puma

3 Posts
 
Posted - 05/05/2006 :  23:16:29  Show Profile  Reply with Quote
I am a fairly new P.T. and I just saw my first patient with TMJ problems. I also received the May issue of The Journal of the American Physical Therapy Association and read an article which discussed the various treatment approaches for TMJ dysfunctions. I was just wondering if anyone else read the article and what your thoughts are? I also wanted to learn more about anyone's P.T. experiences with treating TMJ.
Thanks
Pam

Article: http://www.ptjournal.org/PTJournal/May2006/v86n5p710.cfm
A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders
Margaret L McNeely, Susan Armijo Olivo, David J Magee

lzelman

2 Posts
 
Posted - 05/10/2006 :  17:24:40  Show Profile  Reply with Quote
I have been a PT for 6 years now and have seen a total of 3 patients with TMJ. All three patients reported improvement with their condition with participation in physical therapy. I read the article in the APTA journal and the review is consistent with my experiences. Exercises and STM/manual therapy helped(ie. massage/STM to the muscles in the mouth & joint mobilizations). I also applied ultrasound to the regions of the temporalis muscles if their was tissue irritability. Another exercise program that I used is called the Rocobado 6 x 6 program. It helps the patient learn proper mechanics when opening/closing the mouth. If you are not familiar with this program, let me know and I can post it.
Lisa

puma

3 Posts
 
Posted - 05/10/2006 :  22:06:18  Show Profile  Reply with Quote
Lisa,
Could you please post the Rocobado 6 x 6 program.
Thanks

lzelman

2 Posts
 
Posted - 05/12/2006 :  08:46:46  Show Profile  Reply with Quote
Rocobado 6 x 6 program

Addresses following postural relationships
1) head to neck
2) neck to shoulders
3) lower jaw to upper jaw

Objective for Patient
1) learn new postural position
2) fight the soft tissue memory of the old position
3) restore the original muscle length-tension relationships
4) restore normal joint mobility
5) restore normal body balance
6) initiate this exercise program whenever sx & dysfucntions return

Components of Program
1) rest position of tongue
a) make a clicking sound with tongue 6 x's
b) find normal resting position = gentlyhold 1/3rd of tongue
gently against the roof of th mouth just behind the front teeth
c) diaphragmatically breathe through nose while tongue is in
resting position x 6 breaths
2) control tmj rotation- tongue on roof of mouth and open x 6 reps
3) rythmic stabilization- key when a patient has instability =
lightly resist open, close, lateral deviation (visualization /
neuro-muscular re-education is key) - hold 6 sec
4) stabilized head flexion = upper cervical flexion (nodding) -
facilitate upper cervical flexion as most of these patients have
forward head posture resulting in upper cervical extension
deviation. Nod head x 15 degrees back and forth x 6 reps
5) lower cervical retraction = chin tuck x 6 seconds holds
6) shoulder girdle retraction = pull sholders back and down - hold 6
seconds
Edited by - lzelman on 05/12/2006 08:47:17

cdixonpta

USA
1 Posts
 
Posted - 01/14/2007 :  23:13:11  Show Profile  Reply with Quote
Lisa,

I have been looking for a clean copy of the Rocobado 6 x 6 exercises for about four years. Do you have one you could send me?
Thanks, Cathi

puma

3 Posts
 
Posted - 02/06/2008 :  09:25:41  Show Profile  Reply with Quote
I found a great link for information in regards to treating TMJ. Also has Rocobado 6 x 6.
http://www.hsedu.com/HEP/TMJExercises.pdf

Ask a PT

156 Posts
 
Posted - 06/24/2008 :  00:28:10  Show Profile  Reply with Quote
Our user asked: "Suppose you were a physical therapist who was interested in determining if a new ACL rehabilitation technique helped soccer players regain their pre-injury performance levels more quickly than existing ACL rehabilitation techniques. For your research, you utilize a pre/post test of 1RM knee extension (using an isokinetic device) and, for your intervention, soccer players with the same ACL injuries are rehabilitated with either the new technique or an older, existing technique. Your results show that players who rehabbed with the new technique had a significantly higher 1RM than the old technique group after 6 weeks of rehabilitation. In addition, the 1RM of the new rehab group appeared to be almost the same as pre-injury levels. However, when these same players attend their first soccer practice, it is clear that both the old and new groups perform equally well (with respect to their soccer skills). In other words, your research suggested one technique was superior but this did not hold true in the actual soccer setting. What could you have done differently to ensure your results were a more accurate reflection of soccer performance?"

Ask a PT Response: "1 RM would not display an accurate reflection of soccer skill s/p ACL recontruction. This test is not functional based and would be a poor indicator for performance. I would suggest utilizng a single leg three hop test in which you would be able to measure the distance hopped on a single leg three times and also visually analyze not only the mechanics of the hop but the stability at the involved knee as well. My hypothesis would be that an athlete that scores higher on this test would fair better on the soccer field. I hope this helps. Thanks for using CyberPT."

