Psychometric evaluation of a motor control test battery of the craniofacial region.

The primary objective of this study was to determine the structural and known-group validity as well as the inter-rater reliability of a test battery to evaluate the motor control of the craniofacial region. Seventy volunteers without TMD and 25 subjects with TMD (Axes I) per the DC/TMD were asked to execute a test battery consisting of eight tests. The tests were video-taped in the same sequence in a standardised manner. Two experienced physical therapists participated in this study as blinded assessors. We used exploratory factor analysis to identify the underlying component structure of the eight tests. Internal consistency (Cronbach's α), inter-rater reliability (intra-class correlation coefficient) and construct validity (ie, hypothesis testing-known-group validity) (receiver operating curves) were also explored for the test battery. The structural validity showed the presence of one factor underlying the construct of the test battery. The internal consistency was excellent (0.90) as well as the inter-rater reliability. All values of reliability were close to 0.9 or above indicating very high inter-rater reliability. The area under the curve (AUC) was 0.93 for rater 1 and 0.94 for rater two, respectively, indicating excellent discrimination between subjects with TMD and healthy controls. The results of the present study support the psychometric properties of test battery to measure motor control of the craniofacial region when evaluated through videotaping. This test battery could be used to differentiate between healthy subjects and subjects with musculoskeletal impairments in the cervical and oro-facial regions. In addition, this test battery could be used to assess the effectiveness of management strategies in the craniofacial region.

[Is kinesiophobia associated with changes in left/right judgment and emotion recognition during a persisting pain condition? : A cross-sectional study]. / Ist Kinesiophobie während eines anhaltenden Schmerzzustands mit Lateralitäts- und Emotionserkennungsveränderungen assoziiert? : Eine Querschnittstudie.

BACKGROUND: The aim of this study is to investigate the effects of kinesiophobia on emotion recognition and left/right judgement. MATERIALS AND METHODS: A total of 67 patients with chronic musculoskeletal pain were tested. In all, 24 patients achieved a score >37 on the Tampa Scale of Kinesiophobia and were included in the study. The ability to recognize basic emotions coded through facial expression was assessed using the Facially Expressed Emotion Labeling (FEEL) test. Left/right judgement was evaluated using a special Face-mirroring Assessment and Treatment program. The Toronto Alexithymia Scale-26 (TAS-26) was used to assess if the patients showed signs of alexithymia. RESULTS: The FEEL score of patients with kinesiophobia was significantly lower (p = 0.019). The recognition of the basic emotions fear (p = 0.026), anger (p = 0.027), and surprise (p = 0.014) showed significant differences in comparison to unaffected subjects. The basic emotion surprise was recognized more often by patients with kinesiophobia (p = 0.014). Only Scale 1 of the TAS-26 (identification problems of emotions) showed a significant difference between patients with kinesiophobia (p = 0.008) and healthy subjects. CONCLUSION: The results show that kinesiophobic patients have altered recognition of emotions, problems in left/right judgement, and show signs of alexithymia.

[Manual trigger point therapy of shoulder pain : Randomized controlled study of effectiveness]. / Manuelle Triggerpunkttherapie bei Schulterschmerzen : Randomisierte, kontrollierte Studie der Wirksamkeit.

BACKGROUND: Although chronic shoulder pain is highly prevalent and myofascial trigger points (mTrP) are thought to be found in the majority of patients with shoulder complaints, the influence on the pain mechanism remains unclear. There are only very few controlled clinical studies on the effects of manual trigger point compression therapy. OBJECTIVE: This randomized controlled trial (RCT) compared the short-term effects of manual trigger point compression therapy (n = 6) with manual sham therapy (n = 6) in patients with unilateral shoulder pain due to myofascial syndrome (MFS). MATERIAL AND METHODS: The measurement data were collected before and after two sessions of therapy. Pressure pain thresholds (PPT) of mTrP and symmetrically located points on the asymptomatic side were measured together with neutral points in order to detect a potential unilateral or generalized hyperalgesia. Additionally, the pain was assessed on a visual analog scale (VAS) at rest and during movement and the neck disability index (NDI) and disabilities of the arm, shoulder and hand (DASH) questionnaires were also completed and evaluated. RESULTS: Both treatment modalities led to a significant improvement; however, the manual trigger point compression therapy was significantly more effective in comparison to sham therapy, as measured by different parameters. CONCLUSION: The significant improvement of PPT values in the interventional group even at sites that were not directly treated, indicates central mechanisms in pain threshold modulation induced by manual compression therapy. The weaker but still measurable effects of sham therapy might be explained by the sham modality being a hands on technique or by sufficient stimulation of the trigger point region during the diagnostics and PPT measurements.

