Unsupervised machine learning for clustering forward head posture, protraction and retraction movement patterns based on craniocervical angle data in individuals with nonspecific neck pain.

OBJECTIVES: The traditional understanding of craniocervical alignment emphasizes specific anatomical landmarks. However, recent research has challenged the reliance on forward head posture as the primary diagnostic criterion for neck pain. An advanced relationship exists between neck pain and craniocervical alignment, which requires a deeper exploration of diverse postures and movement patterns using advanced techniques, such as clustering analysis. We aimed to explore the complex relationship between craniocervical alignment, and neck pain and to categorize alignment patterns in individuals with nonspecific neck pain using the K-means algorithm. METHODS: This study included 229 office workers with nonspecific neck pain who applied unsupervised machine learning techniques. The craniocervical angles (CCA) during rest, protraction, and retraction were measured using two-dimensional video analysis, and neck pain severity was assessed using the Northwick Park Neck Pain Questionnaire (NPQ). CCA during sitting upright in a comfortable position was assessed to evaluate the resting CCA. The average of midpoints between repeated protraction and retraction measures was considered as the midpoint CCA. The K-means algorithm helped categorize participants into alignment clusters based on age, sex and CCA data. RESULTS: We found no significant correlation between NPQ scores and CCA data, challenging the traditional understanding of neck pain and alignment. We observed a significant difference in age (F = 140.14, p < 0.001), NPQ total score (F = 115.83, p < 0.001), resting CCA (F = 79.22, p < 0.001), CCA during protraction (F = 33.98, p < 0.001), CCA during retraction (F = 40.40, p < 0.001), and midpoint CCA (F = 66.92, p < 0.001) among the three clusters and healthy controls. Cluster 1 was characterized by the lowest resting and midpoint CCA, and CCA during pro- and -retraction, indicating a significant forward head posture and a pattern of retraction restriction. Cluster 2, the oldest group, showed CCA measurements similar to healthy controls, yet reported the highest NPQ scores. Cluster 3 exhibited the highest CCA during protraction and retraction, suggesting a limitation in protraction movement. DISCUSSION: Analyzing 229 office workers, three distinct alignment patterns were identified, each with unique postural characteristics; therefore, treatments addressing posture should be individualized and not generalized across the population.

Comparison of acromiohumeral distance and glenohumeral internal rotation angle between the empty can test and modified empty can test: "thumb pointing down" versus "elbow pointing laterally".

BACKGROUND: During the empty can test, the direction of the thumb (downward) has been widely used as an instruction for producing glenohumeral internal rotation. However, the combination of forearm pronation and thumb motion as a compensatory movement could contribute to the lack of glenohumeral internal rotation during the empty can test. This study aimed to compare the glenohumeral internal rotation angle between the conventional empty can (with thumb direction) and modified empty can tests (with elbow direction), as well as the acromiohumeral distance between the full can, conventional empty can, and modified empty can tests. METHODS: In this laboratory study, we measured the glenohumeral internal rotation angle using a motion sensor and the acromiohumeral distance using ultrasonography during the following tests: full can test (thumb pointing up), conventional empty can test (thumb pointing down), and modified empty can test (elbow pointing laterally) in 20 healthy subjects. RESULTS: Compared with the conventional empty can test, the glenohumeral internal rotation angle was significantly greater during the modified empty can test (p < 0.05). Furthermore, the acromiohumeral distance measured in the modified empty can test was significantly less than that in the full can test (p < 0.001) and conventional empty can test (p < 0.001). However, there was no difference in the acromiohumeral distance between the full can test and the conventional empty can test (p > 0.017). CONCLUSIONS: During the empty can test, the instructions should be given to patients based on the elbow direction (elbow pointing laterally). The modified empty can test can produce full glenohumeral internal rotation, compared with instructions based on the thumb direction (thumb pointing down). Consequently, the modified empty can test can produce a more decreased subacromial space.

Prediction model of subacromial pain syndrome in assembly workers using shoulder range of motion and muscle strength based on support vector machine.

