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Postural disorders disturb muscle activity and lead to joint dysfunction. This study aimed to evaluate the effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome (UCS). Randomized controlled trial. Exercise evaluation was conducted in a laboratory setting. Study recruited 30 healthy males with UCS from university students, who were then randomly divided into the control group (age = 20.14 ± 1.71 years; height = 176.86 ± 4.7 cm; BMI = 21.20 ± 1.96 kg/m2) and the exercise group (age = 21.44 ± 2.06 years; height = 174.2 ± 4.0 cm; BMI = 20.62 ± 3.9 kg/m2). Electromyography activity of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), serratus anterior (SA), and sternocleidomastoid (SCM) was recorded before and after 8-week exercise program. T-test results revealed that baseline activity of SA (P < 0.05), had increased while UT (P < 0.05) and SCM (P < 0.05) activity as well as UT/SA (P < 0.05) and UT/LT (P < 0.05) ratios had decreased. In connection with these finding the effect sizes were large. Eight week corrective exercises balance muscles activity and can be used to manage developing upper quadrant musculoskeletal disorders in person with UCS. •Over active muscle during arm elevation lowered their activity after corrective exercise.•Low active muscle were be able to more active after corrective exercise.•After corrective exercise muscle balance achieved.

We previously demonstrated that rumination is produced by an unperceived, somatic response to food ingestion, and we developed an original biofeedback technique based on electromyography (EMG)-guided control of abdomino-thoracic muscular activity. Our aim was to demonstrate the superiority of biofeedback vs. placebo for the treatment of rumination. Randomized, placebo-controlled trial performed in a referral center. Consecutive patients who fulfilled the Rome III criteria for rumination (18 women, 6 men; 19-79 years age) were selected and all included in the study; 1 patient assigned to placebo withdrew because of an unrelated accident. Abdomino-thoracic muscle activity after a challenge meal was recorded by EMG. The patients in the biofeedback group were shown the signal and instructed to control muscle activity, whereas the patients in the placebo group were not shown the signal and were given oral simethicone. Each patient underwent 3 sessions over a 10-day period. number of rumination events as measured by questionnaires for 10 consecutive days before and after intervention. Patients on biofeedback (n=12) but not on placebo (n=11) effectively learned to reduce intercostal activity (by 51±6% vs. 10±7% increment on placebo; P<0.001) and anterior wall muscle activity (by 52±4% vs. 9±2% increment on placebo; P<0.001). Biofeedback treatment resulted in a 74±6% reduction in rumination activity (from 29±6 before to 7±2 daily events after intervention) vs. 1±14% on placebo; P=0.001 (from 21±2 before to 21±4 daily events after intervention). Rumination can be effectively corrected by biofeedback-guided control of abdomino-thoracic muscular activity.

Background Intensive care unit acquired-weakness syndrome (ICUAWS) leaves several complications in functional movements of patients such as severe walking disability. Objective Assessment of functional outcomes of 1-month inspiratory muscle training (IMT) in elderly with ICUAWS and severe walking disability was our aim. The design, setting, participants, and intervention. This study is a randomized controlled trial. ICUAWS patients who complained of severe walking disability on the Modified Functional Ambulatory Category Test (MFACT) were randomly assigned into the IMT group or control group, n  = 20 for each group. Both groups received the traditional physical therapy program. Results The results showed that the post-therapy between-group comparison of ICUAWS sufferers/groups’ parameters showed a significant improvement toward the IMT group in six-minute walk test, inspiratory and expiratory muscle strength, forced vital capacity, time up and go test, 10-m walk test, forced expiratory volume in the first second, 30-s sit-to-stand test, partial pressure of arterial blood oxygen and carbon dioxide, MFACT, oxygen saturation of arterial blood, physical, and mental summary of short form 36. Conclusion In conclusion, IMT improves functional outcomes in ICUAWS patients with walking disability. Trial registration number The clinical trial ID of this ICUAWS trial is NCT06210763.

Objectives The Functional Clear Aligner (FCA) is a novel orthodontic appliance designed for the treatment of Class II malocclusion with mandibular retrognathia in adolescents. The aim of this study was to investigate the biomechanical characteristics of the masticatory muscles, jawbone, and temporomandibular joint (TMJ) during mandibular advancement using either FCA or Class II elastics combined with clear aligner (Class II elastics) through finite element analysis. Materials and methods A 3D finite element model of the ‘muscle-jawbone-TMJ-appliance’ system was constructed based on CBCT and MRI images of a boy with skeletal Class II malocclusion. Masticatory muscles included masseter, temporal, medial pterygoid, and lateral pterygoid muscles. The TMJ consists of the temporal bone’s glenoid fossa, disc, and mandibular condyle. To observe the biomechanical characteristics of the muscles and TMJ during orthodontic appliance wearing and the retention phase, two different protocols were used: Model 1: The mandibular advancement using FCA; Model 2: The mandibular advancement using Class II elastics. Results The FCA group produced greater and more coordinated masticatory muscle forces compared to the Class II elastics group. Temporal and masseter muscles exhibited the most pronounced variation in muscle strength during mandibular advancement. The FCA group exhibited greater TMJ region stress compared to the Class II elastics group. Interestingly, the stress on the articular discs in both models decreased over time. Tensile stresses were observed in both the condyle and the posterior region of the articular fossa. Conclusion During skeletal Class II malocclusion treatment, masticatory muscle forces and stress on the TMJ were higher in the FCA group compared to the Class II elastics group. In both models, stress cushioning was provided by the articular disc.

