Search Results (51)

Background: Preterm birth, affecting more than 13.4 million infants worldwide each year, remains one of the leading causes of neonatal morbidity and mortality. Among its complications, respiratory distress syndrome and bronchopulmonary dysplasia are predominant contributors to prolonged hospitalization and respiratory support needs. As advances in perinatal care have improved survival, attention has increasingly turned to optimizing respiratory function and reducing complications through non-pharmacological interventions. Respiratory physiotherapy has therefore gained recognition as a valuable adjunct to medical management in this population. Purpose: To provide a comprehensive synthesis of the current clinical evidence regarding respiratory physiotherapy techniques used in preterm neonates with respiratory distress syndrome or bronchopulmonary dysplasia. Summary of Evidence: The available literature describes several physiotherapeutic modalities—including prolonged slow expiration, postural treatment, Vöjta therapy, and gentle mechanical techniques—aimed at improving ventilation, gas exchange, and secretion clearance. Across diverse studies, these interventions have been associated with better oxygenation, improved heart and respiratory rates, shorter mechanical ventilation time, and reduced hospital stay, while showing no relevant adverse effects. Although methodological heterogeneity persists, the consistency of beneficial trends supports their integration into multidisciplinary neonatal care. Conclusions: Respiratory physiotherapy represents a safe and promising therapeutic complement for preterm neonates with respiratory distress syndrome or bronchopulmonary dysplasia. Techniques that combine postural control and controlled expiratory maneuvers appear particularly effective in enhancing pulmonary mechanics and recovery. Future research should focus on standardizing intervention protocols, identifying optimal timing and dosing, and evaluating the long-term respiratory and developmental outcomes of these physiotherapeutic strategies. Full article

Background and Clinical Significance: Hemiplegia following a cerebrovascular accident (CVA) disrupts gait symmetry and efficiency, compromising functional independence. The integration of surface electromyography (sEMG) and inertial measurement units (IMU) enables quantitative assessment of muscle activation and segmental dynamics, providing objective data for therapeutic planning. Case presentation: A 57-year-old male with chronic right hemiplegia, eight years post-ischemic stroke of the left middle cerebral artery. The patient ambulated independently without assistive devices, exhibiting right lower-limb circumduction. Clinical assessment revealed the following scores: Barthel Index 85/100, Tinetti Performance-Oriented Mobility Assessment (POMA) 16/28, Timed Up and Go (TUG) test 13 s, and Modified Ashworth Scale (MAS) scores of 1 (upper limb) and 1+ (lower limb). Methods: Multichannel sEMG (Miotool 800^®, 8 channels) was recorded form the lumbar erectors, gluteus medius and maximus, vastus medialis, vastus intermedius, vastus lateralis, biceps femoris, tibialis anterior, medial gastrocnemius, and lateral gastrocnemius. Ag/AgCI electrodes were positioned according to SENIAM recommendations: sampling rate: 1000 Hz; band-pass filter: 20–500 Hz; notch filter: 60 Hz; normalization to %MVC. Simultaneously, IMU signals (Xsens DOT^®, 60 Hz) were collected from both ankles during slow, medium and fast walking (20 s each) and compared with a healthy control subject. Results: The patient exhibited reduced sEMG amplitude and increased peak irregularity on the affected side, particularly in the gluteus medius, tibialis anterior, and gastrocnemius, along with agonist desynchronication. IMU data revealed decreased range of motion and angular pattern irregularity, with inconsistent acceleration peaks in the right ankle compared to the control, confirming neuromuscular and kinematic asymmetry. Conclusions: The combined sEMG-IMU analysis identified deficits in selective motor control and propulsion on the affected hemibody, providing essential information to guide physiotherapeutic interventions targeting pelvic stability, dorsiflexion, and propulsive phase training, enabling objective follow-up beyond specialized laboratory settings. Full article

