Neuromuscular Electrical Stimulation as a Therapy Adjunct in Children with Spasic Cerebral Palsy
Vasileios Ch. Skoutelis
Spastic cerebral palsy (CP) is the most prevalent neuromuscular condition of childhood encountered by paediatric physiotherapists. The purpose of this project is to investigate the use of neuromuscular electrical stimulation (NMES) as an adjunct therapy in spastic cerebral palsy, via the contemporary literature review. A search was conducted through scientific databases (MEDLINE, PUBMED, CINAHL, AMED, PEDro), from 1990 to October 2010. Seventeen articles were included in the present review, based on specific criteria, of which seven articles represented randomized controlled trials (RCTs), two non-RCTs, three case series studies, four single-subject studies and one case study. The PEDro scale was used to evaluate the methodological quality of seven RCTs and has yielded five studies of moderate and two studies of high methodological quality. The findings of the review indicate that the application of NMES in children or adolescents with spastic CP has a positive effect on the reduction of dynamic and myostatic contractures and on the improvement of active range of movement and muscle strength as well. The efficacy of this method was explained via the presentation of theories. Nevertheless, the lack of assent to the parameters and application modes complicate the analysis and interpretation of the relative effects, rendering NMES controversial therapy that needs further investigation.
Achilles Tendinopathy: Pathology, assessment and management
Chrysovalantis Sassanis, Polyzois Sideris, Anastasios Pliagos
Although the word ?tendinitis? had been used for many decades to describe symptoms arising from the Achilles region, research has proven that in chronic conditions there is no true tissue inflammation. The new term ?tendinopathy? was adopted to describe the degeneration of the tendon, which consists of microrupture of the collagen type I fibers, production of the thinner type III fibers with random orientation and finally appearance of new vessels and nerves into the tendon. These new nerve endings are thought to be the source of the pain in Achilles tendinopathy. The tendinopathy of the Achilles tendon can be classified according to the location of the pathology into midportion, concerning the main body of the tendon and into insertional, the area of the tendon?s insertion into the calcaneus. Although the two forms of tendinopathy have common histological features, their etiology seems to be different. This fact implies that the management of the two forms should not probably be the same. There is sound amount of evidence that the eccentric exercise protocol of Alfredson is a very effective tool in managing the mid-portion tendinopathy. On the other hand, it seems that the above protocol is not that successful in the treatment of the insertional tendinopathy, although in a recent study the modification of the original protocol and showed promising outcomes. Apart from the eccentric exercise, a large variety of physical therapy interventions have been proposed in the literature, but they either rely on studies with poor methodological quality or on clinical experience.