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Objective The aim of the study was the evaluation of the effects of a single manual medicine treatment (SMMT) for infants with postural and motor asymmetries in upper cervical asymmetry disorder respectively kinematic imbalance due to suboccipital strain (KISS). Methods Design: Multicentre double-blind randomised study Subjects/Setting: 202 infants at the age of 14–24 weeks with postural and movement findings were examined in four study centres using the standardized 4-item Symmetry-Score (points: 4=symmetric to 17=asymmetric). The inclusion criterion was a score of at least 10 points. The intervention group (IG) received a SMMT, whereas the control group (CG) did not receive any manual therapy. In addition, the infants of both groups were trained with a home exercise programme by their parents. Statistical Methods The primary target parameter was the result of the Symmetry-Score, measured before the intervention and 4–6 weeks afterwards. Results 171 children were randomised (IG=83/CG=88). All infants enrolled were measured to the second time-point (Intention-to-treat-analysis). The average improvement of IG compared to CG in Symmetry-Score was 2.3 points (p Conclusions The SMMT significantly improves postural and motor asymmetries in infants with KISS.

BACKGROUND Conservative scoliosis therapy in the form of assisted physiotherapeutic scoliosis exercises is supplemented by self-contained training at home, depending on the approach (e.g., Schroth, SEAS, etc.). Complex exercises, lack of awareness of the importance of training and missing supervision by therapists often lead to uncer-tainty and reduced motivation, which in turn reduces the success of the home-based therapy. Increasing digitalization in the healthcare sector offers opportuni-ties to close this gap. However, research is needed to analyze the requirements and to translate the potential of digital tools into concrete solution concepts. OBJECTIVE The aim of this study was to evaluate potentials for optimizing scoliosis home ther-apy in the topics of motivation, assistive devices, and digital tools. METHODS In collaboration with the Institute of Physiotherapy at the Jena University Hospital, a survey was initiated, which adresses scoliosis patients and physical therapists. A digital questionnaire was created for each target group and distributed via physio-therapies, scoliosis forums and the Bundesverband für Skoliose Selbsthilfe e. V. via link and QR code. The survey collected data on demographics, therapy, exercise habits, motivation, assistive devices, and digital tools. Descriptive statistics were used for the evaluation. RESULTS Of 141 survey participants, 72 scoliosis patients (62 female, 10 male) with an aver-age age of 40 years and 30 scoliosis therapists completed the respective question-naires. The analysis of home-based therapy showed that scoliosis patients exercise less per week (two times or less; 45/72; 62.5%) than they are recommended to do by therapists (at least three times; 53/72; 73.6%). Patients indicated that their mo-tivation could be increased by practicing together with friends and acquaintances (54/72; 75%), a supportive therapy device (48/72; 66.7%) or a digital profile (46/72; 63.9%). The most important assistive devices, which are comparatively rarely used in home-based therapy, include balance boards (20/72; 27.8%), wall bars (23/72; 31.9%), mirrors (36/72; 50%) and long bars (40/72; 55.6%). Thera-pists saw the greatest benefit of digital tools for scoliosis therapy in increasing mo-tivation (26/30; 87%), improving home therapy (25/30; 83%), monitoring therapy progress (25/30; 83%), and demonstrating exercise instructions (24/30; 80%). CONCLUSIONS In this study, we investigated whether there is potential for improvement in the home-based scoliosis therapy. For this purpose, we asked scoliosis patients and therapists via online questionnaires about the topics: Exercise habits, outpatient and home-based therapy, motivation, supportive devices, and digital tools. The re-sults showed that a lack of motivation, suitable training equipment and tools for self-control lead to a low training workload. From the perspective of the patients surveyed, this problem can be addressed by community training with friends or acquaintances, a supportive therapy device and digital elements such as apps with training instructions and user profiles.

Aims Left atrial strain (LAS) and skeletal muscle endurance demonstrate a linear relationship to peak VO2. Less is known about the relationship between central (cardiac) and peripheral (muscle endurance) limitations of exercise capacity in patients with heart failure (HF). We investigated this relationship using novel cardiac markers such as LAS and left atrial ejection fraction (LAEF). Methods We analysed echocardiographic measurements, cardiopulmonary exercise testing, and isokinetic muscle function in 55 subjects with HF and controls (17 heart failure with preserved ejection fraction -HFpEF, 18 heart failure with reduced ejection fraction-HFrEF and 20 healthy controls). Results Patients with reduced LAEF showed reduced peak VO2: 14.3±3.5 vs. 18.5±3.5 ml/min/kg, p=0.003 and reduced muscle endurance (RME): 64.3±23.9 vs. 88.5±32.3 Nm/kg, p=0.028. Patients with reduced LAS showed similar results. Neither left ventricular global longitudinal strain (LVGLS) nor left atrial volume index (LAVI) were associated with RME. The area under the curve of LAS and LAEF in patients with HF in association with RME were (0.76 vs. 0.80) with 95% confidence interval (CI) (0.59–0.96, p=0.012 vs. 0.63–0.98, p=0.006, respectively). Peak torque of the left leg was associated with E/LAS (E: early diastolic) in patients with HFpEF (r=−0.6, p=0.020). Endurance of the left leg was associated with LAEF (r=0.79, p=0.001) in patients with HFrEF. Conclusion LAS/LAEF are potential cardiac markers in demonstrating the link between cardiac and peripheral limitations of exercise capacity. Thus, integrating LAS/LAEF in the evaluation of exercise intolerance in patients with HF could be useful. Funding Acknowledgement Type of funding sources: None.