Subacromial pain syndrome (SAPS) is the most common upper-extremity musculoskeletal problem among workers. In this study, a machine learning model was built to predict and classify the presence or absence of SAPS in assembly workers with shoulder joint range of motion (ROM) and muscle strength data using support vector machine (SVM). Permutation importance was used to determine important variables for predicting workers with or without SAPS. The accuracy of the support vector classifier (SVC) polynomial model for classifying workers with SAPS was 82.4%. The important variables in model construction were internal rotation and abduction of shoulder ROM and internal rotation of shoulder muscle strength. It is possible to accurately perform SAPS classification of workers with relatively easy-to-obtain shoulder ROM and muscle strength data using this model. In addition, preventing SAPS in workers is possible by adjusting the factors affecting model building using exercise or rehabilitation programs.Practitioner summary: This study aimed to create a machine learning model that can predict and classify SAPS using shoulder ROM and muscle strength and identify the variables that are of high importance in model construction. This model could be used to predict or classify workers' SAPS and manage or prevent SAPS.

Comparison of the Shoulder External Rotator Strength and Asymmetry Ratio Between Workers With and Without Shoulder Impingement Syndrome.

ABSTRACT: Kim, J-H, Kwon, O-Y, Hwang, U-J, Jung, S-H, Ahn, S-H, and Kim, H-A. Comparison of shoulder external rotator strength and the asymmetry ratio between workers with and without shoulder impingement syndrome. J Strength Cond Res 35(12): 3364-3369, 2021-Shoulder impingement syndrome (SIS) is the most common shoulder problem causing shoulder pain. Several studies have indicated that shoulder external rotator muscles provide dynamic stability to the shoulder joint. However, the relationship of SIS to changes in shoulder external rotator muscle strength remains controversial. The purpose of the study was to compare the shoulder external rotator strength and asymmetry ratio between workers with SIS and the normal group in a side-lying position. Twelve male industrial workers with SIS and the normal group of 12 workers participated in this study. A pulling sensor measured shoulder external rotator muscle strength in a side-lying position with the shoulder at 0° and 90° of flexion. The asymmetry ratio was calculated by a specific formula using the shoulder external rotator muscle strength of the dominant side and the unaffected side. Two-way analysis of variance was used to determine between-group differences in shoulder external rotator muscle strength and the asymmetry ratio among the 2 positions. Subjects with SIS did not exhibit significant differences in shoulder external rotator muscle strength in the side-lying position with the shoulder at 0° and 90° of flexion relative to the normal group. However, subjects with SIS had a significantly increased asymmetry ratio of shoulder external rotation strength in the side-lying position with the shoulder at 90° of flexion compared with the normal group. In conclusion, workers with SIS had an asymmetry of shoulder external rotator strength in side-lying with the shoulder at 90° of flexion.

Effect of Abdominal Electrical Muscle Stimulation Training With and Without Superimposed Voluntary Muscular Contraction on Lumbopelvic Control.

CONTEXT: Electrical muscle stimulation (EMS) was designed for artificial muscle activation or superimposed training. OBJECTIVES: To compare the effects of 8 weeks of superimposed technique (ST; application of electrical stimulation during a voluntary muscle action) and EMS on the cross-sectional area of the rectus abdominis, lateral abdominal wall, and on lumbopelvic control. SETTING: University research laboratory. DESIGN: Randomized controlled trial. PARTICIPANTS: Fifty healthy subjects were recruited and randomly assigned to either the ST or EMS group. INTERVENTION: The participants engaged with the electrical stimulation techniques (ST or EMS) for 8 weeks. MAIN OUTCOME MEASURES: In all participants, the cross-sectional area of the rectus abdominis and lateral abdominal wall was measured by magnetic resonance imaging and lumbopelvic control, quantified using the single-leg and double-leg lowering tests. RESULTS: There were no significant differences in the cross-sectional area of the rectus abdominis (right: P = .70, left: P = .99) or lateral abdominal wall (right: P = .07, left: P = .69) between groups. There was a significant difference between groups in the double-leg lowering test (P = .03), but not in the single-leg lowering test (P = .88). There were significant differences between the preintervention and postintervention in the single-leg (P < .001) and double-leg lowering tests (P < .001). CONCLUSIONS: ST could improve lumbopelvic control in the context of athletic training and fitness.

