The repeatability of subjective and objective assessments of neck muscle fatigue is very importan... more The repeatability of subjective and objective assessments of neck muscle fatigue is very important with regard to the clinical applicability of these methods.To establish between-days reliability, 33 healthy volunteers performed a 60% maximum voluntary isometric contraction test from a standing position in all neck movements. Cervical muscle fatigue was assessed on three separate occasions from the spectral (median frequency, MF) and amplitude (root mean square, RMS) analysis of the electromyogram (EMG) signal recorded from the cervical paraspinal group, splenius capitis, levator scapulae and sternocleidomastoid. Subjective assessment of fatigue was rated by employing the Borg scale. Intraclass correlation coefficient ICC(1,1), standard error of measurement (SEM), smallest detectable difference (SDD) indices and Pearson’s correlation co-efficient were calculated for the analysis of the results.Normalised median frequency (MF) slope had low repeatability and large between-day error (ICC(1,1) = 0.28–0.61; SEM = 0.33–0.60%/s; SDD = 132.7–703.2%) for the protagonist muscles of each movement. Initial median frequency (IMF) had moderate to good reliability and small error (ICC(1,1) = 0.64–0.81; SEM = 2.8–8.8 Hz; SDD = 19.9–38.5%). The RMS slope yielded also poor repeatability. The Borg assessment was more reliable than the EMG estimate though variability between sessions was still quite high (SDD = 29.2–136.5%). No correlation was found between the EMG and Borg assessment of neck muscle fatigue (r = −0.01–0.39).The protocol used for assessing neck muscle fatigue proved to be reliable only for the IMF but the clinical usefulness of this measure remains questionable. The lack of correlation between objective and subjective estimation of neck muscle fatigue was possibly a consequence of the poor measurement repeatability. Further research is needed to identify the factors responsible for these results on neck area.
The purpose of this study was to cross-culturally adapt and validate the Greek version of Knee Ou... more The purpose of this study was to cross-culturally adapt and validate the Greek version of Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), a self-reported instrument used for patients with various knee pathological conditions including osteoarthritis. Ninety-four patients (57 males and 37 females) with a variety of pathological knee disorders and impairments being referred to physical therapy for evaluation and treatment were included in the study. For the crοss-cultural translation, a back-translation procedure was utilized by 3 bi-lingual translators. To assess test–retest reliability the patients were asked to complete the KOS-ADLS twice at initial visit; before and after physiotherapy treatment. To assess responsiveness, patients completed the KOS-ADLS at the end of all physiotherapy sessions and the score was compared with KOS-ADLS at initial (pre-treatment) visit. Finally, concurrent validity was measured by comparing the responses to the KOS-ADLS scores against the scores obtained from Visual Analogue Scale (VAS) and Global Rating Scale (GRS). Reliability was found satisfactory (ICC = 0.97; SEM = 3.03; SDD = 23.05; Cronbach's alpha = 0.98). Moreover, a gender subgroup analysis showed that women were more reliable than men. Minor floor/ceiling effects were detected. Concerning validity, all correlations were statistically significant, ranging from r = 0.315 to r = 0.741, however GRS presented higher correlations with KOS-ADLS in comparison with VAS. Finally, Greek KOS-ADLS was able to detect changes over time (standardized effect size = 1.31 and standardized response mean = 1.64). The Greek version of KOS-ADLS was found to be reliable, valid, responsive and comprehensible to use with patients with knee pathology.
This paper describes a presumptive mechanism for the development of changes in respiratory functi... more This paper describes a presumptive mechanism for the development of changes in respiratory function due to chronic neck pain. The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction. The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and pharmacological prescription.
Rationale, aims and objectives Identifying homogenous subgroups of low back pain (LBP) patients ... more Rationale, aims and objectives Identifying homogenous subgroups of low back pain (LBP) patients is considered a priority in musculoskeletal rehabilitation and is believed to enhance clinical outcomes. In order to achieve this, the specific features of each subgroup need to be identified. The aim of this study was to develop a list of clinical and cultural features that are included in the assessment of LBP patients in Greece, among health professionals. This ‘list’ will be, utilized in a clinical study for developing LBP subgroups.Methods Three focus groups were conducted, each one comprising health professionals with homogenous characteristics and all coordinated by a single moderator. There were: 11 physiotherapists (PTs) with clinical experience in LBP patients, seven PTs specialized in LBP management, and five doctors with a particular spinal interest. The focus of discussions was to develop a list of clinical and cultural features that were important in the examination of LBP. Content analysis was performed by two researchers.Results Clinicians and postgraduates developed five categories within the History (Present Symptoms, History of Symptoms, Function, Psychosocial, Medical History) and six categories within the Physical Examination (Observation, Neurological Examination, Active and Passive Movements, Muscle Features and Palpation). The doctors identified four categories in History (Symptomatology, Function, Psychosocial, Medical History) and an additional in Physical Examination (Special Tests). All groups identified three cultural categories; Attitudes of Health Professionals, Patients’ Attitudes and Health System influences.Conclusion An extensive Greek ‘list’ of clinical and cultural features was developed from the groups’ analysis. Although similarities existed in most categories, there were several differences across the three focus groups which will be discussed.
