Search Results (33)

Background: Nemaline myopathy is a rare congenital neuromuscular disease associated with progressive weakness and frequent respiratory complications. In emergency situations, families often serve as the first and only responders. The aim of this study is to explore how parents in Spain care for children with nemaline myopathy during emergency situations, focusing on the clinical responses performed at home and the organizational challenges encountered when interacting with healthcare systems. Methods: A qualitative phenomenological study was conducted with 17 parents from 10 families belonging to the Asociación Yo Nemalínica. Semi-structured interviews were performed via video calls, transcribed verbatim, and analyzed using Giorgi’s descriptive method and ATLAS.ti software (version 24). Methodological rigor was ensured through triangulation, reflexivity, and member validation. Results: Four themes were identified. First, families were described as acting under extreme pressure and in isolation during acute home emergencies, often providing cardiopulmonary resuscitation and respiratory support without professional backup. Second, families managed ambiguous signs of deterioration using clinical judgment and home monitoring tools, often preventing fatal outcomes. Third, parents frequently assumed guiding roles in emergency departments due to a lack of clinician familiarity with the disease, leading to delays or errors. Finally, the transition to the Pediatric Intensive Care Unit was marked by emotional distress and rapid decision-making, with families often participating in critical choices about invasive procedures. These findings underscore the complex, multidisciplinary nature of caregiving. Conclusions: Parents play an active clinical role during emergencies and episodes of deterioration. Their lived experience should be formally integrated into emergency protocols and the continuity of care strategies to improve safety and outcomes. Full article

This paper introduces a new conceptual framework for interpreting urethral retro-resistance pressure (URP) as a dynamic, intra-procedural tool—ΔURP—for evaluating external urethral sphincter (EUS) engagement during injection therapy. With renewed interest in therapies that directly target the EUS, there is a critical need for real-time functional feedback at the site of action. This conceptual review re-examines URP in the context of emerging EUS-targeted treatments—such as bulking agents, regenerative injections, and neuromodulatory interventions—and proposes a dynamic model (ΔURP) to measure changes in sphincteric resistance as a functional biomarker during intervention. We review the anatomical, neurophysiological, and histological features of the EUS complex; trace the clinical rise and decline of URP; and compare its utility to conventional diagnostic tools. ΔURP, defined as the change in URP from baseline, is explored as an objective measure of EUS function. We outline its potential applications in guiding therapy, evaluating response, and standardizing outcomes across treatments. Conventional urodynamic measures fail to isolate distal sphincter function. In contrast, URP directly challenges the EUS and, when combined with imaging or procedural tools, may provide real-time feedback on sphincter engagement. When reframed as a dynamic, motion-based readout, URP may fill a critical gap in procedural urology—offering a physiologic signal of therapeutic engagement during EUS-targeted interventions. ΔURP has the potential to revive and repurpose a once-abandoned method into a clinically actionable biomarker for next-generation continence care. Full article

Background and Objectives: Arthrogenic muscle inhibition (AMI) is a key neurophysiological barrier to effective rehabilitation in individuals with chronic ankle instability (CAI). The primary objective of this narrative review is to explore the role of arthrogenic muscle inhibition (AMI) in chronic ankle instability (CAI) and to critically appraise neurophysiological and rehabilitative strategies targeting its resolution. Although peripheral strengthening remains a cornerstone of treatment, the roles of spinal and cortical modulation are increasingly recognised. Materials and Methods: A narrative review was conducted to examine recent clinical trials targeting AMI in CAI populations. A structured search of MEDLINE, Web of Science, Scopus, Cochrane Central, and PEDro was performed. Five studies were included, encompassing peripheral, spinal, and cortical interventions. The outcomes were grouped and analysed according to neurophysiological and functional domains. Results: Manual therapy combined with exercise improved pain, strength, and functional mobility. Fibular reposition taping transiently enhanced spinal reflex excitability, while transcranial direct current stimulation (tDCS) over the primary motor cortex significantly modulated corticospinal excitability and voluntary muscle activation. Improvements in subjective stability, dynamic balance, and neuromuscular responsiveness were observed in the majority of the five included studies, although methodological heterogeneity and short-term follow-ups limit generalisability. Conclusions: Multimodal interventions targeting different levels of the neuromotor system appear to be more effective than isolated approaches. Integrating manual therapy, sensorimotor training, and neuromodulation may optimise outcomes in CAI rehabilitation. Future trials should focus on standardised outcome measures and long-term efficacy. Full article