Introduction Postural control plays a central role in dance performance. The most dance styles contain manifold balance requirements. However, the data available on balance performance in dance is meagre. The dancers’ balancing ability depends on different components, which are still not totally understood. It can be assumed that standing stability as well as balance and therefore the test results of dancers are better than those of the recently published norm values. The aim of the study is to compare and verify the published standard values of the Jenaer-Standing-Stability-Score (JESS-Score). Material and Methods 24 dancers were included and measured with the first version of the recently published JESS-Score. 11 items include the assessment of mobility, sensorimotor skills, posture control and strength endurance. The dancers average test results are compared to the norm population. Results The dancers reached the norm or were even better concerning the tested items of the JESS-Score. Conclusion Standing stability and balance are basic requirements for dancing. The components measured by the JESS-Score are clearly involved in the equilibrium performance. Moreover, it shows the applicability of the JESS-Score norm values to a healthy, but untrained control population.

Menschen mit einer zervikalen Dystonie leiden in Folge unwillkürlicher Anspannungen der Hals- und Nackenmuskulatur häufig unter Schmerzen und einer eingeschränkten Bewegungsfähigkeit. In diesem Artikel erfahren Sie, warum forcierte Dehnungen und Massagegriffe an der betroffenen Muskulatur kontraindiziert sind.

BackgroundThere are different therapeutic approaches to persistent positional preference (kinematic imbalance due to suboccipital strain, KISS) in infants. There are no evidence-based or controlled studies investigating the effect of manual medicine treatment in children aged 3–6 months, particularly in combination with a home exercise programme. The presented monocentric study on one-time manual medicine treatment of infants aged 14–24 exhibiting these symptoms aims to close this gap.MethodsThis study comprises a controlled double-blind trial and per-protocol-analysis. Primary outcome was the 4-item symmetry score (4–17 points). The second measurement was performed after 4–6 weeks.ResultsA total of 62 infants were treated and evaluated (mean age 17 weeks). The intervention and control groups started with a symmetry score of 12.9 ± 2.1 and 12.5 ± 1.7 points, respectively. In the intervention group the score improved by 4.9 ± 2.4 to 8.0 ± 2.7 points, in the control group it improved by 2.9 ± 2.9 to 9.6 ± 3.0 points. The difference between the groups was statistically significant (p = 0.03). Both groups had significantly better values over time (p ConclusionManual medicine treatment of infants with postural and movement asymmetries as well as positional preference in combination with a home exercise programme is superior to a home exercise programme alone. Both treatment concepts achieved significant improvements. However, the manual medicine treatment played an important role in reducing the symmetry score value for the affected children, such they were no longer in need of treatment.

Aims: Metabolic and structural perturbations in skeletal muscle have been found in patients with heart failure (HF) both with preserved (HFpEF) and reduced (HFrEF) ejection fraction in association with reduced muscle endurance (RME). We aimed in the current study to create phenotypes for patients with RME and HFpEF compared to RME HFrEF according to their metabolomic profiles and to test the potential of Kynurenine (Kyn) as a marker for RME. Methods: Altogether, 18 HFrEF, 17 HFpEF, and 20 healthy controls (HC) were prospectively included in the current study. The following tests were performed on all participants: isokinetic muscle function tests, echocardiography, spiroergometry, and varied blood tests. Liquid chromatography tandem mass spectrometry was used to quantify metabolites in serum. Results: Except for aromatic and branched amino acids (AA), patients with HF showed reduced AAs compared to HC. Further perturbations were elevated concentrations of Kyn and acylcarnitines (ACs) in HFpEF and HFrEF patients (p < 0.05). While patients with HFpEF and RME presented with reduced concentrations of ACs (long- and medium-chains), those with HFrEF and RME had distorted AAs metabolism (p < 0.05). With an area under the curve (AUC) of 0.83, Kyn shows potential as a marker in HF and RME (specificity 70%, sensitivity 83%). In a multiple regression model consisting of short-chain-ACs, spermine, ornithine, glutamate, and Kyn, the latest was an independent predictor for RME (95% CI: −13.01, −3.30, B: −8.2 per 1 µM increase, p = 0.001). Conclusions: RME in patients with HFpEF vs. HFrEF proved to have different metabolomic profiles suggesting varied pathophysiology. Kyn might be a promising biomarker for patients with HF and RME.

Purpose Tinnitus is a common symptom with multiple causes and treatment options. Previous studies have investigated the effect of lidocaine iontophoresis. The aim of this review is to systematically present the effects on tinnitus and to derive possible effects. Methods In accordance to the PRISMA statement, the search and analysis were performed. An abstract in German or English and a performed intervention with lidocaine iontophoresis for the treatment of tinnitus, independent of the study design, were considered as inclusion criteria. Due to the heterogeneity of the studies, only a narrative synthesis was performed. Results The search yielded 179 studies of which 170 were excluded. Six full-texts and three abstracts were included. In total, 957 patients were treated with lidocaine iontophoresis. The percent improvement in symptoms after lidocaine iontophoresis ranged from 4% to 62%. The qualitative assessment of the studies resulted in an overall “weak” rating for all of them. Conclusions Due to the heterogeneity and the limited quality of the studies found, no clear statement can be made about the efficacy. The number of those who benefited from therapy varied widely. In addition, it cannot be ruled out that the effect was merely due to electrical stimulation of the cochlea.

