (DNS-HS) test. OBJECTIVE: The purpose of this study was to establish the criterion validity and test-retest reliability of the novel DNS-HS test. METHOD: Twenty young adults with core instability completed both the bilateral straight leg lowering test (BSLLT) and DNS-HS test for the criterion validity study and repeated the DNS-HS test for the test-retest reliability study. Criterion validity was determined by comparing hip joint angle data that were obtained from BSLLT and DNS-HS measures. The test-retest reliability was determined by comparing hip joint angle data. RESULTS: Criterion validity was (ICC2,3) = 0.700 (p< 0.05), suggesting a good relationship between the two core stability measures. Test-retest reliability was (ICC3,3) = 0.953 (p< 0.05), indicating excellent consistency between the repeated DNS-HS measurements. CONCLUSIONS: Criterion validity data demonstrated a good relationship between the gold standard BSLLT and DNS-HS core stability measures. Test-retest reliability data suggests that DNS-HS core stability was a reliable test for core stability. Clinically, the DNS-HS test is useful to objectively quantify core instability and allow early detection and evaluation.

Reflex-mediated dynamic neuromuscular stabilization in stroke patients: EMG processing and ultrasound imaging.

BACKGROUND: Postural core instability is associated with poor dynamic balance and a high risk of serious falls. Both neurodevelopmental treatment (NDT) and dynamic neuromuscular stabilization (DNS) core stabilization exercises have been used to improve core stability, but the outcomes of these treatments remain unclear. OBJECTIVE: This study was undertaken to examine the therapeutic effects of NDT and DNS core stabilization exercises on muscular activity, core stability, and core muscle thickness. METHODS: Ten participants (5 healthy adults; 5 hemiparetic stroke patients) were recruited. Surface electromyography (EMG) was used to determine core muscle activity of the transversus abdominis/internal oblique (TrA/IO), external oblique (EO), and rectus abdominis (RA) muscles. Ultrasound imaging was used to measure transversus abdominals/internal oblique (TrA/IO) thickness, and a pressure biofeedback unit (PBU) was used to measure core stability during the DNS and NDT core exercise conditions. Data are reported as median and range and were compared using nonparametric Mann - Whitney U test and Wilcoxon signed rank test at p< 0.05. RESULTS: Both healthy and hemiparetic stroke groups showed greater median EMG amplitude in the TrA/IO muscles, core stability, and muscle thickness values during the DNS exercise condition than during the NDT core exercise condition, respectively (p< 0.05). However, the relative changes in the EMG amplitude, core stability, and muscle thickness values were greater during the DNS exercise condition than during the NDT core exercise condition in the hemiparetic stroke patient group (p< 0.05). CONCLUSIONS: Our novel results provide the first clinical evidence that DNS is more effective than NDT in both healthy and hemiparetic stroke subjects to provide superior deep core muscle activation, core stabilization, and muscle thickness. Moreover, such advantageous therapeutic benefits of the DNS core stabilization exercise over the NDT exercise were more apparent in the hemiparetis stroke patients than normal controls.