RESUMEN
An elongated styloid process is an anatomic anomaly present in 2% to 30% of adults; it is occasionally associated with pain. Its prevalence among patients with classic temporomandibular disorder pain symptoms is unknown. The effect of conservative treatment on patients who have symptoms of temporomandibular disorders and an elongated styloid process is also unknown. The objectives of this study were to determine the prevalence of the elongated styloid process in a sample of patients with temporomandibular disorders and to compare patients with and without the elongated styloid process on initial presenting signs and symptoms and treatment outcome. A total of 100 panoramic radiographs of patients with symptomatic temporomandibular disorders were examined to ascertain the presence or absence of an elongated styloid process. All patients participated in a conservative treatment program of biofeedback and stress management and a flat-plane intraoral appliance. Initial symptoms and treatment outcome of patients with and without an elongated styloid process were compared by use of multivariate analysis of variance on several oral-paraoral and psychosocial-behavioral methods. The prevalence of an elongated styloid process in this clinic sample of temporomandibular disorders was 27%. The patients with or without an elongated styloid process were not significantly different in pretreatment symptoms, and both groups exhibited substantial treatment gains. However, patients with an elongated styloid process showed significantly less improvement on unassisted mandibular opening without pain than did patients who did not have an elongated styloid process. This suggests that an elongated styloid process may place structural limitations on pain-free maximum mandibular opening. The results support conservative management of patients with symptoms of temporomandibular disorders when an elongated styloid process is present.
Asunto(s)
Hueso Temporal/anomalías , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/terapia , Adolescente , Adulto , Biorretroalimentación Psicológica , Dolor Facial/etiología , Humanos , Ligamentos Articulares/anomalías , Masculino , Persona de Mediana Edad , Análisis Multivariante , Músculos del Cuello/fisiopatología , Ferulas Oclusales , Dimensión del Dolor , Inventario de Personalidad , Radiografía Panorámica , Rango del Movimiento Articular , Terapia por Relajación , Estudios Retrospectivos , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Forty-eight dysfunctional patients (i.e., high levels of pain, interference, and affective distress and low levels of perceived control) with temporomandibular disorders (TMDs) were randomly assigned either to a treatment consisting of an intraoral appliance (IA) and stress management with biofeedback (SM) plus nondirective, supportive counseling (SC) -- IA + SM + SC -- or to a customized treatment that included cognitive therapy (CT) with the IA and SM--IA + SM + CT. Both treatment groups reported statistically significant reductions on a set of physical, psychosocial, and behavioral measures posttreatment and at a 6-month follow-up. However, the intervention that included CT demonstrated significantly greater reductions in pain, depression, and medication use. Only the groups receiving the treatment that included the CT demonstrated continued improvements to the follow-up on pain associated with muscle palpation, self-reported pain severity, depression, and use of medications. These results support the efficacy of the tailored treatment for dysfunctional TMD.
Asunto(s)
Biorretroalimentación Psicológica , Terapia Cognitivo-Conductual , Aparatos Ortodóncicos , Psicoterapia Centrada en la Persona , Síndrome de la Disfunción de Articulación Temporomandibular/terapia , Adulto , Terapia Combinada , Depresión/psicología , Depresión/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de la Disfunción de Articulación Temporomandibular/psicología , Resultado del TratamientoRESUMEN
STUDY DESIGN: This study evaluated performance differences between patients with chronic low back pain and a control group during their performance of a novel functional capacity task. OBJECTIVE: To 1) evaluated strength and endurance differences between patients and control subjects, 2) test for movement pattern differences between these groups, and 3) evaluate how these patterns changed with repetitive performance of the wheel-turning task. SUMMARY OF BACKGROUND DATA: Despite increased emphasis on quantifying functional capacities, few well-controlled studies comparing the performances of patients with low back pain with those of control subjects have appeared in the literature, particularly for movement patterns. METHODS: Forty patients with low back pain and 40 control subjects performed a sustained isodynamic wheel turning task. This task was selected because it simultaneously combined several common pain-related movements. A set of kinematic measures to characterize the basic movement patterns during this task were developed. RESULTS: Control subjects produced significantly higher levels of static torque and completed significantly more wheel-turning repetitions. Patients with low back pain exhibited significantly less upper torso and pelvic motion, upper torso rotation, and lateral trunk flexion than those in the control group. CONCLUSION: The dissimilar movement strategies found between the patient and control groups suggests that factors beyond more global physical explanations (e.g., deconditioning) may be important in accounting for the large discrepancy between these groups regarding the amount of work performed. These findings, along with the basic kinematic patterns developed in this study, may have important implications for determining the efficacy of instruction in body mechanics and treatment outcome for patients with chronic low back pain.
Asunto(s)
Dolor de la Región Lumbar/fisiopatología , Movimiento/fisiología , Adulto , Análisis de Varianza , Fenómenos Biomecánicos , Condicionamiento Psicológico/fisiología , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Análisis por Apareamiento , Matemática , Análisis Multivariante , Contracción Muscular/fisiología , Pelvis/fisiología , Rotación , Columna Vertebral/fisiología , Columna Vertebral/fisiopatología , Grabación en VideoRESUMEN
Jefferson Evening Program (JEP) is an evening partial hospital in operation for 14 years treating higher-functioning adults. This paper describes the benefits and problems in engaging and treating a broad population mix in a partial hospital and programmatic solutions to these clinical challenges.