Background: Patients with neurodevelopmental and neuromuscular disorders often show overlapping clinical phenotypes. Pathogenic variants in KMT5B, a histone lysine methyltransferase, have been linked to neurodevelopmental disorders, yet their effects on human skeletal muscle remain unexplored. We report on a patient with KMT5B-linked disease who presented to a neuromuscular specialty clinic with significant involvement of skeletal muscle, where a multi-omics approach established the genetic diagnosis and revealed neuromuscular findings relevant for diagnosis, care and rehabilitation. Methods: Whole-exome sequencing was performed from blood and data was analyzed using the RD-Connect Genome Phenome Analysis Platform. Histological analysis and proteomic profiling were performed on muscle tissue. Results: Whole-exome sequencing revealed a pathogenic heterozygous variant (c.554_557del, p.Tyr185Cysfs*27) in KMT5B. Histological examination revealed fiber-type grouping, angular fibers, increased fast-twitch fiber proportion, and lipid droplet accumulation, indicative of muscle denervation. Proteomic profiling identified 77 dysregulated proteins, including upregulation of sarcomeric proteins, mitochondrial and glycolytic enzymes, acute-phase and complement factors, and extracellular matrix components, reflecting structural remodeling, metabolic adaptation, and inflammatory activation. These findings align with the role types observed in Kmt5b mouse models, supporting a role of KMT5B in neuromuscular function. Conclusions: We present the first combined histological and proteomic analysis of quadriceps muscle from a patient carrying a pathogenic KMT5B variant with a neuromuscular phenotype. The convergence of histological and proteomic alterations suggests that KMT5B haploinsufficiency may be associated with fiber-type shifts, denervation, and metabolic stress in human skeletal muscle. Understanding these processes provides mechanistic insight into motor deficits and informs targeted therapeutic strategies, including physiotherapeutic interventions, and early compensatory measures. Full article

Background/Objectives: Cerebral palsy (CP) is a non-progressive, permanent syndrome of childhood, with approximately 80% of patients exhibiting spasticity. Untreated spasticity can cause pain, structural changes in bones, muscles, and nerves negatively impacting quality of life and functionality. Photobiomodulation (PBM) has demonstrated biological effects such as tissue regeneration, muscle relaxation, inflammation reduction, and pain relief. The objective of this pilot study is to evaluate the action of PBM on the spasticity of the medial and lateral right gastrocnemius muscles of children and adolescents with spastic cerebral palsy. Methods: This single-blinded, randomized, controlled trial evaluated PBM’s effect on gastrocnemius spasticity in children and adolescents with CP. The study presents pilot preliminary results from twelve children and adolescents (7–16 years) with spastic CP who were randomized into two groups: active PBM (850 nm, 100 mW, 1.5 J/point, 2 points, weekly for 8 weeks) or placebo (same protocol, device off). Both groups received standard rehabilitation exercises. Outcomes were assessed using the Modified Ashworth Scale (MAS), Pediatric Evaluation of Disability Inventory (PEDI), Gross Motor Function Classification System (GMFCS), and ankle range of motion before and after the intervention (8 weeks). Results: MAS and all outcomes improved significantly over time in both groups. No significant differences were found between groups for all outcomes. The PBM effect size on MAS improvement (ANOVA, Analysis of Vari, η² = 0.171) suggests modest but positive benefits. PBM did not worsen spasticity, and no adverse effects were reported. Conclusion: This study represents a pioneering effort in evaluating a safe PBM protocol for the spastics gastrocnemius in children and adolescents with CP. This protocol, used as an adjunct to physiotherapy, demonstrated no short-term adverse effects and no participant dropouts. Future studies should explore this PBM protocol in patients with less severe GMFCS levels, those with minimally preserved functionality, or those with contraindications to physiotherapeutic exercises. Full article

Background: Hemophilia A and B are hereditary bleeding disorders that result in recurrent joint and muscle hemorrhages, leading to hemophilic arthropathy, muscle atrophy, and disability. Recent evidence suggests that physiotherapeutic interventions, including resistance training and manual therapy, may mitigate these effects, although comprehensive studies remain limited. This case series aimed to describe the outcomes of an eight-week physiotherapy program combining progressive resistance training and manual therapy in four adolescent boys (aged 11–17 years) with severe hemophilia. Methods: The program targeted joint function, muscle strength, ultrasound findings, and pain, with additional exploratory evaluation of neuroinflammatory and endothelial biomarkers: interleukin-18 (IL-18), C-C motif chemokine ligand 2 (CCL2), soluble intercellular adhesion molecule-1 (ssICAM-1), β-nerve growth factor (β-NGF), and soluble receptor for advanced glycation end-products (sRAGE). Results: After the intervention, Hemophilia Joint Health Score (HJHS) total scores decreased by 35–62%, indicating functional improvement, while muscle strength increased across most joints. No progression of arthropathy was observed on ultrasound (HEAD-US). IL-18 and ssICAM-1 levels decreased on average by 42% and 29%, respectively, whereas β-NGF and sRAGE increased by 39% and 11%, suggesting potential anti-inflammatory and neuroprotective responses. Conclusions: These descriptive findings indicate that individualized physiotherapy may serve as a supportive component of hemophilia care, while biomarker monitoring provides exploratory insight into treatment-related physiological responses. Full article