This paper describes a plausible mechanism for the development of brain plastic changes due to a ... more This paper describes a plausible mechanism for the development of brain plastic changes due to a peripheral joint injury, such as anterior cruciate ligament (ACL) rupture. Evidence for the hypothesis is based on mainly three indications derived from the literature review: (a) the existence of two different categories of ACL patients, the copers and non-copers, presenting different features of functional deficiencies, (b) the demand of a sufficient post-traumatic time (more than 6 months) for the dysfunction development and (c) the fact that the dysfunction is not limited to the injured limb but also concerns the non-injured one. Considering the fact that ACL contains mechanoreceptors, which inform the central nervous system (CNS) about joint sense position and kinaesthesia, it can be suggested that this kind of injury might be regarded as a neurophysiological dysfunction, not being a simple musculoskeletal injury. The rupture of the ACL could lead to the cessation/depletion or differentiation of the ascending afferent pathway from the injured joint towards CNS, inducing to the joint de-afferentation and consequently CNS reorganization and joint de-efferentation. In case of presumable evidence of the proposed hypothesis, its clinical application could concern several aspects of the intervention procedures. For example, a number of clinical findings, such as the functional differences presented between two separate clinical groups of patients (copers and non-copers) could be justified or the rehabilitation strategies might have to be revised, provided that certain therapeutic components have influence on facilitating brain plastic changes that induce to beneficial functional outcomes.
Functional magnetic resonance imaging (fMRI) was used 1) to describe the pattern of whole brain a... more Functional magnetic resonance imaging (fMRI) was used 1) to describe the pattern of whole brain activity during motion of isolated joints of the lower limb, 2) to examine the somatotopic organization of lower limb joint representations in the primary sensorimotor cortex and the anterior lobe of the cerebellum and 3) to quantify the degree of overlap between these lower limb joint activations. Eighteen healthy, right leg dominant volunteers participated in a motor block-design study, performing repetitive knee, ankle and toes flexion/extension movements. In order to relate lower limb joints activation to the well-described patterns of finger movement, serial finger-to-thumb opposition was also assessed. All movements were auditory paced at 72 beats/min (1.2 Hz). Isolated lower limb joints movement activated a distributed sensorimotor network, including primary and non-primary sensorimotor areas. Although a large overlap was evident in primary sensorimotor cortex (SM1) and cerebellum representations of the three lower limb joints, a somatotopic arrangement was recognizable with reference to center of mass coordinates of each individual joint in the above areas. Detection of active brain regions during movement of the lower limb joints is feasible with fMRI although a carefully optimized methodology protocol is required.
Studies of unilateral finger movement in right-handed subjects have shown asymmetrical patterns o... more Studies of unilateral finger movement in right-handed subjects have shown asymmetrical patterns of activation in primary motor cortex and subcortical regions. In order to investigate the existence of an analogous pattern during lower limb joints movements, functional magnetic resonance imaging (fMRI) was used. Eighteen healthy, right leg dominant volunteers participated in a motor block design study, performing unilateral right and left repetitive knee, ankle and toes flexion/extension movements. Aiming to relate lower limb joints activation to the well-described patterns of finger movement, serial finger-to-thumb opposition was also assessed. All movements were auditory paced at 72 beats/min (1.2 Hz). Brain activation during movement of the nondominant joints was more bilateral than during the same movement performed with the dominant joints. Finger movement had a stronger lateralized pattern of activation in comparison with lower limb joints, implying a different functional specialization. Differences were also evident between the joints of the lower limb. Ankle and toes movements elicited the same extend of MR signal change in the majority of the examined brain regions, whereas knee joint movement was associated with a different pattern. Finally, lateralization index in primary sensorimotor cortex and basal ganglia was significantly affected by the main effect of dominance, whereas the lateralization index in cerebellum was significantly affected by the joint main effect, demonstrating a lateralization index increase from proximal to distal joints.