Background and Objectives: Obturator reflex during transurethral resection of bladder tumors (TURBT) can cause serious complications, such as bladder perforation, hemorrhage, and incomplete resection. Although obturator nerve block (ONB) is routinely recommended under spinal anesthesia, it is often omitted under general anesthesia (GA) based on the assumption that neuromuscular blockade (NMB) alone prevents adductor muscle contractions. However, clinical observations suggest that the obturator reflex may still occur under deep NMB. This study aimed to determine whether adductor longus muscle (ALM) contraction persists under GA with deep NMB during TURBT. Materials and Methods: Thirty patients scheduled for TURBT under GA were prospectively enrolled. A selective ONB was performed under ultrasound and nerve stimulator guidance. After establishing the baseline current intensity for ALM contraction, neuromuscular monitoring was initiated, and rocuronium (0.6 mg/kg) was administered. Stimulation thresholds required to induce ALM contraction were sequentially assessed at decreasing Train-of-Four ratio (TOFr) stages (90% to 10%) and Train-of-Four count (TOFc) stages (3 to 0). Final measurements were repeated 1 min after achieving TOFc 0. Changes in stimulation intensity were analyzed using a linear mixed-effects model (LMM). Results: As NMB deepened, the current intensity required to provoke ALM contraction progressively increased: 0.51 ± 0.25 mA at TOFr 90%, 1.66 ± 0.53 mA at TOFr 10%, 2.04 ± 0.66 mA at TOFc 0, and 2.61 ± 0.29 mA at 1 min after TOFc 0. Notably, all patients demonstrated ALM contraction at TOFc 0 and thereafter, confirming the persistence of the obturator reflex despite complete NMB. LMM analysis revealed a significant trend of increasing stimulation thresholds with progressive NMB depth (β = 0.133, p < 0.001). Conclusions: Adductor muscle contractions in response to obturator nerve stimulation persist even under deep NMB. These findings raise concerns that deep NMB alone may be insufficient to prevent obturator reflex and suggest that ONB should be considered as an adjunctive practice during TURBT under GA in patients at risk. Full article

Study Design: Pilot randomized clinical trial. Objective: To examine the effect of electrically evoked muscle hypertrophy on indices of spasticity, as measured by Biodex after spinal cord injury (SCI). Setting: Medical research center. Methods: Thirteen males with chronic SCI were randomized into sixteen weeks of either surface neuromuscular resistance training (NMES-RT) + testosterone treatment (TT) (n = 7) or a TT-only group (n = 6). A Biodex isokinetic dynamometer was used to measure knee extensor and flexor muscle spasticity at the beginning (baseline; BL) and at the end (post-intervention; PI) of 16 weeks. The passive tension of the right knee extensor and flexor muscle groups were evaluated at angles of 5°, 30°, 60°, 90°, 180°, and 270° per second (sec). Dual energy X-ray absorptiometry and magnetic resonance imaging were used to measure leg lean mass and thigh muscle cross-sectional areas (CSAs). Results: Robust muscle hypertrophy was noted in leg lean mass [11%, p = 0.023] as well as whole thigh [17%, p = 0.001] and knee extensor muscle [28%, p = 0.001] CSAs in the NMES-RT+TT compared to the TT-only group. There was no difference in extensor or flexor spasticity between the NMES-RT+TT or TT-only groups at different angular velocities following 16 weeks of intervention. Collapsing the extensor passive torques indicated an (24–28%) increase (p < 0.004) in response to angular velocities at BL and following PI measurements [180 deg/sec (23%; p = 0.03) and 270 deg/sec (32%; p = 0.009)] compared to 5 deg/sec. The extensor slope showed a non-significant (p > 0.05) decrease of 15–28% across all angular velocities. The catch-AB slopes were non-significantly lower in the TT-only group compared to the NMES-RT+TT at higher speeds [90 deg/sec and 270 deg/sec] and attained a trend towards lower passive torque at 180 deg/sec [180 deg/sec: 15.5%, p = 0.05]. Conclusions: Evoking skeletal muscle hypertrophy did not increase spasticity indices at different angular velocities following sixteen weeks of NMES-RT+TT or TT in persons with chronic SCI. Augmenting muscle hypertrophy is likely to attenuate the hyper reflexive slope of the extensor spasticity. The findings may suggest that evoking muscle hypertrophy following NMES-RT does not increase indices of spasticity after SCI. The clinical implications are highly important in managing spasticity after SCI. Full article

