Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis.

STUDY DESIGN: Crossover repeated-measure design. INTRODUCTION: Scapular dyskinesis rehabilitation programs that focus on inhibiting upper trapezius (UT) and activating the lower trapezius (LT) may assist in restoring scapular movements. We hypothesized that taping may be able to normalize scapular movements and associated muscular recruitment. PURPOSE OF THE STUDY: The purpose of this study was to investigate the immediate effects of kinesio taping over trapezius on scapular kinematics and muscular activation in different dyskinesis patterns. We expected that taping can improve scapular kinematics and muscular activation in subjects with dyskinesis. METHODS: Fifty-four participants with inferior angle prominence (pattern I), medial border prominence (pattern II), and mixed pattern (pattern I + II) were recruited. Kinesio taping was applied over 3 parts of trapezius muscles, including UT, middle trapezius (MT), and LT. The scapular kinematics and electromyographic data of trapezius and serratus anterior were collected during scapular plane elevation without taping and after each taping application. RESULTS: UT taping decreased UT activity (5%-7%; P = .001-.003) in 72% of participants with pattern II and pattern I + II dyskinesis, with increased posterior tipping (2.2°-2.5°; P = .003) in pattern II dyskinesis. MT taping increased UT activity (3%; P = .003) in 48% of participants with pattern II dyskinesis. DISCUSSION: The taping over the trapezius muscle may help to restore coordinated scapular muscle balance and increased upward rotation of the scapula, especially in pattern II dyskinesis. Although no electromyography or kinematic difference was found with LT taping in each dyskinesis pattern, methods of applying LT taping need to be further investigated. CONCLUSION: Reduced UT muscle activity and scapular posterior tipping are appropriate when applying taping over UT muscle in patterns II and I + II dyskinesis. Caution should be taken when applying taping over MT and LT muscles in terms of increased UT activity, especially in pattern II dyskinesis.

Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation.

PURPOSE: Scapular dyskinesis has been related to acromioclavicular injuries. A rehabilitation protocol has been studied in order to treat scapular dyskinesis, but it has not yet been evaluated. This rehabilitation programme was adopted to improve the shoulder function, thereby improving the scapular dyskinesis in patients with chronic acromioclavicular dislocation. METHOD: Twenty-four patients diagnosed with chronic type III acromioclavicular dislocation and scapular dyskinesis that have already been conservatively treated were enrolled in the rehabilitation protocol and analysed. Fourteen of these patients had a Scapular Inferior Coracoid dysKinesis (SICK) Syndrome. The adopted rehabilitation protocol consisted of 12 strengthening and stretching exercises of the scapulae. The final follow-ups were performed after 6 weeks, 6 months and 12 months using clinical measurements of scapular position and clinical evaluation of the scapular motion. In order to evaluate the SICK scapula syndrome, we used the SICK Scapula Rating Scale. The shoulder function was evaluated with a Constant Score and a Subjective Shoulder Value. RESULTS: After 12 months, the follow-up concluded that the scapular dyskinesis was no longer present in 18/23 patients (78.2 %). SICK scapula syndrome was observed in 4/8 patients with a scapular malposition. The Scapula Rating Scale score in 4 patients with SICK scapula was 7.5 points. After 12 months of rehabilitation, the mean Constant Score and Subjective Shoulder Value grew up to 85 points. CONCLUSION: The scapular dyskinesis and SICK syndrome secondary to chronic type III AC dislocation can be treated with the proposed rehabilitation protocol resulting in positive improvements of the shoulder function within 6 weeks; however, patients that do not respond to the rehabilitation programme will not improve with extended rehabilitation time. It is important to advise patients of the specific exercises for the prevention/treatment of scapular dyskinesis in the rehabilitation programme after AC joint dislocation. LEVEL OF EVIDENCE: IV.

Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete.