Multiple sclerosis is an inflammatory and neurodegenerative disease that leads to motor, cognitive, and sensory impairments, significantly affecting walking and quality of life. This study aimed to analyze the relationship between quality of life and kinematic walking parameters in individuals with multiple sclerosis, as well as to evaluate the influence of fatigue, balance, and cognitive performance on different aspects of quality of life. A cross-sectional observational study was conducted with 32 patients diagnosed with multiple sclerosis with Expanded Disability Status Scale scores of ≤5.5. Quality of life was assessed using the MusiQoL questionnaire, and clinical variables included fatigue (Fatigue Scale for Motor and Cognitive Functions, Borg scale), balance (Berg Balance Scale), and cognitive performance (Trail Making Test). Walking kinematics were analyzed using the Vicon motion capture system to obtain walking speed, step frequency, and joint asymmetry indices. Spearman correlations and linear regression models were applied. Results showed significant correlations between quality of life and walking speed (rho = 0.506), step frequency (rho = 0.508), and knee asymmetry (rho = −0.525), as well as strong associations with cognitive fatigue (rho = −0.796) and balance (rho = 0.635). Regression models explained up to 58.4% of the variance in the Activities of Daily Living dimension. These findings indicate that quality of life in multiple sclerosis is influenced by both clinical and biomechanical factors, highlighting the importance of comprehensive assessments to guide physiotherapeutic interventions. Full article

Background and objectives: Pain is a prevalent and often underestimated issue in children with cerebral palsy (CP). When left untreated, pain can result in secondary complications such as reduced mobility and mental health challenges, which negatively impact social activity, participation, and overall quality of life. This review explores the complex mechanisms underlying pain in CP, highlights contributing factors, and places particular emphasis on diagnostic challenges and multimodal pain management strategies. Methods: Three scientific databases and, additionally, guideline repositories (2015–2025) were searched, yielding 1335 records. Following a two-step deduplication process, 850 unique items remained. Eighty-five full texts were assessed, of which 49 studies were included. These comprised one randomised controlled trial, 16 non-randomised studies, 12 systematic reviews, 8 non-systematic reviews, and 12 guidelines or consensus statements. Methodological quality was appraised with AMSTAR-2 where applicable, and Oxford levels of evidence were assigned to all studies. Results: Study quality was variable: 25% were systematic reviews, with only one randomised controlled trial. This literature identifies overlapping nociceptive, neuropathic, and nociplastic mechanisms of pain development. Classification remains inconsistent, though the International Classification of Diseases provides a useful framework. Only five assessment tools have been validated for this population. Interventions were reported in 45% of studies, predominantly pharmacological (27%) and physiotherapeutic (23%). Evidence gaps remain substantial. Conclusions: This review highlights the complexity of pain in children and adolescents with cerebral palsy and the need for a biopsychosocial approach to assessment and management. Evidence supports individualised, multimodal strategies integrating physical therapies, contextual supports, and, where appropriate, medical or surgical interventions. Clinical implementation remains inconsistent due to limited high-quality evidence, inadequate assessment tools, and poor interdisciplinary integration. Full article

