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Context Despite the documented effectiveness of high-velocity, low-amplitude (HVLA) treatment of the cervical spine, concerns about patient safety potentially limit didactic instruction and use in clinical practice. Understanding how cervical HVLA is taught and employed is of interest to osteopathic educators and clinicians. Objectives To characterize the perspectives of osteopathic manipulative medicine/osteopathic principles and practices (OMM/OPP) departments within colleges of osteopathic medicine (COMs) in the US regarding patterns of teaching and practice of HVLA treatment of the cervical spine. Methods A questionnaire was distributed on April 11, 2019 in paper format to OMM/OPP department chairs or designated faculty member attendees at the Educational Council on Osteopathic Principles biannual meeting. If the department chair was not available, the survey was provided to the faculty member designated to represent the Chair of the institution at ECOP. All respondents in this category returned the survey in paper before they left the meeting. The OMM/OPP department chairs who did not attend or send representatives to the ECOP meeting were sent the survey by email on April 11, 2019 and given three opportunities over 6 weeks at 2-week intervals to reply to this voluntary online survey. The survey was given or sent to a total of 51 OMM/OPP department chairs or representatives. Six questions elicited demographic information pertaining to status, age, gender, ethnicity, board-certified specialty, and COM affiliation. Nine questions examined perspectives related to the instruction of cervical HVLA manipulation and treatment. Results Of the 51 OMM/OPP department chairs surveyed, 38 (74.5%) responded, 32 to the paper survey at the ECOP meeting and six to the digital survey. Respondents were primarily dual Board-certified in Family Medicine and Neuromuscular Medicine (55.3%). At over 90% (35) of the COMs for which department chairs responded to the survey, cervical HVLA instruction occurs in the curriculum primarily during program years 1 and 2. Instruction in cervical HVLA to the 2nd through 7th cervical vertebral levels occurred in 97% (37), while 11% (4) of the COMs excluded the occipital-atlanto (OA) and atlanto-axial (AA) joints. A high percentage (81.6%; 31) of the OMM/OPP department chairs or representatives reported employing cervical HVLA techniques within their practice. Among the respondents, 40.5% (15) reported that 0–25% of their school’s medical school class could perform cervical HVLA competently upon graduation, whereas 27% (10) said that 51–75% of their class could perform cervical HVLA. Conclusions A majority of COMs provide education in their curricula related to cervical HVLA primarily in the first 2 years of medical education. However, instruction often excludes cervical HVLA to the upper regions of the cervical spine. At COMs where HVLA to the cervical spine is not taught, that decision is because the techniques are thought to be too difficult and the attendant medicolegal risk perceived to be too high. OMM/OPP department chairs expressed confidence in only a small proportion of their graduates having the ability to competently apply HVLA to the cervical spine immediately after completing their predoctoral medical training.

Coronavirus disease of 2019 (COVID-19) belongs to the betacoronavirus family which is known to cross species barriers and lead to high pathogenicity. There is rapidly growing evidence that COVID-19 infection can be associated with neuromuscular complications. A comprehensive literature review was conducted evaluating articles published related to neuromuscular complications in COVID-19. In this review we focus our discussion on two ways that COVID-19 critically impacts neuromuscular medicine: (1) serious complications and outcomes associated with the viral infection and; (2) management considerations for neuromuscular patients on immunotherapies during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has changed the face of health care delivery. Health care institutions rapidly transitioned to telehealth to provide care to patients. Prior to the pandemic, telehealth services extended mostly to patients with established diagnoses. Driven by a necessity to provide care to all patients during the pandemic, neurologists started evaluating new patients also via telehealth. OBJECTIVE: To explore opportunities, challenges, and feasibility of telehealth for new patients with neuromuscular disorders. METHODS: New patient visits performed in our neuromuscular clinic were analyzed from March 18, 2020 - July 31, 2020. Data collected included visit volume, demographics, geographic distance of patient’s residence from our institution, and no-show and cancellation rates. RESULTS: Total number of patients seen was 1,471; 472 (32%) were new patients. No-show and cancellation rates for telehealth visits were lower than historical in-person visits. There was a wide range of ages (35–74 years) with representation of new patients from a large geographical territory. CONCLUSION: This study advances our understanding regarding the adoption and implementation of telehealth for new patients. Our clinic was able to provide timely access and care to a significant number of patients who could not travel to our institution during COVID-19.

Mary Broadfoot Walker (1888-1974) was the first to demonstrate the ‘Mary Walker effect’ describing the weakness of other muscle groups following release of the arteriovenous occlusion of an unrelated exercising muscle group in patients with myasthenia gravis, which led to the search for a circulating causative agent for myasthenia gravis. She was the first to clearly demonstrate that strength temporarily improved in patients with myasthenia gravis with physostigmine or Prostigmin (neostigmine). This dramatic treatment response has been erroneously termed the ‘Mary Walker effect'. Further, she noted hypokalaemia during attacks of weakness in familial periodic paralysis, pioneering treatment with potassium chloride. Although Mary Walker practiced in a nonacademic setting and trained at a time when women were not allowed to train alongside men, she was the first to convincingly demonstrate three life-changing treatments in the field of neuromuscular medicine, a feat that few physicians of any era can claim.

Aim: Duchenne muscular dystrophy (DMD) is a severe and rare X-linked neuromuscular childhood disorder that results in functional decline, loss of ambulation and early death due to cardiac or respiratory failure. The objective of this paper is to address different aspects of the current management of DMD in the Middle East, north Africa (MENA) region, and to gather experts’ recommendations on how to optimally diagnose and treat patients suffering from this disease. Methods: A group of experts (neuromuscular medicine, neuropediatricians and geneticists) convened to discuss the diagnosis and management of DMD in the MENA region. A list of practical statements was prepared by the chair of the meeting to guide the discussions around critical aspects relating to the current and future management of DMD. Results & conclusion: Ideally, DMD management should be a multidisciplinary approach. Nevertheless, few tertiary care hospitals in the region are currently able to provide the full spectrum of medical expertise and services needed by DMD patients. Clinical practice in the region remains heterogeneous. Specific guidelines for diagnosis and treatment are needed in the MENA region to improve outcomes. Disease awareness among the general public and the medical community is lacking. Now that mutation-specific therapies are being developed and more widely studied, general education programs regarding early signs and symptoms, a standardized referral and diagnosis pathway, patient registries and support groups will significantly improve the management of the disease.

Background and Objectives We investigated the prevalence of late-onset Pompe disease (LOPD) in patients presenting to 13 academic, tertiary neuromuscular practices in the United States and Canada. Methods All successive patients presenting with proximal muscle weakness or isolated hyperCKemia and/or neck muscle weakness to these 13 centers were invited to participate in the study. Whole blood was tested for acid alpha-glucosidase (GAA) assay through the fluorometric method, and all cases with enzyme levels of ≤10 pmoL/punch/h were reflexed to molecular testing for mutations in the GAA gene. Clinical and demographic information was abstracted from their clinical visit and, along with study data, entered into a purpose-built REDCap database, and analyzed at the University of California, Irvine. Results GAA enzyme assay results were available on 906 of the 921 participants who consented for the study. LOPD was confirmed in 9 participants (1% prevalence). Another 9 (1%) were determined to have pseudodeficiency of GAA, whereas 19 (1.9%) were found to be heterozygous for a pathogenic GAA mutation (carriers). Of the definite LOPD participants, 8 (89%) were Caucasian and were heterozygous for the common leaky (IVS1) splice site mutation in the GAA gene (c -32-13T>G), with a second mutation that was previously confirmed to be pathogenic. Discussion The prevalence of LOPD in undiagnosed patients meeting the criteria of proximal muscle weakness, high creatine kinase, and/or neck weakness in academic, tertiary neuromuscular practices in the United States and Canada is estimated to be 1%, with an equal prevalence rate of pseudodeficiency alleles. Trial Registration Information Clinical trial registration number: NCT02838368.

Myotonia, i.e., delayed muscle relaxation in certain hereditary muscle disorders, can be assessed quantitatively using different techniques ranging from force measurements to electrodiagnostics. Ultrasound shear wave elastography (SWE) has been proposed as a novel tool in biomechanics and neuromuscular medicine for the non-invasive estimation of muscle elasticity and, indirectly, muscle force. The aim of this study is to provide ‘proof-of-principle’ that SWE allows a quantitative measurement of the duration of delayed muscle relaxation in myotonia in a simple clinical setting. In six myotonic muscle disorder patients and six healthy volunteers, shear wave velocities (SWV) parallel to the fiber orientation in the flexor digitorum superficialis muscle in the forearm were recorded with a temporal resolution of one per second during fist-clenching and subsequent relaxation; the relaxation time to 10% of normalized shear wave velocity (RT0.1) was calculated. Forty-six SWE imaging sequences were acquired, yielding a mean RT0.1 of 7.38 s in myotonic muscle disorder patients, significantly higher than in healthy volunteers (1.36 s), which is comparable to data obtained by mechanical dynamometry. SWV measurements during the baseline relaxation and voluntary contraction phases did not differ significantly between groups. We conclude that SWE is a promising, non-invasive, widely available tool for the quantitative assessment of myotonia to aid in diagnosis and therapeutic monitoring.

Modern neuromuscular electrodiagnosis (EDX) and neuromuscular ultrasound (NMUS) require a universal language for effective communication in clinical practice and research and, in particular, for teaching young colleagues. Therefore, the AANEM and the IFCN have decided to publish a joint glossary as they feel the need for an updated terminology to support educational activities in neuromuscular EDX and NMUS in all parts of the world. In addition NMUS has been rapidly progressing over the last years and is now widely used in the diagnosis of disorders of nerve and muscle in conjunction with EDX. This glossary has been developed by experts in the field of neuromuscular EDX and NMUS on behalf of the AANEM and the IFCN and has been agreed upon by electronic communication between January and November 2019. It is based on the glossaries of the AANEM from 2015 and of the IFCN from 1999. The EDX and NMUS terms and the explanatory illustrations have been updated and supplemented where necessary. The result is a comprehensive glossary of terms covering all fields of neuromuscular EDX and NMUS. It serves as a standard reference for clinical practice, education and research worldwide. HIGHLIGHTS: Optimal terminology in neuromuscular electrodiagnosis and ultrasound has been revisited. A team of international experts have revised and expanded a standardized glossary. This list of terms serves as standard reference for clinical practice, education and research.

Neuromuscular ultrasound (NMUS) is a rapidly evolving technique used in neuromuscular medicine to provide complimentary information to standard electrodiagnostic studies. NMUS provides a dynamic, real time assessment of anatomy which can alter both diagnostic and management pathways in peripheral nerve disorders. This review describes the current and future techniques used in NMUS and details the applications and developments in the diagnosis and monitoring of compressive, hereditary, immune-mediated and axonal peripheral nerve disorders, and motor neuron diseases. Technological advances have allowed the increased utilisation of ultrasound for management of peripheral nerve disorders; however, several practical considerations need to be taken into account to facilitate the widespread uptake of this technique.

The goal of this article is to provide physiatrists, neurologists, and neuromuscular medicine physicians a framework that can be easily used in the process of evaluating, identifying, and treating patients with toxic myopathies. This review attempts to classify these rare but potentially deadly conditions in clinical patterns and distinguishes the cellular mechanisms in which the offending agents tend to impact the structure and function of myocytes.

Zusammenfassung. Im Bereich der neuromuskulären Erkrankungen hat sich in der nicht-invasiven Diagnostik wie auch der Therapien in den letzten Jahren enorm viel entwickelt. So können Ganzkörper MRI Untersuchungen der Muskulatur ein spezifisches Muster einer Muskelerkrankung aufzeigen und direkt zur molekulargenetischen Analyse überleiten; bedside Ultraschall Untersuchung der peripheren Nerven vermag behandelbare inflammatorische Neuropathien erkennen, sodass in gewissen Fällen auf die Lumbalpunktion wie auch Nervenbiopsie verzichtet werden kann. Spezifische Antikörper helfen, die erworbenen autoimmun bedingten Erkrankungen besser zu charakterisieren und das Therapieansprechen abzuschätzen. Für die spinale Muskelatrophie und die familiäre Transthyretin Amyloidose stehen uns erste Gentherapien zur Verfügung, die direkt den zugrundeliegenden Gendefekt beheben und eine neue Ära in der Behandlung von monogenetisch bedingten neuromuskulären Erkrankungen eingeläutet haben. Diese Zusammenfassung soll Ihnen eine Auswahl an neuen diagnostischen und therapeutischen Errungenschaften im Bereich der neuromuskulären Erkrankungen präsentieren.

Advances in the understanding of peripheral nerve disorders occur when new techniques allow a better insight into the underlying pathophysiology. Functional tests have to date led the way in furthering our understanding of peripheral nerve disorders. EMG was rapidly followed by nerve conduction studies and further technical refinements enabled the use of evoked potentials, intraneural microneurography and threshold tracking. Similar to what happened in the exploration of the central nervous system, there was a gap in the field of Neuromuscular medicine until clinically useful imaging of the peripheral nerves emerged. Because of its ready availability, excellent resolution and relative low cost, peripheral nerve Ultrasound has rapidly become part of clinical routine. A particular domain of peripheral nerve MRI scanning is the depiction of neural structure lying deep and behind bone such as the lumbosacral plexus. In this review, we will be looking at how imaging techniques compliments functional tests and provides a comprehensive evaluation of the peripheral nervous system.

Neurology subspecialty training and certification are in the midst of rapid transformation, with steady expansion in subspecialty fellowship and certification options and increased requirements over the past 15 years. This includes new epilepsy, neuromuscular medicine, and sleep medicine certification and training via the American Board of Psychiatry and Neurology (ABPN) and Accreditation Council for Graduate Medical Education (ACGME) and >200 new fellowship programs in 8 subspecialties accredited by the United Council for Neurologic Subspecialties (UCNS) since 2006.1 In response, the American Academy of Neurology (AAN) has published a position statement with a proposed unified fellowship timeline.2 This period has also seen the advent of Maintenance of Certification (MOC) for ABPN specialties and subsequent changes in the MOC process. In this context of rapid change and controversy in subspecialty education and certification, the article by Juul et al.3 on the recent history and current status of clinical neurophysiology (CNP) is particularly timely.

ObjectiveTo describe the development and current status of training and certification in clinical neurophysiology (CNP); to explore the impact of the newer subspecialties in sleep medicine, neuromuscular medicine, and epilepsy; and to obtain information about aspects of practice in the subspecialty.MethodsInformation about training programs and certification was obtained from the records of the Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology, and diplomates were surveyed about their CNP practice activities and attitudes toward certification/recertification.ResultsIn the years since the first examination was administered, a robust number of CNP training programs developed, but recently, there has been a decrease in the number of programs and fellows, although the number of programs and fellows in the subspecialties of epilepsy, neuromuscular medicine, and sleep medicine has increased. A diplomate survey indicated that most respondents devoted significant practice time to CNP procedures, especially to EEGs and EMGs. Although more diplomates performed EEGs than EMGs, a substantial portion performed both. Most diplomates were planning to or had maintained certification in CNP.ConclusionOver 3,000 neurologists, child neurologists, and psychiatrists have obtained certification in CNP, and the majority are participating in recertification. Although the newer and overlapping subspecialties of epilepsy, neuromuscular medicine, and sleep medicine may be having a negative impact on CNP, it continues to have a relatively large number of programs and attracts a relatively large number of fellows.

Complementary and alternative treatment modalities are commonly utilized by patients for neuropathy and neuropathic pain due to perceived lack of benefit from conventional medical treatment. As the association between metabolic syndrome and neuropathy is increasingly recognized, diet and lifestyle interventions are becoming important components in the management of neuropathy. Progress in the understanding of the gut-immune interaction highlights the role the gut microbiome and inflammation plays in the modulation of neuropathy and neuropathic pain. Evidence for nutritional interventions, exercise, supplements, acupuncture, and mindfulness-based practices in the treatment of neuropathic pain is encouraging. This article reviews the available evidence to support the safe use of complementary and alternative treatments for commonly encountered conditions associated with neuropathy and neuropathic pain. Muscle Nerve 60: 124-136, 2019.

Neuromuscular dysfunction in cancer is well recognized and is a major cause of pain and disability in this population. Injury of any segment of the neuromuscular system can lead to dysfunction and pain. Identification and characterization of the pain pattern and localization is crucial for diagnosis; however, symptoms may vary in presentation. Electrodiagnostic tools, such as nerve conduction studies (NCS) and needle electromyography (EMG), are used to differentiate and localize suspected injury to the neuromuscular system such as in radiculopathy, plexopathy, mononeuropathy, and peripheral neuropathy. There is limited evidence on the efficacy of the treatment options for neuromuscular dysfunction in the cancer patient. Treatment may be challenging, and an interdisciplinary and multimodal program is recommended.

Objective: Disability is both a cause and a consequence of poverty, reducing access to education, employment, opportunities and resources. Poor people without disabilities can develop them, due to inadequate nutrition, unclean environments, disease, insufficient health services and poor infrastructure. The purpose of this study was to determine the level of disability, accessibility and utilization of rehabilitation service, in gwan-gwan community. Method: Eighty six (86) people participated in the study, the participants were choosen using multistage sampling technique, questionnaire was administered to the subjects, information about disability, type of disability, access and utilization of rehabilitation services was collected and analysed descriptively. Result: Findings of the study showed that majority of the participants are disabled (55.7%), back has the highest form of disability (26.1%), they don’t have access to rehabilitation centres (63.6%) and also they don’t utilize rehabilitation service(78.4%). Conclusion: It was therefore concluded that majority of people of this community are living with disability with lack of accessibility to rehabilitation centers and less utilisation of rehabilitation services. It is therefore, recommended that government of Nigeria should lead the way in making accessibility of rehabilitation centres a priority. This can be achieved by enacting laws which protect the accessibility rights of people living with disability.

Cerebral Palsy is considered a neurological disorder caused by a non-progressive brain injury or malformation that occurs while the child’s brain is under development. Cerebral Palsy primarily affects body movement and muscle coordination. It can also impact fine motor skills, gross motor skills, and oral motor functioning. Balance, posture, and coordination can also be affected by Cerebral Palsy. Tasks such as walking, sitting, or tying shoes may be difficult for some, while others might have difficulty grasping objects. In this study, we conducted a survey to investigate the cerebral palsy in Giresun, Turkey. We tried to get statistical clues to understanding the disease.

Purpose: This study analyzed the applicability in the speech pathology clinic of a praxis-productive intervention program for children with phonological disorder, by its implementation. Methods: the study proposed a theoretical model of the program, based on a literature review on speech motor control, which orders muscle contraction for the execution of praxis, including the planning, preparation of movements and execution of plans, aiming at muscle contractions and movements of structures that ultimately lead to speech articulation. Thereafter, the material was applied to 12 children aged 6 to 8 years with phonological disorder, to show the applicability of the praxis-productive intervention program in practice. Results: the results showed improvement of speech in all individuals within the time defined by the instrument, with higher scores for the evaluative evidence of phonology and oral praxis after intervention compared to the scores before intervention. Conclusion: the praxis-productive intervention program was useful, simple easy to apply by the speech pathologist and well understood by the participants, with favorable responses for the acquisition of phonemes.

A rehabilitation audit was performed comparing admission and discharge values of FIM and Barthel Index (self report) of the last 6 years. The results indicate substantial changes in FIM and BI thus justifying the rehabilitation process. Performing an audit of the used instruments we found a small group of patients (between 6% (post surgery patients) and 26.4% (rheumatological patients)) for whom no overall improvement could be indicated. These patients differ significantly from the other patients in reaching higher values on admission thus indicating a possible ceiling effect in FIM and in BI.

Today I am honored and privileged to share with the International Physical Medicine and Rehabilitation Journal an important discovery from the field of psychology. We now have a psychology approach that is able to treat the root cause of those afflicted with physical ailments needing rehabilitation. Stress, in the form of physical injuries vary in the degree of frequency, intensity, and duration. From minor slips and falls to quadriplegia, human being suffers physical ailments of varying degrees. Often times, this can lead to weeks and months in rehabilitation centers. Physical pain can cause great stress on the mind. Financial stress, including hospital bills can cause further stress. Being away from family and friends can often mean less support and energy. This in turn can hamper recovery and rehabilitation efforts. Often time, individuals need pain medication to cope with the unnerving pain. Coupled with all this, loved ones also can feel debilitating stress worrying about the long term progress of those afflicted with serious physical injuries and ailments. Now, with Emotional Core Therapy, we have a psychological process that treats the root cause of all of the above stressors. All of the above stressors have one aspect in common. The above stressors, like any psychological stress, can cause further stress on the mind and body. Why does this dynamic occur? Psychic stress is caused by the temporary arousal of one of the four true and authentic emotions. The four true emotions are joy, grief, fear, and relief. These four emotions evolve from entering and leaving relationships. Grief and fear vary in intensity from person to person. For example, a heavyweight professional boxer is likely to absorb a punch from a 250 pound man much better than an eleven year old, sixty five pound child. Perception of stress varies from person, depending on their own world view. From the time human beings are infants till their passing, the four true emotions serve as a navigation tool for all humans. Generally speaking, we want to choose and move towards relationships that bring joy and relief. We want to disengage and leave relationships that bring rehabilitating individuals grief and fear. Herein lies the dilemma facing medical doctors and staff treating those afflicted with serious physical ailments. How do hospital and health services staff impart psychological relief and remedies to those injured and needing rehabilitation services? After all, patients enter treatment with varying degrees of psychical pain. Patients also enter treatment with varying educational levels. Indeed, as mentioned above, patients perceive physical stress differently also. Therefore, assessment and treatment go hand in hand. One cannot treat a patient successfully unless one assesses them first accurately. All these difficult decisions can be answered more easily and readily with the mastering of the Emotional Core Therapy Process. Below you will see the process used to treat the root cause of stress for those afflicted with serious long term injuries.

Background and Purpose: Stroke is a disease that can cause neurological impairments that can affect a patient’s ability to ambulate. Research suggests that body weight supported treadmill training (BWSTT) may improve gait speed and reduce the risk of falls for those with difficulty ambulating. The purpose of this case report is to describe the effects of a novel BWSTT device on the gait speed and fall risk on a 39-year-old patient who had suffered a stroke. Case description: The patient was a 39-year-old female who had suffered a stroke resulting in right side hemiplegia. Over a 4-week period, the patient completed seven sessions of BWSTT with the GlideTrak. The duration of each session and the intervals within the session were performed at the patient’s tolerance for treadmill speed and duration of the interval. Outcomes: Improvement of 35% on the Activities-specific Balance Confidence (ABC) Scale and 25% on the Timed Up and Go (TUG) indicate that the intervention may have lowered the risk for falls but a 14% increase in the 10 Meter Walk Test time indicated that the intervention didn’t improve the patient’s gait speed as predicted. Discussion: This case report indicates that one month of body weight supported treadmill training using the GlideTrak does not improve gait speed in a patient with hemiplegia, but is shown to have a positive effect on patient’s balance. This intervention may have a role in maintaining a patient’s cardiovascular and overall fitness, but should not be the sole intervention to improve gait speed.

Objective: Phasic alerting (PA) is a theory-motivated treatment approach for unilateral spatial neglect (USN). It aims to improve the non-spatial attentional components of the syndrome. The objective of this pilot study was to examine the potential benefit of a novel therapeutic approach, combining PA with Visual Spatial Training for individuals with USN. Method: This pilot study, was conducted with 18 USN stroke patients allocated quasi-randomly to one of 3 groups (each 6 participants): experimental (receiving computerized Visual spatial Training combined with PA), ‘spatial’ control (receiving similar Visual spatial Training without PA), and ‘non-spatial’ control (receiving a similar amount of non-spatial cognitive treatment). Treatment comprised of 10 daily 30-minute sessions. Assessments of USN and function were made at 3 points in time: before and after the intervention period and after 5 weeks. Results: The experimental group showed more than 50% amelioration in distinct measures of neglect during the treatment period. In contrast, the control groups did not show this trend during that period. All groups showed improvement at the follow-up period. However, in most tests the experimental group performed better with moderate effect size values in major USN tests. Conclusion: Visual spatial training combined with PA shows promising results in producing amelioration in USN reflected both in measures of USN and ADLs.

Objective: correlate between clinical and electrophysiological findings of carpal tunnel syndrome Methods: cross sectional study at outpatient setting.109 patients (83females, 26males) with clinical manifestations of carpal tunnel syndrome participated in the study. All the patients had the following: Medical history and neurological examination including Tinel’s sign and Phalen test and nerve conduction studies including median-ulnar, median -radial comparative studies and electromyography of both upper extremities. Results: mean age 57.71±13.4. pain was mild in 9.2%, moderate in 25.7% and severe in 56% of patients. Numbness was present in 87.2%. Impaired sensory exam in 43.1% Impaired motor exam in 8.3%. Positive Tinel’s sign unilateral (38.5%) and bilateral (47.7%). Positive Phalen test unilateral (30.3%) and bilateral (34.9%). Unilateral thenar Muscle wasting in 4.6% and bilateral in 1.8%. Pure sensory median neuropathy was found in 65 patients (59.6%), sensory motor median neuropathy in 44 patients (40.37%). Demyelinating neuropathy in 91.7% and demyelinating-axonal neuropathy in 8.3% of patients. Abnormal distal motor latency was significantly correlated with severity of pain p=0.0025, impaired sensory exam p=0.0001, impaired motor exam p=0.0001, positive Tinel’s sign of both hands p=0.0001, positive Phalen test of both hands p=0.0001. as well as with unilateral or bilateral muscle wasting p=0.001. Prolonged peak median sensory latency was significantly correlated with numbness p=0.0001, severity of pain p=0.001, Impaired sensory exam p=0.005, positive Tinel’s sign for either one or both hands p=0.0001, positive Phalen test of one or both hands p=0.0001 Conclusion: Highly significant correlation was found between subjective and objective sensory manifestation and peak median sensory latency. While distal motor latency were significantly correlated with severe pain, only bilateral positive Tinel’s sign and Bilateral Phalen test and the objective sensory and motor deficit.

