Background Exercises are used to treat temporomandibular disorders (TMD), but they are often assessed with other therapies. Local endurance exercises may alter the resistance to fatigue and pain. Objective To assess the effects of an 8‐week protocol of local endurance exercises of masticatory muscles on muscle excitation, force response, perceived pain and over muscle efficiency. Design Randomised controlled trial. Setting Ambulatory care. Subjects In a placebo randomised controlled trial, 46 women with TMD and oro‐facial pain were randomised into intervention group and placebo group. The intervention group received a protocol of biting endurance exercises, controlled by biofeedback. The placebo group received a placebo (simulated laser therapy). Main Outcome Measures The primary outcomes were collected at baseline, 4 weeks and 8 weeks. Pain was assessed through visual analogue scale (VAS) and pressure pain thresholds (PPT). Bite force was collected by a load cell synchronised with surface electromyography of masticatory muscles, bilaterally. Results Pain scores decreased for both groups, but the intervention group showed lower values at 8 weeks. No differences were noted between groups for PPT, but the results increased for both overtime. Time until fatigue and muscle efficiency were higher in the intervention group vs placebo group in both within‐ and between‐subject analysis. Force increased from 4 to 8 weeks in the PG, without differences between groups. Temporal muscle excitation was higher on 8 weeks compared with baseline for the intervention group, without differences between groups. Conclusion Eight‐week exercise protocol of muscle endurance alleviates the pain and improves the resistance to fatigue and muscle efficiency in TMD subjects.

Issues around turning can impair daily tasks and trigger episodes of freezing of gait in individuals with Parkinson's disease (PD). Slow speeds associated with aging produce a more en-bloc movement strategy which have been linked with falls while turning. However, the influence of speed of turning on the complex whole-body coordination considering eye movements, turning kinematics, and stepping characteristics during turning has not been examined. The aim of this study was to investigate if individuals with PD have a different response to changes in turning speed compared to healthy older adults during 180° standing turns. 20 individuals with PD and 20 healthy age matched adults participated in this study. Data were collected during clockwise and counter-clockwise turns at three self-selected speeds in a randomised order: (a) normal; (b) faster than normal; and (c) slower than normal. Eye movement and turning kinematics were investigated using electrooculography and Inertial Measurement Units. Mixed Model Analysis of Variance (MM ANOVA) tests with post hoc pairwise comparisons were performed to assess the differences between groups and turning speed. In addition, further post hoc Repeated Measures ANOVA (RM ANOVA) tests were performed if any significant interactions were seen between groups and turning speed. Significant interaction effects were found in eye movement and turning kinematics, and the RM ANOVA showed significant main effects for turning speeds within the PD and the control groups. Turning slowly resulted in similar alterations in eye movement, turning kinematics and stepping characteristics in the PD group and the healthy controls. However, individuals with PD showed a different response to the healthy controls, with a greater delay in eye movement and onset latency of segments in turning kinematics and step variables between the different speeds. These findings help our understanding regarding the turning strategies in individuals with PD. The incorporation of guidance with regard to faster turning speeds may be useful in the management of individuals with PD. Clinical training using different turn directions and speeds may improve coordination, increase confidence and reduce the risk of falling.

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Respiratory function problems are caused by both motor and non-motor symptoms of Parkinson disease (PD). One major problem involving the changes in respiratory function in people with PD is a decrease in chest movement caused by musculoskeletal problems around the neck and upper trunk. The relationship between these respiratory changes and pulmonary volume in people with PD can lead to the main cause of mortality as the disease progresses. Dry needling technique (DNT) is a myofascial release technique that has been reported to provide an immediate effect on pain, decreased muscle spasm or tightness and lead to restoration of range of motion of upper trunk by using needles to stimulate hypersensitive and painful nodules in the musculature called trigger points (TP). However, to date, the use of this technique has not been reported to release muscle tightness or pain in people with PD. The present study aimed to explore the effects of a single session of bilateral DNT to the trapezius muscles trigger point on chest expansion and vital capacity which could lead to improvements in respiratory function in people with PD. Thirty-eight people with PD were randomly allocated to DN and Sham needling treatment groups. The maximum and mean volumes of vital capacity were assessed by using a ventilometer at pre-intervention, immediately after intervention, and one-week follow-up. Mixed Model Analysis of Variance(MM ANOVA) tests with post hoc pairwise comparisons were used to test the differences between groups and assessment time points. No interaction effects were found between groups and assessment time points for maximum and mean vital capacity volume. In addition, no statistically significant main effects of DNT were found for both groups and assessment time points for either maximum or mean vital capacity volume. These findings can provide evidence that a single session of dry needling does not help to improve respiratory function in people with PD. However, slight improvements in vital capacity were observed in the DN group, which may be clinically relevant when considering progressive neurodegenerative disease. More sessions of dry needling need to be explored over a greater time period to determine if longer term effect are possible with this treatment.

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