A systematic review of temporomandibular disorder diagnostic methods

Objective: To compile the screening tools used to study temporomandibular disorders (TMD), classify and analyze their potential application in the field of physiotherapy.Methods: All gathered data included randomized clinical trials on humans over 18 years of age pulled from three databases up to November 2019.Results: Nineteen articles were retained, in which the subjects included 1095 women and 385 men. The 32 valuation systems reported were classified as follows: direct, requiring observation and/or palpation in situ by a clinician, which can be subdivided into protocols and instrumental systems; and indirect, requiring neither observation nor palpation by a clinician, which can be subdivided into questionnaires and scales.Conclusion: In order to evaluate TMD, the best choice is to combine direct and indirect assessment methodologies. The valuation of pressure pain threshold with an algometer and Fonseca's Anamnestic Index in combination with Anamnestic Questionnaire CMD, respectively, seems to provide the best results.

Influence of Transcranial Direct Current Stimulation and Exercise on Physical Capacity and Gait in Multiple Sclerosis: A Cross-Over Pilot Study

Physical capacity provides a link between disease or impairment and limitations in activity; in multiple sclerosis (MS), it is limited and decreased. The aim of this study was to study the effects of exercise and transcranial direct current stimulation (tDCS) on the left dorsolateral prefrontal cortex area in MS patients with fatigue and an impaired gait ability. A cross-over design was carried out on fifteen patients with two disability associations, but three were excluded. Before and after each intervention, the 6 min walk test (6MWT) and the 2 min walk test (2MWT) were used to assess walking ability and the Modified Fatigue Impact Scale (MFIS) was used to assess fatigue. A total of twelve patients were enrolled (48.0 median age, Kurtzke Disability Scale (EDSS) 3.66 ± 1.3): five females and seven males. After the application of the exercise program, significant improvements were observed in the 6MWT (p < 0.001, g = 0.159) and 2MWT (p < 0.001, g = 0.182). Furthermore, fatigue was significantly reduced after the application of the exercise program (p < 0.05, g = 0.742) and after tDCS (p < 0.05, g = 0.525). We could consider therapeutic exercise in the future to improve the walking ability and fatigue in MS patients. Furthermore, tDCS did not exert a significant improvement in walking ability, but it appeared to influence fatigue. Clinical trial registration code: ACTRN12622000264785.

Influence of Transcranial Direct Current Stimulation and Exercise on Fatigue and Quality of Life in Multiple Sclerosis

BACKGROUND

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that leads to a great deterioration in the quality of life.

OBJECTIVE

We aimed to assess the effectiveness of two individual programs, one based on transcranial direct current stimulation (tDCS) and another based on the effect of physical exercise on fatigue and quality of life in patients with MS.

METHODS

A total of 12 patients with relapsing-remitting and progressive secondary MS participated. Fatigue and quality of life were assessed before and after intervention. The exercise program and tDCS were carried out over a 4-week period, with a washout period of 5 months.

RESULTS

The results show significant improvements in the different quality of life subscales after the application of tDCS, activities of daily living (r = 0.625; p = 0.037) (g = 0.465), psychological well-being (r = 0.856; p = 0.004) (g = 0.727) and coping (r = 0.904; p = 0.18) (g = 0.376), and in those after the application of exercise, activities of daily living (r = 0.853; p = 0.003) (g = 0.570) and psychological well-being (r = 0.693; p = 0.041) (g = 0.417). After the application of both therapies, more than 50% of the subjects did not have a positive fatigue score on the MFIS scale.

CONCLUSION

The major findings suggest that the application of both therapies produces a beneficial effect with significant improvements in the quality of life of this sample.

The Effect of Combining Transcranial Direct Current Stimulation Treatment and an Exercise Program on Fragility in a Population with Multiple Sclerosis: Cross-Over Design Trial

BACKGROUND

The relationship between fragility and neurological diseases is extensive and affects many patients with multiple sclerosis (MS), whose risk factors are related to fragility.

OBJECTIVE

To study the effects of exercise and transcranial direct current stimulation (tDCS) in MS patients with fatigue from four dimensions: functional mobility, balance, fatigue, and depression.

METHODS

A total of 12 patients who belonged to two associations of people with physical disabilities participated. Functional mobility, depression, balance, and fatigue were assessed before and after the intervention. Transcranial direct current stimulation and the exercise program were carried out over a 4-week period with a wash-out period of 5 months.