Objective: Genu valgum (GV), also known as valgus knee, or knock-knee, is a common orthopaedic condition in growing children. Physiological genu valgum have intermalleolar distance of up to 8 cm, the greatest distance being observed between 3 and 4 years, disappearing gradually after the age of 7-8 years. If the longitudinal axis of the knee joint is not aligned by then, physiotherapeutic intervention is called for. Aim: The aim of our study was to determine if garment with elastic straps and pressure applicator could be used in mechanotherapy to correct children’s excessive GV. Methods: The study has lasted last 6 years and there has been three study periods. In all study-periods, practical part lasted six months. Inclusion criterias were: subjects were not involved in physical therapy and did not wear orthoses during the study. Once in every month myometric values (tone, biomechanical and viscoelastic properties of m. sartorius, tensor fasciae latae, semitendinosus, tibialis anterior, gastrocnemius caput mediale, m. peroneus longus) were determined with MyotonPro (Myoton AS, Estonia); anthropometric (height, body mass, intermalleolar distance), and goniometric (tibiofemoral angle) parameters were measured according to the standard technique. During the last three months children didn’t wear garment and final measurement was done to evaluate long term effect of garment. Individual analysis was carried out to evaluate the results. Results: After wearing the garments with pressure and elastic components the changes in the lower limb joint alignment and biomechanical parameters promoted the correction of GV position. Three months after the wearing period the changes occurred the worsening of GV position, which indicates that the muscles could not maintain the condition achieved by wearing the garment. Conclusion: The relationship between applied mechano therapeutic stimulus and changes in the lower limb joint alignment and changes of the biomechanical parameters are individual. Study continues with upgrading a device where a new solution is found using digital technology to measure tensile strength at a desired period.

Typical noninvasive interventions for action hand tremor are limited to compensatory techniques by using weighted equipment, adaptive equipment, and stabilizing devices. Those approaches provide only temporary effects during patients’ performance of purposeful activities. The five step Stress Reduction Hand Tremor Control (SRHTC) approach demonstrated decreased action tremor in the hands and significant improvement of hand function for daily activities.

Background: Paired associative stimulation (PAS) combines peripheral nerves stimulation (PNS) with transcranial magnetic stimulation (TMS) and it is believed to induce plastic changes in the human corticospinal tract after spinal cord injury (SCI). The aim of the present study was to investigate the advantages of PAS added to conventional rehabilitation protocol for patients with chronic SCI. Methodology: The study was monocentric sham-controlled and involved 11 patients with lower paraparesis 3-12 months after the trauma. TMS was delivered over vertex using a round coil with 150% of resting threshold. ESPN of both n. peroneous and n. tibialis was performed with supramaximal intensity at fossa poplitea for 5 minutes for each nerve. The interval between TMS and PNS was individually defined (around 35ms). The intervention consisted 30 sessions of 1Hz PAS in total. Results: After the intervention, the improvement of motor and sensory function (via ASIA impairment scale) was observed in both groups but the intergroup difference was insignificant (Mann–Whitney U test, p=0.0675). Spasticity (via modified Ashworth scale) was not changed significantly but 4 patients noticed more uncontrolled movements. Expectedly, patients with no peripheral M-response at the beginning do not demonstrated any improvements. The best functional outcome was found into patients with preserved MEP in the study group. Two patients with absent MEP at the beginning from the study group showed unstable MEP after a month. Conclusion: PAS could be seen as an additional tool to facilitate the recovery after chronic SCI. Patients with preserved MEP may benefit more from this technique. On the other hand, the absence of M response could be considered as an exclusion criterion while the selection of individuals for PAS. The choice of stimulation protocols is still arguable that can lead to diverse and controversial results.