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Recognition of a patient with neck autonomic dysfunction: findings from a rare case report of harlequin syndrome in direct access physiotherapy. 识别颈部自主神经功能障碍患者:直接物理治疗中哈勒金综合征罕见病例报告的发现。
Pub Date : 2024-05-17 DOI: 10.1080/10669817.2024.2349338
F. Mourad, Irene Scotto, J. Dunning, Andrea Giudice, Giorgio Maritati, F. Maselli, Rik Kranenburg, Alan Taylor, R. Kerry, N. Hutting
BACKGROUNDHarlequin syndrome is a rare autonomic condition consisting of unilateral facial flushing and sweating induced by heat, emotion or physical activity. The affected side presents anhidrosis and midline facial pallor due to denervation of the sympathetic fibers.CASE DESCRIPTIONThis case describes a patient who reported right-side redness of the face associated with hyperhidrosis during physical activity. She had two previous major motor vehicle accidents. The patient demonstrated difficulties in the visual accommodation of the left eye, but cranial nerve assessment was unremarkable; the patient was then referred to an ophthalmologist, who excluded any autonomic dysfunction as the primary cause of convergence and visual acuity.OUTCOMESA left-sided sympathetic dysfunction with Harlequin sign diagnosis was made followed by a progressive compensatory adaptation of the right face. The patient was educated and reassured about the benign nature of her problem.DISCUSSIONKnowledge of the autonomic nervous system is still limited in clinical practice. Although challenging, physiotherapists should develop the knowledge and ability needed to perform appropriate assessment of autonomic dysfunctions.CONCLUSIONA dispositional reasoning model should be considered in differential diagnosis.
背景哈勒金综合征是一种罕见的自律神经疾病,由热、情绪或体力活动诱发单侧面部潮红和出汗。由于交感神经纤维的去神经化,患侧会出现多汗症和面部中线苍白。病例描述本病例描述的是一名患者在体育活动时报告右侧面部发红并伴有多汗症。她曾两次遭遇重大车祸。患者左眼视力调节困难,但颅神经评估结果无异常;随后,患者被转诊至眼科医生,该医生排除了辐辏和视力的主要原因是自主神经功能障碍。临床实践中对自律神经系统的了解仍然有限。尽管具有挑战性,但物理治疗师应掌握对自律神经功能障碍进行适当评估所需的知识和能力。
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引用次数: 0
Interrater reliability of the modified prone instability test for lumbar segmental instability in individuals with mechanical low back pain. 针对机械性腰痛患者腰椎节段不稳定性的改良俯卧不稳定性测试的相互间可靠性。
Pub Date : 2024-05-16 DOI: 10.1080/10669817.2024.2352934
Ellen R Larkin, Darren Q Calley, John H Hollman
OBJECTIVEThe purpose of this study was to establish the interrater reliability of measures obtained with a novel Modified Prone Instability Test (mPIT), which, like the original Prone Instability Test (PIT), is proposed to identify lumbar segmental instability. The mPIT has clinical feasibility advantages to the PIT, but its psychometric properties are yet to be determined.DESIGNRepeated measures (test-retest) design, methods study.METHODSThe mPIT was administered by two blinded testers, an orthopedic physical therapy resident with < 1 year experience and board-certified orthopedic specialist physical therapist with >25 years' experience. Procedures were administered at an outpatient physical therapy clinic of a tertiary Medical Center. Participants included 50 adults (≥18 years old) with mechanical low back pain and no radicular (below the knee) symptoms (mean age 50.7 years, 66% female, 76% reported previous episodes of low back pain). Interrater reliability was measured via Fleiss' kappa coefficient.RESULTSAssessments of the mPIT had moderate interrater agreement (κ = .579 [95% CI = .302 to .856], p < .001.).CONCLUSIONMeasures obtained using the mPIT demonstrated moderate interrater reliability between a new graduate and an experienced clinician, which aligns with several studies examining interrater reliability of the original PIT. Further study examining comparative validation of the mPIT with other lumbar instability measures is warranted.