In contemporary societies, computer use by children is a necessity and thus highly prevalent. Using computers for long hours is related to a higher risk of computer-related muscular disorders like forward head posture (FHP) and neck pain (NP). Deep cervical flexor (DCF) muscles are important head-on-neck posture stabilizers; thus, their training may lead to an improvement in FHP and NP. The aim of this study was to determine if 4 weeks of DCF training is effective in alleviating NP, improving FHP, and functional status in adolescent children using computers regularly, a pretest-posttest experimental group design was used. Subjects were randomly assigned into the experimental group (receiving DCF training and postural education) and the control group (receiving postural education only). 30 subjects with a mean age of 15.7±1.725 years with NP and FHP using computers regularly participated in the study. Dependent variables were measured on day 1 (at baseline) and after 4 weeks of training. Photographic analysis was used for measuring FHP, visual analog scale for NP intensity, and neck disability index for functional status. Data analysis showed that in both groups, no significant improvement occurred in FHP. In both groups, there was a significant improvement in functional status and NP. There was no significant difference between both groups for FHP and NP. There was a significant improvement in functional status in the experimental group in comparison to the control group. Four weeks of DCF training does not cause a significant improvement in FHP in 13 to 18 years old adolescent children using computers regularly.

Abstract Objectives To determine whether two independent examiners can agree on a diagnosis of myofascial pain syndrome (MPS). To evaluate interexaminer reliability in identifying myofascial trigger points in upper quarter muscles. To evaluate the reliability of clinical diagnostic criteria for the diagnosis of MPS. To evaluate the validity of clinical diagnostic criteria for the diagnosis of MPS. Design Validity and reliability study. Setting Provincial Hospital. Toledo, Spain. Participants Twenty myofascial pain syndrome patients and 20 healthy, normal control subjects, enrolled by a trained and experienced examiner. Methods Ten bilateral muscles from the upper quarter were evaluated by two experienced examiners. The second examiner was blinded to the diagnosis group. The MPS diagnosis required at least one muscle to have an active myofascial trigger point. Three to four days separated the two examinations. The primary outcome measure was the frequency with which the two examiners agreed on the classification of the subjects as patients or as healthy controls. The kappa statistic (K) was used to determine the level of agreement between both examinations, interpreted as very good (0.81–1.00), good (0.61–0.80), moderate (0.41–0.60), fair (0.21–0.40), or poor (≤0.20). Results Interexaminer reliability for identifying subjects with MPS was very good (K = 1.0). Interexaminer reliability for identifying muscles leading to a diagnosis of MPS was also very good (K = 0.81). Sensitivity and specificity showed high values for most examination tests in all muscles, which confirms the validity of clinical diagnostic criteria in the diagnosis of MPS. Conclusions Interrater reliability between two expert examiners identifying subjects with MPS involving upper quarter muscles exhibited substantial agreement. These results suggest that clinical criteria can be valid and reliable in the diagnosis of this condition.

Even though robotic rehabilitation is very useful to improve motor function, there is no conclusive evidence on its role in reducing post-stroke spasticity. Focal muscle vibration (MV) is instead very useful to reduce segmental spasticity, with a consequent positive effect on motor function. Therefore, it could be possible to strengthen the effects of robotic rehabilitation by coupling MV. To this end, we designed a pilot randomized controlled trial (Clinical Trial NCT03110718) that included twenty patients suffering from unilateral post-stroke upper limb spasticity. Patients underwent 40 daily sessions of Armeo-Power training (1 hour/session, 5 sessions/week, for 8 weeks) with or without spastic antagonist MV. They were randomized into two groups of 10 individuals, which received (group-A) or not (group-B) MV. The intensity of MV, represented by the peak acceleration (a-peak), was calculated by the formula (2πf)2A, where f is the frequency of MV and A is the amplitude. Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio (HMR) were the primary outcomes measured before and after (immediately and 4 weeks later) the end of the treatment. In all patients of group-A, we observed a greater reduction of MAS (p = 0.007, d = 0.6) and HMR (p<0.001, d = 0.7), and a more evident increase of SICI (p<0.001, d = 0.7) up to 4 weeks after the end of the treatment, as compared to group-B. Likewise, group-A showed a greater function outcome of upper limb (Functional Independence Measure p = 0.1, d = 0.7; Fugl-Meyer Assessment of the Upper Extremity p = 0.007, d = 0.4) up to 4 weeks after the end of the treatment. A significant correlation was found between the degree of MAS reduction and SICI increase in the agonist spastic muscles (p = 0.004). Our data show that this combined rehabilitative approach could be a promising option in improving upper limb spasticity and motor function. We could hypothesize that the greater rehabilitative outcome improvement may depend on a reshape of corticospinal plasticity induced by a sort of associative plasticity between Armeo-Power and MV.

