A Simplified Approach to Diagnosing Sleep Disordered Breathing and Nocturnal Hypercapnia in Individuals with Spinal Cord Injury


The objective of this study was to to evaluate a strategy of home-based testing to diagnose sleep-disordered breathing and nocturnal hypercapnia (NH) in patients with spinal cord injury (SCI) though a case series design  of ninety-one adults with C1-T6 SCI. Subjects were eligible if ≥ 18 years old, with SCI of ≥ 3 months duration, living within 100 miles of the study site and not meeting exclusion criteria. Of the 161 individuals contacted from the SCI Model System database that were not enrolled, reasons were not interested in participating, change of location, prior PPV use or medical contraindication. Ten patients did not complete the study. The intervention was the  performance of an unsupervised home sleep apnea test (HSAT) combined with transcutaneous (tc) pCO2/SpO2 monitoring. This was measured through the prevalence of sleep disordered breathing and nocturnal hypercapnia. Clinical and physiologic variables were examined to determine which, if any, correlate with the severity of sleep-disordered breathing. Results showed that obstructive sleep apnea (OSA) was found in 81.3% of subjects, central sleep apnea (CSA) in 23.8%, and nonspecific hypopnea events (NSHE), where respiratory effort was too uncertain to classify, were present in 35%. Nonspecific hypopnea events correlated closely with CSA but weakly with OSA, suggesting that conventional sleep apnea test scoring may underestimate central/neuromuscular hypopneas. Nocturnal hypercapnia was present in 28% and oxygen desaturation in 18.3%. Neck circumference was the primary predictor for OSA, while baclofen use and O-AHI weakly predicted CSA. Awake tc-pCO2 and CSA were only marginally associated with NH.

Unsupervised, home sleep apnea testing with transcutaneous capnography effectively identifies sleep-disordered breathing and NH in SCI patients.


Cervical and scapulothoracic stabilization exercises with and without connective tissue massage for chronic mechanical neck pain: A prospective, randomized controlled trial.

cervical vert

This study planned to assess and compare the effectiveness of cervical and scapulothoracic stabilization exercise treatment with and without connective tissue massage (CTM) on pain, anxiety, and the quality of life in patients with chronic mechanical neck pain (MNP). Sixty patients with chronic MNP (18-65 years) were recruited and randomly allocated into stabilization exercise with (Group 1, n = 30) and without the CTM (Group 2, n = 30). The program was carried out for 12 sessions, 3 days/week in 4 weeks. Pain intensity with Visual Analog Scale, pressure pain threshold with digital algometer (JTech Medical Industries, ZEVEX Company), level of anxiety with Spielberger State Trait Anxiety Inventory, and quality of life with Short Form-36 were evaluated before and after the treatment. After the program, pain intensity and the level of anxiety decrease, physical health increase in Group 1 and 2 were found (p < 0.05). Pressure pain threshold and mental health increase were detected in only Group 1 (p < 0.05). The intergroup comparison showed that significant difference in pain intensity at night, pressure pain threshold, state anxiety and mental health were seen in favor of Group 1 (p < 0.05).

The study suggested that stabilization exercises with and without the CTM might be a useful treatment for patients with chronic MNP. However, stabilization exercises with CTM might be superior in improving pain intensity at night, pressure pain threshold, state anxiety and mental health compared to stabilization exercise alone.

Task- and Context-specific Balance Training Programme Enhances Dynamic Balance and Functional Performance in Parkinsonian Non-fallers: A Randomised Controlled Trial with Six-month Follow-up

European Physiotherapy Guideline for Parkinson’s disease

The objective of this article was to investigate the short- and long-term effects of a task- and context-specific balance training programme on dynamic balance and functional performance, and to explore the effects on preventing total and injurious falls in Parkinsonian (PD) non-fallers. This was achieved through an RCT including 70 PD fallers randomised into the control (n=38) and balance (n=32) groups. The balance group received four weeks indoor and four weeks outdoor balance training (with a two-hour session/week). The control group received eight weeks of upper limb training at the same dosage. Both groups were instructed to perform 3 hours home exercise weekly post-training. The balance performance was assessed using the following outcome measures; 1. Dynamic balance performance: Mini-BESTest; 2. Functional performance: functional reach (FR), five-time-sit-to-stand (FTSTS), one-leg-stance (OLS), time-up-and-go (TUG) and dual-task TUG tests; 3. Fall-related outcomes: ratios of total non-fallers to fallers and non-injurious fallers to injurious fallers, total and injurious fall rates, times to first falls and injurious falls. Sixty-eight participants completed training. A total of seven patients (10%) withdrew before the six-month follow-up, but not due to any adverse effects. At immediate and six-month post-training, BAL group showed significantly greater improvements (from baseline) than CON group in Mini-BESTest total scores, FR distances and OLS times, together with greater time reductions in FTSTS, TUG and dual-task TUG tests (allp<0.05). The number of injurious fallers was significantly lower in BAL group at six-month follow-up.

This task- and context-specific balance training programme improved the dynamic balance and fall-prone functional performance of PD non-fallers for up to six months after training. The BAL group showed a reduction in injurious fallers.

Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: A randomized controlled study.



Thoracic spinal manipulation therapy (SMT) can improve symptoms in patients with subacromial impingement syndrome. However, at this time the mechanisms of SMT are not well established. It is possible that changes in pain sensitivity may occur following SMT. The objective of this article was to assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy (SMT) using pressure pain threshold (PPT), and to assess the relationship of change in pain sensitivity to patient-rated outcomes of pain and function following treatment. Subjects with unilateral subacromial impingement syndrome (n = 45) were randomly assigned to receive treatment with thoracic SMT or sham thoracic SMT. PPT was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. Patient-rated outcomes were pain (numeric pain rating scale – NPRS), function (Pennsylvania Shoulder Score – Penn), and global rating of change (GROC). There were no significant differences between groups in pre-to post-treatment changes in PPT (p ≥ 0.583) nor were there significant changes in PPT within either group (p ≥ 0.372) following treatment. NPRS, Penn and GROC improved across both groups (p < 0.001), but there were no differences between the groups (p ≥ 0.574).