Cognitive deficits and fear of falling (FOF) can both influence gait patterns in Parkinson’s disease (PD). While cognitive deficits contribute to gait changes under dual-task (DT) conditions, it is unclear if FOF also influences changes to gait while performing a cognitive task. Here, we aimed to explore the association between FOF and DT costs in PD, we additionally describe associations between FOF, cognition, and gait parameters under single-task and DT. In 40 PD patients, motor symptoms (MDS-revised version of the Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr), FOF (Falls Efficacy Scale International), and Montreal Cognitive Assessment (MoCA) were assessed. Spatiotemporal gait parameters were recorded with a validated mobile gait analysis system with inertial measurement units at each foot while patients walked in a 50 m hallway at their preferred speed under single-task and DT conditions. Under single-task conditions, stride length (β = 0.798) and spatial variability (β = 0.202) were associated with FOF (adjusted R2 = 0.19, p < 0.001) while the MoCA was only weakly associated with temporal variability (adjusted R2 = 0.05, p < 0.001). Under DT conditions, speed, stride length, and cadence decreased, while spatial variability, temporal variability, and stride duration increased with the largest effect size for speed. DT costs of stride length (β = 0.42) and age (β = 0.58) explained 18% of the MoCA variance. However, FOF was not associated with the DT costs of gait parameters. Gait difficulties in PD may exacerbate when cognitive tasks are added during walking. However, FOF does not appear to have a relevant effect on dual-task costs of gait.

Mild motor abnormalities can herald the beginning of Parkinson´s disease but their diagnostic value is limited by multifactorial ageing-related influences on motor function. We characterized mild motor abnormalities in different motor domains by conducting a systematic motor assessment in 20 patients with clinically isolated REM sleep behaviour disorder (iRBD) without parkinsonian motor signs and 20 healthy controls. We addressed the influence of lifestyle factors and age on motor function, which needs to be distinguished from neurodegenerative motor features, and assessed the diagnostic value of innovative and established quantitative motor tests in iRBD. Patients with iRBD showed abnormalities in perceptual motor speed (falling stick test), trunk movement coordination (bend, twist and touch test) and dynamic balance (line walk test) without alterations in simple motor speed (alternate tap test), dexterity (grooved pegboard), static balance (force plate) and gait (timed up and go test). The falling stick test showed the highest diagnostic accuracy in identifying subjects with RBD (ROC-AUC 0.85, p ≤ 0.001). Multivariate analysis revealed physical activity and age as additional determinants of motor test performance. iRBD comprises a wide spectrum of mild motor abnormalities which cannot be verified by established tests for motor speed, gait and balance. The falling stick test, an innovative screening test for perceptual motor speed, provides high diagnostic potential in identifying subjects with subclinical neurodegenerative symptoms before parkinsonian motor signs become apparent. Normative data for physical activity and age need to be obtained to ensure correct interpretation of motor test results in prodromal Parkinson-related disease.

Zusammenfassung Fragestellung Untersucht wurde die Anwendbarkeit des Fragebogens Heidelberger Health Score 3.0 (HHS 3.0) zur Erfassung der Arbeitsfähigkeit und der berufsbezogenen Gesundheitsfaktoren in einer Verlaufsbeobachtung im betrieblichen Setting. Methode Es liegt ein multizentrisches Prä-Post-Studiendesign vor. Der HHS 3.0 kam bei 121 Beschäftigten zum Einsatz. Es erfolgte eine zehnmonatige Intervention zur Gesundheitsförderung. Die Interventionsgruppe wurde mit einer Kontrollgruppe (n=49) sowie mit Referenzdaten (n=1253) verglichen. Ergebnisse Es konnten bei der Interventions- im Vergleich mit der Kontrollgruppe positive Effekte auf den Gesamt-Score, das Aktivitätsprofil und die mentale Widerstandsfähigkeit (p≤0,001–0,002) belegt werden. Schlussfolgerung Der HHS 3.0 kann unter Einbezug der Referenzdaten zur Bedarfsanalyse sowie unter Verwendung einer Kontrollgruppe zur Evaluation gesundheitsfördernder Maßnahmen eingesetzt werden. Hierbei sind jahreszeitliche Einflussgrößen zu berücksichtigen. Für Unternehmen ist es von Bedeutung, die Vergleichspopulation je nach Zielstellung der Befragung zu wählen.

Impaired tissue oxygenation is the key pathomechanism in the development of organ dysfunction in shock; mitochondrial impairment can aggravate the condition. However, measuring tissue oxygenation directly and non-invasively still poses a clinical challenge. A novel device (COMET) allows the assessment of mitochondrial oxygen metabolism using the Protoporphyrin IX Triplet State Lifetime Technique (PpIX-TSLT). Critically ill patients, especially in sepsis, often exhibit oedema which may interfere with the COMET measurement. Furthermore, patients' physical activity level differs significantly before and during hospitalisation. Thus, the aim of this study was to identify the effects of physical activity and body composition on mitochondrial oxygen tension (mitoPO2) and consumption (mitoVO2) in healthy controls (N = 40). Furthermore, the study tested the repeatability of the COMET variables and identified covariates. Multiple COMET measurements were performed before (T1, T2), during and after (T3, T4) ergometry. Body composition was assessed by bioimpedance analysis. Physiological variables (blood pressure, heart rate, oxygen saturation) were recorded. In the analytical sample (n = 26), physical activity significantly decreased mitoVO2; other COMET variables remained unchanged between T2 and T3. During ergometry, mitoPO2 increased significantly. The distribution of body water significantly influenced mitoVO2. In our setting, the method demonstrated moderate repeatability. Variables of fitness (heart rate recovery, phase angle and physical activity level), signal quality and duration of exposure to 5-aminolevulinic acid (obligatory for PpIX-TSLT) were identified as significant covariates of mitoVO2. Mitochondrial oxygen delivery (mitoDO2) was established as a new variable of COMET analysis. Results of this pilot study should be validated in future studies.

ZusammenfassungDie motorische Differenzierungsfähigkeit ist eine Eigenschaft, welche essentiell für die Bewegungsausführung ist. Der Zielschritt-Test eröffnet die Möglichkeit diese Fähigkeit zu überprüfen und einzuschätzen. Dieser Test wird hier vorgestellt.