Comparison of MRI cross-sectional area and functions of core muscles among asymptomatic individuals with and without lumbar intervertebral disc degeneration.

BACKGROUND: Previous studies suggested that patients with symptomatic intervertebral disc degeneration (IDD) of lumbar spine have reduced cross-sectional area (CSA) and functions of core muscles. However, reduced CSA and functions of core muscles have been observed not only in patients with symptomatic IDD but also in patients with other subgroups of low back pain (LBP). Thus, it is uncertain whether reduced CSA and functions of core muscles lead to IDD and LBP, or pain leads to reduced CSA and functions of core muscles in patients with symptomatic IDD. Therefore, this study aimed to compare the CSA and functions of core muscles between asymptomatic participants with and without IDD in magnetic resonance imaging (MRI). METHODS: Twenty asymptomatic participants (12 men and 8 women) participated in this study. Ten participants had asymptomatic IDD at L4-5. The others were healthy controls (without IDD at all levels of lumbar spine). The CSA of core muscles was measured using MRI. Maximal isometric trunk flexor strength and side bridge strength were measured by a Smart KEMA strength sensor. Trunk flexor endurance test, side bridge endurance test and plank endurance test were used to measure core endurance. Double legs loading test was used to measure core stability. Mann-Whitney U test was used to compare the differences between two groups. RESULTS: There were no significant differences in core muscle functions between the two groups (p > 0.05). Moreover, there was no significant difference in CSA between the two groups (p > 0.05). CONCLUSIONS: There was no significant difference in CSA and core muscle functions between asymptomatic participants with and without IDD. These findings indicate that a degenerative or bulging disc in asymptomatic individuals has little effect on CSA and functions of core muscles, especially in young age. Therefore, the general core endurance test or strength test could not differentiate asymptomatic people with and without IDD of lumbar spine. TRIAL REGISTRATION NUMBER: Clinical Research information Service. KCT0004061. Registered 13 June 2019. retrospectively registered.

Effect of a Facial Muscle Exercise Device on Facial Rejuvenation.

BACKGROUND: The efficacy of facial muscle exercises (FMEs) for facial rejuvenation is controversial. In the majority of previous studies, nonquantitative assessment tools were used to assess the benefits of FMEs. OBJECTIVES: This study examined the effectiveness of FMEs using a Pao (MTG, Nagoya, Japan) device to quantify facial rejuvenation. METHODS: Fifty females were asked to perform FMEs using a Pao device for 30 seconds twice a day for 8 weeks. Facial muscle thickness and cross-sectional area were measured sonographically. Facial surface distance, surface area, and volumes were determined using a laser scanning system before and after FME. Facial muscle thickness, cross-sectional area, midfacial surface distances, jawline surface distance, and lower facial surface area and volume were compared bilaterally before and after FME using a paired Student t test. RESULTS: The cross-sectional areas of the zygomaticus major and digastric muscles increased significantly (right: P < 0.001, left: P = 0.015), while the midfacial surface distances in the middle (right: P = 0.005, left: P = 0.047) and lower (right: P = 0.028, left: P = 0.019) planes as well as the jawline surface distances (right: P = 0.004, left: P = 0.003) decreased significantly after FME using the Pao device. The lower facial surface areas (right: P = 0.005, left: P = 0.006) and volumes (right: P = 0.001, left: P = 0.002) were also significantly reduced after FME using the Pao device. CONCLUSIONS: FME using the Pao device can increase facial muscle thickness and cross-sectional area, thus contributing to facial rejuvenation.

Effect of Humeral-Elevation Angle on Electromyographic Activity in the Serratus Anterior During the Push-Up-Plus Exercise.