The repeatability of subjective and objective assessments of neck muscle fatigue is very importan... more The repeatability of subjective and objective assessments of neck muscle fatigue is very important with regard to the clinical applicability of these methods.To establish between-days reliability, 33 healthy volunteers performed a 60% maximum voluntary isometric contraction test from a standing position in all neck movements. Cervical muscle fatigue was assessed on three separate occasions from the spectral (median frequency, MF) and amplitude (root mean square, RMS) analysis of the electromyogram (EMG) signal recorded from the cervical paraspinal group, splenius capitis, levator scapulae and sternocleidomastoid. Subjective assessment of fatigue was rated by employing the Borg scale. Intraclass correlation coefficient ICC(1,1), standard error of measurement (SEM), smallest detectable difference (SDD) indices and Pearson’s correlation co-efficient were calculated for the analysis of the results.Normalised median frequency (MF) slope had low repeatability and large between-day error (ICC(1,1) = 0.28–0.61; SEM = 0.33–0.60%/s; SDD = 132.7–703.2%) for the protagonist muscles of each movement. Initial median frequency (IMF) had moderate to good reliability and small error (ICC(1,1) = 0.64–0.81; SEM = 2.8–8.8 Hz; SDD = 19.9–38.5%). The RMS slope yielded also poor repeatability. The Borg assessment was more reliable than the EMG estimate though variability between sessions was still quite high (SDD = 29.2–136.5%). No correlation was found between the EMG and Borg assessment of neck muscle fatigue (r = −0.01–0.39).The protocol used for assessing neck muscle fatigue proved to be reliable only for the IMF but the clinical usefulness of this measure remains questionable. The lack of correlation between objective and subjective estimation of neck muscle fatigue was possibly a consequence of the poor measurement repeatability. Further research is needed to identify the factors responsible for these results on neck area.
The purpose of this study was to cross-culturally adapt and validate the Greek version of Knee Ou... more The purpose of this study was to cross-culturally adapt and validate the Greek version of Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), a self-reported instrument used for patients with various knee pathological conditions including osteoarthritis. Ninety-four patients (57 males and 37 females) with a variety of pathological knee disorders and impairments being referred to physical therapy for evaluation and treatment were included in the study. For the crοss-cultural translation, a back-translation procedure was utilized by 3 bi-lingual translators. To assess test–retest reliability the patients were asked to complete the KOS-ADLS twice at initial visit; before and after physiotherapy treatment. To assess responsiveness, patients completed the KOS-ADLS at the end of all physiotherapy sessions and the score was compared with KOS-ADLS at initial (pre-treatment) visit. Finally, concurrent validity was measured by comparing the responses to the KOS-ADLS scores against the scores obtained from Visual Analogue Scale (VAS) and Global Rating Scale (GRS). Reliability was found satisfactory (ICC = 0.97; SEM = 3.03; SDD = 23.05; Cronbach's alpha = 0.98). Moreover, a gender subgroup analysis showed that women were more reliable than men. Minor floor/ceiling effects were detected. Concerning validity, all correlations were statistically significant, ranging from r = 0.315 to r = 0.741, however GRS presented higher correlations with KOS-ADLS in comparison with VAS. Finally, Greek KOS-ADLS was able to detect changes over time (standardized effect size = 1.31 and standardized response mean = 1.64). The Greek version of KOS-ADLS was found to be reliable, valid, responsive and comprehensible to use with patients with knee pathology.
This paper describes a presumptive mechanism for the development of changes in respiratory functi... more This paper describes a presumptive mechanism for the development of changes in respiratory function due to chronic neck pain. The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction. The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and pharmacological prescription.
Rationale, aims and objectives Identifying homogenous subgroups of low back pain (LBP) patients ... more Rationale, aims and objectives Identifying homogenous subgroups of low back pain (LBP) patients is considered a priority in musculoskeletal rehabilitation and is believed to enhance clinical outcomes. In order to achieve this, the specific features of each subgroup need to be identified. The aim of this study was to develop a list of clinical and cultural features that are included in the assessment of LBP patients in Greece, among health professionals. This ‘list’ will be, utilized in a clinical study for developing LBP subgroups.Methods Three focus groups were conducted, each one comprising health professionals with homogenous characteristics and all coordinated by a single moderator. There were: 11 physiotherapists (PTs) with clinical experience in LBP patients, seven PTs specialized in LBP management, and five doctors with a particular spinal interest. The focus of discussions was to develop a list of clinical and cultural features that were important in the examination of LBP. Content analysis was performed by two researchers.Results Clinicians and postgraduates developed five categories within the History (Present Symptoms, History of Symptoms, Function, Psychosocial, Medical History) and six categories within the Physical Examination (Observation, Neurological Examination, Active and Passive Movements, Muscle Features and Palpation). The doctors identified four categories in History (Symptomatology, Function, Psychosocial, Medical History) and an additional in Physical Examination (Special Tests). All groups identified three cultural categories; Attitudes of Health Professionals, Patients’ Attitudes and Health System influences.Conclusion An extensive Greek ‘list’ of clinical and cultural features was developed from the groups’ analysis. Although similarities existed in most categories, there were several differences across the three focus groups which will be discussed.