Background: The consequences of median nerve compression at the carpal tunnel level require a precise diagnostic evaluation before a frequently applied surgical intervention. Positive Tinel or Phalen signs are not always related to abnormal results in electroneurographic examinations of sensory and motor nerve fibers, which are intended to confirm final diagnoses, thereby confusing both surgeons and neurophysiologists. In the face of contradictory data, this study aims to reinvestigate these correlations in a randomly chosen population of patients with a primary diagnosis of carpal tunnel syndrome (CTS). Methods: Seventy-five randomly chosen patients with clinically detected CTS underwent neurophysiological studies of median nerve sensory (SNAP) and motor (CMAP) fibers conduction at the wrist. Both the median and ulnar nerves were assessed to reduce the risk of misinterpretation related to anatomical variations. Results: This study provides evidence on the relatively high utility of Phalen’s test in the early clinical detection of CTS within a general population of patients, whose positive results moderately correlate (rho = −0.327) with abnormalities in amplitudes rather than the distal latency parameters of SNAP recordings. The axonal injury type is more distinct than slowing-down impulses at the wrist following compression of the sensory nerve fibers in the early course of CTS. Positive Tinel’s test results are useful in diagnosing CTS patients with advanced axonal and demyelinating changes in the motor fibers at the wrist, which weakly correlate with prolonged latency and decreased amplitude in SNAP recordings (rho = −0.214 and rho = −0.235, respectively), but not with abnormalities in recordings of both amplitudes and latencies in CMAP electroneurography. Conclusions: The correlations between clinical signs and neurophysiological findings in CTS indicate that provocative tests, such as Phalen’s and Tinel’s, have limited diagnostic value, demonstrating only weak-to-moderate associations with neural conduction parameters. A positive Tinel’s sign should be regarded mainly as a marker of severe or chronic sensory impairment, often accompanied by motor fibers involvement in advanced pathological stages, rather than as an indicator of motor damage alone. Nerve conduction studies remain essential for confirming CTS, assessing its severity, and guiding treatment decisions, including surgical qualification. The presented correlation of clinical and functional neurophysiological results in CTS diagnosis allows us not only to specify the source and severity of the pathology of the median nerve fibers but also may influence the personalization of physiotherapeutic and surgical treatments. Full article

Lumbar spine pain (LBP) is a leading cause of disability worldwide and remains a major challenge in clinical practice. Among non-invasive treatment strategies, manual therapy plays a central role, offering individualized interventions that target both biomechanical dysfunction and pain. This narrative review compares three commonly used physiotherapeutic approaches—Kaltenborn-Evjenth mobilization, the McKenzie method, and high-velocity low-amplitude (HVLA) manipulation—based on current evidence regarding their effectiveness, safety, and clinical application. A total of 32 randomized controlled trials, systematic reviews, and meta-analyses published between 2003 and 2024 were analyzed. The Kaltenborn-Evjenth method demonstrated notable effectiveness in improving range of motion and reducing chronic pain, particularly in patients with segmental hypomobility. The McKenzie method showed strong outcomes in both acute and chronic LBP, especially in cases involving symptom centralization and high patient engagement. HVLA techniques offered rapid symptom relief in acute phases but required careful patient selection due to their mechanical intensity. The findings suggest that no single method is universally superior. Instead, optimal outcomes are achieved through individualized treatment plans that integrate multiple techniques based on clinical presentation, pain chronicity, and functional limitations. Multimodal strategies that combine manual therapy with exercise and patient education appear to be the most effective in managing LBP and preventing recurrence. Full article

The aim of this pilot study was to evaluate the relaxation, stress reduction and behavioral changes observed after manual therapy applied to horses exposed to racing and physical training stimulus. This descriptive approach is aimed at veterinary clinicians to evaluate the therapy process more effectively with behavioral feedback. For this purpose, the study was conducted in two different equestrian clubs in Adana (Adana Mediterranean and Suvari Equestrian Clubs) between 2023 and 2024. A total of 32 racehorses (16 Thoroughbred, 16 Arabian; 16 female, 16 male) of different ages, genders and breeds were included in the study. Five minutes of manual therapy was applied for each of 7 different muscle groups. After the massage, behavioral observations were made for 10 min by moving 2 m away from the animals, and no separate baseline assessment was performed prior to the intervention. The application was carried out by a veterinarian with 15 years of experience. Importantly, no separate baseline assessment or control group was performed, and only behavioral responses were evaluated, which represents a major limitation of this pilot study. Among the observed behaviors in all horses, blinking, muscle twitching, respiratory changes, lip relaxation, licking and chewing were recorded for all horses. Relaxation signs such as head dropping (78.1%), yawning (34.4%), and ears falling to the side (62.5%) were frequently observed. Behaviors such as the appearance of the third eyelid (3.1%), grunting (12.5%) and sneezing (15.6%) were observed at a low percentage. Individual variables such as gender and breed did not have a statistically significant effect on the percentage of behavior (Chi-square test, p > 0.05). In conclusion, these preliminary findings suggest that manual therapy applications might be effective in reducing stress by triggering relaxation behaviors in riding horses, as these behaviors have been previously reported in the literature as reliable indicators of relaxation. Evaluation of behavioral responses after massage could be an important tool in determining physiotherapeutic effects. The fact that the application is performed by experienced people is an important factor that increases the success of the therapy and shows that manual therapy provides relaxation regardless of individual differences. Future controlled studies integrating physiological stress biomarkers are warranted to confirm these observations. Full article