目的:本研究旨在确定新型改良俯卧不稳定性测试(mPIT)测量结果的互测可靠性,该测试与最初的俯卧不稳定性测试(PIT)一样,旨在确定腰椎节段不稳定性。设计重复测量(测试-重复测试)设计,方法研究。方法mPIT由两名盲测者实施,盲测者是一名拥有25年经验的骨科理疗住院医师。测试在一家三级医疗中心的物理治疗门诊进行。参与者包括 50 名成年人(≥18 岁),他们都有机械性腰背痛,但没有根性(膝盖以下)症状(平均年龄 50.7 岁,66% 为女性,76% 的人表示以前曾有过腰背痛发作)。结果mPIT的评估结果具有中等程度的互测一致性(κ = .579 [95% CI = .302 to .856],p < .001)。结论使用mPIT进行的测量结果表明,新毕业生和经验丰富的临床医师之间具有中等程度的互测可靠性,这与对原始PIT的互测可靠性进行的多项研究结果一致。有必要进一步研究 mPIT 与其他腰椎不稳定性测量方法的比较验证。
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引用次数: 0
Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial. 穆里根胸腔持续自然顶骨滑道对肩峰下撞击综合征患者肩峰下疼痛的疗效:单盲随机对照试验。
Pub Date : 2024-04-15 DOI: 10.1080/10669817.2024.2341453
S. T. Abu El Kasem, Fatma Alzahraa A Alaa, Neveen A. Abd El-Raoof, Alshaymaa S Abd-Elazeim
PURPOSETo investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome.METHODSSeventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention).RESULTSAfter 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05).CONCLUSIONMulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.
目的探讨Mulligan胸椎持续自然顶叶滑行(SNAGS)技术和传统锻炼对肩峰下撞击综合征患者的疼痛、肩关节功能、肩峰下间隙大小和肩关节活动度的影响。方法74名肩峰下撞击综合征患者(25至40岁)参加了本研究,并被随机分配到两个相同的小组:实验组A(Mulligan SNAGS和锻炼)和对照组B(仅锻炼)。所有患者均接受了疼痛强度视觉模拟量表(VAS)、肩关节疼痛与残疾指数(SPADI)、肩峰下间隙大小X光平片和肩关节活动范围(ROM)动态关节角度计的评估。结果干预 4 周后,在肩峰下间隙大小、疼痛强度、肩关节功能和肩关节活动范围方面,组间差异有统计学意义,Mulligan SNAGS 更优(P < 0.05)。在组内分析中,所有测量变量在治疗前和治疗后的差异也有统计学意义(P < 0.05)。结论 Mulligan 胸椎(SNAGS)伸展运动和传统运动可改善肩峰下撞击综合征患者的肩峰下间隙大小、疼痛强度、肩关节功能和肩关节活动范围。在治疗肩峰下撞击综合征时,建议采用闷罐式 SNAGS 方法来活动胸椎。
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引用次数: 0
McKenzie neck exercise versus cranio-cervical flexion exercise on strength and endurance of deep neck flexor muscles, pain, disability, and craniovertebral angle in individuals with chronic neck pain: a randomized clinical trial. 麦肯锡颈部运动与颅颈屈伸运动对慢性颈部疼痛患者颈部深屈肌力量和耐力、疼痛、残疾和颅椎角度的影响:随机临床试验。
Pub Date : 2024-04-03 DOI: 10.1080/10669817.2024.2337979
Sawita Chaiyawijit, R. Kanlayanaphotporn
PURPOSETo compare the effectiveness of McKenzie neck exercise and cranio-cervical flexion (CCF) exercise on strength and endurance of deep neck flexor (DNF) muscles, pain, disability, and craniovertebral angle (CVA) in individuals with chronic neck pain.METHODSForty individuals with chronic neck pain were randomly allocated to the McKenzie neck or CCF exercise group. Each group performed exercises at home daily. The strength and endurance of DNF muscles were measured at baseline, immediately after the first exercise session, and each week follow-up for six weeks. Average pain over the past week was measured at baseline and each week follow-up for six weeks. Disability and CVA were measured at baseline and the end of six weeks.RESULTSAt six weeks, both groups exhibited significant improvements across all outcome variables (p < 0.001) but there were no differences between groups (p > 0.05). The significant difference from baseline in the strength of DNF muscles was observed as early as the second week of each intervention (p ≤ 0.001). The significant difference from baseline in the endurance of DNF muscles was observed as early as the first week in the CCF exercise group (p < 0.05) and the second week in the McKenzie neck exercise group (p < 0.05). A significant decrease in pain intensity from baseline was observed after the first week in the McKenzie neck exercise group (p < 0.001) while it was after the second week in the CCF exercise group (p < 0.05).CONCLUSIONBoth the McKenzie neck exercise and CCF exercise produced similar effects in enhancing the strength and endurance of the DNF muscles, decreasing pain, alleviating neck disability, and improving the CVA.
目的比较麦肯锡颈部运动和颅颈屈曲(CCF)运动对慢性颈痛患者颈部深屈肌(DNF)的力量和耐力、疼痛、残疾和颅椎角度(CVA)的影响。 方法将 40 名慢性颈痛患者随机分配到麦肯锡颈部运动组或 CCF 运动组。每组每天在家进行锻炼。分别在基线、首次锻炼后和每周随访六周时测量 DNF 肌肉的力量和耐力。在基线和每周随访六周时测量过去一周的平均疼痛程度。结果六周后,两组的所有结果变量均有显著改善(P 0.05)。早在每次干预的第二周,就观察到 DNF 肌肉力量与基线相比有明显差异(p ≤ 0.001)。CCF锻炼组的DNF肌肉耐力与基线相比早在第一周就出现了明显差异(p < 0.05),麦肯锡颈部锻炼组的DNF肌肉耐力与基线相比早在第二周就出现了明显差异(p < 0.05)。结论麦肯锡颈部运动和 CCF 运动在增强 DNF 肌肉的力量和耐力、减轻疼痛、缓解颈部残疾和改善 CVA 方面产生了相似的效果。
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引用次数: 0
Asymptomatic intraspinal epidermoid cyst in a 7-year-old male with juvenile idiopathic arthritis identified by an advanced physiotherapist practitioner: a case report. 一名高级物理治疗师在一名患有幼年特发性关节炎的 7 岁男性身上发现的无症状椎管内表皮样囊肿:病例报告。
Pub Date : 2024-04-02 DOI: 10.1080/10669817.2024.2334103
Julie Herrington, Michelle Batthish, Heba Takrouri, Blake Yarascavitch, Anita Gross
BACKGROUNDPediatric intraspinal epidermoid cysts are rare with potential to cause life-altering outcomes if not addressed. Reports to date describe symptomatic presentations including loss of bladder or bowel function and motor and sensory losses. This case report identifies the diagnostic challenge of an asymptomatic intraspinal epidermoid cyst in the cauda equina region presenting in a 7-year-old male with juvenile idiopathic arthritis (JIA).DIAGNOSISAn advanced physiotherapist practitioner assessed and diagnosed a previously healthy 7-year-old-male of South Asian descent with JIA based on persistent knee joint effusions. Complicating factors delayed the investigation of abnormal functional movement patterns, spinal and hip rigidity and severe restriction of straight leg raise, all atypical for JIA. Further delaying the diagnosis was the lack of subjective complaints including no pain, no reported functional deficits, and no neurologic symptoms. A spinal MRI investigation 10-months from initial appointment identified intraspinal epidermoid cysts occupying the cauda equina region requiring urgent referral to neurosurgery.DISCUSSIONClinical characteristics and pattern recognition are essential for diagnosing spinal conditions in pediatric populations. Diagnostic challenges present in this case included co-morbidity (JIA), a severe adverse reaction to treatment, a lack of subjective complaints and a very low prevalence of intraspinal epidermoid cysts.IMPACT STATEMENTSEarly signs of pediatric asymptomatic intraspinal epidermoid cysts included abnormal functional movement patterns, rigidity of spine, severely limited straight leg raise and hip flexion without pain. Advanced physiotherapist practitioners can be integral to pediatric rheumatology teams considering their basic knowledge in musculoskeletal examination and functional mobility assessment when identifying rare spinal conditions that present within the complex context of rheumatic diseases.
背景小儿椎管内表皮样囊肿非常罕见,如果不及时治疗,可能会导致生命危险。迄今为止的报告描述的症状表现包括膀胱或肠道功能丧失以及运动和感觉减退。本病例报告指出,一名 7 岁男性幼年特发性关节炎(JIA)患者的马尾区域出现无症状椎管内表皮样囊肿,给诊断带来挑战。由于并发症的存在,对异常功能运动模式、脊柱和髋关节僵硬以及直腿抬高严重受限的调查被推迟,而这些都是 JIA 的非典型症状。没有疼痛等主观主诉、没有功能障碍报告、没有神经系统症状也进一步延误了诊断。首次就诊10个月后,脊柱磁共振成像检查发现马尾区域有椎管内表皮样囊肿,需要紧急转诊至神经外科。本病例的诊断难题包括合并症(JIA)、对治疗的严重不良反应、缺乏主观主诉以及椎管内表皮样囊肿的发病率极低。影响声明小儿无症状椎管内表皮样囊肿的早期症状包括功能运动模式异常、脊柱僵硬、直腿抬高和髋关节屈曲严重受限且无疼痛。考虑到高级物理治疗师在肌肉骨骼检查和功能活动性评估方面的基础知识,他们在识别风湿性疾病复杂背景下出现的罕见脊柱疾病时,可以成为儿科风湿病团队不可或缺的一员。
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引用次数: 0
Comparison of Structural Diagnosis and Management (SDM) approach and Myofascial Release (MFR) for improving planter heel pain, ankle range of motion and disability: A Randomized Clinical Trial 结构诊断和管理(SDM)入路和肌筋膜松解(MFR)改善植足者足跟疼痛、踝关节活动范围和残疾的比较:一项随机临床试验
Pub Date : 2022-08-17 DOI: 10.1101/2022.08.15.22278805
S. Akter, Mohammad Shahadat Hossain, K. Hossain, Z. Uddin, Mohammad Anwar Hossain, Foisal Alom, Md. Feroz Kabir, L. Walton, Veena Raigangar
[Purpose] This study compared the effect of Structural Diagnosis and Management (SDM) approach over Myofascial Release (MFR) on gastrocnemii, soleus and plantar fascia in patients with plantar heel pain. [Subjects] Sixty-four (n=64) subjects, aged 30-60 years, with a diagnosis of plantar heel pain, plantar fasciitis or calcaneal spur by a physician and according to ICD-10. Participants were equally allocated to MFR (n=32) and SDM (n=32) group by hospital randomization and concealed allocation. [Methods] In this assessor blinded randomized clinical trial, the control group performed MFR (three tissue specific stretching techniques) and the experimental group performed 2 tissue-specific interventions utilizing the Structural Diagnosis and Management (SDM) concept for 12 sessions over a 4-week period. In addition, both groups received strengthening exercises and other conventional treatments. Pain, activity limitations and disability were assessed as primary outcomes utilizing the foot function index (FFI) and range of motion (ROM) of the ankle dorsiflexors and plantar flexors were measured with a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. [Result] Both MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including: pain, activity level, disability, range of motion and function after the 12-week intervention period (p<.05), The SDM group showed more significant improvements than MFR for FFI pain (p=.001), FFI activity (p=.009), FFI (p= .001) and FADI (p=.002). [Conclusion] MFR and SDM approaches are both effective to reduce pain, improving function, ankle range of motion, and reduce disability in plantar heel pain. However, the SDM approach is significantly superior (for reducing pain, improving function and reducing disability (p<.05).
【目的】本研究比较结构诊断与管理(SDM)入路与肌筋膜松解(MFR)入路对足底跟痛患者腓肠肌、比目鱼肌和足底筋膜的影响。[受试者]64名(n=64)受试者,年龄30-60岁,经医生诊断为足底跟痛、足底筋膜炎或跟骨刺,并符合ICD-10。采用医院随机和隐式分配方法将参与者平均分配到MFR组(n=32)和SDM组(n=32)。[方法]在这项评估者盲法随机临床试验中,对照组进行MFR(三种组织特异性拉伸技术),实验组利用结构诊断和管理(SDM)概念进行2次组织特异性干预,为期4周,共12次。此外,两组都接受了强化锻炼和其他常规治疗。使用足功能指数(FFI)评估疼痛、活动受限和残疾作为主要结果,使用通用测角仪测量踝关节背屈肌和足底屈肌的活动范围(ROM)。次要结果采用足踝关节残疾指数(FADI)和踝关节背屈肌和足底屈肌的十点手动肌肉测试过程来测量。[结果]干预12周后,MFR组和SDM组在疼痛、活动水平、失能、活动范围和功能等所有结局变量均较基线有显著改善(p< 0.05),其中SDM组在FFI疼痛(p= 0.001)、FFI活动(p= 0.009)、FFI (p= 0.001)和FADI (p= 0.002)方面比MFR组改善更显著。[结论]MFR入路和SDM入路均能有效减轻足跟疼痛,改善功能和踝关节活动范围,减少足跟疼痛的致残性。然而,SDM方法在减轻疼痛、改善功能和减少残疾方面明显优于SDM方法(p< 0.05)。
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引用次数: 0
Author response. 作者的回应。
Pub Date : 2022-07-01 DOI: 10.7554/elife.16578.046
A. Schafer, T. Hall, Kerstin Luudtke, J. Mallwitz, N. Briffa
{"title":"Author response.","authors":"A. Schafer, T. Hall, Kerstin Luudtke, J. Mallwitz, N. Briffa","doi":"10.7554/elife.16578.046","DOIUrl":"https://doi.org/10.7554/elife.16578.046","url":null,"abstract":"","PeriodicalId":281286,"journal":{"name":"The Journal of Manual & Manipulative Therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133219507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"Let's not forget our Raison d'etre". “不要忘记我们存在的理由”。
Pub Date : 2015-12-01 DOI: 10.1080/10669817.2015.1130485
Dan Vaughn
{"title":"\"Let's not forget our Raison d'etre\".","authors":"Dan Vaughn","doi":"10.1080/10669817.2015.1130485","DOIUrl":"https://doi.org/10.1080/10669817.2015.1130485","url":null,"abstract":"","PeriodicalId":281286,"journal":{"name":"The Journal of Manual & Manipulative Therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130878918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Author response. 作者的回应。
Pub Date : 1900-01-01 DOI: 10.7554/elife.41542.015
D. Davis
{"title":"Author response.","authors":"D. Davis","doi":"10.7554/elife.41542.015","DOIUrl":"https://doi.org/10.7554/elife.41542.015","url":null,"abstract":"","PeriodicalId":281286,"journal":{"name":"The Journal of Manual & Manipulative Therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132906817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
The Journal of Manual & Manipulative Therapy
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