The scapula functions as a bridge between the shoulder complex and the cervical spine and plays a very important role in providing both mobility and stability of the neck/shoulder region. The association between abnormal scapular positions and motions and glenohumeral joint pathology has been well established in the literature, whereas studies investigating the relationship between neck pain and scapular dysfunction have only recently begun to emerge. Although several authors have emphasised the relevance of restoring normal scapular kinematics through exercise and manual therapy techniques, overall scapular rehabilitation guidelines decent for both patients with shoulder pain as well as patients with neck problems are lacking. The purpose of this paper is to provide a science-based clinical reasoning algorithm with practical guidelines for the rehabilitation of scapular dyskinesis in patients with chronic complaints in the upper quadrant.

Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'.

The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. The areas covered included the scapula and shoulder injury, the scapula and sports participation, clinical evaluation and interventions and known outcomes. Major conclusions were (1) scapular dyskinesis is present in a high percentage of most shoulder injuries; (2) the exact role of the dyskinesis in creating or exacerbating shoulder dysfunction is not clearly defined; (3) shoulder impingement symptoms are particularly affected by scapular dyskinesis; (4) scapular dyskinesis is most aptly viewed as a potential impairment to shoulder function; (5) treatment strategies for shoulder injury can be more effectively implemented by evaluation of the dyskinesis; (6) a reliable observational clinical evaluation method for dyskinesis is available and (7) rehabilitation programmes to restore scapular position and motion can be effective within a more comprehensive shoulder rehabilitation programme.

Managing Scapular Dyskinesis.

Scapular dyskinesis, the impairment of optimal scapular position and motion, is common in association with shoulder injury. A comprehensive evaluation process can show the causative factors and lead to effective treatment protocols. The complexity of scapular motion and the integrated relationship between the scapula, humerus, trunk, and legs suggest a need to develop rehabilitation programs that involve all segments working as a unit rather than isolated components. This is best accomplished with an integrated rehabilitation approach that includes rectifying deficits in mobility, strength, and motor control but not overtly focusing on any one area.

[Scapular dyskinesis]. / Dyskinésie de l'omoplate.

The scapula plays a crucial role for proper shoulder function, serving as a stable base for rotator cuff activation and as a link in the kinetic chain. Joint, ligament or muscular problems near the scapula can lead to malpositions or to an altered movement pattern. This abnormal situation is called "scapular dyskinesis", which appears to be a non-specific response to a painful condition of the shoulder. The clinical examination of the scapula is crucial for every patient presenting a painful shoulder. Systematic observation and testing enable the practitioner to detect subtle static and dynamic abnormalities. Visual evaluation, objective measurements and corrective manoeuvres can evaluate the role of the "scapular dyskinesis" in the shoulder painful condition. The scapular rehabilitation will address muscular retractions and imbalances and restore a good dynamic stability, starting with analytical work, and evolving into more functional and specific exercises.

Kinematic analysis of the human body during sit-to-stand in healthy young adults.

ABSTRACT: Sit-to-stand (STS) motion is one of the most important and energy-consuming basic motions in everyday life. Kinematic analysis provides information regarding what strategy or motion pattern is used by the healthy people, and through which, we can understand and obtain the law of the STS motion. The objective of this article is to study the law of STS motion through the experiment to determine a suitable description of STS motion in healthy adults, so as to provide a starting point and bases for future design and control of STS assistive devices.Thirty healthy adult subjects participated in this study and carried out STS motion experiment of standing up naturally. The STS motions were recorded using a high-definition camera. The experimentally collected kinematic data and a link segment model of the human body were used to obtain the coordinates of joints and to calculate the coordinates, velocity, and momentum of center of gravity; the postures of human body during STS are also obtained. The relationship between human body parameters and motion parameters is analyzed by using Pearson correlation method.The STS motion is divided into 4 phases; the phases are differentiated in terms of STS motion characteristics and postures, and momentum of center of gravity of human body. The main factors determining the differences in STS motion among individuals are horizontal distance between hip joint and ankle joint, lower leg length, thigh length, and the length of the transition period. The horizontal distance between hip joint and ankle joint is positively correlated with the duration from motion begin to trunk stops flexing forward (P = .021 < .05), but not so with the duration from motion begin to the end of phase 2 (P = .15 > .05).The results suggest that when designing the sit-to-stand assistive devices, one should pay attention to the whole-body posture control in STS motion, such as the posture guidance of trunk and lower leg, and should carry out specific training according to different STS phases. Sit-to-stand assistive devices should provide the same horizontal distance between hip joint and ankle joint for different individuals during the STS motion. Transition period should be properly controlled, and the degree of freedom of the lower leg should not be limited.