Objectives: The present study aimed to analyze the psychophysiological and neuromuscular reflex modifications following a single functional neurology intervention in individuals presenting vestibulo-ocular reflex (VOR) cancellation dysfunction. Methods: A total of 66 healthy participants, comprising an experimental group (n = 48; 22 females, 26 males; mean age 28.1 ± 7.8 years) and a control group (n = 18; 9 females, 9 males; mean age 28.6 ± 7.0 years), underwent comprehensive assessments at four distinct measurement moments: baseline, post-indicator muscle failure pre-intervention, immediately post-functional neurology intervention, and post-intervention indicator muscle failure, assessing neuromuscular (handgrip strength) and psychophysiological parameters, including blood oxygen saturation, heart rate, cortical arousal (critical flicker fusion threshold, CFFT), and pain perception (pressure pain threshold, PPT). The functional neurology treatment was tailored based on the ^®NeuroReEvolution protocol, emphasizing individualized proprioceptive recalibration, trigger point desensitization, and holistic neuroreflex modulation. Results: Statistical analyses indicated significant improvements within the experimental group following intervention. Specifically, tolerance to VOR cancellation stimuli significantly increased from a baseline of 1.0 ± 0.0 to 129.0 ± 36.7 post-intervention (p < 0.001, η² = 0.926), whereas the control group demonstrated no meaningful change. Furthermore, significant enhancements were noted in pressure pain threshold (27.49 ± 0.67 to 35.69 ± 0.60 kgf; p = 0.029), handgrip strength (20.41 ± 0.72 N to 26.56 ± 0.52 N; p = 0.012), and critical flicker fusion threshold (32.24 ± 0.45 Hz to 38.32 ± 0.60 Hz; p = 0.003). Conclusions: The results of this study demonstrate that a single functional neurology intervention significantly improved psychophysiological responses and neuromuscular reflex performance in participants with vestibulo-ocular reflex (VOR) cancellation dysfunction. Specifically, the intervention led to marked enhancements in pain tolerance, cortical arousal, and handgrip strength, and notably, an increased tolerance to VOR cancellation stimuli, indicating improved vestibular control. Cardiovascular parameters remained stable, highlighting the safety of the intervention. These findings support functional neurology as an effective therapeutic approach to address VOR-related dysfunctions by promoting neurophysiological resilience and motor function optimization. Full article