RESULTS

After the application of tDCS, we found significant improvements in balance (p < 0.05, g = 0.632), depression (p < 0.05, g = 0.402), functional mobility (p < 0.05, g = 0.297), and fatigue (p < 0.05, g = 0.526). After the exercise program, significant improvements were shown in balance (p < 0.01, g = 0.418), depression (p < 0.001, g = 0.540), functional mobility (p < 0.01, g = 0.262), and fatigue (p < 0.01, g = 0.742). Two-way mixed-measures ANOVA showed that all variables improved in both groups, with significant differences over time but not between groups. Secondary analysis showed significant correlations between balance and functional mobility (r = 0.671, p = 0.017), depression and fatigue (r = 0.586, p = 0.044) and between intensity of rehabilitation and balance (r = 0.622, p = 0.031).

CONCLUSION

Participating in an exercise program and receiving tDCS separately improved the variables of depression, balance, mobility, and fatigue.

Reading Performance Improvements in Patients with Central Vision Loss without Age-Related Macular Degeneration after Undergoing Personalized Rehabilitation Training

PURPOSE

To evaluate the efficacy of a reading rehabilitation program (RRP) in patients with central visual loss (CVL) and assess the impact of the RRP on the quality of life (QoL).

METHODS

The RRP included four in-office and 39 in-home training sessions over 6 weeks. Reading speed, duration, and font size were evaluated during each in-office session. The subjective perception of the QoL was assessed before and after the RRP using the short version of a questionnaire (World Health Organization Quality of Life). A control group who received advice about ocular conditions and low-vision aids also was included.

RESULTS

Seventeen patients with Stargardt's disease (STGD), 11 with adult-onset foveomacular vitelliform dystrophy (AFVD), and eight with myopic macular degeneration (MMD) were included. The control group included five patients each with STGD, AFVD, and MMD. The respective mean corrected distance visual acuities (VAs) in patients with STGD, AFVD, MMD, and the control group were 0.57 ± 0.38, 0.51 ± 0.38, 0.49 ± 0.24, and 0.55 ± 0.25 logarithm of the minimum angle of resolution; the mean corrected near VAs were 0.89 ± 0.20, 1.08 ± 0.17, 0.99 ± 0.34, and 1.18 ± 0.37 (M notation) using low-vision aids. The reading speed, duration, and font size improved in all groups. The RRP groups obtained (p ≤ 0.01) greater improvements than the control group in each reading performance variable assessed. Patients with STGD obtained greater improvements in the subjective evaluation; the control group did not obtain noteworthy improvement in any domain.

CONCLUSIONS

The RRP improved reading performance in patients with CVL and positively impacted the subjective perception of the QoL.

Adaptation of Perceptual Responses to Low-Load Blood Flow Restriction Training

Martín-Hernández, J, Ruiz-Aguado, J, Herrero, AJ, Loenneke, JP, Aagaard, P, Cristi-Montero, C, Menéndez, H, and Marín, PJ. Adaptation of perceptual responses to low-load blood flow restriction training. J Strength Cond Res 31(3): 765-772, 2017-The purpose of this study was to determine the adaptive response of ratings of perceived exertion (RPE) and pain over 6 consecutive training sessions. Thirty subjects were assigned to either a blood flow restriction training (BFRT) group or a high-intensity resistance training (HIT) group. Blood flow-restricted training group performed 4 sets (30 + 15 + 15 + 15, respectively) of unilateral leg extension at an intensity of 20% one repetition maximum (1RM) while a restrictive cuff was applied to the most proximal part of the leg. The HIT group performed 3 sets of 8 repetitions with 85% 1RM. Ratings of perceived exertion and pain were assessed immediately after each exercise set along the 6 training sessions and were then averaged to obtain the overall RPE and pain per session. Statistical analyses showed significant main effects for group (p ≤ 0.05) and time (p < 0.001). Ratings of perceived exertion values dropped from session 1 to session 6 in both BFRT (8.12 ± 1.3 to 5.7 ± 1.1, p < 0.001) and HIT (8.5 ± 1.2 to 6.40 ± 1.2, p < 0.001). Similar results were observed regarding pain ratings (BFRT: 8.12 ± 1.3 to 5.90 ± 1.55, p < 0.001; HIT: 6.22 ± 1.7 to 5.14 ± 1.42, p < 0.01). Our results indicate that RPE was higher after HIT, whereas differences did not reach significance regarding pain. These perceptual responses were attenuated over time, and the time course of this adaptive response was similar between BFRT and HIT. In summary, BFRT induces a marked perceptual response to training, comparable with that observed with HIT. However, this response becomes attenuated with continuous practice, leading to moderate values of RPE and pain. Perceptual responses may not limit the application of BFRT to highly motivated individuals.