CONTEXT: The push-up-plus (PP) exercise has been recommended for strengthening of the serratus anterior (SA). Previous studies have investigated the effect of different stability properties of the base of support to adjust the difficulty level of SA muscle-strengthening exercises in the PP position. However, the optimal humeral-elevation angle (HEA) for selective activation and maximum contraction of the SA during PP has not been investigated. OBJECTIVES: To assess the effects of HEA during PP on electromyographic (EMG) activity in the SA, upper trapezius (UT), and pectoralis major (PM) and on the UT:SA and PM:SA activity ratios. DESIGN: Comparative, repeated-measures design. SETTING: University research laboratory. PARTICIPANTS: 29 healthy men. MAIN OUTCOME MEASURES: The subjects performed PP at 3 different HEAs (60°, 90°, and 120°); EMG activity in the SA, UT, and PM was measured, and the UT:SA and PM:SA activity ratios were calculated. Differences in muscle activity and ratios between the 60°, 90°, and 120° HEAs were assessed using 1-way repeated-measures analysis of variance; the Bonferroni correction was applied. RESULTS: SA muscle activity was significantly increased, in order of magnitude, at the 120°, 90°, and 60° HEAs. UT:SA and PM:SA activity ratios were significantly greater during performance of the PP at an HEA of 60° than at HEAs of 120° and 90°. CONCLUSION: The results suggest that an HEA of 120° should be used during performance of the PP because it produces greater SA activation than HEAs of 60° and 90°.

Comparison of Hip- and Back-Muscle Activity and Pelvic Compensation in Healthy Subjects During 3 Different Prone Table Hip-Extension Exercises.

CONTEXT: Prone hip extension has been recommended for strengthening the back and hip muscles. Previous studies have investigated prone hip extension conducted with subjects on the floor in the prone position. However, no study has compared 3 different table hip-extension (THE) positions in terms of the activities of the back- and hip-joint muscles with lumbopelvic motion. OBJECTIVE: To identify more effective exercises for strengthening the gluteus maximus (GM) by comparing 3 different exercises (THE alone, THE with the abdominal drawing-in maneuver [THEA], and THEA with chair support under the knee [THEAC]) based on electromyographic muscle activity and pelvic compensation. DESIGN: Repeated-measure within-subject intervention. SETTING: University research laboratory. PARTICIPANTS: 16 healthy men. MAIN OUTCOME MEASURES: Surface electromyography (EMG) was used to obtain data on the GM, erector spinae (ES), multifidus, biceps femoris (BF), and semitendinosus (ST). Pelvic compensation was monitored using an electromagnetic motion-tracking device. Exertion during each exercise was recorded. Any significant difference in electromyographic muscle activity and pelvic motion among the 3 conditions (THE vs THEA vs THEAC) was assessed using a 1-way repeated-measures analysis of variance (ANOVA) with Bonferroni post hoc test. RESULTS: The muscle activities recorded by EMG differed significantly among the 3 exercises (P < .01). GM activity was increased significantly during THEAC (P < .01). There was a significant difference in lumbopelvic kinematics in terms of anterior tilting (F = 19.49, P < .01) and rotation (F= 27.38, P < .01) among the 3 exercises. CONCLUSIONS: The THEAC exercise was the most effective for strengthening the GM without overactivity of the ES, BF, and ST muscles and lumbopelvic compensation compared with THE and THEA.

Relationship between cervical lordotic angle and cervical segmental motion during craniocervical flexion test: A cross-sectional study.

