Mirror visual feedback as therapeutic modality in unilateral upper extremity complex regional pain syndrome type I: randomized controlled trial.

BACKGROUND: There is growing evidence for the effectiveness of mirror therapy (MT) on pain reduction in patients with type I complex regional pain syndrome (CRPS I). AIM: To evaluate the efficacy of MT on pain reduction and hand function in subjects with unilateral upper extremity CRPS I. DESIGN: Randomized controlled trial with control group cross-over (half cross-over design). SETTING: Subjects with CRPS I were outpatients of a university hospital and cooperating centers. All patients carried out the daily exercise at home. POPULATION: Subjects with unilateral upper extremity CRPS I meeting the Budapest diagnostic criteria. METHODS: Subjects were randomly divided into two groups. Group A (N.=13) carried out a ten-minute MT exercise daily, for a total duration of six weeks. Group B (N.=14) acted as a control group for six weeks followed by six weeks of MT with the same characteristics as Group A. Upper extremity active range of motion, strength, dexterity, limb volume, affected-to-unaffected hand temperature difference, and health-related quality of life were evaluated before and after each period. Daily records on the visual analogue scale were used for pain evaluation. Effectiveness was calculated using mixed-effects modelling for between-group comparisons and within-group variability, and identification of significant predictors. RESULTS: Twenty-three females and four males with an average age of 56.1±9.6 years completed the study. Except for the affected-to-unaffected hand temperature difference, both groups consistently demonstrated significant or near-significant improvements in measured parameters after MT period. The improvements were evident upon an intergroup comparison of Group A and the control period of Group B as well as longitudinally within Group B. No significant improvement was found during the control period. CONCLUSIONS: Principles focused on mirror visual feedback to the central nervous system can sustain promising therapeutic potential as part of the treatment for pain reduction and hand function in CRPS I patients. CLINICAL REHABILITATION IMPACT: MT can be considered as part of the therapeutic regimen employed for the treatment of CRPS I.

The Prevalence and Development of Neck and Lower Back Pain and Associated Factors in Dentistry Students-A Long-Term Prospective Study.

Musculoskeletal disorders (MSDs) represent a significant occupational burden for dentists and dentistry students. This study aimed to assess the five-year development of most common musculoskeletal complaints among dentistry students during the whole length of their studies and to analyze the impact of some potentially associated risk factors. A longitudinal questionnaire survey regarding the occurrence of MSDs was conducted among a total of 73 dentistry students between 2014 and 2021. The same students enrolled in three consecutive years were monitored throughout their entire studies. Statistical analysis was performed using methods of descriptive statistics, Chi-square test, Fisher's exact test, McNemar test, and univariate and multivariate logistic regression analyses. The most frequent areas of complaints were neck (61.6%) and lower back (49.3%). The increase in self-reported complaints between the first and the fifth year was statistically significant for neck pain (increase by 15%, p = 0.043) but not for lower back pain (by 6.8%, p = 0.44). According to our data, age, performing top-level sport, and participating in regular sporting activities had a statistically significant influence on neck and/or back pain. The results of this longitudinal prospective study showed that neck, as well as lower back pain, are significant problems for dentistry students.

The Development of Musculoskeletal Disorders during Undergraduate Dentistry Studies-A Long-Term Prospective Study.

Musculoskeletal disorders (MSDs) frequently occur among dental practitioners and present a significant occupational burden with an early onset in the dentists' career. This study aimed to analyze the five-year development of self-reported overall MSDs among the dentistry students during the course of their studies and to assess the possible influence of the risk as well as protective factors. The questionnaire inquiry was performed among the first-year dentistry students, regarding the occurrence of MSDs and the presence of potential risk and protective factors. The same students were followed, and they filled in the same questionnaire in the middle and at the end of their studies. A total of 73 dentistry students and 28 general medicine students participated. The occurrence of the overall MSDs statistically significantly increased from 30.1% at the beginning of the first year to 45.2% at the end of the fifth year among the dentistry students. The top-level sport was statistically significantly associated with the higher occurrence of MSDs in the fifth year and with the development of new MSDs between the first and the fifth year. This longitudinal prospective evaluation showed a significant increase in the MSDs occurrence among the dentistry students during their studies.

Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment.

Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches-in situ decompression and anterior transpositions.

Prevalence of Musculoskeletal Disorders Symptoms Among Czech Dental Students. Part 2: The Predictive Value of Digital Assessment.

This article is the second part of an evaluation of musculoskeletal disorders (MSDs) prevalence among dental students. As the majority of complaints are in the back region, there is an endeavor to analyze objectively the disorders in this region. One of the non-invasive and non-radiation methods is the spinal curve mapping using the Spinal Mouse® device (Idiag AG, Fehraltorf, Switzerland). The aim of this study was to determine a correlation between subjectively described complaints and the results of an objective examination of the spine using the Spinal Mouse® device. Information about the participants is given in the first part of the article. All the participants were examined with the Spinal Mouse® device in several body positions. Further, the Matthiass test was performed to evaluate neuromuscular stabilization of the axial skeleton in static conditions. Musculoskeletal pain occurred more often in students who had a higher range of motion (ROM) and had worse static stabilization of spine. Other assessed factors or measured parameters did not have any influence on musculoskeletal pain. Some of the parameters measured with the Spinal Mouse® device showed a correlation with the prevalence of musculoskeletal.