Patients with cirrhosis often have functional limitations, decreased muscle mass, and a high risk of falls. These variables could improve with exercise. The aim was to study the effects of moderate exercise on functional capacity, body composition and risk of falls in patients with cirrhosis. Twenty-three cirrhotic patients were randomized to an exercise programme (n = 14) or to a relaxation programme (n = 9). Both programmes consisted of a one-hour session 3 days a week for 12 weeks. At the beginning and end of the study, we measured functional capacity using the cardiopulmonary exercise test, evaluated body composition using anthropometry and dual energy X-ray absorptiometry, and estimated risk of falls using the Timed Up&Go test. In the exercise group, cardiopulmonary exercise test showed an increase in total effort time (p<0.001) and ventilatory anaerobic threshold time (p = 0.009). Upper thigh circumference increased and mid-arm and mid-thigh skinfold thickness decreased. Dual energy X-ray absorptiometry showed a decrease in fat body mass (-0.94 kg, 95%CI -0.48 to -1.41, p = 0.003) and an increase in lean body mass (1.05 kg, 95%CI 0.27 to 1.82, p = 0.01), lean appendicular mass (0.38 kg, 95%CI 0.06 to 0.69, p = 0.03) and lean leg mass (0.34 kg, 95%CI 0.10 to 0.57, p = 0.02). The Timed Up&Go test decreased at the end of the study compared to baseline (p = 0.02). No changes were observed in the relaxation group. We conclude that a moderate exercise programme in patients with cirrhosis improves functional capacity, increases muscle mass, and decreases body fat and the Timed Up&Go time. ClinicalTrials.gov NCT01447537.

Cold temperatures (<−15°C) increase exercise‐induced bronchoconstriction (EIB), while hypoxic‐induced hyperventilation exacerbates respiratory muscle fatigue for a given exercising task. This study aimed to determine the individual and combined effects of cold and normobaric hypoxia on the respiratory system responses to high‐intensity exercise. Fourteen trained male runners (V̇O2max ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{max}}}$ : 64 ± 5 mL/kg/min) randomly performed an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion under four environmental conditions: normothermic (18°C) normoxia (FIO2 ${{F}_{{\\mathrm{I}}{{{\\mathrm{O}}}_2}}}$ : 20.9%) and hypoxia (FIO2 ${{F}_{{\\mathrm{I}}{{{\\mathrm{O}}}_2}}}$ : 13.5%), and cold (−20°C) normoxia and hypoxia. Ventilatory responses during exercise and lung function (LF), maximal inspiratory (MIP) and expiratory (MEP) pressure measurements before and after exercise were evaluated. Volume of air forcefully exhaled in 1 s (FEV1), FEV1/forced vital capacity (FVC), peak expiratory flow, forced expiratory flow during the mid (25–75%) portion of the FVC, and maximal expiratory flow at 50% of FVC were affected by cold exposure. No significant pre‐ to post‐exercise change in MIP and MEP was found, independent of environmental conditions. Greater LF impairments in cold‐normoxia and coldhypoxia were associated with the lowest peak ventilatory responses during exercise. Cold exposure was found to negatively impact peak ventilatory responses and post‐exercise LF, further highlighting a relationship between EIB presence and the blunted ventilatory response in the cold. Respiratory muscle strength remained unchanged after exercise regardless of the environmental condition, suggesting no detrimental effect of hypoxia on this parameter when intermittent short‐duration high‐intensity exercises are performed. Future studies should investigate the combined cold‐hypoxic effect on longer exercise durations at a sustained high intensity, accounting for differences between normobaric and hypobaric hypoxia exposures. What is the central question of this study? What are the independent and combined effects of cold and normobaric hypoxia on respiratory responses to high‐intensity exercise? What is the main finding and its importance? Cold exposure impaired lung function and peak ventilatory responses during high‐intensity exercise, with greater impairments observed under combined cold‐hypoxia condition. The findings highlight a link between exercise‐induced bronchoconstriction and reduced ventilatory capacity in cold environments. Respiratory muscle strength remained unaffected post‐exercise across all conditions, suggesting no detrimental impact of hypoxia during short‐duration high‐intensity tasks.