Motor Dysfunction in REM Sleep Behavior Disorder: A Rehabilitation Framework for Prodromal Synucleinopathy.

Parkinson disease (PD) and other related diseases with α-synuclein pathology are associated with a long prodromal or preclinical stage of disease. Predictive models based on diagnosis of idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) make it possible to identify people in the prodromal stage of synucleinopathy who have a high probability of future disease and provide an opportunity to implement neuroprotective therapies. However, rehabilitation providers may be unaware of iRBD and the motor abnormalities that indicate early motor system dysfunction related to α-synuclein pathology. Furthermore, there is no existing rehabilitation framework to guide early interventions for people with iRBD. The purpose of this work is to (1) review extrapyramidal signs of motor system dysfunction in people with iRBD and (2) propose a framework for early protective or preventive therapies in prodromal synucleinopathy using iRBD as a predictive marker. Longitudinal and cross-sectional studies indicate that the earliest emerging motor deficits in iRBD are bradykinesia, deficits performing activities of daily living, and abnormalities in speech, gait, and posture. These deficits may emerge up to 12 years before a diagnosis of synucleinopathy. The proposed rehabilitation framework for iRBD includes early exercise-based interventions of aerobic exercise, progressive resistance training, and multimodal exercise with rehabilitation consultations to address exercise prescription, progression, and monitoring. This rehabilitation framework may be used to implement neuroprotective, multidisciplinary, and proactive clinical care in people with a high likelihood of conversion to PD, dementia with Lewy bodies, or multiple systems atrophy.

A robotic wheelchair trainer: design overview and a feasibility study.

BACKGROUND: Experiencing independent mobility is important for children with a severe movement disability, but learning to drive a powered wheelchair can be labor intensive, requiring hand-over-hand assistance from a skilled therapist. METHODS: To improve accessibility to training, we developed a robotic wheelchair trainer that steers itself along a course marked by a line on the floor using computer vision, haptically guiding the driver's hand in appropriate steering motions using a force feedback joystick, as the driver tries to catch a mobile robot in a game of "robot tag". This paper provides a detailed design description of the computer vision and control system. In addition, we present data from a pilot study in which we used the chair to teach children without motor impairment aged 4-9 (n = 22) to drive the wheelchair in a single training session, in order to verify that the wheelchair could enable learning by the non-impaired motor system, and to establish normative values of learning rates. RESULTS AND DISCUSSION: Training with haptic guidance from the robotic wheelchair trainer improved the steering ability of children without motor impairment significantly more than training without guidance. We also report the results of a case study with one 8-year-old child with a severe motor impairment due to cerebral palsy, who replicated the single-session training protocol that the non-disabled children participated in. This child also improved steering ability after training with guidance from the joystick by an amount even greater than the children without motor impairment. CONCLUSIONS: The system not only provided a safe, fun context for automating driver's training, but also enhanced motor learning by the non-impaired motor system, presumably by demonstrating through intuitive movement and force of the joystick itself exemplary control to follow the course. The case study indicates that a child with a motor system impaired by CP can also gain a short-term benefit from driver's training with haptic guidance.

Infraspinatus strength assessment before and after scapular muscles rehabilitation in professional volleyball players with scapular dyskinesis.