The craniocervical flexion test (CCFT) is commonly used for assessing the performance and function of the deep cervical flexor muscles; however, objective measurements of cervical segmental motion during craniocervical flexion (CCF) are lacking. Therefore, the purpose of this study aimed to investigate cervical segmental motions during CCFT and determine the relationship between changes of cervical segmental motions and the cervical lordotic angle. A cross-sectional study of prospectively collected data. Twenty healthy participants without neck pain underwent standing cervical radiography (lateral view) to measure the cervical lordotic angle, followed by radiography in supine position during the CCFT. The occipito-atlantal (OA) joint angle, atlantoaxial (AA) joint angle, and cervical spinous process posterior displacement (CSPPD) of the C1-C6 vertebrae were measured using lateral cervical radiographs taken during the initial (20 mm Hg) and low-stage (24 mm Hg) CCFT conditions. The CCF motion during the low-stage CCFT was characterized by a significantly increased OA joint angle, decreased AA joint angle, and increased C1-C6 CSPPD compared with the initial stage (P < .05). The change in the value of C1-C6 CSPPD at low-stage CCFT showed a significant positive correlation with the cervical lordotic angle. These results indicate that the cervical lordotic angle is important in minimizing CSPPD and performing appropriately-isolated CCF motion during CCFT.

Machine learning models for classifying non-specific neck pain using craniocervical posture and movement.

OBJECTIVE: Physical therapists and clinicians commonly confirm craniocervical posture (CCP), cervical retraction, and craniocervical flexion as screening tests because they contribute to non-specific neck pain (NSNP). We compared the predictive performance of statistical machine learning (ML) models for classifying individuals with and without NSNP using datasets containing CCP and cervical kinematics during pro- and retraction (CKdPR). DESIGN: Exploratory, cross-sectional design. SETTING AND PARTICIPANTS: In total, 773 public service office workers (PSOWs) were screened for eligibility (NSNP, 441; without NSNP, 332). METHODS: We set up five datasets (CCP, cervical kinematics during the protraction, cervical kinematics during the retraction, CKdPR and combination of the CCP and CKdPR). Four ML algorithms-random forest, logistic regression, Extreme Gradient boosting, and support vector machine-were trained. MAIN OUTCOME MEASURES: Model performance were assessed using area under the curve (AUC), accuracy, precision, recall and F1-score. To interpret the predictions, we used Feature permutation importance and SHapley Additive explanation values. RESULTS: The random forest model in the CKdPR dataset classified PSOWs with and without NSNP and achieved the best AUC among the five datasets using the test data (AUC, 0.892 [good]; F1, 0.832). The random forest model in the CCP dataset had the worst AUC among the five datasets using the test data [AUC, 0.738 (fair); F1, 0.715]. CONCLUSION: ML performance was higher for the CKdPR dataset than for the CCP dataset, suggesting that ML algorithms are more suitable than classical statistical methods for developing robust models for classifying PSOWs with and without NSNP.

Classification of chronic ankle instability using machine learning technique based on ankle kinematics during heel rise in delivery workers.

Objective: Ankle injuries in delivery workers (DWs) are often caused by trips, and high recurrence rates of ankle sprains are related to chronic ankle instability (CAI). Heel rise requires joint angles and moments similar to those of the terminal stance phase of walking that the foot supinates. Thus, our study aimed to develop, determine, and compare the predictive performance of statistical machine learning models to classify DWs with and without CAI using ankle kinematics during heel rise. Methods: In total, 203 DWs were screened for eligibility. Seven predictors were included in our study (age, work duration, body mass index, calcaneal stance position angle [CSPA] in the initial and terminal positions during heel rise, calcaneal movement during heel rise [CMHR], and plantar flexion angle during heel rise). Six machine learning algorithms, including logistic regression, decision tree, AdaBoost, Extreme Gradient boosting machines, random forest, and support vector machine, were trained. Results: The random forest model (area under the curve [AUC], 0.967 [excellent]; F1, 0.889; accuracy, 0.925) confirmed the best predictive performance in the test datasets among the six machine learning models. For Shapley Additive Explanations, old age, low CMHR, high CSPA in the initial position, high PFA, long work duration, low CSPA in the terminal position, and high body mass index were the most important predictors of CAI in the random forest model. Conclusion: Ankle kinematics during heel rise can be considered in the classification of DWs with and without CAI.

Influence of strength and balance ability on functional performance in the involved and uninvolved sides after anterior cruciate ligament reconstruction.

