Pediatric aquatic therapy on motor function and enjoyment in children diagnosed with cerebral palsy of various motor severities.

This study investigates the effects of pediatric aquatic therapy on motor function, enjoyment, activities of daily living, and health-related quality of life for children with spastic cerebral palsy of various motor severities. Children with spastic cerebral palsy were assigned to a pediatric aquatic therapy group (n = 11; mean age = 85.0 ± 33.1 months; male : female = 4 : 7) or a control group (n = 13; mean age = 87.6 ± 34.0 months; male : female = 9 : 4). The statistic results indicate that the pediatric aquatic therapy group had greater average 66-item Gross Motor Function Measure following intervention than the control group (η(2) = 0.308, P = .007), even for children with Gross Motor Function Classification System level IV (5.0 vs 1.3). The pediatric aquatic therapy group had higher Physical Activity Enjoyment Scale scores than the control group at post-treatment (P = .015). These findings demonstrate that pediatric aquatic therapy can be an effective and alternative therapy for children with cerebral palsy even with poor Gross Motor Function Classification System level.

Massage-induced brachial plexus injury.

BACKGROUND AND PURPOSE: There are few reports in the literature of adverse effects resulting from massage therapy (MT) and no reports of brachial plexus injury (BPI) associated with MT. This case report describes an uncommon case of BPI that developed after a session of MT and reviews previously published reports of peripheral nerve injury following MT. CASE DESCRIPTION: A 58-year-old Asian woman developed sudden unilateral paralysis of her left shoulder girdle after a session of MT. A diagnosis of acute BPI was suspected due to her recent history and the results of several examinations. The results of electrodiagnostic studies indicated a possible location for the lesion and ultimately led to a different diagnosis. OUTCOMES: The patient regularly participated in a twice-weekly rehabilitation program targeting the left shoulder. The rehabilitation program included supervised passive range of motion, strengthening, and stretching exercises as well as a home exercise program. A 12-month follow-up showed the patient had achieved gradual recovery of shoulder strength, resolution of limitations of range of motion, and relief of shoulder pain. DISCUSSION: This is believed to be the first report of BPI associated with MT. This case report serves as a reminder to massage therapists and physical therapists that MT of the neck should be carefully performed to avoid injury. Further studies will help design safer and more effective MT for the future.

The therapeutic effect of collateral meridian therapy is comparable to acupoint pressure therapy in treating myofascial pain syndrome.

PURPOSE: This study compared the therapeutic effects of collateral meridian therapy (CMT) with traditional acupoint pressure therapy (APT) in patients with unilateral upper back pain. MATERIAL AND METHODS: Forty-nine patients with active myofascial trigger points in upper trapezius muscle were randomly allocated to the control (CTL), APT, or CMT group. Each subject in the CMT and APT groups received 2 sessions of treatment per week over 1 month. RESULTS: Patients in the APT and CMT groups showed significant improvements 1 month after treatment in visual analogue scale, range of motion, pain pressure threshold, regional superficial blood flow, and physical health, as compared to the CTL group. No significant differences in outcome measures were found between APT and CMT groups 1 month after treatment. CONCLUSION: Both APT and CMT have comparable therapeutic efficacy in the treatment of unilateral upper back pain with active myofascial trigger points in the upper trapezius muscle.

Cervical cord injury after massage.

We present the case of a 47-yr-old gentleman with cervical cord injury after he received massage in the neck area. Magnetic resonance imaging of the cervical spine showed a herniation of the nucleus pulposus and compressive myelopathy. The patient required surgical intervention and rehabilitation. Despite 6 mos of rehabilitation, residual hand dysfunction and minor ambulation problems persisted. Although massage has many benefits, this case reminds us that there is potential danger in performing neck massage.

Protective effects of preconditioned local somatothermal stimulation on neuromuscular plasticity against ischemia--reperfusion injury in rats.

The aim of this study was to investigate whether preconditioned local somatotheral stimulation (LSTS) protects the muscle and nerve against ischemia-reperfusion (I/R) injuries. Male rats were randomly assigned to normal, preconditioned LSTS only, and I/R-injured groups with or without LSTS preconditioning. I/R injuries of the lower limb were induced by rubber band wrapping, followed by measurements of gait function and nerve conduction, muscle pathology, serum enzymatic activity, and the expression of heat-shock protein 70 (HSP-70) in the gastrocnemius muscles. No significant change of neuromuscular function was found between LSTS (-) and LSTS (+) groups on the first day after I/R injury. In contrast, gait stride length, compound motor action potential, and serum creatine phosphokinase MM isoenzyme were significantly improved on the eighth day after one or two doses of preconditioned LSTS and subsequent I/R injury. Western blot analysis disclosed no significant change of HSP-70 expression in the muscle of I/R injured limbs between LSTS (-) and LSTS (+) groups. We conclude that preconditioned LSTS is a safe modality that improves the neuromuscular plasticity against I/R injured limbs, which provides a new strategy for I/R injury in clinical applications, such as intraoperative use of tourniquets.