Background: Reduced exercise capacity in patients with heart failure (HF) could be partially explained by skeletal muscle dysfunction. We compared skeletal muscle function, structure, and metabolism among clinically stable outpatients with HF with preserved ejection fraction, HF with reduced ejection fraction, and healthy controls (HC). Furthermore, the molecular, metabolic, and clinical profile of patients with reduced muscle endurance was described. Methods: Fifty-five participants were recruited prospectively at the University Hospital Jena (17 HF with preserved ejection fraction, 18 HF with reduced ejection fraction, and 20 HC). All participants underwent echocardiography, cardiopulmonary exercise testing, 6-minute walking test, isokinetic muscle function, and skeletal muscle biopsies. Expression levels of fatty acid oxidation, glucose metabolism, atrophy genes, and proteins as well as inflammatory biomarkers were assessed. Mitochondria were evaluated using electron microscopy. Results: Patients with HF with preserved ejection fraction showed compared with HF with reduced ejection fraction and HC reduced muscle strength (eccentric extension: 13.3±5.0 versus 18.0±5.9 versus 17.9±5.1 Nm/kg, P =0.04), elevated levels of MSTN-2 (myostatin-2), FBXO-32 (F-box only protein 32 [Atrogin1]) gene and protein, and smaller mitochondrial size ( P P P =0.043], log10 CPT1B per fold increase [B, 49.3 (95% CI, 1.90–96.77), P =0.042]; oral anticoagulation present [B, 44.8 (95% CI, 27.90–61.78), P Conclusions: Patients with HF with preserved ejection fraction have worse muscle function and predominant muscle atrophy compared with those with HF with reduced ejection fraction and HC. Inflammatory biomarkers, fatty acid oxidation, and oral anticoagulation were independent factors for predicting reduced muscle endurance.

Demographischer Wandel, vermehrte Ausgrenzung und erhohte Krankheitstage alterer Beschaftigter bringen Unternehmen in die Verantwortung, praventive Ansatze zu ergreifen, die gesundes Arbeiten und Teilhabe der Beschaftigten bis ins Alter ermoglichen. Das vorliegende Projekt „Gesund mit Erfahrung“ hat 31 Beschaftigte zu Gesundheitsmentoren geschult. Neben dem Wissenserwerb erfolgte die Ableitung und Umsetzung von Gesundheitsstrategien. Das Mentorenkonzept fuhrt die Wissensvermittlung weiter und setzt sie in konkrete Handlungen um. Es resultiert ein fundiertes Mentorenkonzept, welches sich aus Schulungsinhalten sowie Arbeits- und Praxishilfen zur Entwicklung von Gesundheitsstrategien zusammensetzt. Der Pausenwurfel, die Tauschborse und das Bewegungsspiel stellen konkrete Hilfen fur eine gemeinsame gesunde Pausenkultur dar. Das partizipative Konzept mit seinen Hilfen unterstutzt Unternehmen bei der Entwicklung und Umsetzung von Gesundheitsstrategien und der Teilhabeforderung von Beschaftigten.

Background Treatment of choice for cervical dystonia comprises botulinum neurotoxin therapy. Whether additional physiotherapy can achieve better results is unclear. Objectives To show effects of physiotherapy as an add-on treatment to botulinum neurotoxin therapy. Methods 18 patients participated in this prospective interventional study (DRKS00006562) consisting of 2, 3-month periods. In the first period, usual botulinum toxin was applied. The second period comprised an additional multimodal physiotherapy program. Outcome measures were: range of motion, SF-36, Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), surface electromyography. Results In the comparison first phase vs. second phase patients showed significant improvements in range of motion (flexion/extension: 16.3 ± 25.4; rotation: 19.1 ± 24.6), TWSTRS (severity: 3.8 ± 3.0; disability: 1.7 ± 2.0; pain: 4.4 ± 4,1) and in mental health (SF-36: 5.9 ± 7.5); p Conclusion Multimodal physiotherapy is a feasible and save additional treatment option for patients with cervical dystonia. An add-on physiotherapy program can achieve better treatment outcomes. Patients benefited especially with improved range of motion, and reduced pain and severity of symptoms.

Zusammenfassung Fragestellung Trotz ergonomischer Arbeitsmittel sind berufsbedingte muskuloskeletale Erkrankungen die häufigste Ursache für Arbeitsunfähigkeit. Anhand des Oberflächen-EMGs kann muskuläre Beanspruchung über Amplitudenwerte ermittelt werden. Um einen Teil der Arbeitsausfälle zu verhindern, stellt sich die Frage, ob sich die muskuläre Beanspruchung bei der Nutzung verschiedener PC-Eingabegeräte voneinander unterscheidet? Material und Methodik Es werden unterschiedliche PC-Eingabegeräte getestet, mit denen Probanden verschiedene Textverarbeitungsaufgaben ausführen müssen. Die Amplitude des OEMGs wird am M. extensor digitorum und am M. trapezius descendens gemessen. Zudem werden die Winkelgrade des Handgelenks von Supination und Extension über einen Goniometer erfasst. Zielstellung Es soll überprüft werden, ob ergonomische PC-Mäuse gegenüber gewöhnlichen PC Eingabegeräten geringere muskuläre Beanspruchung verursachen. Zudem soll durch den Einbezug der Sitzhaltung sowie der Handgelenksposition eine Einteilung der Arbeitsbeanspruchung vorgenommen werden.