This paper describes a plausible mechanism for the development of brain plastic changes due to a ... more This paper describes a plausible mechanism for the development of brain plastic changes due to a peripheral joint injury, such as anterior cruciate ligament (ACL) rupture. Evidence for the hypothesis is based on mainly three indications derived from the literature review: (a) the existence of two different categories of ACL patients, the copers and non-copers, presenting different features of functional deficiencies, (b) the demand of a sufficient post-traumatic time (more than 6 months) for the dysfunction development and (c) the fact that the dysfunction is not limited to the injured limb but also concerns the non-injured one. Considering the fact that ACL contains mechanoreceptors, which inform the central nervous system (CNS) about joint sense position and kinaesthesia, it can be suggested that this kind of injury might be regarded as a neurophysiological dysfunction, not being a simple musculoskeletal injury. The rupture of the ACL could lead to the cessation/depletion or differentiation of the ascending afferent pathway from the injured joint towards CNS, inducing to the joint de-afferentation and consequently CNS reorganization and joint de-efferentation. In case of presumable evidence of the proposed hypothesis, its clinical application could concern several aspects of the intervention procedures. For example, a number of clinical findings, such as the functional differences presented between two separate clinical groups of patients (copers and non-copers) could be justified or the rehabilitation strategies might have to be revised, provided that certain therapeutic components have influence on facilitating brain plastic changes that induce to beneficial functional outcomes.
Functional magnetic resonance imaging (fMRI) was used 1) to describe the pattern of whole brain a... more Functional magnetic resonance imaging (fMRI) was used 1) to describe the pattern of whole brain activity during motion of isolated joints of the lower limb, 2) to examine the somatotopic organization of lower limb joint representations in the primary sensorimotor cortex and the anterior lobe of the cerebellum and 3) to quantify the degree of overlap between these lower limb joint activations. Eighteen healthy, right leg dominant volunteers participated in a motor block-design study, performing repetitive knee, ankle and toes flexion/extension movements. In order to relate lower limb joints activation to the well-described patterns of finger movement, serial finger-to-thumb opposition was also assessed. All movements were auditory paced at 72 beats/min (1.2 Hz). Isolated lower limb joints movement activated a distributed sensorimotor network, including primary and non-primary sensorimotor areas. Although a large overlap was evident in primary sensorimotor cortex (SM1) and cerebellum representations of the three lower limb joints, a somatotopic arrangement was recognizable with reference to center of mass coordinates of each individual joint in the above areas. Detection of active brain regions during movement of the lower limb joints is feasible with fMRI although a carefully optimized methodology protocol is required.
Studies of unilateral finger movement in right-handed subjects have shown asymmetrical patterns o... more Studies of unilateral finger movement in right-handed subjects have shown asymmetrical patterns of activation in primary motor cortex and subcortical regions. In order to investigate the existence of an analogous pattern during lower limb joints movements, functional magnetic resonance imaging (fMRI) was used. Eighteen healthy, right leg dominant volunteers participated in a motor block design study, performing unilateral right and left repetitive knee, ankle and toes flexion/extension movements. Aiming to relate lower limb joints activation to the well-described patterns of finger movement, serial finger-to-thumb opposition was also assessed. All movements were auditory paced at 72 beats/min (1.2 Hz). Brain activation during movement of the nondominant joints was more bilateral than during the same movement performed with the dominant joints. Finger movement had a stronger lateralized pattern of activation in comparison with lower limb joints, implying a different functional specialization. Differences were also evident between the joints of the lower limb. Ankle and toes movements elicited the same extend of MR signal change in the majority of the examined brain regions, whereas knee joint movement was associated with a different pattern. Finally, lateralization index in primary sensorimotor cortex and basal ganglia was significantly affected by the main effect of dominance, whereas the lateralization index in cerebellum was significantly affected by the joint main effect, demonstrating a lateralization index increase from proximal to distal joints.
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