Stroke, complex regional pain syndrome and phantom limb pain: Can commonalities direct future management?

Despite being different conditions, complex regional pain syndrome type 1, phantom limb pain and stroke share some potentially important similarities. This report examines experimental and clinical findings from each patient population. It identifies common aspects of symptomatic presentation, sensory phenomena and patterns of cortical reorganization. Based on these common findings, we argue that established principles of stroke rehabilitation are also applicable to rehabilitation of complex regional pain syndrome type 1 and phantom limb pain. In addition, we contend that promising treatment approaches for complex regional pain syndrome type I and phantom limb pain may be helpful in stroke rehabilitation. Examples of emerging supportive evidence for these hypotheses are provided and discussed

The first five years of development of children born pre-term

This study investigated the first five years of developmental progress of a group of pre-term infants. Of an initial group of 136 surviving infants born five or more weeks before term in Brisbane in 1975, more than 82% were assessed regularly through their pre-school years. Results indicated that a normal sequence of development was followed by the majority of the children. Although the incidence of cerebral palsy, speech difficulties and minor motor incoordination was higher than average, all but two children were ready to enter school with their peers. Except for a small group of neurologically related signs, factors predictive of development at five years generally differed with age. Regular comprehensive developmental assessment is recommended for identification of age related problems

Dry needling and exercise for chronic whiplash - a randomised controlled trial

Chronic whiplash is a common and costly problem. Sensory hypersensitivity is a feature of chronic whiplash that is associated with poor responsiveness to physical treatments such as exercise. Modalities such as dry-needling have shown some capacity to modulate sensory hypersensitivity, suggesting that when combined with advice and exercise, such an approach may be more effective in the management of chronic whiplash. The primary aim of this project is to investigate the effectiveness of dry-needling, advice and exercise for chronic whiplash

Digitally tender points: their significance in physiotherapy

Clinicians, including physiotherapists, involved in treatment of musculoskeletal conditions, routinely identify digitally tender points in superficial tissue. The characteristics of these points and their significance for assessment, prognosis and treatment of musculoskeletal conditions are controversial. There is evidence that altered central mediation of pain may explain some digitally tender points. Muscle spindle and end-plate abnormalities have also been implicated in the development of digitally tender points. Models proposed to explain muscle pain and dysfunction may provide insights into the physiological processes underlying digitally tender points. There is a need for further investigation to characterise digitally tender points and determine their significance for assessment and treatment of musculoskeletal conditions. The Strain–Counterstrain paradigm, in which tender points are located by palpation of defined anatomical sites and are used to guide passive body positioning treatment, appears to offer a convenient means for investigation of digitally tender points

Sensory characteristics of tender points in the lower back

Palpation of tender points in superficial tissue is commonly undertaken in the management of musculoskeletal pain. The sensory characteristics of digitally tender points (DTPs) have not been defined. This study had two major aims: 1) to characterise 'Strain-Counterstrain' DTPs, using quantitative sensory testing (QST) in participants with low back pain (LBP); 2) to compare corresponding points at lumbar sites in participants with LBP to those without LBP. Fifteen participants with LBP (9 females), mean (SD) Oswestry scores 20.8 (10.1)) and 15 participants without LBP (6 females) were included. QST was undertaken by a single examiner blind to the location of DTPs and included measurement of electrical detection and electrical pain threshold, thermal (hot/cold) detection and thermal pain threshold, vibration detection threshold and pressure-pain threshold. In participants with LBP, DTPs demonstrated significantly lower electrical detection and electrical pain thresholds compared to contralateral non-tender points (p < 0.0001). These findings may be indicative of altered central processing of Aβ afferents with terminal receptors at DTPs. Participants with LBP demonstrated elevated cold pain thresholds at lower back sites and at the peripheral shoulder site compared to participants without LBP (p < 0.001). This may also indicate augmented central pain processing in participants with LBP. © 2010 Elsevier Ltd

Penetration and spread of interferential current in cutaneous, subcutaneous and muscle tissues

To investigate the penetration depth of interferential current (IFC) through soft tissue and the area over which it spreads during clinical application.A laboratory-based study of healthy participants.A university research laboratory.Twelve healthy subjects.Premodulated IFC at 90 Hz and 'true' IFC at frequencies of 4, 40 and 90 Hz were applied via four electrodes, in a quadrant setting, to the distal medial thigh of each participant on separate occasions.Voltage induced by tested currents was measured at three locations (middle of the four electrodes, in line with one circuit and outside the four electrodes) and three depths (skin, subcutaneous and muscle tissues) using three Teflon-coated needle electrodes connected to a Cambridge Electronic Design data acquisition system.All voltages were greater at all depths and locations compared with baseline (

Neck movement and muscle activity characteristics in female office workers with neck pain

Study Design Cross-sectional study. Objective To explore aspects of cervical musculoskeletal function in female office workers with neck pain. Summary of Background Data Evidence of physical characteristics that differentiate computer workers with and without neck pain is sparse. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius (UT) muscles during specific tasks. Understanding cervical musculoskeletal function in office workers will better direct intervention and prevention strategies. Methods Measures included neck range of motion; superficial neck flexor muscle activity during a clinical test, the craniocerivcal flexion test; and a motor task, a unilateral muscle coordination task, to assess the activity of both the anterior and posterior neck muscles. Office workers with and without neck pain were formed into 3 groups based on their scores on the Neck Disability Index. Nonworking women without neck pain formed the control group. Surface electromyographic activity was recorded bilaterally from the sternocleidomastoid, anterior scalene (AS), cervical extensor (CE) and UT muscles. Results Workers with neck pain had reduced rotation range and increased activity of the superficial cervical flexors during the craniocervical flexion test. During the coordination task, workers with pain demonstrated greater activity in the CE muscles bilaterally. On completion of the task, the UT and dominant CE and AS muscles demonstrated an inability to relax in workers with pain. In general, there was a linear relationship between the workers’ self-reported levels of pain and disability and the movement and muscle changes. Conclusion These results are consistent with those found in other cervical musculoskeletal disorders and may represent an altered muscle recruitment strategy to stabilize the head and neck. An exercise program including motor reeducation may assist in the management of neck pain in office workers