International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study.

BACKGROUND: A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. OBJECTIVES: To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. DESIGN/METHODS: Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. RESULTS: Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. CONCLUSIONS: Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.

[Emotion Recognition in Patients with Peripheral Facial Paralysis - A Pilot Study]. / Fähigkeit von Patienten mit einer peripheren Fazialisparese zur Erkennung von Emotionen - Eine Pilotstudie.

BACKGROUND: The perception of emotions is an important component in enabling human beings to social interaction in everyday life. Thus, the ability to recognize the emotions of the other one's mime is a key prerequisite for this. OBJECTIVE: The following study aimed at evaluating the ability of subjects with 'peripheral facial paresis' to perceive emotions in healthy individuals. METHODS: A pilot study was conducted in which 13 people with 'peripheral facial paresis' participated. This assessment included the 'Facially Expressed Emotion Labeling-Test' (FEEL-Test), the 'Facial-Laterality-Recognition Test' (FLR-Test) and the 'Toronto-Alexithymie-Scale 26' (TAS 26). The results were compared with data of healthy people from other studies. RESULTS: In contrast to healthy patients, the subjects with 'facial paresis' show more difficulties in recognizing basic emotions; however the results are not significant. The participants show a significant lower level of speed (right/left: p<0.001) concerning the perception of facial laterality compared to healthy people. With regard to the alexithymia, the tested group reveals significantly higher results (p<0.001) compared to the unimpaired people. CONCLUSIONS: The present pilot study does not prove any impact on this specific patient group's ability to recognize emotions and facial laterality. For future studies the research question should be verified in a larger sample size.

[Effects of Reactive Jump Training in Handball Players Regarding Jump Height and Power Development in the Triceps Surae Muscle]. / Trainingseffekte eines reaktiven Sprungkrafttrainings bei Handballern in Bezug auf die Sprunghöhe und die Kraftentfaltung des Musculus triceps surae.

BACKGROUND: Studies have shown changes in the technical and physical demands in modern handball. The game has increased considerably in speed, power and dynamics. Jump training has, therefore, become ever more important in the training of the athletes. These developments contribute to the fact that handball is now one of the most injury-prone types of sport, with the lower extremities being most frequently affected. Reactive jump training is not only used in training by now, but also increasingly in injury prevention. The aim of this study was to investigate the effectiveness of reactive jump training with handball players. MATERIAL AND METHODS: 21 regional league handball players were randomly divided into an intervention group (n = 12) and a control group (n = 9). The intervention group completed a six-week reactive jump training programme while the control group went through a non-specific training programme. Jump height (squat and counter movement jump), isokinetic and isometric maximum power as well as muscle activity served as measuring parameters. RESULTS: A comparison of the intervention and control groups revealed that the reactive jump training led to significant improvements in jump height. The isometric and isokinetic maximum power measurements and the electromyographic activities of the triceps surae muscle demonstrated an improvement in the values within the intervention group. However, this improvement was not significant compared with the control group. Likewise both jumps correlated with the muscle activity of the soleus muscle as shown by electromyography. A moderate correlation was noticed between the isokinetic maximum power measurement and the electromyographic activity of the soleus and gastrocnemius medialis muscles. Furthermore, the correlations of the isometric and isokinetic maximum power meas-urements resulted in a strong correlation coefficient. CONCLUSION: This study revealed a significant increase in jump height after reactive jump training. There was no significant difference in power development between the two groups. However, we were able to demonstrate correlations which would make it seem reasonable and interesting to investigate the question more closely. An interesting field of research could be the question of the effectiveness of reactive jump training in the areas of rehabilitation and injury prevention.

People with chronic facial pain perform worse than controls at a facial emotion recognition task, but it is not all about the emotion.