HYPOTHESIS: This study tested the hypothesis that infraspinatus strength in professional volleyball players can be assessed with the scapula free (infraspinatus strength test, IST) and with the scapula retracted (infraspinatus scapula retraction test, ISRT) before and after scapular musculature training. MATERIALS AND METHODS: A prospective study was performed in 31 professional volleyball players. Isometric strength (kg) of the infraspinatus with IST and with ISRT was recorded by a handheld dynamometer and compared with the values found after 3 and 6 months of rehabilitation. Magnetic resonance imaging was performed to exclude articular and cuff pathology. Pain scores were assessed using a visual analog scale. RESULTS: The mean increase in the force values of IST was statistically significant after 3 months (P < .01) and 6 months (P < .001) of rehabilitation. The mean difference between IST and ISRT decreased from 4.72 ± 0.007 before rehabilitation to 1.2 ± 0.26 at 3 months and to 0.4 ± 0.006 at 6 months. The mean score for pain was 2.4 ± 1.8 at 3 months and 2.6 ± 1.4 at 6 months. DISCUSSION: Acquired scapular dyskinesis in overhead athletes can lead to the rotator cuff weakness. Inhibition due to pain and the negative biomechanic effect of scapular dyskinesis results in specific infraspinatus dysfunction that arise with the ISRT. CONCLUSIONS: ISRT is practical and consistent to assess the infraspinatus strength in overhead athletes with scapular dyskinesis. A functional rehabilitation protocol, designed to restore scapular muscles balance and shoulder mobility, is essential in the training program to prevent shoulder dysfunction and improve sports performance.

Parkinson's Disease Multimodal Complex Treatment improves motor symptoms, depression and quality of life.

Parkinson's disease (PD) is the world's fastest growing neurological disorder disabling patients through a broad range of motor and non-motor symptoms. For the clinical management, a multidisciplinary approach has increasingly been shown to be beneficial. In Germany, inpatient Parkinson's Disease Multimodal Complex Treatment (PD-MCT) is a well-established and frequent approach, although data on its effectiveness are rare. We conducted a prospective real-world observational study in 47 subjects [age (M ± SD): 68.5 ± 9.0 years, disease duration: 8.5 ± 5.3 years, modified Hoehn and Yahr stage (median, IQR): 3, 2.5-3] aiming at evaluating the effectiveness of 14-day PD-MCT in terms of quality of life (Parkinson's Disease Questionnaire, EuroQol), motor [Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III], Timed Up and Go Test, Purdue Pegboard Test) and non-motor symptoms (revised Beck Depression Inventory). Six weeks after hospital discharge, a follow-up examination was performed. PD patients with a predominantly moderate disability level benefited from PD-MCT in terms of health-related quality of life, motor symptoms and non-motor symptoms (depression). Significant improvements were found for social support, emotional well-being and bodily discomfort domains of health-related quality of life. Sustainable improvement occurred for motor symptoms and the subjective evaluation of health state. We found a higher probability of motor response especially for patients with moderate motor impairment (MDS-UPDRS III ≥ 33). In conclusion, Parkinson's Disease Multimodal Complex Treatment improves motor symptoms, depression and quality of life. A more detailed selection of patients who will benefit best from this intervention should be examined in future studies.

Eye Gaze Gaming Intervention in Children with Dyskinetic Cerebral Palsy: A Pilot Study of Task Performance and Its Relation with Dystonia and Choreoathetosis.

OBJECTIVES: To investigate the operational competences screen navigation and dwell function underlying eye gaze performance, and the relation of dystonia and choreoathetosis with eye gaze performance in children with dyskinetic cerebral palsy (DCP). METHODS: During a 5-week intervention, ten participants with DCP played eye gaze video games daily for 30 minutes. Six games were used to assess task performance, fixation count, and eye movement accuracy during four measurements. Dystonia and choreoathetosis were evaluated using the Dyskinesia Impairment Scale. RESULTS: Eye gaze performance improved over time (p = .013). Moderate to strong within-subject correlations were found between eye movement accuracy and task performance, and between eye movement accuracy and fixation count. No significant correlations were found with the movement disorders. CONCLUSIONS: Eye gaze technology shows great potential to be a successful computer interface for children with severe DCP, thereby potentially improving their communication skills, participation levels, and quality of life.