Positioning Techniques to Improve the Ultrasound Evaluation of the Elbow.

We introduce an ergonomic positioning for sonographic scanning of elbow joint where the patient is lying semisupine on the examination bed. This is in contrast with the conventional positioning where the patient is sitting on the edge of the bed or across the table on a chair. Our proposed positioning is more comfortable for both the patient and ultrasound practitioner. It also allows immediate ultrasound-guided injections with lesser risk regarding a vasovagal syncope of the patient.

Prevalence of Musculoskeletal Disorders Symptoms among Czech Dental Students. Part 1: a Questionnaire Survey.

Musculoskeletal disorders (MSDs) frequently occur among dentists and dental students. The first aim of this study was to gather and analyze information about the prevalence of symptoms of MSDs. The second aim was to determine a correlation between subjectively described complaints and the results of an objective examination of the spine using the Spinal Mouse® device; that part is described in the second section of this article. Dental students of the first, third and fifth years at Charles University, Faculty of Medicine in Hradec Králové were included. The participants filled out a questionnaire regarding the prevalence of symptoms of MSDs and the potential risk factors. From a total of 182 students that participated in this study, 71 reported musculoskeletal pain (prevalence 39%). The musculoskeletal pain was more frequent among women. During the studies its prevalence increased. The most frequent areas of pain were neck, lower back and upper back. The results indicate that musculoskeletal pain often begins and continues to develop throughout the dentistry studies.

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury.

CONTEXT/OBJECTIVE: Traumatic damage to the cervical spinal cord is usually associated with a disruption of the autonomic nervous system (ANS) and impaired cardiovascular control both during and following exercise. The magnitude of the cardiovascular dysfunction remains unclear. The aim of the current study was to compare cardiovascular responses to peak voluntary exercise in individuals with tetraplegia and able-bodied participants. DESIGN: A case-control study. SUBJECTS: Twenty males with cervical spinal cord injury (SCI) as the Tetra group and 27 able-bodied males as the Control group were included in the study. OUTCOME MEASURES: Blood pressure (BP) response one minute after the peak exercise, peak heart rate (HRpeak), and peak oxygen consumption (VO2peak) on an arm crank ergometer were measured. In the second part of the study, 17 individuals of the Control group completed the Tetra group's workload protocol with the same parameters recorded. RESULTS: There was no increase in BP in response to the exercise in the Tetra group. Able-bodied individuals exhibited significantly increased post-exercise systolic BP after the maximal graded exercise test (123±16%) and after completion of the Tetra group's workload protocol (114±11%) as compared to pre-exercise. The Tetra group VO2peak was 59% and the HRpeak was 73% of the Control group VO2peak and HRpeak, respectively. CONCLUSIONS: BP did not increase following maximal arm crank exercise in males with a cervical SCI unlike the increases observed in the Control group. Some males in the Tetra group appeared to be at risk of severe hypotension following high intensity exercise, which can limit the ability to progressive increase and maintain high intensity exercise.

Validation of physical activity monitors in individuals with diabetes: energy expenditure estimation by the multisensor SenseWear Armband Pro3 and the step counter Omron HJ-720 against indirect calorimetry during walking.

BACKGROUND: The purpose of this study is to test the agreement between energy expenditure estimate of the SenseWear(®) Armband Pro3 (SWA) (BodyMedia, Pittsburgh, PA) and the Omron HJ-720 (Omron Healthcare, Kyoto, Japan) step counter with indirect calorimetry (IC) as a gold standard in older individuals with type 1 and type 2 diabetes mellitus while walking on a treadmill. SUBJECTS AND METHODS: In total, six men (60.3±3.1 years old) and 13 women (51.1±11.0 years old) with type 1 or type 2 diabetes mellitus were included in the study. Each subject performed three 15-min walking sessions with different combinations of speed and incline (3 km/h, 0%; 4 km/h, 0%; 5 km/h, 5%) on a treadmill. Energy expenditure (EE) was simultaneously measured by the SWA, Omron, and IC. Mean over-/underestimation and Pearson's correlation coefficients were used for statistical evaluation of the agreement between tested methods and IC. RESULTS: At the speed of 3 km/h with 0% incline, mean overestimation of +81.19±23.81% was found for SWA (r=0.79, P<0.001) and +70.51±20.91% for Omron (r=0.77, P<0.001). At the speed of 4 km/h and 0% incline, mean overestimation found for SWA was +78.18±33.96% (r=0.63, P<0.01) and +75.77±33.36% for Omron (r=0.52, P<0.05). At the level of high-intensity exercise at the speed of 5 km/h and 5% incline, mean underestimation was -7.88±16.86% for SWA (r=0.74, P<0.001) and -7.37±16.07% for Omron (r=0.75, P<0.001). CONCLUSIONS: Both methods led to considerable overestimation of calculated EE in level walking and a relatively minor underestimation during fast uphill walking.