BACKGROUND: The restoration and management of the uninvolved side have been emphasized to prevent a second anterior cruciate ligament (ACL) injury and to ensure that athletes return to sports after ACL reconstruction. OBJECTIVE: To determine the factors influencing the single leg hop test (SLHT) and single leg vertical jump test (SLVJT) at 1 year postoperatively after ACL reconstruction in both the involved and uninvolved sides. METHODS: Ninety-four patients who underwent ACL reconstruction were assessed at 1 year postoperatively. Multiple regression models included eight independent variables with two dependent variables (SLHT and SLVJT.), each on the involved and uninvolved side. RESULTS: On the involved side, the Y balance test (YBT), extensor peak torque per body weight (PT/BW), Biodex balance system anteroposterior index (BBS-API), and sex accounted for 53.9% of the variance in SLHT (P= 0.002), and extensor PT/BW and YBT accounted for 26.3% of the variance in SLVJT (P= 0.027). On the uninvolved side, YBT, sex, age, BBS-API, and flexor PT/BW accounted for 47.0% of the variance in SLHT (P= 0.046), and flexor PT/BW, YBT, and age accounted for 44.9% of the variance in SLVJT (P= 0.002). CONCLUSION: Knee extensor strength on the involved side and flexor strength on the uninvolved side influence the two functional performance tests. The YBT was an important factor in the two functional performance tests in both sides. Anteroposterior stability was the only factor that influenced the SLHT bilaterally.

Effect of electrical stimulation training and detraining on abdominal muscle function.

BACKGROUND: Electrical muscle stimulation (EMS) has been applied in many rehabilitation settings for muscle strengthening, facilitation of muscle contraction, re-education of muscle action, and maintenance of muscle strength and size during prolonged immobilization. OBJECTIVE: The purpose of this study was to investigate effect of 8 weeks of EMS training on abdominal muscle function and to determine whether the training effect could be maintained after 4 weeks of EMS detraining. METHODS: Twenty-five subjects performed EMS training for 8 weeks. Before and after 8 weeks of EMS training, and after 4 weeks of EMS detraining, muscle size (cross-sectional area [CSA] of the rectus abdominals [RA] and lateral abdominal wall [LAW]), strength, endurance, and lumbopelvic control (LC) were measured. RESULTS: There were significant increases in CSA [RA (p< 0.001); LAW (p< 0.001)], strength [trunk flexor (p= 0.005); side-bridge (p< 0.05)], endurance [trunk flexor (p= 0.010); side-bridge (p< 0.05)], and LC (p< 0.05) after 8 weeks of EMS training. The CSA of the RA (p< 0.05) and the LAW (p< 0.001) were measured after 4 weeks of detraining and they were greater than that of the baseline. There were no significant differences in abdominal strength, endurance, and LC between baseline measurements and post-detraining. CONCLUSION: The study indicates that there is less of a detraining effect on muscle size than on muscle strength, endurance, and LC.

Relationship between female sexual function, vaginal volume, vaginal resting tone, and pelvic floor muscle strength in women with stress urinary incontinence.

OBJECTIVE: Vaginal morphology and pelvic floor muscle (PFM) strength may influence sexual stimulation, sensation, and orgasmic response. This study aimed to determine the relationship between female sexual function and PFM strength and vaginal morphology (represented by vaginal resting tone and vaginal volume) in women with stress urinary incontinence (SUI). METHODS: Forty-two subjects with SUI were recruited for the study. Female sexual function was measured using the female sexual function index (FSFI) questionnaire. PFM strength was measured by digital palpation. Vaginal resting tone (mmHg) and vaginal volume (mL) were measured using a perineometer. The significance of the correlations between female sexual function and PFM function and hip muscle strength was assessed using Pearson's correlation coefficients. If a significant correlation between vaginal morphology and FSFI score was confirmed using Pearson's correlation, the cutoff value was confirmed through a decision tree. RESULTS: PFM strength was significantly correlated with desire (r=0.397), arousal (r=0.388), satisfaction (r=0.326), and total (r=0.315) FSFI scores. Vaginal resting tone (r=-0.432) and vaginal volume (r=0.332) were significantly correlated with the FSFI pain score. The cutoff point of vaginal resting tone for the presence of pain-related sexual dysfunction was >15.2 mmHg. CONCLUSION: PFM strength training should be the first strategy to improve female sexual function. Additionally, because of the relationship between vaginal morphology and pain-related sexual dysfunction, surgical procedures to achieve vaginal rejuvenation should be carefully considered.