Acute effects of simultaneous electromyostimulation and vibration on leg blood flow in spinal cord injury

STUDY DESIGN

Randomized crossover.

OBJECTIVES

To analyze the acute effects of isolated and simultaneous application of whole-body vibration (WBV) and electromyostimulation (ES) on popliteal artery blood velocity (BV) and skin temperature (ST) of the calf in subjects with spinal cord injury (SCI).

SETTING

Valladolid, Spain.

METHODS

Ten subjects with SCI were assessed in five different sessions. After a familiarization session, four interventions were applied in random order; WBV, ES, simultaneous WBV and ES (WBV+ES), and 30 s of WBV followed by 30 s of ES (WBV30/ES30). Each intervention consisted of 10 sets × 1 min ON+1 min OFF. Subjects were seated on their own wheelchairs with their feet on the vibration platform (10 Hz, 5 mm peak-to-peak), and ES was applied on the gastrocnemius muscle of both legs (8 Hz, 400 μs).

RESULTS

The simultaneous application (WBV+ES) produced the greatest increase in mean BV (MBV; 36% and 42%, respectively) and peak BV (PBV; 30% and 36%, respectively) during the intervention. This intervention produced the greatest mean increases in MBV (21%) and PBV (19%) during the recovery period. Last, this intervention produced the highest increase in ST during the intervention (2.1 °C).

CONCLUSION

The simultaneous application of WBV+ES seems to produce a greater increase in MBV and PBV of the popliteal artery and ST of the calf than the isolated (WBV or ES) or consecutive application of both stimuli (WBV30/ES30). This study provides an efficient therapeutic methodology to improve peripheral arterial properties, which is pivotal in SCI patient's rehabilitation.

Influence of isolated or simultaneous application of electromyostimulation and vibration on leg blood flow

PURPOSE

The aim of this study was to analyze the acute effects of isolated or simultaneously applied whole-body vibration (WBV) and electromyostimulation (ES) on the popliteal arterial blood velocity and skin temperature (ST) of the calf.

METHODS

Thirteen healthy males were assessed in five different sessions. After a familiarization session, four interventions were applied in random order; WBV, ES, simultaneous WBV and ES (WBV+ES), and 30 s of WBV followed by 30 s of ES (WBV30/ES30). Each intervention consisted of 10 sets × 1 min ON + 1 min OFF. The subject was standing on the vibration platform (squat position, 30° knee flexion, 26 Hz, 5 mm peak-to-peak), and ES was applied on the gastrocnemius of both the legs (8 Hz, 400 µs).

RESULTS

The WBV+ES intervention was the only one that maintained the mean blood velocity (MBV) elevated above baseline during the 10 sets, from set-1 (134.6 % p < 0.01) to set-10 (112.6 % p < 0.05). The combined interventions were the only ones that maintained the peak blood velocity (PBV) elevated above baseline during all the sets, from set-1 (113.5 % p < 0.001) to set-10 (88.8 % p < 0.01) and from set-1 (58.4 % p < 0.01) to set-10 (49.1 % p < 0.05) for WBV+ES and WBV30/ES30, respectively.

CONCLUSION

The simultaneous application of WBV and ES produced a general greater increase in MBV and PBV than the application of each method alone or consecutive. This novel methodological proposal could be interesting in different fields such as sports or the rehabilitation process of different pathologies, to achieve an enhanced peripheral blood flow.

Reliability of infrared thermography in skin temperature evaluation of wheelchair users

STUDY DESIGN

Test-retest reliability analysis segmented by body parts.

OBJECTIVES

To examine the reliability of infrared thermography (IRT) in wheelchair users (WCUs), as a noninvasive and risk-free technique to detect the natural thermal radiation emitted by human skin and to allow subsequent interpretations of temperature distributions.

SETTING

Research Center on Physical Disability of Valladolid, ASPAYM Castilla y León Foundation, Spain.

METHODS

Twenty-four manual WCUs (22 men, 2 women) participated in this study. Skin temperature (Tsk) of 16 and 20 areas of the front and rear upper body, respectively, were measured using an infrared camera. Two thermographic images were recorded in each session during two days separated by 24 h. Results were analyzed using descriptive statistics, intraclass correlation coefficients, coefficients of variation and side-to-side skin temperature differences (δTsk).