CONSORT-Assistive technology-180° rotating eating spoon improves the ability of eating of self-care patients with upper extremity dyskinesia: Rotating eating spoon improves eating ability.

OBJECTIVE: This study aims to develop an assistive technology-180° rotating feeding spoon that could improve the ability of eating of self-care patients with upper extremity dyskinesia. METHODS: The Brunnstrom 6-stage rating of hemiplegia was adopted. During the different recovery stages of the upper limbs, the patients orally ate using a feeding spoon with a non-rotatory head and a 180° rotating feeding spoon. The ability of these patients to eat by themselves was observed, and the basic activity of daily living (BADL) was assessed using the Barthel index (BI). RESULTS: The Brunnstrom assessment scale was used to analyze the results of the patient's upper limb function examination, and the results revealed that the 180° rotating feeding spoon could assist patients with different degrees of upper limb dysfunction when eating independently. CONCLUSIONS: The 180° rotating feeding spoon can assist patients with upper limb dysfunction when eating independently. For patients with different degrees of upper limb dysfunction, the spoon can provide different degrees of aid.

Categorisation of goals set using Goal Attainment Scaling for treatment of leg spasticity: a multicentre analysis.

Background: Goal-classification of person-centred goals, using Goal Attainment Scaling for leg spasticity treatment. Methods: The study was conducted in two phases: phase I, a retrospective review to evaluate categories of goal set in routine clinical practice. Findings were used to design a goal classification system. Phase II, a multi-centre study to confirm the goal categories. Goals set (n = 270) were analysed from data collected at three centres in the UK (one centre for phase I). Goal categories were mapped onto the domains of the World Health Organisation, International Classification of Functioning Disability and Health. Results: One hundred and twenty seven participants were recruited in two cohorts: phase I: 63; phase II: 64. Goal categories using both cohorts were assigned to two domains, each subdivided into three key goal categories: Domain 1: body structure impairment 121 (44%): (a) pain/discomfort 34 (12%), (b) involuntary movements 20 (7%), and (c) range of movement/contracture prevention 67 (25%). Domain 2: activity function 149 (56%): (a) passive function (ease of caring for the affected limb) n = 89 (33%), (b) active function (transfers) 26 (10%), and (c) active function (mobility) 27 (10%), other n = 7 (3%). Conclusions: Patients individual leg spasticity goals can be grouped into six categories and two domains, which will assist clinicians, patients and cares in setting and evaluating goals in practice. Implications for Rehabilitation Six goal areas used in clinical goal setting for leg spasticity management were identified, under the two domains: (1) body structure impairment: pain, involuntary movements, and range of movement and (2) activities/function: passive function (ease of caring), active function - transfers or standing and active function - mobility. Categorisation of goals is consistent on repeated evaluation and across different clinical services. Using clinical goals for leg spasticity treatment is an effective method to identify treatment priorities.

[Clinical effects of high frequency repeated transcranial magnetic stimulation therapy on dyskinesia in patients with incomplete spinal cord injury:a Meta-analysis].

OBJECTIVE: To systematically evaluate the clinical effect of high frequency repeated transcranial magnetic stimulation(HF rTMS)therapy on dyskinesia in patients with incomplete spinal cord injury. METHODS: Randomized controlled trials(RCTs) about HF rTMS therapy on patients with motor incomplete spinal cord injury were searched electronically in PubMed, Google scholar, Cochrane library, Clinical trial, Medline, Web of science, CNKI, VIP, and Wanfang database before October 2016. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, as well as extracted the data and assessed the methodological quality. The observed outcomes included ASIA motor score, ASIA lower extremities motor score(LEMS), Modified Ashworth score (MAS), Ten-meter walking test (10MWT) and Walking index for SCI II(WISCI II), and the outcomes were analyzed using RevMan5.2 software provided by the Cochrane information management system. RESULTS: Five RCTs involved 103 patients were included, and 61 patients(experimental group) accepted real rTMS and physical rehabilitation care for SCI, 51 patients(control group) accepted only physical rehabilitation care. There were significant differences in ASIA motor score, LEMS and 10MWT between two groups after HF rTMS therapy (statistics were Z=2.96, P=0.003; Z=3.04, P=0.002; Z=2.16, P=0.03; respectively). When stimulating the leg motor cortex, there was significant difference in MAS between two groups(Z=2.79, P=0.005), and when stimulating the vertex, there was no significant difference(Z=0.09, P=0.93). There was no significant difference in WISCI IIscore after HF rTMS therapy between two groups(Z=0.90, P=0.37). CONCLUSIONS: HF rTMS can raise motor score in patients with incomplete spinal cord injury, improve the spasticity of the lower extremities, and increase the motor ability.