Background and Objectives: Facial paralysis involves the complete or partial loss of facial movement due to damage to the facial nerve, leading to impaired voluntary muscle function and facial asymmetry. Given its significant physical and psychosocial impact, there is an urgent need to strengthen the evidence supporting non-pharmacological treatments. This umbrella review aims to compile the most reliable and current data to establish a consensus on the effectiveness of such interventions for patients with facial paralysis. Materials and Methods: This study is an umbrella review. A systematic search was conducted in PubMed, Embase, Scopus, and CINAHL (28 July 2024). The variables assessed included overall healing/recovery rate, facial disability, and facial function. Methodological quality was evaluated using the AMSTAR and ROBIS tools. Screening was performed independently by two reviewers, with a third reviewer resolving any discrepancies. Results: Five systematic reviews were included, all evaluating the impact of non-pharmacological interventions in facial paralysis. The findings suggest that acupuncture and electrical stimulation may improve recovery rates and facial function, although high heterogeneity and methodological limitations were noted in some studies. No definitive conclusions could be drawn regarding facial disability. Conclusions: The combination of electrotherapy with other complementary techniques, such as facial exercises or laser therapy, appears to be a safe and potentially effective approach for facial paralysis rehabilitation. Nonetheless, further research employing standardized protocols and higher methodological quality is necessary to establish more robust conclusions for physiotherapeutic practice. Full article

Objective: Symptomatic flat foot is quite a common pathology in adults. Myofascial release is one of the physiotherapeutic methods that are currently very often used in the treatment of musculoskeletal diseases. This study aimed to assess the impact of myofascial release on the range of motion and functional efficiency of the flat foot in adults. Method: The study involved 60 people with flat feet allocated to four groups and subjected to therapy lasting four weeks: group MRE (Myofascial Release and Exercises; 15 people): myofascial techniques and an exercise programme; group MR (Myofascial Release; 15 people): only myofascial techniques; group E (Exercises; 15 people): only an exercise programme; and the control group C (Control; 15 people): no intervention. Goniometric measurements of the range of motion of the ankle joint and the Foot and Ankle Outcomes Questionnaire (FAOQ) were used to evaluate the effects of the therapy. Results: The range of all tested movements significantly improved after therapy in both feet simultaneously in groups MRE (left foot: dorsiflexion p = 0.017; plantar flexion p = 0.006; inversion p = 0.003; and eversion p = 0.001; right foot: dorsiflexion p = 0.008; plantar flexion p = 0.003; inversion p = 0.008; and eversion p = 0.004) and MR (left foot: dorsiflexion p = 0.001; plantar flexion p = 0.001; inversion p = 0.001; and eversion p = 0.001; right foot: dorsiflexion p = 0.001; plantar flexion p = 0.002; inversion p = 0.001; and eversion p = 0.029). The FAOQ results were significantly better after therapy in groups MRE (p = 0.010), MR (p = 0.001) and E (p = 0.015). Conclusions: In the people studied, the combination of myofascial techniques and exercises (MRE) was the most effective for improving the tested ranges of motion of the ankle joint. Myofascial techniques had a significant impact on the performance of the feet assessed with the FAOQ. Full article