RESULTS

The intraclass correlation coefficient produced values ranging from 15 to 95 for the various regions of interest. The coefficient of variation ranged between 1.05-6.18%. The mean Tsk of the front upper body was 31.92 °C, and that of the rear upper body was 31.77 °C. The total δTsk was 0.09±0.44°C, r=0.583.

CONCLUSION

The reliability of IRT varies depending on the analyzed areas. IRT is a noninvasive and noncontact technique that allows measuring the temperature of the skin, with which to advance in WCU research.

Whole-body vibration applied during upper body exercise improves performance

Whole-body vibration (WBV) training has exercisers perform static and dynamic resistance training exercises on a ground-based platform. Exposure to WBV exposure has demonstrated benefits and no effect on lower body strength, power, and performance. The aim of this study was to determine if WBV exposure (50 Hz, 2.51 mm) has any potentiating effects postexercise by measuring the kinematic variables of a set of upper body elbow-extensor exercise (70% one-repetition maximum [1RM]) to volitional exhaustion. Sixteen recreationally active students (12 male and 4 female) performed 3 different experimental conditions on separate days. Each condition had the subjects perform 1 set of elbow-extension exercise to fatigue with 1 of 3 WBV treatments: WBV simultaneously during the set (AE); 60 seconds after application of WBV for 30 seconds (RE); and no WBV (CTRL). Kinematic parameters of each repetition were monitored by linking a rotary encoder to the highest load plate. The mean velocity and acceleration throughout the set and perceived exertion were analyzed. A significant increase (p < 0.05) was observed in the mean velocity for the whole set in the AE condition vs. the CTRL condition. The mean acceleration was significantly higher (p < 0.05) in the AE condition in comparison with RE (increased by 45.3%) and CTRL (increased by 50.4%) conditions. The positive effect induced by WBV on upper-limb performance is only achieved when the stimulus is applied during the exercise. However, WBV applied 60 seconds before upper body exercise results in no benefit.

Changes in muscle architecture induced by low load blood flow restricted training

In order to ascertain whether differing structural mechanisms could underlie blood flow restricted training (BFRT) and high intensity training (HIT), this study had two aims: (i) to gain an insight into the acute variations of muscle architecture following a single bout of two different volumes of BFRT, and (ii) to compare these variations with those observed after HIT. Thirty-five young men volunteered for the study and were randomly divided into three groups: BFRT low volume (BFRT LV), BFRT high volume (BFRT HV) and traditional high intensity resistance training (HIT). All subjects performed a bilateral leg extension exercise session with a load of 20% of one repetition maximum (1RM) in the BFRT groups, whereas the load of the HIT group was equivalent to an 85% of their 1RM. Before and immediately after the exercise bout, ultrasound images were taken from the rectus femoris (RF) and the vastus lateralis (VL). All groups increased their RF (p < 0.001) and VL (p < 0.001) muscle thickness, while the increases in pennation angle were larger in HIT as compared to BFRT LV (p = 0.013) and BFRT HV (p = 0.037). These results support the hypothesis that acute muscle cell swelling may be involved in the processes underlying BFRT induced muscle hypertrophy. Furthermore, our data indicate differing structural responses to exercise between BFRT and HIT.

Effects of different magnitudes of whole-body vibration on arm muscular performance

The purpose of this study was to analyze the effects of different vibration magnitudes via feet on the number of repetitions performed, mean velocity, and perceived exertion during a set of elbow-extension exercise to failure (70% 1 repetition maximum [1RM] load). Twenty recreationally active students (14 men and 6 women) performed, in 3 different days, 1 elbow-extension set applying randomly 1 of the 3 experimental conditions: high magnitude (HM; 50 Hz and 2.51 mmp-p; 98.55 mxs-2), low magnitude (LM; 30 Hz and 1.15 mmp-p; 20.44 m.s-2) or control (Control, without vibration stimulus). Results indicate that the vibration via feet provides superimposed stimuli for elbow-extensor performance, enhancing the total number of repetitions performed in the HM and LM conditions, which was significantly higher (p <or= 0.05) than that performed in the Control condition (21.5 and 18.1%, respectively). Moreover, there was a significant increase (p <or= 0.05) in the average velocity for the whole set in the HM condition in comparison to the LM and Control conditions. This study provides evidence that an HM of vibration generates more neuromuscular facilitation than an LM. These data suggest that a vibration stimulus applied to the feet can result in positive improvements in upper body resistance exercise performance.