Correlation between trunk rotation and lateral flexion range of motion, peak cough flow, and chest expansion in stroke patients.

INTRODUCTION: Stroke patients have problems with voluntary movement and trunk control. Moreover, the respiratory function in stroke patients is affected by neurological impairment, which increases the incidence of respiratory complications. OBJECTIVES: To determine the correlation between trunk rotation range of motion (TRROM) and trunk lateral flexion range of motion (TLFROM), peak cough flow (PCF), and chest expansion in stroke patients. METHODS: This was an observational study involving 21 patients with a clinical diagnosis of stroke from October 2021 to January 2022. TRROM and TLFROM were assessed using smartphone applications (Compass and Clinometer), respectively, PCF was assessed using a peak flow meter, and chest expansion was assessed using a tape measure. Pearson's correlation was used to analyze the relationships between the variables. RESULTS: Statistically significant correlations were found between TRROM and TLFROM (r = 0.91, p < 0.01) and between upper chest expansion and PCF (r = 0.59, p < 0.01). There were significant correlations between lower chest expansion and TRROM (r = 0.50, p < 0.05) and between lower chest expansion and TLFROM (r = 0.51, p < 0.05). CONCLUSION: This study demonstrates the relationship between upper chest expansion and PCF. Upper chest expansion exercises should be considered to improve the PCF in stroke patients. In addition, a very strong positive correlation between TRROM and TLFROM was demonstrated. TRROM and TLFROM exercises should be considered to improve the lower chest expansion in stroke patients.

Effect of pelvic floor muscle electrical stimulation on lumbopelvic control in women with stress urinary incontinence: randomized controlled trial.

INTRODUCTION: The pelvic floor muscle (PFM) plays a role not only in lumbopelvic stabilization, but also in incontinence and sexual function. OBJECTIVE: This study aimed to determine the effectiveness of PFM training by electrical stimulation (ES) on urinary incontinence, PFM performance (i.e. strength and power), lumbopelvic control, and abdominal muscle thickness in women with stress urinary incontinence (SUI). METHODS: Participants were randomized into ES and control groups. The ES group underwent PFM ES for 8 weeks, whereas the control group underwent only a walking program. The impact of urinary incontinence on quality of life was assessed by the Incontinence Impact Questionnaire (IIQ)-7. PFM strength and power were measured using a perineometer. Lumbopelvic control was measured by one and double-leg-lowering tests. Abdominal muscle thickness was measured by sonography. RESULTS: The ES group showed significantly improved IIQ-7 scores and PFM performance, and had significantly higher values in both one and double-leg lowering tests (p < .05) after 8 weeks of training, indicating significant improvement from pre-session values (p < .005). There were no significant between- or within-group differences at rest in abdominal muscle thickness. CONCLUSION: PFM ES could improve lumbopelvic control and PFM performance, and reduce subjective symptoms of urinary incontinence in women with SUI.

Respiratory Parameters as Predictors of Balance and Gait Ability in Patients with Stroke at Discharge.