Alexithymia, or a lack of emotional awareness, is prevalent in some chronic pain conditions and has been linked to poor recognition of others' emotions. Recognising others' emotions from their facial expression involves both emotional and motor processing, but the possible contribution of motor disruption has not been considered. It is possible that poor performance on emotional recognition tasks could reflect problems with emotional processing, motor processing or both. We hypothesised that people with chronic facial pain would be less accurate in recognising others' emotions from facial expressions, would be less accurate in a motor imagery task involving the face, and that performance on both tasks would be positively related. A convenience sample of 19 people (15 females) with chronic facial pain and 19 gender-matched controls participated. They undertook two tasks; in the first task, they identified the facial emotion presented in a photograph. In the second, they identified whether the person in the image had a facial feature pointed towards their left or right side, a well-recognised paradigm to induce implicit motor imagery. People with chronic facial pain performed worse than controls at both tasks (Facially Expressed Emotion Labelling (FEEL) task P < 0·001; left/right judgment task P < 0·001). Participants who were more accurate at one task were also more accurate at the other, regardless of group (P < 0·001, r(2)  = 0·523). Participants with chronic facial pain were worse than controls at both the FEEL emotion recognition task and the left/right facial expression task and performance covaried within participants. We propose that disrupted motor processing may underpin or at least contribute to the difficulty that facial pain patients have in emotion recognition and that further research that tests this proposal is warranted.

[Changes in basic emotion recognition in patients with chronic low back pain. A cross-sectional study analyzing emotion recognition and alexithymia]. / Einschränkungen in der Erkennung von Basisemotionen bei Patienten mit chronischem Kreuzschmerz. Eine Querschnittstudie zur Analyse von Emotionserkennung und Alexithymie.

BACKGROUND: Persistent chronic pain leads to cortical changes in areas involved in the recognition of emotions. Wand et al. suggest a close correlation between the affective pain component and the extent to which these changes occur. As a consequence, the emotion profile may be influenced and difficulties in emotional communication may arise. MATERIALS AND METHODS: A total of 49 patients with chronic low back pain (CLBP) were classified as grade 1 + 2 or 3 + 4 using the Graded Chronic Pain Scale (GCPS) questionnaire. In all patients, the ability to recognize basic emotions coded through facial expression was assessed using the Facially Expressed Emotion Labeling (FEEL) test. Furthermore, the Toronto Alexithymia Scale-26 (TAS-26) was used to assess if the patients showed signs of alexithymia. Data of the GCPS grade 3 + 4 (n = 35) group were analyzed. RESULTS: Findings of the FEEL test indicate that the GCPS grade 3 + 4 group recognized the basic emotion 'surprise' significantly more often (p = 0.001) and showed a higher level of currently perceived anger than unaffected subjects. The TAS-26 showed that 28.5 % of the patients with CLBP were alexithym. CONCLUSION: The results suggest changes in the recognition of emotions and that patients with CLBP show signs of alexithymia. Further studies with larger sample sizes are required to confirm the detected trends.

[The sural nerve as a contributing factor in chronic achillodynia - an explorative ultrasound study]. / Der N. suralis als beitragender Faktor für eine chronische Achillodynie - eine explorative Sonografie-Studie.

BACKGROUND AND AIM: Achillodynia is often seen as a sign of repetitive strain of dorsal tissue of the calf. A neurogene component is also considered for this disease pattern. This association haven`t been investigated yet. The major goal of this study was the investigation of the dynamics of the sural nerve by ultrasonography with regard to movements of ankle, knee and hip. This concerns the physiological situation and pathological aspects of achillodynia. SUBJECTS/METHOD: In this cross sectional study without a blinding-assay 29 sural nerves of 15 healthy subjects (group A) and 6 sural nerves of 3 subjects with pain or dysaesthesia at the achilles tendon or the lateral foot (group B) have been investigated by diagnostic ultrasonography. RESULTS: The sural nerve has an average size of 3.7 mm (2) (± 0.05 mm (2)) for healthy subjects and 4.1 mm (2) (± 0.1 mm (2)) for those with achillodynia. The lateral (Mlat = 3.89 mm) and anterio-posterior (Map = 0.56 mm) movement of the sural nerve has a statistic significantly greater extent by the whole range of motion of dorsalflexion and plantarflexion than by flexion and extension of the kneejoint (Mlat: p = 0.008; Map: p = 0.0115) or by abduction and adduction of the hipjoint (Mlat: p = 0.0025; Map: p = 0.002) for group A. Within this study, no statistic significant differences between both groups could be observed regarding the dynamics and concerning the size of the sural nerve.