Background/Objectives: This study aimed to analyze the psychophysiological effects of functional neurology intervention on dysfunction in vestibular saccadic stimuli, focusing on its impact on muscle performance, psychophysiological arousal, and pain perception. Methods: Seventy-five healthy volunteer participants were randomly divided into two groups: an experimental group that received functional neurology treatment and a control group that did not. Both groups underwent the same evaluations at four distinct time points. Key measurements included pressure pain threshold (PPT), hand strength, critical flicker fusion threshold (CFFT), blood oxygen saturation, heart rate, and the number of saccadic stimuli tolerated until dysfunction in an indicator muscle (anterior deltoid). The functional neurology intervention involved proprioceptive reflexes, trigger point desensitization, and systemic approaches to rectify neuromuscular dysfunctions. Results: The results showed that the functional neurology intervention significantly increased the number of saccadic stimuli tolerated, from 3.6 ± 3.3 to 26.1 ± 8.7, indicating an improvement in neuromuscular endurance. Additionally, PPT readings exhibited an upward trend from baseline to post-intervention, with the final reading averaging at 10.2 ± 5.3 kgf, and hand strength measurements showed a modest but significant increase post-intervention. Notably, CFFT and blood oxygen saturation levels remained relatively stable, suggesting that the intervention’s primary impact was on neuromuscular performance and pain perception rather than on cognitive arousal or systemic oxygenation. Heart rate data indicated a decrease post-intervention, implying potential improvements in autonomic nervous system function. In contrast, the control group did not present significant changes in any of the psychophysiological parameters evaluated. These findings underscore the potential of targeted functional neurology treatments to enhance physical performance and provide valuable therapeutic benefits for neuromuscular and cognitive dysfunctions. Conclusions: Functional neurology interventions can effectively improve muscle endurance, pain management, and overall neuromuscular health, highlighting its relevance as a therapeutic modality in sports performance optimization and rehabilitation contexts. Full article

The clinical use of spinal manipulation to treat musculoskeletal conditions has nearly tripled in the United States since 1980, and it is currently recommended by most global clinical guidelines as a conservative treatment for musculoskeletal pain, despite a lack of knowledge concerning its mechanisms of action. This overview highlights evidence of direct neuromuscular responses to high-velocity, low-amplitude spinal manipulation (HVLA-SM) as delivered by chiropractic, osteopathic, and physical therapy clinicians, with an intent to foster greater interprofessional dialogue and collaborative research to better address current gaps in mechanistic knowledge of the neuromuscular response to HVLA-SM. Three databases (PubMed, CINAHL Ultimate (EBSCO), EMBASE (Elsevier)) were searched from 2000 to December 2024 with specific search terms related to thrust HVLA-SM and the neuromuscular response. To focus strictly on neuromuscular responses related to HVLA-SM, this literature overview excluded articles using non-HVLA-SM manual therapy techniques (i.e., massage, non-thrust joint mobilization, and/or combined HVLA-SM with other forms of treatment such as exercise or non-thrust joint mobilization) and studies in which patient-centered outcomes (i.e., pain scores) were the primary outcomes of the HVLA-SM interventions. Pediatric studies, animal studies, and studies in languages other than English were also excluded. One-hundred and thirty six articles were identified and included in this overview. Neuromuscular findings related to HVLA-SM in the areas of electromyography (EMG), muscle thickness, muscle strength, reflexes, electroencephalogram (EEG), and evoked potential were often mixed; however, evidence is beginning to accumulate either in favor of or opposed to particular neuromuscular responses to HVLA-SM as larger and more scientifically rigorous studies are being performed. Recurrent limitations of many HVLA-SM-related studies are small sample sizes, leading to a lack of generalizability, and the non-standardization of HVLA-SM delivery, which has prevented researchers from arriving at definitive conclusions regarding neuromuscular responses to HVLA-SM. Discussions of future neuromuscular research needs related to HVLA-SM are included for clinicians and researchers inside and outside of the field of manual therapy, to advance this field. Full article