Effects of needle electrical intramuscular stimulation on shoulder and cervical myofascial pain syndrome and microcirculation.

BACKGROUND: To evaluate the effects of needle electrical intramuscular stimulation (NEIMS) on myofascial trigger points (MTrPs) and their epidermal blood flow. METHODS: Forty adult patients with active MTrPs in the upper trapezius or levator scapulae underwent 4 weekly NEIMS sessions. Visual analog scale (VAS) and pain pressure threshold (PPT), along with cervical and shoulder range of motion (ROM) were used as outcome measures. Microcirculatory changes were also evaluated by laser Doppler flowmetry of the epidermal area above these MTrPs. Data were collected before and after each treatment. Paired t tests were used to compare pre- and post-treatment data. Outcomes were presented as box plots displaying medians and 25th to 75th percentile values. RESULTS: VAS and PPT pain significantly improved immediately after each treatment; effects persisted till the end of the experiment. NEIMS treatment also had immediate and mid-term positive effects on cervical and shoulder ROM. There was an overall negative correlation between epidermal blood flow and VAS score before the first treatment. Regional blood flow significantly increased immediately but temporarily after each treatment. CONCLUSION: NEIMS did have positive effects on myofascial pain syndrome, but the data did not indicate that increased regional microcirculation was the possible therapeutic mechanism.

Central modulation of pain evoked from myofascial trigger point.

OBJECTIVES: Low-intensity low-frequency electrostimulation delivered within a myofascial trigger point (MTP) has been used as intervention to deactivate MTPs. The therapeutic effect has been suggested to be due to peripheral mechanisms. However, nonpainful stimuli are also known to reduce simultaneous pain through central effects. The primary objective of the present study was to assess if central pain modulation occurs after intervention with low-intensity electrostimulation within an MTP. We hypothesized that intervention induces pain inhibition via the periaqueductal gray (PAG). METHODS: Twenty-four patients with myofascial pain syndrome participated in the study. During functional magnetic resonance scanning, painful (high-intensity) intramuscular electrostimulation was delivered at random intervals (mean interstimulus interval=10.2 s) within an MTP of the upper left trapezius muscle. In-between scanning sessions, intervention (intramuscular electrostimulation, low-intensity, interstimulus interval=0.5 s) was applied to the same area. Patients were divided into responders and nonresponders according to their change in pressure pain thresholds relative to intervention. In addition to a whole brain search, a region of interest approach was also implemented to test the effect of intervention on PAG signal change. RESULTS: The main findings were: (1) intervention modulated PAG activity to painful stimuli more in responders than in nonresponders, (2) change in PAG activity from the whole patient population correlated with change in pressure pain threshold, and (3) a network known to regulate affective qualities of the pain experience was (subsignificantly) engaged more in responders than in nonresponders. DISCUSSION: The applied intervention most likely involves supraspinal pain control mechanisms related to both antinociception and regulation of pain affect.

Complex regional pain syndrome after transradial cardiac catheterization.

Complex regional pain syndrome (CRPS) is a disease with unclear pathophysiology. The condition is characterized by pain, soft tissue change, vasomotor change, and even psychosocial disturbance. It may affect the upper more than the lower extremities, and the distal more than the proximal. The trigger factors include carpal tunnel release, Dupuytren's repair, tendon release procedures, knee surgery, crush injury, ankle arthrodesis, amputation, and hip arthroplasty. Rarely, it has been associated with stroke, mastectomy, pregnancy, and osteogenesis imperfecta. Herein, we present a rare case of a patient who was diagnosed with CRPS after transradial cardiac catheterization. CRPS was first diagnosed due to hand swelling, allodynia, paresthesia, and the limited range of motion of interphalangeal, metacarpophalangeal, and wrist joints, with the preceding factor of transradial cardiac catheterization, and was then confirmed by a three-phase bone scan. After intensive physical therapy with hydrotherapy, manual soft tissue release, and occupational therapy for the hand function, there was much improvement in range of motion and hand function. There was no allodynia or painful sensation in the follow-up. After training, the functional status of this patient was adequate for daily activity.

Electrical twitch-obtaining intramuscular stimulation in lower back pain: a pilot study.