Pulmonary complications are frequent in stroke, contributing to both mortality and morbidity rates. Respiratory parameters in such patients encompass both pulmonary function and respiratory muscle strength. Identifying respiratory function variables that influence the balance and gait ability of patients with stroke is crucial for enhancing their recovery in these aspects. However, no study has assessed predictions for a comprehensive array of balance and gait abilities in such patients. We aimed to examine whether initial respiratory muscle strength and pulmonary function can predict balance and gait ability at discharge from a rehabilitation program. Thirty-one patients with stroke were included in this prospective observational study. Multiple regression models with a forward selection procedure were employed to identify respiratory parameters (including peak expiratory flow and maximal expiratory pressure) that contributed to the results of balance assessments and gait evaluations at the time of discharge. The peak expiratory flow (PEF) served as a predictor explaining 42.0% of the variance. Similarly, the maximal expiratory pressure (MEP) was a predictor variable explaining 32.0% of the variance. PEF and MEP assessments at the initial stage as predictive factors for both balance and gait ability are important in stroke management.

Investigating the Anti-Aging Effects of Caviar Oil on Human Skin.

BACKGROUND/AIM: As the largest organ of the human body, the skin serves as a critical barrier against environmental damage. However, many factors, such as genetics, sun exposure, and lifestyle choices can lead to skin damage creating wrinkles, sagging, and loss of elasticity. The use of skincare products containing natural ingredients has become increasingly popular as a way to combat the signs of aging. Caviar oil is one such ingredient that has gained attention due to its rich composition of fatty acids, vitamins, and minerals. The objective of this study was to investigate the potential anti-aging effects of caviar oil and to develop a product, Cavi Balm, which could potentially reduce wrinkles and skin sagging. MATERIALS AND METHODS: An in vitro model using the 3T3-L1 cell line was employed to assess the effect of caviar oil on adipocyte differentiation. An ex vivo study using human skin tissue was conducted to investigate the impact of caviar oil on collagen and elastin formation and the expression of matrix metalloproteinase-1,2,9 (MMP-1, MMP-2, MMP-9). Furthermore, 102 participants were enrolled in five clinical studies to evaluate the anti-aging efficacy of our product, "Cavi Balm", in facial and neck wrinkles, facial and eye area lifting, and various skin parameters, such as skin moisture, skin elasticity, skin density, skin tightening relief, skin clarity, and skin turnover. RESULTS: In vitro, caviar oil enhanced adipocyte differentiation, and increased lipid accumulation inside the cells. The ex vivo analysis revealed that caviar oil reduced the expression levels of MMP-1, MMP-2, and MMP-9, and increased the formation of elastin and collagen I, III. Moreover, in the clinical study, Cavi Balm improved skin parameters after one-time use, with more significant effects observed after four weeks of usage. CONCLUSION: Caviar oil has a substantial impact on mitigating skin aging and holds potential for application in anti-aging products.

Influencing factors of pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain: A cross-sectional study.

It is unclear which factors contribute to the developing pressure pain hypersensitivity of the upper trapezius, a type of neurophysiological hyperexcitability. The present study investigated the relationship between physical and psychological factors and pressure pain hypersensitivity of the upper trapezius for each sex. In total, 154 individuals with neck/shoulder myofascial pain participated, among 372 food service workers. Participants completed a questionnaire (Beck Depression Inventory, and Borg Rating of Perceived Exertion scale) and were photographed to measure posture. Pressure pain sensitivity, 2 range of motions (cervical lateral bending and rotation), and 4 muscle strengths (serratus anterior, lower trapezius [LT], biceps, and glenohumeral external rotator) were measured by a pressure algometer, iPhone application, and handheld dynamometer, respectively. For each sex, forward multivariate logistic regression was used to test our a priori hypothesis among selected variables that a combination of psychosocial and physical factors contributed to the risk for pressure pain hypersensitivity. In multivariate analyses, LT strength (odds ratio = 0.94, 95% confidence interval = 0.91-0.97, P = .001) was the only significant influencing factor for pressure pain hypersensitivity in men. Dominant painful ipsilateral cervical rotation range of motion (odds ratio = 0.96, 95% confidence interval = 0.92-0.99, P = .037) was the only influencing factor for pressure pain hypersensitivity in women. LT strength and dominant painful ipsilateral cervical rotation range of motion could serve as guidelines for preventing and managing pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain.