Scapular Muscle Exercises Following Neck Dissection Surgery for Head and Neck Cancer: A Comparative Electromyographic Study.

Scapular Muscle Exercises Following Neck Dissection Surgery for Head and Neck Cancer: A Comparative Electromyographic Study.

Phys Ther. 2013 Feb 21;
McGarvey AC, Osmotherly PG, Hoffman GR, Chiarelli P

BACKGROUND: Shoulder pain and dysfunction can occur following neck dissection surgery for cancer. These conditions often are due to accessory nerve injury. Such an injury leads to trapezius muscle weakness, which, in turn, alters scapular biomechanics. OBJECTIVE: The aim of this study was to assess which strengthening exercises incur the highest dynamic activity of affected trapezius and accessory scapular muscles in patients with accessory nerve dysfunction compared with their unaffected side. DESIGN: A comparative design was utilized for this study. METHODS: The study was conducted in a physical therapy department. Ten participants who had undergone neck dissection surgery for cancer, with signs of accessory nerve injury, were recruited. Surface electromyographic activity of the upper trapezius, middle trapezius, rhomboid major, and serratus anterior muscles on the affected side was compared dynamically with that of the unaffected side during 7 scapular strengthening exercises. RESULTS: Electromyographic activity of the upper and middle trapezius muscles of the affected side was lower than that of the unaffected side. The neck dissection side affected by surgery demonstrated higher levels of upper and middle trapezius muscle activity during exercises involving overhead movement. The rhomboid and serratus anterior muscles of the affected side demonstrated higher levels of activity compared with the unaffected side. LIMITATIONS: Exercises were repeated 3 times on one occasion. Muscle activation under conditions of increased exercise dosage should be inferred with caution. CONCLUSIONS: Overhead exercises are associated with higher levels of trapezius muscle activity in patients with accessory nerve injury following neck dissection surgery. However, pain and correct scapular form must be carefully monitored in this patient group during exercises. Rhomboid and serratus anterior accessory muscles may have a compensatory role, and this role should be considered during rehabilitation. HubMed – rehab


Clinical Decision Making in an Infant With Hypotonia and Gross Motor Delay: A Case Report of Spinal Muscular Atrophy Type 1.

Phys Ther. 2013 Feb 21;
Malerba KH, Tecklin JS

BACKGROUND AND PURPOSE: Children are often referred to physical therapy with the diagnosis of hypotonia when the definitive cause of hypotonia is unknown. The purpose of this case report is to describe the clinical decision making process using the HOAC II for a 5 month old patient with hypotonia and gross motor delay. CASE DESCRIPTION: The patient was a 5 month old infant who had been evaluated by a neurologist and then referred to physical therapy by his pediatrician. Physical therapy evaluation results and clinical observations of marked hypotonia, significant gross motor delay, tongue fasciculations, feeding difficulties, and respiratory abnormalities prompted necessary referral to specialists. Recognition of developmental, neurologic, and respiratory abnormalities facilitated clinical decision making for determining the appropriate physical therapy plan of care. OUTCOMES: During the brief episode of care for physical therapy, the patient was referred to a feeding specialist and diagnosed with pharyngeal phase dysphasia and mild aspiration. Continued global weakness, signs and symptoms of SMA Type 1, and concerns for increased work of breathing and respiratory compromise were discussed with the referring physician. After inconclusive laboratory testing for metabolic etiologies of hypotonia, a genetics consult was recommended and confirmed the diagnosis of SMA Type 1 at 9 months of age. DISCUSSION: Physical therapists use clinical decision making to determine whether to treat or to refer to other medical professionals. Accurate and timely referral to appropriate specialists may assist families in obtaining a diagnosis for their child and guide necessary interventions. In the case of SMA Type 1, early diagnosis may affect outcomes and survival rate in this pediatric population. HubMed – rehab


Vascular Elasticity and Grip Strength Are Associated With Bone Health of the Hemiparetic Radius in Chronic Stroke: Implications for Rehabilitation.

Phys Ther. 2013 Feb 21;
Pang MY, Yang FZ, Jones AY

BACKGROUND: Individuals with stroke often sustain increased bone loss and fracture rate. Increasing evidence has demonstrated a link between cardiovascular health and bone loss in other patient populations. OBJECTIVE: To compare the bone density and geometry of the radius diaphysis between the two sides in people with chronic stroke and aged-matched controls, and to examine the relationship between the bone strength index of the hemiparetic radius diaphysis and vascular health in people with chronic stroke. DESIGN: This was a case-control study. METHODS: The radius diaphysis on both sides was scanned using peripheral quantitative computed tomography in 65 people with chronic stroke and 34 controls. Large and small artery elasticity indices were evaluated using a cardiovascular profiling system. RESULTS: The paretic radius diaphysis had significantly lower value in cortical bone mineral density, cortical thickness, cortical area, bone strength index but greater marrow cavity area than the non-paretic radius diaphysis in the stroke group whereas none of the bone measurements showed significant side-to-side difference in controls. Multiple regression analyses showed that large artery elasticity index and grip strength remained significantly associated with bone strength index of the hemiparetic radius diaphysis, after controlling for age, sex, time since stroke diagnosis, body mass index, physical activity (R(2)=0.790, p?0.001). LIMITATIONS: This study was cross-sectional and could not establish causality. The radius diaphysis is not the most common site of fracture after stroke. CONCLUSIONS: Both the integrity of the vasculature and muscle strength were significantly associated with the bone strength index at the hemiparetic radius diaphysis among people with chronic stroke. The results may be useful in guiding rehabilitative programs for enhancing bone health in the paretic arm following a stroke. HubMed – rehab


The long-term effect of ambulatory oxygen in normoxaemic COPD patients: A randomised study.

Chron Respir Dis. 2013 Feb 21;
Ringbaek T, Martinez G, Lange P

Aim: To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation. Patients and methods: Normoxaemic COPD who participated in outpatient PR and desaturated >4% and <90% during endurance shuttle walk test (ESWT) were randomised to control (n = 23) or AO 2 L/min from a portable oxygen concentrator (n = 22) to be used during exercise. PR consisted of supervised training for 20 weeks combined with unsupervised daily training at home followed by 13 weeks without supervised training. Results: Only 45 of 165 eligible patients wanted to participate. Mean forced expiratory volume in 1 s = 32% (SD 13.8) and Medical Research Council (MRC) = 4.5 (3-5). Supplemental oxygen improved oxygen saturation during ESWT by 2.3% (95% CI: 1.2%-3.5%; p < 0.001). In the study period of 33 weeks, 10 and 6 patients withdrew from the AO group and control group, respectively. Patients spent an average of 7.9 h/week on oxygen. PR improved ESWT by 18,076 s (95% CI: 101-258 s; p < 0.001) and St. George's Respiratory Questionnaire (SGRQ) score by 2.6 units (95% CI: 0.1-5.1 s; p = 0.04) after 7 weeks, and these gains remained at 33 weeks of evaluation. There were no differences between the AO group and control group at 33 weeks of evaluation with regard to change in ESWT (223 vs. 241 s; p = 0.32), change in SGRQ (-3.6 vs. -4.5 units, 0.91), and number of patients with acute exacerbation in COPD (AECOPD), hospital admission or dropout (17 of 22 vs. 20 of 23, p = 0.59). Conclusions: AO seems not to provide additional beneficial effects in patients with COPD participating in pulmonary rehabilitation and experiencing exertional desaturation without severe resting hypoxaemia. HubMed – rehab



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