Zusammenfassung Fragestellung Muskuloskeletale Erkrankungen zählen zu den häufigsten berufsbedingten Erkrankungen. Mittels Oberflächen-Elektromyografie (OEMG) lässt sich der muskuläre Beanspruchungsgrad messen, der die beruflichen Tätigkeiten am Bildschirmarbeitsplatz widerspiegelt. In Untersuchungen konnte eine Korrelation zwischen statischer Haltung mit wiederkehrend gleichen Bewegungen und berufsbedingten muskuloskeletalen Erkrankungen nachgewiesen werden. Vor diesem Hintergrund stellt sich die Frage, ob das OEMG hinreichende Daten zur Analyse körperlicher Beanspruchung am Bildschirmarbeitsplatz liefert. Material und Methoden Eine systematische Literaturrecherche zu Electromyografy AND Work-Related Disorders innerhalb der Datenbank Web of Science Core Collection wurde durchgeführt. Ergebnisse Von 124 Abstracts wurden 19 in die Volltextanalyse einbezogen. Diskussion Die OEMG ist eine effektive Methode muskuläre Beanspruchungen zu erfassen, jedoch fehlen einheitliche Datenpools, um eine Klassifikation der Daten vorzunehmen. Schlussfolgerung Einheitliche Studiendesigns sind zwingend notwendig, um gesundheitsförderliche Ableitungen treffen zu können.

Zusammenfassung Ziel der Studie Nachweis von Wirkunterschieden von Ultraschall bzw. Leistungslaser in Kombination mit Manueller Therapie auf die Lebensqualität bei LWS- und Schulterpatienten. Methodik 2×20 Patienten mit LWS- bzw. Schulterbeschwerden wurden randomisiert in ein Parallel-Design eingeschlossen. Nach 2 Wochen Wash-Out-Phase erfolgte die Behandlung mit Ultraschall bzw. Laser und Manueller Therapie über 2 Wochen mit insgesamt 6 Behandlungsterminen. Ein Follow-up von 4 Wochen wurde ebenfalls in die Untersuchung einbezogen. An 4 Messzeitpunkten wurden SF-36, EQ-5D, DASH bzw. FFbH-R ausgewertet. Ergebnisse Besserungen sämtlicher Assessmentscores im Studienzeitraum. Kein Unterschied zwischen Regionen und Anwendungen. Schlussfolgerung Laser und Ultraschall in Kombination mit Manueller Therapie führten bei der Studienpopulation zur Besserung der Assessmentscores.

The FED method (Fixation, Elongation, Derotation) is a treatment method approach to Patients with scoliosis. The FED method is especially established in Spain and Poland, whereby in Germany it is less well-known. Nevertheless the FED method is within the scope of a research project (Project Number: 19200 BR/3). The purpose of the paper is to characterize the FED method and to highlight the specificities in contrast to the Schroth method, which is international established and especially in Germany.This systematic literature research was conducted in Nov 2017-Jan 2018. Therefore common medical and physiotherapeutic databases were used. Furthermore there was a hand search in selected scientific journals. Only a small number of relevant references were identified. That is why the respective authors were asked to provide the full-texts of their papers and to recommend further references.A total of 378 references were identified. After removing duplicates and the content-related selection, 19 references were deemed to be relevant. Based on the analysis of this relevant literature, the FED method was comprehensively characterized. First of all the general structure of the FED method and the scientific evidence for its effectiveness was described. And as a result of the literature research, the operating principles of the FED method were pointed out. Then these operating principles were discussed in comparison with the Schroth method. The Schroth method based on sensomotoric and kinesthetic principles and the correction of the pathologic posture was performed by selective muscle activation and breathing-pattern. Thus, the posture correction will be performed by the patients (auto correction). Compared to the Schroth method, the FED method implements the posture correction by the FED-device. This correction is influenced by mechanical forces with a comparatively high strength and intensity. The repetitive mechanical correction stimulates the sensomotoric system. And due to trophic/biochemical adaptations, the physiological bone growth will be stimulated.In total the authors want to clarify, that both treatment methods (Schroth method, FED method) supposed to be applied in consideration of the preconditions of the patients and the pursue of the different treatment goals. Thus, the implementation of treatment methods should be used according to the individual treatment demand and on different stages in the treatment process.Die FED-Methode (Fixation, Elongation, Derotation) wird vor allem in Spanien und Polen zur Behandlung von Skoliose eingesetzt. Die FED-Methode wird in einem aktuellem Forschungsprojekt (Förderkennzeichen: 19 200 BR/3) beforscht. Mit dem Ziel, die in Deutschland eher unbekannte FED-Methode zu charakterisieren und deren Besonderheiten zu verdeutlichen, wurde eine systematische Literaturrecherche durchgeführt.Die systematische Literaturrecherche wurde von November 2017 bis Januar 2018 durchgeführt unter Verwendung gängiger Literaturdatenbanken und einer Handsuche. Da nur relevante Literaturstellen identifiziert wurden, wurden die beteiligten Autoren um die nicht zugänglichen Volltexte sowie um weitere Literaturempfehlungen gebeten.Insgesamt ergab die Literatursuche 378 Referenzen. Nach der Entfernung von Duplikaten und der inhaltlichen Selektion wurden insgesamt 19 relevante Literaturstellen identifiziert und der Volltextanalyse unterzogen. Die vorliegende Übersichtsarbeit bietet eine ganzheitliche Charakteristik der FED-Methode. Neben dem allgemeinen Aufbau der Behandlungsmethode und der wissenschaftlichen Evidenz wurden auf Grundlage der Literaturanalyse die Wirkprinzipien der FED-Methode umfassend beschrieben und gegenüber der Schroth-Methode abgegrenzt. Die FED-Methode verfolgt im Unterschied zur Schroth-Methode eine mechanische Haltungskorrektur mit vergleichsweise hohen einwirkenden Kräften. Die repetitive Haltungskorrektur bewirkt beim Patienten eine Verbesserung der Sensomotorik und durch trophische Veränderungen die Stimulation des gesunden Knochenwachstums.Insgesamt ist zu verdeutlichen, dass die beiden Behandlungsmethoden unter Berücksichtigung der Grundvoraussetzungen der jeweiligen Patienten eingesetzt werden müssen. Aufgrund dessen und wegen ihrer verschiedenen Zielrichtungen können diese methodisch an unterschiedlichen Zeitpunkten im Therapieverlauf bzw. entsprechend des Behandlungsbedarfs angewendet werden.

AIMS Vaginal surface electromyography (sEMG) is a tool used for the diagnosis and therapeutic intervention of urinary incontinence. Current sEMG systems differ in regard to electrode arrangement and data reproducibility. The aim of this study was to determine the intrasession, intraday, and interday reliabilities of sEMG parameters using a probe with circumferential electrode-position. METHODS The intrasession, intraday, and interday reliabilities of maximum isometric voluntary contractions (MVC) of the pelvic floor muscles were assessed for 19 healthy continent women. Three sEMG parameters that are used to describe muscle activity were verified: maximal EMG (EMGmax ), mean over 500 ms around EMGmax (EMGA0.5 ), and mean over 2 seconds during MVC plateau (EMGA2-4 ). Relative and absolute reliability parameters were calculated, and the statistical methods described by Bland and Altman were applied to the data. RESULTS We observed substantial reliabilities for all obtained parameters (EMGmax , EMGA2-4 , and EMGA0.5 ) in regard to the intrasession measurements (ICC = 0.93-0.97; CI = 0.86-0.99). Overall, the intraday reliability has been moderate (ICC = 0.64-0.75; CI = 0.27-0.90). EMGmax (ICC = 0.75; CI = 0.45-0.90) and EMGA2-4 (ICC = 0.73, CI = 0.42-0.89) were higher than EMGA0.5 (ICC = 0.64; CI = 0.27-0.85). However, the interday reliability was only fair for EMGmax (ICC = 0.48; CI = 0.04-0.77) and EMGA0.5 (ICC = 0.51; CI = 0.07-0.78) but moderate for EMGA2-4 (ICC = 0.65; CI = 0.28-0.85). CONCLUSIONS This intrasession, intraday, and interday reliability results are similar to the results reported in the literature using probes with longitudinally oriented bars. The mean sEMG signal over 2 seconds (EMGA2-4 ) exhibited the highest reliability and is recommended for further studies. The interday reliability might be enhanced by considering the menstruation cycle.

Treatment modalities of spinal pain patients are discussed diversely, and different multimodal therapy programs have been developed. Purpose of the present study was to evaluate therapy outcome and effectiveness of an inpatient interdisciplinary and multimodal treatment program. This prospective multicentre clinical trial has been performed with patients from orthopedic hospitals receiving a functional musculoskeletal therapy pathway. Outcome measures were pain intensity and back-specific function (Oswestry Disability Index) before (T1) and after the intervention (T2) as well as after 6 and 12 months (T3, T4). Statistical approach included parametric (t test) and nonparametric (Wilcoxon-test) tests and the calculation of effect sizes. Additionally, a statistical subgroup analysis based on selected parameters (degree of pain chronicity, gender, and age) was performed using linear mixed models. In total, 249 patients (42.6% men, 57.4% women) with spinal pain were included, 133 patients were accessible for follow-up at T3 and 106 patients at T4. Average pain (AP) reduced significantly (P

Chronische Schmerzsyndrome des Bewegungssystems sind ein bedeutender Kostenfaktor. Trotz dieser Ausgaben sind die Behandlungsergebnisse oft nicht zufriedenstellend. Ist die stationare multimodale muskuloskeletale Komplexbehandlung bei Patienten mit chronisch vertebragenem Schmerzsyndrom wirksam? In einer Voruntersuchung wurde an 40 Patienten mit vertebragenem Schmerzsyndrom die Veranderung der Parameter Schmerz, Funktion und Psychometrie gemessen. Das interdisziplinare Diagnostik- und Therapieschema wurde von der Arbeitsgemeinschaft nichtoperativer orthopadischer manualmedizinischer Akutkliniken (ANOA) erarbeitet, standardisiert und mit dem OPS-Kode 8-977 im DRG-Entgeltungssystem verankert. Es besteht aus einer interdisziplinaren multimodalen Diagnostik und Komplexbehandlung des Bewegungssystems von mindestens 12 Tagen. Bei allen untersuchten Parametern konnte eine Verbesserung unter der Therapie festgestellt werden. Im primaren Zielkriterium Schmerz (von Korff) zeigte sich eine signifikante Reduktion des aggregierten Schmerzes (68,33→59,75; p=0,00). Die Schmerzwahrnehmung der letzten 14 Tage zeigte nur die Tendenz der Besserung (6,20→5,98; p=0,183). Beim Kriterium Funktion (Oswestry-Score) konnte dies statistisch signifikant belegt werden (37,95→28,88; p=0,00). Die Hospital Depression and Anxiety Scale (HADS) zeigte signifikante Verbesserungen fur Angst (6,77→4,90; p=0,00) und Depression (6,00→4,10; p=0,00) nach Abschluss der Intervention. Die kurzfristige Therapieeffektivitat des ANOA-Ansatzes konnte nachgewiesen werden. Die verwendeten Instrumente erscheinen geeignet, Veranderungen zu messen. Die Ergebnisse dienen zur Fallzahlplanung einer multizentrischen Studie. Der Nachweis der Nachhaltigkeit der Therapieerfolge steht aus.

Zusammenfassung Fragestellung Die Arbeit soll einen aktuellen Überblick über die konservativen Therapieverfahren (skoliosespezifischen Physiotherapie) bei Patienten mit idiopathischer Adoleszentenskoliose (AIS) im Allgemeinen liefern. Im Speziellen ist die FED-Methode (Fixation, Elongation, Derotation), welche Inhalt eines Forschungsprojektes (Förderkennzeichen: 19200 BR/3) ist, Gegenstand der Recherche. Material und Methoden Diese narrative Literaturrecherche wurde in den Zeitraum von Nov. 2016 bis Jul. 2017 durchgeführt. Die erste Recherche erzielt die Auflistung der Therapieverfahren für Skoliosepatienten, während der zweite Teil der Charakterisierung dieser Verfahren dient. Ergebnisse Insgesamt wurden 34 relevante Literaturstellen identifiziert und der Volltextanalyse unterzogen. Es existieren Behandlungsverfahren mit und ohne Autokorrektur. Zu den Behandlungsverfahren mit Autokorrektur zählen die folgenden Konzepte: Schroth-Methode, Side Shift Program, SEAS-Program, DoboMed, Lyon School, BSPTS, FITS und teilweise Klapp’sches Kriechen. Die Verfahren Vojta-Therapie, PEP-Programm, Hanke-Konzept E-Technik®, Bobath-Konzept, PNF und Riemenübungen gehören zu den Behandlungsverfahren ohne Autokorrektur. Diskussion Die Schroth-Methode ist ein grundlegendes Therapieverfahren, woraus sich weitere Verfahren ableiteten. Zur Charakterisierung der FED-Methode (Fixation, Elongation, Derotation) wurde keine Referenz gefunden. Dieses Behandlungsverfahren wurde lediglich kurz in einer Arbeit erwähnt. Schlussfolgerung Verschiedene Verfahren werden bei AIS angewendet. Diese Arbeit bietet einen Überblick über diese Therapieverfahren. Weitere Untersuchungen sollten sich mit den Wirkmechanismen der die FED-Methode befassen.

Background: The treatment of choice for cervical dystonia comprises a local injection of botulinum neurotoxin type A (BoNT-A). Whether additional physiotherapy can achieve better results is not clearly documented in the literature. The present study aims to show possible effects of physiotherapy as an add-on treatment to therapy with botulinum neurotoxin type A in terms of pain, severity of dystonia, statics and function of the cervical spine as well as the quality of life in order to optimize the treatment of cervical dystonia. Design/Methods: This is a prospective, single-center, interventional study of a target patient population comprising 20 participants. The study is divided into 2 phases, with each phase lasting for 3 months. During the first phase, the usual BoNT-A will be applied. In addition, the baseline values will be collected and these assessments will be repeated at an interval of 6 weeks. In the second phase, participants will undergo a physiotherapy program consisting of two 45 min sessions per week in addition to the BoNT-A treatment. The assessments will be undertaken at the same intervals as in the first phase. Analysis: In order to determine the effect of the add-on physiotherapy program, the following parameters will be measured for each assessment: quality of life using the SF- 36 score and the range of motion determined by the ZEBRIS measurement system which will comprise the primary endpoints. Furthermore, for each assessment the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and electrical activity from the trapezius and the sternocleidomastoid muscles measured by a surface electromyography will be recorded. Descriptive statistical analysis will be performed for all of the collected data. Possible changes in the measured values will be compared to the baseline values over the 2 periods by means of the Wilcoxon-test at a significance level of p Trial registration: Deutsches Register Klinischer Studien: DRKS00006562

Measurements of exercise-induced metabolic changes, such as oxygen consumption, carbon dioxide exhalation or lactate concentration, are important indicators for assessing the current performance level of athletes in training science. With exercise-limiting metabolic processes occurring in loaded muscles

Aktuelle Studien zeigen, dass 38% der Frauen nach der Schwangerschaft unter postnataler Inkontinenz leiden 1 . Die Symptome konnen durch operative Techniken oder durch konservative Therapien behandelt werden. Die Behandlung postnataler Inkontinenz mittels konservativer Therapien ist noch umstritten. In diesem Uberblicksartikel werden die Erkenntnisse der letzten 20 Jahre zur konservativen Therapieform diskutiert. Am Ende des Artikels wird ein Ausblick zur weiteren Forschungsrichtung gegeben. Insgesamt 15 Studien erfullten die Einschlusskriterien zum Vergleich der Ergebnisse in dieser Untersuchung. Dabei handelt es sich um 3 nationale und 12 interna­tionale Arbeiten, die im Zeitraum von 1994–2013 veroffentlicht wurden. Die Studiendurchfuhrungen weichen in Parametern wie der Probandenzahl oder der Uberprufungsmethoden stark voneinander ab. Dennoch kommen alle ubereinstimmend zu dem Ergebnis, dass die konservativen Methoden wirkungsvoll und eine gute Alternative zu operativen Verfahrensweisen sind. Jedoch herrscht Uneinigkeit daruber, ob ein angeleitetes Beckenbodentraining erfolgsversprechender ist als der Einsatz von Biofeedback, Vaginalkonen oder Elektrostimulation. Die konservative Therapie ist eine wirkungsvolle Behandlungsmethode postnataler Inkontinenz. Die Anwendung in der Praxis ist gerechtfertigt. Im Ruckbildungstraining (ca. 6 Wochen nach der Entbindung) sollten Hilfsmittel wie Konen, Biofeedback oder Elektrostimulation als Erganzung zum angeleiteten Beckenbodentraining eingesetzt werden.

Do patients with bi- or trimalleolar ankle injury show differences in motor skills and safety in comparison with healthy, active, age-matched control subjects?Prospective controlled cross-sectional study.Inclusion of 17 patients with bi- or trimalleolar ankle injury (mean 1.5 years postsurgery) and 23 healthy, active subjects of comparable age (fitness studio). Measurement instruments: motor test procedures and questionnaires.Comparison of patients and control subjects by routine daily motor function: patients controls with the "timed 'UpGo' test" (TUG, p = 0.011), the chair rising test and a coordination test using a gymnastic hoop (CRT and GR p 0.05), fear of falling: patients controls (p = 0.003) and physical activity: patients controls (p = 0.032).There were no significant motor deficits in activities of daily life between the patients and controls, only tendencies; however, the patients showed definite limitations with an increased fear of falling and a reduced physical activity compared with the healthy control group. The resulting differences should be positively influenced by appropriate enhancement of training or participation in sports courses. The aim is to achieve a similar quality of life by a perception of safety and trust in one's own motor skills.

About 5-8 million people in Germany suffer from chronic pain. This costs the state about 20 billion € per year. An insufficient investigated non-pharmacological pain treatment is the application of high-intensity lasers.The present study analyzed and compared the effectiveness of ultrasound applications in comparison to high-intensity laser regarding to the outcome measure of pain intensity. There were 20 patients recruited at the Institute of Physiotherapy of the university hospital of Jena, who suffered from disorders of the lumbar spine or the shoulder region. Study participants were randomized after a cross-over design and treated for 2 weeks with ultrasound or high-intensity laser. Then they switched and received the other therapy. After the intervention was a follow-up of 4 weeks.Both therapies significantly reduced the intensity of regional pain. The separate analysis showed that the high-intensity laser achieved greater effectiveness compared to ultrasound in terms of pain intensity. No differences were observed in terms of functionality and quality of life.The reduction of regional pain could be expected. The cause of advantages in high-intensity laser treatments are still hidden. However, it should receive attention that the laser has a perceptible effect of heat and a certain “exotic” or modern character to the application of ultrasound. That's why partially placebo effect cannot be excluded. The comparison with other studies in this combination is difficult, because the data situation is not very comprehensive.The mono thermotherapy with high-intensity laser or ultrasound in case of acute exacerbation of chronic pain may be an appropriate action to achieve pain reduction. High-intensity laser applications exhibit a stronger effect.

BACKGROUND: A continuously increasing use of laser light has been shown in diagnostic as well as in therapy in many different medical areas since this light was discovered in 1960. Patients of physiotherapy are treated with low as well as high level laser light. AIMS OF THE STUDY: The purpose of the present study was to gather first experience with the Opton-7-Watt-Laser by the “Zimmer Medizinsysteme” company and to further demonstrate fields of treatment with positiv results by courtesy of high level laser therapy in order to define therapeutical concepts in a first step. MATERIAL AND METHODS: After checking for exclusion criterion's we included 120 patients with musculosceletal disorders recruited by the ambulance of the Department for Physiotherapy at the University Hospital Jena. We combine the patients in groups. The patients reported about positive results with respect to functioning and pain subjectively. The high level laser was the Opton-7W-Laser of “Zimmer Medizinsysteme”. We work therapeutically with the full power (7W), but at any patients with 4W. RESULTS: 100% of the patients with only muscular disorders profited from the treatment. Patients with injury of tendon and ligaments reported discomfort by treatment with 7W. After adapting the power to 4W by equal energy similar good effects as in the other group were noticed. The results of the remaining patients which not could be classified were variable. DISCUSSION: Patients with discomfort of myofascial patients of the body showed response to laser therapy. It has been shown that problems on solid structures are very difficult to be positively influenced. Earliest reason might be the better hyperemia in the muscle and in the tendon areas. There were not be looked at objective function and pain parameters. The effect of treatment therefore is subjective described by the patients. CONCLUSION: The option of high level laser treatment is primarily recommendable for processes on muscle and tendon. An evaluation of the method for individual clinical pictures and symptoms has to follow in the future.

Measurements of exercise-induced metabolic changes, such as oxygen consumption, carbon dioxide exhalation or lactate concentration, are important indicators for assessing the current performance level of athletes in training science. With exercise-limiting metabolic processes occurring in loaded muscles, 31 P-MRS represents a particularly powerful modality to identify and analyze corresponding training-induced alterations. Against this background, the current study aimed to analyze metabolic adaptations after an exhaustive exercise in two calf muscles (m. soleus - SOL - and m. gastrocnemius medialis - GM) of sprinters and endurance athletes by using localized dynamic 31 P-MRS. In addition, the respiratory parameters VO2 and VCO2 , as well as blood lactate concentrations, were monitored simultaneously to assess the effects of local metabolic adjustments in the loaded muscles on global physiological parameters. Besides noting obvious differences between the SOL and the GM muscles, we were also able to identify distinct physiological strategies in dealing with the exhaustive exercise by recruiting two athlete groups with opposing metabolic profiles. Endurance athletes tended to use the aerobic pathway in the metabolism of glucose, whereas sprinters produced a significantly higher peak concentration of lactate. These global findings go along with locally measured differences, especially in the main performer GM, with sprinters revealing a higher degree of acidification at the end of exercise (pH 6.29 ± 0.20 vs. 6.57 ± 0.21). Endurance athletes were able to partially recover their PCr stores during the exhaustive exercise and seemed to distribute their metabolic activity more consistently over both investigated muscles. In contrast, sprinters mainly stressed Type II muscle fibers, which corresponds more to their training orientation preferring the glycolytic energy supply pathway. In conclusion, we were able to analyze the relation between specific local metabolic processes in loaded muscles and typical global adaptation parameters, conventionally used to monitor the training status of athletes, in two cohorts with different sports orientations.