Whole-body vibration alters blood flow velocity and neuromuscular activity in Friedreich's ataxia

The purpose of this study was to investigate the effects of whole-body vibration (WBV) on blood flow velocity and muscular activity after different vibration protocols in Friedreich's ataxia (FA) patients. After two familiarization sessions ten patients received six 3 min WBV treatments depending on a combination of frequency (10, 20 or 30 Hz) and protocol (constant or fragmented). Femoral artery blood flow velocity, vastus lateralis (VL) and vastus medialis (VM) electromyography (EMG), and rate of perceived exertion were registered. Peak blood velocity was increased with respect to basal values after 1, 2 and 3 min of WBV (14·8%, 18·8% and 19·7%, respectively, P<0·001). Likewise, mean blood velocity was increased with respect to basal values after 1, 2 and 3 min of WBV (17·3%, 19·4% and 16·6%, respectively, P<0·001). EMG amplitude of VL and VM was increased (39% and 23%, respectively, P<0·05) and EMG frequencies decreased during the application of WBV. The results of this study suggest that higher frequencies (30 Hz) produce a greater increase in blood flow velocity and rate of perceived exertion. WBV is an effective method to increase blood flow and to activate muscle mass in patients with Friedreich's ataxia, and could therefore be considered to be incorporated in rehabilitation programs of this collective.

Effects of whole-body vibration on blood flow and neuromuscular activity in spinal cord injury

STUDY DESIGN

Crossover trial.

OBJECTIVES

To investigate the effects of whole-body vibration (WBV) on muscular activity and blood flow velocity after different vibration treatments in patients with spinal cord injury (SCI).

SETTING

Research Center on Physical Disability (Spain).

METHODS

Eight individuals with SCI received six 3-min WBV treatments depending on a combination of frequency (10, 20 or 30 Hz) and protocol (constant, that is, three consecutive minutes of WBV, or fragmented, that is, three sets of 1 min of WBV with 1 min of rest between the sets). Femoral artery blood flow velocity was registered at minutes 1, 2 and 3 of WBV, and at minutes 1 and 2 after the end of the stimulus. Electromyography activity (EMG) of vastus lateralis (VL) and vastus medialis (VM) was registered at baseline and during WBV.

RESULTS

Peak blood velocity (PBV) increased after 1, 2 and 3 min of WBV. The 10 Hz frequency did not alter blood flow, whereas the 20 Hz frequency increased PBV after 2 and 3 min of WBV, and the 30 Hz frequency increased PBV after 1, 2 and 3 min of WBV and during the first minute after the end of the stimulus. No protocol effect was observed for blood parameters. EMG activity of VL and VM increased independently of the applied frequency or protocol.

CONCLUSION

WBV is an effective method to increase leg blood flow and to activate muscle mass in SCI patients, and could be considered to be incorporated in their rehabilitation programs.

Differences in electrical stimulation thresholds between men and women

OBJECTIVE

Surface electrical stimulation (ES) of skeletal muscle is used in a variety of clinical settings in healthy and unhealthy subjects of both sexes. Although women generally present larger amounts of subcutaneous adipose tissue than men, which could limit current flow to the stimulated muscle, sex-related differences in ES current levels have not been clearly demonstrated to date. We report data from healthy men and women.

METHODS

Sensory (current perception), motor (minimal knee extension torque production), and supramotor thresholds (10% of the maximal voluntary knee extension torque) and perceived pain during surface ES of the quadriceps femoris muscle were investigated in 40 healthy volunteers (20 men, 20 women).

RESULTS

Sensory threshold was lower in women than in men (-43%; p < 0.001). Similarly, female muscles required lower current amplitudes to attain the supramotor threshold (-17%; p < 0.01). The Visual Analogue Scale pain score was significantly greater in women than in men at motor threshold (+112%; p < 0.01) but not at supramotor threshold (+36%; p > 0.05).

INTERPRETATION

Collectively, our data demonstrate higher sensory and supramotor excitability to surface ES in female subjects and provide further evidence for a neurophysiological explanation for more pronounced pain perception in women. These observations may help clinicians to better understand the sex-specific response to ES and to design more rational stimulation treatments with the ultimate goal of optimizing patient care and safety.