OBJECTIVES: To determine if electrical twitch-obtaining intramuscular stimulation (ETOIMS) provides greater myofascial lower back pain relief than muscle stimulation or skin stimulation. DESIGN: In this single-blinded, crossover, pilot trial performed at a university-affiliated outpatient rehabilitation medicine department in Taiwan, 12 acupuncture-naive patients with lower back pain of 3-60 mos duration received one crossover treatment every 2 wks by monopolar needle electrode insertion at bilateral T10-S1 levels to: (1) paraspinal muscles, (2) overlying skin, and (3) paraspinal muscles with ETOIMS applied via the needle electrode at individual treatment sites. A total of 30 manual insertions per side per treatment were performed, with withdrawal after 2 secs. Beginning 1 wk before each trial and continuing until 2 wks after, patients completed a visual analog scale twice daily. In addition, on the day of treatment, patients received a physical examination and completed a visual analog scale both before and after treatment. RESULTS: Significant and immediate reduction in the visual analog scale levels was noted only with ETOIMS. Immediate improvement occurred in one of nine physical tests with muscle stimulation and ETOIMS only. In the 2 wks after treatment, absolute visual analog scale levels for ETOIMS were significantly lower than muscle stimulation and skin stimulation. ETOIMS resulted in a greater percentage of pain relief in the first week after treatment, although it was not statistically significant from muscle stimulation and skin stimulation. CONCLUSIONS: ETOIMS provided significantly greater immediate and sustained myofascial lower back pain relief than muscle stimulation and skin stimulation. Although a greater percentage of pain reduction occurred with ETOIMS, it was not statistically significant.

Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study.

OBJECTIVES: To evaluate the therapeutic effect of extracorporeal shock wave therapy (ESWT) in shoulders with chronic calcific tendinitis, to compare the functional outcomes of ESWT and transcutaneous electric nerve stimulation (TENS) therapy, and to investigate which types of calcium deposit effectively respond to ESWT. DESIGN: Randomized controlled trial. SETTING: Outpatient clinics of the departments of physical medicine and rehabilitation and of orthopedics and traumatology of a veterans hospital in Taiwan. PARTICIPANTS: Sixty patients with continuous shoulder pain for 6 months or more and with radiographically and sonographically verified calcific tendinitis. Patients were randomly allocated to receive ESWT (33 shoulders) or TENS treatment (30 shoulders). INTERVENTIONS: ESWT was performed with 2000 shock waves at 2Hz and energy level between.26 and.32mJ/mm(2) per session. Treatment was given in 2 sessions, 14 days apart. TENS therapy was given 3 times a week for 4 weeks. MAIN OUTCOME MEASURES: Mean Constant score, visual analog scale (VAS), manual muscle test, and changes of sonographic size and shape of calcium deposits were calculated for 4 time points: at baseline, 2 weeks, 4 weeks, 12 weeks posttherapy. RESULTS: In both groups, Constant score and VAS improved significantly at 2-, 4-, and 12-week follow-ups (P<.05), and the size of calcium deposits decreased significantly at the 4- and 12-week follow-ups. Moreover, the arc-shaped calcific plaques of the rotator cuff were markedly meliorated with ESWT. CONCLUSIONS: ESWT is more effective in the treatment of chronic calcific tendinitis of the shoulder than is TENS therapy, especially for arc-type calcific plaque.

Effects of functional electric stimulation on upper limb motor function and shoulder range of motion in hemiplegic patients.

OBJECTIVES: The present study examines functional electric stimulation (FES) applied on patients with hemiplegia of short and long duration for the purpose of upper limb motor recovery and increasing shoulder range of motion. DESIGN: Patients with hemiplegia with subluxation participating in the study were placed into a short-duration group or a long-duration group. Subjects in each group were then randomly assigned to either the control or the experimental subgroup. The experimental groups of both short- and long-duration groups received FES therapy in which the supraspinatus and posterior deltoid muscles were induced to contract repetitively up to 6 hr a day for 6 wk. Duration of FES session and muscle contraction/relaxation ratio were progressively increased as performance improved. The experimental groups also received a second 6-wk FES therapy 6 wk after completing the first FES therapy. RESULTS: After the first 6-wk FES therapy, the experimental group of short-duration hemiplegia showed significant improvements in motor recovery as indicated by Fugl-Meyer scores compared with the control group. Such significant improvement did not occur for the experimental group of long-duration hemiplegia. The changes in the second FES treatment program were insignificant. CONCLUSIONS: This study suggests that patients with hemiplegia of short duration are effectively trained by FES for motor recovery.