Background: Rigid bronchoscopy (RB) is the gold standard for managing central airway obstruction (CAO), a life-threatening condition caused by both malignant and benign etiologies. Anesthetic management is challenging as it requires balancing deep sedation with maintaining spontaneous breathing to avoid airway collapse. There is no consensus on the optimal anesthetic approach, with options including general anesthesia with neuromuscular blockers or spontaneous assisted ventilation (SAV). Methods: This case series presents our anesthetic protocol using remifentanil–propofol–ketamine total intravenous anesthesia (TIVA) with SAV in four patients with airway obstructions. Muscle relaxants were avoided in all cases. Results: Ketamine’s ability to preserve respiratory drive and airway reflexes, along with its bronchodilating properties, made it ideal for managing CAO. All procedures successfully restored airway patency without complications or drug-related side effects. Conclusions: Our findings suggest that remifentanil–propofol–ketamine TIVA combined with SAV is a viable anesthetic approach for therapeutic RB, offering effective sedation, maintaining airway patency, and minimizing perioperative complications. Full article

Background: This case study investigates the effect of a five-session whole-body cryostimulation (WBC) cycle on a 55-year-old female patient with cerebral palsy (CP) and lower limb spasticity (LLS) with a typical diplegic gait pattern. CP is a common physical disability characterized by motor impairments, including spasticity, which significantly impacts mobility and quality of life. The current treatments for spasticity often have limited efficacy and considerable side effects, making alternative therapies like WBC an area of interest. Methods: The patient underwent a 10-day inpatient rehabilitation program integrated with five WBC sessions at −110 °C for 2 min. The treatment effects were assessed immediately before and after the five WBC sessions using the Ashworth Scale, Fugl-Meyer Assessment, H-reflex test, and gait analysis. Psychosocial outcomes were measured with the SF-36, WHO-5, PSQI, ESS, and BDI questionnaires. Results: Immediately after the WBC cycle, gait analysis showed increased walking speed (0.48 to 0.61 m/s left; 0.49 to 0.57 m/s right) and step length (0.30 to 0.38 m left; 0.30 to 0.35 m right). The H/M ratio in the H-reflex test improved, indicating a better neuromuscular efficiency. Psychosocial assessments revealed a 42.5% reduction in pain and a 24% improvement in overall quality of life and well-being. Discussion and Conclusions: The objective improvements in gait parameters and neuromuscular modulation, along with the subjectively reported enhancements in functional abilities, highlight the potential of WBC as a valuable addition to rehabilitation strategies for this population. Further research is needed to confirm these findings and assess long-term outcomes. Full article

Background/Objective: Short hamstring syndrome is common in the general population and can lead to impaired balance, function, and posture, and increased risk of injuries. Local treatments have obtained controversial results, so it is necessary to evaluate the effectiveness of other types of therapy such as osteopathic treatment. To evaluate the efficacy of osteopathic techniques in increasing the elasticity of the hamstring musculature in short hamstring syndrome. Methods: A systematic review of randomised controlled trials was conducted in PubMed, Medline, Cinhal, Scopus, WOS, SPORTDiscuss, and PEDro. The PEDro scale was used to evaluate the methodological quality and the RoB2 for the evaluation of biases. Results: A total of eight articles were selected. Most of the participants were assessed with the Active Knee Extension or Straight Leg Raise tests. The osteopathic techniques used were the muscle energy technique, suboccipital inhibition, and vertebral mobilisations. As for the control interventions, they mainly included passive stretching and placebo. Conclusions: The results suggest that osteopathic techniques are more effective than placebo or other interventions in increasing flexibility in adult patients with short hamstring syndrome. This effect can be explained by neurophysiological (Golgi apparatus, neuromuscular spindle activity, and Hoffmann reflex) and structural factors (dura mater, posture, and myofascial chains). Nevertheless, the evidence suggests that it would be beneficial to incorporate this type of treatment into flexibility improvement programmes. Full article