Objective: Although Global Postural Re-education (GPR) is widely used for musculoskeletal conditions, its specific benefits for this population remain unclear due to inconsistent findings across studies. This systematic review aims to analyze the effects of GPR on pain intensity, functionality, and range of motion (ROM) in individuals with chronic non-specific neck pain. Methods: Computerized search was performed in the Cochrane CENTRAL, Lilacs, EBSCO, PEDro, Pubmed, RCAAP and Scielo databases using the keyword combination (“Global Postural Rehabilitation” OR “Global Postural Reeducation” OR “Global Posture Reeducation” OR “Global Postural Re-education” OR “GPR”) AND (“Neck Pain” OR “Cervicalgia”). Methodological quality was assessed using the Physiotherapy Evidence Database Scale. Results: Six studies with a total of 393 participants (322 women, aged 18–80) were included. The methodological quality was moderate (average PEDro score: 6.7/10), with frequent limitations related to lack of blinding and allocation concealment. Risk of bias was rated as “some concerns” in four studies and “high” in two. GPR was associated with improvements in pain intensity, functionality, and cervical ROM (flexion/extension). While three studies found no significant differences between GPR and static stretching or specific cervical exercises, the remaining three studies reported greater improvements with GPR compared to manual therapy or traditional neck education and exercise therapy. No adverse effects were reported in any of the included trials. Conclusions: GPR appears to be a safe and potentially effective intervention for individuals with chronic non-specific neck pain, particularly in improving pain, function, and cervical ROM. Nonetheless, further high-quality randomized controlled trials are needed to confirm its superiority over other physiotherapeutic interventions and to determine the optimal treatment parameters. PROSPERO registration: CRD420251068974. Full article

Background/Objectives: Adolescent Idiopathic Scoliosis (AIS) is a lateral curvature of the spine combined with rotation and associated postural changes. Curves are classified according to direction and the spinal region, with right thoracic curves being a common presentation. Curve magnitude is measured using Cobb angles on radiographs and is used to monitor curve progression, with one of the main aims of treatment being prevention of progression to surgical levels. Treatment options may include observation, physiotherapeutic scoliosis-specific exercises (PSSE), thoracolumbosacral orthotic (TLSO) bracing, or surgery and are dependent on curve magnitude, risk of progression, and patient goals. Methods: This case series includes five patients (four female and one male, mean age of 14.8 y) who received previous non-surgical treatment without success and had severe right thoracic AIS with an average Cobb angle measurement of 53.4°, involving spinal curve magnitudes that warrant surgical recommendation. Results: These patients’ curves were successfully reduced to nonsurgical levels utilizing a non-surgical, multimodal treatment approach combining 3D corrective TLSO bracing using the ScoliBrace^®, PSSEs, and spinal rehabilitation over an average of 37.0 months. The average Cobb angle reduced from 53.4° to 29.6° (44.6% reduction) after being weaned off treatment. Conclusions: This series has shown successful, clinically significant improvement in Cobb angle and trunk symmetry in five patients with severe AIS using a non-surgical, multimodal approach combining 3D corrective TLSO bracing using the ScoliBrace^® and spinal rehabilitation procedures. Further investigation into this multimodal non-surgical approach for children, parents, and healthcare providers and policymakers seeking an alternative to surgical intervention for AIS is warranted. Full article

Osteoarthritis is the most common disease among the elderly population and is expected to be one of the leading causes of physical disability worldwide. Our objective was to compare the effects of physiotherapeutic interventions versus pharmacological treatment on outcomes and quality of life in elderly patients with osteoarthritis. This cohort study was conducted on 119 elderly individuals aged 60 to 95 years (58.8% women) from the YUYAQ nursing home. Two groups were divided: the intervention group (58 individuals–48.7%) received a two-month physiotherapy program, and the control group (61–51.5%) received exclusive use of anti-inflammatories. Between the intervention and control groups, we observed significant improvements (all p < 0.001) regarding pain (93.1% vs. 60.75%), stiffness (94.8% vs. 62.3%), and functional capacity (96.6% vs. 68.9%). Additionally, the intervention group showed better quality of life than the control group (13.81 vs. 41.38, p < 0.001). Quality of life improvement and clinical outcomes in the treatment group significantly improved in all areas of osteoarthritis, primarily in hip, spine, and knee osteoarthritis (p < 0.001). In conclusion, the physiotherapy intervention improved pain, stiffness, functional capacity, and quality of life in elderly patients with osteoarthritis after two months of treatment. Transitioning from pharmacological treatment to physiotherapeutic treatment in patients with osteoarthritis may substantially improve quality of life and disease symptomatology, but long-term studies are needed. Full article