A Model to Estimate the Optimal Layout for Assistive Communication Touchscreen Devices in Children With Dyskinetic Cerebral Palsy.

Excess involuntary movements and slowness of movement in children with dyskinetic cerebral palsy often result in the inability to properly interact with augmentative and alternative communication (AAC) devices. This significantly limits communication. It is, therefore, essential to know how to adjust the device layout in order to maximize each child's rate of communication. The aim of this paper was to develop a mathematical model to estimate the information rate in children with dyskinetic cerebral palsy and to determine the optimal AAC layout for a touchscreen tablet that results in enhanced speed of communication. The model predicts information rate based on button size, number, spacing between buttons, and the probability of making an error or missing target buttons. Estimation of the information rate confirmed our hypothesis of lower channel capacity in children with dyskinetic cerebral palsy compared with age-matched healthy children. Information rate increased when the AAC layout was customized based on the optimal parameters predicted by the model. In conclusion, this paper quantifies the effect of motor impairments on communication with assistive communication devices and shows that communication performance can be improved by optimally matching the parameters of the AAC touchscreen device to the abilities of the child.

Jaw Exercise Therapy and Psychoeducation to Reduce Oral Parafunctional Activities for the Management of Persistent Dentoalveolar Pain.

Objective: To retrospectively analyze the effects of our original combination therapy treatment on patients with nonodontogenic persistent dentoalveolar pain. Methods: Twenty-one patients suffering from persistent dentoalveolar pain (nineteen females and two males; mean age ± standard deviation: 55.7 ± 19.6 years) participated in this study. They were treated with a therapy combination of jaw exercise and psychoeducation to reduce oral parafunctional activities every month. The intensity of pain in these subjects was evaluated using a numerical rating scale (NRS) before and after treatment. Results: The NRSs at the baseline ranged from 5 to 10 (median, 8), from 0 to 10 (median, 2) at one month after treatment, from 0 to 10 (median, 1) at three months after treatment, and from 0 to 10 (median, 0) at the end of treatment. Pain intensity after treatment improved significantly. Conclusion: There was a significant reduction in pain after our combination of therapies as nonpharmacological treatments, and therefore this treatment could be useful in the management of NPDP patients.

Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study.

OBJECTIVE: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention. METHODS: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities. RESULTS: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high. DISCUSSION: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Mirror therapy for involuntary movement due to chronic thalamic hemorrhage: a case report.

BACKGROUND: Some stroke survivors suffer from involuntary movement, which often disturbs upper-limb function, but there are few effective modality options. CASE REPORT: A 70-year-old man presented with persisting right-upper-limb hemiballism due to left thalamic hemorrhage ten years before. We provided inpatient rehabilitation, including repetitive-facilitative exercise and task-related training, and prescribed clonazepam from day 5 after admission. However, the affected upper limb showed no significant change and remained nonfunctional. When we introduced mirror therapy (MT) to the rehabilitation program on day 14, hemiballism immediately decreased during the MT session, so we added daily MT sessions of 20 min/day. At discharge on day 42, he was able to use his right hand for eating meals and folding laundry. CLINICAL REHABILITATION IMPACT: This shows that MT may have the potential to be a novel therapeutic method for treating involuntary movement. Further research is needed to elucidate mechanisms by which MT may reduce hemiballism.