There were no differences in pressure pain sensitivity between participants receiving thoracic SMT versus sham thoracic SMT. Both groups had improved patient-rated pain and function within 24-48 h of treatment, but there was no difference in outcomes between the groups.

3 Ways to make your clinic more attractive to patients!

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It may be a novel approach but bear with me on this … Setting up a grocery stall in a market is similar to setting up your clinic. Just like a market stall you need to display your wears in the most appealing way possible to attract customers. These three tips will help to make you more attractive to patients!

When you go to a market there are usually lots of stalls and if you don’t like what you see you keep on walking until you find something that appeals. Perhaps a friend recommended a particular market trader to go to for the best fruit, vegetables, or a great butcher. Alternatively if you shop at supermarkets I’m sure you will have discussed where to find the best deals or tasty offers with friends and colleagues. Of course healthcare is very different to fruit and vegetables but the decisions that patients make are grounded in these daily patterns so you need to set up your stall as well and as visible as possible! It also illustrates the importance of patient to patient referral and is the foundation of many clinics.

So how can you make your clinic more attractive in a modern world?


A clear, concise and updated website with easy access to appointments is a great start but many clinics are slow on the uptake with this. There’s nothing worse than an out of date or unloved website. A website is setting your stall in the market place! Why not check out TM2’s deal with Physio123 who can design a perfect webpage to get you going and take the stress out of it?
Free website 

Modern information leaflets / materials

Simple but effective leaflets are great to highlight the various services you offer and the benefits of treatment. Check with your professional organizations as they often have approved up to date material which is great to pass on to patients.

Patient experience 

People’s expectations are certainly on the rise especially in healthcare. Easily accessible services are now an expectation. Patients may not be willing to wait 6-8 weeks for visits when they can get them via same day or next day services.

These days you can’t afford to have your doors closed when a patient needs help but at the same time you can’t work 24 hours a day, 7 days a week, so what do you do without crippling your clinic with costs? Well of course TM2 is the answer …. I would say that wouldn’t I? Yes, your right I am biased but for the right reasons. We have worked long and hard and listened to clinics to provide truly efficient and cost effective software solutions to the market for over 10 years. With TM2 you can not only manage your diary, clinical notes and finances but if you choose to you can also have access to:

  • TM2 24/7 : (a 24 hour/ 365 days per year phone answering service)
    This means no more appointments lost to missed calls or people who don’t want to leave an answerphone message. Your clinic is always open!
  • TM2 New Online Bookings: Under your control you can enable patients to book online with ease.
  • Pronto network: With Pronto, referrers can link directly with clinics, securely and in real time. So life for the referrer, clinic and patient is improved.

So there you have it!  Set up your stall as best as you can and give easy access to your services, that way your clinic will continue to grow into the future.

To find out more why not get in touch and see how we can help?


Comparison of scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor stretching on scapular alignment and scapular upward rotators activity in subjects with short pectoralis minor.


Scapular rehabilitation can seem daunting to many physiotherapists, its movement is atypical and the myriad of attachments can appear confusing. The exercises can be complex for therapists and patients alike. The objective of this study was to compare scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor (PM) stretching on the PM index (PMI), scapular anterior tilting index, scapular upward rotation angle, and scapular upward rotators’ activity in subjects with a short PM (n=15). The PMI, scapular anterior tilting index, and scapular upward rotation angle were measured after scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. Scapular upward rotators’ activities were collected during scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. The PMI and scapular upward rotation angle, as well as the activity of the upper trapezius, lower trapezius, and serratus anterior muscles, were significantly greater for scapular posterior tilting exercise after PM stretching and the scapular anterior tilting index was significantly lower for scapular posterior tilting exercise after PM stretching than the scapular posterior tilting exercise alone.

Scapular posterior tilting exercise after PM stretching in subjects with a short PM could be an effective method of modifying scapular alignment and scapular upward rotator activity.

Facilitating Community-Based Exercise for People With Stroke: Cross-Sectional e-Survey of Physical Therapist Practice and Perceived Needs


Educating people with stroke about community-based exercise programs (CBEPs) is a recommended practice which physical therapists (PTs) are well-positioned to implement; sometimes community rehabilitation is more effective. The objective of this study is to evaluate the provision of education about CBEPs to people with stroke, barriers to providing education, and preferences for resources to facilitate education among PTs in neurological practice. A link to the questionnaire was e-mailed to PTs in a provincial stroke network, a provincial physical therapy association, and on hospital and previous research lists. Responses from 186 PTs were analyzed. The percentage of respondents who reported providing CBEP education was 84.4%. Only 36.6% reported typically providing education to ≥7 out of 10 patients with stroke. Physical (90.5%) and preventative (84.6%) health benefits of exercise were most frequently discussed. Therapists reported most commonly delivering education at discharge (73.7%). Most frequently cited barriers to educating were a perceived lack of suitable programs (53.2%) and a lack of awareness of local CBEPs (23.8%). Lists of CBEPs (94.1%) or brochures (94.1%) were considered as facilitators. The percentage of PTs providing CBEP education varied across acute, rehabilitation, and public outpatient settings (p<0.001).

While a high proportion of PTs provide CBEP education, education is not consistently delivered to the majority of patients post-stroke. Although a CBEP list or brochure would facilitate education regarding existing CBEPs, efforts to implement CBEPs are needed to help overcome the lack of suitable programs.