Mutations in the SACS gene are associated with autosomal recessive spastic ataxia of Charlevoix-Saguenay disease (ARSACS) or complex clinical phenotypes of Charcot-Marie-Tooth disease (CMT). This study aimed to identify SACS mutations in a Korean CMT cohort with cerebellar ataxia and spasticity by whole exome sequencing (WES). As a result, eight pathogenic SACS mutations in four families were identified as the underlying causes of these complex phenotypes. The prevalence of CMT families with SACS mutations was determined to be 0.3%. All the patients showed sensory, motor, and gait disturbances with increased deep tendon reflexes. Lower limb magnetic resonance imaging (MRI) was performed in four patients and all had fatty replacements. Of note, they all had similar fatty infiltrations between the proximal and distal lower limb muscles, different from the neuromuscular imaging feature in most CMT patients without SACS mutations who had distal dominant fatty involvement. Therefore, these findings were considered a characteristic feature in CMT patients with SACS mutations. Although further studies with more cases are needed, our results highlight lower extremity MRI findings in CMT patients with SACS mutations and broaden the clinical spectrum. We suggest screening for SACS in recessive CMT patients with complex phenotypes of ataxia and spasticity. Full article

Despite the fact that the global COVID-19 pandemic has officially ended, we continue to feel its effects and discover new correlations between SARS-CoV-2 infection and changes in the organism that have occurred in patients. It has been shown that the disease can be associated with a variety of complications, including disorders of the nervous system such as a characteristic loss of smell and taste, as well as less commonly reported incidents such as cranial polyneuropathy or neuromuscular disorders. Nervous system diseases that are suspected to be related to COVID-19 include Guillain–Barré syndrome, which is frequently caused by viruses. During the course of the disease, autoimmunity destroys peripheral nerves, which despite its rare occurrence, can lead to serious consequences, such as symmetrical muscle weakness and deep reflexes, or even their complete abolition. Since the beginning of the pandemic, case reports suggesting a relationship between these two disease entities have been published, and in some countries, the increasing number of Guillain–Barré syndrome cases have also been reported. This suggests that previous contact with SARS-CoV-2 may have had an impact on their occurrence. This article is a review and summary of the literature that raises awareness of the neurological symptoms’ prevalence, including Guillain–Barré syndrome, which may be impacted by the commonly occurring COVID-19 disease or vaccination against it. The aim of this review was to better understand the mechanisms of the virus’s action on the nervous system, allowing for better detection and the prevention of its complications. Full article

The reflexive responses to resist external forces and maintain posture result from the coordination between the vestibular system, muscle, tendon, and joint proprioceptors, and vision. Aging deteriorates these crucial functions, increasing the risk of falls. This study aimed to verify whether a training program with water bags, an Instability Neuromuscular training (INT) using the inertial load of water, could positively impact balance ability and dynamic stability. This study was conducted with twenty-two healthy older women aged ≥ 65 (mean age: 74.82 ± 7.00 years, height: 154.20 ± 5.49 cm, weight: 55.84 ± 7.46 kg, BMI: 23.55 ± 3.58 kg/m²). The participants were randomly allocated into two groups: a group that used water bags and a control group performing bodyweight exercises. The intervention training lasted 12 weeks, with 2 sessions per week totaling 24 sessions, each lasting 60 min. The pre- and post-tests were compared using t-tests to examine within- and-between-group differences. The effect size was examined based on the interaction between group and time using a two-way repeated measures ANOVA. The Modified Timed Up and Go manual (TUG manual), Sharpened Romberg Test (SRT), and Y-balance test (YBT) were conducted to assess dynamic stability, including gait function, static stability, and reactive ability. In comparison between groups, the waterbag training group showed a decrease in task completion time associated with an increase in walking speed in the TUG manual test (p < 0.05), and an increase in static stability and reaction time in the Sharpened Romberg test with eyes closed (p < 0.05), and an increase in single-leg stance ability in both legs in the Y-balance test (p < 0.05). All statistical confidence interval levels were set 95%. INT using the inertial load of water enhanced the somatosensory system and gait related to dynamic stability in older women. Therefore, the clinical application of this training program is expected to reduce the risk of falls in healthy older women, improving dynamic stability related to gait. Full article

(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability. Full article