Ask a PT

156 Posts
 
Posted - 12/07/2007 :  09:23:00  Show Profile  Reply with Quote
Our user asked: "I was wondering if anyone had come across any journal article on research of Estim and pts with Osteoperosis. More specifically Low Volt Estim. I am trying to determine its effectiveness for an 80 y/o female with thoracolumbar ms spasms."

Ask a PT Response: "You can utilize out CyberPT Medical Resource Library to assist you in finding research articles. http://www.cyberpt.com/CyberPTmedlib.asp

We have also conducted a literature search for you for osteoporosis and electrical stimulation and have come upon the following articles which may be of interest. You can probably obtain the articles at a medical library or purchase a temporary subscription to the Journal for online access. We have attached the one article which was available online. We hope this helps and thank you for using CyberPT.

The skeleton after spinal cord injury part 2: management of sublesional osteoporosis. Segatore M; SCI Nursing, 1995 Dec; 12 (4): 115-20 (journal article) PMID: 8715335 CINAHL AN: 1996016656

Increases in bone mineral density after functional electrical stimulation cycling exercises in spinal cord injured patients. (includes abstract) Chen S; Disability & Rehabilitation, 2005 Nov 30; 27 (22): 1337-41 (journal article - research, tables/charts) CINAHL AN: 2009083414

PURPOSE: To assess the change in bone mineral density (BMD) after spinal cord injury (SCI) and to evaluate whether BMD loss can be reversed with the intervention of functional electric stimulation cycling exercises (FESCE). METHODS: Fifteen males with SCI were included. Fifteen able-bodied males were also tested to compare BMD. In the SCI group, the FESCE was performed for six months, and then was discontinued in the subsequent six months. BMD was performed before the FESCE, immediately after six months of the FESCE, and at the end of the subsequent six months. RESULTS: Before the FESCE, the BMD of the SCI subjects in every site, except the lumbar spine, was lower than that of the able-bodied subjects. After six months of FESCE, BMD of the distal femur (DF) and proximal tibia (PT) increased significantly, and BMD of the calcaneus (heel) showed a trend of increase. However, the BMD in the DF, PT, and heel decreased significantly after the subsequent six months without FESCE. The BMD of the femoral neck (FN) decreased progressively throughout the programme. CONCLUSIONS: Our study showed site-specific BMD changes after FESCE. The BMD loss in the DF and PT was partially reversed after six months of FESCE, but the effect faded once the exercise was discontinued.

Carter EL Jr, Pollack SR, Brighton CT.
Theoretical determination of the current density distributions in human vertebral bodies during electrical stimulation.
IEEE Trans Biomed Eng. 1990 Jun;37(6):606-14.

Electrical stimulation with a 60 kHz sinewave input signal, supplied via external plate electrodes on the skin surface, is presently being studied as a treatment for human systemic osteoporosis. In this paper, Maxwell's equations were solved for voltage and current density values at nodal points in a three-dimensional, anatomically-based, finite element grid model of the human trunk constructed from T5 to L5. Based on the dose response results from Luessenhop's castrated Sprague Dawley breeder rat experiment and our theoretical determination, the magnitude of the input current to the electrodes necessary to induce a response in the human vertebral body was determined. Four different electrode systems in current clinical use were evaluated, and the optimal input current determined. In addition, the effect of subcutaneous fat was studied.

Kenner GH, Gabrielson EW, Lovell JE, Marshall AE, Williams WS.
Electrical modification of disuse osteoporosis.
Calcif Tissue Res. 1975 Jul 25;18(2):111-7.

Localized electrical stimulation of the immobilized hind limb of young rabbits resulted in dramatically more bone in the tuber calcis (heel bone) compared to the severe loss of bone (osteoporosis) seen in unstimulated, immobilized controls. Detailed histological evaluation using microradiography and fluorescence and polarization microscopy showed that the increase was probably due to an overall inhibition of surface cortical bone loss )endosteal resorption) and an increase in the quantity of the new immature bone. There was also evidence of increased osteonal resorption in the stimulated animals.

Rehab Guy

4 Posts
 
Posted - 02/23/2006 :  10:41:39  Show Profile  Reply with Quote
I read a recent article in Advance (Dec 5, 2005, Vol 16 No.26) which had an interesting article on the use of hot and cold therapy to treat conditions such as an ankle sprain or achilles tendonitis. What they found was that the recovery time was a lot faster with utilizing the duo modalities. Just wondering if anyone else had thoughts on this?

ABPT

11 Posts
 
Posted - 02/23/2006 :  14:19:14  Show Profile  Reply with Quote
I often utilize duo modalities as well. I utilize heat prior to treatment ie. s/p RCR to help promote blood flow and healing and to assist in increasing tissue pliability. I then utilize cold after treatment to help assist in decreasing tissue irritability and pain.